§ 1621h. Mental health prevention and treatment services

Footnotes

1. 1 See References in Text note below.

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

1. 1990

   Indian Health Care Improvement Act

   Pub. L. 94–437 title II § 209 · 90 Stat. 1400

   Enacted · 25 U.S.C. § 1621h

   Pub. L. 94–437, title II, § 209, as added Pub. L. 101–630, title V, § 503(b), Nov. 28, 1990, 104 Stat. 4557

   Source evidence

   Code source credit
   Pub. L. 94–437, title II, § 209, as added Pub. L. 101–630, title V, § 503(b), Nov. 28, 1990, 104 Stat. 4557

2. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 § 902(3)(A) · 106 Stat. 4526

   Changed · 25 U.S.C. § 1621h

   Pub. L. 102–573, § 902(3)(A), made technical amendment to section catchline

   Source evidence

   Code amendment note
   Pub. L. 102–573, § 902(3)(A), made technical amendment to section catchline.

   Enacted provision · exact public law section
   (A) by striking out “SEC. 209. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES.” and inserting in lieu thereof the following: “Sec. 209. ”; and

3. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 § 902(3)(B) · 106 Stat. 4526

   Redesignated · 25 U.S.C. § 1621h(b)

   Pub. L. 102–573, § 902(3)(B), redesignated subsec. (c) as (b). Prior to amendment, no subsec. (b) had been enacted

   Source evidence

   Code amendment note
   Subsec. (b). Pub. L. 102–573, § 902(3)(B), redesignated subsec. (c) as (b). Prior to amendment, no subsec. (b) had been enacted.

   Enacted provision · exact public law section
   (B) in section 209, by redesignating subsections (c) through (1) as subsections (b) through (k), respectively;

4. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 title II · 106 Stat. 4526

   1. Redesignated · 25 U.S.C. § 1621h(c)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (d) as (c)

   2. Redesignated · 25 U.S.C. § 1621h(c)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), struck out par. (5) which authorized appropriations of $500,000 for fiscal year 1991 and $1,000,000 for fiscal year 1992 to carry out this subsec. Former subsec. (c) redesignated (b)

   Source evidence

   Code amendment note
   Subsec. (c). Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (d) as (c) and struck out par. (5) which authorized appropriations of $500,000 for fiscal year 1991 and $1,000,000 for fiscal year 1992 to carry out this subsec. Former subsec. (c) redesignated (b).

   Enacted provision · exact public law
   TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

5. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 title II · 106 Stat. 4526

   1. Redesignated · 25 U.S.C. § 1621h(d)

      Pub. L. 102–573, §§ 217(b)(4)(A), (D), 902(3)(B), redesignated subsec. (e) as (d)

   2. Substituted · 25 U.S.C. § 1621h(d)

      Pub. L. 102–573, §§ 217(b)(4)(A), (D), 902(3)(B), substituted “this section” for “this subsection” in par. (3)(B)

   3. Redesignated · 25 U.S.C. § 1621h(d)

      Pub. L. 102–573, §§ 217(b)(4)(A), (D), 902(3)(B), struck out par. (6) which authorized appropriations of $500,000 for fiscal year 1991 and $5,000,000 for fiscal year 1992 to carry out this subsec., with certain amounts to be allocated for community education. Former subsec. (d) redesignated (c)

   Source evidence

   Code amendment note
   Subsec. (d). Pub. L. 102–573, §§ 217(b)(4)(A), (D), 902(3)(B), redesignated subsec. (e) as (d), substituted “this section” for “this subsection” in par. (3)(B), and struck out par. (6) which authorized appropriations of $500,000 for fiscal year 1991 and $5,000,000 for fiscal year 1992 to carry out this subsec., with certain amounts to be allocated for community education. Former subsec. (d) redesignated (c).

   Enacted provision · exact public law
   TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

6. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 § 902(3)(B) · 106 Stat. 4526

   Redesignated · 25 U.S.C. § 1621h(e)

   Pub. L. 102–573, § 902(3)(B), redesignated subsec. (f) as (e). Former subsec. (e) redesignated (d)

   Source evidence

   Code amendment note
   Subsec. (e). Pub. L. 102–573, § 902(3)(B), redesignated subsec. (f) as (e). Former subsec. (e) redesignated (d).

