,i #aae? ,,congress #a/ ,session ,h4 ,r4 #acfi ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,m>* #f1 #bjag ,mr4 ,cole introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,natural ,res\rces1 & 9 addition to ! ,committees on ,en]gy & ,comm]ce1 ,ways & ,means1 & ! ,budget1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d ! ,indian ,heal? ,c>e ,improvem5t ,act to revise & ext5d t ,act1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,title ,i--,indian ,heal? ,c>e ,improvem5t ,act reau?orization & am5dm5ts ,sec4 #aja4 ,reau?orization4 ,sec4 #ajb4 ,f9d+s4 ,sec4 #ajc4 ,decl>ation ( national ,indian heal? policy4 ,sec4 #ajd4 ,def9itions4 ,subtitle ,a--,indian heal? manp[] ,sec4 #aaa4 ,community ,heal? ,aide ,program4 ,sec4 #aab4 ,heal? pr(essional *ronic %ortage demon/ration programs4 ,sec4 #aac4 ,exemption f paym5t ( c]ta9 fees4 ,subtitle ,b--,heal? s]vices ,sec4 #aba4 ,indian ,heal? ,c>e ,improvem5t ,fund4 ,sec4 #abb4 ,cata/rophic ,heal? ,em]g5cy ,fund4 ,sec4 #abc4 ,diabetes prev5tion1 treatm5t1 & control4 ,sec4 #abd4 ,o!r au?ority = provision ( s]vices2 %>$ s]vices = long-t]m c>e4 ,sec4 #abe4 ,reimbursem5t f c]ta9 ?ird p>ties ( co/s ( heal? s]vices4 ,sec4 #abf4 ,cr$it+ ( reimbursem5ts4 ,sec4 #abg4 ,behavioral heal? tra9+ & community education programs4 ,sec4 #abh4 ,canc] scre5+s4 ,sec4 #abi4 ,pati5t travel co/s4 ,sec4 #acj4 ,epidemiology c5t]s4 ,sec4 #aca4 ,indian y\? grant program4 ,sec4 #acb4 ,am]ican ,indians ,into ,psy*ology ,program4 ,sec4 #acc4 ,prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases4 ,sec4 #acd4 ,me?ods to increase cl9ician recruitm5t & ret5tion issues4 ,sec4 #ace4 ,liability = paym5t4 ,sec4 #acf4 ,(fices ( ,indian ,m5's ,heal? & ,indian ,wom5's ,heal?4 ,sec4 #acg4 ,contract heal? s]vice adm9i/ration & disbursem5t =mula4 ,subtitle ,c--,heal? facilities ,sec4 #ada4 ,heal? c>e facility priority sy/em4 ,sec4 #adb4 ,priority ( c]ta9 projects protect$4 ,sec4 #adc4 ,indian heal? c>e deliv]y demon/ration projects4 ,sec4 #add4 ,tribal managem5t ( f$]ally own$ qu>t]s4 ,sec4 #ade4 ,o!r fund+1 equipm5t1 & supplies = facilities4 ,sec4 #adf4 ,indian c\ntry modul> compon5t facilities demon/ration program4 ,sec4 #adg4 ,mobile heal? /ations demon/ration program4 ,subtitle ,d--,access to heal? s]vices ,sec4 #aea4 ,treatm5t ( paym5ts "u ,social ,security ,act heal? b5efits programs4 ,sec4 #aeb4 ,pur*as+ heal? c>e cov]age4 ,sec4 #aec4 ,grants to & contracts ) ! ,s]vice1 ,indian tribes1 tribal organizations1 & urban ,indian organizations to facilitate outrea*1 enrollm5t1 & cov]age ( ,indians "u ,social ,security ,act heal? b5efit programs & o!r heal? b5efits programs4 ,sec4 #aed4 ,%>+ arrangem5ts ) ,f$]al ag5cies4 ,sec4 #aee4 ,eligible ,indian vet]an s]vices4 ,sec4 #aef4 ,nondiscrim9ation "u ,f$]al heal? c>e programs 9 qualifications = reimbursem5t = s]vices4 ,sec4 #aeg4 ,access to ,f$]al insurance4 ,sec4 #aeh4 ,g5]al exceptions4 ,sec4 #aei4 ,navajo ,nation ,m$icaid ,ag5cy feasibility /udy4 ,subtitle ,e--,heal? s]vices = urban ,indians ,sec4 #afa4 ,facilities r5ovation4 ,sec4 #afb4 ,treatm5t ( c]ta9 demon/ration projects4 ,sec4 #afc4 ,requirem5t to conf] ) urban ,indian organizations4 ,sec4 #afd4 ,exp&$ program au?ority = urban ,indian organizations4 ,sec4 #afe4 ,community heal? repres5tatives4 ,sec4 #aff4 ,use ( ,f$]al ,gov]nm5t facilities & s\rces ( supply2 heal? in=mation te*nology4 ,subtitle ,f--,organizational improvem5ts ,sec4 #aga4 ,e/abli%m5t ( ! ,indian ,heal? ,s]vice z an ag5cy ( ! ,public ,heal? ,s]vice4 ,sec4 #agb4 ,(fice ( ,direct ,s]vice ,tribes4 ,sec4 #agc4 ,nevada area (fice4 ,subtitle ,g--,behavioral heal? programs ,sec4 #aha4 ,behavioral heal? programs4 ,subtitle ,h--,miscellane\s ,sec4 #aia4 ,confid5tiality ( m$ical quality assurance records2 qualifi$ immunity = p>ticipants4 ,sec4 #aib4 ,limitation on use ( funds approprait$ to ! ,indian ,heal? ,s]vice4 ,sec4 #aic4 ,arizona1 ,nor? ,dakota1 & ,s\? ,dakota z contract heal? s]vice deliv]y areas2 eligibility ( ,cali=nia ,indians4 ,sec4 #aid4 ,me?ods to increase access to pr(essionals ( c]ta9 corps4 ,sec4 #aie4 ,heal? s]vices = ineligible p]sons4 ,sec4 #aif4 ,annual budget submission4 ,sec4 #aig4 ,prescription drug monitor+4 ,sec4 #aih4 ,tribal heal? program option = co/ %>+4 ,sec4 #aii4 ,disease & injury prev5tion report4 ,sec4 #bjj4 ,o!r ,,gao reports4 ,sec4 #bja4 ,traditional heal? c>e practices4 ,sec4 #bjb4 ,director ( ,,hiv_/,,aids ,prev5tion & ,treatm5t4 ,title ,,ii--,am5dm5ts to o!r ,acts & miscellane\s provisions ,sec4 #bja4 ,elim9ation ( sunset = reimbursem5t = all ,m$ic>e "p ,b s]vices furni%$ by c]ta9 indian hospitals & cl9ics4 ,sec4 #bjb4 ,includ+ co/s incurr$ by aids drug assi/ance programs & indian heal? s]vice 9 provid+ prescription drugs t[>d ! annual out-(-pocket ?re%old "u "p ,d4 ,sec4 #bjc4 ,prohibition ( use ( ,f$]al funds = abortion4 ,sec4 #bjd4 ,reau?orization ( ,native ,hawaiian heal? c>e programs4 ,i ,indian ,heal? ,c>e ,improvem5t ,act reau?orization & am5dm5ts #aja4 ,reau?orization 7a7 ,9 g5]al ,section #hbe ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afhjo7 is am5d$ to read z foll[s3 #hbe4 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ?is ,act = fiscal ye> #bjag & ea* fiscal ye> !reaft]1 to rema9 available until exp5d$4 4 7b7 ,repeals ,! foll[+ provisions ( ! ,indian ,heal? ,c>e ,improvem5t ,act are repeal$3 7#a7 ,section #abc 7#be ,u4,s4,c4 #afafp74 7#b7 ,p>agraph 7#f7 ( section #bji7m7 7#be ,u4,s4,c4 #afba;h7m774 7#c7 ,subsection 7g7 ( section #baa 7#be ,u4,s4,c4 #afba;j74 7#d7 ,subsection 7e7 ( section #baf 7#be ,u4,s4,c4 #afbao74 7#e7 ,section #bbd 7#be ,u4,s4,c4 #afbaw74 7#f7 ,section #cji 7#be ,u4,s4,c4 #afch;a74 7#g7 ,section #djg 7#be ,u4,s4,c4 #afdg74 7#h7 ,subsection 7c7 ( section #eab 7#be ,u4,s4,c4 #affj;b74 7#i7 ,section #ead 7#be ,u4,s4,c4 #affj;d74 7#aj7 ,section #fjc 7#be ,u4,s4,c4 #affc74 7#aa7 ,section #hje 7#be ,u4,s4,c4 #afge74 7c7 ,con=m+ am5dm5ts 7#a7 ,section #bjd7;c77#a7 ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;c7c77#a77 is am5d$ by /rik+ ?r\gh fiscal ye> #bjjj4 7#b7 ,section #bac ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbal7 is am5d$ by /rik+ 7a7 ,! ,secret>y & ins]t+ ,! ,secret>y4 7#c7 ,section #caj ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afch;b7 is am5d$ by /rik+ funds provid$ pursuant to ! au?orization conta9$ 9 section #cji ea* place x appe>s & ins]t+ funds made available to c>ry out ?is title4 #ajb4 ,f9d+s ,section #b ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja7 is am5d$-- 7#a7 by r$esignat+ subsections 7a71 7b71 7c71 & 7d7 z p>agraphs 7#a71 7#c71 7#d71 & 7#e71 respectively1 & ind5t+ ! p>agraphs appropriately2 & 7#b7 by ins]t+ aft] p>agraph 7#a7 7z s r$esignat$7 ! foll[+3 7#b7 ,a major national goal ( ! ,unit$ ,/ates is to provide ! res\rces1 processes1 & /ructure t w enable ,indian tribes & tribal memb]s to obta9 ! quantity & quality ( heal? c>e s]vices & opportunities t w eradicate ! heal? disp>ities betwe5 ,indians & ! g5]al population ( ! ,unit$ ,/ates4 4 #ajc4 ,decl>ation ( national ,indian heal? policy ,section #c ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjb7 is am5d$ to read z foll[s3 #c4 ,decl>ation ( national ,indian heal? policy ,congress decl>es t x is ! policy ( ?is ,nation1 9 fulfillm5t ( its special tru/ responsibilities & legal obligations to ,indians-- 7#a7 to ensure ! highe/ possible heal? /atus = ,indians & urban ,indians & to provide all res\rces necess>y to effect t policy2 7#b7 to raise ! heal? /atus ( ,indians & urban ,indians to at lea/ ! levels set =? 9 ! goals conta9$ )9 ! ,heal?y ,p #bjaj initiative or successor objectives2 7#c7 to ensure maximum ,indian p>ticipation 9 ! direction ( heal? c>e s]vices s z to r5d] ! p]sons adm9i/]+ su* s]vices & ! s]vices !mselves m responsive to ! ne$s & desires ( ,indian communities2 7#d7 to increase ! proportion ( all degrees 9 ! heal? pr(essions & alli$ & associat$ heal? pr(essions aw>d$ to ,indians s t ! proportion ( ,indian heal? pr(essionals 9 ea* ,s]vice area is rais$ to at lea/ ! level ( t ( ! g5]al population2 7#e7 to require t all actions "u ?is ,act %all be c>ri$ out ) active & mean+ful consultation ) ,indian tribes & tribal organizations1 & conf]5ce ) urban ,indian organizations1 to implem5t ?is ,act & ! national policy ( ,indian self-det]m9ation2 7#f7 to ensure t ! ,unit$ ,/ates & ,indian tribes "w 9 a gov]nm5t-to-gov]nm5t relation%ip to ensure quality heal? c>e = all tribal memb]s2 & 7#g7 to provide fund+ = programs & facilities op]at$ by ,indian tribes & tribal organizations 9 am\nts t are n less ?an ! am\nts provid$ to programs & facilities op]at$ directly by ! ,s]vice4 4 #ajd4 ,def9itions ,section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc7 is am5d$-- 7#a7 by /rik+ ! matt] prec$+ subsection 7a7 & ins]t+ ,9 ?is ,act32 7#b7 9 ea* ( subsections 7c71 7j71 7k71 & 7l71 by r$esignat+ ! p>agraphs conta9$ 9 ! subsections z subp>agraphs & ind5t+ ! subp>agraphs appropriately2 7#c7 by r$esignat+ subsections 7a7 ?r\gh 7q7 z p>agraphs 7#ag71 7#ah71 7#ac71 7#ad71 7#bf71 7#bh71 7#bg71 7#bi71 7#a71 7#bj71 7#aa71 7#g71 7#ai71 7#aj71 7#ba71 7#h71 & 7#i71 respectively1 ind5t+ ! p>agraphs appropriately1 & mov+ ! p>agraphs s z to appe> 9 num]ical ord]2 7#d7 9 ea* p>agraph 7z s r$esignat$71 by ins]t+ a head+ ! text ( :i* is compris$ ( ! t]m def9$ 9 ! p>agraph2 7#e7 by ins]t+ ,! t]m aft] ea* p>agraph head+2 7#f7 by ins]t+ aft] p>agraph 7#a7 7z r$esignat$ by p>agraph 7#c77 ! foll[+3 7#b7 ,behavioral heal? 7,a7 ,9 g5]al ,! t]m behavioral heal? means ! bl5d+ ( sub/ance 7alcohol1 drugs1 inhalants1 & tobacco7 abuse & m5tal heal? disord]s prev5tion & treatm5t = ! purpose ( provid+ compreh5sive s]vices4 7,b7 ,inclusions ,! t]m behavioral heal? includes ! jo9t developm5t ( sub/ance abuse & m5tal heal? treatm5t plann+ & coord9at$ case managem5t us+ a multidiscipl9>y approa*4 7#c7 ,cali=nia ,indian ,! t]m ,cali=nia ,indian means any ,indian :o is eligible = heal? s]vices provid$ by ! ,s]vice pursuant to section #hji4 7#d7 ,community college ,! t]m community college means-- 7,a7 a tribal college or univ]sity2 or 7,b7 a junior or community college4 7#e7 ,contract heal? s]vice ,! t]m contract heal? s]vice means any heal? s]vice t is-- 7,a7 deliv]$ bas$ on a ref]ral by1 or at ! exp5se (1 an ,indian heal? program2 & 7,b7 provid$ by a public or private m$ical provid] or hospital t is n a provid] or hospital ( ! ,indian heal? program4 7#f7 ,dep>tm5t ,! t]m ,dep>tm5t1 unless o!rwise designat$1 means ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 2 7#g7 by /rik+ p>agraph 7#g7 7z r$esignat$ by p>agraph 7#c77 & ins]t+ ! foll[+3 7#g7 ,disease prev5tion 7,a7 ,9 g5]al ,! t]m disease prev5tion means any activity =-- 7i7 ! r$uction1 limitation1 & prev5tion (-- 7,i7 disease2 & 7,,ii7 complications ( disease2 & 7ii7 ! r$uction ( consequ5ces ( disease4 7,b7 ,inclusions ,! t]m disease prev5tion includes an activity =-- 7i7 controll+-- 7,i7 ! developm5t ( diabetes2 7,,ii7 high blood pressure2 7,,iii7 infecti\s ag5ts2 7,,iv7 injuries2 7,v7 occupational haz>ds & disabilities2 7,,vi7 sexually transmittable diseases2 or 7,,vii7 toxic ag5ts2 or 7ii7 provid+-- 7,i7 fluoridation ( wat]2 or 7,,ii7 immunizations4 2 7#h7 by /rik+ p>agraph 7#i7 7z r$esignat$ by p>agraph 7#c77 & ins]t+ ! foll[+3 7#i7 ,,fas ,! t]m fetal alcohol syndrome or ,,fas means a syndrome 9 :i*1 ) a hi/ory ( mat]nal alcohol consumption dur+ pregnancy1 ! foll[+ crit]ia are met3 7,a7 ,c5tral n]v\s sy/em involvem5t su* z m5tal ret>dation1 developm5tal delay1 intellectual deficit1 micro5cephaly1 or neurologic abnormalities4 7,b7 ,crani(acial abnormalities ) at lea/ #b ( ! foll[+3 microoph?almia1 %ort palpebral fissures1 poorly develop$ philtrum1 ?9 upp] lip1 flat nasal bridge1 & %ort upturn$ nose4 7,c7 ,pr5atal or po/natal gr[? delay4 2 7#i7 by /rik+ p>agraphs 7#aa7 & 7#ab7 7z r$esignat$ by p>agraph 7#c77 & ins]t+ ! foll[+3 7#aa7 ,heal? promotion ,! t]m heal? promotion means any activity =-- 7,a7 fo/]+ social1 economic1 environm5tal1 & p]sonal factors conducive to heal?1 includ+ rais+ public aw>5ess reg>d+ heal? matt]s & enabl+ individuals to cope ) heal? problems by increas+ k & provid+ valid in=mation2 7,b7 enc\rag+ adequate & appropriate diet1 ex]cise1 & sleep2 7,c7 promot+ education & "w 9 accordance ) physical & m5tal capacity2 7,d7 mak+ available safe wat] & sanit>y facilities2 7,e7 improv+ ! physical1 economic1 cultural1 psy*ological1 & social environm5t2 7,f7 promot+ culturally compet5t c>e2 & 7,g7 provid+ adequate & appropriate programs1 includ+ programs =-- 7i7 abuse prev5tion 7m5tal & physical72 7ii7 community heal?2 7iii7 community safety2 7iv7 consum] heal? education2 7v7 diet & nutrition2 7vi7 immunization & o!r me?ods ( prev5tion ( communicable diseases1 includ+ ,,hiv_/,,aids2 7vii7 environm5tal heal?2 7viii7 ex]cise & physical fitness2 7ix7 avoidance ( fetal alcohol spectrum disord]s2 7x7 fir/ aid & ,,cpr education2 7xi7 human gr[? & developm5t2 7xii7 injury prev5tion & p]sonal safety2 7xiii7 behavioral heal?2 7xiv7 monitor+ ( disease indicators betwe5 heal? c>e provid] visits ?r\gh appropriate means1 includ+ ,int]net-bas$ heal? c>e managem5t sy/ems2 7xv7 p]sonal heal? & wellness practices2 7xvi7 p]sonal capacity build+2 7xvii7 pr5atal1 pregnancy1 & infant c>e2 7xviii7 psy*ological well-be+2 7xix7 reproductive heal? & family plann+2 7xx7 safe & adequate wat]2 7xxi7 heal?y "w environm5ts2 7xxii7 elim9ation1 r$uction1 & prev5tion ( contam9ants t create unheal?y h\sehold conditions 7includ+ mold & o!r all]g5s72 7xxiii7 /ress control2 7xxiv7 sub/ance abuse2 7xxv7 sanit>y facilities2 7xxvi7 sudd5 infant dea? syndrome prev5tion2 7xxvii7 tobacco use cessation & r$uction2 7xxviii7 viol5ce prev5tion2 & 7xxix7 su* o!r activities id5tifi$ by ! ,s]vice1 a tribal heal? program1 or an urban ,indian organization to promote a*ievem5t ( any ( ! objectives ref]r$ to 9 section #c7b74 7#ab7 ,indian heal? program ,! t]m ,indian heal? program means-- 7,a7 any heal? program adm9i/]$ directly by ! ,s]vice2 7,b7 any tribal heal? program2 & 7,c7 any ,indian tribe or tribal organization to :i* ! ,secret>y provides fund+ pursuant to section #bc ( ! ,act ( ,june #be1 #aiaj 7#be ,u4,s4,c4 #dg7 7commonly kn[n z ! ,buy ,indian ,act74 2 7#aj7 by ins]t+ aft] p>agraph 7#ad7 7z r$esignat$ by p>agraph 7#c77 ! foll[+3 7#ae7 ,junior or community college ,! t]m junior or community college has ! mean+ giv5 ! t]m 9 section #cab7;e7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajeh7;e774 7#af7 ,res]vation 7,a7 ,9 g5]al ,! t]m res]vation means a res]vation1 ,pueblo1 or colony ( any ,indian tribe4 7,b7 ,inclusions ,! t]m res]vation includes-- 7i7 =m] res]vations 9 ,oklahoma2 7ii7 ,indian allotm5ts2 & 7iii7 ,alaska ,native ,regions e/abli%$ pursuant to ! ,alaska ,native ,claims ,settlem5t ,act 7#dc ,u4,s4,c4 #afja et seq474 2 7#aa7 by /rik+ p>agraph 7#bj7 7z r$esignat$ by p>agraph 7#c77 & ins]t+ ! foll[+3 7#bj7 ,s]vice unit ,! t]m ,s]vice unit means an adm9i/rative entity ( ! ,s]vice or a tribal heal? program ?r\gh :i* s]vices are provid$1 directly or by contract1 to eligible ,indians )9 a def9$ geographic area4 2 7#ab7 by ins]t+ aft] p>agraph 7#ba7 7z r$esignat$ by p>agraph 7#c77 ! foll[+3 7#bb7 ,teleheal? ,! t]m teleheal? has ! mean+ giv5 ! t]m 9 section #ccj,k7a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#af7;a774 7#bc7 ,telem$ic9e ,! t]m telem$ic9e means a telecommunications l9k to an end us] ?r\gh ! use ( eligible equipm5t t electronically l9ks heal? pr(essionals or pati5ts & heal? pr(essionals at sep>ate sites 9 ord] to ex*ange heal? c>e in=mation 9 audio1 video1 graphic1 or o!r =mat = ! purpose ( provid+ improv$ heal? c>e s]vices4 7#bd7 ,tribal college or univ]sity ,! t]m tribal college or univ]sity has ! mean+ giv5 ! t]m 9 section #caf7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;c7b774 7#be7 ,tribal heal? program ,! t]m tribal heal? program means an ,indian tribe or tribal organization t op]ates any heal? program1 s]vice1 function1 activity1 or facility fund$1 9 :ole or "p1 by ! ,s]vice ?r\gh1 or provid$ = 91 a contract or compact ) ! ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 2 & 7#ac7 by /rik+ p>agraph 7#bf7 7z r$esignat$ by p>agraph 7#c77 & ins]t+ ! foll[+3 7#bf7 ,tribal organization ,! t]m tribal organization has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b74 4 ,a ,indian heal? manp[] #aaa4 ,community ,heal? ,aide ,program ,section #aai ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afafl7 is am5d$ to read z foll[s3 #aai4 ,community ,heal? ,aide ,program 7a7 ,g5]al purposes ( program ,pursuant to ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all develop & op]ate a ,community ,heal? ,aide ,program 9 ! ,/ate ( ,alaska "u :i* ! ,s]vice-- 7#a7 provides = ! tra9+ ( ,alaska ,natives z heal? aides or community heal? practition]s2 7#b7 uses ^? aides or practition]s 9 ! provision ( heal? c>e1 heal? promotion1 & disease prev5tion s]vices to ,alaska ,natives liv+ 9 villages 9 rural ,alaska2 & 7#c7 provides = ! e/abli%m5t ( teleconf]5c+ capacity 9 heal? cl9ics locat$ 9 or ne> ^? villages = use by community heal? aides or community heal? practition]s4 7b7 ,specific program requirem5ts ,! ,secret>y1 act+ ?r\gh ! ,community ,heal? ,aide ,program ( ! ,s]vice1 %all-- 7#a7 us+ tra9]s accr$it$ by ! ,program1 provide a high /&>d ( tra9+ to community heal? aides & community heal? practition]s to ensure t ^? aides & practition]s provide quality heal? c>e1 heal? promotion1 & disease prev5tion s]vices to ! villages s]v$ by ! ,program2 7#b7 9 ord] to provide su* tra9+1 develop a curriculum t-- 7,a7 comb9es education reg>d+ ! !ory ( heal? c>e ) sup]vis$ practical exp]i5ce 9 ! provision ( heal? c>e2 7,b7 provides in/ruction & practical exp]i5ce 9 ! provision ( acute c>e1 em]g5cy c>e1 heal? promotion1 disease prev5tion1 & ! effici5t & effective managem5t ( cl9ic ph>macies1 supplies1 equipm5t1 & facilities2 & 7,c7 promotes ! a*ievem5t ( ! heal? /atus objectives specifi$ 9 section #c7b72 7#c7 e/abli% & ma9ta9 a ,community ,heal? ,aide ,c]tification ,bo>d to c]tify z community heal? aides or community heal? practition]s individuals :o h successfully complet$ ! tra9+ describ$ 9 p>agraph 7#a7 or c demon/rate equival5t exp]i5ce2 7#d7 develop & ma9ta9 a sy/em t id5tifies ! ne$s ( community heal? aides & community heal? practition]s = cont9u+ education 9 ! provision ( heal? c>e1 includ+ ! areas describ$ 9 p>agraph 7#b77;,b71 & develop programs t meet ! ne$s = su* cont9u+ education2 7#e7 develop & ma9ta9 a sy/em t provides close sup]vision ( community heal? aides & community heal? practition]s2 7#f7 develop a sy/em "u :i* ! "w ( community heal? aides & community heal? practition]s is review$ & evaluat$ to ensure ! provision ( quality heal? c>e1 heal? promotion1 & disease prev5tion s]vices2 & 7#g7 ensure t-- 7,a7 pulpal !rapy 7n includ+ pulpotomies on decidu\s tee?7 or extraction ( adult tee? c be p]=m$ by a d5tal heal? aide !rapi/ only aft] consultation ) a lic5s$ d5ti/ :o det]m9es t ! proc$ure is a m$ical em]g5cy t _c be resolv$ ) palliative treatm5t2 & 7,b7 d5tal heal? aide !rapi/s are /rictly prohibit$ f p]=m+ all o!r oral or jaw surg]ies1 subject to ! condition t uncomplicat$ extractions %all n be consid]$ oral surg]y "u ?is section4 7c7 ,program review 7#a7 ,neutral panel 7,a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% a neutral panel to c>ry out ! /udy "u p>agraph 7#b74 7,b7 ,memb]%ip ,memb]s ( ! neutral panel %all be appo9t$ by ! ,secret>y f among cl9icians1 economi/s1 community practition]s1 oral epidemiologi/s1 & ,alaska ,natives4 7#b7 ,/udy 7,a7 ,9 g5]al ,! neutral panel e/abli%$ "u p>agraph 7#a7 %all conduct a /udy ( ! d5tal heal? aide !rapi/ s]vices provid$ by ! ,community ,heal? ,aide ,program "u ?is section to ensure t ! quality ( c>e provid$ ?r\gh ^? s]vices is adequate & appropriate4 7,b7 ,p>amet]s ( /udy ,! ,secret>y1 9 consultation ) int]e/$ p>ties1 includ+ pr(essional d5tal organizations1 %all develop ! p>amet]s ( ! /udy4 7,c7 ,inclusions ,! /udy %all include a det]m9ation by ! neutral panel ) respect to-- 7i7 ! ability ( ! d5tal heal? aide !rapi/ s]vices "u ?is section to address ! d5tal c>e ne$s ( ,alaska ,natives2 7ii7 ! quality ( c>e provid$ ?r\gh ^? s]vices1 includ+ any tra9+1 improvem5t1 or additional ov]sight requir$ to improve ! quality ( c>e2 & 7iii7 :e!r saf] & less co/ly alt]natives to ! d5tal heal? aide !rapi/ s]vices exi/4 7,d7 ,consultation ,9 c>ry+ out ! /udy "u ?is p>agraph1 ! neutral panel %all consult ) ,alaska tribal organizations ) respect to ! adequacy & accuracy ( ! /udy4 7#c7 ,report ,! neutral panel %all submit to ! ,secret>y1 ! ,committee on ,indian ,affairs ( ! ,s5ate1 & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report describ+ ! results ( ! /udy "u p>agraph 7#b71 includ+ a description (-- 7,a7 any det]m9ation ( ! neutral panel "u p>agraph 7#b77;,c72 & 7,b7 any comm5ts receiv$ f ,alaska tribal organizations "u p>agraph 7#b77;,d74 7d7 ,nationalization ( ,program 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 may e/abli% a national ,community ,heal? ,aide ,program 9 accordance ) ! program "u ?is section1 z ! ,secret>y det]m9es to be appropriate4 7#b7 ,requirem5t2 exclusion ,subject to p>agraphs 7#c7 & 7#d71 9 e/abli%+ a national program "u p>agraph 7#a71 ! ,secret>y-- 7,a7 %all n r$uce ! am\nts provid$ = ! ,community ,heal? ,aide ,program describ$ 9 subsections 7a7 & 7b72 & 7,b7 %all exclude d5tal heal? aide !rapi/ s]vices f s]vices cov]$ "u ! program4 7#c7 ,election ( ,indian tribe or tribal organization 7,a7 ,9 g5]al ,subp>agraph 7,b7 ( p>agraph 7#b7 %all n apply 9 ! case ( an election made by an ,indian tribe or tribal organization locat$ 9 a ,/ate 7o!r ?an ,alaska7 9 :i* ! use ( d5tal heal? aide !rapi/ s]vices or midlevel d5tal heal? provid] s]vices is au?oriz$ "u ,/ate law to supply su* s]vices 9 accordance ) ,/ate law4 7,b7 ,action by ,secret>y ,on an election by an ,indian tribe or tribal organization "u subp>agraph 7,a71 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all facilitate implem5tation ( ! s]vices elect$4 7#d7 ,vacancies ,! ,secret>y %all n fill any vacancy = a c]tifi$ d5ti/ 9 a program op]at$ by ! ,s]vice ) a d5tal heal? aide !rapi/4 7e7 ,effect ( section ,no?+ 9 ?is section %all re/rict ! ability ( ! ,s]vice1 an ,indian tribe1 or a tribal organization to p>ticipate 9 any program or to provide any s]vice au?oriz$ by any o!r ,f$]al law4 4 #aab4 ,heal? pr(essional *ronic %ortage demon/ration programs ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq47 7z am5d$ by section #aja7;b77 is am5d$ by add+ at ! end ! foll[+3 #abc4 ,heal? pr(essional *ronic %ortage demon/ration programs 7a7 ,demon/ration programs ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 may fund demon/ration programs = ,indian heal? programs to address ! *ronic %ortages ( heal? pr(essionals4 7b7 ,purposes ( programs ,! purposes ( demon/ration programs "u subsection 7a7 %all be-- 7#a7 to provide direct cl9ical & practical exp]i5ce )9 an ,indian heal? program to heal? pr(ession /ud5ts & resid5ts f m$ical s*ools2 7#b7 to improve ! quality ( heal? c>e = ,indians by ensur+ access to qualifi$ heal? pr(essionals2 7#c7 to provide academic & s*ol>ly opportunities = heal? pr(essionals s]v+ ,indians by id5tify+ all academic & s*ol>ly res\rces ( ! region2 & 7#d7 to provide tra9+ & support = alt]native provid] types1 su* z community heal? repres5tatives1 & community heal? aides4 7c7 ,advisory bo>d ,! demon/ration programs e/abli%$ pursuant to subsection 7a7 %all incorporate a program advisory bo>d1 :i* may be compos$ ( repres5tatives ( tribal gov]nm5ts1 ,indian heal? programs1 & ,indian communities 9 ! areas to be s]v$ by ! demon/ration programs4 4 #aac4 ,exemption f paym5t ( c]ta9 fees ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq47 7z am5d$ by section #aab7 is am5d$ by add+ at ! end ! foll[+3 #abd4 ,exemption f paym5t ( c]ta9 fees ,employees ( a tribal heal? program or urban ,indian organization %all be exempt f paym5t ( lic5s+1 regi/ration1 & any o!r fees impos$ by a ,f$]al ag5cy to ! same ext5t t (fic]s ( ! commission$ corps ( ! ,public ,heal? ,s]vice & o!r employees ( ! ,s]vice are exempt f ^? fees4 4 ,b ,heal? s]vices #aba4 ,indian ,heal? ,c>e ,improvem5t ,fund ,section #bja ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba7 is am5d$ to read z foll[s3 #bja4 ,indian ,heal? ,c>e ,improvem5t ,fund 7a7 ,use ( funds ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 is au?oriz$ to exp5d funds1 directly or "u ! au?ority ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 :i* are appropriat$ "u ! au?ority ( ?is section1 = ! purposes (-- 7#a7 elim9at+ ! defici5cies 9 heal? /atus & heal? res\rces ( all ,indian tribes2 7#b7 elim9at+ backlogs 9 ! provision ( heal? c>e s]vices to ,indians2 7#c7 meet+ ! heal? ne$s ( ,indians 9 an effici5t & equitable mann]1 includ+ ! use ( teleheal? & telem$ic9e :5 appropriate2 7#d7 elim9at+ inequities 9 fund+ = bo? direct c>e & contract heal? s]vice programs2 & 7#e7 augm5t+ ! ability ( ! ,s]vice to meet ! foll[+ heal? s]vice responsibilities ) respect to ^? ,indian tribes ) ! highe/ levels ( heal? /atus defici5cies & res\rce defici5cies3 7,a7 ,cl9ical c>e1 includ+ inpati5t c>e1 outpati5t c>e 7includ+ audiology1 cl9ical eye1 & vision c>e71 prim>y c>e1 second>y & t]ti>y c>e1 & long-t]m c>e4 7,b7 ,prev5tive heal?1 includ+ mammography & o!r canc] scre5+4 7,c7 ,d5tal c>e4 7,d7 ,m5tal heal?1 includ+ community m5tal heal? s]vices1 inpati5t m5tal heal? s]vices1 dormitory m5tal heal? s]vices1 !rapeutic & resid5tial treatm5t c5t]s1 & tra9+ ( traditional heal? c>e practition]s4 7,e7 ,em]g5cy m$ical s]vices4 7,f7 ,treatm5t & control (1 & rehabilitative c>e relat$ to1 alcoholism & drug abuse 7includ+ fetal alcohol syndrome7 among ,indians4 7,g7 ,injury prev5tion programs1 includ+ data collection & evaluation1 demon/ration projects1 tra9+1 & capacity build+4 7,h7 ,home heal? c>e4 7,i7 ,community heal? repres5tatives4 7,j7 ,ma9t5ance & improvem5t4 7b7 ,no (fset or limitation ,any funds appropriat$ "u ! au?ority ( ?is section %all n be us$ to (fset or limit any o!r appropriations made to ! ,s]vice "u ?is ,act or ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 or any o!r provision ( law4 7c7 ,allocation2 use 7#a7 ,9 g5]al ,funds appropriat$ "u ! au?ority ( ?is section %all be allocat$ to ,s]vice units1 ,indian tribes1 or tribal organizations4 ,! funds allocat$ to ea* ,indian tribe1 tribal organization1 or ,s]vice unit "u ?is p>agraph %all be us$ by ! ,indian tribe1 tribal organization1 or ,s]vice unit "u ?is p>agraph to improve ! heal? /atus & r$uce ! res\rce defici5cy ( ea* ,indian tribe s]v$ by su* ,s]vice unit1 ,indian tribe1 or tribal organization4 7#b7 ,apportionm5t ( allocat$ funds ,! apportionm5t ( funds allocat$ to a ,s]vice unit1 ,indian tribe1 or tribal organization "u p>agraph 7#a7 among ! heal? s]vice responsibilities describ$ 9 subsection 7a77#e7 %all be det]m9$ by ! ,s]vice 9 consultation )1 & ) ! active p>ticipation (1 ! affect$ ,indian tribes & tribal organizations4 7d7 ,provisions relat+ to heal? /atus & res\rce defici5cies ,= ! purposes ( ?is section1 ! foll[+ def9itions apply3 7#a7 ,def9ition ,! t]m heal? /atus & res\rce defici5cy means ! ext5t to :i*-- 7,a7 ! heal? /atus objectives set =? 9 sections #c7a7 & #c7b7 are n be+ a*iev$2 & 7,b7 ! ,indian tribe or tribal organization does n h available to x ! heal? res\rces x ne$s1 tak+ into acc\nt ! actual co/ ( provid+ heal? c>e s]vices giv5 local geographic1 climatic1 rural1 or o!r circum/ances4 7#b7 ,available res\rces ,! heal? res\rces available to an ,indian tribe or tribal organization include heal? res\rces provid$ by ! ,s]vice z well z heal? res\rces us$ by ! ,indian tribe or tribal organization1 includ+ s]vices & f9anc+ sy/ems provid$ by any ,f$]al programs1 private insurance1 & programs ( ,/ate or local gov]nm5ts4 7#c7 ,process = review ( det]m9ations ,! ,secret>y %all e/abli% proc$ures :i* all[ any ,indian tribe or tribal organization to petition ! ,secret>y = a review ( any det]m9ation ( ! ext5t ( ! heal? /atus & res\rce defici5cy ( su* ,indian tribe or tribal organization4 7e7 ,eligibility = funds ,tribal heal? programs %all be eligible = funds appropriat$ "u ! au?ority ( ?is section on an equal basis ) programs t are adm9i/]$ directly by ! ,s]vice4 7f7 ,report ,by no lat] ?an ! date t is #c ye>s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ,congress ! curr5t heal? /atus & res\rce defici5cy report ( ! ,s]vice = ea* ,s]vice unit1 includ+ newly recogniz$ or ackn[l$g$ ,indian tribes4 ,su* report %all set out-- 7#a7 ! me?odology !n 9 use by ! ,s]vice = det]m9+ tribal heal? /atus & res\rce defici5cies1 z well z ! mo/ rec5t application ( t me?odology2 7#b7 ! ext5t ( ! heal? /atus & res\rce defici5cy ( ea* ,indian tribe s]v$ by ! ,s]vice or a tribal heal? program2 7#c7 ! am\nt ( funds necess>y to elim9ate ! heal? /atus & res\rce defici5cies ( all ,indian tribes s]v$ by ! ,s]vice or a tribal heal? program2 & 7#d7 an e/imate (-- 7,a7 ! am\nt ( heal? s]vice funds appropriat$ "u ! au?ority ( ?is ,act1 or any o!r ,act1 includ+ ! am\nt ( any funds transf]r$ to ! ,s]vice = ! prec$+ fiscal ye> :i* is allocat$ to ea* ,s]vice unit1 ,indian tribe1 or tribal organization2 7,b7 ! numb] ( ,indians eligible = heal? s]vices 9 ea* ,s]vice unit or ,indian tribe or tribal organization2 & 7,c7 ! numb] ( ,indians us+ ! ,s]vice res\rces made available to ea* ,s]vice unit1 ,indian tribe or tribal organization1 &1 to ! ext5t available1 in=mation on ! wait+ li/s & numb] ( ,indians turn$ away = s]vices due to lack ( res\rces4 7g7 ,inclusion 9 base budget ,funds appropriat$ "u ?is section = any fiscal ye> %all be includ$ 9 ! base budget ( ! ,s]vice = ! purpose ( det]m9+ appropriations "u ?is section 9 subsequ5t fiscal ye>s4 7h7 ,cl>ification ,no?