USC Subchapter II

USC Subchapter II
in effect

25 U.S.C. § 1621 Indian Health Care Improvement Fund

(a) Use of fundsThe Secretary, acting through the Service, is authorized to expend funds, directly or under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),11 See References in Text note below. which are appropriated under the authority of this section, for the purposes of—(1) eliminating the deficiencies in health status and health resources of all Indian tribes; (2) eliminating backlogs in the provision of health care services to Indians; (3) meeting the health needs of Indians in an efficient and equitable manner, including the use of telehealth and telemedicine when appropriate; (4) eliminating inequities in funding for both direct care and contract health service programs; and (5) augmenting the ability of the Service to meet the following health service responsibilities with respect to those Indian tribes with the highest levels of health status deficiencies and resource deficiencies:(A) Clinical care, including inpatient care, outpatient care (including audiology, clinical eye, and vision care), primary care, secondary and tertiary care, and long-term care. (B) Preventive health, including mammography and other cancer screening. (C) Dental care. (D) Mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treatment centers, and training of traditional health care practitioners. (E) Emergency medical services. (F) Treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians. (G) Injury prevention programs, including data collection and evaluation, demonstration projects, training, and capacity building. (H) Home health care. (I) Community health representatives. (J) Maintenance and improvement. (b) No offset or limitationAny funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the Service under this chapter or section 13 of this title, or any other provision of law. (c) Allocation; use(1) In generalFunds appropriated under the authority of this section shall be allocated to Service units, Indian tribes, or tribal organizations. The funds allocated to each Indian tribe, tribal organization, or Service unit under this paragraph shall be used by the Indian tribe, tribal organization, or Service unit under this paragraph to improve the health status and reduce the resource deficiency of each Indian tribe served by such Service unit, Indian tribe, or tribal organization. (2) Apportionment of allocated fundsThe apportionment of funds allocated to a Service unit, Indian tribe, or tribal organization under paragraph (1) among the health service responsibilities described in subsection (a)(5) shall be determined by the Service in consultation with, and with the active participation of, the affected Indian tribes and tribal organizations. (d) Provisions relating to health status and resource deficienciesFor the purposes of this section, the following definitions apply:(1) DefinitionThe term “health status and resource deficiency” means the extent to which—(A) the health status objectives set forth in sections 1602(1) and 1602(2) of this title are not being achieved; and (B) the Indian tribe or tribal organization does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances. (2) Available resourcesThe health resources available to an Indian tribe or tribal organization include health resources provided by the Service as well as health resources used by the Indian tribe or tribal organization, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments. (3) Process for review of determinationsThe Secretary shall establish procedures which allow any Indian tribe or tribal organization to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such Indian tribe or tribal organization. (e) Eligibility for fundsTribal health programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service. (f) ReportBy no later than the date that is 3 years after March 23, 2010, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service unit, including newly recognized or acknowledged Indian tribes. Such report shall set out—(1) the methodology then in use by the Service for determining tribal health status and resource deficiencies, as well as the most recent application of that methodology; (2) the extent of the health status and resource deficiency of each Indian tribe served by the Service or a tribal health program; (3) the amount of funds necessary to eliminate the health status and resource deficiencies of all Indian tribes served by the Service or a tribal health program; and (4) an estimate of—(A) the amount of health service funds appropriated under the authority of this chapter, or any other Act, including the amount of any funds transferred to the Service for the preceding fiscal year which is allocated to each Service unit, Indian tribe, or tribal organization; (B) the number of Indians eligible for health services in each Service unit or Indian tribe or tribal organization; and (C) the number of Indians using the Service resources made available to each Service unit, Indian tribe or tribal organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of resources. (g) Inclusion in base budgetFunds appropriated under this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years. (h) ClarificationNothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve equity among Indian tribes and tribal organizations. (i) Funding designationAny funds appropriated under the authority of this section shall be designated as the “Indian Health Care Improvement Fund”.

