109th CONGRESS
1st Session
S. 1057
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
IN THE SENATE OF THE UNITED STATES
May 17, 2005
Mr. MCCAIN (for himself and Mr. DORGAN) introduced the following bill; which
was read twice and referred to the Committee on Indian Affairs
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Indian Health Care Improvement Act Amendments
of 2005'.
SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.
(a) IN GENERAL- The Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.) is amended to read as follows:
`SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
`(a) SHORT TITLE- This Act may be cited as the `Indian Health Care Improvement
Act'.
`(b) TABLE OF CONTENTS- The table of contents for this Act is as follows:
`Sec. 1. Short title; table of contents.
`Sec. 2. Findings.
`Sec. 3. Declaration of National Indian health policy.
`Sec. 4. Definitions.
`TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
`Sec. 101. Purpose.
`Sec. 102. Health professions recruitment program for Indians.
`Sec. 103. Health professions preparatory scholarship program for Indians.
`Sec. 104. Indian health professions scholarships.
`Sec. 105. American Indians Into Psychology program.
`Sec. 106. Funding for tribes for scholarship programs.
`Sec. 107. Indian Health Service extern programs.
`Sec. 108. Continuing education allowances.
`Sec. 109. Community health representative program.
`Sec. 110. Indian Health Service loan repayment program.
`Sec. 111. Scholarship and Loan Repayment Recovery Fund.
`Sec. 112. Recruitment activities.
`Sec. 113. Indian recruitment and retention program.
`Sec. 114. Advanced training and research.
`Sec. 115. Quentin N. Burdick American Indians Into Nursing program.
`Sec. 116. Tribal cultural orientation.
`Sec. 117. Inmed program.
`Sec. 118. Health training programs of community colleges.
`Sec. 119. Retention bonus.
`Sec. 120. Nursing residency program.
`Sec. 121. Community health aide program for Alaska.
`Sec. 122. Tribal health program administration.
`Sec. 123. Health professional chronic shortage demonstration programs.
`Sec. 124. National Health Service Corps.
`Sec. 125. Substance abuse counselor educational curricula demonstration
programs.
`Sec. 126. Behavioral health training and community education programs.
`Sec. 127. Authorization of appropriations.
`TITLE II--HEALTH SERVICES
`Sec. 201. Indian Health Care Improvement Fund.
`Sec. 202. Catastrophic Health Emergency Fund.
`Sec. 203. Health promotion and disease prevention services.
`Sec. 204. Diabetes prevention, treatment, and control.
`Sec. 205. Shared services for long-term care.
`Sec. 206. Health services research.
`Sec. 207. Mammography and other cancer screening.
`Sec. 208. Patient travel costs.
`Sec. 209. Epidemiology centers.
`Sec. 210. Comprehensive school health education programs.
`Sec. 211. Indian youth program.
`Sec. 212. Prevention, control, and elimination of communicable and infectious
diseases.
`Sec. 213. Authority for provision of other services.
`Sec. 214. Indian women's health care.
`Sec. 215. Environmental and nuclear health hazards.
`Sec. 216. Arizona as a contract health service delivery area.
`Sec. 216A. North Dakota and South Dakota as a contract health service delivery
area.
`Sec. 217. California contract health services program.
`Sec. 218. California as a contract health service delivery area.
`Sec. 219. Contract health services for the Trenton service area.
`Sec. 220. Programs operated by Indian tribes and tribal organizations.
`Sec. 221. Licensing.
`Sec. 222. Notification of provision of emergency contract health services.
`Sec. 223. Prompt action on payment of claims.
`Sec. 224. Liability for payment.
`Sec. 225. Authorization of appropriations.
`TITLE III--FACILITIES
`Sec. 301. Consultation: construction and renovation of facilities; reports.
`Sec. 302. Sanitation facilities.
`Sec. 303. Preference to Indians and Indian firms.
`Sec. 304. Expenditure of nonservice funds for renovation.
`Sec. 305. Funding for the construction, expansion, and modernization of
small ambulatory care facilities.
`Sec. 306. Indian health care delivery demonstration project.
`Sec. 307. Land transfer.
`Sec. 308. Leases, contracts, and other agreements.
`Sec. 309. Loans, loan guarantees, and loan repayment.
`Sec. 310. Tribal leasing.
`Sec. 311. Indian Health Service/tribal facilities joint venture program.
`Sec. 312. Location of facilities.