+ 9 ?is section is int5d$ to dim9i% ! prim>y responsibility ( ! ,s]vice to elim9ate exi/+ backlogs 9 unmet heal? c>e ne$s1 nor are ! provisions ( ?is section int5d$ to disc\rage ! ,s]vice f und]tak+ additional ef=ts to a*ieve equity among ,indian tribes & tribal organizations4 7i7 ,fund+ designation ,any funds appropriat$ "u ! au?ority ( ?is section %all be designat$ z ! ,indian ,heal? ,c>e ,improvem5t ,fund4 4 #abb4 ,cata/rophic ,heal? ,em]g5cy ,fund ,section #bjb ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;a7 is am5d$ to read z foll[s3 #bjb4 ,cata/rophic ,heal? ,em]g5cy ,fund 7a7 ,e/abli%m5t ,!re is e/abli%$ an ,indian ,cata/rophic ,heal? ,em]g5cy ,fund 7h]eaft] 9 ?is section ref]r$ to z ! ,,*ef7 consi/+ (-- 7#a7 ! am\nts deposit$ "u subsection 7f72 & 7#b7 ! am\nts appropriat$ to ,,*ef "u ?is section4 7b7 ,adm9i/ration ,,*ef %all be adm9i/]$ by ! ,secret>y1 act+ ?r\gh ! headqu>t]s ( ! ,s]vice1 solely = ! purpose ( meet+ ! extraord9>y m$ical co/s associat$ ) ! treatm5t ( victims ( disa/]s or cata/rophic illnesses :o are )9 ! responsibility ( ! ,s]vice4 7c7 ,conditions on use ( fund ,no "p ( ,,*ef or its adm9i/ration %all be subject to contract or grant "u any law1 includ+ ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 nor %all ,,*ef funds be allocat$1 apportion$1 or delegat$ on an ,area ,(fice1 ,s]vice ,unit1 or o!r simil> basis4 7d7 ,regulations ,! ,secret>y %all promulgate regulations consi/5t ) ! provisions ( ?is section to-- 7#a7 e/abli% a def9ition ( disa/]s & cata/rophic illnesses = :i* ! co/ ( ! treatm5t provid$ "u contract w\ld qualify = paym5t f ,,*ef2 7#b7 provide t a ,s]vice ,unit %all n be eligible = reimbursem5t = ! co/ ( treatm5t f ,,*ef until its co/ ( treat+ any victim ( su* cata/rophic illness or disa/] has rea*$ a c]ta9 ?re%old co/ :i* ! ,secret>y %all e/abli% at-- 7,a7 ! #bjjj level ( #ai1jjj2 & 7,b7 = any subsequ5t ye>1 n less ?an ! ?re%old co/ ( ! previ\s ye> increas$ by ! p]c5tage increase 9 ! m$ical c>e exp5diture category ( ! consum] price index = all urban consum]s 7,unit$ ,/ates city av]age7 = ! #ab-mon? p]iod end+ ) ,decemb] ( ! previ\s ye>2 7#c7 e/abli% a proc$ure = ! reimbursem5t ( ! portion ( ! co/s t exce$s su* ?re%old co/ incurr$ by-- 7,a7 ,s]vice ,units2 or 7,b7 :5ev] o!rwise au?oriz$ by ! ,s]vice1 non-,s]vice facilities or provid]s2 7#d7 e/abli% a proc$ure = paym5t f ,,*ef 9 cases 9 :i* ! exig5cies ( ! m$ical circum/ances w>rant treatm5t prior to ! au?orization ( su* treatm5t by ! ,s]vice2 & 7#e7 e/abli% a proc$ure t w ensure t no paym5t %all be made f ,,*ef to any provid] ( treatm5t to ! ext5t t su* provid] is eligible to receive paym5t = ! treatm5t f any o!r ,f$]al1 ,/ate1 local1 or private s\rce ( reimbursem5t = :i* ! pati5t is eligible4 7e7 ,no (fset or limitation ,am\nts appropriat$ to ,,*ef "u ?is section %all n be us$ to (fset or limit appropriations made to ! ,s]vice "u ! au?ority ( ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 or any o!r law4 7f7 ,deposit ( reimbursem5t funds ,!re %all be deposit$ into ,,*ef all reimbursem5ts to :i* ! ,s]vice is entitl$ f any ,f$]al1 ,/ate1 local1 or private s\rce 7includ+ ?ird p>ty insurance7 by reason ( treatm5t r5d]$ to any victim ( a disa/] or cata/rophic illness ! co/ ( :i* 0 paid f ,,*ef4 4 #abc4 ,diabetes prev5tion1 treatm5t1 & control ,section #bjd ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;c7 is am5d$ to read z foll[s3 #bjd4 ,diabetes prev5tion1 treatm5t1 & control 7a7 ,det]m9ations reg>d+ diabetes ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 & 9 consultation ) ,indian tribes & tribal organizations1 %all det]m9e-- 7#a7 by ,indian tribe & by ,s]vice unit1 ! incid5ce (1 & ! types ( complications result+ f1 diabetes among ,indians2 & 7#b7 bas$ on ! det]m9ations made pursuant to p>agraph 7#a71 ! measures 7includ+ pati5t education & effective ongo+ monitor+ ( disease indicators7 ea* ,s]vice unit %\ld take to r$uce ! incid5ce (1 & prev5t1 treat1 & control ! complications result+ f1 diabetes among ,indian tribes )9 t ,s]vice unit4 7b7 ,diabetes scre5+ ,to ! ext5t m$ically indicat$ & ) in=m$ cons5t1 ! ,secret>y %all scre5 ea* ,indian :o receives s]vices f ! ,s]vice = diabetes & = conditions :i* indicate a high risk t ! individual w become diabetic & e/abli% a co/-effective approa* to ensure ongo+ monitor+ ( disease indicators4 ,su* scre5+ & monitor+ may be conduct$ by a tribal heal? program & may be conduct$ ?r\gh appropriate ,int]net-bas$ heal? c>e managem5t programs4 7c7 ,diabetes projects ,! ,secret>y %all cont9ue to ma9ta9 ea* model diabetes project 9 exi/5ce on ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 any su* o!r diabetes programs op]at$ by ! ,s]vice or tribal heal? programs1 & any additional diabetes projects1 su* z ! ,m$ical ,vangu>d program provid$ = 9 title ,,iv ( ,public ,law #ajh-hg1 z implem5t$ to s]ve ,indian tribes4 tribal heal? programs %all receive recurr+ fund+ = ! diabetes projects t !y op]ate pursuant to ?is section1 bo? at ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag & = projects :i* are add$ & fund$ !reaft]4 7d7 ,dialysis programs ,! ,secret>y is au?oriz$ to provide1 ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 dialysis programs1 includ+ ! pur*ase ( dialysis equipm5t & ! provision ( necess>y /aff+4 7e7 ,o!r duties ( ! ,secret>y 7#a7 ,9 g5]al ,! ,secret>y %all1 to ! ext5t fund+ is available-- 7,a7 9 ea* area (fice1 consult ) ,indian tribes & tribal organizations reg>d+ programs = ! prev5tion1 treatm5t1 & control ( diabetes2 7,b7 e/abli% 9 ea* area (fice a regi/ry ( pati5ts ) diabetes to track ! incid5ce ( diabetes & ! complications f diabetes 9 t area2 & 7,c7 ensure t data collect$ 9 ea* area (fice reg>d+ diabetes & relat$ complications among ,indians are dissem9at$ to all o!r area (fices1 subject to applicable pati5t privacy laws4 7#b7 ,diabetes control (fic]s 7,a7 ,9 g5]al ,! ,secret>y may e/abli% & ma9ta9 9 ea* area (fice a position ( diabetes control (fic] to coord9ate & manage any activity ( t area (fice relat+ to ! prev5tion1 treatm5t1 or control ( diabetes to assi/ ! ,secret>y 9 c>ry+ out a program "u ?is section or section #ccj;,c ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#c74 7,b7 ,c]ta9 activities ,any activity c>ri$ out by a diabetes control (fic] "u subp>agraph 7,a7 t is ! subject ( a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 & any funds made available to c>ry out su* an activity1 %all n be divisible = purposes ( t ,act4 4 #abd4 ,o!r au?ority = provision ( s]vices2 %>$ s]vices = long-t]m c>e 7a7 ,o!r au?ority = provision ( s]vices 7#a7 ,9 g5]al ,section #bje ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;d7 is am5d$ to read z foll[s3 #bje4 ,o!r au?ority = provision ( s]vices 7a7 ,def9itions ,9 ?is section3 7#a7 ,assi/$ liv+ s]vice ,! t]m assi/$ liv+ s]vice means any s]vice provid$ by an assi/$ liv+ facility 7z def9$ 9 section #bcb7;b7 ( ! ,national ,h\s+ ,act 7#ab ,u4,s4,c4 #agaew7b7771 except t su* an assi/$ liv+ facility-- 7,a7 %all n be requir$ to obta9 a lic5se2 b 7,b7 %all meet all applicable /&>ds = lic5sure4 7#b7 ,home- & community-bas$ s]vice ,! t]m home- & community-bas$ s]vice means #a or m ( ! s]vices specifi$ 9 p>agraphs 7#a7 ?r\gh 7#i7 ( section #aibi7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acift7a77 7:e!r provid$ by ! ,s]vice or by an ,indian tribe or tribal organization pursuant to ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq477 t are or w be provid$ 9 accordance ) applicable /&>ds4 7#c7 ,hospice c>e ,! t]m hospice c>e means-- 7,a7 ! items & s]vices specifi$ 9 subp>agraphs 7,a7 ?r\gh 7,h7 ( section #ahfa7;dd77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#a772 & 7,b7 su* o!r s]vices z an ,indian tribe or tribal organization det]m9es are necess>y & appropriate to provide 9 fur!rance ( t c>e4 7#d7 ,long-t]m c>e s]vices ,! t]m long-t]m c>e s]vices has ! mean+ giv5 ! t]m qualifi$ long-t]m c>e s]vices 9 section #ggjb;,b7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7b7 ,fund+ au?oriz$ ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 may provide fund+ "u ?is ,act to meet ! objectives set =? 9 section #c ?r\gh heal? c>e-relat$ s]vices & programs n o!rwise describ$ 9 ?is ,act = ! foll[+ s]vices3 7#a7 ,hospice c>e4 7#b7 ,assi/$ liv+ s]vices4 7#c7 ,long-t]m c>e s]vices4 7#d7 ,home- & community-bas$ s]vices4 7c7 ,eligibility ,! foll[+ individuals %all be eligible to receive long-t]m c>e s]vices "u ?is section3 7#a7 ,individuals :o are unable to p]=m a c]ta9 numb] ( activities ( daily liv+ )\t assi/ance4 7#b7 ,individuals ) a m5tal impairm5t1 su* z dem5tia1 ,alzheim]'s disease1 or ano!r disabl+ m5tal illness1 :o may be able to p]=m activities ( daily liv+ "u sup]vision4 7#c7 ,su* o!r individuals z an applicable tribal heal? program det]m9es to be appropriate4 7d7 ,au?orization ( conv5i5t c>e s]vices ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 may also provide fund+ "u ?is ,act to meet ! objectives set =? 9 section #c = conv5i5t c>e s]vices programs pursuant to section #cjg7;c77#b77;,a74 4 7#b7 ,repeal ,section #hba ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afhjk7 is repeal$4 7b7 ,%>$ s]vices = long-,t]m c>e ,section #hbb ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afhjl7 is am5d$ to read z foll[s3 #hbb4 ,%>$ s]vices = long-t]m c>e 7a7 ,long-,t]m c>e 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 is au?oriz$ to provide directly1 or ent] into contracts or compacts "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 ) ,indian tribes or tribal organizations =1 ! deliv]y ( long-t]m c>e 7includ+ heal? c>e s]vices associat$ ) long-t]m c>e7 provid$ 9 a facility to ,indians4 7#b7 ,inclusions ,ea* agreem5t "u p>agraph 7#a7 %all provide = ! %>+ ( /aff or o!r s]vices betwe5 ! ,s]vice or a tribal heal? program & a long-t]m c>e or relat$ facility own$ & op]at$ 7directly or ?r\gh a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq477 by ! ,indian tribe or tribal organization4 7b7 ,cont5ts ( agreem5ts ,an agreem5t ent]$ into pursuant to subsection 7a7-- 7#a7 may1 at ! reque/ ( ! ,indian tribe or tribal organization1 delegate to ! ,indian tribe or tribal organization su* p[]s ( sup]vision & control ov] ,s]vice employees z ! ,secret>y det]m9es to be necess>y to c>ry out ! purposes ( ?is section2 7#b7 %all provide t exp5ses 7includ+ sal>ies7 relat+ to s]vices t are %>$ betwe5 ! ,s]vice & ! tribal heal? program be allocat$ proportionately betwe5 ! ,s]vice & ! ,indian tribe or tribal organization2 & 7#c7 may au?orize ! ,indian tribe or tribal organization to con/ruct1 r5ovate1 or exp& a long-t]m c>e or o!r simil> facility 7includ+ ! con/ruction ( a facility atta*$ to a ,s]vice facility74 7c7 ,m9imum requirem5t ,any nurs+ facility provid$ = "u ?is section %all meet ! requirem5ts = nurs+ facilities "u section #aiai ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr74 7d7 ,o!r assi/ance ,! ,secret>y %all provide su* te*nical & o!r assi/ance z may be necess>y to enable applicants to comply ) ?is section4 7e7 ,use ( exi/+ or und]us$ facilities ,! ,secret>y %all enc\rage ! use ( exi/+ facilities t are und]us$1 or all[ ! use ( sw+ b$s1 = long-t]m or simil> c>e4 4 #abe4 ,reimbursem5t f c]ta9 ?ird p>ties ( co/s ( heal? s]vices ,section #bjf ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;e7 is am5d$ to read z foll[s3 #bjf4 ,reimbursem5t f c]ta9 ?ird p>ties ( co/s ( heal? s]vices 7a7 ,"r ( recov]y ,except z provid$ 9 subsection 7f71 ! ,unit$ ,/ates1 an ,indian tribe1 or tribal organization %all h ! "r to recov] f an insurance company1 heal? ma9t5ance organization1 employee b5efit plan1 ?ird-p>ty tortfeasor1 or any o!r responsible or liable ?ird p>ty 7includ+ a political subdivision or local gov]nm5tal entity ( a ,/ate7 ! reasonable *>ges bill$ by ! ,secret>y1 an ,indian tribe1 or tribal organization 9 provid+ heal? s]vices ?r\gh ! ,s]vice1 an ,indian tribe1 or tribal organization1 or1 if high]1 ! highe/ am\nt ! ?ird p>ty w\ld pay = c>e & s]vices furni%$ by provid]s o!r ?an gov]nm5tal entities1 to any individual to ! same ext5t t su* individual1 or any nongov]nm5tal provid] ( su* s]vices1 w\ld be eligible to receive damages1 reimbursem5t1 or indemnification = su* *>ges or exp5ses if-- 7#a7 su* s]vices _h be5 provid$ by a nongov]nm5tal provid]2 & 7#b7 su* individual _h be5 requir$ to pay su* *>ges or exp5ses & did pay su* *>ges or exp5ses4 7b7 ,limitations on recov]ies f ,/ates ,subsection 7a7 %all provide a "r ( recov]y aga9/ any ,/ate1 only if ! injury1 illness1 or disability = :i* heal? s]vices 7 provid$ is cov]$ "u-- 7#a7 work]s' comp5sation laws2 or 7#b7 a no-fault automobile accid5t insurance plan or program4 7c7 ,nonapplicability ( o!r laws ,no law ( any ,/ate1 or ( any political subdivision ( a ,/ate & no provision ( any contract1 insurance or heal? ma9t5ance organization policy1 employee b5efit plan1 self-insurance plan1 manag$ c>e plan1 or o!r heal? c>e plan or program ent]$ into or r5ew$ aft] ! date ( enactm5t ( ! ,indian ,heal? ,c>e ,am5dm5ts ( #aihh1 %all prev5t or h9d] ! "r ( recov]y ( ! ,unit$ ,/ates1 an ,indian tribe1 or tribal organization "u subsection 7a74 7d7 ,no effect on private rights ( action ,no action tak5 by ! ,unit$ ,/ates1 an ,indian tribe1 or tribal organization to en=ce ! "r ( recov]y provid$ "u ?is section %all op]ate to d5y to ! injur$ p]son ! recov]y = t portion ( ! p]son's damage n cov]$ h]eund]4 7e7 ,en=cem5t 7#a7 ,9 g5]al ,! ,unit$ ,/ates1 an ,indian tribe1 or tribal organization may en=ce ! "r ( recov]y provid$ "u subsection 7a7 by-- 7,a7 int]v5+ or jo9+ 9 any civil action or proce$+ br\ght-- 7i7 by ! individual = :om heal? s]vices 7 provid$ by ! ,secret>y1 an ,indian tribe1 or tribal organization2 or 7ii7 by any repres5tative or heirs ( su* individual1 or 7,b7 in/itut+ a sep>ate civil action1 includ+ a civil action = injunctive relief & o!r relief & includ+1 ) respect to a political subdivision or local gov]nm5tal entity ( a ,/ate1 su* an action aga9/ an (ficial !re(4 7#b7 ,notice ,all reasonable ef=ts %all be made to provide notice ( action in/itut$ "u p>agraph 7#a77;,b7 to ! individual to :om heal? s]vices 7 provid$1 ei!r be=e or dur+ ! p5d5cy ( su* action4 7#c7 ,recov]y f tortfeasors 7,a7 ,9 g5]al ,9 any case 9 :i* an ,indian tribe or tribal organization t is au?oriz$ or requir$ "u a compact or contract issu$ pursuant to ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 to furni% or pay = heal? s]vices to a p]son :o is injur$ or suff]s a disease on or aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag "u circum/ances t e/abli% gr\nds = a claim ( liability aga9/ ! tortfeasor ) respect to ! injury or disease1 ! ,indian tribe or tribal organization %all h a "r to recov] f ! tortfeasor 7or an insur] ( ! tortfeasor7 ! reasonable value ( ! heal? s]vices s furni%$1 paid =1 or to be paid =1 9 accordance ) ! ,f$]al ,m$ical ,c>e ,recov]y ,act 7#db ,u4,s4,c4 #bfea et seq471 to ! same ext5t & "u ! same circum/ances z ! ,unit$ ,/ates may recov] "u t ,act4 7,b7 ,treatm5t ,! "r ( an ,indian tribe or tribal organization to recov] "u subp>agraph 7,a7 %all be indep5d5t ( ! rights ( ! injur$ or diseas$ p]son s]v$ by ! ,indian tribe or tribal organization4 7f7 ,limitation ,abs5t specific writt5 au?orization by ! gov]n+ body ( an ,indian tribe = ! p]iod ( su* au?orization 7:i* may n be = a p]iod ( m ?an #a ye> & :i* may be revok$ at any "t ^u writt5 notice by ! gov]n+ body to ! ,s]vice71 ! ,unit$ ,/ates %all n h a "r ( recov]y "u ?is section if ! injury1 illness1 or disability = :i* heal? s]vices 7 provid$ is cov]$ "u a self-insurance plan fund$ by an ,indian tribe1 tribal organization1 or urban ,indian organization4 ,:]e su* au?orization is provid$1 ! ,s]vice may receive & exp5d su* am\nts = ! provision ( additional heal? s]vices consi/5t ) su* au?orization4 7g7 ,co/s & attorney's fees ,9 any action br\ght to en=ce ! provisions ( ?is section1 a prevail+ pla9tiff %all be aw>d$ its reasonable attorney's fees & co/s ( litigation4 7h7 ,nonapplicability ( claims fil+ requirem5ts ,an insurance company1 heal? ma9t5ance organization1 self-insurance plan1 manag$ c>e plan1 or o!r heal? c>e plan or program 7"u ! ,social ,security ,act or o!rwise7 may n d5y a claim = b5efits submitt$ by ! ,s]vice or by an ,indian tribe or tribal organization bas$ on ! =mat 9 :i* ! claim is submitt$ if su* =mat complies ) ! =mat requir$ = submission ( claims "u title ,,xviii ( ! ,social ,security ,act or recogniz$ "u section #aage ( su* ,act4 7i7 ,application to urban ,indian organizations ,! previ\s provisions ( ?is section %all apply to urban ,indian organizations ) respect to populations s]v$ by su* ,organizations 9 ! same mann] !y apply to ,indian tribes & tribal organizations ) respect to populations s]v$ by su* ,indian tribes & tribal organizations4 7j7 ,/atute ( limitations ,! provisions ( section #bdae ( title #bh1 ,unit$ ,/ates ,code1 %all apply to all actions comm5c$ "u ?is section1 & ! ref]5ces !re9 to ! ,unit$ ,/ates are deem$ to include ,indian tribes1 tribal organizations1 & urban ,indian organizations4 7k7 ,sav+s ,no?+ 9 ?is section %all be con/ru$ to limit any "r ( recov]y available to ! ,unit$ ,/ates1 an ,indian tribe1 or tribal organization "u ! provisions ( any applicable1 ,f$]al1 ,/ate1 or tribal law1 includ+ m$ical li5 laws4 4 #abf4 ,cr$it+ ( reimbursem5ts ,section #bjg ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;f7 is am5d$ to read z foll[s3 #bjg4 ,cr$it+ ( reimbursem5ts 7a7 ,use ( am\nts 7#a7 ,ret5tion by program ,except z provid$ 9 sections #bjb7;a77#b7 & #hac1 all reimbursem5ts receiv$ or recov]$ "u any ( ! programs describ$ 9 p>agraph 7#b71 includ+ "u section #hac1 by reason ( ! provision ( heal? s]vices by ! ,s]vice1 by an ,indian tribe or tribal organization1 or by an urban ,indian organization1 %all be cr$it$ to ! ,s]vice1 su* ,indian tribe or tribal organization1 or su* urban ,indian organization1 respectively1 & may be us$ z provid$ 9 section #dja4 ,9 ! case ( su* a s]vice provid$ by or ?r\gh a ,s]vice ,unit1 su* am\nts %all be cr$it$ to su* unit & us$ = su* purposes4 7#b7 ,programs cov]$ ,! programs ref]r$ to 9 p>agraph 7#a7 are ! foll[+3 7,a7 ,titles ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act4 7,b7 ,?is ,act1 includ+ section #hac4 7,c7 ,public ,law #hg-fic4 7,d7 ,any o!r provision ( law4 7b7 ,no (fset ( am\nts ,! ,s]vice may n (fset or limit any am\nt obligat$ to any ,s]vice ,unit or entity receiv+ fund+ f ! ,s]vice because ( ! receipt ( reimbursem5ts "u subsection 7a74 4 #abg4 ,behavioral heal? tra9+ & community education programs ,section #bji ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba;h7 is am5d$ by /rik+ subsection 7d7 & ins]t+ ! foll[+3 7d7 ,behavioral heal? tra9+ & community education programs 7#a7 ,/udy2 li/ ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 & ! ,secret>y ( ! ,int]ior1 9 consultation ) ,indian tribes & tribal organizations1 %all conduct a /udy & compile a li/ ( ! types ( /aff positions specifi$ 9 p>agraph 7#b7 ^: qualifications include1 or %\ld include1 tra9+ 9 ! id5tification1 prev5tion1 education1 ref]ral1 or treatm5t ( m5tal illness1 or dysfunctional & self de/ructive behavior4 7#b7 ,positions ,! positions ref]r$ to 9 p>agraph 7#a7 are-- 7,a7 /aff positions )9 ! ,bureau ( ,indian ,affairs1 includ+ exi/+ positions1 9 ! fields (-- 7i7 elem5t>y & second>y education2 7ii7 social s]vices & family & *ild welf>e2 7iii7 law en=cem5t & judicial s]vices2 & 7iv7 alcohol & sub/ance abuse2 7,b7 /aff positions )9 ! ,s]vice2 & 7,c7 /aff positions simil> to ^? id5tifi$ 9 subp>agraphs 7,a7 & 7,b7 e/abli%$ & ma9ta9$ by ,indian tribes & tribal organizations 7)\t reg>d to ! fund+ s\rce74 7#c7 ,tra9+ crit]ia 7,a7 ,9 g5]al ,! appropriate ,secret>y %all provide tra9+ crit]ia appropriate to ea* type ( position id5tifi$ 9 p>agraphs 7#b77;,a7 & 7#b77;,b7 & ensure t appropriate tra9+ has be51 or %all be provid$ to any individual 9 any su* position4 ,) respect to any su* individual 9 a position id5tifi$ pursuant to p>agraph 7#b77;,c71 ! respective ,secret>ies %all provide appropriate tra9+ to1 or provide funds to1 an ,indian tribe or tribal organization = tra9+ ( appropriate individuals4 ,9 ! case ( positions fund$ "u a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 ! appropriate ,secret>y %all ensure t su* tra9+ co/s are includ$ 9 ! contract or compact1 z ! ,secret>y det]m9es necess>y4 7,b7 ,position specific tra9+ crit]ia ,position specific tra9+ crit]ia %all be culturally relevant to ,indians & ,indian tribes & %all ensure t appropriate in=mation reg>d+ traditional heal? c>e practices is provid$4 7#d7 ,community education on m5tal illness ,! ,s]vice %all develop & implem5t1 on reque/ ( an ,indian tribe1 tribal organization1 or urban ,indian organization1 or assi/ ! ,indian tribe1 tribal organization1 or urban ,indian organization to develop & implem5t1 a program ( community education on m5tal illness4 ,9 c>ry+ out ?is p>agraph1 ! ,s]vice %all1 ^u reque/ ( an ,indian tribe1 tribal organization1 or urban ,indian organization1 provide te*nical assi/ance to ! ,indian tribe1 tribal organization1 or urban ,indian organization to obta9 & develop community educational mat]ials on ! id5tification1 prev5tion1 ref]ral1 & treatm5t ( m5tal illness & dysfunctional & self-de/ructive behavior4 7#e7 ,plan ,n lat] ?an #ij days aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all develop a plan "u :i* ! ,s]vice w increase ! heal? c>e /aff provid+ behavioral heal? s]vices by at lea/ #ejj positions )9 #e ye>s aft] ! date ( enactm5t ( t ,act1 ) at lea/ #bjj ( su* positions devot$ to *ild1 adolesc5t1 & family s]vices4 ,! plan develop$ "u ?is p>agraph %all be implem5t$ "u ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act74 4 #abh4 ,canc] scre5+s ,section #bab ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbak7 is am5d$ by ins]t+ & o!r canc] scre5+s be=e ! p]iod at ! end4 #abi4 ,pati5t travel co/s ,section #bac ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbal7 is am5d$ to read z foll[s3 #bac4 ,pati5t travel co/s 7a7 ,def9ition ( qualifi$ escort ,9 ?is section1 ! t]m qualifi$ escort means-- 7#a7 an adult escort 7includ+ a p>5t1 gu>dian1 or o!r family memb]7 :o is requir$ because ( ! physical or m5tal condition1 or age1 ( ! applicable pati5t2 7#b7 a heal? pr(essional = ! purpose ( provid+ necess>y m$ical c>e dur+ travel by ! applicable pati5t2 or 7#c7 o!r escorts1 z ! ,secret>y or applicable ,indian ,heal? ,program det]m9es to be appropriate4 7b7 ,provision ( funds ,! ,secret>y1 act+ ?r\gh ! ,s]vice & ,tribal ,heal? ,programs1 is au?oriz$ to provide funds = ! foll[+ pati5t travel co/s1 includ+ qualifi$ escorts1 associat$ ) receiv+ heal? c>e s]vices provid$ 7ei!r ?r\gh direct or contract c>e or ?r\gh a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq477 "u ?is ,act-- 7#a7 em]g5cy air transportation & non-em]g5cy air transportation :]e gr\nd transportation is infeasible2 7#b7 transportation by private vehicle 7:]e no o!r means ( transportation is available71 specially equipp$ vehicle1 & ambulance2 & 7#c7 transportation by su* o!r means z may be available & requir$ :5 air or motor vehicle transportation is n available4 4 #acj4 ,epidemiology c5t]s ,section #bad ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbam7 is am5d$ to read z foll[s3 #bad4 ,epidemiology c5t]s 7a7 ,e/abli%m5t ( c5t]s 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% an epidemiology c5t] 9 ea* ,s]vice area to c>ry out ! functions describ$ 9 subsection 7b74 7#b7 ,new c5t]s 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 any new c5t] e/abli%$ aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag may be op]at$ "u a grant au?oriz$ by subsection 7d74 7,b7 ,requirem5t ,fund+ provid$ 9 a grant describ$ 9 subp>agraph 7,a7 %all n be divisible4 7#c7 ,funds n divisible ,an epidemiology c5t] e/abli%$ "u ?is subsection %all be subject to ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 b ! funds = ! c5t] %all n be divisible4 7b7 ,functions ( c5t]s ,9 consultation ) & on ! reque/ ( ,indian tribes1 tribal organizations1 & urban ,indian organizations1 ea* ,s]vice area epidemiology c5t] e/abli%$ "u ?is section %all1 ) respect to ! applicable ,s]vice area-- 7#a7 collect data relat+ to1 & monitor progress made t[>d meet+1 ea* ( ! heal? /atus objectives ( ! ,s]vice1 ! ,indian tribes1 tribal organizations1 & urban ,indian organizations 9 ! ,s]vice area2 7#b7 evaluate exi/+ deliv]y sy/ems1 data sy/ems1 & o!r sy/ems t impact ! improvem5t ( ,indian heal?2 7#c7 assi/ ,indian tribes1 tribal organizations1 & urban ,indian organizations 9 id5tify+ highe/-priority heal? /atus objectives & ! s]vices ne$$ to a*ieve ^? objectives1 bas$ on epidemiological data2 7#d7 make recomm5dations = ! t>get+ ( s]vices ne$$ by ! populations s]v$2 7#e7 make recomm5dations to improve heal? c>e deliv]y sy/ems = ,indians & urban ,indians2 7#f7 provide reque/$ te*nical assi/ance to ,indian tribes1 tribal organizations1 & urban ,indian organizations 9 ! developm5t ( local heal? s]vice priorities & incid5ce & preval5ce rates ( disease & o!r illness 9 ! community2 & 7#g7 provide disease surveillance & assi/ ,indian tribes1 tribal organizations1 & urban ,indian communities to promote public heal?4 7c7 ,te*nical assi/ance ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all provide te*nical assi/ance to ! c5t]s 9 c>ry+ out ?is section4 7d7 ,grants = /udies 7#a7 ,9 g5]al ,! ,secret>y may make grants to ,indian tribes1 tribal organizations1 ,indian organizations1 & eligible int]tribal consortia to conduct epidemiological /udies ( ,indian communities4 7#b7 ,eligible int]tribal consortia ,an int]tribal consortium or ,indian organization %all be eligible to receive a grant "u ?is subsection if ! int]tribal consortium is-- 7,a7 incorporat$ = ! prim>y purpose ( improv+ ,indian heal?2 & 7,b7 repres5tative ( ! ,indian tribes or urban ,indian communities resid+ 9 ! area 9 :i* ! int]tribal consortium is locat$4 7#c7 ,applications ,an application = a grant "u ?is subsection %all be submitt$ 9 su* mann] & at su* "t z ! ,secret>y %all prescribe4 7#d7 ,requirem5ts ,an applicant = a grant "u ?is subsection %all-- 7,a7 demon/rate ! te*nical1 adm9i/rative1 & f9ancial exp]tise necess>y to c>ry out ! functions describ$ 9 p>agraph 7#e72 7,b7 consult & coop]ate ) provid]s ( relat$ heal? & social s]vices 9 ord] to avoid duplication ( exi/+ s]vices2 & 7,c7 demon/rate coop]ation f ,indian tribes or urban ,indian organizations 9 ! area to be s]v$4 7#e7 ,use ( funds ,a grant provid$ "u p>agraph 7#a7 may be us$-- 7,a7 to c>ry out ! functions describ$ 9 subsection 7b72 7,b7 to provide in=mation to1 & consult )1 tribal lead]s1 urban ,indian community lead]s1 & relat$ heal? /aff reg>d+ heal? c>e & heal? s]vice managem5t issues2 & 7,c7 9 collaboration ) ,indian tribes1 tribal organizations1 & urban ,indian organizations1 to provide to ! ,s]vice in=mation reg>d+ ways to improve ! heal? /atus ( ,indians4 7e7 ,access to in=mation 7#a7 ,9 g5]al ,an epidemiology c5t] op]at$ by a grantee pursuant to a grant aw>d$ "u subsection 7d7 %all be treat$ z a public heal? au?ority 7z def9$ 9 section #afd4eja ( title #de1 ,code ( ,f$]al ,regulations 7or a successor regulation77 = purposes ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7,public ,law #ajd-aia2 #aaj ,/at4 #aicf74 7#b7 ,access to in=mation ,! ,secret>y %all grant to ea* epidemiology c5t] describ$ 9 p>agraph 7#a7 access to use ( ! data1 data sets1 monitor+ sy/ems1 deliv]y sy/ems1 & o!r protect$ heal? in=mation 9 ! possession ( ! ,secret>y4 7#c7 ,requirem5t ,! activities ( an epidemiology c5t] describ$ 9 p>agraph 7#a7 %all be = ! purposes ( rese>* & = prev5t+ & controll+ disease1 injury1 or disability 7z ^? activities are describ$ 9 section #afd4eab ( title #de1 ,code ( ,f$]al ,regulations 7or a successor regulation771 = purposes ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7,public ,law#ajd-aia2 #aaj ,/at4 #aicf74 4 #aca4 ,indian y\? grant program ,section #baf7;b77#b7 ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbao7b77#b77 is am5d$ by /rik+ section #bji7m7 & ins]t+ section #gjh7;c74 #acb4 ,am]ican ,indians ,into ,psy*ology ,program ,section #bag ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbap7 is am5d$ to read z foll[s3 #bag4 ,am]ican ,indians ,into ,psy*ology ,program 7a7 ,grants au?oriz$ ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all make grants ( n m ?an #cjj1jjj to ea* ( #i colleges & univ]sities = ! purpose ( develop+ & ma9ta9+ ,indian psy*ology c>e] recruitm5t programs z a means ( enc\rag+ ,indians to ent] ! behavioral heal? field4 ,^! programs %all be locat$ at v>i\s locations ?r\gh\t ! c\ntry to maximize _! availability to ,indian /ud5ts & new programs %all be e/abli%$ 9 diff]5t locations f "t to "t4 7b7 ,qu5t9 ,n4 ,burdick program grant ,! ,secret>y %all provide a grant au?oriz$ "u subsection 7a7 to develop & ma9ta9 a program at ! ,univ]sity ( ,nor? ,dakota to be kn[n z ! ,qu5t9 ,n4 ,burdick ,am]ican ,indians ,into ,psy*ology ,program4 ,su* program %all1 to ! maximum ext5t feasible1 coord9ate ) ! ,qu5t9 ,n4 ,burdick ,indian heal? programs au?oriz$ "u section #aag7;b71 ! ,qu5t9 ,n4 ,burdick ,am]ican ,indians ,into ,nurs+ ,program au?oriz$ "u section #aae7;e71 & exi/+ univ]sity rese>* & communications networks4 7c7 ,regulations ,! ,secret>y %all issue regulations pursuant to ?is ,act = ! competitive aw>d+ ( grants provid$ "u ?is section4 7d7 ,conditions ( grant ,applicants "u ?is section %all agree to provide a program :i*1 at a m9imum-- 7#a7 provides outrea* & recruitm5t = heal? pr(essions to ,indian communities includ+ elem5t>y1 second>y1 & accr$it$ & accessible community colleges t w be s]v$ by ! program2 7#b7 incorporates a program advisory bo>d compris$ ( repres5tatives f ! tribes & communities t w be s]v$ by ! program2 7#c7 provides summ] enri*m5t programs to expose ,indian /ud5ts to ! v>i\s fields ( psy*ology ?r\gh rese>*1 cl9ical1 & exp]im5tal activities2 7#d7 provides /ip5ds to und]graduate & graduate /ud5ts to pursue a c>e] 9 psy*ology2 7#e7 develops affiliation agreem5ts ) tribal colleges & univ]sities1 ! ,s]vice1 univ]sity affiliat$ programs1 & o!r appropriate accr$it$ & accessible entities to enhance ! education ( ,indian /ud5ts2 7#f7 to ! maximum ext5t feasible1 uses exi/+ univ]sity tutor+1 c\nsel+1 & /ud5t support s]vices2 & 7#g7 to ! maximum ext5t feasible1 employs qualifi$ ,indians 9 ! program4 7e7 ,active duty s]vice requirem5t ,! active duty s]vice obligation prescrib$ "u section #cch;,c ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedm7 %all be met by ea* graduate :o receives a /ip5d describ$ 9 subsection 7d77#d7 t is fund$ "u ?is section4 ,su* obligation %all be met by s]vice-- 7#a7 9 an ,indian heal? program2 7#b7 9 a program assi/$ "u title ,v2 or 7#c7 9 ! private practice ( psy*ology if1 z det]m9$ by ! ,secret>y1 9 accordance ) guidel9es promulgat$ by ! ,secret>y1 su* practice is situat$ 9 a physician or o!r heal? pr(essional %ortage area & addresses ! heal? c>e ne$s ( a sub/antial numb] ( ,indians4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #b1gjj1jjj = fiscal ye> #bjag & ea* fiscal ye> !reaft]4 4 #acc4 ,prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases ,section #bah ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbaq7 is am5d$ to read z foll[s3 #bah4 ,prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases 7a7 ,grants au?oriz$ ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 & aft] consultation ) ! ,c5t]s = ,disease ,control & ,prev5tion1 may make grants available to ,indian tribes & tribal organizations = ! foll[+3 7#a7 ,projects = ! prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases1 includ+ tub]culosis1 hepatitis1 ,,hiv1 respiratory syncytial virus1 hanta virus1 sexually transmitt$ diseases1 & ,h4 pylori4 7#b7 ,public in=mation & education programs = ! prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases4 7#c7 ,education1 tra9+1 & cl9ical skills improvem5t activities 9 ! prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases = heal? pr(essionals1 includ+ alli$ heal? pr(essionals4 7#d7 ,demon/ration projects = ! scre5+1 treatm5t1 & prev5tion ( hepatitis ,c virus 7,,hcv74 7b7 ,application requir$ ,! ,secret>y may provide fund+ "u subsection 7a7 only if an application or proposal = fund+ is submitt$ to ! ,secret>y4 7c7 ,coord9ation ) heal? ag5cies ,indian tribes & tribal organizations receiv+ fund+ "u ?is section are enc\rag$ to coord9ate _! activities ) ! ,c5t]s = ,disease ,control & ,prev5tion & ,/ate & local heal? ag5cies4 7d7 ,te*nical assi/ance2 report ,9 c>ry+ out ?is section1 ! ,secret>y-- 7#a7 may1 at ! reque/ ( an ,indian tribe or tribal organization1 provide te*nical assi/ance2 & 7#b7 %all prep>e & submit a report to ,congress bi5nially on ! use ( funds "u ?is section & on ! progress made t[>d ! prev5tion1 control1 & elim9ation ( communicable & infecti\s diseases among ,indians & urban ,indians4 4 #acd4 ,me?ods to increase cl9ician recruitm5t & ret5tion issues 7a7 ,lic5s+ ,section #bba ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbat7 is am5d$ to read z foll[s3 #bba4 ,lic5s+ ,lic5s$ heal? pr(essionals employ$ by a tribal heal? program %all be exempt1 if lic5s$ 9 any ,/ate1 f ! lic5s+ requirem5ts ( ! ,/ate 9 :i* ! tribal heal? program p]=ms ! s]vices describ$ 9 ! contract or compact ( ! tribal heal? program "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 4 7b7 ,cont9u+ education all[ances ,section #ajf ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afae7 is am5d$ to read z foll[s3 #ajf4 ,cont9u+ education all[ances ,9 ord] to enc\rage s*ol>%ip & /ip5d recipi5ts "u sections #ajd1 #aje1 & #aae & heal? pr(essionals1 includ+ community heal? repres5tatives & em]g5cy m$ical te*nicians1 to jo9 or cont9ue 9 an ,indian heal? program & to provide s]vices 9 ! rural & remote areas 9 :i* a significant portion ( ,indians reside1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 may-- 7#a7 provide programs or all[ances to transition into an ,indian heal? program1 includ+ lic5s+1 bo>d or c]tification exam9ation assi/ance1 & te*nical assi/ance 9 fulfill+ s]vice obligations "u sections #ajd1 #aje1 & #aae2 & 7#b7 provide programs or all[ances to heal? pr(essionals employ$ 9 an ,indian heal? program to enable ^? pr(essionals1 = a p]iod ( "t ea* ye> prescrib$ by regulation ( ! ,secret>y1 to take leave ( ! duty /ations ( ! pr(essionals = pr(essional consultation1 managem5t1 lead]%ip1 & refre%] tra9+ c\rses4 4 #ace4 ,liability = paym5t ,section #bbb ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbau7 is am5d$ to read z foll[s3 #bbb4 ,liability = paym5t 7a7 ,no pati5t liability ,a pati5t :o receives contract heal? c>e s]vices t are au?oriz$ by ! ,s]vice %all n be liable = ! paym5t ( any *>ges or co/s associat$ ) ! provision ( su* s]vices4 7b7 ,notification ,! ,secret>y %all notify a contract c>e provid] & any pati5t :o receives contract heal? c>e s]vices au?oriz$ by ! ,s]vice t su* pati5t is n liable = ! paym5t ( any *>ges or co/s associat$ ) ! provision ( su* s]vices n lat] ?an #e bus9ess days aft] receipt ( a notification ( a claim by a provid] ( contract c>e s]vices4 7c7 ,no rec\rse ,foll[+ receipt ( ! notice provid$ "u subsection 7b71 or1 if a claim has be5 deem$ accept$ "u section #bbj7;b71 ! provid] %all h no fur!r rec\rse aga9/ ! pati5t :o receiv$ ! s]vices4 4 #acf4 ,(fices ( ,indian ,m5's ,heal? & ,indian ,wom5's ,heal? ,section #bbc ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afbav7 is am5d$-- 7#a7 by /rik+ ! section designation & head+ & all t foll[s ?r\gh ov]see ef=ts ( ! ,s]vice to & ins]t+ ! foll[+3 #bbc4 ,(fices ( ,indian ,m5's ,heal? & ,indian ,wom5's ,heal? 7a7 ,(fice ( ,indian ,m5's ,heal? 7#a7 ,e/abli%m5t ,! ,secret>y may e/abli% )9 ! ,s]vice an (fice1 to be kn[n z ! ,(fice ( ,indian ,m5's ,heal?4 7#b7 ,director 7,a7 ,9 g5]al ,! ,(fice ( ,indian ,m5's ,heal? %all be head$ by a director1 to be appo9t$ by ! ,secret>y4 7,b7 ,duties ,! director %all coord9ate & promote ! heal? /atus ( ,indian m5 9 ! ,unit$ ,/ates4 7#c7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( the,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all submit to ,congress a report describ+-- 7,a7 any activity c>ri$ out by ! director z ( ! date on :i* ! report is prep>$2 & 7,b7 any f9d+ ( ! director ) respect to ! heal? ( ,indian m54 7b7 ,(fice ( ,indian ,wom5's ,heal? ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% an (fice1 to be kn[n z ! ,(fice ( ,indian ,wom5's ,heal?1 to 2 & 7#b7 9 subsection 7b7 7z s r$esignat$7 by ins]t+ 7includ+ urban ,indian wom57 be=e ( all ages4 #acg4 ,contract heal? s]vice adm9i/ration & disbursem5t =mula ,title ,,ii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afba et seq47 is am5d$ by add+ at ! end ! foll[+3 #bbf4 ,contract heal? s]vice adm9i/ration & disbursem5t =mula 7a7 ,submission ( report ,z soon z practicable aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,secret>y1 ! ,committee on ,indian ,affairs ( ! ,s5ate1 & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives1 & make available to ea* ,indian tribe1 a report describ+ ! results ( ! /udy ( ! ,comptroll] ,g5]al reg>d+ ! fund+ ( ! contract heal? s]vice program 7includ+ hi/oric fund+ levels & a recomm5dation ( ! fund+ level ne$$ = ! program7 & ! adm9i/ration ( ! contract heal? s]vice program 7includ+ ! di/ribution ( funds pursuant to ! program71 z reque/$ by ,congress 9 ,m>* #bjji1 or pursuant to section #hcj4 7b7 ,consultation ) tribes ,on receipt ( ! report "u subsection 7a71 ! ,secret>y %all consult ) ,indian tribes reg>d+ ! contract heal? s]vice program1 includ+ ! di/ribution ( funds pursuant to ! program-- 7#a7 to det]m9e :e!r ! curr5t di/ribution =mula w\ld require modification if ! contract heal? s]vice program 7 fund$ at ! level recomm5d$ by ! ,comptroll] ,g5]al2 7#b7 to id5tify any inequities 9 ! curr5t di/ribution =mula "u ! curr5t fund+ level or inequitable results = any ,indian tribe "u ! fund+ level recomm5d$ by ! ,comptroll] ,g5]al2 7#c7 to id5tify any areas ( program adm9i/ration t may result 9 ! ineffici5t or ineffective managem5t ( ! program2 & 7#d7 to id5tify any o!r issues & recomm5dations to improve ! adm9i/ration ( ! contract heal? s]vices program & correct any unfair results or fund+ disp>ities id5tifi$ "u p>agraph 7#b74 7c7 ,subsequ5t action by ,secret>y ,if1 aft] consultation ) ,indian tribes "u subsection 7b71 ! ,secret>y det]m9es t any issue describ$ 9 subsection 7b77#b7 exi/s1 ! ,secret>y may initiate proc$ures "u sub*apt] ,,iii ( *apt] #e ( title #e1 ,unit$ ,/ates ,code1 to negotiate or promulgate regulations to e/abli% a disbursem5t =mula = ! contract heal? s]vice program fund+4 4 ,c ,heal? facilities #ada4 ,heal? c>e facility priority sy/em ,section #cja ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afca7 is am5d$-- 7#a7 by r$esignat+ subsection 7d7 z subsection 7h72 & 7#b7 by /rik+ subsection 7c7 & ins]t+ ! foll[+3 7c7 ,heal? c>e facility priority sy/em 7#a7 ,9 g5]al 7,a7 ,priority sy/em ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all ma9ta9 a heal? c>e facility priority sy/em1 :i*-- 7i7 %all be develop$ 9 consultation ) ,indian tribes & tribal organizations2 7ii7 %all give ,indian tribes' ne$s ! highe/ priority2 7iii7 7,i7 may include ! li/s requir$ 9 p>agraph 7#b77;,b77ii72 & 7,,ii7 %all include ! me?odology requir$ 9 p>agraph 7#b77;,b77v72 & 7,,iii7 may include su* heal? c>e facilities1 & su* r5ovation or expansion ne$s ( any heal? c>e facility1 z ! ,s]vice may id5tify2 & 7iv7 %all provide an opportunity = ! nom9ation ( plann+1 design1 & con/ruction projects by ! ,s]vice1 ,indian tribes1 & tribal organizations = consid]ation "u ! priority sy/em at lea/ once e #c ye>s1 or m frequ5tly z ! ,secret>y det]m9es to be appropriate4 7,b7 ,ne$s ( facilities "u ,,isdeaa agreem5ts ,! ,secret>y %all ensure t ! plann+1 design1 con/ruction1 r5ovation1 & expansion ne$s ( ,s]vice & non-,s]vice facilities op]at$ "u contracts or compacts 9 accordance ) ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 are fully & equitably integrat$ into ! heal? c>e facility priority sy/em4 7,c7 ,crit]ia = evaluat+ ne$s ,= purposes ( ?is subsection1 ! ,secret>y1 9 evaluat+ ! ne$s ( facilities op]at$ "u a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 %all use ! crit]ia us$ by ! ,secret>y 9 evaluat+ ! ne$s ( facilities op]at$ directly by ! ,s]vice4 7,d7 ,priority ( c]ta9 projects protect$ ,! priority ( any project e/abli%$ "u ! con/ruction priority sy/em 9 effect on ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag %all n be affect$ by any *ange 9 ! con/ruction priority sy/em tak+ place aft] t date if ! project-- 7i7 0 id5tifi$ 9 ! fiscal ye> #bjjh ,s]vice budget ju/ification z-- 7,i7 #a ( ! #aj top-priority inpati5t projects2 7,,ii7 #a ( ! #aj top-priority outpati5t projects2 7,,iii7 #a ( ! #aj top-priority /aff qu>t]s developm5ts2 or 7,,iv7 #a ( ! #aj top-priority ,y\? ,regional ,treatm5t ,c5t]s2 7ii7 _h complet$ bo? ,phase ,i & ,phase ,,ii ( ! con/ruction priority sy/em 9 effect on ! date ( enactm5t ( su* ,act2 or 7iii7 is n includ$ 9 clause 7i7 or 7ii7 & is select$1 z det]m9$ by ! ,secret>y-- 7,i7 on ! initiative ( ! ,secret>y2 or 7,,ii7 pursuant to a reque/ ( an ,indian tribe or tribal organization4 7#b7 ,report2 cont5ts 7,a7 ,initial compreh5sive report 7i7 ,def9itions ,9 ?is subp>agraph3 7,i7 ,facilities ,appropriation ,advisory ,bo>d ,! t]m ,facilities ,appropriation ,advisory ,bo>d means ! advisory bo>d1 compris$ ( #ab memb]s repres5t+ ,indian tribes & #b memb]s repres5t+ ! ,s]vice1 e/abli%$ at ! discretion ( ! ,director-- 7aa7 to provide advice & recomm5dations = policies & proc$ures ( ! programs fund$ pursuant to facilities appropriations2 & 7bb7 to address o!r facilities issues4 7,,ii7 ,facilities ,ne$s ,assessm5t ,workgr\p ,! t]m ,facilities ,ne$s ,assessm5t ,workgr\p means ! workgr\p e/abli%$ at ! discretion ( ! ,director-- 7aa7 to review ! heal? c>e facilities con/ruction priority sy/em2 & 7bb7 to make recomm5dations to ! ,facilities ,appropriation ,advisory ,bo>d = revis+ ! priority sy/em4 7ii7 ,initial report 7,i7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report t describes ! compreh5sive1 national1 rank$ li/ ( all heal? c>e facilities ne$s = ! ,s]vice1 ,indian tribes1 & tribal organizations 7includ+ inpati5t heal? c>e facilities1 outpati5t heal? c>e facilities1 specializ$ heal? c>e facilities 7su* z = long-t]m c>e & alcohol & drug abuse treatm5t71 wellness c5t]s1 & /aff qu>t]s1 & ! r5ovation & expansion ne$s1 if any1 ( su* facilities7 develop$ by ! ,s]vice1 ,indian tribes1 & tribal organizations = ! ,facilities ,ne$s ,assessm5t ,workgr\p & ! ,facilities ,appropriation ,advisory ,bo>d4 7,,ii7 ,inclusions ,! initial report %all include-- 7aa7 ! me?odology & crit]ia us$ by ! ,s]vice 9 det]m9+ ! ne$s & e/abli%+ ! rank+ ( ! facilities ne$s2 & 7bb7 su* o!r in=mation z ! ,secret>y det]m9es to be appropriate4 7iii7 ,updates ( report ,beg9n+ 9 cal5d> ye> #bjag1 ! ,secret>y %all-- 7,i7 update ! report "u clause 7ii7 n less frequ5tly t once e #e ye>s2 & 7,,ii7 include ! updat$ report 9 ! appropriate annual report "u subp>agraph 7,b7 = submission to ,congress "u section #hja4 7,b7 ,annual reports ,! ,secret>y %all submit to ! ,presid5t1 = inclusion 9 ! report requir$ to be transmitt$ to ,congress "u section #hja1 a report :i* sets =? ! foll[+3 7i7 ,a description ( ! heal? c>e facility priority sy/em ( ! ,s]vice e/abli%$ "u p>agraph 7#a74 7ii7 ,heal? c>e facilities li/s1 :i* may include-- 7,i7 ! #aj top-priority inpati5t heal? c>e facilities2 7,,ii7 ! #aj top-priority outpati5t heal? c>e facilities2 7,,iii7 ! #aj top-priority specializ$ heal? c>e facilities 7su* z long-t]m c>e & alcohol & drug abuse treatm5t72 & 7,,iv7 ! #aj top-priority /aff qu>t]s developm5ts associat$ ) heal? c>e facilities4 7iii7 ,! ju/ification = su* ord] ( priority4 7iv7 ,! project$ co/ ( su* projects4 7v7 ,! me?odology adopt$ by ! ,s]vice 9 e/abli%+ priorities "u its heal? c>e facility priority sy/em4 7#c7 ,requirem5ts = prep>ation ( reports ,9 prep>+ ! report requir$ "u p>agraph 7#b71 ! ,secret>y %all-- 7,a7 consult ) & obta9 in=mation on all heal? c>e facilities ne$s f ,indian tribes & tribal organizations2 & 7,b7 review ! total unmet ne$s ( all ,indian tribes & tribal organizations = heal? c>e facilities 7includ+ /aff qu>t]s71 includ+ ne$s = r5ovation & expansion ( exi/+ facilities4 7d7 ,review ( me?odology us$ = heal? facilities con/ruction priority sy/em 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! e/abli%m5t ( ! priority sy/em "u subsection 7c77#a77;,a71 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all prep>e & f9alize a report review+ ! me?odologies appli$1 & ! processes foll[$1 by ! ,s]vice 9 mak+ ea* assessm5t ( ne$s = ! li/ "u subsection 7c77#b77;,a77ii7 & develop+ ! priority sy/em "u subsection 7c77#a71 includ+ a review (-- 7,a7 ! recomm5dations ( ! ,facilities ,appropriation ,advisory ,bo>d & ! ,facilities ,ne$s ,assessm5t ,workgr\p 7z ^? t]ms are def9$ 9 subsection 7c77#b77;,a77i772 & 7,b7 ! relevant crit]ia us$ 9 rank+ or prioritiz+ facilities o!r ?an hospitals or cl9ics4 7#b7 ,submission to ,congress ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit ! report "u p>agraph 7#a7 to-- 7,a7 ! ,committees on ,indian ,affairs & ,appropriations ( ! ,s5ate2 7,b7 ! ,committees on ,natural ,res\rces & ,appropriations ( ! ,h\se ( ,repres5tatives2 & 7,c7 ! ,secret>y4 7e7 ,fund+ condition ,all funds appropriat$ "u ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 = ! plann+1 design1 con/ruction1 or r5ovation ( heal? facilities = ! b5efit ( #a or m ,indian ,tribes %all be subject to ! provisions ( section #ajb ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;f7 or sections #ejd & #eje ( t ,act 7#be ,u4,s4,c4 #deh;aaa-#c1 #deh;aaa-#d74 7f7 ,developm5t ( innovative approa*es ,! ,secret>y %all consult & coop]ate ) ,indian tribes & tribal organizations1 & conf] ) urban ,indian organizations1 9 develop+ innovative approa*es to address all or "p ( ! total unmet ne$ = con/ruction ( heal? facilities1 t may include-- 7#a7 ! e/abli%m5t ( an area di/ribution fund 9 :i* a portion ( heal? facility con/ruction fund+ c\ld be devot$ to all ,s]vice areas2 7#b7 approa*es provid$ = 9 o!r provisions ( ?is title2 & 7#c7 o!r approa*es1 z ! ,secret>y det]m9es to be appropriate4 4 #adb4 ,priority ( c]ta9 projects protect$ ,section #cja ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afca7 7z am5d$ by section #ada7 is am5d$ by add+ at ! end ! foll[+3 7g7 ,priority ( c]ta9 projects protect$ ,! priority ( any project e/abli%$ "u ! con/ruction priority sy/em 9 effect on ! date ( enactm5t ( ?is ,indian ,heal?c>e ,improvem5t ,act ( #bjag %all n be affect$ by any *ange 9 ! con/ruction priority sy/em tak+ place aft] t date if ! project-- 7#a7 0 id5tifi$ 9 ! fiscal ye> #bjjh ,s]vice budget ju/ification z-- 7,a7 #a ( ! #aj top-priority inpati5t projects2 7,b7 #a ( ! #aj top-priority outpati5t projects2 7,c7 #a ( ! #aj top-priority /aff qu>t]s developm5ts2 or 7,d7 #a ( ! #aj top-priority ,y\? ,regional ,treatm5t ,c5t]s2 7#b7 _h complet$ bo? ,phase ,i & ,phase ,,ii ( ! con/ruction priority sy/em 9 effect on ! date ( enactm5t ( su* ,act2 or 7#c7 is n includ$ 9 clause 7i7 or 7ii7 & is select$1 z det]m9$ by ! ,secret>y-- 7,a7 on ! initiative ( ! ,secret>y2 or 7,b7 pursuant to a reque/ ( an ,indian tribe or tribal organization4 4 #adc4 ,indian heal? c>e deliv]y demon/ration projects ,section #cjg ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afcg7 is am5d$ to read z foll[s3 #cjg4 ,indian heal? c>e deliv]y demon/ration projects 7a7 ,purpose & g5]al au?ority 7#a7 ,purpose ,! purpose ( ?is section is to enc\rage ! e/abli%m5t ( demon/ration projects t meet ! applicable crit]ia ( ?is section to be c>ri$ out by ! ,secret>y1 act+ ?r\gh ! ,s]vice1 or ,indian tribes or tribal organizations act+ pursuant to contracts or compacts "u ! ,indian ,self ,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47-- 7,a7 to te/ alt]native means ( deliv]+ heal? c>e & s]vices to ,indians ?r\gh facilities2 or 7,b7 to use alt]native or innovative me?ods or models ( deliv]+ heal? c>e s]vices to ,indians 7includ+ prim>y c>e s]vices1 contract heal? s]vices1 or any o!r program or s]vice au?oriz$ by ?is ,act7 ?r\gh conv5i5t c>e s]vices 7z def9$ 9 subsection 7c771 community heal? c5t]s1 or coop]ative agreem5ts or arrangem5ts ) o!r heal? c>e provid]s t %>e or coord9ate ! use ( facilities1 fund+1 or o!r res\rces1 or o!rwise coord9ate or improve ! coord9ation ( activities ( ! ,s]vice1 ,indian tribes1 or tribal organizations1 ) ^? ( ! o!r heal? c>e provid]s4 7#b7 ,au?ority ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 is au?oriz$ to c>ry out1 or to ent] into contracts or compacts "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 ) ,indian tribes or tribal organizations to c>ry out1 heal? c>e deliv]y demon/ration projects t-- 7,a7 te/ alt]native means ( deliv]+ heal? c>e & s]vices to ,indians ?r\gh facilities2 or 7,b7 o!rwise c>ry out ! purposes ( ?is section4 7b7 ,use ( funds ,! ,secret>y1 9 approv+ projects pursuant to ?is section-- 7#a7 may au?orize su* contracts = ! con/ruction & r5ovation ( hospitals1 heal? c5t]s1 heal? /ations1 & o!r facilities to deliv] heal? c>e s]vices2 & 7#b7 is au?oriz$-- 7,a7 to waive any leas+ prohibition2 7,b7 to p]mit use & c>ryov] ( funds appropriat$ = ! provision ( heal? c>e s]vices "u ?is ,act 7includ+ = ! pur*ase ( heal? b5efits cov]age1 z au?oriz$ by section #djb7;a772 7,c7 to p]mit ! use ( o!r available funds1 includ+ o!r ,f$]al funds1 funds f ?ird-p>ty collections 9 accordance ) sections #bjf1 #bjg1 & #dja1 & non-,f$]al funds contribut$ by ,/ate or local gov]nm5tal ag5cies or facilities or private heal? c>e provid]s pursuant to coop]ative or o!r agreem5ts ) ! ,s]vice1 #a or m ,indian tribes1 or tribal organizations2 7,d7 to p]mit ! use ( funds or prop]ty donat$ or o!rwise provid$ f any s\rce = project purposes2 7,e7 to provide = ! rev]sion ( donat$ real or p]sonal prop]ty to ! donor2 & 7,f7 to p]mit ! use ( ,s]vice funds to mat* o!r funds1 includ+ ,f$]al funds4 7c7 ,heal? c>e demon/ration projects 7#a7 ,def9ition ( conv5i5t c>e s]vice ,9 ?is subsection1 ! t]m conv5i5t c>e s]vice means any prim>y heal? c>e s]vice1 su* z urg5t c>e s]vices1 nonem]g5t c>e s]vices1 prev5tion s]vices & scre5+s1 & any s]vice au?oriz$ by section #bjc or #bje7;d71 t is (f]$-- 7,a7 at an alt]native sett+2 or 7,b7 dur+ h\rs o!r ?an regul> work+ h\rs4 7#b7 ,g5]al projects 7,a7 ,crit]ia ,! ,secret>y may approve "u ?is section demon/ration projects t meet ! foll[+ crit]ia3 7i7 ,!re is a ne$ = a new facility or program1 su* z a program = conv5i5t c>e s]vices1 or an improvem5t 91 increas$ effici5cy at1 or reori5tation ( an exi/+ facility or program4 7ii7 ,a significant numb] ( ,indians1 includ+ ,indians ) l[ heal? /atus1 w be s]v$ by ! project4 7iii7 ,! project has ! pot5tial to deliv] s]vices 9 an effici5t & effective mann]4 7iv7 ,! project is economically viable4 7v7 ,= projects c>ri$ out by an ,indian tribe or tribal organization1 ! ,indian tribe or tribal organization has ! adm9i/rative & f9ancial capability to adm9i/] ! project4 7vi7 ,! project is integrat$ ) provid]s ( relat$ heal? or social s]vices 7includ+ ,/ate & local heal? c>e ag5cies or o!r heal? c>e provid]s7 & is coord9at$ )1 & avoids duplication (1 exi/+ s]vices 9 ord] to exp& ! availability ( s]vices4 7,b7 ,priority ,9 approv+ demon/ration projects "u ?is p>agraph1 ! ,secret>y %all give priority to demon/ration projects1 to ! ext5t ! projects meet ! crit]ia describ$ 9 subp>agraph 7,a71 locat$ 9 any ( ! foll[+ ,s]vice units3 7i7 ,cass ,lake1 ,m9nesota4 7ii7 ,mescal]o1 ,new ,mexico4 7iii7 ,owyhee & ,elko1 ,nevada4 7iv7 ,s*urz1 ,nevada4 7v7 ,ft4 ,yuma1 ,cali=nia4 7#c7 ,innovative heal? s]vices deliv]y demon/ration project 7,a7 ,application or reque/ ,on receipt ( an application or reque/ f an ,indian tribe1 a consortium ( ,indian tribes1 or a tribal organization )9 a ,s]vice area1 ! ,secret>y %all take into consid]ation alt]native or innovat$ me?ods to deliv] heal? c>e s]vices )9 ! ,s]vice area 7or a portion (1 or facility )91 ! ,s]vice area7 z describ$ 9 ! application or reque/1 includ+ m$ical1 d5tal1 ph>maceutical1 nurs+1 cl9ical laboratory1 contract heal? s]vices1 conv5i5t c>e s]vices1 community heal? c5t]s1 or any o!r heal? c>e s]vices deliv]y models design$ to improve access to1 or effici5cy or quality (1 ! heal? c>e1 heal? promotion1 or disease prev5tion s]vices & programs "u ?is ,act4 7,b7 ,approval ,9 addition to projects describ$ 9 p>agraph 7#b71 9 any fiscal ye>1 ! ,secret>y is au?oriz$ "u ?is p>agraph to approve n m ?an #aj applications = heal? c>e deliv]y demon/ration projects t meet ! crit]ia describ$ 9 subp>agraph 7,c74 7,c7 ,crit]ia ,! ,secret>y %all approve "u subp>agraph 7,b7 demon/ration projects t meet all ( ! foll[+ crit]ia3 7i7 ,! crit]ia set =? 