110th CONGRESS
1st Session
S. 1200
To amend the Indian Health Care Improvement Act to revise and extend
that Act.
IN THE SENATE OF THE UNITED STATES
April 24, 2007
Mr. DORGAN (for himself, Mrs. BOXER, Mr. REID, Ms. CANTWELL, Mr. JOHNSON,
Mr. TESTER, Mr. INOUYE, Mr. DOMENICI, Mr. BINGAMAN, Mr. BAUCUS, Ms. KLOBUCHAR,
Mr. THOMAS, Mr. OBAMA, and Ms. MURKOWSKI) 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; TABLE OF CONTENTS.
(a) Short Title- This Act may be cited as the `Indian Health Care Improvement
Act Amendments of 2007'.
(b) Table of Contents- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--AMENDMENTS TO INDIAN LAWS
Sec. 101. Indian Health Care Improvement Act amended.
Sec. 102. Soboba sanitation facilities.
Sec. 103. Native American Health and Wellness Foundation.
TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL
SECURITY ACT
Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for
all covered services furnished by Indian Health Programs.
Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and improved
cooperation in the provision of items and services to Indians under Social
Security Act health benefit programs.
Sec. 203. Additional provisions to increase outreach to, and enrollment
of, Indians in SCHIP and Medicaid.
Sec. 204. Premiums and cost sharing protections under Medicaid, eligibility
determinations under Medicaid and SCHIP, and protection of certain Indian
property from Medicaid estate recovery.
Sec. 205. Nondiscrimination in qualifications for payment for services
under Federal health care programs.
Sec. 206. Consultation on Medicaid, SCHIP, and other health care programs
funded under the Social Security Act involving Indian Health Programs
and Urban Indian Organizations.
Sec. 207. Exclusion waiver authority for affected Indian Health Programs
and safe harbor transactions under the Social Security Act.
Sec. 208. Rules applicable under Medicaid and SCHIP to managed care entities
with respect to Indian enrollees and Indian health care providers and
Indian managed care entities.
Sec. 209. Annual report on Indians served by Social Security Act health
benefit programs.
TITLE I--AMENDMENTS TO INDIAN LAWS
SEC. 101. 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. 3. Declaration of national Indian health policy.
`TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
`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. Scholarship programs for Indian Tribes.
`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.
`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. Other authority for provision of 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 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. 222. Notification of provision of emergency contract health services.
`Sec. 223. Prompt action on payment of claims.
`Sec. 224. Liability for payment.
`Sec. 225. Office of Indian Men's Health.
`Sec. 226. 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 non-Service funds for renovation.
`Sec. 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities.
`Sec. 306. Indian health care delivery demonstration projects.
`Sec. 307. Land transfer.
`Sec. 308. Leases, contracts, and other agreements.
`Sec. 309. Study on 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 benefits
programs.
`Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations to facilitate outreach,
enrollment, and coverage of Indians under Social Security Act health benefit
programs and other health benefits programs.
`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 under Federal health care programs in qualifications
for reimbursement for services.
`Sec. 410. State Children's Health Insurance Program (SCHIP).
`Sec. 411. Exclusion waiver authority for affected Indian Health Programs
and safe harbor transactions under the Social Security Act.
`Sec. 412. Premium and cost sharing protections and eligibility determinations
under Medicaid and SCHIP and protection of certain Indian property from
Medicaid estate recovery.
`Sec. 413. Treatment under Medicaid and SCHIP managed care.
`Sec. 414. Navajo Nation Medicaid Agency feasibility study.
`Sec. 415. General exceptions.
`Sec. 416. Authorization of appropriations.
`TITLE V--HEALTH SERVICES FOR URBAN INDIANS
`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. 510. Division 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. Urban youth treatment center demonstration.
`Sec. 516. Grants for diabetes prevention, treatment, and control.
`Sec. 517. Community Health Representatives.
`Sec. 518. Effective date.
`Sec. 519. Eligibility for services.
`Sec. 520. 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. Indian youth telemental health demonstration project.
`Sec. 709. Inpatient and community-based mental health facilities design,
construction, and staffing.
`Sec. 710. Training and community education.
`Sec. 711. Behavioral health program.
`Sec. 712. Fetal alcohol disorder programs.
`Sec. 713. Child sexual abuse and prevention treatment programs.
`Sec. 714. Behavioral health research.
`Sec. 716. Authorization of appropriations.
`TITLE VIII--MISCELLANEOUS
`Sec. 803. Plan of implementation.
`Sec. 804. Availability of funds.
`Sec. 805. Limitation on use of funds appropriated to 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. 812. Tribal employment.
`Sec. 813. Severability provisions.
`Sec. 814. Establishment of National Bipartisan Commission on Indian Health
Care.
`Sec. 815. Confidentiality of medical quality assurance records; qualified
immunity for participants.
`Sec. 816. Appropriations; availability.
`Sec. 817. 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 Urban
Indians and to provide all resources necessary to effect that policy;
`(2) to raise the health status of Indians and Urban Indians to at least
the levels set forth in the goals contained within the Healthy People
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 for
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) the 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 safe water and sanitary facilities;
`(E) improving the physical, economic, cultural, psychological, and
social environment;
`(F) promoting culturally competent care; and
`(G) providing adequate and appropriate programs, which may include--
`(i) abuse prevention (mental and physical);
`(iv) consumer health education;
`(vi) immunization and other prevention of communicable diseases,
including HIV/AIDS;
`(vii) environmental health;
`(viii) exercise and physical fitness;
`(ix) avoidance of fetal alcohol disorders;
`(x) first aid and CPR education;
`(xi) human growth and development;
`(xii) injury prevention and personal safety;
`(xiii) behavioral health;
`(xiv) monitoring of disease indicators between health care provider
visits, through appropriate means, including Internet-based health
care management systems;
`(xv) personal health and wellness practices;
`(xvi) personal capacity building;
`(xvii) prenatal, pregnancy, and infant care;
`(xviii) psychological well-being;
`(xix) reproductive health and family planning;
`(xx) safe and adequate water;
`(xxi) healthy work environments;
`(xxii) elimination, reduction, and prevention of contaminants that
create unhealthy household conditions (including mold and other allergens);
`(xxv) sanitary facilities;
`(xxvi) sudden infant death syndrome prevention;
`(xxvii) tobacco use cessation and reduction;
`(xxviii) violence prevention; and
`(xxix) such other activities identified by the Service, a Tribal
Health Program, or an Urban Indian Organization, to promote achievement
of any of the objectives described in section 3(2).