   Enacted provision · exact public law section
   (B) in section 209, by redesignating subsections (c) through (1) as subsections (b) through (k), respectively;

7. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 title II · 106 Stat. 4526

   1. Redesignated · 25 U.S.C. § 1621h(f)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (g) as (f)

   2. Redesignated · 25 U.S.C. § 1621h(f)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), struck out par. (4) which appropriated $1,200,000 for fiscal year 1992 to carry out this subsec. Former subsec. (f) redesignated (e)

   Source evidence

   Code amendment note
   Subsec. (f). Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (g) as (f) and struck out par. (4) which appropriated $1,200,000 for fiscal year 1992 to carry out this subsec. Former subsec. (f) redesignated (e).

   Enacted provision · exact public law
   TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

8. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 title II · 106 Stat. 4526

   1. Redesignated · 25 U.S.C. § 1621h(g)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (h) as (g)

   2. Redesignated · 25 U.S.C. § 1621h(g)

      Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), struck out par. (5) which authorized appropriation of $1,000,000 for fiscal year 1992 for purposes of providing training required under this subsec. Former subsec. (g) redesignated (f)

   Source evidence

   Code amendment note
   Subsec. (g). Pub. L. 102–573, §§ 217(b)(4)(A), 902(3)(B), redesignated subsec. (h) as (g) and struck out par. (5) which authorized appropriation of $1,000,000 for fiscal year 1992 for purposes of providing training required under this subsec. Former subsec. (g) redesignated (f).

   Enacted provision · exact public law
   TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

9. 1992

   Indian Health Amendments of 1992

   Pub. L. 102–573 title II · 106 Stat. 4526

   1. Redesignated · 25 U.S.C. § 1621h(h)

      Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), redesignated subsec. (i) as (h)

   2. Struck · 25 U.S.C. § 1621h(h)

      Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), struck out par. (1) designation before “The Secretary, acting”

   3. Redesignated · 25 U.S.C. § 1621h(h)

      Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), redesignated subpars. (A) and (B) as pars. (1) and (2), respectively

   4. Substituted · 25 U.S.C. § 1621h(h)

      Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), substituted “paragraph (1)” and “paragraph (2)” for “subparagraph (A)” and “subparagraph (B)”, respectively, in closing provisions

   5. Redesignated · 25 U.S.C. § 1621h(h)

      Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), struck out former par. (2) which authorized appropriation of $2,000,000 for fiscal year 1992 to carry out this subsec., to remain available until expended. Former subsec. (h) redesignated (g)

   Source evidence

   Code amendment note
   Subsec. (h). Pub. L. 102–573, §§ 217(b)(4)(B), 902(3)(B), redesignated subsec. (i) as (h), struck out par. (1) designation before “The Secretary, acting”, redesignated subpars. (A) and (B) as pars. (1) and (2), respectively, substituted “paragraph (1)” and “paragraph (2)” for “subparagraph (A)” and “subparagraph (B)”, respectively, in closing provisions, and struck out former par. (2) which authorized appropriation of $2,000,000 for fiscal year 1992 to carry out this subsec., to remain available until expended. Former subsec. (h) redesignated (g).

   Enacted provision · exact public law
   TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

10. 1992

    Indian Health Amendments of 1992

    Pub. L. 102–573 title II · 106 Stat. 4526

    1. Redesignated · 25 U.S.C. § 1621h(i)

       Pub. L. 102–573, §§ 217(b)(4)(C), 902(3)(B), redesignated subsec. (j) as (i)

    2. Struck · 25 U.S.C. § 1621h(i)

       Pub. L. 102–573, §§ 217(b)(4)(C), 902(3)(B), struck out par. (1) designation before “Within one year”

    3. Redesignated · 25 U.S.C. § 1621h(i)

       Pub. L. 102–573, §§ 217(b)(4)(C), 902(3)(B), struck out par. (2) which authorized appropriation of $500,000 for fiscal year 1992 to make the assessment required by this subsec. Former subsec. (i) redesignated (h)

    Source evidence

    Code amendment note
    Subsec. (i). Pub. L. 102–573, §§ 217(b)(4)(C), 902(3)(B), redesignated subsec. (j) as (i), struck out par. (1) designation before “Within one year”, and struck out par. (2) which authorized appropriation of $500,000 for fiscal year 1992 to make the assessment required by this subsec. Former subsec. (i) redesignated (h).