25 U.S.C. § 1621a Catastrophic Health Emergency Fund

(a) EstablishmentThere is established an Indian Catastrophic Health Emergency Fund (hereafter in this section referred to as the “CHEF”) consisting of—(1) the amounts deposited under subsection (f); and (2) the amounts appropriated to CHEF under this section. (b) AdministrationCHEF shall be administered by the Secretary, acting through the headquarters of the Service, solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the Service. (c) Conditions on use of FundNo part of CHEF or its administration shall be subject to contract or grant under any law, including the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),11 See References in Text note below. nor shall CHEF funds be allocated, apportioned, or delegated on an Area Office, Service Unit, or other similar basis. (d) RegulationsThe Secretary shall promulgate regulations consistent with the provisions of this section to—(1) establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from CHEF; (2) provide that a Service Unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at—(A) the 2000 level of $19,000; and (B) for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers (United States city average) for the 12-month period ending with December of the previous year; (3) establish a procedure for the reimbursement of the portion of the costs that exceeds such threshold cost incurred by—(A) Service Units; or (B) whenever otherwise authorized by the Service, non-Service facilities or providers; (4) establish a procedure for payment from CHEF in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the Service; and (5) establish a procedure that will ensure that no payment shall be made from CHEF to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible. (e) No offset or limitationAmounts appropriated to CHEF under this section shall not be used to offset or limit appropriations made to the Service under the authority of section 13 of this title, or any other law. (f) Deposit of reimbursement fundsThere shall be deposited into CHEF all reimbursements to which the Service is entitled from any Federal, State, local, or private source (including third party insurance) by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from CHEF.

25 U.S.C. § 1621b Health promotion and disease prevention services

(a) AuthorizationThe Secretary, acting through the Service, shall provide health promotion and disease prevention services to Indians so as to achieve the health status objectives set forth in section 1602(b) 11 See References in Text note below. of this title. (b) Evaluation statement for Presidential budgetThe Secretary shall submit to the President for inclusion in each statement which is required to be submitted to the Congress under section 1671 of this title an evaluation of—(1) the health promotion and disease prevention needs of Indians, (2) the health promotion and disease prevention activities which would best meet such needs, (3) the internal capacity of the Service to meet such needs, and (4) the resources which would be required to enable the Service to undertake the health promotion and disease prevention activities necessary to meet such needs.

25 U.S.C. § 1621c Diabetes prevention, treatment, and control

(a) Determinations regarding diabetesThe Secretary, acting through the Service, and in consultation with Indian tribes and tribal organizations, shall determine—(1) by Indian tribe and by Service unit, the incidence of, and the types of complications resulting from, diabetes among Indians; and (2) based on the determinations made pursuant to paragraph (1), the measures (including patient education and effective ongoing monitoring of disease indicators) each Service unit should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among Indian tribes within that Service unit. (b) Diabetes screeningTo the extent medically indicated and with informed consent, the Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic and establish a cost-effective approach to ensure ongoing monitoring of disease indicators. Such screening and monitoring may be conducted by a tribal health program and may be conducted through appropriate Internet-based health care management programs. (c) Diabetes projectsThe Secretary shall continue to maintain each model diabetes project in existence on March 23, 2010, any such other diabetes programs operated by the Service or tribal health programs, and any additional diabetes projects, such as the Medical Vanguard program provided for in title IV of Public Law 108–87, as implemented to serve Indian tribes. tribal 11 So in original. Probably should be capitalized. health programs shall receive recurring funding for the diabetes projects that they operate pursuant to this section, both at March 23, 2010, and for projects which are added and funded thereafter. (d) Dialysis programsThe Secretary is authorized to provide, through the Service, Indian tribes, and tribal organizations, dialysis programs, including the purchase of dialysis equipment and the provision of necessary staffing. (e) Other duties of the Secretary(1) In generalThe Secretary shall, to the extent funding is available—(A) in each area office, consult with Indian tribes and tribal organizations regarding programs for the prevention, treatment, and control of diabetes; (B) establish in each area office a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area; and (C) ensure that data collected in each area office regarding diabetes and related complications among Indians are disseminated to all other area offices, subject to applicable patient privacy laws. (2) Diabetes control officers(A) In generalThe Secretary may establish and maintain in each area office a position of diabetes control officer to coordinate and manage any activity of that area office relating to the prevention, treatment, or control of diabetes to assist the Secretary in carrying out a program under this section or section 254c–3 of title 42. (B) Certain activitiesAny activity carried out by a diabetes control officer under subparagraph (A) that is the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),22 See References in Text note below. and any funds made available to carry out such an activity, shall not be divisible for purposes of that Act.