`(12) The term `Indian', unless otherwise designated, means any person
who is a member of an Indian Tribe or is eligible for health services
under section 806, except that, for the purpose of sections 102 and 103,
the term also means any individual who--
`(A)(i) irrespective of whether the individual lives on or near a reservation,
is a member of a tribe, band, or other organized group of Indians, including
those tribes, bands, or groups terminated since 1940 and those recognized
now or in the future by the State in which they reside; or
`(ii) is a descendant, in the first or second degree, of any such member;
`(B) is an Eskimo or Aleut or other Alaska Native;
`(C) is considered by the Secretary of the Interior to be an Indian
for any purpose; or
`(D) is determined to be an Indian under regulations promulgated by
the Secretary.
`(13) The term `Indian Health Program' means--
`(A) any health program administered directly by the Service;
`(B) any Tribal Health Program; or
`(C) any Indian Tribe or Tribal Organization to which the Secretary
provides funding pursuant to section 23 of the Act of June 25, 1910
(25 U.S.C. 47) (commonly known as the `Buy Indian Act').
`(14) The term `Indian Tribe' has the meaning given the term in the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).
`(15) The term `junior or community college' has the meaning given the
term by section 312(e) of the Higher Education Act of 1965 (20 U.S.C.
1058(e)).
`(16) The term `reservation' means any federally recognized Indian Tribe's
reservation, Pueblo, or colony, including former reservations in Oklahoma,
Indian allotments, and Alaska Native Regions established pursuant to the
Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
`(17) The term `Secretary', unless otherwise designated, means the Secretary
of Health and Human Services.
`(18) The term `Service' means the Indian Health Service.
`(19) The term `Service Area' means the geographical area served by each
Area Office.
`(20) The term `Service Unit' means an administrative entity of the Service,
or a Tribal Health Program through which services are provided, directly
or by contract, to eligible Indians within a defined geographic area.
`(21) The term `telehealth' has the meaning given the term in section
330K(a) of the Public Health Service Act (42 U.S.C. 254c-16(a)).
`(22) The term `telemedicine' means a telecommunications link to an end
user through the use of eligible equipment that electronically links health
professionals or patients and health professionals at separate sites in
order to exchange health care information in audio, video, graphic, or
other format for the purpose of providing improved health care services.
`(23) The term `tribal college or university' has the meaning given the
term in section 316(b)(3) of the Higher Education Act (20 U.S.C. 1059c(b)(3)).
`(24) The term `Tribal Health Program' means an Indian Tribe or Tribal
Organization that operates any health program, service, function, activity,
or facility funded, in whole or part, by the Service through, or provided
for in, a contract or compact with the Service under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.).
`(25) The term `Tribal Organization' has the meaning given the term in
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
450 et seq.).
`(26) The term `Urban Center' means any community which has a sufficient
Urban Indian population with unmet health needs to warrant assistance
under title V of this Act, as determined by the Secretary.
`(27) The term `Urban Indian' means any individual who resides in an Urban
Center and who meets 1 or more of the following criteria:
`(A) Irrespective of whether the individual lives on or near a reservation,
the individual is a member of a tribe, band, or other organized group
of Indians, including those tribes, bands, or groups terminated since
1940 and those tribes, bands, or groups that are recognized by the States
in which they reside, or who is a descendant in the first or second
degree of any such member.
`(B) The individual is an Eskimo, Aleut, or other Alaska Native.
`(C) The individual is considered by the Secretary of the Interior to
be an Indian for any purpose.
`(D) The individual is determined to be an Indian under regulations
promulgated by the Secretary.
`(28) The term `Urban Indian Organization' means a nonprofit corporate
body that (A) is situated in an Urban Center; (B) is governed by an Urban
Indian-controlled board of directors; (C) provides for the participation
of all interested Indian groups and individuals; and (D) is capable of
legally cooperating with other public and private entities for the purpose
of performing the activities described in section 503(a).
`TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
`SEC. 101. PURPOSE.
`The purpose of this title is to increase, to the maximum extent feasible,
the number of Indians entering the health professions and providing health
services, and to assure an optimum supply of health professionals to the
Indian Health Programs and Urban Indian Organizations involved in the provision
of health services to Indians.
`SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.
`(a) In General- The Secretary, acting through the Service, shall make grants
to public or nonprofit private health or educational entities, Tribal Health
Programs, or Urban Indian Organizations to assist such entities in meeting
the costs of--
`(1) identifying Indians with a potential for education or training in
the health professions and encouraging and assisting them--
`(A) to enroll in courses of study in such health professions; or
`(B) if they are not qualified to enroll in any such courses of study,
to undertake such postsecondary education or training as may be required
to qualify them for enrollment;
`(2) publicizing existing sources of financial aid available to Indians
enrolled in any course of study referred to in paragraph (1) or who are
undertaking training necessary to qualify them to enroll in any such course
of study; or
`(3) establishing other programs which the Secretary determines will enhance
and facilitate the enrollment of Indians in, and the subsequent pursuit
and completion by them of, courses of study referred to in paragraph (1).
`(1) APPLICATION- The Secretary shall not make a grant under this section
unless an application has been submitted to, and approved by, the Secretary.
Such application shall be in such form, submitted in such manner, and
contain such information, as the Secretary shall by regulation prescribe
pursuant to this Act. The Secretary shall give a preference to applications
submitted by Tribal Health Programs or Urban Indian Organizations.
`(2) AMOUNT OF GRANTS; PAYMENT- The amount of a grant under this section
shall be determined by the Secretary. Payments pursuant to this section
may be made in advance or by way of reimbursement, and at such intervals
and on such conditions as provided for in regulations issued pursuant
to this Act. To the extent not otherwise prohibited by law, grants shall
be for 3 years, as provided in regulations issued pursuant to this Act.
`SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR INDIANS.
