Table Of Content110thCongress Rept. 110-564
HOUSE OFREPRESENTATIVES
2dSession Paft ,
I
INDIAN HEALTH CARE IMPROVEMENT ACT
AMENDMENTS OF 2007
REPORT
OF THE
COMMITTEE ON NATURAL RESOURCES
ON
H.R. 1328
SST
1M ^i""
HOUSE OFREPRESENTATIVES
INDIAN HEALTH CARE IMPROVEMENT ACT
AMENDMENTS OF 2007
REPORT
OF THE
COMMITTEE ON NATURAL RESOURCES
ON
H.R. 1328
c:
44
U.S. GOVERNMENT PRINTING OFFICE
69-006 WASHINGTON 2008
:
110th Congress Rept. 110-564
] HOUSE OF REPRESENTATIVES \
2dSession } { Part x
INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS
OF 2007
—
April4, 2008. Orderedtobe printed
Mr. Rahall, from the Committee on Natural Resources,
submitted the following
REPORT
[To accompany H.R. 1328]
[Includingcostestimate ofthe Congressional BudgetOffice]
The Committee on Natural Resources, to whom was referred the
bill (H.R. 1328) to amend the Indian Health Care Improvement Act
to revise and extend that Act, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the following:
SECTION1.SHORTTI—TLE;TABLEOFCONTENTS.
(a) ShortTitle. This Act maybe cited as the "Indian Health Care Improvement
ActAmendments of2007".—
(b) Table of Contents. The table ofcontents ofthis Actis as follows:
Sec. 1. Shorttitle;tableofcontents.
TITLEI—AMENDMENTSTOINDIANLAWS
Sec. 101. IndianHealthCareImprovementActamended.
Sec. 102. Sobobasanitationfacilities.
Sec. 103. NativeAmericanHealthandWellnessFoundation.
TITLEII—IMPROVEMENTOFINDIANHEALTHCAREPROVIDEDUNDERTHESOCIALSECURITYACT
Sec. 201. Expansion ofpayments underMedicare, Medicaid, and SCHIPfor all covered services furnished by
IndianHealthPrograms.
Sec. 202. IncreasedoutreachtoIndiansunderMedicaidandSCHIPandimprovedcooperationintheprovision
ofitemsandservicestoIndiansunderSocialSecurityActhealthbenefitprograms.
Sec. 203. Additionalprovisionstoincreaseoutreachto,andenrollmentof,IndiansinSCHIPandMedicaid.
Sec. 204. PremiumsandcostsharingprotectionsunderMedicaid,eligibilitydeterminationsunderMedicaidand
SCHIP,andprotectionofcertainIndianpropertyfromMedicaidestaterecovery.
Sec. 205. NondiscriminationinqualificationsforpaymentforservicesunderFederalhealthcareprograms.
Sec. 206. ConsultationonMedicaid, SCHIP, andotherhealthcareprogramsfundedundertheSocial Security
ActinvolvingIndianHealthProgramsandUrbanIndianOrganizations.
Sec. 207. Exclusion waiver authorityforaffected Indian HealthPrograms andsafeharbortransactions under
theSocialSecurityAct.
Sec. 208. RulesapplicableunderMedicaidandSCHIPtomanagedcareentitieswithrespecttoIndianenrollees
andIndianhealthcareprovidersandIndianmanagedcareentities.
Sec. 209. AnnualreportonIndiansservedbySocialSecurityActhealthbenefitprograms.
69-006
2
SEC.2.REPORT—ONTHIRD-PARTYPAYMENTCOLLECTIONS.
(a) Study. The Secretary of Health and Human Services shall conduct a thor-
ough study ofthe system ofthird-party payment collections for items and services
furnishedthro—ughthe IndianHealth Service.
(b) Report. Not later than 6 months after the date ofthe enactment ofthis Act,
the Secretary shall submit to each House ofCongress a report on such study. Such
report shall include such recommendations on how to improve such third-partypay-
ment collections as the Secretary determines appropriate.
TITLE I—AMENDMENTS TO INDIAN LAWS
SEC.101.INDIANHEALTHCAREIMPROVEMENTACTAMENDED.
(a) In General.—The Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.) is amendedtoread as follows:
"SECTION1.SHORTTIT—LE;TABLEOFCONTENTS.
"(a) Short Title. This Act may be cited as the 'Indian Health Care Improve-
mentAct'.
"(b)Table of Contents.—Thetable ofcontents forthisActis as follows:
"Sec. 1. Shorttitle;tableofcontents.
"Sec. 2. Findings.
"Sec. 3. DeclarationofnationalIndianhealthpolicy.