9 p>agraph 7#b77;,a74 7ii7 ,!re is a lack ( access to heal? c>e s]vices at exi/+ heal? c>e facilities1 :i* may be due to limit$ h\rs ( op]ation at ^? facilities or o!r factors4 7iii7 ,! project-- 7,i7 exp&s ! availability ( s]vices2 or 7,,ii7 r$uces-- 7aa7 ! burd5 on ,contract ,heal? ,s]vices2 or 7bb7 ! ne$ = em]g5cy room visits4 7d7 ,te*nical assi/ance ,on receipt ( an application or reque/ f an ,indian tribe1 a consortium ( ,indian tribes1 or a tribal organization1 ! ,secret>y %all provide su* te*nical & o!r assi/ance z may be necess>y to enable applicants to comply ) ?is section1 includ+ in=mation reg>d+ ! ,s]vice unit budget & available fund+ = c>ry+ out ! propos$ demon/ration project4 7e7 ,s]vice to ineligible p]sons ,subject to section #hac1 ! au?ority to provide s]vices to p]sons o!rwise ineligible = ! heal? c>e b5efits ( ! ,s]vice1 & ! au?ority to ext5d hospital privileges 9 ,s]vice facilities to non-,s]vice heal? practition]s z provid$ 9 section #hac1 may be includ$1 subject to ! t]ms ( t section1 9 any demon/ration project approv$ pursuant to ?is section4 7f7 ,equitable treatm5t ,= purposes ( subsection 7c71 ! ,secret>y1 9 evaluat+ facilities op]at$ "u any contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 %all use ! same crit]ia t ! ,secret>y uses 9 evaluat+ facilities op]at$ directly by ! ,s]vice4 7g7 ,equitable integration ( facilities ,! ,secret>y %all ensure t ! plann+1 design1 con/ruction1 r5ovation1 & expansion ne$s ( ,s]vice & non-,s]vice facilities t are ! subject ( a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 = heal? s]vices are fully & equitably integrat$ into ! implem5tation ( ! heal? c>e deliv]y demon/ration projects "u ?is section4 4 #add4 ,tribal managem5t ( f$]ally own$ qu>t]s ,title ,,iii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7z am5d$ by section #aja7;b77 is am5d$ by ins]t+ aft] section #cjh 7#be ,u4,s4,c4 #afch7 ! foll[+3 #cji4 ,tribal managem5t ( f$]ally own$ qu>t]s 7a7 ,r5tal rates 7#a7 ,e/abli%m5t ,not)/&+ any o!r provision ( law1 a tribal heal? program t op]ates a hospital or o!r heal? facility & ! f$]ally own$ qu>t]s associat$ ) su* a facility pursuant to a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 may e/abli% ! r5tal rates *>g$ to ! occupants ( ^? qu>t]s1 on provid+ notice to ! ,secret>y4 7#b7 ,objectives ,9 e/abli%+ r5tal rates "u ?is subsection1 a tribal heal? program %all attempt-- 7,a7 to base ! r5tal rates on ! reasonable value ( ! qu>t]s to ! occupants ( ! qu>t]s2 & 7,b7 to g5]ate suffici5t funds to prud5tly provide = ! op]ation & ma9t5ance ( ! qu>t]s1 & at ! discretion ( ! tribal heal? program1 to supply res]ve funds = capital repairs & replacem5t ( ! qu>t]s4 7#c7 ,equitable fund+ ,a f$]ally own$ qu>t]s ! r5tal rates = :i* are e/abli%$ by a tribal heal? program "u ?is subsection %all rema9 eligible to receive improvem5t & repair funds to ! same ext5t t all f$]ally own$ qu>t]s us$ to h\se p]sonnel 9 programs ( ! ,s]vice are eligible to receive ^? funds4 7#d7 ,notice ( rate *ange ,a tribal heal? program t e/abli%es a r5tal rate "u ?is subsection %all provide occupants ( ! f$]ally own$ qu>t]s a notice ( any *ange 9 ! r5tal rate by n lat] ?an ! date t is #fj days notice be=e ! effective date ( ! *ange4 7#e7 ,rates 9 ,alaska ,a r5tal rate e/abli%$ by a tribal heal? program "u ?is section = a f$]ally own$ qu>t]s 9 ! ,/ate ( ,alaska may be bas$ on ! co/ ( comp>able private r5tal h\s+ 9 ! ne>e/ e/abli%$ community ) a ye>-r\nd population ( #a1ejj or m individuals4 7b7 ,direct collection ( r5t 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 & subject to p>agraph 7#b71 a tribal heal? program may collect r5t directly f ,f$]al employees :o occupy f$]ally own$ qu>t]s if ! tribal heal? program submits to ! ,secret>y & ! employees a notice ( ! election ( ! tribal heal? program to collect r5ts directly f ! employees4 7#b7 ,action by employees ,on receipt ( a notice describ$ 9 p>agraph 7#a7-- 7,a7 ! affect$ ,f$]al employees %all pay r5t = occupancy ( a f$]ally own$ qu>t]s directly to ! applicable tribal heal? program2 & 7,b7 ! ,secret>y %all n h ! au?ority to collect r5t f ! employees ?r\gh payroll d$uction or o!rwise4 7#c7 ,use ( paym5ts ,! r5t paym5ts "u ?is subsection-- 7,a7 %all be reta9$ by ! applicable tribal heal? program 9 a sep>ate acc\nt1 :i* %all be us$ by ! tribal heal? program = ! ma9t5ance 7includ+ capital repairs & replacem5t7 & op]ation ( ! qu>t]s1 z ! tribal heal? program det]m9es to be appropriate2 & 7,b7 %all n be made payable to1 or o!rwise be deposit$ )1 ! ,unit$ ,/ates4 7#d7 ,retrocession ( au?ority ,if a tribal heal? program t elect$ to collect r5t directly "u p>agraph 7#a7 reque/s retrocession ( ! au?ority ( ! tribal heal? program to collect t r5t1 ! retrocession %all take effect on ! e>li] (-- 7,a7 ! fir/ day ( ! mon? t beg9s n less ?an #ahj days aft] ! tribal heal? program submits ! reque/2 & 7,b7 su* o!r date z may be mutually agre$ on by ! ,secret>y & ! tribal heal? program4 4 #ade4 ,o!r fund+1 equipm5t1 & supplies = facilities ,title ,,iii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afca et seq47 is am5d$ by add+ at ! end ! foll[+3 #caa4 ,o!r fund+1 equipm5t1 & supplies = facilities 7a7 ,au?orization 7#a7 ,au?ority to transf] funds ,! head ( any ,f$]al ag5cy to :i* funds1 equipm5t1 or o!r supplies are made available = ! plann+1 design1 con/ruction1 or op]ation ( a heal? c>e or sanitation facility may transf] ! funds1 equipm5t1 or supplies to ! ,secret>y = ! plann+1 design1 con/ruction1 or op]ation ( a heal? c>e or sanitation facility to a*ieve-- 7,a7 ! purposes ( ?is ,act2 & 7,b7 ! purposes = :i* ! funds1 equipm5t1 or supplies 7 made available to ! ,f$]al ag5cy4 7#b7 ,au?ority to accept funds ,! ,secret>y may-- 7,a7 accept f any s\rce1 includ+ ,f$]al & ,/ate ag5cies1 funds1 equipm5t1 or supplies t are available = ! con/ruction or op]ation ( heal? c>e or sanitation facilities2 & 7,b7 use ^? funds1 equipm5t1 & supplies to plan1 design1 con/ruct1 & op]ate heal? c>e or sanitation facilities = ,indians1 includ+ pursuant to a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7#c7 ,effect ( receipt ,receipt ( funds by ! ,secret>y "u ?is subsection %all n affect any priority e/abli%$ "u section #cja4 7b7 ,int]ag5cy agreem5ts ,! ,secret>y may ent] into int]ag5cy agreem5ts ) ,f$]al or ,/ate ag5cies & o!r entities1 & accept funds1 equipm5t1 or o!r supplies f ^? entities1 to provide = ! plann+1 design1 con/ruction1 & op]ation ( heal? c>e or sanitation facilities to be adm9i/]$ by ,indian heal? programs to a*ieve-- 7#a7 ! purposes ( ?is ,act2 & 7#b7 ! purposes = :i* ! funds 7 appropriat$ or o!rwise provid$4 7c7 ,e/abli%m5t ( /&>ds 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli%1 by regulation1 /&>ds = ! plann+1 design1 con/ruction1 & op]ation ( heal? c>e or sanitation facilities s]v+ ,indians "u ?is ,act4 7#b7 ,o!r regulations ,not)/&+ any o!r provision ( law1 any o!r applicable regulations ( ! ,dep>tm5t %all apply 9 c>ry+ out projects us+ funds transf]r$ "u ?is section4 7d7 ,def9ition ( sanitation facility ,9 ?is section1 ! t]m sanitation facility means a safe & adequate wat] supply sy/em1 sanit>y sewage disposal sy/em1 or sanit>y solid wa/e sy/em 7includ+ all relat$ equipm5t & support infra/ructure74 4 #adf4 ,indian c\ntry modul> compon5t facilities demon/ration program ,title ,,iii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afca et seq47 7z am5d$ by section #ade7 is am5d$ by add+ at ! end ! foll[+3 #cab4 ,indian c\ntry modul> compon5t facilities demon/ration program 7a7 ,def9ition ( modul> compon5t heal? c>e facility ,9 ?is section1 ! t]m modul> compon5t heal? c>e facility means a heal? c>e facility t is con/ruct$-- 7#a7 (f-site us+ prefabricat$ compon5t units = subsequ5t transport to ! de/9ation location2 & 7#b7 repres5ts a m economical me?od = provision ( heal? c>e facility ?an a traditionally con/ruct$ heal? c>e build+4 7b7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% a demon/ration program "u :i* ! ,secret>y %all aw>d no less ?an #c grants = pur*ase1 in/allation & ma9t5ance ( modul> compon5t heal? c>e facilities 9 ,indian communities = provision ( heal? c>e s]vices4 7c7 ,selection ( locations 7#a7 ,petitions 7,a7 ,solicitation ,! ,secret>y %all solicit f ,indian tribes petitions = location ( ! modul> compon5t heal? c>e facilities 9 ! ,s]vice areas ( ! petition+ ,indian tribes4 7,b7 ,petition ,to be eligible to receive a grant "u ?is section1 an ,indian tribe or tribal organization mu/ submit to ! ,secret>y a petition to con/ruct a modul> compon5t heal? c>e facility 9 ! ,indian community ( ! ,indian tribe1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#b7 ,selection ,9 select+ ! location ( ea* modul> compon5t heal? c>e facility to be provid$ "u ! demon/ration program1 ! ,secret>y %all give priority to projects already on ! ,indian ,heal? ,s]vice facilities con/ruction priority li/ & petitions :i* demon/rate t erection ( a modul> compon5t heal? facility-- 7,a7 is m economical ?an con/ruction ( a traditionally con/ruct$ heal? c>e facility2 7,b7 c be con/ruct$ & erect$ on ! select$ location 9 less "t ?an traditional con/ruction2 & 7,c7 c adequately h\se ! heal? c>e s]vices ne$$ by ! ,indian population to be s]v$4 7#c7 ,effect ( selection ,a modul> compon5t heal? c>e facility project select$ = p>ticipation 9 ! demon/ration program %all n be eligible = entry on ! facilities con/ruction priorities li/ entitl$ ,,ihs ,heal? ,c>e ,facilities ,,fy #bjaa ,plann$ ,con/ruction ,budget & dat$ ,may #g1 #bjji 7or any successor li/74 7d7 ,eligibility 7#a7 ,9 g5]al ,an ,indian tribe may submit a petition "u subsection 7c77#a77;,b7 reg>dless ( :e!r ! ,indian tribe is a p>ty to any contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 7#b7 ,adm9i/ration ,at ! election ( an ,indian tribe or tribal organization select$ = p>ticipation 9 ! demon/ration program1 ! funds provid$ = ! project %all be subject to ! provisions ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 7e7 ,reports ,n lat] ?an #a ye> aft] ! date on :i* funds are made available = ! demon/ration program & annually !reaft]1 ! ,secret>y %all submit to ,congress a report describ+-- 7#a7 ea* activity c>ri$ out "u ! demon/ration program1 includ+ an evaluation ( ! success ( ! activity2 & 7#b7 ! pot5tial b5efits ( increas$ use ( modul> compon5t heal? c>e facilities 9 o!r ,indian communities4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ #ej1jjj1jjj to c>ry out ! demon/ration program "u ?is section = ! fir/ #e fiscal ye>s1 & su* sums z may be necess>y to c>ry out ! program 9 subsequ5t fiscal ye>s4 4 #adg4 ,mobile heal? /ations demon/ration program ,title ,,iii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afca et seq47 7z am5d$ by section #adf7 is am5d$ by add+ at ! end ! foll[+3 #cac4 ,mobile heal? /ations demon/ration program 7a7 ,def9itions ,9 ?is section3 7#a7 ,eligible tribal consortium ,! t]m eligible tribal consortium means a consortium compos$ ( #b or m ,s]vice units betwe5 :i* a mobile heal? /ation c be transport$ by road 9 up to #h h\rs4 ,a ,s]vice unit op]at$ by ! ,s]vice or by an ,indian tribe or tribal organization %all be equally eligible = p>ticipation 9 su* consortium4 7#b7 ,mobile heal? /ation ,! t]m mobile heal? /ation means a heal? c>e unit t-- 7,a7 is con/ruct$1 ma9ta9$1 & capable ( be+ transport$ )9 a semi-trail] truck or simil> vehicle2 7,b7 is equipp$ = ! provision ( #a or m specialty heal? c>e s]vices2 & 7,c7 c be equipp$ to be dock$ to a /ation>y heal? c>e facility :5 appropriate4 7#c7 ,specialty heal? c>e s]vice 7,a7 ,9 g5]al ,! t]m specialty heal? c>e s]vice means a heal? c>e s]vice :i* requires ! s]vices ( a heal? c>e pr(essional ) specializ$ k or exp]i5ce4 7,b7 ,inclusions ,! t]m specialty heal? c>e s]vice includes any s]vice relat+ to-- 7i7 dialysis2 7ii7 surg]y2 7iii7 mammography2 7iv7 d5ti/ry2 or 7v7 any o!r specialty heal? c>e s]vice4 7b7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% a demon/ration program "u :i* ! ,secret>y %all provide at lea/ #c mobile heal? /ation projects4 7c7 ,petition ,to be eligible to receive a mobile heal? /ation "u ! demon/ration program1 an eligible tribal consortium %all submit to ! ,secret>y1 a petition at su* "t1 9 su* mann]1 & conta9+-- 7#a7 a description ( ! ,indian population to be s]v$2 7#b7 a description ( ! specialty s]vice or s]vices = :i* ! mobile heal? /ation is reque/$ & ! ext5t to :i* su* s]vice or s]vices are curr5tly available to ! ,indian population to be s]v$2 & 7#c7 su* o!r in=mation z ! ,secret>y may require4 7d7 ,use ( funds ,! ,secret>y %all use am\nts made available to c>ry out ! demon/ration program "u ?is section-- 7#a7 7,a7 to e/abli%1 pur*ase1 lease1 or ma9ta9 mobile heal? /ations = ! eligible tribal consortia select$ = projects2 & 7,b7 to provide1 ?r\gh ! mobile heal? /ation1 su* specialty heal? c>e s]vices z ! affect$ eligible tribal consortium det]m9es to be necess>y = ! ,indian population s]v$2 7#b7 to employ an exi/+ mobile heal? /ation 7reg>dless ( :e!r ! mobile heal? /ation is own$ or r5t$ & op]at$ by ! ,s]vice7 to provide specialty heal? c>e s]vices to an eligible tribal consortium2 & 7#c7 to e/abli%1 pur*ase1 or ma9ta9 dock+ equipm5t = a mobile heal? /ation1 includ+ ! e/abli%m5t or ma9t5ance ( su* equipm5t at a modul> compon5t heal? c>e facility 7z def9$ 9 section #cab7;a771 if applicable4 7e7 ,reports ,n lat] ?an #a ye> aft] ! date on :i* ! demon/ration program is e/abli%$ "u subsection 7b7 & annually !reaft]1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all submit to ,congress a report describ+-- 7#a7 ea* activity c>ri$ out "u ! demon/ration program includ+ an evaluation ( ! success ( ! activity2 & 7#b7 ! pot5tial b5efits ( increas$ use ( mobile heal? /ations to provide specialty heal? c>e s]vices = ,indian communities4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ #e1jjj1jjj p] ye> to c>ry out ! demon/ration program "u ?is section = ! fir/ #e fiscal ye>s1 & su* sums z may be ne$$ to c>ry out ! program 9 subsequ5t fiscal ye>s4 4 ,d ,access to heal? s]vices #aea4 ,treatm5t ( paym5ts "u ,social ,security ,act heal? b5efits programs ,section #dja ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda7 is am5d$ to read z foll[s3 #dja4 ,treatm5t ( paym5ts "u ,social ,security ,act heal? b5efits programs 7a7 ,disreg>d ( ,m$ic>e1 ,m$icaid1 & ,,*ip paym5ts 9 det]m9+ appropriations ,any paym5ts receiv$ by an ,indian heal? program or by an urban ,indian organization "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act = s]vices provid$ to ,indians eligible = b5efits "u su* respective titles %all n be consid]$ 9 det]m9+ appropriations = ! provision ( heal? c>e & s]vices to ,indians4 7b7 ,nonpref]5tial treatm5t ,no?+ 9 ?is ,act au?orizes ! ,secret>y to provide s]vices to an ,indian ) cov]age "u title ,,xviii1 ,,xix1 or ,,xi ( ! ,social ,security ,act 9 pref]5ce to an ,indian )\t su* cov]age4 7c7 ,use ( funds 7#a7 ,special fund 7,a7 #ajj p]c5t pass-?r\gh ( paym5ts due to facilities ,not)/&+ any o!r provision ( law1 b subject to p>agraph 7#b71 paym5ts to :i* a facility ( ! ,s]vice is entitl$ by reason ( a provision ( title ,,xviii or ,,xix ( ! ,social ,security ,act %all be plac$ 9 a special fund to be held by ! ,secret>y4 ,9 mak+ paym5ts f su* fund1 ! ,secret>y %all ensure t ea* ,s]vice unit ( ! ,s]vice receives #ajj p]c5t ( ! am\nt to :i* ! facilities ( ! ,s]vice1 = :i* su* ,s]vice unit makes collections1 are entitl$ by reason ( a provision ( ei!r su* title4 7,b7 ,use ( funds ,am\nts receiv$ by a facility ( ! ,s]vice "u subp>agraph 7,a7 by reason ( a provision ( title ,,xviii or ,,xix ( ! ,social ,security ,act %all fir/ be us$ 7to su* ext5t or 9 su* am\nts z are provid$ 9 appropriation ,acts7 = ! purpose ( mak+ any improvem5ts 9 ! programs ( ! ,s]vice op]at$ by or ?r\gh su* facility :i* may be necess>y to a*ieve or ma9ta9 compliance ) ! applicable conditions & requirem5ts ( su* respective title4 ,any am\nts s receiv$ t are 9 excess ( ! am\nt necess>y to a*ieve or ma9ta9 su* conditions & requirem5ts %all1 subject to consultation ) ! ,indian tribes be+ s]v$ by ! ,s]vice unit1 be us$ = r$uc+ ! heal? res\rce defici5cies 7z det]m9$ 9 section #bja7;c77 ( su* ,indian tribes1 includ+ ! provision ( s]vices pursuant to section #bje4 7#b7 ,direct paym5t option ,p>agraph 7#a7 %all n apply to a tribal heal? program ^u ! election ( su* program "u subsection 7d7 to receive paym5ts directly4 ,no paym5t may be made out ( ! special fund describ$ 9 su* p>agraph ) respect to reimbursem5t made = s]vices provid$ by su* program dur+ ! p]iod ( su* election4 7d7 ,direct bill+ 7#a7 ,9 g5]al ,subject to comply+ ) ! requirem5ts ( p>agraph 7#b71 a tribal heal? program may elect to directly bill =1 & receive paym5t =1 heal? c>e items & s]vices provid$ by su* program = :i* paym5t is made "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act or f any o!r ?ird p>ty payor4 7#b7 ,direct reimbursem5t 7,a7 ,use ( funds ,ea* tribal heal? program mak+ ! election describ$ 9 p>agraph 7#a7 ) respect to a program "u a title ( ! ,social ,security ,act %all be reimburs$ directly by t program = items & s]vices furni%$ )\t reg>d to subsection 7c77#a71 except t all am\nts s reimburs$ %all be us$ by ! tribal heal? program = ! purpose ( mak+ any improvem5ts 9 facilities ( ! tribal heal? program t may be necess>y to a*ieve or ma9ta9 compliance ) ! conditions & requirem5ts applicable g5]ally to su* items & s]vices "u ! program "u su* title & to provide additional heal? c>e s]vices1 improvem5ts 9 heal? c>e facilities & tribal heal? programs1 any heal? c>e-relat$ purpose 7includ+ cov]age = a s]vice or s]vice )9 a contract heal? s]vice deliv]y area or any portion ( a contract heal? s]vice deliv]y area t w\ld o!rwise be provid$ z a contract heal? s]vice71 or o!rwise to a*ieve ! objectives provid$ 9 section #c ( ?is ,act4 7,b7 ,audits ,! am\nts paid to a tribal heal? program mak+ ! election describ$ 9 p>agraph 7#a7 ) respect to a program "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act %all be subject to all audit+ requirem5ts applicable to ! program "u su* title1 z well z all audit+ requirem5ts applicable to programs adm9i/]$ by an ,indian heal? program4 ,no?+ 9 ! prec$+ s5t5ce %all be con/ru$ z limit+ ! application ( audit+ requirem5ts applicable to am\nts paid "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act4 7,c7 ,id5tification ( s\rce ( paym5ts ,any tribal heal? program t receives reimbursem5ts or paym5ts "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act %all provide to ! ,s]vice a li/ ( ea* provid] enrollm5t numb] 7or o!r id5tifi]7 "u :i* su* program receives su* reimbursem5ts or paym5ts4 7#c7 ,exam9ation & implem5tation ( *anges 7,a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice & ) ! assi/ance ( ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all exam9e on an ongo+ basis & implem5t any adm9i/rative *anges t may be necess>y to facilitate direct bill+ & reimbursem5t "u ! program e/abli%$ "u ?is subsection1 includ+ any agreem5ts ) ,/ates t may be necess>y to provide = direct bill+ "u a program "u title ,,xix or ,,xxi ( ! ,social ,security ,act4 7,b7 ,coord9ation ( in=mation ,! ,s]vice %all provide ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ) copies ( ! li/s submitt$ to ! ,s]vice "u p>agraph 7#b77;,c71 enrollm5t data reg>d+ pati5ts s]v$ by ! ,s]vice 7& by tribal heal? programs1 to ! ext5t su* data is available to ! ,s]vice71 & su* o!r in=mation z ! ,adm9i/rator may require = purposes ( adm9i/]+ title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act4 7#d7 ,)drawal f program ,a tribal heal? program t bills directly "u ! program e/abli%$ "u ?is subsection may )draw f p>ticipation 9 ! same mann] & "u ! same conditions t an ,indian tribe or tribal organization may retroc$e a contract$ program to ! ,secret>y "u ! au?ority ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 ,all co/ acc\nt+ & bill+ au?ority "u ! program e/abli%$ "u ?is subsection %all be return$ to ! ,secret>y ^u ! ,secret>y's acceptance ( ! )drawal ( p>ticipation 9 ?is program4 7#e7 ,t]m9ation = failure to comply ) requirem5ts ,! ,secret>y may t]m9ate ! p>ticipation ( a tribal heal? program or 9 ! direct bill+ program e/abli%$ "u ?is subsection if ! ,secret>y det]m9es t ! program has fail$ to comply ) ! requirem5ts ( p>agraph 7#b74 ,! ,secret>y %all provide a tribal heal? program ) notice ( a det]m9ation t ! program has fail$ to comply ) any su* requirem5t & a reasonable opportunity to correct su* noncompliance prior to t]m9at+ ! program's p>ticipation 9 ! direct bill+ program e/abli%$ "u ?is subsection4 7e7 ,relat$ provisions "u ! ,social ,security ,act ,= provisions relat$ to subsections 7c7 & 7d71 see sections #ahhj1 #aiaa1 & #bajg7;e77#a77;,d7 ( ! ,social ,security ,act4 4 #aeb4 ,pur*as+ heal? c>e cov]age ,section #djb ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afdb7 is am5d$ to read z foll[s3 #djb4 ,pur*as+ heal? c>e cov]age 7a7 ,9 g5]al ,ins(> z am\nts are made available "u law 7includ+ a provision ( ! ,social ,security ,act1 ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 or o!r law1 o!r ?an "u section #djd7 to ,indian tribes1 tribal organizations1 & urban ,indian organizations = heal? b5efits = ,s]vice b5efici>ies1 ,indian tribes1 tribal organizations1 & urban ,indian organizations may use su* am\nts to pur*ase heal? b5efits cov]age 7includ+ cov]age = a s]vice1 or s]vice )9 a contract heal? s]vice deliv]y area1 or any portion ( a contract heal? s]vice deliv]y area t w\ld o!rwise be provid$ z a contract heal? s]vice7 = su* b5efici>ies 9 any mann]1 includ+ ?r\gh-- 7#a7 a tribally own$ & op]at$ heal? c>e plan2 7#b7 a ,/ate or locally au?oriz$ or lic5s$ heal? c>e plan2 7#c7 a heal? insurance provid] or manag$ c>e organization2 7#d7 a self-insur$ plan2 or 7#e7 a high d$uctible or heal? sav+s acc\nt plan4 7b7 ,f9ancial ne$ ,! pur*ase ( cov]age "u subsection 7a7 by an ,indian tribe1 tribal organization1 or urban ,indian organization may be bas$ on ! f9ancial ne$s ( su* b5efici>ies 7z det]m9$ by ! #a or m ,indian tribes be+ s]v$ bas$ on a s*$ule ( income levels develop$ or implem5t$ by su* #a or m ,indian tribes74 7c7 ,exp5ses = self-,insur$ plan ,9 ! case ( a self-insur$ plan "u subsection 7a77#d71 ! am\nts may be us$ = exp5ses ( op]at+ ! plan1 includ+ adm9i/ration & insurance to limit ! f9ancial risks to ! entity (f]+ ! plan4 7d7 ,con/ruction ,no?+ 9 ?is section %all be con/ru$ z affect+ ! use ( any am\nts n ref]r$ to 9 subsection 7a74 4 #aec4 ,grants to & contracts ) ! ,s]vice1 ,indian tribes1 tribal organizations1 & urban ,indian organizations to facilitate outrea*1 enrollm5t1 & cov]age ( ,indians "u ,social ,security ,act heal? b5efit programs & o!r heal? b5efits programs ,section #djd ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afdd7 is am5d$ to read z foll[s3 #djd4 ,grants to & contracts ) ! ,s]vice1 ,indian tribes1 tribal organizations1 & urban ,indian organizations to facilitate outrea*1 enrollm5t1 & cov]age ( ,indians "u ,social ,security ,act heal? b5efit programs & o!r heal? b5efits programs 7a7 ,indian tribes & tribal organizations ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all make grants to or ent] into contracts ) ,indian tribes & tribal organizations to assi/ su* tribes & tribal organizations 9 e/abli%+ & adm9i/]+ programs on or ne> res]vations & tru/ l&s1 includ+ programs to provide outrea* & enrollm5t ?r\gh video1 electronic deliv]y me?ods1 or telecommunication devices t all[ real-"t or "t-delay$ communication betwe5 individual ,indians & ! b5efit program1 to assi/ individual ,indians-- 7#a7 to enroll = b5efits "u a program e/abli%$ "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act & o!r heal? b5efits programs2 & 7#b7 ) respect to su* programs = :i* ! *>g+ ( premiums & co/ %>+ is n prohibit$ "u su* programs1 to pay premiums or co/ %>+ = cov]age = su* b5efits1 :i* may be bas$ on f9ancial ne$ 7z det]m9$ by ! ,indian tribe or tribes or tribal organizations be+ s]v$ bas$ on a s*$ule ( income levels develop$ or implem5t$ by su* tribe1 tribes1 or tribal organizations74 7b7 ,conditions ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all place conditions z deem$ necess>y to effect ! purpose ( ?is section 9 any grant or contract :i* ! ,secret>y makes ) any ,indian tribe or tribal organization pursuant to ?is section4 ,su* conditions %all include requirem5ts t ! ,indian tribe or tribal organization successfully und]take-- 7#a7 to det]m9e ! population ( ,indians eligible = ! b5efits describ$ 9 subsection 7a72 7#b7 to educate ,indians ) respect to ! b5efits available "u ! respective programs2 7#c7 to provide transportation = su* individual ,indians to ! appropriate (fices = enrollm5t or applications = su* b5efits2 & 7#d7 to develop & implem5t me?ods ( improv+ ! p>ticipation ( ,indians 9 receiv+ b5efits "u su* programs4 7c7 ,application to urban ,indian organizations 7#a7 ,9 g5]al ,! provisions ( subsection 7a7 %all apply ) respect to grants & o!r fund+ to urban ,indian organizations ) respect to populations s]v$ by su* organizations 9 ! same mann] !y apply to grants & contracts ) ,indian tribes & tribal organizations ) respect to programs on or ne> res]vations4 7#b7 ,requirem5ts ,! ,secret>y %all include 9 ! grants or contracts made or provid$ "u p>agraph 7#a7 requirem5ts t are-- 7,a7 consi/5t ) ! requirem5ts impos$ by ! ,secret>y "u subsection 7b72 7,b7 appropriate to urban ,indian organizations & urban ,indians2 & 7,c7 necess>y to effect ! purposes ( ?is section4 7d7 ,facilitat+ coop]ation ,! ,secret>y1 act+ ?r\gh ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all develop & dissem9ate be/ practices t w s]ve to facilitate coop]ation )1 & agreem5ts betwe51 ,/ates & ! ,s]vice1 ,indian tribes1 tribal organizations1 or urban ,indian organizations ) respect to ! provision ( heal? c>e items & s]vices to ,indians "u ! programs e/abli%$ "u title ,,xviii1 ,,xix1 or ,,xxi ( ! ,social ,security ,act4 7e7 ,agreem5ts relat+ to improv+ enrollm5t ( ,indians "u ,social ,security ,act heal? b5efits programs ,= provisions relat+ to agreem5ts ( ! ,secret>y1 act+ ?r\gh ! ,s]vice1 = ! collection1 prep>ation1 & submission ( applications by ,indians = assi/ance "u ! ,m$icaid & *ildr5's heal? insurance programs e/abli%$ "u titles ,,xix & ,,xxi ( ! ,social ,security ,act1 & b5efits "u ! ,m$ic>e program e/abli%$ "u title ,,xviii ( su* ,act1 see subsections 7a7 & 7b7 ( section #aaci ( ! ,social ,security ,act4 7f7 ,def9ition ( premiums & co/ %>+ ,9 ?is section3 7#a7 ,premium ,! t]m premium includes any enrollm5t fee or simil> *>ge4 7#b7 ,co/ %>+ ,! t]m co/ %>+ includes any d$uction1 d$uctible1 copaym5t1 co9surance1 or simil> *>ge4 4 #aed4 ,%>+ arrangem5ts ) ,f$]al ag5cies ,section #dje ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afde7 is am5d$ to read z foll[s3 #dje4 ,%>+ arrangem5ts ) ,f$]al ag5cies 7a7 ,au?ority 7#a7 ,9 g5]al ,! ,secret>y may ent] into 7or exp&7 arrangem5ts = ! %>+ ( m$ical facilities & s]vices betwe5 ! ,s]vice1 ,indian tribes1 & tribal organizations & ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,dep>tm5t ( ,def5se4 7#b7 ,consultation by ,secret>y requir$ ,! ,secret>y may n f9alize any arrangem5t betwe5 ! ,s]vice & a ,dep>tm5t describ$ 9 p>agraph 7#a7 )\t fir/ consult+ ) ! ,indian tribes :i* w be significantly affect$ by ! arrangem5t4 7b7 ,limitations ,! ,secret>y %all n take any action "u ?is section or "u sub*apt] ,,iv ( *apt] #ha ( title #ch1 ,unit$ ,/ates ,code1 :i* w\ld impair-- 7#a7 ! priority access ( any ,indian to heal? c>e s]vices provid$ ?r\gh ! ,s]vice & ! eligibility ( any ,indian to receive heal? s]vices ?r\gh ! ,s]vice2 7#b7 ! quality ( heal? c>e s]vices provid$ to any ,indian ?r\gh ! ,s]vice2 7#c7 ! priority access ( any vet]an to heal? c>e s]vices provid$ by ! ,dep>tm5t ( ,vet]ans ,affairs2 7#d7 ! quality ( heal? c>e s]vices provid$ by ! ,dep>tm5t ( ,vet]ans ,affairs or ! ,dep>tm5t ( ,def5se2 or 7#e7 ! eligibility ( any ,indian :o is a vet]an to receive heal? s]vices ?r\gh ! ,dep>tm5t ( ,vet]ans ,affairs4 7c7 ,reimbursem5t ,! ,s]vice1 ,indian tribe1 or tribal organization %all be reimburs$ by ! ,dep>tm5t ( ,vet]ans ,affairs or ! ,dep>tm5t ( ,def5se 7z ! case may be7 :]e s]vices are provid$ ?r\gh ! ,s]vice1 an ,indian tribe1 or a tribal organization to b5efici>ies eligible = s]vices f ei!r su* ,dep>tm5t1 not)/&+ any o!r provision ( law4 7d7 ,con/ruction ,no?