I 110th CONGRESS S.1200 2d Session IN THE HOUSE OF REPRESENTATIVES February 28, 2008 Referred to the Committee on Natural Resources, and in addition to the Com- mittee on Energy and Commerce and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned AN ACT To amend the Indian Health Care Improvement Act to revise and extend that Act. 1 Be it enacted by the Senate and House ofRepresenta- 2 fives ofthe United States ofAmerica in Congress assembled, 2 SECTION SHORT TITLE; TABLE OF CONTENTS. 1 1. — 2 (a) Short Title. This Act may be cited as the 3 "Indian Health Care Improvement Act Amendments of 4 2008". — 5 (b) Table of Contents. The table of contents of 6 this Act is as follows: Sec. 1. Short title; table ofcontents. — TITLE AMENDMENTS TO INDIAN LAWS I See. 101. Indian Health Care Improvement Act amended. See. 102. Soboba sanitation facilities. Sec. 103. Native American Health and Wellness Foundation. Sec. 104. Modification ofterm. Sec. 105. GAO study and report on payments for contract health services. Sec. 106. GAO study of membership criteria for federally recognized Indian tribcs. See. 107. GAO study of tribaljustice systems. 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 im- proved cooperation in the provision of items and services to In- dians under Social SecurityAct health benefit programs. See. 203. Additional provisions to increase outreach to, and enrollment of, Indi- ans in SCHIP and Medicaid. Sec. 204. Premiums and cost sharing protections under Medicaid, eligibility de- terminations 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- See. 208. Rules applicable under Medicaid and SCHIP to managed care entities with respect to Indian enrollees and Indian health care pro- viders and Indian managed care entities. Sec. 209. Annual report on Indians served by Social Security Act health benefit programs. See. 210. Development of recommendations to improve interstate coordination of Medicaid and SCHIP coverage of Indian children and other children who are outside of their State of residency because of educational or other needs. Sec. 211. Establishment of National Child Welfare Resource Center for Tribes. S 1200 RFH — — — I CMS Library . C2-07-13 7500 Secu-ity Blvd. o jjoit:;riCtra, MaryjMd .21244 See. 212. Adjustment to the Medicare Advantage stabilization fund. See. 213. Moratorium on implementation of changes to case management and targeted case management payment requirements under Med- icaid. Sec. 214. Increased civil money penalties and criminal fines for Medicare fraud and abuse. Sec. 215. Increased sentences for felonies involving Medicare fraud and abuse. — TITLE MISCELLANEOUS III Sec. 301. Resolution of apology7 to Native Peoples ofUnited States. TITLE I—AMENDMENTS TO 1 INDIAN LAWS 2 3 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 4 AMENDED. 5 The Indian Health Care Improvement Act (25 U.S.C. 6 1601 et seq.) is amended to read as follows: 7 "SECTION 1. SHORT TITLE; TABLE OF CONTENTS. — 8 "(a) Short Title. This Act may be cited as the 9 'Indian Health Care Improvement Act'. — 10 "(b) Table of Contents. The table of contents 1 1 for this Act is as follows: "Sec. 1. Short title; table of contents. "See. 2. Findings. "Sec. 3. Declaration ofnational Indian health policy. "Sec. 4. Definitions. "TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT "Sec. 101. Purpose. "Sec. 102. Health professions recruitment program for Indians. "Sec. 103. Health professions preparatory scholarship program for Indians. "See. 104. Indian health professions scholarships. "Sec. 105. American Indians Into Psychology Program. "Sec. 106. Scholarship programs for Indian Tribes. "See. 107. Indian Health Service extern programs. "See. 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. S 1200 RFH 4 "Sec. 113. "Sec. 114. Advanced training- and research. "Sec. 115. "Sec. 116. "Sec. 117. "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. "See. 124. "Sec. 125. Substance abuse counselor educational curricula demonstration pro- grams. "Sec. 126. Behavioral health training and community education programs. See. 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. "See. 