"Sec. 4. Definitions.
"TITLEI—INDIANHEALTH,HUMANRESOURCES,ANDDEVELOPMENT
Purpose.
HealthprofessionsrecruitmentprogramforIndians.
HealthprofessionspreparatoryscholarshipprogramforIndians.
Indianhealthprofessionsscholarships.
AmericanIndiansIntoPsychologyProgram.
ScholarshipprogramsforIndianTribes.
IndianHealthServiceexternprograms.
Continuingeducationallowances.
CommunityHealthRepresentativeProgram.
IndianHealthServiceLoanRepaymentProgram.
ScholarshipandLoanRepaymentRecoveryFund.
Recruitmentactivities.
Indianrecruitmentandretentionprogram.
Advancedtrainingandresearch.
QuentinN.BurdickAmericanIndiansIntoNursingProgram.
Tribalculturalorientation.
INMEDProgram.
Healthtrainingprogramsofcommunitycolleges.
Retentionbonus.
Nursingresidencyprogram.
CommunityHealthAideProgram.
TribalHealthProgramadministration.
Healthprofessionalchronicshortagedemonstrationprograms.
NationalHealthServiceCorps.
Substanceabusecounseloreducationalcurriculademonstrationprograms.
Behavioralhealthtrainingandcommunityeducationprograms.
Authorizationofappropriations.
"TITLEII—HEALTHSERVICES
"Sec. 201. IndianHealthCareImprovementFund.
"Sec. 202. CatastrophicHealthEmergencyFund.
"Sec. 203. Healthpromotionanddiseasepreventionservices.
"Sec. 204. Diabetesprevention,treatment,andcontrol.
"Sec. 205. Sharedservicesforlong-termcare.
"Sec. 206. Healthservicesresearch.
"Sec. 207. Mammographyandothercancerscreening.
"Sec. 208. Patienttravelcosts.
"Sec. 209. Epidemiologycenters.
"Sec. 210. Comprehensiveschoolhealtheducationprograms.
"Sec. 211. Indianyouthprogram.
"Sec. 212. Prevention,control,andeliminationofcommunicableandinfectiousdiseases.
"Sec. 213. Authorityforprovisionofotherservices.
"Sec. 214. Indianwomen'shealthcare.
"Sec. 215. Environmentalandnuclearhealthhazards.
"Sec. 216. Arizonaasacontracthealthservicedeliveryarea.
"Sec. 217. NorthDakotaandSouthDakotaascontracthealthservicedeliveryarea.
"Sec. 218. Californiacontracthealthservicesprogram.
"Sec. 219. Californiaasacontracthealthservicedeliveryarea.
"Sec. 220. ContracthealthservicesfortheTrentonServiceArea.
"Sec. 221. ProgramsoperatedbyIndianTribesandTribalOrganizations.
"Sec. 222. Licensing.
"Sec. 223. Notificationofprovisionofemergencycontracthealthservices.
"Sec. 224. Promptactiononpaymentofclaims.
"Sec. 225. Liabilityforpayment.
"Sec. 226. OfficeofIndianMen'sHealth.
"Sec. 227. Authorizationofappropriations.
3
"TITLEIII—FACILITIES
"Sec. 301. Consultation;constructionandrenovationoffacilities;reports.
"Sec. 302. Sanitationfacilities.
"Sec. 303. PreferencetoIndiansandIndianfirms.
"Sec. 304. Expenditureofnon-Servicefundsforrenovation.
"Sec. 305. Fundingfortheconstruction,expansion,andmodernizationofsmallambulatorycarefacilities.
"Sec. 306. Indianhealthcaredeliverydemonstrationproject.
"Sec. 307. Landtransfer.
"Sec. 308. Leases,contracts,andotheragreements.
"Sec. 309. Studyonloans,loanguarantees,andloanrepayment.
'Sec. 310. Triballeasing.
"Sec. 311. IndianHealthService/tribalfacilitiesjointventureprogram.
"Sec. 312. Locationoffacilities.
'Sec. 313. Maintenanceandimprovementofhealthcarefacilities.
"Sec. 314. Tribalmanagementoffederally-ownedquarters.
"Sec. 315. ApplicabilityofBuyAmericanActrequirement.
'Sec. 316. Otherfundingforfacilities.
"Sec. 317. Authorizationofappropriations.
"TITLEIV—ACCESSTOHEALTHSERVICES
"Sec. 401. TreatmentofpaymentsunderSocialSecurityActhealthbenefitsprograms.
"Sec. 402. GrantstoandcontractswiththeService,IndianTribes,TribalOrganizations,andUrbanIndianOr-
ganizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act
healthbenefitprogramsandotherhealthbenefitsprograms.
