Public Law 102–573

SEC. 101. PURPOSE.

Section 101 of the Act (25 U.S.C. 1611) is amended to read as follows:

“Sec. 101.

The purpose of this title is to increase the number of Indians entering the health professions and to assure an adequate supply of health professionals to the Service, Indian tribes, tribal organizations, and urban Indian organizations involved in the provision of health care to Indian people.”.

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SEC. 102. HEALTH PROFESSIONS.

SEC. 103. BREACH OF CONTRACT PROVISIONS RELATING TO INDIAN HEALTH SCHOLARSHIPS.

Section 104(b) of the Act (25 U.S.C. 1613a(b)) (as amended by section 102(c) of this Act) is amended by adding at the end the following new paragraph:

“(5)“(5)

(A)(A)

An individual who has, on or after the date of the enactment of this paragraph, entered into a written contract with the Secretary under this section and who—

“(i)“(i)

fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary),

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“(ii)“(ii)

is dismissed from such educational institution for disciplinary reasons,

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“(iii)“(iii)

voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or

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“(iv)“(iv)

fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract,

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in lieu of any service obligation arising under such contract, shall be liable to the United States for the amount which has been paid to him, or on his behalf, under the contract.

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“(B)“(B)

If for any reason not specified in subparagraph (A) an individual breaches his written contract by failing either to begin such individual’s service obligation under this section or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (1) of section 108 in the manner provided for in such subsection.”.

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SEC. 104. NURSING.

SEC. 105. MAINTENANCE OF COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

Section 107(b) of the Act (25 U.S.C. 1616(b)) is amended—

SEC. 106. CHANGES TO INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

SEC. 107. RECRUITMENT ACTIVITIES.

Section 109 of the Act (25 U.S.C. 1616b) is amended—

SEC. 108. ADVANCED TRAINING AND RESEARCH.

Section 111 of the Act (25 U.S.C. 1616d) is amended—

SEC. 109. INMED PROGRAM.

Section 114(b) of the Act (25 U.S.C. 1616g(b)) is amended—

SEC. 110. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

Title I of the Act is amended by inserting after section 108 the following new section:

“Sec. 108A.

(a)(a)

There is established in the Treasury of the United States a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the ‘Fund’). The Fund shall consist of such amounts as may be appropriated to the Fund under subsection (b). Amounts appropriated for the Fund shall remain available until expended.

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“(b)“(b)

For each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of—

“(1)“(1)

the amount collected during the preceding fiscal year by the Federal Government pursuant to—

“(A)“(A)

the liability of individuals under subparagraph (A) or (B) of section 104(b)(5) for the breach of contracts entered into under section 104; and

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“(B)“(B)

the liability of individuals under section 108(1) for the breach of contracts entered into under section 108; and

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“(2)“(2)

the aggregate amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to subsection (d) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year.

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“(c)“(c)

“(1)“(1)

Amounts in the Fund and available pursuant to appropriation Acts may be expended by the Secretary, acting through the Service, to make payments to an Indian tribe or tribal organization administering a health care program pursuant to a contract entered into under the Indian Self-Determination Act—

“(A)“(A)

to which a scholarship recipient under section 104 or a loan repayment program participant under section 108 has been assigned to meet the obligated service requirements pursuant to sections; and

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“(B)“(B)

that has a need for a health professional to provide health care services as a result of such recipient or participant having breached the contract entered into under section 104 or section 108.

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“(2)“(2)

An Indian tribe or tribal organization receiving payments pursuant to paragraph (1) may expend the payments to recruit and employ, directly or by contract, health professionals to provide health care services.

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“(d)“(d)

(1)(1)

The Secretary of the Treasury shall invest such amounts

Investments.

of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price.

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“(2)“(2)

Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price.”.

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SEC. 111. COMMUNITY HEALTH AIDE PROGRAM.

Title I of the Act (as amended by section 104 of this Act) is amended by adding at the end the following new section:

“Sec. 119.

(a)(a)

Under the authority of the Act of November

25 USC 1616l.

2, 1921 (25 U.S.C. 13; popularly known as the Snyder Act), the Secretary shall maintain a Community Health Aide Program in Alaska under which the Service—

“(1)“(1)

provides for the training of Alaska Natives as health aides or community health practitioners;

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“(2)“(2)

uses such aides or practitioners in the provision of health care, health promotion, and disease prevention services to Alaska Natives living in villages in rural Alaska; and

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“(3)“(3)

provides for the establishment of teleconferencing capacity in health clinics located in or near such villages for use by community health aides or community health practitioners.

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“(b)“(b)

The Secretary, acting through the Community Health Aide Program of the Service, shall—

“(1)“(1)

using trainers accredited by the Program, provide a high standard of training to community health aides and community health practitioners to ensure that such aides and practitioners provide quality health care, health promotion, and disease prevention services to the villages served by the Program;

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“(2)“(2)

in order to provide such training, develop a curriculum that—

“(A)“(A)

combines education in the theory of health care with supervised practical experience in the provision of health care;

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“(B)“(B)

provides instruction and practical experience in the provision of acute care, emergency care, health promotion, disease prevention, and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and

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“(C)“(C)

promotes the achievement of the health status objectives specified in section 3(b);

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“(3)“(3)

establish and maintain a Community Health Aide Certification Board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in paragraph (1) or can demonstrate equivalent experience;

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“(4)“(4)

develop and maintain a system which identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care, including the areas described in paragraph (2)(B), and develop programs that meet the needs for such continuing education;

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“(5)“(5)

develop and maintain a system that provides close supervision of community health aides and community health practitioners; and

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“(6)“(6)

develop a system under which the work of community health aides and community health practitioners is reviewed and evaluated to assure the provision of quality health care, health promotion, and disease prevention services.”.

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SEC. 112. MATCHING GRANTS TO TRIBES.

Title I of the Act (as amended by section 111 of this Act) is amended by adding at the end the following new section:

“Sec. 120.