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 a contract health service deliv- . ery area. "Sec. 217. California contract health services program. "Sec. 218. California as a contract health service delivery area. "Sec. 219. Contract health services for the Trenton service area. "Sec. 220. Programs operated by Indian Tribes and Tribal Organizations. "Sec. 221. Licensing. "Sec. 222. Notification ofprovision ofemergency contract health services. "Sec. 223. Prompt action on payment ofclaims. "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 offacilities; reports. "Sec. 302. Sanitation facilities. "Sec. 303. Preference to Indians and Indian firms. "Sec. 304. S 1200 RFH 5 "Sec. 305. Funding- for the construction, expansion, and modernization of small ambulatory care facilities. "See. 306. Indian health care delivery demonstration projects. "Sec. 307. Land transfer. "See. 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 facilitiesjoint venture program. "Sec. 312. Location offacilities. "Sec. 313. Maintenance and improvement of health care facilities. "See. 314. Tribal management ofFederally-owned quarters. "Sec. 315. Applicability of BuyAmerican 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 Or- ganizations, and Urban Indian Organizations to facilitate out- reach, enrollment, and coverage of Indians under Social Secu- rity Act health benefit programs and other health benefits pro- grams. "Sec. 403. Reimbursement from certain third parties of costs of health services. "See. 404. Crediting ofreimbursements. "Sec. 405. Purchasing health care coverage. "Sec. 406. Sharing arrangements with Federal agencies. "Sec. 407. Eligible Indian veteran services. "Sec. 408. Payor oflast resort. "See. 409. Nondiscrimination under Federal health care programs in qualifica- tions for reimbursement for services. "Sec. 410. Consultation. "See. 411. State Children's Health Insurance Program (SCHIP). "Sec. 412. Exclusion waiver authority for affected Indian Health Programs and safe harbor transactions under the Social SecurityAct. "Sec. 413. Premium and cost sharing protections and eligibility determinations under Medicaid and SCHIP and protection of certain Indian propertyfrom Medicaid estate recovery. "Sec. 414. Treatment under Medicaid and SCHIP managed care. "Sec. 415. Navajo Nation Medicaid Agency feasibility study. "Sec. 416. General exceptions. "Sec. 417. Authorization of appropriations. "TITLE V—HEALTH SERVICES FOR URBAN INDIANS "Sec. 501. Purpose. "Sec. 502. Contracts with, and grants to, Urban Indian Organizations. "Sec. 503. Contracts and grants for the provision of health care and referral services. "Sec. 504. Contracts and grants for the determination of unmet health care needs. "See. 505. Evaluations; renewals. "Sec. 506. Other contract and grant requirements. "Sec. 507. Reports and records. "Sec. 508. Limitation on contract authority. S 1200 RFH "Sec. 509. "Sec. 510. "Sec. 511. "Sec. 512. "See. 513. "Sec. 514. "See. 515. oec. olb. "Sec. 517. "Sec. 518. "Sec. 519. "Sec. 520. — "TITLE VI ORGANIZATIONAL IMPROVEMENTS "See. 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 ofthe 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. "See. 707. Indian youth program. "See. 708. Indian youth telemental health demonstration project. "Sec. 709. Inpatient and community-based mental health facilities design, con- struction, and staffing. "Sec. 710. Training and community education. "See. 711. "Sec. 712. "Sec. 713. Child sexual abuse and prevention treatment programs. oec. /14. "Sec. 715. "Sec. 716. Behavioral health research. "Sec. 717. Definitions. "Sec. 718. "TITLE VIII—MISCELLANEOUS "Sec. 801. Reports. "Sec. 802. Regulations. "Sec. 803. Plan of implementation. "Sec. 804. Availability offunds. "Sec. 805. Limitation relating to abortion. "Sec. 806. Eligibility of California Indians. "See. 807. Health services for ineligible persons. "Sec. 808. Reallocation ofbase resources. "Sec. 809. Results of demonstration projects. "Sec. 810. Provision of services in Montana. "See. 811. Tribal employment. "Sec. 812. Severability provisions. S 1200 RFH 7 "See. 813. Establishment of National Bipartisan Commission on Indian Health Care. "See. 814. Confidentiality of medical quality assurance records; qualified immu- nity for participants. "Sec. 815. Sense of Congress regarding- law enforcement and methamphetamine issues in Indian Country. "Sec. 816. Tribal Health Program option for cost sharing. "Sec. 817. Testing for sexually transmitted diseases in cases of sexual violence. "Sec. 818. Study on tobacco-related disease and disproportionate health effects on tribal populations. "Sec. 819. Appropriations; availability. "Sec. 820. GAO report on coordination of services. "Sec. 821. Authorization of appropriations. 