25 U.S.C. § 1621d Other authority for provision of services

(a) DefinitionsIn this section:(1) Assisted living serviceThe term “assisted living service” means any service provided by an assisted living facility (as defined in section 1715w(b) of title 12), except that such an assisted living facility—(A) shall not be required to obtain a license; but (B) shall meet all applicable standards for licensure. (2) Home- and community-based serviceThe term “home- and community-based service” means 1 or more of the services specified in paragraphs (1) through (9) of section 1396t(a) of title 42 (whether provided by the Service or by an Indian tribe or tribal organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) 11 See References in Text note below. that are or will be provided in accordance with applicable standards. (3) Hospice careThe term “hospice care” means—(A) the items and services specified in subparagraphs (A) through (H) of section 1395x(dd)(1) of title 42; and (B) such other services as an Indian tribe or tribal organization determines are necessary and appropriate to provide in furtherance of that care. (4) Long-term care servicesThe term “long-term care services” has the meaning given the term “qualified long-term care services” in section 7702B(c) of title 26. (b) Funding authorizedThe Secretary, acting through the Service, Indian tribes, and tribal organizations, may provide funding under this chapter to meet the objectives set forth in section 1602 of this title through health care-related services and programs not otherwise described in this chapter for the following services:(1) Hospice care. (2) Assisted living services. (3) Long-term care services. (4) Home- and community-based services. (c) EligibilityThe following individuals shall be eligible to receive long-term care services under this section:(1) Individuals who are unable to perform a certain number of activities of daily living without assistance. (2) Individuals with a mental impairment, such as dementia, Alzheimer’s disease, or another disabling mental illness, who may be able to perform activities of daily living under supervision. (3) Such other individuals as an applicable tribal health program determines to be appropriate. (d) Authorization of convenient care servicesThe Secretary, acting through the Service, Indian tribes, and tribal organizations, may also provide funding under this chapter to meet the objectives set forth in section 1602 of this title for convenient care services programs pursuant to section 1637(c)(2)(A) of this title.

25 U.S.C. § 1621e Reimbursement from certain third parties of costs of health services

(a) Right of recoveryExcept as provided in subsection (f), the United States, an Indian tribe, or tribal organization shall have the right to recover from an insurance company, health maintenance organization, employee benefit plan, third-party tortfeasor, or any other responsible or liable third party (including a political subdivision or local governmental entity of a State) the reasonable charges billed by the Secretary, an Indian tribe, or tribal organization in providing health services through the Service, an Indian tribe, or tribal organization, or, if higher, the highest amount the third party would pay for care and services furnished by providers other than governmental entities, to any individual to the same extent that such individual, or any nongovernmental provider of such services, would be eligible to receive damages, reimbursement, or indemnification for such charges or expenses if—(1) such services had been provided by a nongovernmental provider; and (2) such individual had been required to pay such charges or expenses and did pay such charges or expenses. (b) Limitations on recoveries from StatesSubsection (a) shall provide a right of recovery against any State, only if the injury, illness, or disability for which health services were provided is covered under—(1) workers’ compensation laws; or (2) a no-fault automobile accident insurance plan or program. (c) Nonapplicability of other lawsNo law of any State, or of any political subdivision of a State and no provision of any contract, insurance or health maintenance organization policy, employee benefit plan, self-insurance plan, managed care plan, or other health care plan or program entered into or renewed after November 23, 1988, shall prevent or hinder the right of recovery of the United States, an Indian tribe, or tribal organization under subsection (a). (d) No effect on private rights of actionNo action taken by the United States, an Indian tribe, or tribal organization to enforce the right of recovery provided under this section shall operate to deny to the injured person the recovery for that portion of the person’s damage not covered hereunder. (e) Enforcement(1) In generalThe United States, an Indian tribe, or tribal organization may enforce the right of recovery provided under subsection (a) by—(A) intervening or joining in any civil action or proceeding brought—(i) by the individual for whom health services were provided by the Secretary, an Indian tribe, or tribal organization; or (ii) by any representative or heirs of such individual, or (B) instituting a separate civil action, including a civil action for injunctive relief and other relief and including, with respect to a political subdivision or local governmental entity of a State, such an action against an official thereof. (2) NoticeAll reasonable efforts shall be made to provide notice of action instituted under paragraph (1)(B) to the individual to whom health services were provided, either before or during the pendency of such action. (3) Recovery from tortfeasors(A) In generalIn any case in which an Indian tribe or tribal organization that is authorized or required under a compact or contract issued pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 11 See References in Text note below. to furnish or pay for health services to a person who is injured or suffers a disease on or after March 23, 2010, under circumstances that establish grounds for a claim of liability against the tortfeasor with respect to the injury or disease, the Indian tribe or tribal organization shall have a right to recover from the tortfeasor (or an insurer of the tortfeasor) the reasonable value of the health services so furnished, paid for, or to be paid for, in accordance with the Federal Medical Care Recovery Act (42 U.S.C. 2651 et seq.), to the same extent and under the same circumstances as the United States may recover under that Act. (B) TreatmentThe right of an Indian tribe or tribal organization to recover under subparagraph (A) shall be independent of the rights of the injured or diseased person served by the Indian tribe or tribal organization. (f) LimitationAbsent specific written authorization by the governing body of an Indian tribe for the period of such authorization (which may not be for a period of more than 1 year and which may be revoked at any time upon written notice by the governing body to the Service), the United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe, tribal organization, or urban Indian organization. Where such authorization is provided, the Service may receive and expend such amounts for the provision of additional health services consistent with such authorization. (g) Costs and attorney’s feesIn any action brought to enforce the provisions of this section, a prevailing plaintiff shall be awarded its reasonable attorney’s fees and costs of litigation. (h) Nonapplicability of claims filing requirementsAn insurance company, health maintenance organization, self-insurance plan, managed care plan, or other health care plan or program (under the Social Security Act [42 U.S.C. 301 et seq.] or otherwise) may not deny a claim for benefits submitted by the Service or by an Indian tribe or tribal organization based on the format in which the claim is submitted if such format complies with the format required for submission of claims under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] or recognized under section 1175 of such Act [42 U.S.C. 1320d–4]. (i) Application to urban Indian organizationsThe previous provisions of this section shall apply to urban Indian organizations with respect to populations served by such Organizations 11 So in original. Probably should not be capitalized. in the same manner they apply to Indian tribes and tribal organizations with respect to populations served by such Indian tribes and tribal organizations. (j) Statute of limitationsThe provisions of section 2415 of title 28 shall apply to all actions commenced under this section, and the references therein to the United States are deemed to include Indian tribes, tribal organizations, and urban Indian organizations. (k) SavingsNothing in this section shall be construed to limit any right of recovery available to the United States, an Indian tribe, or tribal organization under the provisions of any applicable, Federal, State, or tribal law, including medical lien laws.