+ 9 ?is section may be con/ru$ z creat+ any "r ( a non-,indian vet]an to obta9 heal? s]vices f ! ,s]vice4 4 #aee4 ,eligible ,indian vet]an s]vices ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 7z am5d$ by section #aja7;b77 is am5d$ by add+ at ! end ! foll[+3 #djg4 ,eligible ,indian vet]an s]vices 7a7 ,f9d+s2 purpose 7#a7 ,f9d+s ,congress f9ds t-- 7,a7 collaborations betwe5 ! ,secret>y & ! ,secret>y ( ,vet]ans ,affairs reg>d+ ! treatm5t ( ,indian vet]ans at facilities ( ! ,s]vice %\ld be enc\rag$ to ! maximum ext5t practicable2 & 7,b7 increas$ enrollm5t = s]vices ( ! ,dep>tm5t ( ,vet]ans ,affairs by vet]ans :o are memb]s ( ,indian tribes %\ld be enc\rag$ to ! maximum ext5t practicable4 7#b7 ,purpose ,! purpose ( ?is section is to reaffirm ! goals /at$ 9 ! docum5t entitl$ ,memor&um ( ,und]/&+ ,betwe5 ! ,,va_/,vet]ans ,heal? ,adm9i/ration ,& ,,hhs_/,indian ,heal? ,s]vice & dat$ ,febru>y #be1 #bjjc 7relat+ to coop]ation & res\rce %>+ betwe5 ! ,vet]ans ,heal? ,adm9i/ration & ,s]vice74 7b7 ,def9itions ,9 ?is section3 7#a7 ,eligible ,indian vet]an ,! t]m eligible ,indian vet]an means an ,indian or ,alaska ,native vet]an :o receives any m$ical s]vice t is-- 7,a7 au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs2 & 7,b7 adm9i/]$ at a facility ( ! ,s]vice 7includ+ a facility op]at$ by an ,indian tribe or tribal organization ?r\gh a contract or compact ) ! ,s]vice "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq477 pursuant to a local memor&um ( und]/&+4 7#b7 ,local memor&um ( und]/&+ ,! t]m local memor&um ( und]/&+ means a memor&um ( und]/&+ betwe5 ! ,secret>y 7or a designee1 includ+ ! director ( any area (fice ( ! ,s]vice7 & ! ,secret>y ( ,vet]ans ,affairs 7or a designee7 to implem5t ! docum5t entitl$ ,memor&um ( ,und]/&+ ,betwe5 ! ,,va_/,vet]ans ,heal? ,adm9i/ration ,& ,,hhs_/,indian ,heal? ,s]vice & dat$ ,febru>y #be1 #bjjc 7relat+ to coop]ation & res\rce %>+ betwe5 ! ,vet]ans ,heal? ,adm9i/ration & ,indian ,heal? ,s]vice74 7c7 ,eligible ,indian vet]ans exp5ses 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y %all provide = vet]an-relat$ exp5ses incurr$ by eligible ,indian vet]ans z describ$ 9 subsection 7b77#a77;,b74 7#b7 ,me?od ( paym5t ,! ,secret>y %all e/abli% su* guidel9es z ! ,secret>y det]m9es to be appropriate reg>d+ ! me?od ( paym5ts to ! ,secret>y ( ,vet]ans ,affairs "u p>agraph 7#a74 7d7 ,tribal approval ( memor&a ,9 negotiat+ a local memor&um ( und]/&+ ) ! ,secret>y ( ,vet]ans ,affairs reg>d+ ! provision ( s]vices to eligible ,indian vet]ans1 ! ,secret>y %all consult ) ea* ,indian tribe t w\ld be affect$ by ! local memor&um ( und]/&+4 7e7 ,fund+ 7#a7 ,treatm5t ,exp5ses incurr$ by ! ,secret>y 9 c>ry+ out subsection 7c77#a7 %all n be consid]$ to be ,contract ,heal? ,s]vice exp5ses4 7#b7 ,use ( funds ,( funds made available to ! ,secret>y 9 appropriations ,acts = ! ,s]vice 7exclud+ funds made available = facilities1 ,contract ,heal? ,s]vices1 or contract support co/s71 ! ,secret>y %all use su* sums z are necess>y to c>ry out ?is section4 4 #aef4 ,nondiscrim9ation "u ,f$]al heal? c>e programs 9 qualifications = reimbursem5t = s]vices ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 7z am5d$ by section #aee7 is am5d$ by add+ at ! end ! foll[+3 #djh4 ,nondiscrim9ation "u ,f$]al heal? c>e programs 9 qualifications = reimbursem5t = s]vices 7a7 ,requirem5t ,to satisfy g5]ally applicable p>ticipation requirem5ts 7#a7 ,9 g5]al ,a ,f$]al heal? c>e program mu/ accept an entity t is op]at$ by ! ,s]vice1 an ,indian tribe1 tribal organization1 or urban ,indian organization z a provid] eligible to receive paym5t "u ! program = heal? c>e s]vices furni%$ to an ,indian on ! same basis z any o!r provid] qualifi$ to p>ticipate z a provid] ( heal? c>e s]vices "u ! program if ! entity meets g5]ally applicable ,/ate or o!r requirem5ts = p>ticipation z a provid] ( heal? c>e s]vices "u ! program4 7#b7 ,satisfaction ( ,/ate or local lic5sure or recognition requirem5ts ,any requirem5t = p>ticipation z a provid] ( heal? c>e s]vices "u a ,f$]al heal? c>e program t an entity be lic5s$ or recogniz$ "u ! ,/ate or local law :]e ! entity is locat$ to furni% heal? c>e s]vices %all be deem$ to h be5 met 9 ! case ( an entity op]at$ by ! ,s]vice1 an ,indian tribe1 tribal organization1 or urban ,indian organization if ! entity meets all ! applicable /&>ds = su* lic5sure or recognition1 reg>dless ( :e!r ! entity obta9s a lic5se or o!r docum5tation "u su* ,/ate or local law4 ,9 accordance ) section #bba1 ! abs5ce ( ! lic5sure ( a heal? pr(essional employ$ by su* an entity "u ! ,/ate or local law :]e ! entity is locat$ %all n be tak5 into acc\nt = purposes ( det]m9+ :e!r ! entity meets su* /&>ds1 if ! pr(essional is lic5s$ 9 ano!r ,/ate4 7b7 ,application ( exclusion f p>ticipation 9 ,f$]al heal? c>e programs 7#a7 ,exclud$ entities ,no entity op]at$ by ! ,s]vice1 an ,indian tribe1 tribal organization1 or urban ,indian organization t has be5 exclud$ f p>ticipation 9 any ,f$]al heal? c>e program or = :i* a lic5se is "u susp5sion or has be5 revok$ by ! ,/ate :]e ! entity is locat$ %all be eligible to receive paym5t or reimbursem5t "u any su* program = heal? c>e s]vices furni%$ to an ,indian4 7#b7 ,exclud$ individuals ,no individual :o has be5 exclud$ f p>ticipation 9 any ,f$]al heal? c>e program or ^: ,/ate lic5se is "u susp5sion %all be eligible to receive paym5t or reimbursem5t "u any su* program = heal? c>e s]vices furni%$ by t individual1 directly or ?r\gh an entity t is o!rwise eligible to receive paym5t = heal? c>e s]vices1 to an ,indian4 7#c7 ,f$]al heal? c>e program def9$ ,9 ?is subsection1 ! t]m1 ,f$]al heal? c>e program has ! mean+ giv5 t t]m 9 section #aabh;,b7f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f771 except t1 = purposes ( ?is subsection1 su* t]m %all include ! heal? insurance program "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code4 7c7 ,relat$ provisions ,= provisions relat$ to nondiscrim9ation aga9/ provid]s op]at$ by ! ,s]vice1 an ,indian tribe1 tribal organization1 or urban ,indian organization1 see section #aaci7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i7;c774 4 #aeg4 ,access to ,f$]al insurance ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 7z am5d$ by section #aef7 is am5d$ by add+ at ! end ! foll[+3 #dji4 ,access to ,f$]al insurance ,not)/&+ ! provisions ( title #e1 ,unit$ ,/ates ,code1 ,executive ord]1 or adm9i/rative regulation1 an ,indian tribe or tribal organization c>ry+ out programs "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 or an urban ,indian organization c>ry+ out programs "u title ,v ( ?is ,act %all be entitl$ to pur*ase cov]age1 rights1 & b5efits = ! employees ( su* ,indian tribe or tribal organization1 or urban ,indian organization1 "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code1 & *apt] #hg ( su* title if necess>y employee d$uctions & ag5cy contributions 9 paym5t = ! cov]age1 rights1 & b5efits = ! p]iod ( employm5t ) su* ,indian tribe or tribal organization1 or urban ,indian organization1 are curr5tly deposit$ 9 ! applicable ,employee's ,fund "u su* title4 4 #aeh4 ,g5]al exceptions ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 7z am5d$ by section #aeg7 is am5d$ by add+ at ! end ! foll[+3 #daj4 ,g5]al exceptions ,! requirem5ts ( ?is title %all n apply to any except$ b5efits describ$ 9 p>agraph 7#a77;,a7 or 7#c7 ( section #bgia7;c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 4 #aei4 ,navajo ,nation ,m$icaid ,ag5cy feasibility /udy ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 7z am5d$ by section #aeh7 is am5d$ by add+ at ! end ! foll[+3 #daa4 ,navajo ,nation ,m$icaid ,ag5cy feasibility /udy 7a7 ,/udy ,! ,secret>y %all conduct a /udy to det]m9e ! feasibility ( treat+ ! ,navajo ,nation z a ,/ate = ! purposes ( title ,,xix ( ! ,social ,security ,act1 to provide s]vices to ,indians liv+ )9 ! b\nd>ies ( ! ,navajo ,nation ?r\gh an entity e/abli%$ hav+ ! same au?ority & p]=m+ ! same functions z s+le-,/ate m$icaid ag5cies responsible = ! adm9i/ration ( ! ,/ate plan "u title ,,xix ( ! ,social ,security ,act4 7b7 ,consid]ations ,9 conduct+ ! /udy1 ! ,secret>y %all consid] ! feasibility (-- 7#a7 assign+ & pay+ all exp5ditures = ! provision ( s]vices & relat$ adm9i/ration funds1 "u title ,,xix ( ! ,social ,security ,act1 to ,indians liv+ )9 ! b\nd>ies ( ! ,navajo ,nation t are curr5tly paid to or w\ld o!rwise be paid to ! ,/ate ( ,arizona1 ,new ,mexico1 or ,utah2 7#b7 provid+ assi/ance to ! ,navajo ,nation 9 ! developm5t & implem5tation ( su* entity = ! adm9i/ration1 eligibility1 paym5t1 & deliv]y ( m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act2 7#c7 provid+ an appropriate level ( mat*+ funds = ,f$]al m$ical assi/ance ) respect to am\nts su* entity exp5ds = m$ical assi/ance = s]vices & relat$ adm9i/rative co/s2 & 7#d7 au?oriz+ ! ,secret>y1 at ! option ( ! ,navajo ,nation1 to treat ! ,navajo ,nation z a ,/ate = ! purposes ( title ,,xix ( ! ,social ,security ,act 7relat+ to ! ,/ate *ildr5's heal? insurance program7 "u t]ms equival5t to ^? describ$ 9 p>agraphs 7#b7 ?r\gh 7#d74 7c7 ,report ,n lat] !n #c ye>s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs & ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,natural ,res\rces & ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report t includes-- 7#a7 ! results ( ! /udy "u ?is section2 7#b7 a summ>y ( any consultation t occurr$ betwe5 ! ,secret>y & ! ,navajo ,nation1 o!r ,indian ,tribes1 ! ,/ates ( ,arizona1 ,new ,mexico1 & ,utah1 c\nties :i* include ,navajo ,l&s1 & o!r int]e/$ p>ties1 9 conduct+ ?is /udy2 7#c7 project$ co/s or sav+s associat$ ) e/abli%m5t ( su* entity1 & any e/imat$ impact on s]vices provid$ z describ$ 9 ?is section 9 relation to probable co/s or sav+s2 & 7#d7 legislative actions t w\ld be requir$ to au?orize ! e/abli%m5t ( su* entity if su* entity is det]m9$ by ! ,secret>y to be feasible4 4 ,e ,heal? s]vices = urban ,indians #afa4 ,facilities r5ovation ,section #eji ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afei7 is am5d$ by ins]t+ or con/ruction or expansion ( facilities aft] r5ovations to facilities4 #afb4 ,treatm5t ( c]ta9 demon/ration projects ,section #eab ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affj;b7 is am5d$ to read z foll[s3 #eab4 ,treatm5t ( c]ta9 demon/ration projects ,not)/&+ any o!r provision ( law1 ! ,tulsa ,cl9ic & ,oklahoma ,city ,cl9ic demon/ration projects %all-- 7#a7 be p]man5t programs )9 ! ,s]vice's direct c>e program2 7#b7 cont9ue to be treat$ z ,s]vice units & op]at+ units 9 ! allocation ( res\rces & coord9ation ( c>e2 & 7#c7 cont9ue to meet ! requirem5ts & def9itions ( an urban ,indian organization 9 ?is ,act1 & %all n be subject to ! provisions ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 4 #afc4 ,requirem5t to conf] ) urban ,indian organizations 7a7 ,conf]r+ ) urban ,indian organizations ,title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq47 7z am5d$ by section #aja7;b77 is am5d$ by add+ at ! end ! foll[+3 #ead4 ,conf]r+ ) urban ,indian organizations 7a7 ,def9ition ( conf] ,9 ?is section1 ! t]m conf] means to engage 9 an op5 & free ex*ange ( in=mation & op9ions t-- 7#a7 leads to mutual und]/&+ & compreh5sion2 & 7#b7 emphasizes tru/1 respect1 & %>$ responsibility4 7b7 ,requirem5t ,! ,secret>y %all ensure t ! ,s]vice conf]s1 to ! maximum ext5t practicable1 ) urban ,indian organizations 9 c>ry+ out ?is ,act4 4 7b7 ,contracts )1 & grants to1 urban ,indian organizations ,section #ejb ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afeb7 is am5d$ to read z foll[s3 #ejb4 ,contracts )1 & grants to1 urban ,indian organizations 7a7 ,9 g5]al ,pursuant to ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all ent] into contracts )1 or make grants to1 urban ,indian organizations to assi/ ! urban ,indian organizations 9 ! e/abli%m5t & adm9i/ration1 )9 urban c5t]s1 ( programs t meet ! requirem5ts ( ?is title4 7b7 ,conditions ,subject to section #ejf1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all include su* conditions z ! ,secret>y consid]s necess>y to effect ! purpose ( ?is title 9 any contract into :i* ! ,secret>y ent]s )1 or 9 any grant ! ,secret>y makes to1 any urban ,indian organization pursuant to ?is title4 4 #afd4 ,exp&$ program au?ority = urban ,indian organizations ,title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq47 7z am5d$ by section #afc7;a77 is am5d$ by add+ at ! end ! foll[+3 #eae4 ,exp&$ program au?ority = urban ,indian organizations ,not)/&+ any o!r provision ( ?is ,act1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 is au?oriz$ to e/abli% programs1 includ+ programs = aw>d+ grants1 = urban ,indian organizations t are id5tical to any programs e/abli%$ pursuant to sections #bah1 #gjb1 & #gjh7;g74 4 #afe4 ,community heal? repres5tatives ,title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq47 7z am5d$ by section #afd7 is am5d$ by add+ at ! end ! foll[+3 #eaf4 ,community heal? repres5tatives ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 may ent] into contracts )1 & make grants to1 urban ,indian organizations = ! employm5t ( ,indians tra9$ z heal? s]vice provid]s ?r\gh ! ,community ,heal? ,repres5tative ,program "u section #ajg 9 ! provision ( heal? c>e1 heal? promotion1 & disease prev5tion s]vices to urban ,indians4 4 #aff4 ,use ( ,f$]al ,gov]nm5t facilities & s\rces ( supply2 heal? in=mation te*nology ,title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq47 7z am5d$ by section #afe7 is am5d$ by add+ at ! end ! foll[+3 #eag4 ,use ( ,f$]al ,gov]nm5t facilities & s\rces ( supply 7a7 ,9 g5]al ,! ,secret>y may p]mit an urban ,indian organization t has ent]$ into a contract or receiv$ a grant pursuant to ?is title1 9 c>ry+ out ! contract or grant1 to use1 9 accordance ) su* t]ms & conditions = use & ma9t5ance z are agre$ on by ! ,secret>y & ! urban ,indian organizations-- 7#a7 any exi/+ facility "u ! jurisdiction ( ! ,secret>y2 7#b7 all equipm5t conta9$ 9 or p]ta9+ to su* an exi/+ facility2 & 7#c7 any o!r p]sonal prop]ty ( ! ,f$]al ,gov]nm5t "u ! jurisdiction ( ! ,secret>y4 7b7 ,donations ,subject to subsection 7d71 ! ,secret>y may donate to an urban ,indian organization t has ent]$ into a contract or receiv$ a grant pursuant to ?is title any p]sonal or real prop]ty det]m9$ to be excess to ! ne$s ( ! ,s]vice or ! ,g5]al ,s]vices ,adm9i/ration = ! purposes ( c>ry+ out ! contract or grant4 7c7 ,acquisition ( prop]ty ,! ,secret>y may acquire excess or surplus p]sonal or real prop]ty ( ! ,f$]al ,gov]nm5t = donation1 subject to subsection 7d71 to an urban ,indian organization t has ent]$ into a contract or receiv$ a grant pursuant to ?is title if ! ,secret>y det]m9es t ! prop]ty is appropriate = use by ! urban ,indian organization = purposes ( ! contract or grant4 7d7 ,priority ,if ! ,secret>y receives f an urban ,indian organization or an ,indian tribe or tribal organization a reque/ = a specific item ( p]sonal or real prop]ty describ$ 9 subsection 7b7 or 7c71 ! ,secret>y %all give priority to ! reque/ = donation to ! ,indian tribe or tribal organization1 if ! ,secret>y receives ! reque/ f ! ,indian tribe or tribal organization be=e ! e>li] (-- 7#a7 ! date on :i* ! ,secret>y transf]s title to ! prop]ty to ! urban ,indian organization2 & 7#b7 ! date on :i* ! ,secret>y transf]s ! prop]ty physically to ! urban ,indian organization4 7e7 ,executive ag5cy /atus ,= purposes ( section #eja7;a7 ( title #dj1 ,unit$ ,/ates ,code1 an urban ,indian organization t has ent]$ into a contract or receiv$ a grant pursuant to ?is title may be consid]$ to be an ,executive ag5cy 9 c>ry+ out ! contract or grant4 #eah4 ,heal? in=mation te*nology ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 may make grants to urban ,indian organizations "u ?is title = ! developm5t1 adoption1 & implem5tation ( heal? in=mation te*nology 7z def9$ 9 section #cjjj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj771 telem$ic9e s]vices developm5t1 & relat$ infra/ructure4 4 ,f ,organizational improvem5ts #aga4 ,e/abli%m5t ( ! ,indian ,heal? ,s]vice z an ag5cy ( ! ,public ,heal? ,s]vice ,section #fja ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa7 is am5d$ to read z foll[s3 #fja4 ,e/abli%m5t ( ! ,indian ,heal? ,s]vice z an ag5cy ( ! ,public ,heal? ,s]vice 7a7 ,e/abli%m5t 7#a7 ,9 g5]al ,9 ord] to m effectively & effici5tly c>ry out ! responsibilities1 au?orities1 & functions ( ! ,unit$ ,/ates to provide heal? c>e s]vices to ,indians & ,indian tribes1 z are or may be h]eaft] provid$ by ,f$]al /atute or treaties1 !re is e/abli%$ )9 ! ,public ,heal? ,s]vice ( ! ,dep>tm5t ! ,indian ,heal? ,s]vice4 7#b7 ,director ,! ,s]vice %all be adm9i/]$ by a ,director1 :o %all be appo9t$ by ! ,presid5t1 by & ) ! advice & cons5t ( ! ,s5ate4 ,! ,director %all report to ! ,secret>y4 ,effective ) respect to an individual appo9t$ by ! ,presid5t1 by & ) ! advice & cons5t ( ! ,s5ate1 aft] ,janu>y #a1 #bjjh1 ! t]m ( s]vice ( ! ,director %all be #d ye>s4 ,a ,director may s]ve m ?an #a t]m4 7#c7 ,incumb5t ,! individual s]v+ 9 ! position ( ,director ( ! ,s]vice on ! day be=e ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag %all s]ve z ,director4 7#d7 ,advocacy & consultation ,! position ( ,director is e/abli%$ to1 9 a mann] consi/5t ) ! gov]nm5t-to-gov]nm5t relation%ip betwe5 ! ,unit$ ,/ates & ,indian ,tribes-- 7,a7 facilitate advocacy = ! developm5t ( appropriate ,indian heal? policy2 & 7,b7 promote consultation on matt]s relat+ to ,indian heal?4 7b7 ,ag5cy ,! ,s]vice %all be an ag5cy )9 ! ,public ,heal? ,s]vice ( ! ,dep>tm5t1 & %all n be an (fice1 compon5t1 or unit ( any o!r ag5cy ( ! ,dep>tm5t4 7c7 ,duties ,! ,director %all-- 7#a7 p]=m all functions t 71 on ! day be=e ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 c>ri$ out by or "u ! direction ( ! individual s]v+ z ,director ( ! ,s]vice on t day2 7#b7 p]=m all functions ( ! ,secret>y relat+ to ! ma9t5ance & op]ation ( hospital & heal? facilities = ,indians & ! plann+ =1 & provision & utilization (1 heal? s]vices = ,indians1 includ+ by ensur+ t all ag5cy directors1 manag]s1 & *ief executive (fic]s h appropriate & adequate tra9+1 exp]i5ce1 skill levels1 k1 abilities1 & education 7includ+ cont9u+ tra9+ requirem5ts7 to compet5tly fulfill ! duties ( ! positions & ! mission ( ! ,s]vice2 7#c7 adm9i/] all heal? programs "u :i* heal? c>e is provid$ to ,indians bas$ ^u _! /atus z ,indians :i* are adm9i/]$ by ! ,secret>y1 includ+ programs "u-- 7,a7 ?is ,act2 7,b7 ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac72 7,c7 ! ,act ( ,augu/ #e1 #aied 7#db ,u4,s4,c4 #bjja et seq472 7,d7 ! ,act ( ,augu/ #af1 #aieg 7#db ,u4,s4,c4 #bjje et seq472 & 7,e7 ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq472 7#d7 adm9i/] all s*ol>%ip & loan functions c>ri$ out "u title ,i2 7#e7 directly advise ! ,secret>y conc]n+ ! developm5t ( all policy- & budget-relat$ matt]s affect+ ,indian heal?2 7#f7 collaborate ) ! ,assi/ant ,secret>y = ,heal? conc]n+ appropriate matt]s ( ,indian heal? t affect ! ag5cies ( ! ,public ,heal? ,s]vice2 7#g7 advise ea* ,assi/ant ,secret>y ( ! ,dep>tm5t conc]n+ matt]s ( ,indian heal? ) respect to :i* t ,assi/ant ,secret>y has au?ority & responsibility2 7#h7 advise ! heads ( o!r ag5cies & programs ( ! ,dep>tm5t conc]n+ matt]s ( ,indian heal? ) respect to :i* ^? heads h au?ority & responsibility2 7#i7 coord9ate ! activities ( ! ,dep>tm5t conc]n+ matt]s ( ,indian heal?2 & 7#aj7 p]=m su* o!r functions z ! ,secret>y may designate4 7d7 ,au?ority 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director1 %all h ! au?ority-- 7,a7 except to ! ext5t provid$ = 9 p>agraph 7#b71 to appo9t & comp5sate employees = ! ,s]vice 9 accordance ) title #e1 ,unit$ ,/ates ,code2 7,b7 to ent] into contracts = ! procurem5t ( goods & s]vices to c>ry out ! functions ( ! ,s]vice2 & 7,c7 to manage1 exp5d1 & obligate all funds appropriat$ = ! ,s]vice4 7#b7 ,p]sonnel actions ,not)/&+ any o!r provision ( law1 ! provisions ( section #ab ( ! ,act ( ,june #ah1 #aicd 7#dh ,/at4 #ihf2 #be ,u4,s4,c4 #dgb71 %all apply to all p]sonnel actions tak5 ) respect to new positions creat$ )9 ! ,s]vice z a result ( its e/abli%m5t "u subsection 7a74 4 #agb4 ,(fice ( ,direct ,s]vice ,tribes ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #aja7;b77 is am5d$ by add+ at ! end ! foll[+3 #fjc4 ,(fice ( ,direct ,s]vice ,tribes 7a7 ,e/abli%m5t ,!re is e/abli%$ )9 ! ,s]vice an (fice1 to be kn[n z ! ,(fice ( ,direct ,s]vice ,tribes4 7b7 ,treatm5t ,! ,(fice ( ,direct ,s]vice ,tribes %all be locat$ 9 ! ,(fice ( ! ,director4 7c7 ,duties ,! ,(fice ( ,direct ,s]vice ,tribes %all be responsible =-- 7#a7 provid+ ,s]vice-wide lead]%ip1 guidance & support = direct s]vice tribes to include /rategic plann+ & program evaluation2 7#b7 ensur+ maximum flexibility to tribal heal? & relat$ support sy/ems = ,indian b5efici>ies2 7#c7 s]v+ z ! focal po9t = consultation & p>ticipation betwe5 direct s]vice tribes & organizations & ! ,s]vice 9 ! developm5t ( ,s]vice policy2 7#d7 hold+ no less ?an biannual consultations ) direct s]vice tribes 9 appropriate locations to ga!r in=mation & aid 9 ! developm5t ( heal? policy2 & 7#e7 direct+ a national program & provid+ lead]%ip & advocacy 9 ! developm5t ( heal? policy1 program managem5t1 budget =mulation1 res\rce allocation1 & delegation support = direct s]vice tribes4 4 #agc4 ,nevada area (fice ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #agb7 is am5d$ by add+ at ! end ! foll[+3 #fjd4 ,nevada area (fice 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 9 a mann] consi/5t ) ! tribal consultation policy ( ! ,s]vice1 ! ,secret>y %all submit to ,congress a plan describ+ ! mann] & s*$ule by :i* an area (fice1 sep>ate & di/9ct f ! ,pho5ix ,area ,(fice ( ! ,s]vice1 c be e/abli%$ 9 ! ,/ate ( ,nevada4 7b7 ,failure ,to submit plan 7#a7 ,def9ition ( op]ations funds ,9 ?is subsection1 ! t]m op]ations funds means only ! funds us$ =-- 7,a7 ! adm9i/ration ( s]vices1 includ+ functional exp5ses su* z ov]time1 p]sonnel sal>ies1 & associat$ b5efits2 or 7,b7 relat$ tasks t directly affect ! op]ations describ$ 9 subp>agraph 7,a74 7#b7 ,)hold+ ( funds ,if ! ,secret>y fails to submit a plan 9 accordance ) subsection 7a71 ! ,secret>y %all )hold ! op]ations funds res]v$ = ! ,(fice ( ! ,director1 subject to ! condition t ! )hold+ %all n adv]sely impact ! capacity ( ! ,s]vice to deliv] heal? c>e s]vices4 7#c7 ,re/oration ,! op]ations funds )held pursuant to p>agraph 7#b7 may be re/or$1 at ! discretion ( ! ,secret>y1 to ! ,(fice ( ! ,director on a*ievem5t by t ,(fice ( compliance ) ?is section4 4 ,g ,behavioral heal? programs #aha4 ,behavioral heal? programs ,title ,,vii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affe et seq47 is am5d$ to read z foll[s3 ,,vii ,behavioral heal? programs ,a ,g5]al programs #gja4 ,def9itions ,9 ?is subtitle3 7#a7 ,alcohol-relat$ neurodevelopm5tal disord]s2 ,,arnd ,! t]m alcohol-relat$ neurodevelopm5tal disord]s or ,,arnd means1 ) a hi/ory ( mat]nal alcohol consumption dur+ pregnancy1 c5tral n]v\s sy/em abnormalities1 :i* may range f m9or intellectual deficits & developm5tal delays to m5tal ret>dation4 ,,arnd *ildr5 may h behavioral problems1 le>n+ disabilities1 problems ) executive function+1 & att5tion disord]s4 ,! neurological defects ( ,,arnd may be z sev]e z ,,fas1 b facial anomalies & o!r physical *>act]i/ics are n pres5t 9 ,,arnd1 ?us mak+ diagnosis difficult4 7#b7 ,assessm5t ,! t]m assessm5t means ! sy/ematic collection1 analysis1 & dissem9ation ( in=mation on heal? /atus1 heal? ne$s1 & heal? problems4 7#c7 ,behavioral heal? aft]c>e ,! t]m behavioral heal? aft]c>e includes ^? activities & res\rces us$ to support recov]y foll[+ inpati5t1 resid5tial1 int5sive sub/ance abuse1 or m5tal heal? outpati5t or outpati5t treatm5t4 ,! purpose is to help prev5t or deal ) relapse by ensur+ t by ! "t a cli5t or pati5t is dis*>g$ f a level ( c>e1 su* z outpati5t treatm5t1 an aft]c>e plan has be5 develop$ ) ! cli5t4 ,an aft]c>e plan may use su* res\rces z a community-bas$ !rapeutic gr\p1 transitional liv+ facilities1 a #ab-/ep sponsor1 a local #ab-/ep or o!r relat$ support gr\p1 & o!r community-bas$ provid]s4 7#d7 ,dual diagnosis ,! t]m dual diagnosis means coexi/+ sub/ance abuse & m5tal illness conditions or diagnosis4 ,su* cli5ts are sometimes ref]r$ to z m5tally ill *emical abus]s 7,m,i,c,as74 7#e7 ,fetal alcohol spectrum disord]s 7,a7 ,9 g5]al ,! t]m fetal alcohol spectrum disord]s includes a range ( effects t c occur 9 an individual ^: "m drank alcohol dur+ pregnancy1 includ+ physical1 m5tal1 behavioral1 &_/or le>n+ disabilities ) possible lifelong implications4 7,b7 ,inclusions ,! t]m fetal alcohol spectrum disord]s may include-- 7i7 fetal alcohol syndrome 7,,fas72 7ii7 p>tial fetal alcohol syndrome 7p>tial ,,fas72 7iii7 alcohol-relat$ bir? defects 7,,arbd72 & 7iv7 alcohol-relat$ neurodevelopm5tal disord]s 7,,arnd74 7#f7 ,,fas or fetal alcohol syndrome ,! t]m ,,fas or fetal alcohol syndrome means a syndrome 9 :i*1 ) a hi/ory ( mat]nal alcohol consumption dur+ pregnancy1 ! foll[+ crit]ia are met3 7,a7 ,c5tral n]v\s sy/em involvem5t1 su* z m5tal ret>dation1 developm5tal delay1 intellectual deficit1 micro5cephaly1 or neurological abnormalities4 7,b7 ,crani(acial abnormalities ) at lea/ #b ( ! foll[+3 7i7 ,microoph?almia4 7ii7 ,%ort palpebral fissures4 7iii7 ,poorly develop$ philtrum4 7iv7 ,?9 upp] lip4 7v7 ,flat nasal bridge4 7vi7 ,%ort upturn$ nose4 7,c7 ,pr5atal or po/natal gr[? delay4 7#g7 ,rehabilitation ,! t]m rehabilitation means m$ical & heal? c>e s]vices t-- 7,a7 are recomm5d$ by a physician or lic5s$ practition] ( ! heal+ arts )9 ! scope ( _! practice "u applicable law2 7,b7 are furni%$ 9 a facility1 home1 or o!r sett+ 9 accordance ) applicable /&>ds2 & 7,c7 h z _! purpose any ( ! foll[+3 7i7 ,! maximum atta9m5t ( physical1 m5tal1 & developm5tal function+4 7ii7 ,av]t+ det]ioration 9 physical or m5tal functional /atus4 7iii7 ,! ma9t5ance ( physical or m5tal heal? functional /atus4 7#h7 ,sub/ance abuse ,! t]m sub/ance abuse includes inhalant abuse4 #gjb4 ,behavioral heal? prev5tion & treatm5t s]vices 7a7 ,purposes ,! purposes ( ?is section are z foll[s3 7#a7 ,to au?orize & direct ! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 to develop a compreh5sive behavioral heal? prev5tion & treatm5t program :i* emphasizes collaboration among alcohol & sub/ance abuse1 social s]vices1 & m5tal heal? programs4 7#b7 ,to provide in=mation1 direction1 & guidance relat+ to m5tal illness & dysfunction & self-de/ructive behavior1 includ+ *ild abuse & family viol5ce1 to ^? ,f$]al1 tribal1 ,/ate1 & local ag5cies responsible = programs 9 ,indian communities 9 areas ( heal? c>e1 education1 social s]vices1 *ild & family welf>e1 alcohol & sub/ance abuse1 law en=cem5t1 & judicial s]vices4 7#c7 ,to assi/ ,indian tribes to id5tify s]vices & res\rces available to address m5tal illness & dysfunctional & self-de/ructive behavior4 7#d7 ,to provide au?ority & opportunities = ,indian tribes & tribal organizations to develop1 implem5t1 & coord9ate ) community-bas$ programs :i* include id5tification1 prev5tion1 education1 ref]ral1 & treatm5t s]vices1 includ+ ?r\gh multidiscipl9>y res\rce teams4 7#e7 ,to ensure t ,indians1 z citiz5s ( ! ,unit$ ,/ates & ( ! ,/ates 9 :i* !y reside1 h ! same access to behavioral heal? s]vices to :i* all citiz5s h access4 7#f7 ,to modify or supplem5t exi/+ programs & au?orities 9 ! areas id5tifi$ 9 p>agraph 7#b74 7b7 ,plans 7#a7 ,developm5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 %all enc\rage ,indian tribes & tribal organizations to develop tribal plans1 & urban ,indian organizations to develop local plans1 & = all su* gr\ps to p>ticipate 9 develop+ areawide plans = ,indian ,behavioral ,heal? ,s]vices4 ,! plans %all include1 to ! ext5t feasible1 ! foll[+ compon5ts3 7,a7 ,an assessm5t ( ! scope ( alcohol or o!r sub/ance abuse1 m5tal illness1 & dysfunctional & self-de/ructive behavior1 includ+ suicide1 *ild abuse1 & family viol5ce1 among ,indians1 includ+-- 7i7 ! numb] ( ,indians s]v$ :o are directly or indirectly affect$ by su* illness or behavior2 or 7ii7 an e/imate ( ! f9ancial & human co/ attributable to su* illness or behavior4 7,b7 ,an assessm5t ( ! exi/+ & additional res\rces necess>y = ! prev5tion & treatm5t ( su* illness & behavior1 includ+ an assessm5t ( ! progress t[>d a*iev+ ! availability ( ! full cont9uum ( c>e describ$ 9 subsection 7c74 7,c7 ,an e/imate ( ! additional fund+ ne$$ by ! ,s]vice1 ,indian tribes1 tribal organizations1 & urban ,indian organizations to meet _! responsibilities "u ! plans4 7#b7 ,national cle>+h\se ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all coord9ate ) exi/+ national cle>+h\ses & in=mation c5t]s to include at ! cle>+h\ses & c5t]s plans & reports on ! outcomes ( su* plans develop$ by ,indian tribes1 tribal organizations1 urban ,indian organizations1 & ,s]vice areas relat+ to behavioral heal?4 ,! ,secret>y %all ensure access to ^! plans & outcomes by any ,indian tribe1 tribal organization1 urban ,indian organization1 or ! ,s]vice4 7#c7 ,te*nical assi/ance ,! ,secret>y %all provide te*nical assi/ance to ,indian tribes1 tribal organizations1 & urban ,indian organizations 9 prep>ation ( plans "u ?is section & 9 develop+ /&>ds ( c>e t may be us$ & adopt$ locally4 7c7 ,programs ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide1 to ! ext5t feasible & if fund+ is available1 programs includ+ ! foll[+3 7#a7 ,compreh5sive c>e ,a compreh5sive cont9uum ( behavioral heal? c>e :i* provides-- 7,a7 community-bas$ prev5tion1 int]v5tion1 outpati5t1 & behavioral heal? aft]c>e2 7,b7 detoxification 7social & m$ical72 7,c7 acute hospitalization2 7,d7 int5sive outpati5t_/day treatm5t2 7,e7 resid5tial treatm5t2 7,f7 transitional liv+ = ^? ne$+ a tempor>y1 /able liv+ environm5t t is supportive ( treatm5t & recov]y goals2 7,g7 em]g5cy %elt]2 7,h7 int5sive case managem5t2 7,i7 diagno/ic s]vices2 & 7,j7 promotion ( heal?y approa*es to risk & safety issues1 includ+ injury prev5tion4 7#b7 ,*ild c>e ,behavioral heal? s]vices = ,indians f bir? ?r\gh age #ag1 includ+-- 7,a7 pres*ool & s*ool age fetal alcohol spectrum disord] s]vices1 includ+ assessm5t & behavioral int]v5tion2 7,b7 m5tal heal? & sub/ance abuse s]vices 7emotional1 organic1 alcohol1 drug1 inhalant1 & tobacco72 7,c7 id5tification & treatm5t ( co-occurr+ disord]s & comorbidity2 7,d7 prev5tion ( alcohol1 drug1 inhalant1 & tobacco use2 7,e7 e>ly int]v5tion1 treatm5t1 & aft]c>e2 7,f7 promotion ( heal?y approa*es to risk & safety issues2 & 7,g7 id5tification & treatm5t ( neglect & physical1 m5tal1 & sexual abuse4 7#c7 ,adult c>e ,behavioral heal? s]vices = ,indians f age #ah ?r\gh #ee1 includ+-- 7,a7 e>ly int]v5tion1 treatm5t1 & aft]c>e2 7,b7 m5tal heal? & sub/ance abuse s]vices 7emotional1 alcohol1 drug1 inhalant1 & tobacco71 includ+ sex specific s]vices2 7,c7 id5tification & treatm5t ( co-occurr+ disord]s 7dual diagnosis7 & comorbidity2 7,d7 promotion ( heal?y approa*es = risk-relat$ behavior2 7,e7 treatm5t s]vices = wom5 at risk ( giv+ bir? to a *ild ) a fetal alcohol spectrum disord]2 & 7,f7 sex specific treatm5t = sexual assault & dome/ic viol5ce4 7#d7 ,family c>e ,behavioral heal? s]vices = families1 includ+-- 7,a7 e>ly int]v5tion1 treatm5t1 & aft]c>e = affect$ families2 7,b7 treatm5t = sexual assault & dome/ic viol5ce2 & 7,c7 promotion ( heal?y approa*es relat+ to p>5t+1 dome/ic viol5ce1 & o!r abuse issues4 7#e7 ,eld] c>e ,behavioral heal? s]vices = ,indians #ef ye>s ( age & old]1 includ+-- 7,a7 e>ly int]v5tion1 treatm5t1 & aft]c>e2 7,b7 m5tal heal? & sub/ance abuse s]vices 7emotional1 alcohol1 drug1 inhalant1 & tobacco71 includ+ sex specific s]vices2 7,c7 id5tification & treatm5t ( co-occurr+ disord]s 7dual diagnosis7 & comorbidity2 7,d7 promotion ( heal?y approa*es to manag+ conditions relat$ to ag+2 7,e7 sex specific treatm5t = sexual assault1 dome/ic viol5ce1 neglect1 physical & m5tal abuse & exploitation2 & 7,f7 id5tification & treatm5t ( dem5tias reg>dless ( cause4 7d7 ,community behavioral heal? plan 7#a7 ,e/abli%m5t ,! gov]n+ body ( any ,indian tribe1 tribal organization1 or urban ,indian organization may adopt a resolution = ! e/abli%m5t ( a community behavioral heal? plan provid+ = ! id5tification & coord9ation ( available res\rces & programs to id5tify1 prev5t1 or treat sub/ance abuse1 m5tal illness1 or dysfunctional & self-de/ructive behavior1 includ+ *ild abuse & family viol5ce1 among its memb]s or its s]vice population4 ,?is plan %\ld include behavioral heal? s]vices1 social s]vices1 int5sive outpati5t s]vices1 & cont9u+ aft]c>e4 7#b7 ,te*nical assi/ance ,at ! reque/ ( an ,indian tribe1 tribal organization1 or urban ,indian organization1 ! ,bureau ( ,indian ,affairs & ! ,s]vice %all coop]ate ) & provide te*nical assi/ance to ! ,indian tribe1 tribal organization1 or urban ,indian organization 9 ! developm5t & implem5tation ( su* plan4 7#c7 ,fund+ ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 may make fund+ available to ,indian tribes & tribal organizations :i* adopt a resolution pursuant to p>agraph 7#a7 to obta9 te*nical assi/ance = ! developm5t ( a community behavioral heal? plan & to provide