(a)(a)

(1)(1)

The Secretary shall make grants to Indian tribes and tribal organizations for the purpose of assisting such tribes and tribal organizations in educating Indians to serve as health professionals in Indian communities.

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“(2)“(2)

Amounts available for grants under paragraph (1) for any fiscal year shall not exceed 5 percent of amounts available for such fiscal year for Indian Health Scholarships under section 104.

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“(3)“(3)

An application for a grant under paragraph (1) shall be in such form and contain such agreements, assurances, and information as the Secretary determines are necessary to carry out this section.

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“(b)“(b)

(1)(1)

An Indian tribe or tribal organization receiving a grant under subsection (a) shall agree to provide scholarships to Indians pursuing education in the health professions in accordance with the requirements of this section.

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“(2)“(2)

With respect to the costs of providing any scholarship pursuant to paragraph (1)—

“(A)“(A)

80 percent of the costs of the scholarship shall be paid from the grant made under subsection (a) to the Indian tribe or tribal organization; and

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“(B)“(B)

20 percent of such costs shall be paid from non-Federal contributions by the Indian tribe or tribal organization through which the scholarship is provided.

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“(3)“(3)

In determining the amount of non-Federal contributions that have been provided for purposes of subparagraph (B) of paragraph (2), any amounts provided by the Federal (Government to the Indian tribe or tribal organization involved or to any other entity shall not be included.

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“(4)“(4)

Non-Federal contributions required by subparagraph (B) of paragraph (2) may be provided directly by the Indian tribe or tribal organization involved or through donations from public and private entities.

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“(c)“(c)

An Indian tribe or tribal organization shall provide scholarships under subsection (b) only to Indians enrolled or accepted for enrollment in a course of study (approved by the Secretary) in one of the health professions described in section 104(a).

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“(d)“(d)

In providing scholarships under subsection (b), the Secretary

Contracts.

and the Indian tribe or tribal organization shall enter into a written contract with each recipient of such scholarship. Such contract shall—

“(1)“(1)

obligate such recipient to provide service in an Indian health program (as defined in section 108(a)(2)(A)), in the same service area where the Indian tribe or tribal organization providing the scholarship is located, for—

“(A)“(A)

a number of years equal to the number of years for which the scholarship is provided (or the part-time equivalent thereof, as determined by the Secretary), or for a period of 2 years, whichever period is greater; or

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“(B)“(B)

such greater period of time as the recipient and the Indian tribe or tribal organization may agree;

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“(2)“(2)

provide that the amount of such scholarship—

“(A)“(A)

may be expended only for—

“(i)“(i)

tuition expenses, other reasonable educational expenses, and reasonable living expenses incurred in attendance at the educational institution; and

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“(ii)“(ii)

payment to the recipient of a monthly stipend of not more than the amount authorized by section 338A(g)(1)(B) of the Public Health Service Act (42 U.S.C. 254m(g)(1)(B)), such amount to be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled; and

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“(B)“(B)

may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in subparagraph (A);

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“(3)“(3)

require the recipient of such scholarship to maintain an acceptable level of academic standing (as determined by the educational institution in accordance with regulations issued by the Secretary); and

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“(4)“(4)

require the recipient of such scholarship to meet the educational and licensure requirements necessary to be a physi-cian, certified nurse practitioner, certified nurse midwife, or physician assistant.

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“(e)“(e)

(1)(1)

An individual who has entered into a written contract with the Secretary and an Indian tribe or tribal organization under subsection (d) and who—

“(A)“(A)

fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary),

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“(B)“(B)

is dismissed from such educational institution for disciplinary reasons,

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“(C)“(C)

voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or

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“(D)“(D)

fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract,

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in lieu of any service obligation arising under such contract, shall be liable to the United States for the Federal share of the amount which has been paid to him, or on his behalf, under the contract.

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“(2)“(2)

If for any reason not specified in paragraph (1), an individual breaches his written contract by failing either to begin such individual’s service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (1) of section 108 in the manner provided for in such subsection.

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“(3)“(3)

The Secretary may carry out this subsection on the basis of information submitted by the tribes or tribal organizations involved, or on the basis of information collected through such other means as the Secretary determines to be appropriate.

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“(f)“(f)

The recipient of a scholarship under subsection (b) shall agree, in providing health care pursuant to the requirements of subsection (d)(1)—

“(1)“(1)

not to discriminate against an individual seeking such care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to the program established in title XVIII of the Social Security Act or pursuant to the program established in title XIX of such Act; and

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“(2)“(2)

to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act for all services for which payment may be made under part B of title XVIII of such Act, and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX of such Act to provide service to individuals entitled to medical assistance under the plan.

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“(g)“(g)

The Secretary may not make any payments under subsection (a) to an Indian tribe or tribal organization for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the Indian tribe or tribal organization has complied with requirements of this section.”.

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SEC. 113. TRIBAL HEALTH PROGRAM ADMINISTRATION.

Title I of the Act (as amended by section 112 of this Act) is amended by adding at the end the following new section:

“Sec. 121.

The Secretary shall, by contract or otherwise, provide

Contracts.

25 USC 1616n.

training for individuals in the administration and planning of tribal health programs.”.

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SEC. 114. TRIBALLY CONTROLLED VOCATIONAL INSTITUTIONS.

SEC. 115. CONTINUING EDUCATION ALLOWANCES.

Section 106(b) of the Act (25 U.S.C. 1615(b)) is amended to read as follows:

“(b)“(b)

Of amounts appropriated under the authority of this title for each fiscal year to be used to carry out this section, not more than $1,000,000 may be used to establish postdoctoral training programs for health professionals.”.

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SEC. 116. UNIVERSITY OF SOUTH DAKOTA MODEL HEALTH PROGRAM.

Title I of the Act (as amended by section 113 of this Act) is amended by adding at the end the following new section:

“Sec. 122.

(a)(a)

The Secretary may make a grant to the School

25 USC 1616o.

of Medicine of the University of South Dakota (hereafter in this section referred to as ‘USDSM’) to establish a pilot program on an Indian reservation at one or more service units in South Dakota to address the chronic manpower shortage in the Aberdeen Area of the Service.