`(a) Scholarships Authorized- The Secretary, acting through the Service,
shall provide scholarship grants to Indians who--
`(1) have successfully completed their high school education or high school
equivalency; and
`(2) have demonstrated the potential to successfully complete courses
of study in the health professions.
`(b) Purposes- Scholarship grants provided pursuant to this section shall
be for the following purposes:
`(1) Compensatory preprofessional education of any recipient, such scholarship
not to exceed 2 years on a full-time basis (or the part-time equivalent
thereof, as determined by the Secretary pursuant to regulations issued
under this Act).
`(2) Pregraduate education of any recipient leading to a baccalaureate
degree in an approved course of study preparatory to a field of study
in a health profession, such scholarship not to exceed 4 years. An extension
of up to 2 years (or the part-time equivalent thereof, as determined by
the Secretary pursuant to regulations issued pursuant to this Act) may
be approved.
`(c) Other Conditions- Scholarships under this section--
`(1) may cover costs of tuition, books, transportation, board, and other
necessary related expenses of a recipient while attending school;
`(2) shall not be denied solely on the basis of the applicant's scholastic
achievement if such applicant has been admitted to, or maintained good
standing at, an accredited institution; and
`(3) shall not be denied solely by reason of such applicant's eligibility
for assistance or benefits under any other Federal program.
`SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
`(1) AUTHORITY- The Secretary, acting through the Service, shall make
scholarship grants to Indians who are enrolled full or part time in accredited
schools pursuing courses of study in the health professions. Such scholarships
shall be designated Indian Health Scholarships and shall be made in accordance
with section 338A of the Public Health Services Act (42 U.S.C. 254l),
except as provided in subsection (b) of this section.
`(2) DETERMINATIONS BY SECRETARY- The Secretary, acting through the Service,
shall determine--
`(A) who shall receive scholarship grants under subsection (a); and
`(B) the distribution of the scholarships among health professions on
the basis of the relative needs of Indians for additional service in
the health professions.
`(3) CERTAIN DELEGATION NOT ALLOWED- The administration of this section
shall be a responsibility of the Assistant Secretary and shall not be
delegated in a contract or compact under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.).
`(b) Active Duty Service Obligation-
`(1) OBLIGATION MET- The active duty service obligation under a written
contract with the Secretary under this section that an Indian has entered
into shall, if that individual is a recipient of an Indian Health Scholarship,
be met in full-time practice equal to 1 year for each school year for
which the participant receives a scholarship award under this part, or
2 years, whichever is greater, by service in 1 or more of the following:
`(A) In an Indian Health Program.
`(B) In a program assisted under title V of this Act.
`(C) In the private practice of the applicable profession 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.
`(D) In a teaching capacity in a tribal college or university nursing
program (or a related health profession program) if, as determined by
the Secretary, the health service provided to Indians would not decrease.
`(2) OBLIGATION DEFERRED- At the request of any individual who has entered
into a contract referred to in paragraph (1) and who receives a degree
in medicine (including osteopathic or allopathic medicine), dentistry,
optometry, podiatry, or pharmacy, the Secretary shall defer the active
duty service obligation of that individual under that contract, in order
that such individual may complete any internship, residency, or other
advanced clinical training that is required for the practice of that health
profession, for an appropriate period (in years, as determined by the
Secretary), subject to the following conditions:
`(A) No period of internship, residency, or other advanced clinical
training shall be counted as satisfying any period of obligated service
under this subsection.
`(B) The active duty service obligation of that individual shall commence
not later than 90 days after the completion of that advanced clinical
training (or by a date specified by the Secretary).
`(C) The active duty service obligation will be served in the health
profession of that individual in a manner consistent with paragraph
(1).
`(D) A recipient of a scholarship under this section may, at the election
of the recipient, meet the active duty service obligation described
in paragraph (1) by service in a program specified under that paragraph
that--
`(i) is located on the reservation of the Indian Tribe in which the
recipient is enrolled; or
`(ii) serves the Indian Tribe in which the recipient is enrolled.
`(3) PRIORITY WHEN MAKING ASSIGNMENTS- Subject to paragraph (2), the Secretary,
in making assignments of Indian Health Scholarship recipients required
to meet the active duty service obligation described in paragraph (1),
shall give priority to assigning individuals to service in those programs
specified in paragraph (1) that have a need for health professionals to
provide health care services as a result of individuals having breached
contracts entered into under this section.
`(c) Part-Time Students- In the case of an individual receiving a scholarship
under this section who is enrolled part time in an approved course of study--
`(1) such scholarship shall be for a period of years not to exceed the
part-time equivalent of 4 years, as determined by the Secretary;
`(2) the period of obligated service described in subsection (b)(1) shall
be equal to the greater of--
`(A) the part-time equivalent of 1 year for each year for which the
individual was provided a scholarship (as determined by the Secretary);
or
`(3) the amount of the monthly stipend specified in section 338A(g)(1)(B)
of the Public Health Service Act (42 U.S.C. 254l(g)(1)(B)) shall
be reduced pro rata (as determined by the Secretary) based on the number
of hours such student is enrolled.
`(1) SPECIFIED BREACHES- An individual shall be liable to the United States
for the amount which has been paid to the individual, or on behalf of
the individual, under a contract entered into with the Secretary under
this section on or after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007 if that individual--
`(A) fails to maintain an acceptable level of academic standing in the
educational institution in which he or she is enrolled (such level determined
by the educational institution under regulations of the Secretary);
`(B) is dismissed from such educational institution for disciplinary
reasons;
`(C) voluntarily terminates the training in such an educational institution
for which he or she is provided a scholarship under such contract before
the completion of such training; or
`(D) fails to accept payment, or instructs the educational institution
in which he or she is enrolled not to accept payment, in whole or in
part, of a scholarship under such contract, in lieu of any service obligation
arising under such contract.
`(2) OTHER BREACHES- If for any reason not specified in paragraph (1)
an individual breaches a written contract by failing either to begin such
individual's service obligation required under such contract or to complete
such service obligation, the United States shall be entitled to recover
from the individual an amount determined in accordance with the formula
specified in subsection (l) of section 110 in the manner provided for
in such subsection.