adm9i/rative support 9 ! implem5tation ( su* plan4 7e7 ,coord9ation = availability ( s]vices ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all coord9ate behavioral heal? plann+1 to ! ext5t feasible1 ) o!r ,f$]al ag5cies & ) ,/ate ag5cies1 to enc\rage compreh5sive behavioral heal? s]vices = ,indians reg>dless ( _! place ( resid5ce4 7f7 ,m5tal heal? c>e ne$ assessm5t ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all make an assessm5t ( ! ne$ = inpati5t m5tal heal? c>e among ,indians & ! availability & co/ ( inpati5t m5tal heal? facilities :i* c meet su* ne$4 ,9 mak+ su* assessm5t1 ! ,secret>y %all consid] ! possible conv]sion ( exi/+1 und]us$ ,s]vice hospital b$s into psy*iatric units to meet su* ne$4 #gjc4 ,memor&a ( agreem5t ) ! ,dep>tm5t ( ,int]ior 7a7 ,cont5ts ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 & ! ,secret>y ( ! ,int]ior %all develop & ent] into a memor&a ( agreem5t1 or review & update any exi/+ memor&a ( agreem5t1 z requir$ by section #dbje ( ! ,indian ,alcohol & ,sub/ance ,abuse ,prev5tion & ,treatm5t ,act ( #aihf 7#be ,u4,s4,c4 #bdaa7 "u :i* ! ,secret>ies address ! foll[+3 7#a7 ,! scope & nature ( m5tal illness & dysfunctional & self-de/ructive behavior1 includ+ *ild abuse & family viol5ce1 among ,indians4 7#b7 ,! exi/+ ,f$]al1 tribal1 ,/ate1 local1 & private s]vices1 res\rces1 & programs available to provide behavioral heal? s]vices = ,indians4 7#c7 ,! unmet ne$ = additional s]vices1 res\rces1 & programs necess>y to meet ! ne$s id5tifi$ pursuant to p>agraph 7#a74 7#d7 7,a7 ,! "r ( ,indians1 z citiz5s ( ! ,unit$ ,/ates & ( ! ,/ates 9 :i* !y reside1 to h access to behavioral heal? s]vices to :i* all citiz5s h access4 7,b7 ,! "r ( ,indians to p>ticipate 91 & receive ! b5efit (1 su* s]vices4 7,c7 ,! actions necess>y to protect ! ex]cise ( su* "r4 7#e7 ,! responsibilities ( ! ,bureau ( ,indian ,affairs & ! ,s]vice1 includ+ m5tal illness id5tification1 prev5tion1 education1 ref]ral1 & treatm5t s]vices 7includ+ s]vices ?r\gh multidiscipl9>y res\rce teams71 at ! c5tral1 area1 & ag5cy & ,s]vice unit1 ,s]vice area1 & headqu>t]s levels to address ! problems id5tifi$ 9 p>agraph 7#a74 7#f7 ,a /rategy = ! compreh5sive coord9ation ( ! behavioral heal? s]vices provid$ by ! ,bureau ( ,indian ,affairs & ! ,s]vice to meet ! problems id5tifi$ pursuant to p>agraph 7#a71 includ+-- 7,a7 ! coord9ation ( alcohol & sub/ance abuse programs ( ! ,s]vice1 ! ,bureau ( ,indian ,affairs1 & ,indian tribes & tribal organizations 7develop$ "u ! ,indian ,alcohol & ,sub/ance ,abuse ,prev5tion & ,treatm5t ,act ( #aihf 7#be ,u4,s4,c4 #bdja et seq477 ) behavioral heal? initiatives pursuant to ?is ,act1 p>ticul>ly ) respect to ! ref]ral & treatm5t ( dually diagnos$ individuals requir+ behavioral heal? & sub/ance abuse treatm5t2 & 7,b7 ensur+ t ! ,bureau ( ,indian ,affairs & ,s]vice programs & s]vices 7includ+ multidiscipl9>y res\rce teams7 address+ *ild abuse & family viol5ce are coord9at$ ) su* non-,f$]al programs & s]vices4 7#g7 ,direct+ appropriate (ficials ( ! ,bureau ( ,indian ,affairs & ! ,s]vice1 p>ticul>ly at ! ag5cy & ,s]vice unit levels1 to coop]ate fully ) tribal reque/s made pursuant to community behavioral heal? plans adopt$ "u section #gjb7;c7 & section #dbjf ( ! ,indian ,alcohol & ,sub/ance ,abuse ,prev5tion & ,treatm5t ,act ( #aihf 7#be ,u4,s4,c4 #bdab74 7#h7 ,provid+ = an annual review ( su* agreem5t by ! ,secret>ies :i* %all be provid$ to ,congress & ,indian tribes & tribal organizations4 7b7 ,specific provisions requir$ ,! memor&a ( agreem5t updat$ or ent]$ into pursuant to subsection 7a7 %all include specific provisions pursuant to :i* ! ,s]vice %all assume responsibility =-- 7#a7 ! det]m9ation ( ! scope ( ! problem ( alcohol & sub/ance abuse among ,indians1 includ+ ! numb] ( ,indians )9 ! jurisdiction ( ! ,s]vice :o are directly or indirectly affect$ by alcohol & sub/ance abuse & ! f9ancial & human co/2 7#b7 an assessm5t ( ! exi/+ & ne$$ res\rces necess>y = ! prev5tion ( alcohol & sub/ance abuse & ! treatm5t ( ,indians affect$ by alcohol & sub/ance abuse2 & 7#c7 an e/imate ( ! fund+ necess>y to adequately support a program ( prev5tion ( alcohol & sub/ance abuse & treatm5t ( ,indians affect$ by alcohol & sub/ance abuse4 7c7 ,publication ,ea* memor&um ( agreem5t ent]$ into or r5ew$ 7& am5dm5ts or modifications !reto7 "u subsection 7a7 %all be publi%$ 9 ! ,f$]al ,regi/]4 ,at ! same "t z publication 9 ! ,f$]al ,regi/]1 ! ,secret>y %all provide a copy ( su* memor&a1 am5dm5t1 or modification to ea* ,indian tribe1 tribal organization1 & urban ,indian organization4 #gjd4 ,compreh5sive behavioral heal? prev5tion & treatm5t program 7a7 ,e/abli%m5t 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide a program ( compreh5sive behavioral heal?1 prev5tion1 treatm5t1 & aft]c>e1 :i* may include1 if feasible & appropriate1 sy/ems ( c>e1 & %all include-- 7,a7 prev5tion1 ?r\gh educational int]v5tion1 9 ,indian communities2 7,b7 acute detoxification1 psy*iatric hospitalization1 resid5tial1 & int5sive outpati5t treatm5t2 7,c7 community-bas$ rehabilitation & aft]c>e2 7,d7 community education & involvem5t1 includ+ ext5sive tra9+ ( heal? c>e1 educational1 & community-bas$ p]sonnel2 7,e7 specializ$ resid5tial treatm5t programs = high-risk populations1 includ+ pregnant & po/p>tum wom5 & _! *ildr52 & 7,f7 diagno/ic s]vices4 7#b7 ,t>get populations ,! t>get population ( su* programs %all be memb]s ( ,indian tribes4 ,ef=ts to tra9 & educate key memb]s ( ! ,indian community %all also t>get employees ( heal?1 education1 judicial1 law en=cem5t1 legal1 & social s]vice programs4 7b7 ,contract heal? s]vices 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 may ent] into contracts ) public or private provid]s ( behavioral heal? treatm5t s]vices = ! purpose ( c>ry+ out ! program requir$ "u subsection 7a74 7#b7 ,provision ( assi/ance ,9 c>ry+ out ?is subsection1 ! ,secret>y %all provide assi/ance to ,indian tribes & tribal organizations to develop crit]ia = ! c]tification ( behavioral heal? s]vice provid]s & accr$itation ( s]vice facilities :i* meet m9imum /&>ds = su* s]vices & facilities4 #gje4 ,m5tal heal? te*nician program 7a7 ,9 g5]al ,pursuant to ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac7 7commonly kn[n z ! ,snyd] ,act71 ! ,secret>y %all e/abli% & ma9ta9 a m5tal heal? te*nician program )9 ! ,s]vice :i*-- 7#a7 provides = ! tra9+ ( ,indians z m5tal heal? te*nicians2 & 7#b7 employs su* te*nicians 9 ! provision ( community-bas$ m5tal heal? c>e t includes id5tification1 prev5tion1 education1 ref]ral1 & treatm5t s]vices4 7b7 ,p>apr(essional tra9+ ,9 c>ry+ out subsection 7a71 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide high-/&>d p>apr(essional tra9+ 9 m5tal heal? c>e necess>y to provide quality c>e to ! ,indian communities to be s]v$4 ,su* tra9+ %all be bas$ ^u a curriculum develop$ or approv$ by ! ,secret>y :i* comb9es education 9 ! !ory ( m5tal heal? c>e ) sup]vis$ practical exp]i5ce 9 ! provision ( su* c>e4 7c7 ,sup]vision & evaluation ( te*nicians ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all sup]vise & evaluate ! m5tal heal? te*nicians 9 ! tra9+ program4 7d7 ,traditional heal? c>e practices ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all ensure t ! program e/abli%$ pursuant to ?is section involves ! use & promotion ( ! traditional heal? c>e practices ( ! ,indian tribes to be s]v$4 #gjf4 ,lic5s+ requirem5t = m5tal heal? c>e work]s 7a7 ,9 g5]al ,subject to section #bba1 & except z provid$ 9 subsection 7b71 any individual employ$ z a psy*ologi/1 social work]1 or m>riage & family !rapi/ = ! purpose ( provid+ m5tal heal? c>e s]vices to ,indians 9 a cl9ical sett+ "u ?is ,act is requir$ to be lic5s$ z a psy*ologi/1 social work]1 or m>riage & family !rapi/1 respectively4 7b7 ,tra9ees ,an individual may be employ$ z a tra9ee 9 psy*ology1 social "w1 or m>riage & family !rapy to provide m5tal heal? c>e s]vices describ$ 9 subsection 7a7 if su* individual-- 7#a7 works "u ! direct sup]vision ( a lic5s$ psy*ologi/1 social work]1 or m>riage & family !rapi/1 respectively2 7#b7 is enroll$ 9 or has complet$ at lea/ #b ye>s ( c\rse "w at a po/-second>y1 accr$it$ education program = psy*ology1 social "w1 m>riage & family !rapy1 or c\nsel+2 & 7#c7 meets su* o!r tra9+1 sup]vision1 & quality review requirem5ts z ! ,secret>y may e/abli%4 #gjg4 ,indian wom5 treatm5t programs 7a7 ,grants ,! ,secret>y1 consi/5t ) section #gjb1 may make grants to ,indian tribes1 tribal organizations1 & urban ,indian organizations to develop & implem5t a compreh5sive behavioral heal? program ( prev5tion1 int]v5tion1 treatm5t1 & relapse prev5tion s]vices t specifically addresses ! cultural1 hi/orical1 social1 & *ild c>e ne$s ( ,indian wom51 reg>dless ( age4 7b7 ,use ( grant funds ,a grant made pursuant to ?is section may be us$-- 7#a7 to develop & provide community tra9+1 education1 & prev5tion programs = ,indian wom5 relat+ to behavioral heal? issues1 includ+ fetal alcohol spectrum disord]s2 7#b7 to id5tify & provide psy*ological s]vices1 c\nsel+1 advocacy1 support1 & relapse prev5tion to ,indian wom5 & _! families2 & 7#c7 to develop prev5tion & int]v5tion models = ,indian wom5 :i* incorporate traditional heal? c>e practices1 cultural values1 & community & family involvem5t4 7c7 ,crit]ia ,! ,secret>y1 9 consultation ) ,indian tribes & tribal organizations1 %all e/abli% crit]ia = ! review & approval ( applications & proposals = fund+ "u ?is section4 7d7 ,allocation ( funds = urban ,indian organizations #bj p]c5t ( ! funds appropriat$ pursuant to ?is section %all be us$ to make grants to urban ,indian organizations4 #gjh4 ,indian y\? program 7a7 ,detoxification & rehabilitation ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 consi/5t ) section #gjb1 %all develop & implem5t a program = acute detoxification & treatm5t = ,indian y\?s1 includ+ behavioral heal? s]vices4 ,! program %all include regional treatm5t c5t]s design$ to include detoxification & rehabilitation = bo? sexes on a ref]ral basis & programs develop$ & implem5t$ by ,indian tribes or tribal organizations at ! local level "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq474 ,regional c5t]s %all be integrat$ ) ! intake & rehabilitation programs bas$ 9 ! ref]r+ ,indian community4 7b7 ,alcohol & sub/ance abuse treatm5t c5t]s or facilities 7#a7 ,e/abli%m5t 7,a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all con/ruct1 r5ovate1 or1 z necess>y1 pur*ase1 & appropriately /aff & op]ate1 at lea/ #a y\? regional treatm5t c5t] or treatm5t network 9 ea* area "u ! jurisdiction ( an area (fice4 7,b7 ,area (fice 9 ,cali=nia ,= ! purposes ( ?is subsection1 ! area (fice 9 ,cali=nia %all be consid]$ to be #b area (fices1 #a (fice ^: jurisdiction %all be consid]$ to encompass ! nor!rn area ( ! ,/ate ( ,cali=nia1 & #a (fice ^: jurisdiction %all be consid]$ to encompass ! rema9d] ( ! ,/ate ( ,cali=nia = ! purpose ( implem5t+ ,cali=nia treatm5t networks4 7#b7 ,fund+ ,= ! purpose ( /aff+ & op]at+ su* c5t]s or facilities1 fund+ %all be pursuant to ! ,act ( ,novemb] #b1 #aiba 7#be ,u4,s4,c4 #ac74 7#c7 ,location ,a y\? treatm5t c5t] con/ruct$ or pur*as$ "u ?is subsection %all be con/ruct$ or pur*as$ at a location )9 ! area describ$ 9 p>agraph 7#a7 agre$ ^u 7by appropriate tribal resolution7 by a majority ( ! ,indian tribes to be s]v$ by su* c5t]4 7#d7 ,specific provision ( funds 7,a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 ! ,secret>y may1 f am\nts au?oriz$ to be appropriat$ = ! purposes ( c>ry+ out ?is section1 make funds available to-- 7i7 ! ,tanana ,*iefs ,conf]5ce1 ,incorporat$1 = ! purpose ( leas+1 con/ruct+1 r5ovat+1 op]at+1 & ma9ta9+ a resid5tial y\? treatm5t facility 9 ,fairbanks1 ,alaska2 & 7ii7 ! ,s\!a/ ,alaska ,regional ,heal? ,corporation to /aff & op]ate a resid5tial y\? treatm5t facility )\t reg>d to ! proviso set =? 9 section #d7l7 ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej;b7l774 7,b7 ,provision ( s]vices to eligible y\?s ,until additional resid5tial y\? treatm5t facilities are e/abli%$ 9 ,alaska pursuant to ?is section1 ! facilities specifi$ 9 subp>agraph 7,a7 %all make e ef=t to provide s]vices to all eligible ,indian y\?s resid+ 9 ,alaska4 7c7 ,int]m$iate adolesc5t behavioral heal? s]vices 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 may provide int]m$iate behavioral heal? s]vices1 :i* may 1 if feasible & appropriate1 incorporate sy/ems ( c>e1 to ,indian *ildr5 & adolesc5ts1 includ+-- 7,a7 pretreatm5t assi/ance2 7,b7 inpati5t1 outpati5t1 & aft]c>e s]vices2 7,c7 em]g5cy c>e2 7,d7 suicide prev5tion & crisis int]v5tion2 & 7,e7 prev5tion & treatm5t ( m5tal illness & dysfunctional & self-de/ructive behavior1 includ+ *ild abuse & family viol5ce4 7#b7 ,use ( funds ,funds provid$ "u ?is subsection may be us$-- 7,a7 to con/ruct or r5ovate an exi/+ heal? facility to provide int]m$iate behavioral heal? s]vices2 7,b7 to hire behavioral heal? pr(essionals2 7,c7 to /aff1 op]ate1 & ma9ta9 an int]m$iate m5tal heal? facility1 gr\p home1 sob] h\s+1 transitional h\s+ or simil> facilities1 or y\? %elt] :]e int]m$iate behavioral heal? s]vices are be+ provid$2 7,d7 to make r5ovations & hire appropriate /aff to conv]t exi/+ hospital b$s into adolesc5t psy*iatric units2 & 7,e7 = int5sive home- & community-bas$ s]vices4 7#c7 ,crit]ia ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all1 9 consultation ) ,indian tribes & tribal organizations1 e/abli% crit]ia = ! review & approval ( applications or proposals = fund+ made available pursuant to ?is subsection4 7d7 ,f$]ally own$ /ructures 7#a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ,indian tribes & tribal organizations1 %all-- 7,a7 id5tify & use1 :]e appropriate1 f$]ally own$ /ructures suitable = local resid5tial or regional behavioral heal? treatm5t = ,indian y\?s2 & 7,b7 e/abli% guidel9es = det]m9+ ! suitability ( any su* f$]ally own$ /ructure to be us$ = local resid5tial or regional behavioral heal? treatm5t = ,indian y\?s4 7#b7 ,t]ms & conditions = use ( /ructure ,any /ructure describ$ 9 p>agraph 7#a7 may be us$ "u su* t]ms & conditions z may be agre$ ^u by ! ,secret>y & ! ag5cy hav+ responsibility = ! /ructure & any ,indian tribe or tribal organization op]at+ ! program4 7e7 ,rehabilitation & aft]c>e s]vices 7#a7 ,9 g5]al ,! ,secret>y1 ,indian tribes1 or tribal organizations1 9 coop]ation ) ! ,secret>y ( ! ,int]ior1 %all develop & implem5t )9 ea* ,s]vice unit1 community-bas$ rehabilitation & foll[-up s]vices = ,indian y\?s :o are hav+ significant behavioral heal? problems1 & require long-t]m treatm5t1 community re9tegration1 & monitor+ to support ! ,indian y\?s aft] _! return to _! home community4 7#b7 ,adm9i/ration ,s]vices "u p>agraph 7#a7 %all be provid$ by tra9$ /aff )9 ! community :o c assi/ ! ,indian y\?s 9 _! cont9u+ developm5t ( self-image1 positive problem-solv+ skills1 & nonalcohol or sub/ance abus+ behaviors4 ,su* /aff may include alcohol & sub/ance abuse c\nselors1 m5tal heal? pr(essionals1 & o!r heal? pr(essionals & p>apr(essionals1 includ+ community heal? repres5tatives4 7f7 ,inclusion ( family 9 y\? treatm5t program ,9 provid+ ! treatm5t & o!r s]vices to ,indian y\?s au?oriz$ by ?is section1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide = ! inclusion ( family memb]s ( su* y\?s 9 ! treatm5t programs or o!r s]vices z may be appropriate4 ,n less ?an #aj p]c5t ( ! funds appropriat$ = ! purposes ( c>ry+ out subsection 7e7 %all be us$ = outpati5t c>e ( adult family memb]s relat$ to ! treatm5t ( an ,indian y\? "u t subsection4 7g7 ,multidrug abuse program ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide1 consi/5t ) section #gjb1 programs & s]vices to prev5t & treat ! abuse ( multiple =ms ( sub/ances1 includ+ alcohol1 drugs1 inhalants1 & tobacco1 among ,indian y\?s resid+ 9 ,indian communities1 on or ne> res]vations1 & 9 urban areas & provide appropriate m5tal heal? s]vices to address ! incid5ce ( m5tal illness among su* y\?s4 7h7 ,indian y\? m5tal heal? ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all collect data = ! report "u section #hja ) respect to-- 7#a7 ! numb] ( ,indian y\? :o are be+ provid$ m5tal heal? s]vices ?r\gh ! ,s]vice & tribal heal? programs2 7#b7 a description (1 & co/s associat$ )1 ! m5tal heal? s]vices provid$ = ,indian y\? ?r\gh ! ,s]vice & tribal heal? programs2 7#c7 ! numb] ( y\? ref]r$ to ! ,s]vice or tribal heal? programs = m5tal heal? s]vices2 7#d7 ! numb] ( ,indian y\? provid$ resid5tial treatm5t = m5tal heal? & behavioral problems ?r\gh ! ,s]vice & tribal heal? programs1 report$ sep>ately = on- & (f-res]vation facilities2 & 7#e7 ! co/s ( ! s]vices describ$ 9 p>agraph 7#d74 #gji4 ,inpati5t & community-bas$ m5tal heal? facilities design1 con/ruction1 & /aff+ ,n lat] ?an #a ye> aft] ! date ( enactm5t ( the,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 may provide1 9 ea* area ( ! ,s]vice1 n less ?an #a inpati5t m5tal heal? c>e facility1 or ! equival5t1 = ,indians ) behavioral heal? problems4 ,= ! purposes ( ?is subsection1 ,cali=nia %all be consid]$ to be #b area (fices1 #a (fice ^: location %all be consid]$ to encompass ! nor!rn area ( ! ,/ate ( ,cali=nia & #a (fice ^: jurisdiction %all be consid]$ to encompass ! rema9d] ( ! ,/ate ( ,cali=nia4 ,! ,secret>y %all consid] ! possible conv]sion ( exi/+1 und]us$ ,s]vice hospital b$s into psy*iatric units to meet su* ne$4 #gaj4 ,tra9+ & community education 7a7 ,program ,! ,secret>y1 9 coop]ation ) ! ,secret>y ( ! ,int]ior1 %all develop & implem5t or assi/ ,indian tribes & tribal organizations to develop & implem5t1 )9 ea* ,s]vice unit or tribal program1 a program ( community education & involvem5t :i* %all be design$ to provide concise & timely in=mation to ! community lead]%ip ( ea* tribal community4 ,su* program %all include education ab\t behavioral heal? issues to political lead]s1 tribal judges1 law en=cem5t p]sonnel1 memb]s ( tribal heal? & education bo>ds1 heal? c>e provid]s includ+ traditional practition]s1 & o!r critical memb]s ( ea* tribal community4 ,su* program may also include community-bas$ tra9+ to develop local capacity & tribal community provid] tra9+ = prev5tion1 int]v5tion1 treatm5t1 & aft]c>e4 7b7 ,in/ruction ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide in/ruction 9 ! area ( behavioral heal? issues1 includ+ in/ruction 9 crisis int]v5tion & family relations 9 ! context ( alcohol & sub/ance abuse1 *ild sexual abuse1 y\? alcohol & sub/ance abuse1 & ! causes & effects ( fetal alcohol spectrum disord]s to appropriate employees ( ! ,bureau ( ,indian ,affairs & ! ,s]vice1 & to p]sonnel 9 s*ools or programs op]at$ "u any contract ) ! ,bureau ( ,indian ,affairs or ! ,s]vice1 includ+ sup]visors ( em]g5cy %elt]s & halfway h\ses describ$ 9 section #dbac ( ! ,indian ,alcohol & ,sub/ance ,abuse ,prev5tion & ,treatm5t ,act ( #aihf 7#be ,u4,s4,c4 #bdcc74 7c7 ,tra9+ models ,9 c>ry+ out ! education & tra9+ programs requir$ by ?is section1 ! ,secret>y1 9 consultation ) ,indian tribes1 tribal organizations1 ,indian behavioral heal? exp]ts1 & ,indian alcohol & sub/ance abuse prev5tion exp]ts1 %all develop & provide community-bas$ tra9+ models4 ,su* models %all address-- 7#a7 ! elevat$ risk ( alcohol abuse & o!r behavioral heal? problems fac$ by *ildr5 ( alcoholics2 7#b7 ! cultural1 spiritual1 & multig5]ational aspects ( behavioral heal? problem prev5tion & recov]y2 & 7#c7 community-bas$ & multidiscipl9>y /rategies = prev5t+ & treat+ behavioral heal? problems4 #gaa4 ,behavioral heal? program 7a7 ,innovative programs ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 consi/5t ) section #gjb1 may plan1 develop1 implem5t1 & c>ry out programs to deliv] innovative community-bas$ behavioral heal? s]vices to ,indians4 7b7 ,aw>ds2 crit]ia ,! ,secret>y may aw>d a grant = a project "u subsection 7a7 to an ,indian tribe or tribal organization & may consid] ! foll[+ crit]ia3 7#a7 ,! project w address significant unmet behavioral heal? ne$s among ,indians4 7#b7 ,! project w s]ve a significant numb] ( ,indians4 7#c7 ,! project has ! pot5tial to deliv] s]vices 9 an effici5t & effective mann]4 7#d7 ,! ,indian tribe or tribal organization has ! adm9i/rative & f9ancial capability to adm9i/] ! project4 7#e7 ,! project may deliv] s]vices 9 a mann] consi/5t ) traditional heal? c>e practices4 7#f7 ,! project is coord9at$ )1 & avoids duplication (1 exi/+ s]vices4 7c7 ,equitable treatm5t ,= purposes ( ?is subsection1 ! ,secret>y %all1 9 evaluat+ project applications or proposals1 use ! same crit]ia t ! ,secret>y uses 9 evaluat+ any o!r application or proposal = su* fund+4 #gab4 ,fetal alcohol spectrum disord]s programs 7a7 ,programs 7#a7 ,e/abli%m5t ,! ,secret>y1 consi/5t ) section #gjb1 act+ ?r\gh ! ,s]vice1 ,indian ,tribes1 & ,tribal ,organizations1 is au?oriz$ to e/abli% & op]ate fetal alcohol spectrum disord]s programs z provid$ 9 ?is section = ! purposes ( meet+ ! heal? /atus objectives specifi$ 9 section #c4 7#b7 ,use ( funds 7,a7 ,9 g5]al ,fund+ provid$ pursuant to ?is section %all be us$ = ! foll[+3 7i7 ,to develop & provide = ,indians community & 9-s*ool tra9+1 education1 & prev5tion programs relat+ to fetal alcohol spectrum disord]s4 7ii7 ,to id5tify & provide behavioral heal? treatm5t to high-risk ,indian wom5 & high-risk wom5 pregnant ) an ,indian's *ild4 7iii7 ,to id5tify & provide appropriate psy*ological s]vices1 educational & vocational support1 c\nsel+1 advocacy1 & in=mation to fetal alcohol spectrum disord]s-affect$ ,indians & _! families or c>etak]s4 7iv7 ,to develop & implem5t c\nsel+ & support programs 9 s*ools = fetal alcohol spectrum disord]s-affect$ ,indian *ildr54 7v7 ,to develop prev5tion & int]v5tion models :i* incorporate practition]s ( traditional heal? c>e practices1 cultural values1 & community involvem5t4 7vi7 ,to develop1 pr9t1 & dissem9ate education & prev5tion mat]ials on fetal alcohol spectrum disord]s4 7vii7 ,to develop & implem5t1 9 consultation ) ,indian ,tribes & ,tribal ,organizations1 & 9 conf]5ce ) urban ,indian ,organizations1 culturally s5sitive assessm5t & diagno/ic tools includ+ dysmorphology cl9ics & multidiscipl9>y fetal alcohol spectrum disord]s cl9ics = use 9 ,indian communities & urban ,c5t]s4 7viii7 ,to develop & provide tra9+ on fetal alcohol spectrum disord]s to pr(essionals provid+ s]vices to ,indians1 includ+ m$ical & alli$ heal? practition]s1 social s]vice provid]s1 educators1 & law en=cem5t1 c\rt (ficials & corrections p]sonnel 9 ! juv5ile & crim9al ju/ice sy/ems4 7,b7 ,additional uses ,9 addition to any purpose "u subp>agraph 7,a71 fund+ provid$ pursuant to ?is section may be us$ = #a or m ( ! foll[+3 7i7 ,e>ly *ildhood int]v5tion projects f bir? on to mitigate ! effects ( fetal alcohol spectrum disord]s among ,indians4 7ii7 ,community-bas$ support s]vices = ,indians & wom5 pregnant ) ,indian *ildr54 7iii7 ,community-bas$ h\s+ = adult ,indians ) fetal alcohol spectrum disord]s4 7#c7 ,crit]ia = applications ,! ,secret>y %all e/abli% crit]ia = ! review & approval ( applications = fund+ "u ?is section4 7b7 ,s]vices ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian ,tribes1 & ,tribal ,organizations1 %all-- 7#a7 develop & provide s]vices = ! prev5tion1 int]v5tion1 treatm5t1 & aft]c>e = ^? affect$ by fetal alcohol spectrum disord]s 9 ,indian communities2 & 7#b7 provide supportive s]vices1 includ+ s]vices to meet ! special educational1 vocational1 s*ool-to-"w transition1 & indep5d5t liv+ ne$s ( adolesc5t & adult ,indians ) fetal alcohol spectrum disord]s4 7c7 ,appli$ rese>* projects ,! ,secret>y1 act+ ?r\gh ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 %all make grants to ,indian ,tribes1 ,tribal ,organizations1 & urban ,indian ,organizations = appli$ rese>* projects :i* propose to elevate ! und]/&+ ( me?ods to prev5t1 int]v5e1 treat1 or provide rehabilitation & behavioral heal? aft]c>e = ,indians & urban ,indians affect$ by fetal alcohol spectrum disord]s4 7d7 ,fund+ = urban ,indian ,organizations ,t5 p]c5t ( ! funds appropriat$ pursuant to ?is section %all be us$ to make grants to urban ,indian ,organizations fund$ "u title ,v4 #gac4 ,*ild sexual abuse prev5tion & treatm5t programs 7a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli%1 consi/5t ) section #gjb1 9 e ,s]vice area1 programs involv+ treatm5t =-- 7#a7 victims ( sexual abuse :o are ,indian *ildr5 or *ildr5 9 an ,indian h\sehold2 & 7#b7 o!r memb]s ( ! h\sehold or family ( ! victims describ$ 9 p>agraph 7#a74 7b7 ,use ( funds ,fund+ provid$ pursuant to ?is section %all be us$ = ! foll[+3 7#a7 ,to develop & provide community education & prev5tion programs relat$ to sexual abuse ( ,indian *ildr5 or *ildr5 9 an ,indian h\sehold4 7#b7 ,to id5tify & provide behavioral heal? treatm5t to victims ( sexual abuse :o are ,indian *ildr5 or *ildr5 9 an ,indian h\sehold1 & to _! family memb]s :o are affect$ by sexual abuse4 7#c7 ,to develop prev5tion & int]v5tion models :i* incorporate traditional heal? c>e practices1 cultural values1 & community involvem5t4 7#d7 ,to develop & implem5t culturally s5sitive assessm5t & diagno/ic tools = use 9 ,indian communities & urban c5t]s4 7c7 ,coord9ation ,! programs e/abli%$ "u subsection 7a7 %all be c>ri$ out 9 coord9ation ) programs & s]vices au?oriz$ "u ! ,indian ,*ild ,protection & ,family ,viol5ce ,prev5tion ,act 7#be ,u4,s4,c4 #cbja et seq474 #gad4 ,dome/ic & sexual viol5ce prev5tion & treatm5t 7a7 ,9 g5]al ,! ,secret>y1 9 accordance ) section #gjb1 is au?oriz$ to e/abli% 9 ea* ,s]vice area programs involv+ ! prev5tion & treatm5t (-- 7#a7 ,indian victims ( dome/ic viol5ce or sexual abuse2 & 7#b7 o!r memb]s ( ! h\sehold or family ( ! victims describ$ 9 p>agraph 7#a74 7b7 ,use ( funds ,funds made available to c>ry out ?is section %all be us$-- 7#a7 to develop & implem5t prev5tion programs & community education programs relat+ to dome/ic viol5ce & sexual abuse2 7#b7 to provide behavioral heal? s]vices1 includ+ victim support s]vices1 & m$ical treatm5t 7includ+ exam9ations p]=m$ by sexual assault nurse exam9]s7 to ,indian victims ( dome/ic viol5ce or sexual abuse2 7#c7 to pur*ase rape kits2 & 7#d7 to develop prev5tion & int]v5tion models1 :i* may incorporate traditional heal? c>e practices4 7c7 ,tra9+ & c]tification 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all e/abli% appropriate protocols1 policies1 proc$ures1 /&>ds ( practice1 &1 if n available else:]e1 tra9+ curricula & tra9+ & c]tification requirem5ts = s]vices = victims ( dome/ic viol5ce & sexual abuse4 7#b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report t describes ! means & ext5t to :i* ! ,secret>y has c>ri$ out p>agraph 7#a74 7d7 ,coord9ation 7#a7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) ! ,attorney ,g5]al1 ,f$]al & tribal law en=cem5t ag5cies1 ,indian heal? programs1 & dome/ic viol5ce or sexual assault victim organizations1 %all develop appropriate victim s]vices & victim advocate tra9+ programs-- 7,a7 to improve dome/ic viol5ce or sexual abuse responses2 7,b7 to improve =5sic exam9ations & collection2 7,c7 to id5tify problems or ob/acles 9 ! prosecution ( dome/ic viol5ce or sexual abuse2 & 7,d7 to meet o!r ne$s or c>ry out o!r activities requir$ to prev5t1 treat1 & improve prosecutions ( dome/ic viol5ce & sexual abuse4 7#b7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report t describes1 ) respect to ! matt]s describ$ 9 p>agraph 7#a71 ! improvem5ts made & ne$$1 problems or ob/acles id5tifi$1 & co/s necess>y to address ! problems or ob/acles1 & any o!r recomm5dations t ! ,secret>y det]m9es to be appropriate4 #gae4 ,behavioral heal? rese>* 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) appropriate ,f$]al ag5cies1 %all make grants to1 or ent] into contracts )1 ,indian tribes1 tribal organizations1 & urban ,indian organizations or ent] into contracts )1 or make grants to appropriate in/itutions =1 ! conduct ( rese>* on ! incid5ce & preval5ce ( behavioral heal? problems among ,indians s]v$ by ! ,s]vice1 ,indian tribes1 or tribal organizations & among ,indians 9 urban areas4 ,rese>* priorities "u ?is section %all include-- 7#a7 ! multifactorial causes ( ,indian y\? suicide1 includ+-- 7,a7 protective & risk factors & sci5tific data t id5tifies ^? factors2 & 7,b7 ! effects ( loss ( cultural id5tity & ! developm5t ( sci5tific data on ^? effects2 7#b7 ! int]relation%ip & int]dep5d5ce ( behavioral heal? problems ) alcoholism & o!r sub/ance abuse1 suicide1 homicides1 o!r injuries1 & ! incid5ce ( family viol5ce2 & 7#c7 ! developm5t ( models ( prev5tion te*niques4 7b7 ,emphasis ,! effect ( ! int]relation%ips & int]dep5d5cies ref]r$ to 9 subsection 7a77#b7 on *ildr51 & ! developm5t ( prev5tion te*niques "u subsection 7a77#c7 applicable to *ildr51 %all be emphasiz$4 ,b ,indian y\? suicide prev5tion #gba4 ,f9d+s & purpose 7a7 ,f9d+s ,congress f9ds t-- 7#a7 7,a7 ! rate ( suicide ( ,am]ican ,indians & ,alaska ,natives is #a4i times high] ?an ! national av]age rate2 & 