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“(b)“(b)

The purposes of the program established pursuant to a grant provided under subsection (a) are—

“(1)“(1)

to provide direct clinical and practical experience at a service unit to medical students and residents from USDSM and other medical schools;

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“(2)“(2)

to improve the quality of health care for Indians by assuring access to qualified health care professionals; and

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“(3)“(3)

to provide academic and scholarly opportunities for physicians, physician assistants, nurse practitioners, nurses, and other allied health professionals serving Indian people by identifying and utilizing all academic and scholarly resources of the region.

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“(c)“(c)

The pilot program established pursuant to a grant provided under subsection (a) shall—

“(1)“(1)

incorporate a program advisory board composed of representatives from the tribes and communities in the area which will be served by the program; and

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“(2)“(2)

shall be designated as an extension of the USDSM campus and program participants shall be under the direct supervision and instruction of qualified medical staff serving at the service unit who shall be members of the USDSM faculty.

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“(d)“(d)

The USDSM shall coordinate the program established pursuant to a grant provided under subsection (a) with other medical schools in the region, nursing schools, tribal community colleges, and other health professional schools.

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“(e)“(e)

The USDSM, in cooperation with the Service, shall develop additional professional opportunities for program participants on Indian reservations in order to improve the recruitment and retention of qualified health professionals in the Aberdeen Area of the Service.”.

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SEC. 117. AUTHORIZATION OF APPROPRIATIONS.

SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION.

Section 203 of the Act (25 U.S.C. 1621b) is amended—

SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

Section 204 of the Act (25 U.S.C. 1621c) is amended—

SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES.

Section 209 of the Act (25 U.S.C. 1621h) is amended—

SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM.

SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY.

SEC. 208. PATIENT TRAVEL COSTS.

Title II of the Act (as amended by section 207 of this Act) is amended by adding at the end the following new section:

“Sec. 213.

(a)(a)

The Secretary, acting through the Service, shall

25 USC 1621l.

provide funds for the following patient travel costs associated with receiving health care services provided (either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act) under this Act—

“(1)“(1)

emergency air transportation; and

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“(2)“(2)

nonemergency air transportation where ground transportation is infeasible.

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“(b)“(b)

There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”.

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SEC. 209. THIRD PARTY REIMBURSEMENT.

SEC. 210. EPIDEMIOLOGY CENTERS.

Title II of the Act (as amended by section 208 of this Act) is amended by adding at the end the following new section:

“Sec. 214.

(a)(a)

(1)(1)

The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3).

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“(2)“(2)

To assist such centers in carrying out such functions, the Secretary shall perform the following:

“(A)“(A)

In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories.

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“(B)“(B)

Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b).

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“(3)“(3)

In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area—

“(A)“(A)

collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2);

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“(B)“(B)

evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health;

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“(C)“(C)

assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data;

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“(D)“(D)

make recommendations for the targeting of services needed by tribal, urban, and other Indian communities;

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“(E)“(E)

make recommendations to improve health care delivery systems for Indians and urban Indians;

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“(F)“(F)

work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and

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“(G)“(G)

provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community.

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“(4)“(4)

Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.).

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“(5)“(5)

The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection.

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“(6)“(6)

The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection.

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“(b)“(b)

(1)(1)

The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities.

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“(2)“(2)

An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if—

“(A)“(A)

it is incorporated for the primary purpose of improving Indian health; and

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“(B)“(B)

it is representative of the tribes or urban Indian communities in which it is located.

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“(3)“(3)

An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe.

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“(4)“(4)

Applicants for grants under this subsection shall—

“(A)“(A)

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

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“(B)“(B)

consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and

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“(C)“(C)

demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served.

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“(5)“(5)

A grant awarded under paragraph (1) may be used to—

“(A)“(A)

carry out the functions described in subsection (a)(3);

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“(B)“(B)

provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and

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“(C)“(C)

provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people.

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“(6)“(6)

There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”.

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SEC. 211. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

Title II of the Act (as amended by section 210 of this Act) is amended by adding at the end the following new section:

“Sec. 215.

(a)(a)

The Secretary, acting through the Service and

25 USC 1621n.

in consultation with the Secretary of the Interior, may award grants to Indian tribes to develop comprehensive school health education programs for children from preschool through grade 12 in schools located on Indian reservations.

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“(b)“(b)

Grants awarded under this section may be used to—

“(1)“(1)

develop health education curricula;

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“(2)“(2)

train teachers in comprehensive school health education curricula;

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“(3)“(3)

integrate school-based, community-based, and other public and private health promotion efforts;

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“(4)“(4)

encourage healthy, tobacco-free school environments;

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“(5)“(5)

coordinate school-based health programs with existing services and programs available in the community;

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“(6)“(6)

develop school programs on nutrition education, personal health, and fitness;

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“(7)“(7)

develop mental health wellness programs;

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“(8)“(8)

develop chronic disease prevention programs;

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“(9)“(9)

develop substance abuse prevention programs;

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“(10)“(10)

develop accident prevention and safety education programs;

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“(11)“(11)

develop activities for the prevention and control of communicable diseases; and

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“(12)“(12)

develop community and environmental health education programs.

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“(c)“(c)

The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources.

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“(d)“(d)

The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section.

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“(e)“(e)

Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of—

“(1)“(1)

the number of preschools, elementary schools, and secondary schools served;

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“(2)“(2)

the number of students served;

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“(3)“(3)

any new curricula established with funds provided under this section;

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“(4)“(4)

the number of teachers trained in the health curricula; and

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“(5)“(5)

the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section.

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“(f)“(f)

(1)(1)

The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs.

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“(2)“(2)

Such program shall include—

“(A)“(A)

school programs on nutrition education, personal health, and fitness;

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“(B)“(B)

mental health wellness programs;

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“(C)“(C)

chronic disease prevention programs;

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“(D)“(D)

substance abuse prevention programs;

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“(E)“(E)

accident prevention and safety education programs; and

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“(F)“(F)

activities for the prevention and control of communicable diseases.