    Enacted provision · exact public law
    TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

11. 1992

    Indian Health Amendments of 1992

    Pub. L. 102–573 title II · 106 Stat. 4526

    1. Redesignated · 25 U.S.C. § 1621h(j)

       Pub. L. 102–573, §§ 205(1), 902(3)(B), redesignated subsec. (k) as (j)

    2. Redesignated · 25 U.S.C. § 1621h(j)

       Pub. L. 102–573, §§ 205(1), 902(3)(B), substituted “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, a report” for “submit to the Congress an annual report”. Former subsec. (j) redesignated (i)

    Source evidence

    Code amendment note
    Subsec. (j). Pub. L. 102–573, §§ 205(1), 902(3)(B), redesignated subsec. (k) as (j) and substituted “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, a report” for “submit to the Congress an annual report”. Former subsec. (j) redesignated (i).

    Enacted provision · exact public law
    TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

12. 1992

    Indian Health Amendments of 1992

    Pub. L. 102–573 title II · 106 Stat. 4526

    1. Redesignated · 25 U.S.C. § 1621h(k)

       Pub. L. 102–573, §§ 217(b)(4)(E), 902(3)(B), redesignated subsec. (l) as (k), and in par. (6) substituted “section” for “subsection” in second sentence

    2. Redesignated · 25 U.S.C. § 1621h(k)

       Pub. L. 102–573, §§ 217(b)(4)(E), 902(3)(B), struck out first sentence which authorized appropriations of $2,000,000 for fiscal year 1991 and $3,000,000 for fiscal year 1992 to carry out purposes of this subsec. Former subsec. (k) redesignated (j)

    Source evidence

    Code amendment note
    Subsec. (k). Pub. L. 102–573, §§ 217(b)(4)(E), 902(3)(B), redesignated subsec. (l) as (k), and in par. (6) substituted “section” for “subsection” in second sentence and struck out first sentence which authorized appropriations of $2,000,000 for fiscal year 1991 and $3,000,000 for fiscal year 1992 to carry out purposes of this subsec. Former subsec. (k) redesignated (j).