7,b7 ! rate ( suicide ( ,indian & ,alaska ,native y\? ag$ #ae ?r\gh #bd is-- 7i7 #c4e times ! national av]age rate2 & 7ii7 ! highe/ rate ( any population gr\p 9 ! ,unit$ ,/ates2 7#b7 _m risk behaviors & contribut+ factors = suicide are m preval5t 9 ,indian c\ntry ?an 9 o!r areas1 includ+-- 7,a7 hi/ory ( previ\s suicide attempts2 7,b7 family hi/ory ( suicide2 7,c7 hi/ory ( depression or o!r m5tal illness2 7,d7 alcohol or drug abuse2 7,e7 heal? disp>ities2 7,f7 /ressful life ev5ts & losses2 7,g7 easy access to le?al me?ods2 7,h7 exposure to ! suicidal behavior ( o!rs2 7,i7 isolation2 & 7,j7 inc>c]ation2 7#c7 accord+ to national data = #bjje1 suicide 0 ! second-lead+ cause ( dea? = ,indians & ,alaska ,natives ( bo? sexes ag$ #aj ?r\gh #cd2 7#d7 7,a7 ! suicide rates ( ,indian & ,alaska ,native males ag$ #ae ?r\gh #bd are-- 7i7 z comp>$ to suicide rates ( males ( any o!r racial gr\p1 up to #d times great]2 & 7ii7 z comp>$ to suicide rates ( females ( any o!r racial gr\p1 up to #aa times great]2 & 7,b7 data demon/rates t1 ov] _! lifetimes1 females attempt suicide #b to #c times m (t5 ?an males2 7#e7 7,a7 ,indian tribes1 especially ,indian tribes locat$ 9 ! ,great ,pla9s1 h exp]i5c$ epidemic levels ( suicide1 up to #aj times ! national av]age2 & 7,b7 suicide clu/]+ 9 ,indian c\ntry affects entire tribal communities2 7#f7 dea? rates = ,indians & ,alaska ,natives are /ati/ically und]e/imat$ because _m areas ( ,indian c\ntry lack ! prop] res\rces to id5tify & monitor ! pres5ce ( disease2 7#g7 7,a7 ! ,indian ,heal? ,s]vice exp]i5ces heal? pr(essional %ortages1 ) physician vacancy rates ( approximately #ag p]c5t1 & nurs+ vacancy rates ( approximately #ah p]c5t1 9 #bjjg2 7,b7 #ij p]c5t ( all te5s :o die by suicide suff] f a diagnosable m5tal illness at "t ( dea?2 7,c7 m ?an #ab ( te5s :o die by suicide h nev] be5 se5 by a m5tal heal? provid]2 & 7,d7 #a_/c ( heal? ne$s 9 ,indian c\ntry relate to m5tal heal?2 7#h7 (t51 ! lack ( res\rces ( ,indian tribes & ! remote nature ( ,indian res]vations make x difficult to meet ! requirem5ts necess>y to access ,f$]al assi/ance1 includ+ grants2 7#i7 ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration & ! ,s]vice h e/abli%$ specific initiatives to combat y\? suicide 9 ,indian c\ntry & among ,indians & ,alaska ,natives ?r\gh\t ! ,unit$ ,/ates1 includ+ ! ,national ,suicide ,prev5tion ,initiative ( ! ,s]vice1 :i* has work$ ) ,s]vice1 tribal1 & urban ,indian heal? programs s9ce #bjjc2 7#aj7 ! ,national ,/rategy = ,suicide ,prev5tion 0 e/abli%$ 9 #bjja ?r\gh a ,dep>tm5t ( ,heal? & ,human ,s]vices collaboration among-- 7,a7 ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration2 7,b7 ! ,s]vice2 7,c7 ! ,c5t]s = ,disease ,control & ,prev5tion2 7,d7 ! ,national ,in/itutes ( ,heal?2 & 7,e7 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 & 7#aa7 ! ,s]vice & o!r ag5cies ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices use in=mation te*nology & o!r programs to address ! suicide prev5tion & m5tal heal? ne$s ( ,indians & ,alaska ,natives4 7b7 ,purposes ,! purposes ( ?is subtitle are-- 7#a7 to au?orize ! ,secret>y to c>ry out a demon/ration project to te/ ! use ( telem5tal heal? s]vices 9 suicide prev5tion1 int]v5tion1 & treatm5t ( ,indian y\?1 includ+ ?r\gh-- 7,a7 ! use ( psy*o!rapy1 psy*iatric assessm5ts1 diagno/ic int]views1 !rapies = m5tal heal? conditions pr$ispos+ to suicide1 & alcohol & sub/ance abuse treatm5t2 7,b7 ! provision ( cl9ical exp]tise to1 consultation s]vices )1 & m$ical advice & tra9+ = frontl9e heal? c>e provid]s work+ ) ,indian y\?2 7,c7 tra9+ & relat$ support = community lead]s1 family memb]s1 & heal? & education work]s :o "w ) ,indian y\?2 7,d7 ! developm5t ( culturally relevant educational mat]ials on suicide2 & 7,e7 data collection & report+2 7#b7 to enc\rage ,indian tribes1 tribal organizations1 & o!r m5tal heal? c>e provid]s s]v+ resid5ts ( ,indian c\ntry to obta9 ! s]vices ( pr$octoral psy*ology & psy*iatry int]ns2 & 7#c7 to enhance ! provision ( m5tal heal? c>e s]vices to ,indian y\? ?r\gh exi/+ grant programs ( ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration4 #gbb4 ,def9itions ,9 ?is subtitle3 7#a7 ,adm9i/ration ,! t]m ,adm9i/ration means ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration4 7#b7 ,demon/ration project ,! t]m demon/ration project means ! ,indian y\? telem5tal heal? demon/ration project au?oriz$ "u section #gbc7;a74 7#c7 ,telem5tal heal? ,! t]m telem5tal heal? means ! use ( electronic in=mation & telecommunications te*nologies to support long-di/ance m5tal heal? c>e1 pati5t & pr(essional-relat$ education1 public heal?1 & heal? adm9i/ration4 #gbc4 ,indian y\? telem5tal heal? demon/ration project 7a7 ,au?orization 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 is au?oriz$ to c>ry out a demon/ration project to aw>d grants = ! provision ( telem5tal heal? s]vices to ,indian y\? :o-- 7,a7 h express$ suicidal ideas2 7,b7 h attempt$ suicide2 or 7,c7 h behavioral heal? conditions t increase or c\ld increase ! risk ( suicide4 7#b7 ,eligibility = grants ,grants "u p>agraph 7#a7 %all be aw>d$ to ,indian tribes & tribal organizations t op]ate #a or m facilities-- 7,a7 locat$ 9 an area ) docum5t$ disproportionately high rates ( suicide2 7,b7 report+ active cl9ical teleheal? capabilities2 or 7,c7 (f]+ s*ool-bas$ telem5tal heal? s]vices to ,indian y\?4 7#c7 ,grant p]iod ,! ,secret>y %all aw>d grants "u ?is section = a p]iod ( up to #d ye>s4 7#d7 ,maximum numb] ( grants ,n m ?an #e grants %all be provid$ "u p>agraph 7#a71 ) priority consid]ation giv5 to ,indian tribes & tribal organizations t-- 7,a7 s]ve a p>ticul> community or geographic area 9 :i* !re is a demon/rat$ ne$ to address ,indian y\? suicide2 7,b7 ent] into collaborative p>tn]%ips ) ,s]vice or o!r tribal heal? programs or facilities to provide s]vices "u ?is demon/ration project2 7,c7 s]ve an isolat$ community or geographic area t has limit$ or no access to behavioral heal? s]vices2 or 7,d7 op]ate a det5tion facility at :i* ,indian y\? are deta9$4 7#e7 ,consultation ) ,adm9i/ration ,9 develop+ & c>ry+ out ! demon/ration project "u ?is subsection1 ! ,secret>y %all consult ) ! ,adm9i/ration z ! ,f$]al ag5cy focus$ on m5tal heal? issues1 includ+ suicide4 7b7 ,use ( funds 7#a7 ,9 g5]al ,an ,indian tribe or tribal organization %all use a grant receiv$ "u subsection 7a7 = ! foll[+ purposes3 7,a7 ,to provide telem5tal heal? s]vices to ,indian y\?1 includ+ ! provision (-- 7i7 psy*o!rapy2 7ii7 psy*iatric assessm5ts & diagno/ic int]views1 !rapies = m5tal heal? conditions pr$ispos+ to suicide1 & treatm5t2 & 7iii7 alcohol & sub/ance abuse treatm5t4 7,b7 ,to provide cl9ician-int]active m$ical advice1 guidance & tra9+1 assi/ance 9 diagnosis & int]pretation1 crisis c\nsel+ & int]v5tion1 & relat$ assi/ance to ,s]vice or tribal cl9icians & heal? s]vices provid]s work+ ) y\? be+ s]v$ "u ! demon/ration project4 7,c7 ,to assi/1 educate1 & tra9 community lead]s1 heal? education pr(essionals & p>apr(essionals1 tribal outrea* work]s1 & family memb]s :o "w ) ! y\? receiv+ telem5tal heal? s]vices "u ! demon/ration project1 includ+ ) id5tification ( suicidal t5d5cies1 crisis int]v5tion & suicide prev5tion1 em]g5cy skill developm5t1 & build+ & exp&+ networks among ^? individuals & ) ,/ate & local heal? s]vices provid]s4 7,d7 ,to develop & di/ribute culturally appropriate community educational mat]ials reg>d+-- 7i7 suicide prev5tion2 7ii7 suicide education2 7iii7 suicide scre5+2 7iv7 suicide int]v5tion2 & 7v7 ways to mobilize communities ) respect to ! id5tification ( risk factors = suicide4 7,e7 ,to conduct data collection & report+ relat+ to ,indian y\? suicide prev5tion ef=ts4 7#b7 ,traditional heal? c>e practices ,9 c>ry+ out ! purposes describ$ 9 p>agraph 7#a71 an ,indian tribe or tribal organization may use & promote ! traditional heal? c>e practices ( ! ,indian tribes ( ! y\? to be s]v$4 7c7 ,applications 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 to be eligible to receive a grant "u subsection 7a71 an ,indian tribe or tribal organization %all prep>e & submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+-- 7,a7 a description ( ! project t ! ,indian tribe or tribal organization w c>ry out us+ ! funds provid$ "u ! grant2 7,b7 a description ( ! mann] 9 :i* ! project fund$ "u ! grant w\ld-- 7i7 meet ! telem5tal heal? c>e ne$s ( ! ,indian y\? population to be s]v$ by ! project2 or 7ii7 improve ! access ( ! ,indian y\? population to be s]v$ to suicide prev5tion & treatm5t s]vices2 7,c7 evid5ce ( support = ! project f ! local community to be s]v$ by ! project2 7,d7 a description ( h[ ! families & lead]%ip ( ! communities or populations to be s]v$ by ! project w\ld be involv$ 9 ! developm5t & ongo+ op]ations ( ! project2 7,e7 a plan to involve ! tribal community ( ! y\? :o are provid$ s]vices by ! project 9 plann+ & evaluat+ ! behavioral heal? c>e & suicide prev5tion ef=ts provid$1 9 ord] to ensure ! integration ( community1 cl9ical1 environm5tal1 & cultural compon5ts ( ! treatm5t2 & 7,f7 a plan = su/a9+ ! project aft] ,f$]al assi/ance = ! demon/ration project has t]m9at$4 7#b7 ,effici5cy ( grant application process ,! ,secret>y %all c>ry out su* measures z ! ,secret>y det]m9es to be necess>y to maximize ! "t & workload effici5cy ( ! process by :i* ,indian tribes & tribal organizations apply = grants "u p>agraph 7#a74 7d7 ,collaboration ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all enc\rage ,indian tribes & tribal organizations receiv+ grants "u ?is section to collaborate to enable comp>isons reg>d+ be/ practices across projects4 7e7 ,annual report ,ea* grant recipi5t %all submit to ! ,secret>y an annual report t-- 7#a7 describes ! numb] ( telem5tal heal? s]vices provid$2 & 7#b7 includes any o!r in=mation t ! ,secret>y may require4 7f7 ,reports to ,congress 7#a7 ,initial report 7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date on :i* ! fir/ grant is aw>d$ "u ?is section1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report t-- 7i7 describes ea* project fund$ by a grant "u ?is section dur+ ! prec$+ #b-ye> p]iod1 includ+ a description ( ! level ( success a*iev$ by ! project2 & 7ii7 evaluates :e!r ! demon/ration project %\ld be cont9u$ dur+ ! p]iod beg9n+ on ! date ( t]m9ation ( fund+ = ! demon/ration project "u subsection 7g7 & end+ on ! date on :i* ! f9al report is submitt$ "u p>agraph 7#b74 7,b7 ,cont9uation ( demon/ration project ,on a det]m9ation by ! ,secret>y "u clause 7ii7 ( subp>agraph 7,a7 t ! demon/ration project %\ld be cont9u$1 ! ,secret>y may c>ry out ! demon/ration project dur+ ! p]iod describ$ 9 t clause us+ su* sums o!rwise made available to ! ,secret>y z ! ,secret>y det]m9es to be appropriate4 7#b7 ,f9al report ,n lat] ?an #bgj days aft] ! date ( t]m9ation ( fund+ = ! demon/ration project "u subsection 7g71 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a f9al report t-- 7,a7 describes ! results ( ! projects fund$ by grants aw>d$ "u ?is section1 includ+ any data available t indicate ! numb] ( attempt$ suicides2 7,b7 evaluates ! impact ( ! telem5tal heal? s]vices fund$ by ! grants 9 r$uc+ ! numb] ( complet$ suicides among ,indian y\?2 7,c7 evaluates :e!r ! demon/ration project %\ld be-- 7i7 exp&$ to provide m ?an #e grants2 & 7ii7 designat$ z a p]man5t program2 & 7,d7 evaluates ! b5efits ( exp&+ ! demon/ration project to include urban ,indian organizations4 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #a1ejj1jjj = ea* ( fiscal ye>s #bjag ?r\gh #bjai4 #gbd4 ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration grants 7a7 ,grant applications 7#a7 ,effici5cy ( grant application process ,! ,secret>y1 act+ ?r\gh ! ,adm9i/ration1 %all c>ry out su* measures z ! ,secret>y det]m9es to be necess>y to maximize ! "t & workload effici5cy ( ! process by :i* ,indian tribes & tribal organizations apply = grants "u any program adm9i/]$ by ! ,adm9i/ration1 includ+ by provid+ me?ods o!r ?an electronic me?ods ( submitt+ applications = ^? grants1 if necess>y4 7#b7 ,priority = c]ta9 grants 7,a7 ,9 g5]al ,to fulfill ! tru/ responsibility ( ! ,unit$ ,/ates to ,indian tribes1 9 aw>d+ relevant grants pursuant to a program describ$ 9 subp>agraph 7,b71 ! ,secret>y %all take into consid]ation ! ne$s ( ,indian tribes or tribal organizations1 z applicable1 t s]ve populations ) docum5t$ high suicide rates1 reg>dless ( :e!r ^? ,indian tribes or tribal organizations possess adequate p]sonnel or infra/ructure to fulfill all applicable requirem5ts ( ! relevant program4 7,b7 ,description ( grant programs ,a grant program ref]r$ to 9 subp>agraph 7,a7 is a grant program-- 7i7 adm9i/]$ by ! ,adm9i/ration to fund activities relat+ to m5tal heal?1 suicide prev5tion1 or suicide-relat$ risk factors2 & 7ii7 "u :i* an ,indian tribe or tribal organization is an eligible recipi5t4 7#c7 ,cl>ification reg>d+ ,indian tribes & tribal organizations ,not)/&+ any o!r provision ( law1 9 apply+ = a grant "u any program adm9i/]$ by ! ,adm9i/ration1 no ,indian tribe or tribal organization %all be requir$ to apply ?r\gh a ,/ate or ,/ate ag5cy4 7#d7 ,requirem5ts = affect$ ,/ates 7,a7 ,def9itions ,9 ?is p>agraph3 7i7 ,affect$ ,/ate ,! t]m affect$ ,/ate means a ,/ate-- 7,i7 ! b\nd>ies ( :i* include #a or m ,indian tribes2 & 7,,ii7 ! application = a grant "u any program adm9i/]$ by ! ,adm9i/ration ( :i* includes /atewide data4 7ii7 ,indian population ,! t]m ,indian population means ! total numb] ( resid5ts ( an affect$ ,/ate :o are ,indian4 7,b7 ,requirem5ts ,z a condition ( receipt ( a grant "u any program adm9i/]$ by ! ,adm9i/ration1 ea* affect$ ,/ate %all-- 7i7 describe 9 ! grant application-- 7,i7 ! ,indian population ( ! affect$ ,/ate2 & 7,,ii7 ! contribution ( t ,indian population to ! /atewide data us$ by ! affect$ ,/ate 9 ! application2 & 7ii7 demon/rate to ! satisfaction ( ! ,secret>y t-- 7,i7 ( ! total am\nt ( ! grant1 ! affect$ ,/ate w allocate = use = ! ,indian population ( ! affect$ ,/ate an am\nt equal to ! proportion t-- 7aa7 ! ,indian population ( ! affect$ ,/ate2 be>s to 7bb7 ! total population ( ! affect$ ,/ate2 & 7,,ii7 ! affect$ ,/ate w take reasonable ef=ts to collaborate ) ea* ,indian tribe locat$ )9 ! affect$ ,/ate to c>ry out y\? suicide prev5tion & treatm5t measures = memb]s ( ! ,indian tribe4 7,c7 ,report ,n lat] ?an #a ye> aft] ! date ( receipt ( a grant describ$ 9 subp>agraph 7,b71 an affect$ ,/ate %all submit to ! ,secret>y a report describ+ ! measures c>ri$ out by ! affect$ ,/ate to ensure compliance ) ! requirem5ts ( subp>agraph 7,b77ii74 7b7 ,no non-,f$]al %>e requirem5t ,not)/&+ any o!r provision ( law1 no ,indian tribe or tribal organization %all be requir$ to provide a non-,f$]al %>e ( ! co/ ( any project or activity c>ri$ out us+ a grant provid$ "u any program adm9i/]$ by ! ,adm9i/ration4 7c7 ,outrea* = rural & isolat$ ,indian tribes ,due to ! rural1 isolat$ nature ( mo/ ,indian res]vations & communities 7especially ^? res]vations & communities 9 ! ,great ,pla9s region71 ! ,secret>y %all conduct outrea* activities1 ) a p>ticul> emphasis on ! provision ( telem5tal heal? s]vices1 to a*ieve ! purposes ( ?is subtitle ) respect to ,indian tribes locat$ 9 rural1 isolat$ areas4 7d7 ,provision ( o!r assi/ance 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/ration1 %all c>ry out su* measures 7includ+ monitor+ & ! provision ( requir$ assi/ance7 z ! ,secret>y det]m9es to be necess>y to ensure ! provision ( adequate suicide prev5tion & m5tal heal? s]vices to ,indian tribes describ$ 9 p>agraph 7#b71 reg>dless ( :e!r ^? ,indian tribes possess adequate p]sonnel or infra/ructure-- 7,a7 to submit an application = a grant "u any program adm9i/]$ by ! ,adm9i/ration1 includ+ due to problems relat+ to access to ! ,int]net or o!r electronic means t may h result$ 9 previ\s ob/acles to submission ( a grant application2 or 7,b7 to fulfill all applicable requirem5ts ( ! relevant program4 7#b7 ,description ( ,indian tribes ,an ,indian tribe ref]r$ to 9 p>agraph 7#a7 is an ,indian tribe-- 7,a7 ! memb]s ( :i* exp]i5ce-- 7i7 a high rate ( y\? suicide2 7ii7 l[ socioeconomic /atus2 & 7iii7 extreme heal? disp>ity2 7,b7 t is locat$ 9 a remote & isolat$ area2 & 7,c7 t lacks te*nology & communication infra/ructure4 7#c7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y su* sums z ! ,secret>y det]m9es to be necess>y to c>ry out ?is subsection4 7e7 ,e>ly int]v5tion & assessm5t s]vices 7#a7 ,def9ition ( affect$ entity ,9 ?is subsection1 ! t]m affect$ entity means any entity-- 7,a7 t receives a grant = suicide int]v5tion1 prev5tion1 or treatm5t "u a program adm9i/]$ by ! ,adm9i/ration2 & 7,b7 ! population to be s]v$ by :i* includes ,indian y\?4 7#b7 ,requirem5t ,! ,secret>y1 act+ ?r\gh ! ,adm9i/ration1 %all ensure t ea* affect$ entity c>ry+ out a y\? suicide e>ly int]v5tion & prev5tion /rategy describ$ 9 section #ebj;,e7c77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;bb-#cf7;c77#a771 or any o!r y\? suicide-relat$ e>ly int]v5tion & assessm5t activity1 provides tra9+ or education to individuals :o int]act frequ5tly ) ! ,indian y\? to be s]v$ by ! affect$ entity 7includ+ p>5ts1 tea*]s1 coa*es1 & m5tors7 on id5tify+ w>n+ signs ( ,indian y\? :o are at risk ( committ+ suicide4 #gbe4 ,use ( pr$octoral psy*ology & psy*iatry int]ns ,! ,secret>y %all c>ry out su* activities z ! ,secret>y det]m9es to be necess>y to enc\rage ,indian tribes1 tribal organizations1 & o!r m5tal heal? c>e provid]s to obta9 ! s]vices ( pr$octoral psy*ology & psy*iatry int]ns-- 7#a7 to increase ! quantity ( pati5ts s]v$ by ! ,indian tribes1 tribal organizations1 & o!r m5tal heal? c>e provid]s2 & 7#b7 = purposes ( recruitm5t & ret5tion4 #gbf4 ,indian y\? life skills developm5t demon/ration program 7a7 ,purpose ,! purpose ( ?is section is to au?orize ! ,secret>y1 act+ ?r\gh ! ,adm9i/ration1 to c>ry out a demon/ration program to te/ ! effectiv5ess ( a culturally compatible1 s*ool-bas$1 life skills curriculum = ! prev5tion ( ,indian & ,alaska ,native adolesc5t suicide1 includ+ ?r\gh-- 7#a7 ! e/abli%m5t ( tribal p>tn]%ips to develop & implem5t su* a curriculum1 9 coop]ation )-- 7,a7 behavioral heal? pr(essionals1 ) a priority = tribal p>tn]%ips coop]at+ ) m5tal heal? pr(essionals employ$ by ! ,s]vice2 7,b7 tribal or local s*ool ag5cies2 & 7,c7 p>5t & community gr\ps2 7#b7 ! provision by ! ,adm9i/ration or ! ,s]vice (-- 7,a7 te*nical exp]tise2 & 7,b7 cl9icians1 analy/s1 & educators1 z appropriate2 7#c7 tra9+ = tea*]s1 s*ool adm9i/rators1 & community memb]s to implem5t ! curriculum2 7#d7 ! e/abli%m5t ( advisory c\ncils compos$ ( p>5ts1 educators1 community memb]s1 tra9$ pe]s1 & o!rs to provide advice reg>d+ ! curriculum & o!r compon5ts ( ! demon/ration program2 7#e7 ! developm5t ( culturally appropriate support measures to supplem5t ! effectiv5ess ( ! curriculum2 & 7#f7 projects model$ aft] evid5ce-bas$ projects1 su* z programs evaluat$ & publi%$ 9 relevant lit]ature4 7b7 ,demon/ration grant program 7#a7 ,def9itions ,9 ?is subsection3 7,a7 ,curriculum ,! t]m curriculum means ! culturally compatible1 s*ool-bas$1 life skills curriculum = ! prev5tion ( ,indian & ,alaska ,native adolesc5t suicide id5tifi$ by ! ,secret>y "u p>agraph 7#b77;,a74 7,b7 ,eligible entity ,! t]m eligible entity means-- 7i7 an ,indian tribe2 7ii7 a tribal organization2 7iii7 any o!r tribally au?oriz$ entity2 & 7iv7 any p>tn]%ip compos$ ( #b or m entities describ$ 9 clause 7i71 7ii71 or 7iii74 7#b7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,adm9i/ration1 may e/abli% & c>ry out a demon/ration program "u :i* ! ,secret>y %all-- 7,a7 id5tify a culturally compatible1 s*ool-bas$1 life skills curriculum = ! prev5tion ( ,indian & ,alaska ,native adolesc5t suicide2 7,b7 id5tify ! ,indian tribes t are at greate/ risk = adolesc5t suicide2 7,c7 invite ^? ,indian tribes to p>ticipate 9 ! demon/ration program by-- 7i7 respond+ to a compreh5sive program requirem5t reque/ ( ! ,secret>y2 or 7ii7 submitt+1 ?r\gh an eligible entity1 an application 9 accordance ) p>agraph 7#d72 & 7,d7 provide grants to ! ,indian tribes id5tifi$ "u subp>agraph 7,b7 & eligible entities to implem5t ! curriculum ) respect to ,indian & ,alaska ,native y\?s :o-- 7i7 are betwe5 ! ages ( #aj & #ai2 & 7ii7 att5d s*ool 9 a region t is at risk ( high y\? suicide rates1 z det]m9$ by ! ,adm9i/ration4 7#c7 ,requirem5ts 7,a7 ,t]m ,! t]m ( a grant provid$ "u ! demon/ration program "u ?is section %all be n less ?an #d ye>s4 7,b7 ,maximum numb] ,! ,secret>y may provide n m ?an #e grants "u ! demon/ration program "u ?is section4 7,c7 ,am\nt ,! grants provid$ "u ?is section %all be ( equal am\nts4 7,d7 ,c]ta9 s*ools ,9 select+ eligible entities to receive grants "u ?is section1 ! ,secret>y %all ensure t n less ?an #a demon/ration program %all be c>ri$ out at ea* (-- 7i7 a s*ool op]at$ by ! ,bureau ( ,indian ,education2 7ii7 a ,tribal s*ool2 & 7iii7 a s*ool receiv+ paym5ts "u section #hjjb or #hjjc ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ggjb1 #ggjc74 7#d7 ,applications ,to be eligible to receive a grant "u ! demon/ration program1 an eligible entity %all submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+-- 7,a7 an assurance t1 9 implem5t+ ! curriculum1 ! eligible entity w collaborate ) #a or m local educational ag5cies1 includ+ elem5t>y s*ools1 middle s*ools1 & high s*ools2 7,b7 an assurance t ! eligible entity w collaborate1 = ! purpose ( curriculum developm5t1 implem5tation1 & tra9+ & te*nical assi/ance1 ) #a or m-- 7i7 nonpr(it entities ) demon/rat$ exp]tise reg>d+ ! developm5t ( culturally s5sitive1 s*ool-bas$1 y\? suicide prev5tion & int]v5tion programs2 or 7ii7 in/itutions ( high] education ) demon/rat$ int]e/ & k reg>d+ culturally s5sitive1 s*ool-bas$1 life skills y\? suicide prev5tion & int]v5tion programs2 7,c7 an assurance t ! curriculum w be c>ri$ out 9 an academic sett+ 9 conjunction ) at lea/ #a classroom tea*] n less frequ5tly ?an twice ea* s*ool week = ! duration ( ! academic ye>2 7,d7 a description ( ! me?ods by :i* curriculum p>ticipants w be-- 7i7 scre5$ = m5tal heal? at-risk indicators2 & 7ii7 if ne$$ & on a case-by-case basis1 ref]r$ to a m5tal heal? cl9ician = fur!r assessm5t & treatm5t & ) crisis response capability2 & 7,e7 an assurance t supportive s]vices w be provid$ to curriculum p>ticipants id5tifi$ z high-risk p>ticipants1 includ+ ref]ral1 c\nsel+1 & foll[-up s]vices =-- 7i7 drug or alcohol abuse2 7ii7 sexual or dome/ic abuse2 & 7iii7 depression & o!r relevant m5tal heal? conc]ns4 7#e7 ,use ( funds ,an ,indian tribe id5tifi$ "u p>agraph 7#b77;,b7 or an eligible entity may use a grant provid$ "u ?is subsection-- 7,a7 to develop & implem5t ! curriculum 9 a s*ool-bas$ sett+2 7,b7 to e/abli% an advisory c\ncil-- 7i7 to advise ! ,indian tribe or eligible entity reg>d+ curriculum developm5t2 & 7ii7 to provide support s]vices id5tifi$ z necess>y by ! community be+ s]v$ by ! ,indian tribe or eligible entity2 7,c7 to appo9t & tra9 a s*ool- & community-bas$ cultural res\rce liaison1 :o w act z an int]m$i>y among ! ,indian tribe or eligible entity1 ! applicable s*ool adm9i/rators1 & ! advisory c\ncil e/abli%$ by ! ,indian tribe or eligible entity2 7,d7 to e/abli% an on-site1 s*ool-bas$1 ,,ma- or ,ph4,d4-level m5tal heal? practition] 7employ$ by ! ,s]vice1 if practicable7 to "w ) tribal educators & o!r p]sonnel2 7,e7 to provide = ! tra9+ ( pe] c\nselors to assi/ 9 c>ry+ out ! curriculum2 7,f7 to procure te*nical & tra9+ support f nonpr(it or ,/ate entities or in/itutions ( high] education id5tifi$ by ! community be+ s]v$ by ! ,indian tribe or eligible entity z ! be/ suit$ to develop & implem5t ! curriculum2 7,g7 to tra9 tea*]s & s*ool adm9i/rators to effectively c>ry out ! curriculum2 7,h7 to e/abli% an effective ref]ral proc$ure & network2 7,i7 to id5tify & develop culturally compatible curriculum support measures2 7,j7 to obta9 educational mat]ials & o!r res\rces f ! ,adm9i/ration or o!r appropriate entities to ensure ! success ( ! demon/ration program2 & 7,k7 to evaluate ! effectiv5ess ( ! curriculum 9 prev5t+ ,indian & ,alaska ,native adolesc5t suicide4 7c7 ,evaluations ,us+ su* am\nts made available pursuant to subsection 7e7 z ! ,secret>y det]m9es to be appropriate1 ! ,secret>y %all conduct1 directly or ?r\gh a grant1 contract1 or coop]ative agreem5t ) an entity t has exp]i5ce reg>d+ ! developm5t & op]ation ( successful culturally compatible1 s*ool-bas$1 life skills suicide prev5tion & int]v5tion programs or evaluations1 an annual evaluation ( ! demon/ration program "u ?is section1 includ+ an evaluation (-- 7#a7 ! effectiv5ess ( ! curriculum 9 prev5t+ ,indian & ,alaska ,native adolesc5t suicide2 7#b7 areas = program improvem5t2 & 7#c7 additional developm5t ( ! goals & objectives ( ! demon/ration program4 7d7 ,report to ,congress 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 n lat] ?an #ahj days aft] ! date ( t]m9ation ( ! demon/ration program1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs & ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,natural ,res\rces & ! ,committee on ,education & ,labor ( ! ,h\se ( ,repres5tatives a f9al report t-- 7,a7 describes ! results ( ! program ( ea* ,indian tribe or eligible entity "u ?is section2 7,b7 evaluates ! effectiv5ess ( ! curriculum 9 prev5t+ ,indian & ,alaska ,native adolesc5t suicide2 7,c7 makes recomm5dations reg>d+-- 7i7 ! expansion ( ! demon/ration program "u ?is section to additional eligible entities2 7ii7 designat+ ! demon/ration program z a p]man5t program2 & 7iii7 id5tify+ & di/ribut+ ! curriculum ?r\gh ! ,suicide ,prev5tion ,res\rce ,c5t] ( ! ,adm9i/ration2 & 7,d7 incorporates any public comm5ts receiv$ "u p>agraph 7#b74 7#b7 ,public comm5t ,! ,secret>y %all provide a notice ( ! report "u p>agraph 7#a7 & an opportunity = public comm5t on ! report = a p]iod ( n less ?an #ij days be=e submitt+ ! report to ,congress4 7e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = ea* ( fiscal ye>s #bjag ?r\gh #bjbj4 4 ,h ,miscellane\s #aia4 ,confid5tiality ( m$ical quality assurance records2 qualifi$ immunity = p>ticipants ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7z am5d$ by section #aja7;b77 is am5d$ by ins]t+ aft] section #hjd 7#be ,u4,s4,c4 #afgd7 ! foll[+3 #hje4 ,confid5tiality ( m$ical quality assurance records2 qualifi$ immunity = p>ticipants 7a7 ,def9itions ,9 ?is section3 7#a7 ,heal? c>e provid] ,! t]m heal? c>e provid] means any heal? c>e pr(essional1 includ+ community heal? aides & practition]s c]tifi$ "u section #aai1 :o is-- 7,a7 grant$ cl9ical practice privileges or employ$ to provide heal? c>e s]vices at-- 7i7 an ,indian heal? program2 or 7ii7 a heal? program ( an urban ,indian organization2 & 7,b7 lic5s$ or c]tifi$ to p]=m heal? c>e s]vices by a gov]nm5tal bo>d or ag5cy or pr(essional heal? c>e society or organization4 7#b7 ,m$ical quality assurance program ,! t]m m$ical quality assurance program means any activity c>ri$ out be=e1 on1 or aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag by or = any ,indian heal? program or urban ,indian organization to assess ! quality ( m$ical c>e1 includ+ activities conduct$ by or on behalf ( individuals1 ,indian heal? program or urban ,indian organization m$ical or d5tal treatm5t review committees1 or o!r review bodies responsible = quality assurance1 cr$5tials1 infection control1 pati5t safety1 pati5t c>e assessm5t 7includ+ treatm5t proc$ures1 blood1 drugs1 & !rapeutics71 m$ical records1 heal? res\rces managem5t review1 & id5tification & prev5tion ( m$ical or d5tal incid5ts & risks4 7#c7 ,m$ical quality assurance record ,! t]m m$ical quality assurance record means ! proce$+s1 records1 m9utes1 & reports t-- 7,a7 emanate f quality assurance program activities describ$ 9 p>agraph 7#b72 & 7,b7 are produc$ or compil$ by or = an ,indian heal? program or urban ,indian organization z "p ( a m$ical quality assurance program4 7b7 ,confid5tiality ( records ,m$ical quality assurance records creat$ by or = any ,indian heal? program or a heal? program ( an urban ,indian organization z "p ( a m$ical quality assurance program are confid5tial & privileg$4 ,su* records may n be disclos$ to any p]son or entity1 except z provid$ 9 subsection 7d74 7c7 ,prohibition on disclosure & te/imony 7#a7 ,9 g5]al ,no "p ( any m$ical quality assurance record describ$ 9 subsection 7b7 may be subject to discov]y or admitt$ into evid5ce 9 any judicial or adm9i/rative proce$+1 except z provid$ 9 subsection 7d74 7#b7 ,te/imony ,an individual :o reviews or creates m$ical quality assurance records = any ,indian heal? program or urban ,indian organization :o p>ticipates 9 any proce$+ t reviews or creates su* records may n be p]mitt$ or requir$ to te/ify 9 any judicial or adm9i/rative proce$+ ) respect to su* records or ) respect to any f9d+1 recomm5dation1 evaluation1 op9ion1 or action tak5 by su* p]son or body 9 connection ) su* records except z provid$ 9 ?is section4 7d7 ,au?oriz$ disclosure & te/imony 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 a m$ical quality assurance record describ$ 9 subsection 7b7 may be disclos$1 & an individual ref]r$ to 9 subsection 7c7 may give te/imony 9 connection ) su* a record1 only z foll[s3 7,a7 ,to a ,f$]al ag5cy or private organization1 if su* m$ical quality assurance record or te/imony is ne$$ by su* ag5cy or organization to p]=m lic5s+ or accr$itation functions relat$ to any ,indian heal? program or to a heal? program ( an urban ,indian organization to p]=m monitor+1 requir$ by law1 ( su* program or organization4 7,b7 ,to an adm9i/rative or judicial proce$+ comm5c$ by a pres5t or =m] ,indian heal? program or urban ,indian organization provid] conc]n+ ! t]m9ation1 susp5sion1 or limitation ( cl9ical privileges ( su* heal? c>e provid]4 7,c7 ,to a gov]nm5tal bo>d or ag5cy or to a pr(essional heal? c>e society or organization1 if su* m$ical quality assurance record or te/imony is ne$$ by su* bo>d1 ag5cy1 society1 or organization to p]=m lic5s+1 cr$5tial+1 or ! monitor+ ( pr(essional /&>ds ) respect to any heal? c>e provid] :o is or 0 an employee ( any ,indian heal? program or urban ,indian organization4 7,d7 ,to a hospital1 m$ical c5t]1 or o!r in/itution t provides heal? c>e s]vices1 if su* m$ical quality assurance record or te/imony is ne$$ by su* in/itution to assess ! pr(essional qualifications ( any heal? c>e provid] :o is or 0 an employee ( any ,indian heal? program or urban ,indian organization & :o has appli$ = or be5 grant$ au?ority or employm5t to provide heal? c>e s]vices 9 or on behalf ( su* program or organization4 7,e7 ,to an (fic]1 employee1 or contractor ( ! ,indian heal? program or urban ,indian organization t creat$ ! records or = :i* ! records 7 creat$4 ,if t (fic]1 employee1 or contractor has a ne$ = su* record or te/imony to p]=m (ficial duties4 7,f7 ,to a crim9al or civil law en=cem5t ag5cy or in/rum5tality *>g$ "u applicable law ) ! protection ( ! public heal? or safety1 if a qualifi$ repres5tative ( su* ag5cy or in/rum5tality makes a writt5 reque/ t su* record or te/imony be provid$ = a purpose au?oriz$ by law4 7,g7 ,9 an adm9i/rative or judicial proce$+ comm5c$ by a crim9al or civil law en=cem5t ag5cy or in/rum5tality ref]r$ to 9 subp>agraph 7,f71 b only ) respect to ! subject ( su* proce$+4 7#b7 ,id5tity ( p>ticipants ,) ! exception ( ! subject ( a quality assurance action1 ! id5tity ( any p]son receiv+ heal? c>e s]vices f any ,indian heal? program or urban ,indian organization or ! id5tity ( any o!r p]son associat$ ) su* program or organization = purposes ( a m$ical quality assurance program t is disclos$ 9 a m$ical quality assurance record describ$ 9 subsection 7b7 %all be delet$ f t record or docum5t be=e any disclosure ( su* record is made outside su* program or organization4 7e7 ,disclosure = c]ta9 purposes 7#a7 ,9 g5]al ,no?