25 U.S.C. § 1621f Crediting of reimbursements

(a) Use of amounts(1) Retention by programExcept as provided in sections 1621a(a)(2) and 1680c of this title, all reimbursements received or recovered under any of the programs described in paragraph (2), including under section 1680c of this title, by reason of the provision of health services by the Service, by an Indian tribe or tribal organization, or by an urban Indian organization, shall be credited to the Service, such Indian tribe or tribal organization, or such urban Indian organization, respectively, and may be used as provided in section 1641 of this title. In the case of such a service provided by or through a Service Unit, such amounts shall be credited to such unit and used for such purposes. (2) Programs coveredThe programs referred to in paragraph (1) are the following:(A) Titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.]. (B) This chapter, including section 1680c of this title. (C) Public Law 87–693 [42 U.S.C. 2651 et seq.]. (D) Any other provision of law. (b) No offset of amountsThe Service may not offset or limit any amount obligated to any Service Unit or entity receiving funding from the Service because of the receipt of reimbursements under subsection (a).

25 U.S.C. § 1621g Health services research

Of the amounts appropriated for the Service in any fiscal year, other than amounts made available for the Indian Health Care Improvement Fund, not less than $200,000 shall be available only for research to further the performance of the health service responsibilities of the Service. Indian tribes and tribal organizations contracting with the Service under the authority of the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] shall be given an equal opportunity to compete for, and receive, research funds under this section.