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“(3)“(3)

The Secretary of the Interior shall—

“(A)“(A)

provide training to teachers in comprehensive school health education curricula;

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“(B)“(B)

ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and

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“(C)“(C)

encourage healthy, tobacco-free school environments.

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“(g)“(g)

There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”.

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SEC. 212. INDIAN YOUTH GRANT PROGRAM.

Title II of the Act (as amended by section 211 of this Act) is amended by adding at the end the following new section:

“Sec. 216.

(a)(a)

The Secretary, acting through the Service, is

25 USC 1621o.

authorized to make grants to Indian tribes, tribal organizations, and urban Indian organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian preadolescent and adolescent youths.

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“(b)“(b)

(1)(1)

Funds made available under this section may be used to—

“(A)“(A)

develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and

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“(B)“(B)

develop and provide community training and education.

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“(2)“(2)

Funds made available under this section may not be used to provide services described in section 209(m).

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“(c)“(c)

The Secretary shall—

“(1)“(1)

disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents;

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“(2)“(2)

encourage the implementation of such models; and

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“(3)“(3)

at the request of an Indian tribe, provide technical assistance in the implementation of such models.

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“(d)“(d)

The Secretary shall establish criteria for the review and approval of applications under this section.

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“(e)“(e)

There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”.

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SEC. 213. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

Title II of the Act (as amended by section 212 of this Act) is amended by adding at the end the following new section:

“Sec. 217.

(a)(a)

The Secretary may provide grants to at least

25 USC 1621p.

3 colleges and universities for the purpose of developing and maintaining American Indian psychology career recruitment programs as a means of encouraging Indians to enter the mental health field.

#

“(b)“(b)

The Secretary shall provide one of the grants authorized

Grants.

under subsection (a) to develop and maintain a program at the University of North Dakota to be known as the ‘Quentin N. Burdick American Indians Into Psychology Program’. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs authorized under section 114(b), the Quentin N. Burdick American Indians Into Nursing Program authorized under section 112(e), and existing university research and communications networks.

#

“(c)“(c)

(1)(1)

The Secretary shall issue regulations for the competitive

Regulations.

awarding of the grants provided under mis section.

#

“(2)“(2)

Applicants for grants under this section shall agree to provide a program which, at a minimum—

“(A)“(A)

provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program;

#

“(B)“(B)

incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program;

#

“(C)“(C)

provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities;

#

“(D)“(D)

provides stipends to undergraduate and graduate students to pursue a career in psychology;

#

“(E)“(E)

develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students;

#

“(F)“(F)

to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and

#

“(G)“(G)

to the maximum extent feasible, employs qualified Indians in the program.

#

#

#

“(d)“(d)

The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service—

“(1)“(1)

in the Indian Health Service;

#

“(2)“(2)

in a program conducted under a contract entered into under the Indian Self-Determination Act;

#

“(3)“(3)

in a program assisted under title V of this Act; or

#

“(4)“(4)

in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”.

#

#

#

SEC. 214. PREVENTION, CONTROL, AND ELIMINATION OF TUBERCULOSIS.

Title II of the Act (as amended by section 213 of this Act) is amended by adding at the end the following new section:

“Sec. 218.

(a)(a)

The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for—

“(1)“(1)

projects for the prevention, control, and elimination of tuberculosis;

#

“(2)“(2)

public information and education programs for the prevention, control, and elimination of tuberculosis; and

#

“(3)“(3)

education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals.

#

#

“(b)“(b)

The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require.

#

“(c)“(c)

To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that—

“(1)“(1)

the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and

#

“(2)“(2)

the applicant will submit to the Secretary an annual

Reports.

report on its activities for the prevention, control, and elimination of tuberculosis.

#

#

“(d)“(d)

In carrying out this section, the Secretary—

“(1)“(1)

shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants;

#

“(2)“(2)

shall, subject to available appropriations, make at least one grant under subsection (a) within each area office;

#

“(3)“(3)

may, at the request of an Indian tribe or tribal organization, provide technical assistance; and

#

“(4)“(4)

shall prepare and submit a report to the Committee

Reports.

on Energy and Commerce and the Committee on Interior and Insular Affairs of the House and the Select Committee on Indian Affairs of the Senate not later than February 1, 1994, and biennially thereafter, on the use of funds under this section and on the progress made toward the prevention, control, and elimination of tuberculosis among Indian tribes and tribal organizations.

#

#

“(e)“(e)

The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by—

“(1)“(1)

the fair market value of any supplies or equipment furnished the grant recipient; and

#

“(2)“(2)

the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee,

#

when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”.

#

#

SEC. 215. CONTRACT HEALTH SERVICES.

Title II of the Act (as amended by section 214 of this Act) is amended by adding at the end the following new sections:

“Sec. 219.

(a)(a)

The Secretary, acting through the Service and

25 USC 1621r.

in consultation with representatives of Indian tribes and tribal organizations operating contract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) or under self-governance compacts, Service personnel, private contract health services providers, the Indian Health Service Fiscal Intermediary, and other appropriate experts, shall conduct a study—

“(1)“(1)

to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary;

#

“(2)“(2)

to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and

#

“(3)“(3)

to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities.

#

#

“(b)“(b)

The study required by subsection (a) shall—

“(1)“(1)

assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers;

#

“(2)“(2)

assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments;

#

“(3)“(3)

survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians;

#

“(4)“(4)

identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and

#

“(5)“(5)

compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers.

#

#

“(c)“(c)

Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes—

“(1)“(1)

a detailed description of the study conducted pursuant to this section; and

#

“(2)“(2)

a discussion of the findings and conclusions of such study.

#

#

#

“Sec. 220.

(a)(a)

The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification.

#

“(b)“(b)

If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service.

#

“(c)“(c)

The Service shall pay a completed contract care service claim within 30 days after completion of the claim.

#

#

“Sec. 221.