`(3) CANCELLATION UPON DEATH OF RECIPIENT- Upon the death of an individual
who receives an Indian Health Scholarship, any outstanding obligation
of that individual for service or payment that relates to that scholarship
shall be canceled.
`(4) WAIVERS AND SUSPENSIONS-
`(A) IN GENERAL- The Secretary shall provide for the partial or total
waiver or suspension of any obligation of service or payment of a recipient
of an Indian Health Scholarship if the Secretary determines that--
`(i) it is not possible for the recipient to meet that obligation
or make that payment;
`(ii) requiring that recipient to meet that obligation or make that
payment would result in extreme hardship to the recipient; or
`(iii) the enforcement of the requirement to meet the obligation or
make the payment would be unconscionable.
`(B) FACTORS FOR CONSIDERATION- Before waiving or suspending an obligation
of service or payment under subparagraph (A), the Secretary shall consult
with the affected Area Office, Indian Tribes, Tribal Organizations,
or Urban Indian Organizations, and may take into consideration whether
the obligation may be satisfied in a teaching capacity at a tribal college
or university nursing program under subsection (b)(1)(D).
`(5) EXTREME HARDSHIP- Notwithstanding any other provision of law, in
any case of extreme hardship or for other good cause shown, the Secretary
may waive, in whole or in part, the right of the United States to recover
funds made available under this section.
`(6) BANKRUPTCY- Notwithstanding any other provision of law, with respect
to a recipient of an Indian Health Scholarship, no obligation for payment
may be released by a discharge in bankruptcy under title 11, United States
Code, unless that discharge is granted after the expiration of the 5-year
period beginning on the initial date on which that payment is due, and
only if the bankruptcy court finds that the nondischarge of the obligation
would be unconscionable.
`SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
`(a) Grants Authorized- The Secretary, acting through the Service, shall
make grants of not more than $300,000 to each of 9 colleges and universities
for the purpose of developing and maintaining Indian psychology career recruitment
programs as a means of encouraging Indians to enter the behavioral health
field. These programs shall be located at various locations throughout the
country to maximize their availability to Indian students and new programs
shall be established in different locations from time to time.
`(b) Quentin N. Burdick Program Grant- The Secretary shall provide a grant
authorized 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 117(b), the Quentin N. Burdick American Indians
Into Nursing Program authorized under section 115(e), and existing university
research and communications networks.
`(c) Regulations- The Secretary shall issue regulations pursuant to this
Act for the competitive awarding of grants provided under this section.
`(d) Conditions of Grant- Applicants under this section shall agree to provide
a program which, at a minimum--
`(1) provides outreach and recruitment for health professions to Indian
communities including elementary, secondary, and accredited and accessible
community colleges that will be served by the program;
`(2) incorporates a program advisory board comprised of representatives
from the tribes and communities that will be served by the program;
`(3) provides summer enrichment programs to expose Indian students to
the various fields of psychology through research, clinical, and experimental
activities;
`(4) provides stipends to undergraduate and graduate students to pursue
a career in psychology;
`(5) develops affiliation agreements with tribal colleges and universities,
the Service, university affiliated programs, and other appropriate accredited
and accessible entities to enhance the education of Indian students;
`(6) to the maximum extent feasible, uses existing university tutoring,
counseling, and student support services; and
`(7) to the maximum extent feasible, employs qualified Indians in the
program.
`(e) Active Duty Service Requirement- 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 who receives a stipend described in
subsection (d)(4) that is funded under this section. Such obligation shall
be met by service--
`(1) in an Indian Health Program;
`(2) in a program assisted under title V of this Act; or
`(3) 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.
`(f) Authorization of Appropriations- There is authorized to be appropriated
to carry out this section $2,700,000 for each of fiscal years 2008 through
2017.
`SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.
`(1) GRANTS AUTHORIZED- The Secretary, acting through the Service, shall
make grants to Tribal Health Programs for the purpose of providing scholarships
for Indians to serve as health professionals in Indian communities.
`(2) AMOUNT- Amounts available under paragraph (1) for any fiscal year
shall not exceed 5 percent of the amounts available for each fiscal year
for Indian Health Scholarships under section 104.
`(3) APPLICATION- An application for a grant under paragraph (1) shall
be in such form and contain such agreements, assurances, and information
as consistent with this section.
`(1) IN GENERAL- A Tribal Health Program receiving a grant under subsection
(a) shall provide scholarships to Indians in accordance with the requirements
of this section.
`(2) COSTS- With respect to costs of providing any scholarship pursuant
to subsection (a)--
`(A) 80 percent of the costs of the scholarship shall be paid from the
funds made available pursuant to subsection (a)(1) provided to the Tribal
Health Program; and
`(B) 20 percent of such costs may be paid from any other source of funds.
`(c) Course of Study- A Tribal Health Program shall provide scholarships
under this section only to Indians enrolled or accepted for enrollment in
a course of study (approved by the Secretary) in 1 of the health professions
contemplated by this Act.
`(1) IN GENERAL- In providing scholarships under subsection (b), the Secretary
and the Tribal Health Program shall enter into a written contract with
each recipient of such scholarship.
`(2) REQUIREMENTS- Such contract shall--
`(A) obligate such recipient to provide service in an Indian Health
Program or Urban Indian Organization, in the same Service Area where
the Tribal Health Program providing the scholarship is located, for--
`(i) a number of years for which the scholarship is provided (or the
part-time equivalent thereof, as determined by the Secretary), or
for a period of 2 years, whichever period is greater; or
`(ii) such greater period of time as the recipient and the Tribal
Health Program may agree;
`(B) provide that the amount of the scholarship--
`(i) may only be expended for--
`(I) tuition expenses, other reasonable educational expenses, and
reasonable living expenses incurred in attendance at the educational
institution; and
`(II) payment to the recipient of a monthly stipend of not more
than the amount authorized by section 338(g)(1)(B) of the Public
Health Service Act (42 U.S.C. 254m(g)(1)(B)), with such amount to
be reduced pro rata (as determined by the Secretary) based on the
number of hours such student is enrolled, and not to exceed, for
any year of attendance for which the scholarship is provided, the
total amount required for the year for the purposes authorized in
this clause; and
`(ii) may not exceed, for any year of attendance for which the scholarship
is provided, the total amount required for the year for the purposes
authorized in clause (i);
`(C) require the recipient of such scholarship to maintain an acceptable
level of academic standing as determined by the educational institution
in accordance with regulations issued pursuant to this Act; and
`(D) require the recipient of such scholarship to meet the educational
and licensure requirements appropriate to each health profession.