25 U.S.C. § 1621h Mental health prevention and treatment services

(a) National plan for Indian Mental Health Services(1) Not later than 120 days after November 28, 1990, the Secretary, acting through the Service, shall develop and publish in the Federal Register a final national plan for Indian Mental Health Services. The plan shall include—(A) an assessment of the scope of the problem of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians, including—(i) the number of Indians served by the Service who are directly or indirectly affected by such illness or behavior, and (ii) an estimate of the financial and human cost attributable to such illness or behavior; (B) an assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior; and (C) an estimate of the additional funding needed by the Service to meet its responsibilities under the plan. (2) The Secretary shall submit a copy of the national plan to the Congress. (b) Memorandum of agreementNot later than 180 days after November 28, 1990, the Secretary and the Secretary of the Interior shall develop and enter into a memorandum of agreement under which the Secretaries shall, among other things—(1) determine and define the scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians; (2) make an assessment of the existing Federal, tribal, State, local, and private services, resources, and programs available to provide mental health services for Indians; (3) make an initial determination of the unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1); (4)(A) ensure that Indians, as citizens of the United States and of the States in which they reside, have access to mental health services to which all citizens have access; (B) determine the right of Indians to participate in, and receive the benefit of, such services; and (C) take actions necessary to protect the exercise of such right; (5) delineate the responsibilities of the Bureau of Indian Affairs and the Service, including mental health identification, prevention, education, referral, and treatment services (including services through multidisciplinary resource teams), at the central, area, and agency and service unit levels to address the problems identified in paragraph (1); (6) provide a strategy for the comprehensive coordination of the mental health services provided by the Bureau of Indian Affairs and the Service to meet the needs identified pursuant to paragraph (1), including—(A) the coordination of alcohol and substance abuse programs of the Service, the Bureau of Indian Affairs, and the various tribes (developed under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 [25 U.S.C. 2401 et seq.]) with the mental health initiatives pursuant to this chapter, particularly with respect to the referral and treatment of dually-diagnosed individuals requiring mental health and substance abuse treatment; and (B) ensuring that Bureau of Indian Affairs and Service programs and services (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal programs and services; (7) direct appropriate officials of the Bureau of Indian Affairs and the Service, particularly at the agency and service unit levels, to cooperate fully with tribal requests made pursuant to subsection (d); and (8) provide for an annual review of such agreement by the two Secretaries. (c) Community mental health plan(1) The governing body of any Indian tribe may, at its discretion, adopt a resolution for the establishment of a community mental health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat mental illness or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members. (2) In furtherance of a plan established pursuant to paragraph (1) and at the request of a tribe, the appropriate agency, service unit, or other officials of the Bureau of Indian Affairs and the Service shall cooperate with, and provide technical assistance to, the tribe in the development of such plan. Upon the establishment of such a plan and at the request of the tribe, such officials, as directed by the memorandum of agreement developed pursuant to subsection (c), shall cooperate with the tribe in the implementation of such plan. (3) Two or more Indian tribes may form a coalition for the adoption of resolutions and the establishment and development of a joint community mental health plan under this subsection. (4) The Secretary, acting through the Service, may make grants to Indian tribes adopting a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community mental health plan and to provide administrative support in the implementation of such plan. (d) Behavioral health training and community education programs(1) Study; listThe Secretary, acting through the Service, and the Secretary of the Interior, in consultation with Indian tribes and tribal organizations, shall conduct a study and compile a list of the types of staff positions specified in paragraph (2) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness, or dysfunctional and self destructive behavior. (2) PositionsThe positions referred to in paragraph (1) are—(A) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of—(i) elementary and secondary education; (ii) social services and family and child welfare; (iii) law enforcement and judicial services; and (iv) alcohol and substance abuse; (B) staff positions within the Service; and (C) staff positions similar to those identified in subparagraphs (A) and (B) established and maintained by Indian tribes and tribal organizations (without regard to the funding source). (3) Training criteria(A) In generalThe appropriate Secretary shall provide training criteria appropriate to each type of position identified in paragraphs (2)(A) and (2)(B) and ensure that appropriate training has been, or shall be provided to any individual in any such position. With respect to any such individual in a position identified pursuant to paragraph (2)(C), the respective Secretaries shall provide appropriate training to, or provide funds to, an Indian tribe or tribal organization for training of appropriate individuals. In the case of positions funded under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),11 See References in Text note below. the appropriate Secretary shall ensure that such training costs are included in the contract or compact, as the Secretary determines necessary. (B) Position specific training criteriaPosition specific training criteria shall be culturally relevant to Indians and Indian tribes and shall ensure that appropriate information regarding traditional health care practices is provided. (4) Community education on mental illnessThe Service shall develop and implement, on request of an Indian tribe, tribal organization, or urban Indian organization, or assist the Indian tribe, tribal organization, or urban Indian organization to develop and implement, a program of community education on mental illness. In carrying out this paragraph, the Service shall, upon request of an Indian tribe, tribal organization, or urban Indian organization, provide technical assistance to the Indian tribe, tribal organization, or urban Indian organization to obtain and develop community educational materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. (5) PlanNot later than 90 days after March 23, 2010, the Secretary shall develop a plan under which the Service will increase the health care staff providing behavioral health services by at least 500 positions within 5 years after March 23, 2010, with at least 200 of such positions devoted to child, adolescent, and family services. The plan developed under this paragraph shall be implemented under section 13 of this title. (e) Staffing(1) Within 90 days after November 28, 1990, the Secretary shall develop a plan under which the Service will increase the health care staff providing mental health services by at least 500 