(a)(a)

Not later than June 15, 1993, the Secretary

25 USC 1621t.

shall develop and implement, directly or by contract, 2 projects to demonstrate in a pilot setting the use of claims processing technology to improve the accuracy and timeliness of the billing for, and payment of, contract health services.

#

“(b)“(b)

The Secretary shall conduct one of the projects authorized

Arizona.

in subsection (a) in the Service area served by the area office located in Phoenix, Arizona.

#

#

“Sec. 222.

(a)(a)

A patient who receives contract health care

25 USC 1621u.

services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services.

#

“(b)“(b)

The Secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services.”.

#

#

SEC. 216. OFFICE OF WOMEN’S INDIAN HEALTH CARE.

Title II of the Act (as amended by section 215 of this Act) is amended by adding at the end the following new section:

“Sec. 223.

There is established within the Service an Office

Establishment.

25 USC 1621v.

of Indian Women’s Health Care to oversee efforts of the Service to monitor and improve the quality of health care for Indian women of all ages through the planning and delivery of programs administered by the Service, in order to improve and enhance the treatment models of care for Indian women.”.

#

SEC. 217. AUTHORIZATION OF APPROPRIATIONS.

SEC. 301. HEALTH FACILITIES CLOSURE AND PRIORITIES.

Section 301 of the Act (25 U.S.C. 1631) is amended—

SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL FACIUTIES.

Section 302 of the Act (25 U.S.C. 1632) is amended—

SEC. 303. AMBULATORY CARE FACILITIES GRANT PROGRAM.

Section 306 of the Act (25 U.S.C. 1636) is amended to read as follows:

“Sec. 306.

(a)(a)

(1)(1)

The Secretary, acting through the Service, shall make grants to tribes and tribal organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons as provided in subsection (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term ‘construction’ includes the replacement of an existing facility.

#

“(2)“(2)

A grant under paragraph (1) may only be made to a tribe or tribal organization operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to a tribe or tribal organization) pursuant to a contract entered into under the Indian Self-Determination Act.

#

#

“(b)“(b)

(1)(1)

A grant provided under this section may be used only for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility—

“(A)“(A)

located apart from a hospital;

#

“(B)“(B)

not funded under section 301 or section 307; and

#

“(C)“(C)

which, upon completion of such construction, expansion, or modernization will—

“(i)“(i)

have a total capacity appropriate to its projected service population;

#

“(ii)“(ii)

serve no less than 500 eligible Indians annually; and

#

“(iii)“(iii)

provide ambulatory care in a service area (specified in the contract entered into under the Indian Self-Determination Act) with a population of not less than 2,000 eligible Indians.

#

#

#

“(2)“(2)

The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to a tribe or tribal organization applying for a grant under this section whose tribal government offices are located on an island.

#

#

“(c)“(c)

(1)(1)

No grant may be made under this section unless an application for such a grant has been submitted to and approved

Regulations.

by the Secretary. An application for a grant under this section shall be submitted in such form and manner as the Secretary shall by regulation prescribe and shall set forth reasonable assurance by the applicant that, at all times after the construction, expansion, or modernization of a facility carried out pursuant to a grant received under this section—

“(A)“(A)

adequate financial support will be available for the provision of services at such facility;

#

“(B)“(B)

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

#

“(C)“(C)

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

#

#

“(2)“(2)

In awarding grants under this section, the Secretary shall give priority to tribes and tribal organizations that demonstrate—

“(A)“(A)

a need for increased ambulatory care services; and

#

“(B)“(B)

insufficient capacity to deliver such services.

#

#

#

“(d)“(d)

If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be utilized for the purposes of providing ambulatory care services to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States.”.

#

#

SEC. 304. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

Section 305 of the Act (25 U.S.C. 1634) is amended to read as follows:

“Sec. 305.

(a)(a)

“(1)“(1)

Notwithstanding any other provision of law, the Secretary is authorized to accept any major renovation or modernization by any Indian tribe of any Service facility, or of any other Indian health facility operated pursuant to a contract entered into under the Indian Self-Determination Act, including—

“(A)“(A)

any plans or designs for such renovation or modernization; and

#

“(B)“(B)

any renovation or modernization for which funds appropriated under any Federal law were lawfully expended, but only if the requirements of subsection (b) are met.

#

#

“(2)“(2)

The Secretary shall maintain a separate priority list to address the needs of such facilities for personnel or equipment.

#

“(3)“(3)

The Secretary shall submit to the President, for inclusion

Reports.

in each report required to be transmitted to the Congress under section 801, the priority list maintained pursuant to paragraph (2).

#

#

“(b)“(b)

The requirements of this subsection are met with respect to any renovation or modernization if—

“(1)“(1)

the tribe or tribal organization—

“(A)“(A)

provides notice to the Secretary of its intent to renovate or modernize; and

#

“(B)“(B)

applies to the Secretary to be placed on a separate priority list to address the needs of such new facilities for personnel or equipment; and

#

#

“(2)“(2)

the renovation or modernization—

“(A)“(A)

is approved by the appropriate area director of the Service; and

#

“(B)“(B)

is administered by the tribe in accordance with the rules and regulations prescribed by the Secretary with respect to construction or renovation of Service facilities.

#

#

#

“(c)“(c)

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

#

#

SEC. 306. LAND TRANSFER.

Title III of the Act is amended by adding at the end the following new section:

“Sec. 308.

The Bureau of Indian Affairs is authorized to transfer, at no cost, up to 5 acres of land at the Chemawa Indian School, Salem, Oregon, to the Service for the provision of health care services. The land authorized to be transferred by this section is that land adjacent to land under the jurisdiction of the Service and occupied by the Chemawa Indian Health Center.”.

#

SEC. 307. AUTHORIZATION OF APPROPRIATIONS.

SEC. 308. BUY AMERICAN REQUIREMENT.

Title III of the Act (as amended by section 307 of this Act) is amended by adding at the end the following new section:

”Sec. 310.

(a)(a)

The Secretary shall ensure that the requirements of the Buy American Act apply to all procurements made with funds provided pursuant to the authorization contained in section 309.