`Sec. 313. Maintenance and improvement of health care facilities.
`Sec. 314. Tribal management of Federally owned quarters.
`Sec. 315. Applicability of Buy American Act requirement.
`Sec. 316. Other funding for facilities.
`Sec. 317. Authorization of appropriations.
`TITLE IV--ACCESS TO HEALTH SERVICES
`Sec. 401. Treatment of payments under Social Security Act health care programs.
`Sec. 402. Grants to and contracts with the Service, Indian tribes, Tribal
Organizations, and Urban Indian Organizations.
`Sec. 403. Reimbursement from certain third parties of costs of health services.
`Sec. 404. Crediting of reimbursements.
`Sec. 405. Purchasing health care coverage.
`Sec. 406. Sharing arrangements with Federal agencies.
`Sec. 407. Payor of last resort.
`Sec. 408. Nondiscrimination in qualifications for reimbursement for services.
`Sec. 409. Consultation.
`Sec. 410. State Children's Health Insurance Program (SCHIP).
`Sec. 411. Social Security Act sanctions.
`Sec. 412. Cost sharing.
`Sec. 413. Treatment under Medicaid managed care.
`Sec. 414. Navajo Nation Medicaid Agency feasibility study.
`Sec. 415. Authorization of appropriations.
`TITLE V--HEALTH SERVICES FOR URBAN INDIANS
`Sec. 501. Purpose.
`Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
`Sec. 503. Contracts and grants for the provision of health care and referral
services.
`Sec. 504. Contracts and grants for the determination of unmet health care
needs.
`Sec. 505. Evaluations; renewals.
`Sec. 506. Other contract and grant requirements.
`Sec. 507. Reports and records.
`Sec. 508. Limitation on contract authority.
`Sec. 509. Facilities.
`Sec. 510. Office of Urban Indian Health.
`Sec. 511. Grants for alcohol and substance abuse-related services.
`Sec. 512. Treatment of certain demonstration projects.
`Sec. 513. Urban NIAAA transferred programs.
`Sec. 514. Consultation with Urban Indian Organizations.
`Sec. 515. Federal Tort Claim Act coverage.
`Sec. 516. Urban youth treatment center demonstration.
`Sec. 517. Use of Federal Government facilities and sources of supply.
`Sec. 518. Grants for diabetes prevention, treatment, and control.
`Sec. 519. Community health representatives.
`Sec. 520. Regulations.
`Sec. 521. Eligibility for services.
`Sec. 522. Authorization of appropriations.
`TITLE VI--ORGANIZATIONAL IMPROVEMENTS
`Sec. 601. Establishment of the Indian Health Service as an agency of the
Public Health Service.
`Sec. 602. Automated management information system.
`Sec. 603. Authorization of appropriations.
`TITLE VII--BEHAVIORAL HEALTH PROGRAMS
`Sec. 701. Behavioral health prevention and treatment services.
`Sec. 702. Memoranda of agreement with the Department of the Interior.
`Sec. 703. Comprehensive behavioral health prevention and treatment program.
`Sec. 704. Mental health technician program.
`Sec. 705. Licensing requirement for mental health care workers.
`Sec. 706. Indian women treatment programs.
`Sec. 707. Indian youth program.
`Sec. 708. Inpatient and community-based mental health facilities design,
construction, and staffing.
`Sec. 709. Training and community education.
`Sec. 710. Behavioral health program.
`Sec. 711. Fetal alcohol disorder funding.
`Sec. 712. Child sexual abuse and prevention treatment programs.
`Sec. 713. Behavioral health research.
`Sec. 714. Definitions.
`Sec. 715. Authorization of appropriations.
`TITLE VIII--MISCELLANEOUS
`Sec. 801. Reports.
`Sec. 802. Regulations.
`Sec. 803. Plan of implementation.
`Sec. 804. Availability of funds.
`Sec. 805. Limitation on use of funds appropriated to the Indian Health
Service.
`Sec. 806. Eligibility of California Indians.
`Sec. 807. Health services for ineligible persons.
`Sec. 808. Reallocation of base resources.
`Sec. 809. Results of demonstration projects.
`Sec. 810. Provision of services in Montana.
`Sec. 811. Moratorium.
`Sec. 812. Tribal employment.
`Sec. 813. Severability provisions.
`Sec. 814. Establishment of National Bipartisan Commission on Indian Health
Care.
`Sec. 815. Appropriations; availability.