    Enacted provision · exact public law
    TITLE II— HEALTH SERVICES SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. (a) In General.— Section 201 of the Act (25 U.S.C. 1621) is amended— (1) in subsection (a)— (A) in the material preceding paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by amending paragraph (1) to read as follows: “(1) eliminating the deficiencies in health status and resources of all Indian tribes,”; and (C) in paragraph (4), in the material preceding subparagraph (A)— (i) by inserting after “responsibilities” the following: “, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,”; and (ii) by striking out “resources deficiency” and inserting in lieu thereof the following: “status and resource deficiencies”; (2) in subsection (b)— (A) in paragraph (1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (B) by striking out paragraph (2) and redesignating paragraph (3) as paragraph (2); and (C) in paragraph (2)(A) (as redesignated by subparagraph (B))— (i) by striking out “subsection (h)” and inserting in lieu thereof “this section”; (ii) in the first sentence, by striking out “but such allocation” through “met”; (iii) in the second sentence— (I) by striking out “(in accordance with paragraph (2))”; and (II) by striking out “raise the deficiency level” and inserting in lieu thereof the following: “reduce the health status and resource deficiency”; and (D) in paragraph (2)(B) (as redesignated by subparagraph (B)), by inserting after “consultation with” the following: “, and with the active participation of,”; (3) in subsection (c)— (A) by striking out paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: “(1) The term ‘health status and resource deficiency’ means the extent to which— “(A) the health status objectives set forth in section 3(b) are not being achieved; and “(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.”; and (C) in paragraph (3) (as redesignated by subparagraph (A) above)— (i) by striking out “Under regulations, the” and inserting in lieu thereof “The”; and (ii) by striking out “health resources deficiency level” and inserting in lieu thereof “extent of the health status and resource deficiency”; (4) in subsection (d)(1), by striking out “subsection (h)” and inserting in lieu thereof “this section”; (5) in subsection (e)— (A) in the material preceding paragraph (1)— (i) by striking out “60 days” and inserting in lieu thereof “3 years”; (ii) by striking out “Indian Health Care Amendments of 1988” and inserting in lieu thereof “Indian Health Amendments of 1992”; and (iii) by striking out “health services priority system” and inserting in lieu thereof “health status and resource deficiency”; (B) in paragraph (1), by striking out “health resources deficiencies” and inserting in lieu thereof “health status and resource deficiencies”; (C) in paragraph (2), by striking out “the level of health resources deficiency for” and inserting in lieu thereof the following: “the extent of the health status and resource deficiency of”; (D) in paragraph (3), by striking “raise all” and all that follows through the semicolon and insert in lieu thereof the following: “eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and”; and (E) by striking out paragraphs (4) and (5) and redesignating paragraph (6) as paragraph (4); and (6) in subsection (f), by striking out “(f)(1)” and all that follows through the paragraph designation for paragraph (2) and inserting in lieu thereof “(f)”. (b) Effective Date.— Except with respect to the amendments made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) Technical Amendment.— The heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows: SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. (a) In General.— Section 202 of the Act (25 U.S.C. 1621a) is amended— (1) in subsection (a)(1)(B), by striking out “under subsection (e)” and inserting in lieu thereof “to the Fund under this section”; (2) in subsection (b)(2), by striking out “shall establish at not less than $10,000 or not more than $20,000;” and inserting in lieu thereof the following: “shall establish at— “(A) for 1993, not less than $15,000 or not more than $25,000; and “(B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year;”; and (3) in subsection (c), by striking out “Funds appropriated under subsection (e)” and inserting in lieu thereof “Amounts appropriated to the Fund under this section”. (b) Effective Date.— The amendment made by subsection (a)(2) shall take effect January 1, 1993. SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. Section 203 of the Act (25 U.S.C. 1621b) is amended— (1) in subsection (a), by inserting before the period at the end the following: “so as to achieve the health status objectives set forth in section 3(b)”; (2) in subsection (b), in the material preceding paragraph (1), by striking out “section 201(f)” and inserting in lieu thereof “section 801”; and (3) by striking out subsection (c). SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. Section 204 of the Act (25 U.S.C. 1621c) is amended— (1) by amending subsection (c) to read as follows: “(c) (1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located— “(A) at the Claremore Indian Hospital in Oklahoma; “(B) at the Fort Totten Health Center in North Dakota; “(C) at the Sacaton Indian Hospital in Arizona; “(D) at the Winnebago Indian Hospital in Nebraska; “(E) at the Albuquerque Indian Hospital in New Mexico; “(F) at the Perry, Princeton, and Old Town Health Centers in Maine; “(G) at the Bellingham Health Center in Washington; “(H) at the Fort Berthold Reservation; “(I) at the Navajo Reservation; “(J) at the Papago Reservation; “(K) at the Zuni Reservation; or “(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah. “(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).”; and (2) in subsection (d)— (A) in paragraph (2), by striking out “and” after the semicolon; (B) in paragraph (3), by striking out the period and inserting in lieu thereof the following: “; and”; and (C) by adding at the end the following new paragraph: “(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.”. SEC. 205. MENTAL HEALTH PREVENTION AND TREATMENT SERVICES. Section 209 of the Act (25 U.S.C. 1621h) is amended— (1) in subsection (j) (as redesignated by section 902(3)(B) Reports. of this Act), by striking out “submit to the Congress an annual report” and inserting in lieu thereof the following: “submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report”; and (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. (a) Hospice Care.— Title II of the Act is amended by inserting after section 204 the following: “Sec. 205. (a) The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study— “(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and “(2) to determine the most efficient and effective means of furnishing such care. “(b) Such study shall— “(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; “(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; “(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; “(4) identify and evaluate various means for providing hospice care, including— “(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and “(B) the provision of such care by a community-based hospice program under contract to the Service; and “(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties. “(c) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “(d) For the purposes of this section— “(1) the term ‘terminally ill’ means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and “(2) the term ‘hospice program’ means any program which satisfies the requirements of section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2)); and “(3) the term ‘hospice care’ means the items and services specified in subparagraphs (A) through (H) of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 1395x(dd)(1)).”