#

“(b)“(b)

The Secretary shall submit to the Congress a report on the amount of procurements from foreign entities made in fiscal years 1993 and 1994 with funds provided pursuant to the authorization contained in section 309. Such report shall separately indicate the dollar value of items procured with such funds for which the Buy American Act was waived pursuant to the Trade Agreement Act of 1979 or any international agreement to which the United States is a party.

#

“(c)“(c)

If it has been finally determined by a court or Federal agency that any person intentionally affixed a label bearing a ‘Made in America’ inscription, or any inscription with the same meaning, to any product sold in or shipped to the United States that is not made in the United States, such person shall be ineligible to receive any contract or subcontract made with funds provided pursuant to the authorization contained in section 309, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 of title 48, Code of Federal Regulations.

#

#

“(d)“(d)

For purposes of this section, the term “Buy American Act” means title III of the Act entitled “An Act making appropriations for the Treasury and Post Office Departments for the fiscal year ending June 30, 1934, and for other purposes”, approved March 3, 1933 (41 U.S.C. 10a et seq.).”.

#

SEC. 401. TREATMENT OF PAYMENTS TO INDIAN HEALTH SERVICE FACILITIES UNDER MEDICARE AND MEDICAID PROGRAMS.

SEC. 402. REPORT.

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

SEC. 403. APPLICATION ASSISTANCE.

25 USC 1644.

Section 404 of the Act (25 U.S.C. 1622) is amended—

SEC. 404. EXTENSION OF DEMONSTRATION PROGRAM.

25 USC 1645.

Section 405 of the Act (42 U.S.C. 1395qq note) is amended—

SEC. 405. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES.

Title IV of the Act is amended by adding at the end the following new section:

“Sec. 406.

With respect to an elderly or disabled Indian receiving emergency medical care or services from a non-Service provider or in a non-Service facility under the authority of this Act, the time limitation (as a condition of payment) for notifying the Service of such treatment or admission shall be 30 days.”.

#

SEC. 406. AUTHORIZATION OF APPROPRIATIONS.

Title IV of the Act is amended by adding at the end the following new section:

“Sec. 407.

There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”.

#

SEC. 501. GRANT AUTHORITY.

SEC. 502. ALCOHOL AND SUBSTANCE ABUSE.

Title V of the Act is amended by inserting after section 510 (as redesignated by section 902(5)(B) of this Act) the following new section:

“Sec. 511.

(a)(a)

Grants.—

The Secretary may make grants for

25 USC 1660a.

the provision of health-related services in prevention of, treatment of, rehabilitation of, or school and community-based education in, alcohol and substance abuse in urban centers to those urban Indian organizations with whom the Secretary has entered into a contract under this title or under section 201.

#

“(b)“(b)

Goals of Grant.—

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

#

“(c)“(c)

Criteria.—

The Secretary shall establish criteria for the grants made under subsection (a), including criteria relating to the—

“(1)“(1)

size of the urban Indian population;

#

“(2)“(2)

accessibility to, and utilization of, other health resources available to such population;

#

“(3)“(3)

duplication of existing Service or other Federal grants or contracts;

#

“(4)“(4)

capability of the organization to adequately perform the activities required under the grant;

#

“(5)“(5)

satisfactory performance standards for the organization in meeting the goals set forth in such grant, which standards shall be negotiated and agreed to between the Secretary and the grantee on a grant-by-grant basis; and

#

“(6)“(6)

identification of need for services.

#

“The Secretary shall develop a methodology for allocating grants made pursuant to this section based on such criteria.

#

“(d)“(d)

Treatment of Funds Received by Urban Indian Organizations.—

Any funds received by an urban Indian organization under this Act for substance abuse prevention, treatment, and rehabilitation shall be subject to the criteria set forth in subsection (c).”.

#

#

SEC. 503. TREATMENT OF DEMONSTRATION PROJECTS.

Title V of the Act (as amended by section 502 of this Act) is amended by adding at the end the following new section:

“Sec. 512.

(a)(a)

Notwithstanding any other provision of law, the Oklahoma City Clinic demonstration project and the Tulsa Clinic demonstration project shall be treated as service units in the allocation of resources and coordination of care and shall not be subject to the provisions of the Indian Self-Determination Act for the term of such projects. The Secretary shall provide assistance to such projects in the development of resources and equipment and facility needs.

#

“(b)“(b)

Reports.

The Secretary shall submit to the President, for inclusion in the report required to be submitted to the Congress under section 801 for fiscal year 1999, a report on the findings and conclusions derived from the demonstration projects specified in subsection (a).”.

#

#

SEC. 504. URBAN NIAAA TRANSFERRED PROGRAMS.

Title V of the Act (as amended by section 503 of this Act) is amended by adding at the end the following new section:

“Sec. 513.

(a)(a)

The Secretary shall, within the Branch of Urban Health Programs of the Service, make grants or enter into contracts for the administration of urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as ‘NIAAA’) and transferred to the Service.

#

“(b)“(b)

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

#

“(c)“(c)

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

#

“(d)“(d)

For the purpose of carrying out this section, the Secretary may combine NIAAA. alcohol funds with other substance abuse funds currently administered through the Branch of Urban Health Programs of the Service.

#

“(e)“(e)

Reports.

The Secretary shall evaluate and report to the Congress on the activities of programs funded under this section at least every two years.”.

#

#

SEC. 505. AUTHORIZATION OF APPROPRIATIONS.

SEC. 601. INDIAN HEALTH SERVICE.

Section 601(c) of the Act (15 U.S.C. 1661(c)) is amended—

SEC. 602. DIRECTOR OF INDIAN HEALTH SERVICE.

SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

Title VI of the Act (25 U.S.C. 1661 et seq.) is amended by adding at the end the following new section:

“Sec. 603.

There are authorized to be appropriated such sums

25 USC 1663.

as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”.

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SEC. 701. REDESIGNATION OF EXISTING TITLE VII.

SEC. 702. SUBSTANCE ABUSE PROGRAMS.