`(3) SERVICE IN OTHER SERVICE AREAS- The contract may allow the recipient
to serve in another Service Area, provided the Tribal Health Program and
Secretary approve and services are not diminished to Indians in the Service
Area where the Tribal Health Program providing the scholarship is located.
`(1) SPECIFIC BREACHES- An individual who has entered into a written contract
with the Secretary and a Tribal Health Program under subsection (d) shall
be liable to the United States for the Federal share of the amount which
has been paid to him or her, or on his or her behalf, under the contract
if that individual--
`(A) fails to maintain an acceptable level of academic standing in the
educational institution in which he or she is enrolled (such level as
determined by the educational institution under regulations of the Secretary);
`(B) is dismissed from such educational institution for disciplinary
reasons;
`(C) voluntarily terminates the training in such an educational institution
for which he or she is provided a scholarship under such contract before
the completion of such training; or
`(D) fails to accept payment, or instructs the educational institution
in which he or she is enrolled not to accept payment, in whole or in
part, of a scholarship under such contract, in lieu of any service obligation
arising under such contract.
`(2) OTHER BREACHES- If for any reason not specified in paragraph (1),
an individual breaches a written contract by failing to either begin such
individual's service obligation required under such contract or to complete
such service obligation, the United States shall be entitled to recover
from the individual an amount determined in accordance with the formula
specified in subsection (l) of section 110 in the manner provided for
in such subsection.
`(3) CANCELLATION UPON DEATH OF RECIPIENT- Upon the death of an individual
who receives an Indian Health Scholarship, any outstanding obligation
of that individual for service or payment that relates to that scholarship
shall be canceled.
`(4) INFORMATION- The Secretary may carry out this subsection on the basis
of information received from Tribal Health Programs involved or on the
basis of information collected through such other means as the Secretary
deems appropriate.
`(f) Relation to Social Security Act- The recipient of a scholarship under
this section shall agree, in providing health care pursuant to the requirements
herein--
`(1) not to discriminate against an individual seeking care on the basis
of the ability of the individual to pay for such care or on the basis
that payment for such care will be made pursuant to a program established
in title XVIII of the Social Security Act or pursuant to the programs
established in title XIX or title XXI of such Act; and
`(2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social
Security Act for all services for which payment may be made under part
B of title XVIII of such Act, and to enter into an appropriate agreement
with the State agency that administers the State plan for medical assistance
under title XIX, or the State child health plan under title XXI, of such
Act to provide service to individuals entitled to medical assistance or
child health assistance, respectively, under the plan.
`(g) Continuance of Funding- The Secretary shall make payments under this
section to a Tribal Health Program for any fiscal year subsequent to the
first fiscal year of such payments unless the Secretary determines that,
for the immediately preceding fiscal year, the Tribal Health Program has
not complied with the requirements of this section.
`SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.
`(a) Employment Preference- Any individual who receives a scholarship pursuant
to section 104 or 106 shall be given preference for employment in the Service,
or may be employed by a Tribal Health Program or an Urban Indian Organization,
or other agencies of the Department as available, during any nonacademic
period of the year.
`(b) Not Counted Toward Active Duty Service Obligation- Periods of employment
pursuant to this subsection shall not be counted in determining fulfillment
of the service obligation incurred as a condition of the scholarship.
`(c) Timing; Length of Employment- Any individual enrolled in a program,
including a high school program, authorized under section 102(a) may be
employed by the Service or by a Tribal Health Program or an Urban Indian
Organization during any nonacademic period of the year. Any such employment
shall not exceed 120 days during any calendar year.
`(d) Nonapplicability of Competitive Personnel System- Any employment pursuant
to this section shall be made without regard to any competitive personnel
system or agency personnel limitation and to a position which will enable
the individual so employed to receive practical experience in the health
profession in which he or she is engaged in study. Any individual so employed
shall receive payment for his or her services comparable to the salary he
or she would receive if he or she were employed in the competitive system.
Any individual so employed shall not be counted against any employment ceiling
affecting the Service or the Department.
`SEC. 108. CONTINUING EDUCATION ALLOWANCES.
`In order to encourage scholarship and stipend recipients under sections
104, 105, 106, and 115 and health professionals, including community health
representatives and emergency medical technicians, to join or continue in
an Indian Health Program and to provide their services in the rural and
remote areas where a significant portion of Indians reside, the Secretary,
acting through the Service, may--
`(1) provide programs or allowances to transition into an Indian Health
Program, including licensing, board or certification examination assistance,
and technical assistance in fulfilling service obligations under sections
104, 105, 106, and 115; and
`(2) provide programs or allowances to health professionals employed in
an Indian Health Program to enable them for a period of time each year
prescribed by regulation of the Secretary to take leave of their duty
stations for professional consultation, management, leadership, and refresher
training courses.
`SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.
`(a) In General- Under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting through
the Service, shall maintain a Community Health Representative Program under
which Indian Health Programs--
`(1) provide for the training of Indians as community health representatives;
and
`(2) use such community health representatives in the provision of health
care, health promotion, and disease prevention services to Indian communities.
`(b) Duties- The Community Health Representative Program of the Service,
shall--
`(1) provide a high standard of training for community health representatives
to ensure that the community health representatives provide quality health
care, health promotion, and disease prevention services to the Indian
communities served by the Program;
`(2) in order to provide such training, develop and maintain a curriculum
that--
`(A) combines education in the theory of health care with supervised
practical experience in the provision of health care; and
`(B) provides instruction and practical experience in health promotion
and disease prevention activities, with appropriate consideration given
to lifestyle factors that have an impact on Indian health status, such
as alcoholism, family dysfunction, and poverty;
`(3) maintain a system which identifies the needs of community health
representatives for continuing education in health care, health promotion,
and disease prevention and develop programs that meet the needs for continuing
education;
`(4) maintain a system that provides close supervision of Community Health
Representatives;
`(5) maintain a system under which the work of Community Health Representatives
is reviewed and evaluated; and
`(6) promote traditional health care practices of the Indian Tribes served
consistent with the Service standards for the provision of health care,
health promotion, and disease prevention.
`SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.
`(a) Establishment- The Secretary, acting through the Service, shall establish
and administer a program to be known as the Service Loan Repayment Program
(hereinafter referred to as the `Loan Repayment Program') in order to ensure
an adequate supply of trained health professionals necessary to maintain
accreditation of, and provide health care services to Indians through, Indian
Health Programs and Urban Indian Organizations.
`(b) Eligible Individuals- To be eligible to participate in the Loan Repayment
Program, an individual must--
`(i) in a course of study or program in an accredited educational institution
(as determined by the Secretary under section 338B(b)(1)(c)(i) of the
Public Health Service Act (42 U.S.C. 254l-1(b)(1)(c)(i))) and
be scheduled to complete such course of study in the same year such
individual applies to participate in such program; or
`(ii) in an approved graduate training program in a health profession;
or
`(i) a degree in a health profession; and
`(ii) a license to practice a health profession;
`(2)(A) be eligible for, or hold, an appointment as a commissioned officer
in the Regular or Reserve Corps of the Public Health Service;
`(B) be eligible for selection for civilian service in the Regular or
Reserve Corps of the Public Health Service;
`(C) meet the professional standards for civil service employment in the
Service; or
`(D) be employed in an Indian Health Program or Urban Indian Organization
without a service obligation; and
`(3) submit to the Secretary an application for a contract described in
subsection (e).
`(1) INFORMATION TO BE INCLUDED WITH FORMS- In disseminating application
forms and contract forms to individuals desiring to participate in the
Loan Repayment Program, the Secretary shall include with such forms a
fair summary of the rights and liabilities of an individual whose application
is approved (and whose contract is accepted) by the Secretary, including
in the summary a clear explanation of the damages to which the United
States is entitled under subsection (l) in the case of the individual's
breach of contract. The Secretary shall provide such individuals with
sufficient information regarding the advantages and disadvantages of service
as a commissioned officer in the Regular or Reserve Corps of the Public
Health Service or a civilian employee of the Service to enable the individual
to make a decision on an informed basis.
`(2) CLEAR LANGUAGE- The application form, contract form, and all other
information furnished by the Secretary under this section shall be written
in a manner calculated to be understood by the average individual applying
to participate in the Loan Repayment Program.
`(3) TIMELY AVAILABILITY OF FORMS- The Secretary shall make such application
forms, contract forms, and other information available to individuals
desiring to participate in the Loan Repayment Program on a date sufficiently
early to ensure that such individuals have adequate time to carefully
review and evaluate such forms and information.
`(1) LIST- Consistent with subsection (k), the Secretary shall annually--
`(A) identify the positions in each Indian Health Program or Urban Indian
Organization for which there is a need or a vacancy; and
`(B) rank those positions in order of priority.
`(2) APPROVALS- Notwithstanding the priority determined under paragraph
(1), the Secretary, in determining which applications under the Loan Repayment
Program to approve (and which contracts to accept), shall--
`(A) give first priority to applications made by individual Indians;
and
`(B) after making determinations on all applications submitted by individual
Indians as required under subparagraph (A), give priority to--
`(i) individuals recruited through the efforts of an Indian Health
Program or Urban Indian Organization; and
`(ii) other individuals based on the priority rankings under paragraph
(1).
`(e) Recipient Contracts-
`(1) CONTRACT REQUIRED- An individual becomes a participant in the Loan
Repayment Program only upon the Secretary and the individual entering
into a written contract described in paragraph (2).
`(2) CONTENTS OF CONTRACT- The written contract referred to in this section
between the Secretary and an individual shall contain--
`(A) an agreement under which--
`(i) subject to subparagraph (C), the Secretary agrees--
`(I) to pay loans on behalf of the individual in accordance with
the provisions of this section; and
`(II) to accept (subject to the availability of appropriated funds
for carrying out this section) the individual into the Service or
place the individual with a Tribal Health Program or Urban Indian
Organization as provided in clause (ii)(III); and
`(ii) subject to subparagraph (C), the individual agrees--
`(I) to accept loan payments on behalf of the individual;
`(II) in the case of an individual described in subsection (b)(1)--
`(aa) to maintain enrollment in a course of study or training
described in subsection (b)(1)(A) until the individual completes the course
of study or training; and
`(bb) while enrolled in such course of study or training, to maintain
an acceptable level of academic standing (as determined under regulations
of the Secretary by the educational institution offering such course of
study or training); and
`(III) to serve for a time period (hereinafter in this section referred
to as the `period of obligated service') equal to 2 years or such
longer period as the individual may agree to serve in the full-time
clinical practice of such individual's profession in an Indian Health
Program or Urban Indian Organization to which the individual may
be assigned by the Secretary;
`(B) a provision permitting the Secretary to extend for such longer
additional periods, as the individual may agree to, the period of obligated
service agreed to by the individual under subparagraph (A)(ii)(III);
`(C) a provision that any financial obligation of the United States
arising out of a contract entered into under this section and any obligation
of the individual which is conditioned thereon is contingent upon funds
being appropriated for loan repayments under this section;
`(D) a statement of the damages to which the United States is entitled
under subsection (l) for the individual's breach of the contract; and
`(E) such other statements of the rights and liabilities of the Secretary
and of the individual, not inconsistent with this section.
`(f) Deadline for Decision on Application- The Secretary shall provide written
notice to an individual within 21 days on--
`(1) the Secretary's approving, under subsection (e)(1), of the individual's
participation in the Loan Repayment Program, including extensions resulting
in an aggregate period of obligated service in excess of 4 years; or
`(2) the Secretary's disapproving an individual's participation in such
Program.