1 "SEC. 2. FINDINGS. 2 "Congress makes the following findings: 3 "(1) Federal health services to maintain and 4 improve the health of the Indians are consonant 5 with and required by the Federal Government's his- 6 torical and unique legal relationship with, and re- 7 suiting responsibility to, the American Indian people. A 8 "(2) major national goal of the United States 9 is to provide the resources, processes, and structure 10 that will enable Indian Tribes and tribal members to 11 obtain the quantity and quality of health care serv- 12 ices and opportunities that will eradicate the health 13 disparities between Indians and the general popu- 14 lation of the United States. A 15 "(3) major national goal of the United States 16 is to provide the quantity and quality of health serv- 17 ices which will permit the health status of Indians 18 to be raised to the highest possible level and to en- S 1200 RFH — 1 courage the maximum participation of Indians in the 2 planning and management of those services. 3 "(4) Federal health services to Indians have re- 4 suited in a reduction in the prevalence and incidence 5 of preventable illnesses among, and unnecessary and 6 premature deaths of, Indians. 7 "(5) Despite such services, the unmet health 8 needs of the American Indian people are severe and 9 the health status of the Indians is far below that of 10 the general population of the United States. 1 1 "SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL- 12 ICY. 13 "Congress declares that it is the policy of this Nation, 14 in fulfillment of its special trust responsibilities and legal 15 obligations to Indians 16 "(1) to assure the highest possible health status 17 for Indians and Urban Indians and to provide all re- 18 sources necessary to effect that policy; 19 "(2) to raise the health status of Indians and 20 Urban Indians to at least the levels set forth in the 21 goals contained within the Healthy People 2010 or 22 successor objectives; 23 "(3) to ensure maximum Indian participation in 24 the direction of health care services so as to render 25 the persons administering such services and the S 1200 RFH 9 1 services themselves more responsive to the needs and 2 desires of Indian communities; 3 "(4) to increase the proportion of all degrees in 4 the health professions and allied and associated 5 health professions awarded to Indians so that the 6 proportion of Indian health professionals in each 7 Service Area is raised to at least the level of that of 8 the general population; 9 "(5) to require that all actions under this Act 10 shall be carried out with active and meaningful con- 11 sulfation with Indian Tribes and Tribal Organiza- 12 tions, and conference with Urban Indian Organiza- 13 tions, to implement this Act and the national policy 14 of Indian self-determination; 15 "(6) to ensure that the United States and In- 16 dian Tribes work in a government-to-government re- 17 lationship to ensure quality health care for all tribal 18 members; and 19 "(7) to provide funding for programs and facili- 20 ties operated by Indian Tribes and Tribal Organiza- 21 tions in amounts that are not less than the amounts 22 provided to programs and facilities operated directly 23 by the Service. 24 "SEC. 4. DEFINITIONS. 25 "For purposes of this Act: S 1200 RFH — 10 1 "(1) The term 'accredited and accessible' means 2 on or near a reservation and accredited by a na- 3 tional or regional organization with accrediting au- 4 thority. 5 "(2) The term 'Area Office' means an adminis- 6 trative entity, including a program office, within the 7 Service through which services and funds are pro- 8 vided to the Service Units within a defined geo- 9 graphic area. 10 "(3)(A) The term 'behavioral health' means the 11 blending of substance (alcohol, drugs, inhalants, and 12 tobacco) abuse and mental health prevention and 13 treatment, for the purpose of providing comprehen- 14 sive services. 15 "(B) The term 'behavioral health' includes the 16 joint development of substance abuse and mental 17 health treatment planning and coordinated case 18 management using a multidisciplinary approach. 19 "(4) The term 'California Indians' means those 20 Indians who are eligible for health services of the 21 Service pursuant to section 806. 22 "(5) The term 'community college' means 23 "(A) a tribal college or university, or 24 "(B) a junior or community college. 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