. (b) Managed Care.— Title II of the Act is amended by adding at the end the following new section: “Sec. 210. (a) The Secretary, acting through the Service, shall 25 USC 1621i. conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from— “(1) a tribally owned and operated managed care plan; or “(2) a State licensed managed care plan. “(b) Not later than the date which is 12 months after the Reports. date of the enactment of this section, the Secretary shall transmit to the Congress a report containing— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study.”. (c) Contract Care.— Title II of the Act (as amended by subsection (b) of this Act) is amended by adding at the end the following new section: “Sec. 211. (a) The Secretary shall establish a demonstration 25 USC 1621j. program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. “(b) (1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration pro-gram, in providing medical treatment under contract to California Indians described in section 809(b) throughout the California contract health services delivery area described in section 810 with respect to high-cost contract care cases. “(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. “(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 202 or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. “(c) There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. “(d) The demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. “(e) Not later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on— “(1) access to needed health services; “(2) waiting periods for receiving such services; and “(3) the efficient management of high-cost contract care cases. “(f) For the purposes of this section, the term ‘high-cost contract care cases’ means those cases in which the cost of the medical treatment provided to an individual— “(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 202, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 202(b)(2); and “(2) exceeds $1,000. “(g) There are authorized to be appropriated for each of the fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may be necessary to carry out the purposes of this section.”. SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. (a) In General.— Title II of the Act (as amended by section 206(c) of this Act) is amended by adding at the end the following new section: “Sec. 212. The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act.”. (b) Conforming Amendment.— Section 201(a)(4)(B) of the Act (25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon at the end and inserting the following: “, including screening mammography in accordance with section 212;”. 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) 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) emergency air transportation; and “(2) nonemergency air transportation where ground transportation is infeasible. “(b) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. SEC. 209. THIRD PARTY REIMBURSEMENT. (a) Recovery by Indian Tribe.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by inserting “, an Indian tribe, or a tribal organization” after “United States” each place it appears; (2) in subsection (a), by inserting “, an Indian tribe, or a tribal organization” after “Service”; (3) in subsection (a) and subsection (e)(1)(A), by inserting “, an Indian tribe, or a tribal organization” after “Secretary” each place it appears; and (4) in subsection (b), by striking “, or any political subdivision of a State,”. (b) Special Rule With Respect to Self-Insurance Plan.— Section 206 of the Act (25 U.S.C. 1621e) is amended— (1) by striking “(a) The” and inserting the following: “(a) Except as provided in subsection (f), the”; and (2) by adding at the end the following new subsection: “(f) The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.”. 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) (1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3). “(2) To assist such centers in carrying out such functions, the Secretary shall perform the following: “(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 3(b). Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories. “(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 3(b). “(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area— “(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 3(b) using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2); “(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; “(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data; “(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities; “(E) make recommendations to improve health care delivery systems for Indians and urban Indians; “(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and “(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community. “(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.). “(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection. “(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection. “(b) (1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities. “(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if— “(A) it is incorporated for the primary purpose of improving Indian health; and “(B) it is representative of the tribes or urban Indian communities in which it is located. “(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. “(4) Applicants for grants under this subsection shall— “(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); “(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and “(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. “(5) A grant awarded under paragraph (1) may be used to— “(A) carry out the functions described in subsection (a)(3); “(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and “(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people. “(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) Grants awarded under this section may be used to— “(1) develop health education curricula; “(2) train teachers in comprehensive school health education curricula; “(3) integrate school-based, community-based, and other public and private health promotion efforts; “(4) encourage healthy, tobacco-free school environments; “(5) coordinate school-based health programs with existing services and programs available in the community; “(6) develop school programs on nutrition education, personal health, and fitness; “(7) develop mental health wellness programs; “(8) develop chronic disease prevention programs; “(9) develop substance abuse prevention programs; “(10) develop accident prevention and safety education programs; “(11) develop activities for the prevention and control of communicable diseases; and “(12) develop community and environmental health education programs. “(c) The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. “(d) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. “(e) Recipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of— “(1) the number of preschools, elementary schools, and secondary schools served; “(2) the number of students served; “(3) any new curricula