positions within five years after November 28, 1990, with at least 200 of such positions devoted to child, adolescent, and family services. Such additional staff shall be primarily assigned to the service unit level for services which shall include outpatient, emergency, aftercare and follow-up, and prevention and education services. (2) The plan developed under paragraph (1) shall be implemented under section 13 of this title. (f) Staff recruitment and retention(1) The Secretary shall provide for the recruitment of the additional personnel required by subsection (f) and the retention of all Service personnel providing mental health services. In carrying out this subsection, the Secretary shall give priority to practitioners providing mental health services to children and adolescents with mental health problems. (2) In carrying out paragraph (1), the Secretary shall develop a program providing for—(A) the payment of bonuses (which shall not be more favorable than those provided for under sections 1616i and 1616j of this title) for service in hardship posts; (B) the repayment of loans (for which the provisions of repayment contracts shall not be more favorable than the repayment contracts under section 1616a of this title) for health professions education as a recruitment incentive; and (C) a system of postgraduate rotations as a retention incentive. (3) This subsection shall be carried out in coordination with the recruitment and retention programs under subchapter I. (g) Mental Health Technician program(1) Under the authority of section 13 of this title, the Secretary shall establish and maintain a Mental Health Technician program within the Service which—(A) provides for the training of Indians as mental health technicians; and (B) employs such technicians in the provision of community-based mental health care that includes identification, prevention, education, referral, and treatment services. (2) In carrying out paragraph (1)(A), the Secretary shall provide high standard paraprofessional training in mental health care necessary to provide quality care to the Indian communities to be served. Such training shall be based upon a curriculum developed or approved by the Secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care. (3) The Secretary shall supervise and evaluate the mental health technicians in the training program. (4) The Secretary shall ensure that the program established pursuant to this subsection involves the utilization and promotion of the traditional Indian health care and treatment practices of the Indian tribes to be served. (h) Mental health researchThe Secretary, acting through the Service and in consultation with the National Institute of Mental Health, shall enter into contracts with, or make grants to, appropriate institutions for the conduct of research on the incidence and prevalence of mental disorders among Indians on Indian reservations and in urban areas. Research priorities under this subsection shall include—(1) the inter-relationship and inter-dependence of mental disorders with alcoholism, suicide, homicides, accidents, and the incidence of family violence, and (2) the development of models of prevention techniques. The effect of the inter-relationships and interdependencies referred to in paragraph (1) on children, and the development of prevention techniques under paragraph (2) applicable to children, shall be emphasized. (i) Facilities assessmentWithin one year after November 28, 1990, the Secretary, acting through the Service, shall make an assessment of the need for inpatient mental health care among Indians and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the Secretary shall consider the possible conversion of existing, under-utilized service hospital beds into psychiatric units to meet such need. (j) Annual reportThe Service shall develop methods for analyzing and evaluating the overall status of mental health programs and services for Indians and shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, a report on the mental health status of Indians which shall describe the progress being made to address mental health problems of Indian communities. (k) Mental health demonstration grant program(1) The Secretary, acting through the Service, is authorized to make grants to Indian tribes and inter-tribal consortia to pay 75 percent of the cost of planning, developing, and implementing programs to deliver innovative community-based mental health services to Indians. The 25 percent tribal share of such cost may be provided in cash or through the provision of property or services. (2) The Secretary may award a grant for a project under paragraph (1) to an Indian tribe or inter-tribal consortium which meets the following criteria:(A) The project will address significant unmet mental health needs among Indians. (B) The project will serve a significant number of Indians. (C) The project has the potential to deliver services in an efficient and effective manner. (D) The tribe or consortium has the administrative and financial capability to administer the project. (E) The project will deliver services in a manner consistent with traditional Indian healing and treatment practices. (F) The project is coordinated with, and avoids duplication of, existing services. (3) For purposes of this subsection, the Secretary shall, in evaluating applications for grants for projects to be operated under any contract entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.], use the same criteria that the Secretary uses in evaluating any other application for such a grant. (4) The Secretary may only award one grant under this subsection with respect to a service area until the Secretary has awarded grants for all service areas with respect to which the Secretary receives applications during the application period, as determined by the Secretary, which meet the criteria specified in paragraph (2). (5) Not later than 180 days after the close of the term of the last grant awarded pursuant to this subsection, the Secretary shall submit to the Congress a report evaluating the effectiveness of the innovative community-based projects demonstrated pursuant to this subsection. Such report shall include findings and recommendations, if any, relating to the reorganization of the programs of the Service for delivery of mental health services to Indians. (6) Grants made pursuant to this section may be expended over a period of three years and no grant may exceed $1,000,000 for the fiscal years involved. (l) Licensing requirement for mental health care workersAny person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this chapter or through a contract pursuant to the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] shall—(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist; (2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or (3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist. (m) Intermediate adolescent mental health services(1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including—(A) inpatient and outpatient services; (B) emergency care; (C) suicide prevention and crisis intervention; and (D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence. (2) Funds provided under this subsection may be used—(A) to construct or renovate an existing health facility to provide intermediate mental health services; (B) to hire mental health professionals; (C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and (D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units. (3) Funds provided under this subsection may not be used for the purposes described in section 1621o(b)(1) of this title. (4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal, Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization. (5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection.