SEC. 703. INDIAN ALCOHOL AND SUBSTANCE ABUSE PREVENTION AND TREATMENT ACT OF 1986 AMENDMENTS.

The Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et seq.) is amended—

SEC. 801. REPORTS.

Section 801 of the Act (25 U.S.C. 1671) (as redesignated by section 701(b) of this Act) is amended to read as follows:

“Sec. 801.

The President shall, at the time the budget is submitted under section 1105 of title 31, United States Code, for each fiscal year transmit to the Congress a report containing—

“(1)“(1)

a report on the progress made in meeting the objectives of this Act, including a review of programs established or assisted pursuant to this Act and an assessment and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Indians, and ensure a health status for Indians, which are at a parity with the health services available to and the health status of, the general population;

#

“(2)“(2)

a report on whether, and to what extent, new national health care programs, benefits, initiatives, or financing systems have had an impact on the purposes of this Act and any steps that the Secretary may have taken to consult with Indian tribes to address such impact;

#

“(3)“(3)

a report on the use of health services by Indians—

“(A)“(A)

on a national and area or other relevant geographical basis;

#

“(B)“(B)

by gender and age;

#

“(C)“(C)

by source of payment and type of service; and

#

“(D)“(D)

comparing such rates of use with rates of use among comparable non-Indian populations.

#

#

“(4)“(4)

a separate statement which specifies the amount of funds requested to carry out the provisions of section 201;

#

“(5)“(5)

a separate statement of the total amount obligated or expended in the most recently completed fiscal year to achieve each of the objectives described in section 814, relating to infant and maternal mortality and fetal alcohol syndrome;

#

“(6)“(6)

the reports required by sections 3(d), 108(n), 203(b), 209(j), 301(c), 302(g), 305(a)(3), 403, 708(e), and 817(a), and 822(f);

#

“(7)“(7)

for fiscal year 1995, the report required by sections 702(c)(3) and 713(b);

#

“(8)“(8)

for fiscal year 1997, the interim report required by section 307(h)(1); and

#

“(9)“(9)

for fiscal year 1999, the reports required by sections 307(h)(2), 512(b), 711(f), and 821(g).”.

#

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SEC. 802. REGULATIONS.

Section 802 of the Act (25 U.S.C. 1672) (as redesignated by section 701(b) of this Act) is amended to read as follows:

“Sec. 802.

Prior to any revision of or amendment to rules

Federal Register, publication.

or regulations promulgated pursuant to this Act, the Secretary shall consult with Indian tribes and appropriate national or regional Indian organizations and shall publish any proposed revision or amendment in the Federal Register not less than sixty days prior to the effective date of such revision or amendment in order to provide adequate notice to, and receive comments from, other interested parties.”.

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SEC. 803. EXTENSION OF TREATMENT OF ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

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

SEC. 804. INFANT AND MATERNAL MORTALITY; FETAL ALCOHOL SYNDROME.

Section 814 of the Act (25 U.S.C. 1680d) (as redesignated by section 701(b) of this Act) is amended—

SEC. 805. REALLOCATION OF BASE RESOURCES.

Section 817(a) of the Act (25 U.S.C. 1680(g)) (as redesignated

25 USC 1680g.

by section 701(b) of this Act) is amended by striking out “Secretary has submitted to the Congress” and inserting in lieu thereof the following: “Secretary has submitted to the President, for inclusion in the report required to be transmitted to the Congress under section 801,”.

SEC. 806. CHILD SEXUAL ABUSE TKEATMENT PROGRAMS.

Section 819 of the Act (25 U.S.C. 16801) (as redesignated by section 701(b) of this Act) is amended to read as follows:

“Sec. 819.

(a)(a)

The Secretary and the Secretary of the Interior shall, for each fiscal year through fiscal year 1995, continue the demonstration programs involving treatment for child sexual abuse provided through the Hopi Tribe and the Assiniboine and Sioux Tribes of the Fort Peck Reservation.

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“(b)“(b)

Beginning October 1, 1995, the Secretary and the Secretary of the Interior may establish, in any service area, demonstration programs involving treatment for child sexual abuse, except that the Secretaries may not establish a greater number of such programs in one service area than in any other service area until there is an equal number of such programs established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”.

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SEC. 807. TRIBAL LEASING.

Section 820 of the Act (25 U.S.C. 1680j) (as redesignated by section 701(b) of this Act) is amended to read as follows:

“Sec. 820.

Indian tribes providing health care services pursuant to a contract entered into under the Indian Self-Determination Act may lease permanent structures for the purpose of providing such health care services without obtaining advance approval in appropriation Acts.”.

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SEC. 808. EXTENSION OF TERMINATION DATE OF CERTAIN DEMONSTRATION PROJECTS; JOINT VENTURE PROJECTS.

Section 818 of the Act (25 U.S.C. 1680h) (as redesignated by section 701(b) of this Act) is amended—

SEC. 809. HOME AND COMMUNITY BASED CARE DEMONSTRATION PROJECT.

Title VIII of the Act (as redesignated by subsections (a) and (b) of section 701 of this Act) is amended by adding at the end the following new section:

“Sec. 821.

(a)(a)

The Secretary, acting through the Service, is

25 USC 1680k.

authorized to enter into contracts with, or make grants to, Indian tribes or tribal organizations providing health care services pursuant to a contract entered into under the Indian Self-Determination Act, to establish demonstration projects for the delivery of home-and community-based services to functionally disabled Indians.

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“(b)“(b)

(1)(1)

Funds provided for a demonstration project under this section shall be used only for the delivery of home- and community-based services (including transportation services) to functionally disabled Indians.

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“(2)“(2)

Such funds may not be used—

“(A)“(A)

to make cash payments to functionally disabled Indians;

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“(B)“(B)

to provide room and board for functionally disabled Indians;

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“(C)“(C)

for the construction or renovation of facilities or the purchase of medical equipment; or

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“(D)“(D)

for the provision of nursing facility services.