+ 9 ?is section %all be con/ru$ z au?oriz+ or requir+ ! )hold+ f any p]son or entity aggregate /ati/ical in=mation reg>d+ ! results ( any ,indian heal? program or urban ,indian organization's m$ical quality assurance programs4 7#b7 ,)hold+ f ,congress ,no?+ 9 ?is section %all be con/ru$ z au?ority to )hold any m$ical quality assurance record f a committee ( ei!r ,h\se ( ,congress1 any jo9t committee ( ,congress1 or ! ,gov]nm5t ,acc\ntability ,(fice if su* record p]ta9s to any matt] )9 _! respective jurisdictions4 7f7 ,prohibition on disclosure ( record or te/imony ,an individual or entity hav+ possession ( or access to a record or te/imony describ$ by ?is section may n disclose ! cont5ts ( su* record or te/imony 9 any mann] or = any purpose except z provid$ 9 ?is section4 7g7 ,exemption f ,fre$om ( ,in=mation ,act ,m$ical quality assurance records describ$ 9 subsection 7b7 may n be made available to any p]son "u section #eeb ( title #e1 ,unit$ ,/ates ,code4 7h7 ,limitation on civil liability ,an individual :o p>ticipates 9 or provides in=mation to a p]son or body t reviews or creates m$ical quality assurance records describ$ 9 subsection 7b7 %all n be civilly liable = su* p>ticipation or = provid+ su* in=mation if ! p>ticipation or provision ( in=mation 0 9 good fai? bas$ on prevail+ pr(essional /&>ds at ! "t ! m$ical quality assurance program activity took place4 7i7 ,application to in=mation 9 c]ta9 o!r records ,no?+ 9 ?is section %all be con/ru$ z limit+ access to ! in=mation 9 a record creat$ & ma9ta9$ outside a m$ical quality assurance program1 includ+ a pati5t's m$ical records1 on ! gr\nds t ! in=mation 0 pres5t$ dur+ meet+s ( a review body t are "p ( a m$ical quality assurance program4 7j7 ,regulations ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all promulgate regulations pursuant to section #hjb4 7k7 ,cont9u$ protection ,disclosure "u subsection 7d7 does n p]mit r$isclosure except to ! ext5t su* fur!r disclosure is au?oriz$ "u subsection 7d7 or is o!rwise au?oriz$ to be disclos$ "u ?is section4 7l7 ,inconsi/5cies ,to ! ext5t t ! protections "u "p ,c ( title ,,ix ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bbi;b-#ba et seq47 7z am5d$ by ! ,pati5t ,safety & ,quality ,improvem5t ,act ( #bjje 7,public ,law #aji-da2 #aai ,/at4 #dbd77 & ?is section are inconsi/5t1 ! provisions ( :i*ev] is m protective %all control4 7m7 ,relation%ip to o!r law ,?is section %all cont9ue 9 =ce & effect1 except z o!rwise specifically provid$ 9 any ,f$]al law enact$ aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag4 4 #aib4 ,limitation on use ( funds approprait$ to ! ,indian ,heal? ,s]vice ,section #hjf ( ! ,indian ,heal? ,c>e ,improvem5t ,act is am5d$-- 7#a7 by /rik+ ,any limitation & ins]t+ ! foll[+3 7a7 ,,hhs appropriations ,any limitation 2 & 7#b7 by add+ at ! end ! foll[+3 7b7 ,limitations pursuant to o!r ,f$]al law ,any limitation pursuant to o!r ,f$]al laws on ! use ( ,f$]al funds appropriat$ to ! ,s]vice %all apply ) respect to ! p]=mance or cov]age ( abortions4 4 #aic4 ,arizona1 ,nor? ,dakota1 & ,s\? ,dakota z contract heal? s]vice deliv]y areas2 eligibility ( ,cali=nia ,indians ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act is am5d$-- 7#a7 by /rik+ section #hjh 7#be ,u4,s4,c4 #afgh7 & ins]t+ ! foll[+3 #hjh4 ,arizona z contract heal? s]vice deliv]y area 7a7 ,9 g5]al ,! ,/ate ( ,arizona %all be designat$ z a contract heal? s]vice deliv]y area by ! ,s]vice = ! purpose ( provid+ contract heal? c>e s]vices to memb]s ( ,indian tribes 9 ! ,/ate ( ,arizona4 7b7 ,ma9t5ance ( s]vices ,! ,s]vice %all n curtail any heal? c>e s]vices provid$ to ,indians resid+ on res]vations 9 ! ,/ate ( ,arizona if ! curtailm5t is due to ! provision ( contract s]vices 9 t ,/ate pursuant to ! designation ( ! ,/ate z a contract heal? s]vice deliv]y area by subsection 7a74 2 7#b7 by ins]t+ aft] section #hjh 7#be ,u4,s4,c4 #afgh7 ! foll[+3 #hjh;,a4 ,nor? ,dakota & ,s\? ,dakota z contract heal? s]vice deliv]y area 7a7 ,9 g5]al ,! ,/ates ( ,nor? ,dakota & ,s\? ,dakota %all be designat$ z a contract heal? s]vice deliv]y area by ! ,s]vice = ! purpose ( provid+ contract heal? c>e s]vices to memb]s ( ,indian tribes 9 ! ,/ates ( ,nor? ,dakota & ,s\? ,dakota4 7b7 ,ma9t5ance ( s]vices ,! ,s]vice %all n curtail any heal? c>e s]vices provid$ to ,indians resid+ on any res]vation1 or 9 any c\nty t has a common b\nd>y ) any res]vation1 9 ! ,/ate ( ,nor? ,dakota or ,s\? ,dakota if ! curtailm5t is due to ! provision ( contract s]vices 9 ^? ,/ates pursuant to ! designation ( ! ,/ates z a contract heal? s]vice deliv]y area by subsection 7a74 2 & 7#c7 by /rik+ section #hji 7#be ,u4,s4,c4 #afgi7 & ins]t+ ! foll[+3 #hji4 ,eligibility ( ,cali=nia ,indians 7a7 ,9 g5]al ,! foll[+ ,cali=nia ,indians %all be eligible = heal? s]vices provid$ by ! ,s]vice3 7#a7 ,any memb] ( a f$]ally recogniz$ ,indian tribe4 7#b7 ,any desc5dant ( an ,indian :o 0 resid+ 9 ,cali=nia on ,june #a1 #aheb1 if su* desc5dant-- 7,a7 is a memb] ( ! ,indian community s]v$ by a local program ( ! ,s]vice2 & 7,b7 is reg>d$ z an ,indian by ! community 9 :i* su* desc5dant lives4 7#c7 ,any ,indian :o holds tru/ int]e/s 9 public doma91 national =e/1 or res]vation allotm5ts 9 ,cali=nia4 7#d7 ,any ,indian ( ,cali=nia :o is li/$ on ! plans = di/ribution ( ! assets ( ran*]ias & res]vations locat$ )9 ! ,/ate ( ,cali=nia "u ! ,act ( ,augu/ #ah1 #aieh 7#gb ,/at4 #fai71 & any desc5dant ( su* an ,indian4 7b7 ,cl>ification ,no?+ 9 ?is section may be con/ru$ z exp&+ ! eligibility ( ,cali=nia ,indians = heal? s]vices provid$ by ! ,s]vice beyond ! scope ( eligibility = su* heal? s]vices t appli$ on ,may #a1 #aihf4 4 #aid4 ,me?ods to increase access to pr(essionals ( c]ta9 corps ,section #hab ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afhj;b7 is am5d$ to read z foll[s3 #hab4 ,national ,heal? ,s]vice ,corps 7a7 ,no r$uction 9 s]vices ,! ,secret>y %all n remove a memb] ( ! ,national ,heal? ,s]vice ,corps f an ,indian heal? program or urban ,indian organization or )draw fund+ us$ to support su* a memb]1 unless ! ,secret>y1 act+ ?r\gh ! ,s]vice1 has ensur$ t ! ,indians receiv+ s]vices f ! memb] w exp]i5ce no r$uction 9 s]vices4 7b7 ,treatm5t ( ,indian heal? programs ,at ! reque/ ( an ,indian heal? program1 ! s]vices ( a memb] ( ! ,national ,heal? ,s]vice ,corps assign$ to ! ,indian heal? program may be limit$ to ! individuals :o are eligible = s]vices f t ,indian heal? program4 4 #aie4 ,heal? s]vices = ineligible p]sons ,section #hac ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afhj;c7 is am5d$ to read z foll[s3 #hac4 ,heal? s]vices = ineligible p]sons 7a7 ,*ildr5 ,any individual :o-- 7#a7 has n atta9$ #ai ye>s ( age2 7#b7 is ! natural or adopt$ *ild1 /ep*ild1 fo/] *ild1 legal w>d1 or orphan ( an eligible ,indian2 & 7#c7 is n o!rwise eligible = heal? s]vices provid$ by ! ,s]vice1 %all be eligible = all heal? s]vices provid$ by ! ,s]vice on ! same basis & subject to ! same rules t apply to eligible ,indians until su* individual atta9s #ai ye>s ( age4 ,! exi/+ & pot5tial heal? ne$s ( all su* individuals %all be tak5 into consid]ation by ! ,s]vice 9 det]m9+ ! ne$ =1 or ! allocation (1 ! heal? res\rces ( ! ,s]vice4 ,if su* an individual has be5 det]m9$ to be legally incompet5t prior to atta9+ #ai ye>s ( age1 su* individual %all rema9 eligible = su* s]vices until #a ye> aft] ! date ( a det]m9ation ( compet5cy4 7b7 ,sp\ses ,any sp\se ( an eligible ,indian :o is n an ,indian1 or :o is ( ,indian desc5t b is n o!rwise eligible = ! heal? s]vices provid$ by ! ,s]vice1 %all be eligible = su* heal? s]vices if all su* sp\ses or sp\ses :o are m>ri$ to memb]s ( ea* ,indian tribe be+ s]v$ are made eligible1 z a class1 by an appropriate resolution ( ! gov]n+ body ( ! ,indian tribe or tribal organization provid+ su* s]vices4 ,! heal? ne$s ( p]sons made eligible "u ?is p>agraph %all n be tak5 into consid]ation by ! ,s]vice 9 det]m9+ ! ne$ =1 or allocation (1 its heal? res\rces4 7c7 ,heal? facilities provid+ heal? s]vices 7#a7 ,9 g5]al ,! ,secret>y is au?oriz$ to provide heal? s]vices "u ?is subsection ?r\gh heal? facilities op]at$ directly by ! ,s]vice to individuals :o reside )9 ! ,s]vice unit & :o are n o!rwise eligible = su* heal? s]vices if-- 7,a7 ! ,indian tribes s]v$ by su* ,s]vice unit reque/s su* provision ( heal? s]vices to su* individuals1 & 7,b7 ! ,secret>y & ! s]v$ ,indian tribes h jo9tly det]m9$ t ! provision ( su* heal? s]vices w n result 9 a d5ial or dim9ution ( heal? s]vices to eligible ,indians4 7#b7 ,,isdeaa programs ,9 ! case ( heal? facilities op]at$ "u a contract or compact ent]$ into "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq471 ! gov]n+ body ( ! ,indian tribe or tribal organization provid+ heal? s]vices "u su* contract or compact is au?oriz$ to det]m9e :e!r heal? s]vices %\ld be provid$ "u su* contract or compact to individuals :o are n eligible = su* heal? s]vices "u any o!r subsection ( ?is section or "u any o!r provision ( law4 ,9 mak+ su* det]m9ations1 ! gov]n+ body ( ! ,indian tribe or tribal organization %all take into acc\nt ! consid]ation describ$ 9 p>agraph 7#a77;,b74 ,any s]vices provid$ by ! ,indian tribe or tribal organization pursuant to a det]m9ation made "u ?is subp>agraph %all be deem$ to be provid$ "u ! agreem5t ent]$ into by ! ,indian tribe or tribal organization "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 ,! provisions ( section #cad ( ,public ,law #aja-eab 7#ajd ,/at4 #aiei71 z am5d$ by section #cjh ( ,public ,law #ajc-ach 7#ajg ,/at4 #adaf71 %all apply to any s]vices provid$ by ! ,indian tribe or tribal organization pursuant to a det]m9ation made "u ?is subp>agraph4 7#c7 ,paym5t = s]vices 7,a7 ,9 g5]al ,p]sons receiv+ heal? s]vices provid$ by ! ,s]vice "u ?is subsection %all be liable = paym5t ( su* heal? s]vices "u a s*$ule ( *>ges prescrib$ by ! ,secret>y :i*1 9 ! judgm5t ( ! ,secret>y1 results 9 reimbursem5t 9 an am\nt n less ?an ! actual co/ ( provid+ ! heal? s]vices4 ,not)/&+ section #bjg ( ?is ,act or any o!r provision ( law1 am\nts collect$ "u ?is subsection1 includ+ ,m$ic>e1 ,m$icaid1 or *ildr5's heal? insurance program reimbursem5ts "u titles ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 %all be cr$it$ to ! acc\nt ( ! program provid+ ! s]vice & %all be us$ = ! purposes li/$ 9 section #dja7;d77#b7 & am\nts collect$ "u ?is subsection %all be available = exp5diture )9 su* program4 7,b7 ,indig5t p ,heal? s]vices may be provid$ by ! ,secret>y ?r\gh ! ,s]vice "u ?is subsection to an indig5t individual :o w\ld n be o!rwise eligible = su* heal? s]vices b = ! provisions ( p>agraph 7#a7 only if an agreem5t has be5 ent]$ into ) a ,/ate or local gov]nm5t "u :i* ! ,/ate or local gov]nm5t agrees to reimburse ! ,s]vice = ! exp5ses incurr$ by ! ,s]vice 9 provid+ su* heal? s]vices to su* indig5t individual4 7#d7 ,revocation ( cons5t = s]vices 7,a7 ,s+le tribe s]vice area ,9 ! case ( a ,s]vice ,area :i* s]ves only #a ,indian tribe1 ! au?ority ( ! ,secret>y to provide heal? s]vices "u p>agraph 7#a7 %all t]m9ate at ! end ( ! fiscal ye> succe$+ ! fiscal ye> 9 :i* ! gov]n+ body ( ! ,indian tribe revokes its concurr5ce to ! provision ( su* heal? s]vices4 7,b7 ,multitribal s]vice area ,9 ! case ( a multitribal ,s]vice ,area1 ! au?ority ( ! ,secret>y to provide heal? s]vices "u p>agraph 7#a7 %all t]m9ate at ! end ( ! fiscal ye> succe$+ ! fiscal ye> 9 :i* at lea/ #ea p]c5t ( ! numb] ( ,indian tribes 9 ! ,s]vice ,area revoke _! concurr5ce to ! provisions ( su* heal? s]vices4 7d7 ,o!r s]vices ,! ,s]vice may provide heal? s]vices "u ?is subsection to individuals :o are n eligible = heal? s]vices provid$ by ! ,s]vice "u any o!r provision ( law 9 ord] to-- 7#a7 a*ieve /ability 9 a m$ical em]g5cy2 7#b7 prev5t ! spread ( a communicable disease or o!rwise deal ) a public heal? haz>d2 7#c7 provide c>e to non-,indian wom5 pregnant ) an eligible ,indian's *ild = ! duration ( ! pregnancy ?r\gh po/p>tum2 or 7#d7 provide c>e to imm$iate family memb]s ( an eligible individual if su* c>e is directly relat$ to ! treatm5t ( ! eligible individual4 7e7 ,hospital privileges = practition]s 7#a7 ,9 g5]al ,hospital privileges 9 heal? facilities op]at$ & ma9ta9$ by ! ,s]vice or op]at$ "u a contract or compact pursuant to ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 may be ext5d$ to non-,s]vice heal? c>e practition]s :o provide s]vices to individuals describ$ 9 subsection 7a71 7b71 7c71 or 7d74 ,su* non-,s]vice heal? c>e practition]s may1 z "p ( ! privileg+ process1 be designat$ z employees ( ! ,f$]al ,gov]nm5t = purposes ( section #acdf7;b7 & *apt] #aga ( title #bh1 ,unit$ ,/ates ,code 7relat+ to ,f$]al tort claims7 only ) respect to acts or omissions :i* occur 9 ! c\rse ( provid+ s]vices to eligible individuals z a "p ( ! conditions "u :i* su* hospital privileges are ext5d$4 7#b7 ,def9ition ,= purposes ( ?is subsection1 ! t]m non-,s]vice heal? c>e practition] means a practition] :o is n-- 7,a7 an employee ( ! ,s]vice2 or 7,b7 an employee ( an ,indian tribe or tribal organization op]at+ a contract or compact "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 or an individual :o provides heal? c>e s]vices pursuant to a p]sonal s]vices contract ) su* ,indian tribe or tribal organization4 7f7 ,eligible ,indian ,= purposes ( ?is section1 ! t]m eligible ,indian means any ,indian :o is eligible = heal? s]vices provid$ by ! ,s]vice )\t reg>d to ! provisions ( ?is section4 4 #aif4 ,annual budget submission ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 is am5d$ by add+ at ! end ! foll[+3 #hbf4 ,annual budget submission ,effective beg9n+ ) ! submission ( ! annual budget reque/ to ,congress = fiscal ye> #bjag1 ! ,presid5t %all include1 9 ! am\nt reque/$ & ! budget ju/ification1 am\nts t reflect any *anges 9-- 7#a7 ! co/ ( heal? c>e s]vices1 z index$ = ,unit$ ,/ates doll> inflation 7z measur$ by ! ,consum] ,price ,index72 & 7#b7 ! size ( ! population s]v$ by ! ,s]vice4 4 #aig4 ,prescription drug monitor+ ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aie7 is am5d$ by add+ at ! end ! foll[+3 #hbg4 ,prescription drug monitor+ 7a7 ,monitor+ 7#a7 ,e/abli%m5t ,! ,secret>y1 9 coord9ation ) ! ,secret>y ( ! ,int]ior & ! ,attorney ,g5]al1 %all e/abli% a prescription drug monitor+ program1 to be c>ri$ out at heal? c>e facilities ( ! ,s]vice1 tribal heal? c>e facilities1 & urban ,indian heal? c>e facilities4 7#b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report t describes-- 7,a7 ! ne$s ( ! ,s]vice1 tribal heal? c>e facilities1 & urban ,indian heal? c>e facilities ) respect to ! prescription drug monitor+ program "u p>agraph 7#a72 7,b7 ! plann$ developm5t ( t program1 includ+ any relevant /atutory or adm9i/rative limitations2 & 7,c7 ! means by :i* ! program c\ld be c>ri$ out 9 coord9ation ) any ,/ate prescription drug monitor+ program4 7b7 ,abuse 7#a7 ,9 g5]al ,! ,attorney ,g5]al1 9 conjunction ) ! ,secret>y & ! ,secret>y ( ! ,int]ior1 %all conduct-- 7,a7 an assessm5t ( ! capacity (1 & support requir$ by1 relevant ,f$]al & tribal ag5cies-- 7i7 to c>ry out data collection & analysis reg>d+ incid5ts ( prescription drug abuse 9 ,indian communities2 & 7ii7 to ex*ange among ^? ag5cies & ,indian heal? programs in=mation relat+ to prescription drug abuse 9 ,indian communities1 includ+ /atutory & adm9i/rative requirem5ts & limitations relat+ to t abuse2 & 7,b7 tra9+ = ,indian heal? c>e provid]s1 tribal lead]s1 law en=cem5t (fic]s1 & s*ool (ficials reg>d+ aw>5ess & prev5tion ( prescription drug abuse & /rategies = improv+ ag5cy responses to address+ prescription drug abuse 9 ,indian communities4 7#b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,attorney ,g5]al %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report t describes-- 7,a7 ! capacity ( ,f$]al & tribal ag5cies to c>ry out data collection & analysis & in=mation ex*anges z describ$ 9 p>agraph 7#a77;,a72 7,b7 ! tra9+ conduct$ pursuant to p>agraph 7#a77;,b72 7,c7 infra/ructure enhancem5ts requir$ to c>ry out ! activities describ$ 9 p>agraph 7#a71 if any2 & 7,d7 any /atutory or adm9i/rative b>ri]s to c>ry+ out ^? activities4 4 #aih4 ,tribal heal? program option = co/ %>+ ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aif7 is am5d$ by add+ at ! end ! foll[+3 #hbh4 ,tribal heal? program option = co/ %>+ 7a7 ,9 g5]al ,no?+ 9 ?is ,act limits ! ability ( a tribal heal? program op]at+ any heal? program1 s]vice1 function1 activity1 or facility fund$1 9 :ole or "p1 by ! ,s]vice ?r\gh1 or provid$ = 91 a compact ) ! ,s]vice pursuant to title ,v ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #deh;aaa et seq47 to *>ge an ,indian = s]vices provid$ by ! tribal heal? program4 7b7 ,s]vice ,no?+ 9 ?is ,act au?orizes ! ,s]vice-- 7#a7 to *>ge an ,indian = s]vices2 or 7#b7 to require any tribal heal? program to *>ge an ,indian = s]vices4 4 #aii4 ,disease & injury prev5tion report ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aig7 is am5d$ by add+ at ! end ! foll[+3 #hbi4 ,disease & injury prev5tion report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committees on ,natural ,res\rces & ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives describ+-- 7#a7 all disease & injury prev5tion activities conduct$ by ! ,s]vice1 indep5d5tly or 9 conjunction ) o!r ,f$]al dep>tm5ts & ag5cies & ,indian tribes2 & 7#b7 ! effectiv5ess ( ^? activities1 includ+ ! r$uctions ( injury or disease conditions a*iev$ by ! activities4 4 #bjj4 ,o!r ,,gao reports ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aih7 is am5d$ by add+ at ! end ! foll[+3 #hcj4 ,o!r ,,gao reports 7a7 ,coord9ation ( s]vices 7#a7 ,/udy & evaluation ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy1 & evaluate ! effectiv5ess1 ( coord9ation ( heal? c>e s]vices provid$ to ,indians-- 7,a7 ?r\gh ,m$ic>e1 ,m$icaid1 or ,,s*ip2 7,b7 by ! ,s]vice2 or 7,c7 us+ funds provid$ by-- 7i7 ,/ate or local gov]nm5ts2 or 7ii7 ,indian tribes4 7#b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,comptroll] ,g5]al %all submit to ,congress a report-- 7,a7 describ+ ! results ( ! evaluation "u p>agraph 7#a72 & 7,b7 conta9+ recomm5dations ( ! ,comptroll] ,g5]al reg>d+ measures to support & increase coord9ation ( ! provision ( heal? c>e s]vices to ,indians z describ$ 9 p>agraph 7#a74 7b7 ,paym5ts = contract heal? s]vices 7#a7 ,9 g5]al ,! ,comptroll] ,g5]al %all conduct a /udy on ! use ( heal? c>e furni%$ by heal? c>e provid]s "u ! contract heal? s]vices program fund$ by ! ,s]vice & op]at$ by ! ,s]vice1 an ,indian tribe1 or a tribal organization4 7#b7 ,analysis ,! /udy conduct$ "u p>agraph 7#a7 %all include an analysis (-- 7,a7 ! am\nts reimburs$ "u ! contract heal? s]vices program describ$ 9 p>agraph 7#a7 = heal? c>e furni%$ by entities1 individual provid]s1 & suppli]s1 includ+ a comp>ison ( reimbursem5t = t heal? c>e ?r\gh o!r public programs & 9 ! private sector2 7,b7 b>ri]s to access+ c>e "u su* contract heal? s]vices program1 includ+ b>ri]s relat+ to travel di/ances1 cultural diff]5ces1 & public & private sector reluctance to furni% c>e to pati5ts "u ! program2 7,c7 ! adequacy ( exi/+ ,f$]al fund+ = heal? c>e "u ! contract heal? s]vices program2 7,d7 ! adm9i/ration ( ! contract heal? s]vice program1 includ+ ! di/ribution ( funds to ,indian heal? programs pursuant to ! program2 & 7,e7 any o!r items det]m9$ appropriate by ! ,comptroll] ,g5]al4 7#c7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations reg>d+-- 7,a7 ! appropriate level ( ,f$]al fund+ t %\ld be e/abli%$ = heal? c>e "u ! contract heal? s]vices program describ$ 9 p>agraph 7#a72 7,b7 h[ to mo/ effici5tly use t fund+2 & 7,c7 ! id5tification ( any inequities 9 ! curr5t di/ribution =mula or inequitable results = any ,indian tribe "u ! fund+ level1 & any recomm5dations = address+ any inequities or inequitable results id5tifi$4 7#d7 ,consultation ,9 conduct+ ! /udy "u p>agraph 7#a7 & prep>+ ! report "u p>agraph 7#c71 ! ,comptroll] ,g5]al %all consult ) ! ,s]vice1 ,indian tribes1 & tribal organizations4 4 #bja4 ,traditional heal? c>e practices ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aii7 is am5d$ by add+ at ! end ! foll[+3 #hca4 ,traditional heal? c>e practices ,al?\gh ! ,secret>y may promote traditional heal? c>e practices1 consi/5t ) ! ,s]vice /&>ds = ! provision ( heal? c>e1 heal? promotion1 & disease prev5tion "u ?is ,act1 ! ,unit$ ,/ates is n liable = any provision ( traditional heal? c>e practices pursuant to ?is ,act t results 9 damage1 injury1 or dea? to a pati5t4 ,no?+ 9 ?is subsection %all be con/ru$ to alt] any liability or o!r obligation t ! ,unit$ ,/ates may o!rwise h "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #dej et seq47 or ?is ,act4 4 #bjb4 ,director ( ,,hiv_/,,aids ,prev5tion & ,treatm5t ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aii;,a7 is am5d$ by add+ at ! end ! foll[+3 #hcb4 ,director ( ,,hiv_/,,aids ,prev5tion & ,treatm5t 7a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% )9 ! ,s]vice ! position ( ! ,director ( ,,hiv_/,,aids ,prev5tion & ,treatm5t 7ref]r$ to 9 ?is section z ! ,director74 7b7 ,duties ,! ,director %all-- 7#a7 coord9ate & promote ,,hiv_/,,aids prev5tion & treatm5t activities specific to ,indians2 7#b7 provide te*nical assi/ance to ,indian tribes1 tribal organizations1 & urban ,indian organizations reg>d+ exi/+ ,,hiv_/,,aids prev5tion & treatm5t programs2 & 7#c7 ensure int]ag5cy coord9ation to facilitate ! inclusion ( ,indians 9 ,f$]al ,,hiv_/,,aids rese>* & grant opportunities1 ) emphasis on ! programs op]at$ "u ! ,ryan ,:ite ,compreh5sive ,aids ,res\rces ,em]g5cy ,act ( #aiij 7,public ,law #aja-cha2 #ajd ,/at4 #egf7 & ! am5dm5ts made by t ,act4 7c7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ! ,indian ,heal?c>e ,improvem5t ,act ( #bjag1 & n less frequ5tly ?an once e #b ye>s !reaft]1 ! ,director %all submit to ,congress a report describ+1 ) respect to ! prec$+ #b-ye> p]iod-- 7#a7 ea* activity c>ri$ out "u ?is section2 & 7#b7 any f9d+s ( ! ,director ) respect to ,,hiv_/,,aids prev5tion & treatm5t activities specific to ,indians4 4 ,,ii ,am5dm5ts to o!r ,acts & miscellane\s provisions #bja4 ,elim9ation ( sunset = reimbursem5t = all ,m$ic>e "p ,b s]vices furni%$ by c]ta9 indian hospitals & cl9ics 7a7 ,reimbursem5t = all m$ic>e "p b s]vices furni%$ by c]ta9 indian hospitals & cl9ics ,section #ahhj7;e77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieqq7e77#a77;,a77 is am5d$ by /rik+ dur+ ! #e-ye> p]iod beg9n+ on & ins]t+ on or aft]4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to items or s]vices furni%$ on or aft] ,janu>y #a1 #bjag4 #bjb4 ,includ+ co/s incurr$ by aids drug assi/ance programs & indian heal? s]vice 9 provid+ prescription drugs t[>d ! annual out-(-pocket ?re%old "u "p ,d 7a7 ,9 g5]al ,section #ahfj;,d-#b7;b77#d77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77#d77;,c77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ & at ! end2 7#b7 9 clause 7ii7-- 7,a7 by /rik+ su* co/s %all be treat$ z incurr$ only if & ins]t+ subject to clause 7iii71 su* co/s %all be treat$ z incurr$ only if2 7,b7 by /rik+ 1 "u section #ahfj;,d-#ad1 or "u a ,/ate ,ph>maceutical ,assi/ance ,program2 & 7,c7 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by ins]t+ aft] clause 7ii7 ! foll[+ new clause3 7iii7 su* co/s %all be treat$ z incurr$ & %all n be consid]$ to be reimburs$ "u clause 7ii7 if su* co/s are borne or paid-- 7,i7 "u section #ahfj;,d-#ad2 7,,ii7 "u a ,/ate ,ph>maceutical ,assi/ance ,program2 7,,iii7 by ! ,indian ,heal? ,s]vice1 an ,indian tribe or tribal organization1 or an urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act72 or 7,,iv7 "u an ,,aids ,drug ,assi/ance ,program "u "p ,b ( title ,,xxvi ( ! ,public ,heal? ,s]vice ,act4 4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to co/s incurr$ on or aft] ,janu>y #a1 #bjag4 #bjc4 ,prohibition ( use ( ,f$]al funds = abortion ,no funds au?oriz$ or appropriat$ by ?is ,act 7or an am5dm5t made by ?is ,act7 may be us$ to pay = any abortion or to cov] any "p ( ! co/s ( any heal? plan t includes cov]age ( abortion1 except 9 ! case :]e a woman suff]s f a physical disord]1 physical injury1 or physical illness t w\ld1 z c]tifi$ by a physician1 place ! woman 9 dang] ( dea? unless an abortion is p]=m$1 includ+ a life-endang]+ physical condition caus$ by or aris+ f ! pregnancy itself1 or unless ! pregnancy is ! result ( an act ( rape or ince/4 #bjd4 ,reau?orization ( ,native ,hawaiian heal? c>e programs 7a7 ,reau?orization ,! ,native ,hawaiian ,heal? ,c>e ,act ( #aihh 7#db ,u4,s4,c4 #aagja et seq47 is am5d$ by /rik+ #bjja ea* place x appe>s 9 sections #f7;h77#a71 #g7;b71 & #aj7;c7 7#db ,u4,s4,c4 #aagje7;h77#a71 #aagjf7;b71 #aagji7;c77 & ins]t+ #bjai4 7b7 ,heal? & education 7#a7 ,9 g5]al ,section #f7;c7 ( ! ,native ,hawaiian ,heal? ,c>e ,act ( #aihh 7#db ,u4,s4,c4 #aagje7 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,heal? & education ,9 ord] to enable privately fund$ organizations to cont9ue to supplem5t public ef=ts to provide educational programs design$ to improve ! heal?1 capability1 & well-be+ ( ,native ,hawaiians & to cont9ue to provide heal? s]vices to ,native ,hawaiians1 not)/&+ any o!r provision ( ,f$]al or ,/ate law1 x %all be lawful = ! private educational organization id5tifi$ 9 section #gbjb7af7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #geab7af77 to cont9ue to (f] its educational programs & s]vices to ,native ,hawaiians 7z def9$ 9 section #gbjg ( t ,act 7#bj ,u4,s4,c4 #geag77 fir/ & to o!rs only aft] ! ne$ = su* programs & s]vices by ,native ,hawaiians has be5 met4 4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 takes effect on ,decemb] #e1 #bjjf4 7c7 ,def9ition ( heal? promotion ,section #ab7b7 ( ! ,native ,hawaiian ,heal? ,c>e ,act ( #aihh 7#db ,u4,s4,c4 #aagaa7b77 is am5d$-- 7#a7 9 subp>agraph 7,f71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,g71 by /rik+ ! p]iod at ! end & ins]t+ 1 &2 & 7#c7 by add+ at ! end ! foll[+3 7,h7 educational programs ) ! mission ( improv+ ! heal?1 capability1 & well-be+ ( ,native ,hawaiians4 4