25 U.S.C. § 1621i Managed care feasibility study

(a) The Secretary, acting through the Service, shall conduct a study to assess the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage for all members of the tribe from—(1) a tribally owned and operated managed care plan; or (2) a State licensed managed care plan. (b) Not later than the date which is 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report containing—(1) a detailed description of the study conducted pursuant to this section; and (2) a discussion of the findings and conclusions of such study.

25 U.S.C. § 1621j California contract health services demonstration program

(a) EstablishmentThe Secretary shall establish a demonstration program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians. (b) Agreement with California Rural Indian Health Board(1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration program, in providing medical treatment under contract to California Indians described in section 1679(b) 11 See References in Text note below. of this title throughout the California contract health services delivery area described in section 1680 of this title with respect to high-cost contract care cases. (2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year. (3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 1621a of this title or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year. (c) Advisory boardThere is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board. (d) Commencement and termination datesThe demonstration program described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. (e) ReportNot later than July 1, 1998, the California Rural Indian Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on—(1) access to needed health services; (2) waiting periods for receiving such services; and (3) the efficient management of high-cost contract care cases. (f) “High-cost contract care cases” definedFor the purposes of this section, the term “high-cost contract care cases” means those cases in which the cost of the medical treatment provided to an individual—(1) would otherwise be eligible for reimbursement from the Catastrophic Health Emergency Fund established under section 1621a of this title, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 1621a(b)(2) 1 of this title; and (2) exceeds $1,000.

25 U.S.C. § 1621k Coverage of screening mammography

The Secretary, through the Service, shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act [42 U.S.C. 1395x(jj)]) for Indian and urban Indian women 35 years of age or older at a frequency, determined by the Secretary (in consultation with the Director of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the Secretary to assure the safety and accuracy of screening mammography under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] and other cancer screenings.

25 U.S.C. § 1621l Patient travel costs

(a) Definition of qualified escortIn this section, the term “qualified escort” means—(1) an adult escort (including a parent, guardian, or other family member) who is required because of the physical or mental condition, or age, of the applicable patient; (2) a health professional for the purpose of providing necessary medical care during travel by the applicable patient; or (3) other escorts, as the Secretary or applicable Indian Health Program determines to be appropriate. (b) Provision of fundsThe Secretary, acting through the Service and Tribal Health Programs, is authorized to provide funds for the following patient travel costs, including qualified escorts, associated with receiving health care services provided (either through direct or contract care or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) 11 See References in Text note below. under this chapter—(1) emergency air transportation and non-emergency air transportation where ground transportation is infeasible; (2) transportation by private vehicle (where no other means of transportation is available), specially equipped vehicle, and ambulance; and (3) transportation by such other means as may be available and required when air or motor vehicle transportation is not available.

25 U.S.C. § 1621m Epidemiology centers

(a) Establishment of centers(1) In generalThe Secretary shall establish an epidemiology center in each Service area to carry out the functions described in subsection (b). (2) New centers(A) In generalSubject to subparagraph (B), any new center established after March 23, 2010, may be operated under a grant authorized by subsection (d). (B) RequirementFunding provided in a grant described in subparagraph (A) shall not be divisible. (3) Funds not divisibleAn epidemiology center established under this subsection shall be subject to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),11 See References in Text note below. but the funds for the center shall not be divisible. (b) Functions of centersIn consultation with and on the request of Indian tribes, tribal organizations, and urban Indian organizations, each Service area epidemiology center established under this section shall, with respect to the applicable Service area—(1) collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the Service, the Indian tribes, tribal organizations, and urban Indian organizations in the Service area; (2) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health; (3) assist Indian tribes, tribal organizations, and urban Indian organizations in identifying highest-priority health status objectives and the services needed to achieve those objectives, based on epidemiological data; (4) make recommendations for the targeting of services needed by the populations served; (5) make recommendations to improve health care delivery systems for Indians and urban Indians; (6) provide requested technical assistance to Indian tribes, tribal organizations, and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community; and (7) provide disease surveillance and assist Indian tribes, tribal organizations, and urban Indian communities to promote public health. (c) Technical assistanceThe Director of the Centers for Disease Control and Prevention shall provide technical assistance to the centers in carrying out this section. (d) Grants for studies(1) In generalThe Secretary may make grants to Indian tribes, tribal organizations, Indian organizations, and eligible intertribal consortia to conduct epidemiological studies of Indian communities. (2) Eligible intertribal consortiaAn intertribal consortium or Indian organization shall be eligible to receive a grant under this subsection if the intertribal consortium is—(A) incorporated for the primary purpose of improving Indian health; and (B) representative of the Indian tribes or urban Indian communities residing in the area in which the intertribal consortium is located. (3) ApplicationsAn application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe. (4) RequirementsAn applicant for a grant under this subsection shall—(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5); (B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and (C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served. (5) Use of fundsA grant provided under paragraph (1) may be used—(A) to carry out the functions described in subsection (b); (B) to provide information to, and consult with, tribal leaders, urban Indian community leaders, and related health staff regarding health care and health service management issues; and (C) in collaboration with Indian tribes, tribal organizations, and urban Indian organizations, to provide to the Service information regarding ways to improve the health status of Indians. (e) Access to information(1) In generalAn epidemiology center operated by a grantee pursuant to a grant awarded under subsection (d) shall be treated as a public health authority (as defined in section 164.501 of title 45, Code of Federal Regulations (or a successor regulation)) for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 1936). (2) Access to informationThe Secretary shall grant to each epidemiology center described in paragraph (1) access to use of the data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the Secretary. (3) RequirementThe activities of an epidemiology center described in paragraph (1) shall be for the purposes of research and for preventing and controlling disease, injury, or disability (as those activities are described in section 164.512 of title 45, Code of Federal Regulations (or a successor regulation)), for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 1936).