established with funds provided under this section; “(4) the number of teachers trained in the health curricula; and “(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. “(f) (1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. “(2) Such program shall include— “(A) school programs on nutrition education, personal health, and fitness; “(B) mental health wellness programs; “(C) chronic disease prevention programs; “(D) substance abuse prevention programs; “(E) accident prevention and safety education programs; and “(F) activities for the prevention and control of communicable diseases. “(3) The Secretary of the Interior shall— “(A) provide training to teachers in comprehensive school health education curricula; “(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and “(C) encourage healthy, tobacco-free school environments. “(g) There are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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. “(b) (1) Funds made available under this section may be used to— “(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and “(B) develop and provide community training and education. “(2) Funds made available under this section may not be used to provide services described in section 209(m). “(c) The Secretary shall— “(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; “(2) encourage the implementation of such models; and “(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. “(d) The Secretary shall establish criteria for the review and approval of applications under this section. “(e) There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”. 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) 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) 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) (1) The Secretary shall issue regulations for the competitive Regulations. awarding of the grants provided under mis section. “(2) Applicants for grants under this section shall agree to provide a program which, at a minimum— “(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program; “(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program; “(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities; “(D) provides stipends to undergraduate and graduate students to pursue a career in psychology; “(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students; “(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and “(G) to the maximum extent feasible, employs qualified Indians in the program. “(d) The active duty service obligation prescribed under section 338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) that is funded by a grant provided under this section. Such obligation shall be met by service— “(1) in the Indian Health Service; “(2) in a program conducted under a contract entered into under the Indian Self-Determination Act; “(3) in a program assisted under title V of this Act; or “(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.”. 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) The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for— “(1) projects for the prevention, control, and elimination of tuberculosis; “(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and “(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals. “(b) The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) and such other agreements, assurances, and information as the Secretary may require. “(c) To be eligible for a grant under subsection (a), an applicant must provide assurances satisfactory to the Secretary that— “(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and “(2) the applicant will submit to the Secretary an annual Reports. report on its activities for the prevention, control, and elimination of tuberculosis. “(d) In carrying out this section, the Secretary— “(1) shall establish criteria for the review and approval of applications for grants under subsection (a), including requirement of public health qualifications of applicants; “(2) shall, subject to available appropriations, make at least one grant under subsection (a) within each area office; “(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and “(4) shall prepare and submit a report to the Committee 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) The Secretary may, at the request of a recipient of a grant under subsection (a), reduce the amount of such grant by— “(1) the fair market value of any supplies or equipment furnished the grant recipient; and “(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee, when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.”. 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) 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) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; “(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and “(3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. “(b) The study required by subsection (a) shall— “(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; “(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; “(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; “(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and “(5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. “(c) Not later than 12 months after the date of the enactment of this section, the Secretary shall transmit to the Congress a report that includes— “(1) a detailed description of the study conducted pursuant to this section; and “(2) a discussion of the findings and conclusions of such study. “Sec. 220. (a) The Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. “(b) If the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. “(c) The Service shall pay a completed contract care service claim within 30 days after completion of the claim. “Sec. 221. (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) 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 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) 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. (a) Authorization.— Title II of the Act (as amended by section 216 of this Act) is amended by adding at the end the following new section: “Sec. 224. Except as provided in sections 209(m), 211, 213, 25 USC 1621w. 214(b)(5), 215, and 216, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.”. (b) Conforming Amendments.— Title II of the Act is amended— (1) in section 201(h), by striking out the first sentence 25 USC 1621. and striking out “subsection” and inserting in lieu thereof “section”. (2) in section 202, by striking out subsection (e); (3) in section 204(e), by striking out the first sentence 25 USC 1621c. and striking out “subsection (c)” and inserting in lieu thereof “this section”; and (4) in section 209 (as amended by section 902(3)(B) of 25 USC 1621h. this Act)— (A) by striking out subsections (c)(5), (d)(6), (f)(4), and (g)(5); (B) in subsection (h)— (i) by striking out paragraph (2) and by striking out “(1)”; (ii) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; (iii) by striking out “subparagraph (A)” and inserting “paragraph (1)”; and (iv) by striking out “subparagraph (B)” and inserting “paragraph (2)”; (C) in subsection (i), by striking out paragraph (2) and by striking out “(1)”; (D) in subsection (d)(3)(B), by striking out “this subsection” and inserting in lieu thereof “this section”; and (E) in subsection (k)(6), by striking out the first sentence and in the second sentence by striking out “subsection” and inserting in lieu thereof “section”.