`(1) IN GENERAL- A loan repayment provided for an individual under a written
contract under the Loan Repayment Program shall consist of payment, in
accordance with paragraph (2), on behalf of the individual of the principal,
interest, and related expenses on government and commercial loans received
by the individual regarding the undergraduate or graduate education of
the individual (or both), which loans were made for--
`(B) all other reasonable educational expenses, including fees, books,
and laboratory expenses, incurred by the individual; and
`(C) reasonable living expenses as determined by the Secretary.
`(2) AMOUNT- For each year of obligated service that an individual contracts
to serve under subsection (e), the Secretary may pay up to $35,000 or
an amount equal to the amount specified in section 338B(g)(2)(A) of the
Public Health Service Act, whichever is more, on behalf of the individual
for loans described in paragraph (1). In making a determination of the
amount to pay for a year of such service by an individual, the Secretary
shall consider the extent to which each such determination--
`(A) affects the ability of the Secretary to maximize the number of
contracts that can be provided under the Loan Repayment Program from
the amounts appropriated for such contracts;
`(B) provides an incentive to serve in Indian Health Programs and Urban
Indian Organizations with the greatest shortages of health professionals;
and
`(C) provides an incentive with respect to the health professional involved
remaining in an Indian Health Program or Urban Indian Organization with
such a health professional shortage, and continuing to provide primary
health services, after the completion of the period of obligated service
under the Loan Repayment Program.
`(3) TIMING- Any arrangement made by the Secretary for the making of loan
repayments in accordance with this subsection shall provide that any repayments
for a year of obligated service shall be made no later than the end of
the fiscal year in which the individual completes such year of service.
`(4) REIMBURSEMENTS FOR TAX LIABILITY- For the purpose of providing reimbursements
for tax liability resulting from a payment under paragraph (2) on behalf
of an individual, the Secretary--
`(A) in addition to such payments, may make payments to the individual
in an amount equal to not less than 20 percent and not more than 39
percent of the total amount of loan repayments made for the taxable
year involved; and
`(B) may make such additional payments as the Secretary determines to
be appropriate with respect to such purpose.
`(5) PAYMENT SCHEDULE- The Secretary may enter into an agreement with
the holder of any loan for which payments are made under the Loan Repayment
Program to establish a schedule for the making of such payments.
`(h) Employment Ceiling- Notwithstanding any other provision of law, individuals
who have entered into written contracts with the Secretary under this section
shall not be counted against any employment ceiling affecting the Department
while those individuals are undergoing academic training.
`(i) Recruitment- The Secretary shall conduct recruiting programs for the
Loan Repayment Program and other manpower programs of the Service at educational
institutions training health professionals or specialists identified in
subsection (a).
`(j) Applicability of Law- Section 214 of the Public Health Service Act
(42 U.S.C. 215) shall not apply to individuals during their period of obligated
service under the Loan Repayment Program.
`(k) Assignment of Individuals- The Secretary, in assigning individuals
to serve in Indian Health Programs or Urban Indian Organizations pursuant
to contracts entered into under this section, shall--
`(1) ensure that the staffing needs of Tribal Health Programs and Urban
Indian Organizations receive consideration on an equal basis with programs
that are administered directly by the Service; and
`(2) give priority to assigning individuals to Indian Health Programs
and Urban Indian Organizations that have a need for health professionals
to provide health care services as a result of individuals having breached
contracts entered into under this section.
`(1) SPECIFIC BREACHES- An individual who has entered into a written contract
with the Secretary under this section and has not received a waiver under
subsection (m) shall be liable, in lieu of any service obligation arising
under such contract, to the United States for the amount which has been
paid on such individual's behalf under the contract if that individual--
`(A) is enrolled in the final year of a course of study and--
`(i) fails to maintain an acceptable level of academic standing in
the educational institution in which he or she is enrolled (such level
determined by the educational institution under regulations of the
Secretary);
`(ii) voluntarily terminates such enrollment; or
`(iii) is dismissed from such educational institution before completion
of such course of study; or
`(B) is enrolled in a graduate training program and fails to complete
such training program.
`(2) OTHER BREACHES; FORMULA FOR AMOUNT OWED- If, for any reason not specified
in paragraph (1), an individual breaches his or her written contract under
this section by failing either to begin, or complete, such individual's
period of obligated service in accordance with subsection (e)(2), the
United States shall be entitled to recover from such individual an amount
to be determined in accordance with the following formula: A=3Z(t-s/t)
in which--
`(A) `A' is the amount the United States is entitled to recover;
`(B) `Z' is the sum of the amounts paid under this section to, or on
behalf of, the individual and the interest on such amounts which would
be payable if, at the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as determined by the
Secretary of the Treasury;
`(C) `t' is the total number of months in the individual's period of
obligated service in accordance with subsection (f); and
`(D) `s' is the number of months of such period served by such individual
in accordance with this section.
`(3) DEDUCTIONS IN MEDICARE PAYMENTS- Amounts not paid within such period
shall be subject to collection through deductions in Medicare payments
pursuant to section 1892 of the Social Security Act.
`(4) TIME PERIOD FOR REPAYMENT- Any amount of damages which the United
States is entitled to recover under this subsection shall be paid to the
United States within the 1-year period beginning on the date of the breach
or such longer period beginning on such date as shall be specified by
the Secretary.
`(5) RECOVERY OF DELINQUENCY-
`(A) IN GENERAL- If damages described in paragraph (4) are delinquent
for 3 months, the Secretary shall, for the purpose of recovering such
damages--
`(i) use collection agencies contracted with by the Administrator
of General Services; or
`(ii) enter into contracts for the recovery of such damages with collection
agencies selected by the Secretary.
`(B) REPORT- Each contract for recovering damages pursuant to this subsection
shall provide that the contractor will, not less than once each 6 months,
submit to the Secretary a status report on the success of the contractor
in collecting such damages. Section 3718 of title 31, United States
Code, shall apply to any such contract to the extent not inconsistent
with this subsection.
`(m) Waiver or Suspension of Obligation-
`(1) IN GENERAL- The Secretary shall by regulation provide for the partial
or total waiver or suspension of any obligation of service or payment
by an individual under the Loan Repayment Program whenever compliance
by the individual is impossible or would involve extreme hardship to the
individual and if enforcement of such obligation with respect to any individual
would be unconscionable.