"Sec. 403. Reimbursementfromcertainthirdpartiesofcostsofhealthservices.
"Sec. 404. Creditingofreimbursements.
"Sec. 405. Purchasinghealthcarecoverage.
"Sec. 406. SharingarrangementswithFederalagencies.
"Sec. 407. Payoroflastresort.
"Sec. 408. NondiscriminationunderFederalhealthcareprogramsinqualificationsforreimbursementforserv-
ices.
"Sec. 409. Consultation.
"Sec. 410. StateChildren'sHealthInsuranceProgram(SCHIP).
''Sec. 411. ExclusionwaiverauthorityforaffectedIndianHealthProgramsandsafeharbortransactionsunder
theSocialSecurityAct.
"Sec. 412. PremiumandcostsharingprotectionsandeligibilitydeterminationsunderMedicaidandSCHIPand
protectionofcertainIndianpropertyfromMedicaidestaterecovery.
"Sec. 413. TreatmentunderMedicaidandSCHIPmanagedcare.
"Sec. 414. NavajoNationMedicaidAgencyfeasibilitystudy.
"Sec. 415. Generalexceptions.
"Sec. 416. Authorizationofappropriations.
"TITLEV—HEALTHSERVICESFORURBANINDIANS
"Sec. 501. Purpose.
"Sec. 502. Contractswith,andgrantsto,UrbanIndianOrganizations.
"Sec. 503. Contractsandgrantsfortheprovisionofhealthcareandreferralservices.
"Sec. 504. Contractsandgrantsforthedeterminationofunmethealthcareneeds.
"Sec. 505. Evaluations;renewals.
"Sec. 506. Othercontractandgrantrequirements.
"Sec. 507. Reportsandrecords.
"Sec. 508. Limitationoncontractauthority.
"Sec. 509. Facilities.
"Sec. 510. DivisionofUrbanIndianHealth.
"Sec. 511. Grantsforalcoholandsubstanceabuse-relatedservices.
"Sec. 512. Treatmentofcertaindemonstrationprojects.
"Sec. 513. UrbanNIAAAtransferredprograms.
"Sec. 514. ConsultationwithUrbanIndianOrganizations.
"Sec. 515. Urbanyouthtreatmentcenterdemonstration.
"Sec. 516. Grantsfordiabetesprevention,treatment,andcontrol.
"Sec. 517. Communityhealthrepresentatives.
"Sec. 518. Effectivedate.
"Sec. 519. Eligibilityforservices.
"Sec. 520. Authorizationofappropriations.
"TITLEVI—ORGANIZATIONALIMPROVEMENTS
"Sec. 601. EstablishmentoftheIndianHealthServiceasanagencyofthePublicHealthService.
"Sec. 602. Automatedmanagementinformationsystem.
"Sec. 603. Authorizationofappropriations.
"TITLEVII—BEHAVIORALHEALTHPROGRAMS
"Sec. 701. Behavioralhealthpreventionandtreatmentservices.
"Sec. 702. MemorandaofagreementwiththeDepartmentoftheInterior.
"Sec. 703. Comprehensivebehavioralhealthpreventionandtreatmentprogram.
"Sec. 704. Mentalhealthtechnicianprogram.
"Sec. 705. Licensingrequirementformentalhealthcareworkers.
"Sec. 706. Indianwomentreatmentprograms.
"Sec. 707. Indianyouthprogram.
"Sec. 708. Indianyouthtelementalhealthdemonstrationproject.
"Sec. 709. Inpatientandcommunity-basedmentalhealthfacilitiesdesign,construction,andstaffing.
"Sec. 710. Trainingandcommunityeducation.
"Sec. 711. Behavioralhealthprogram.
"Sec. 712. Fetalalcoholdisorderprograms.
"Sec. 713. Childsexualabuseandpreventiontreatmentprograms.
"Sec. 714. Behavioralhealthresearch.
"Sec. 715. Definitions.
"Sec. 716. Authorizationofappropriations.
"TITLEVIII—MISCELLANEOUS
"Sec. 801. Reports.
— —
4
"Sec. 802. Regulations.
"Sec. 803. Planofimplementation.
"Sec. 804. Availabilityoffunds.
"Sec. 805. LimitationonuseoffundsappropriatedtoIndianHealthService.
"Sec. 806. EligibilityofCaliforniaIndians.
"Sec. 807. Healthservicesforineligiblepersons.
"Sec. 808. Reallocationofbaseresources.
"Sec. 809. Resultsofdemonstrationprojects.
"Sec. 810. ProvisionofservicesinMontana.