13. 1992

    Indian Health Amendments of 1992

    Pub. L. 102–573 § 205(2) · 106 Stat. 4526

    Redesignated · 25 U.S.C. § 1621h(l); 25 U.S.C. § 1621h(m)

    Pub. L. 102–573, § 205(2), added subsecs. (l) and (m). Former subsec. (l) redesignated (k)

    Source evidence

    Code amendment note
    Subsecs. (l), (m). Pub. L. 102–573, § 205(2), added subsecs. (l) and (m). Former subsec. (l) redesignated (k).

    Enacted provision · exact public law section
    (2) by adding at the end the following new subsections: “(l) Licensing Requirement for Mental Health Care Workers.— Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this Act or through a contract pursuant to the Indian Self-Determination Act shall— “(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; “(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or “(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. “(m) Intermediate Adolescent Mental Health Services.— (1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including— “(A) inpatient and outpatient services; “(B) emergency care; “(C) suicide prevention and crisis intervention; and “(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. “(2) Funds provided under this subsection may be used— “(A) to construct or renovate an existing health facility to provide intermediate mental health services; “(B) to hire mental health professionals; “(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and “(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. “(3) Funds provided under this subsection may not be used for the purposes described in section 216(b)(1). “(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal. Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. “(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. “(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.”.

14. 2010

    Patient Protection and Affordable Care Act

    Pub. L. 111–148 title X § 10221(a) · 124 Stat. 119

    1. Added · 25 U.S.C. § 1621h(d)

       Pub. L. 111–148 added subsec. (d)

    2. Struck · 25 U.S.C. § 1621h(d)

       Pub. L. 111–148 struck out former subsec. (d) which related to mental health training and community education programs

    Source evidence

    Code amendment note
    Subsec. (d). Pub. L. 111–148 added subsec. (d) and struck out former subsec. (d) which related to mental health training and community education programs.

    Enacted provision · exact public law section
    (a) In General.— Except as provided in subsection (b), S. 1790 entitled “A bill to amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.”, as reported by the Committee on Indian Affairs of the Senate in December 2009, is enacted into law.

15. 2010

    Patient Protection and Affordable Care Act

    Pub. L. 111–148 title X § 10221(a) · 124 Stat. 119

    Struck · 25 U.S.C. § 1621h(m)(6)

    Pub. L. 111–148 struck out par. (6) which authorized appropriations for fiscal years 1993 to 2000

    Source evidence

    Code amendment note
    Subsec. (m)(6). Pub. L. 111–148 struck out par. (6) which authorized appropriations for fiscal years 1993 to 2000.

    Enacted provision · exact public law section
    (a) In General.— Except as provided in subsection (b), S. 1790 entitled “A bill to amend the Indian Health Care Improvement Act to revise and extend that Act, and for other purposes.”, as reported by the Committee on Indian Affairs of the Senate in December 2009, is enacted into law.

7 of 29 references resolved to an enrolled provision · 22 partial