`(2) CANCELED UPON DEATH- Any obligation of an individual under the Loan
Repayment Program for service or payment of damages shall be canceled
upon the death of the individual.
`(3) HARDSHIP WAIVER- The Secretary may waive, in whole or in part, the
rights of the United States to recover amounts under this section in any
case of extreme hardship or other good cause shown, as determined by the
Secretary.
`(4) BANKRUPTCY- Any obligation of an individual under the Loan Repayment
Program for payment of damages may be released by a discharge in bankruptcy
under title 11 of the United States Code only if such discharge is granted
after the expiration of the 5-year period beginning on the first date
that payment of such damages is required, and only if the bankruptcy court
finds that nondischarge of the obligation would be unconscionable.
`(n) Report- The Secretary shall submit to the President, for inclusion
in the report required to be submitted to Congress under section 801, a
report concerning the previous fiscal year which sets forth by Service Area
the following:
`(1) A list of the health professional positions maintained by Indian
Health Programs and Urban Indian Organizations for which recruitment or
retention is difficult.
`(2) The number of Loan Repayment Program applications filed with respect
to each type of health profession.
`(3) The number of contracts described in subsection (e) that are entered
into with respect to each health profession.
`(4) The amount of loan payments made under this section, in total and
by health profession.
`(5) The number of scholarships that are provided under sections 104 and
106 with respect to each health profession.
`(6) The amount of scholarship grants provided under section 104 and 106,
in total and by health profession.
`(7) The number of providers of health care that will be needed by Indian
Health Programs and Urban Indian Organizations, by location and profession,
during the 3 fiscal years beginning after the date the report is filed.
`(8) The measures the Secretary plans to take to fill the health professional
positions maintained by Indian Health Programs or Urban Indian Organizations
for which recruitment or retention is difficult.
`SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
`(a) Establishment- There is established in the Treasury of the United States
a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery
Fund (hereafter in this section referred to as the `LRRF'). The LRRF shall
consist of such amounts as may be collected from individuals under section
104(d), section 106(e), and section 110(l) for breach of contract, such
funds as may be appropriated to the LRRF, and interest earned on amounts
in the LRRF. All amounts collected, appropriated, or earned relative to
the LRRF shall remain available until expended.
`(1) BY SECRETARY- Amounts in the LRRF may be expended by the Secretary,
acting through the Service, to make payments to an Indian Health Program--
`(A) to which a scholarship recipient under section 104 and 106 or a
loan repayment program participant under section 110 has been assigned
to meet the obligated service requirements pursuant to such sections;
and
`(B) that has a need for a health professional to provide health care
services as a result of such recipient or participant having breached
the contract entered into under section 104, 106, or section 110.
`(2) BY TRIBAL HEALTH PROGRAMS- A Tribal Health Program receiving payments
pursuant to paragraph (1) may expend the payments to provide scholarships
or recruit and employ, directly or by contract, health professionals to
provide health care services.
`(c) Investment of Funds- The Secretary of the Treasury shall invest such
amounts of the LRRF as the Secretary of Health and Human Services determines
are not required to meet current withdrawals from the LRRF. Such investments
may be made only in interest bearing obligations of the United States. For
such purpose, such obligations may be acquired on original issue at the
issue price, or by purchase of outstanding obligations at the market price.
`(d) Sale of Obligations- Any obligation acquired by the LRRF may be sold
by the Secretary of the Treasury at the market price.
`SEC. 112. RECRUITMENT ACTIVITIES.
`(a) Reimbursement for Travel- The Secretary, acting through the Service,
may reimburse health professionals seeking positions with Indian Health
Programs or Urban Indian Organizations, including individuals considering
entering into a contract under section 110 and their spouses, for actual
and reasonable expenses incurred in traveling to and from their places of
residence to an area in which they may be assigned for the purpose of evaluating
such area with respect to such assignment.
`(b) Recruitment Personnel- The Secretary, acting through the Service, shall
assign 1 individual in each Area Office to be responsible on a full-time
basis for recruitment activities.
`SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.
`(a) In General- The Secretary, acting through the Service, shall fund,
on a competitive basis, innovative demonstration projects for a period not
to exceed 3 years to enable Tribal Health Programs and Urban Indian Organizations
to recruit, place, and retain health professionals to meet their staffing
needs.
`(b) Eligible Entities; Application- Any Tribal Health Program or Urban
Indian Organization may submit an application for funding of a project pursuant
to this section.
`SEC. 114. ADVANCED TRAINING AND RESEARCH.
`(a) Demonstration Program- The Secretary, acting through the Service, shall
establish a demonstration project to enable health professionals who have
worked in an Indian Health Program or Urban Indian Organization for a substantial
period of time to pursue advanced training or research areas of study for
which the Secretary determines a need exists.
`(b) Service Obligation- An individual who participates in a program under
subsection (a), where the educational costs are borne by the Service, shall
incur an obligation to serve in an Indian Health Program or Urban Indian
Organization for a period of obligated service equal to at least the period
of time during which the individual participates in such program. In the
event that the individual fails to complete such obligated service, the
individual shall be liable to the United States for the period of service
remaining. In such event, with respect to individuals entering the program
after the date of enactment of the Indian Health Care Improvement Act Amendments
of 2007, the United States shall be entitled to recover from such individual
an amount to be determined in accordance with the formula specified in subsection
(l) of section 110 in the manner provided for in such subsection.
`(c) Equal Opportunity for Participation- Health professionals from Tribal
Health Programs and Urban Indian Organizations shall be given an equal opportunity
to participate in the program under subsection (a).
`SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.
`(a) Grants Authorized- For the purpose of increasing the number of nurses,
nurse midwives, and nurse practitioners who deliver health care services
to Indians, the Secretary, acting through the Service, shall provide grants
to the following:
`(1) Public or private schools of nursing.
`(2) Tribal colleges or universities.
`(3) Nurse midwife programs and advanced practice nurse programs that
are provided by any tribal college or university accredited nursing program,
or in the absence of such, any other public or private institutions.
`(b) Use of Grants- Grants provided under subsection (a) may be used for
1 or more of the following:
`(1) To recruit individuals for programs which train individuals to be
nurses, nurse midwives, or advanced practice nurses.