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“(c)“(c)

Not later than 180 days after the date of the enactment of this section, the Secretary, after consultation with Indian tribes and tribal organizations, shall develop and issue criteria for the approval of applications submitted under this section. Such criteria shall ensure that demonstration projects established under this section promote the development of the capacity of tribes and tribal organizations to deliver, or arrange for the delivery of, high quality, culturally appropriate home- and community-based services to functionally disabled Indians;

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“(d)“(d)

The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section.

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“(e)“(e)

At the discretion of the tribe or tribal organization, services provided under a demonstration project established under this section may be provided (on a cost basis) to persons otherwise ineligible for the health care benefits of the Service.

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“(f)“(f)

The Secretary shall establish not more than 24 demonstration projects under this section. The Secretary may not establish a greater number of demonstration projects under this section in one service area than in any other service area until there is an equal number of such demonstration projects established with respect to all service areas from which the Secretary receives applications during the application period (as determined by the Secretary) which meet the criteria issued pursuant to subsection (c).

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“(g)“(g)

The Secretary shall submit to the President, for inclusion in the report which is required to be submitted under section 801 for fiscal year 1999, a report on the findings and conclusions derived from the demonstration projects conducted under this section, together with legislative recommendations.

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“(h)“(h)

For the purposes of this section, the following definitions shall apply:

“(1)“(1)

The term ‘home- and community-based services’ means one or more of the following:

“(A)“(A)

Homemaker/home health aide services.

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“(B)“(B)

Chore services.

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“(C)“(C)

Personal care services.

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“(D)“(D)

Nursing care services provided outside of a nursing facility by, or under the supervision of, a registered nurse.

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“(E)“(E)

Respite care.

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“(F)“(F)

Training for family members in managing a functionally disabled individual.

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“(G)“(G)

Adult day care.

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“(H)“(H)

Such other home- and community-based services as the Secretary may approve.

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“(2)“(2)

The term ‘functionally disabled’ means an individual who is determined to require home- and community-based services based on an assessment that uses criteria (including, at the discretion of the tribe or tribal organization, activities of daily living) developed by the tribe or tribal organization.

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“(i)“(i)

There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out this section. Such sums shall remain available until expended.”.

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SEC. 810. SHARED SERVICES DEMONSTRATION PROJECTS.

Title VIII of the Act (as redesignated by subsections (a) and (b) of section 701 and amended by section 809 of this Act) is amended by adding at the end the following new section:

“Sec. 822.

(a)(a)

The Secretary, acting through the Service and notwithstanding any other provision of law, is authorized to enter into contracts with Indian tribes or tribal organizations to establish not more than 6 shared services demonstration projects for the delivery of long-term care to Indians. Such projects shall provide for the sharing of staff or other services between a Service facility and a nursing facility owned and operated (directly or by contract) by such Indian tribe or tribal organization.

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“(b)“(b)

A contract entered into pursuant to subsection (a)—

“(1)“(1)

may, at the request of the Indian tribe or tribal organization, delegate to such tribe or tribal organization such powers of supervision and control over Service employees as the Secretary deems necessary to carry out the purposes of this section;

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“(2)“(2)

shall provide that expenses (including salaries) relating to services that are shared between the Service facility and the tribal facility be allocated proportionately between the Service and the tribe or tribal organization; and

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“(3)“(3)

may authorize such tribe or tribal organization to construct, renovate, or expand a nursing facility (including the construction of a facility attached to a Service facility), except that no funds appropriated for the Service shall be obligated or expended for such purpose.

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“(c)“(c)

To be eligible for a contract under this section, a tribe or tribal organization, shall, as of the date of the enactment of this Act—

“(1)“(1)

own and operate (directly or by contract) a nursing facility;

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“(2)“(2)

have entered into an agreement with a consultant to develop a plan for meeting the long-term needs of the tribe or tribal organization; or

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“(3)“(3)

have adopted a tribal resolution providing for the construction of a nursing facility.

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“(d)“(d)

Any nursing facility for which a contract is entered into under this section shall meet the requirements for nursing facilities under section 1919 of the Social Security Act.

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“(e)“(e)

The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section.

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“(f)“(f)

The Secretary shall submit to the President, for inclusion

Reports.

in each report required to be transmitted to the Congress under section 801, a report on the findings and conclusions derived from the demonstration projects conducted under this section.”.

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SEC. 811. RESULTS OF DEMONSTRATION PROJECTS.

Title VIII of the Act (as redesignated by subsections (a) and (b) of section 701 and amended by section 810 of this Act) is amended by adding at the end the following new section:

“Sec. 823.

The Secretary shall provide for the dissemination

25 USC 1680m.

to Indian tribes of the findings and results of demonstration projects conducted under this Act.”.

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SEC. 812. PRIORITY FOR INDIAN RESERVATIONS.

Title VIII of the Act (as redesignated by subsections (a) and (b) of section 701 and amended by section 811 of this Act) is amended by adding at the end the following new section:

“Sec. 824.

(a)(a)

Beginning on the date of the enactment of this

25 USC 1680n.

section, the Bureau of Indian Affairs and the Service shall, in all matters involving the reorganization or development of Service facilities, or in the establishment of related employment projects to address unemployment conditions in economically depressed areas, give priority to locating such facilities and projects on Indian lands if requested by the Indian tribe with jurisdiction over such lands.

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“(b)“(b)

For purposes of this section, the term “Indian lands” means—

“(1)“(1)

all lands within the limits of any Indian reservation; and

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“(2)“(2)

any lands title which is held in trust by the United States for the benefit of any Indian tribe or individual Indian, or held by any Indian tribe or individual Indian subject to restriction by the United States against alienation and over which an Indian tribe exercises governmental power.”.

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SEC. 813. AUTHORIZATION OF APPROPRIATIONS.

SEC. 814. TRIBAL SELF-GOVERNANCE PROJECT.

The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450f note) is amended—

SEC. 901. REPEAL OF EXPIRED REPORTING REQUIREMENTS.

The Act is amended—

SEC. 902. OTHER TECHNICAL CORRECTIONS.

The Act is amended—