`Sec. 816. Authorization of appropriations.
`SEC. 2. FINDINGS.
`Congress makes the following findings:
`(1) Federal health services to maintain and improve the health of the Indians
are consonant with and required by the Federal Government's historical and
unique legal relationship with, and resulting responsibility to, the American
Indian people.
`(2) A major national goal of the United States is to provide the quantity
and quality of health services which will permit the health status of Indians
to be raised to the highest possible level and to encourage the maximum
participation of Indians in the planning and management of those services.
`(3) Federal health services to Indians have resulted in a reduction in
the prevalence and incidence of preventable illnesses among, and unnecessary
and premature deaths of, Indians.
`(4) Despite such services, the unmet health needs of the American Indian
people are severe and the health status of the Indians is far below that
of the general population of the United States.
`SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.
`Congress declares that it is the policy of this Nation, in fulfillment of
its special trust responsibilities and legal obligations to Indians--
`(1) to assure the highest possible health status for Indians and to provide
all resources necessary to effect that policy;
`(2) to raise the health status of Indians by the year 2010 to at least
the levels set forth in the goals contained within the Healthy People 2010
or successor objectives;
`(3) to the greatest extent possible, to allow Indians to set their own
health care priorities and establish goals that reflect their unmet needs;
`(4) to increase the proportion of all degrees in the health professions
and allied and associated health professions awarded to Indians so that
the proportion of Indian health professionals in each Service Area is raised
to at least the level of that of the general population;
`(5) to require meaningful consultation with Indian Tribes, Tribal Organizations,
and Urban Indian Organizations to implement this Act and the national policy
of Indian self-determination; and
`(6) to provide funding for programs and facilities operated by Indian Tribes
and Tribal Organizations in amounts that are not less than the amounts provided
to programs and facilities operated directly by the Service.
`SEC. 4. DEFINITIONS.
`For purposes of this Act:
`(1) The term `accredited and accessible' means on or near a reservation
and accredited by a national or regional organization with accrediting authority.
`(2) The term `Area Office' means an administrative entity, including a
program office, within the Service through which services and funds are
provided to the Service Units within a defined geographic area.
`(3) The term `Assistant Secretary' means the Assistant Secretary of Indian
Health.
`(4)(A) The term `behavioral health' means the blending of substance (alcohol,
drugs, inhalants, and tobacco) abuse and mental health prevention and treatment,
for the purpose of providing comprehensive services.
`(B) The term `behavioral health' includes the joint development of substance
abuse and mental health treatment planning and coordinated case management
using a multidisciplinary approach.
`(5) The term `California Indians' means those Indians who are eligible
for health services of the Service pursuant to section 806.
`(6) The term `community college' means--
`(A) a tribal college or university, or
`(B) a junior or community college.
`(7) The term `contract health service' means health services provided at
the expense of the Service or a Tribal Health Program by public or private
medical providers or hospitals, other than the Service Unit or the Tribal
Health Program at whose expense the services are provided.
`(8) The term `Department' means, unless otherwise designated, the Department
of Health and Human Services.
`(9) The term `disease prevention' means the reduction, limitation, and
prevention of disease and its complications and reduction in the consequences
of disease, including--
`(i) development of diabetes;
`(ii) high blood pressure;
`(iii) infectious agents;
`(v) occupational hazards and disabilities;
`(vi) sexually transmittable diseases; and
`(i) fluoridation of water; and
`(10) The term `health profession' means allopathic medicine, family medicine,
internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology,
podiatric medicine, nursing, public health nursing, dentistry, psychiatry,
osteopathy, optometry, pharmacy, psychology, public health, social work,
marriage and family therapy, chiropractic medicine, environmental health
and engineering, allied health professions, and any other health profession.
`(11) The term `health promotion' means--
`(A) fostering social, economic, environmental, and personal factors conducive
to health, including raising public awareness about health matters and
enabling the people to cope with health problems by increasing their knowledge
and providing them with valid information;
`(B) encouraging adequate and appropriate diet, exercise, and sleep;
`(C) promoting education and work in conformity with physical and mental
capacity;
`(D) making available suitable housing, safe water, and sanitary facilities;
`(E) improving the physical, economic, cultural, psychological, and social
environment;
`(F) promoting adequate opportunity for spiritual, religious, and Traditional
Health Care Practices; and
`(G) providing adequate and appropriate programs, including--
`(i) abuse prevention (mental and physical);
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