"Sec. 811. Moratorium.
"Sec. 812. Severabilityprovisions.
"Sec. 813. EstablishmentofNationalBipartisanCommissiononIndianHealthCare.
"Sec. 814. Confidentialityofmedicalqualityassurancerecords;qualifiedimmunityforparticipants.
"Sec. 815. Appropriations;availability.
"Sec. 816. Authorizationofappropriations.
"SEC.2.FINDINGS.
"Congress makes thefollowingfindings:
"(1) Federal health services to maintain and improve the health ofthe Indi-
ans are consonant with and required by the Federal Government's historical
and unique legal relationship with, and resulting responsibility to, the Amer-
icanIndianpeople.
"(2) Amajor national goal ofthe United States is to provide the quantity and
quality ofhealth services which will permit the health status ofIndians to be
raisedto the highestpossible level andto encourage the maximum participation
ofIndians inthe planning andmanagement ofthose services.
"(3) Federal health services to Indians have resulted in a reduction in the
prevalence and incidence ofpreventable 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 ofthe Indians is far below that ofthe
general population ofthe United States.
"SEC.3.DECLARATIONOFNATIONALINDIANHEALTHPOLICY.
"Congress declares that it is the policy ofthis Nation, in fulfillment ofits special
trustresponsibilities andlegal obligations to Indians
"(1) to assure the highest possible health status for Indians and Urban Indi-
ans andto provide allresources necessaryto effectthatpolicy;
"(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 suc-
cessor objectives;
"(3) to the greatest extent possible, to allow Indians to set their own health
care priorities andestablish goals thatreflecttheirunmetneeds;
"(4) to increase the proportion ofall degrees in the health professions and al-
lied and associatedhealth professions awardedto Indians so thatthe proportion
ofIndianhealthprofessionals in each ServiceArea is raisedto atleastthe level
ofthatofthegeneral population;
"(5) to require meaningful consultation with Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations to implement this Act and the national
policyofIndian 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 pro-
videdtoprograms andfacilities operated directlybythe Service.
"SEC.4.DEFINITIONS.
"Forpurposes ofthisAct:
"(1) The term 'accredited and accessible' means on or near a reservation and
accreditedbyanational orregionalorganizationwith accrediting authority.
"(2) The term 'Area Office' means an administrative entity, including a pro-
gram office, within the Service through which services and funds are provided
to the Service Units within a definedgeographic area.
"(3) The term 'Assistant Secretary means the Assistant Secretary of Indian
Health.
"(4)(A) The term 'behavioral health' means the blending ofsubstance (alcohol,
drugs, inhalants, and tobacco) abuse and mental health prevention and treat-
ment, forthepurpose ofprovidingcomprehensive services.
"(B) The term behavioral health' includes thejoint development ofsubstance
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 ofthe Service pursuantto section 806.
"(6) The term 'communitycollege' means
"(A) a tribal college oruniversity, or
"(B) ajunioror communitycollege.
——— — —
5
"(7) The term 'contract health service' means health services provided at the
expense ofthe Service or a Tribal Health Program by public or private medical
providers or hospitals, other than the Service Unit or the Tribal Health Pro-
gram atwhose expense the services are provided.
"(8) The term 'Department' means, unless otherwise designated, the Depart-
mentofHealth andHuman Services.
"(9) The term 'disease prevention' means the reduction, limitation, and pre-
vention of disease and its complications and reduction in the consequences of
disease, including
"(A) controlling
"(i)the development ofdiabetes;
"(ii)highbloodpressure;
"(hi)infectious agents;
"(iv) injuries;
"(v) occupationalhazards and disabilities;
"(vi) sexuallytransmittable diseases; and
"(vii) toxic agents; and
"(B) providing
"(i) fluoridation ofwater; and
"(ii) immunizations.
"(10) The term 'health profession' means allopathic medicine, familymedicine,
internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology,
podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteop-
athy, optometry, pharmacy, psychology, public health, social work, marriage
and family therapy, chiropractic medicine, environmental health and engineer-
ing, allied health professions, naturopathic medicine, and any other health pro-
fession.
"(11) The term 'healthpromotion' means
"(A) fostering social, economic, environmental, and personal factors con-
ducive to health, including raising public awareness about health matters
and enabling the people to cope with health problems by increasing their
knowledge and providingthemwithvalidinformation;
"(B) encouragingadequate and appropriate diet, exercise, and sleep;
"(C) promoting education and work in conformity with physical and men-
talcapacity;
"(D)makingavailable safe water and sanitaryfacilities;
"(E) improving the physical, economic, cultural, psychological, and social
environment;
"(F) promotingculturallycompetent care; and
"(G) providing adequate and appropriate programs, which may include
"(i) abuse prevention (mental and physical);
"(ii) communityhealth;
"(hi) community safety;
"(iv) consumerhealth education;
"(v) diet andnutrition;
"(vi) immunization and other prevention of communicable diseases,
includingHIV/AIDS;
"(vii) environmentalhealth;
"(viii) exercise andphysicalfitness;
"(ix) avoidance offetal alcohol disorders;
"(x)first aid and CPR education;
"(xi) human growth and development;
"(xii) injuryprevention and personal safety;
"(xiii)behavioralhealth;
"(xiv) monitoring of disease indicators between health care provider
visits, through appropriate means, including Internet-basedhealth care
management systems;
"(xv) personalhealth andwellness practices;
"(xvi) personal capacitybuilding;
"(xvii) prenatal, pregnancy, andinfant care;
"(xviii) psychologicalwell-being;
"(xix) reproductive health andfamily planning;
"(xx) safe and adequate water;
"(xxi) healthyworkenvironments;
"(xxii) elimination, reduction, and prevention of contaminants that
create unhealthy household conditions (including mold and other aller-
gens);
"(xxiii) stress control;
"(xxiv) substance abuse;
— —
6
"(xxv) sanitaryfacilities;
"(xxvi) suddeninfant death syndrome prevention;
"(xxvii) tobaccouse cessation andreduction;
"(xxviii)violence prevention; and
"(xxix) such other activities identifiedbythe Service, a Tribal Health
Program, or an Urban Indian Organization, to promote achievement of
anyofthe objectives describedin 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 ofsections 102 and 103, the term also means
anyindividualwho
"(A)(i) irrespective ofwhether the individual lives on or near a reserva-
tion, is a member ofa tribe, band, or other organized group ofIndians, in-
cluding those tribes, bands, or groups terminated since 1940 and those rec-
ognizednoworinthefuturebythe State inwhichtheyreside; or
"(h) is a descendant, in the first or second degree, of any such member;
"(B)is anEskimo orAleut or otherAlaskaNative;
"(C) is considered by the Secretary ofthe 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'IndianHealthProgram' means
"(A) anyhealth program administered directlybythe Service;
"(B) anyTribal HealthProgram; or
"(C) any Indian Tribe or Tribal Organization to which the Secretary pro-
vides funding pursuant to section 23 ofthe Act ofJune 25, 1910 (25 U.S.C.
47) (commonlyknown as the 'Buy IndianAct').
"(14) The term 'Indian Tribe' has the meaning given the term in the Indian
Self-Determination and EducationAssistanceAct (25 U.S.C. 450 et seq.).
"(15) The term 'junior or community college' has the meaning given the term
by section 312(e) ofthe HigherEducationAct of1965 (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, In-
dian allotments, andAlaska Native Regions established pursuant to the Alaska
Native Claims SettlementAct (43 U.S.C. 1601 et seq.).
"(17) The term 'Secretary5 unless otherwise designated, means the Secretary
ofHealth andHuman Service,s.
"(18) The term'Service' means the IndianHealth Service.
"(19) The term 'Service Area' means the geographical area served by each
Area Office.
"(20) The term 'Service Unit' means an administrative entity ofthe 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 giventhe term in section 330K(a)
ofthe Public Health ServiceAct(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 profes-
sionals or patients and health professionals at separate sites in order to ex-
change health care information in audio, video, graphic, or other format for the
purpose ofprovidingimprovedhealth care services.
"(23) The term 'tribal college or university' has the meaning given the term
in section 316(b)(3) ofthe HigherEducationAct (20 U.S.C. 1059c(b)(3))".
"(24) The term 'Tribal Health Program' means an Indian Tribe or Tribal Or-
ganization that operates anyhealth program, service, function, activity, or facil-
ity funded, in whole or part, by the Service through, or provided for in, a con-
tractorcompactwiththe Serviceunderthe Indian Self-Determination andEdu-
cationAssistanceAct (25 U.S.C. 450 et seq.).
"(25) The term 'Tribal Organization' has the meaning given the term in the
Indian Self-Determination and EducationAssistanceAct (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
titleVofthis Act, as determinedbythe Secretary.
"(27) The term 'Urban Indian' means any individual who resides in an Urban
Center andwhomeets 1 ormore ofthe followingcriteria:
"(A) Irrespective ofwhether the individual lives on or near a reservation,
the individual is a member ofa tribe, band, or other organized group ofIn-
dians, including those tribes, bands, or groups terminated since 1940 and
those tribes, bands, or groups that are recognized by the States in which