25 U.S.C. § 1621n Comprehensive school health education programs

(a) Award of grantsThe Secretary, acting through the Service and in consultation with the Secretary of the Interior, may award grants to Indian tribes to develop comprehensive school health education programs for children from preschool through grade 12 in schools located on Indian reservations. (b) Use of grantsGrants awarded under this section may be used to—(1) develop health education curricula; (2) train teachers in comprehensive school health education curricula; (3) integrate school-based, community-based, and other public and private health promotion efforts; (4) encourage healthy, tobacco-free school environments; (5) coordinate school-based health programs with existing services and programs available in the community; (6) develop school programs on nutrition education, personal health, and fitness; (7) develop mental health wellness programs; (8) develop chronic disease prevention programs; (9) develop substance abuse prevention programs; (10) develop accident prevention and safety education programs; (11) develop activities for the prevention and control of communicable diseases; and (12) develop community and environmental health education programs. (c) AssistanceThe Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources. (d) Criteria for review and approval of applicationsThe Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this section. (e) Report of recipientRecipients of grants under this section shall submit to the Secretary an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of—(1) the number of preschools, elementary schools, and secondary schools served; (2) the number of students served; (3) any new curricula established with funds provided under this section; (4) the number of teachers trained in the health curricula; and (5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section. (f) Program development(1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs. (2) Such program shall include—(A) school programs on nutrition education, personal health, and fitness; (B) mental health wellness programs; (C) chronic disease prevention programs; (D) substance abuse prevention programs; (E) accident prevention and safety education programs; and (F) activities for the prevention and control of communicable diseases. (3) The Secretary of the Interior shall—(A) provide training to teachers in comprehensive school health education curricula; (B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and (C) encourage healthy, tobacco-free school environments. (g) Authorization of appropriationsThere are authorized to be appropriated to carry out this section $15,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.

25 U.S.C. § 1621o Indian youth grant program

(a) GrantsThe Secretary, acting through the Service, is authorized to make grants to Indian tribes, tribal organizations, and urban Indian organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian preadolescent and adolescent youths. (b) Use of funds(1) Funds made available under this section may be used to—(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and (B) develop and provide community training and education. (2) Funds made available under this section may not be used to provide services described in section 1665g(c) of this title. (c) Models for delivery of comprehensive health care servicesThe Secretary shall—(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents; (2) encourage the implementation of such models; and (3) at the request of an Indian tribe, provide technical assistance in the implementation of such models. (d) Criteria for review and approval of applicationsThe Secretary shall establish criteria for the review and approval of applications under this section.

25 U.S.C. § 1621p American Indians Into Psychology Program

(a) Grants authorizedThe 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 grantThe 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 1616j(b) 11 See References in Text note below. of this title, the Quentin N. Burdick American Indians Into Nursing Program authorized under section 1616h(e) 1 of this title, and existing university research and communications networks. (c) RegulationsThe Secretary shall issue regulations pursuant to this chapter for the competitive awarding of grants provided under this section. (d) Conditions of grantApplicants 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 requirementThe active duty service obligation prescribed under section 254m of title 42 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 subchapter IV; 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 appropriationsThere is authorized to be appropriated to carry out this section $2,700,000 for fiscal year 2010 and each fiscal year thereafter.

25 U.S.C. § 1621q Prevention, control, and elimination of communicable and infectious diseases

(a) Grants authorizedThe Secretary, acting through the Service, and after consultation with the Centers for Disease Control and Prevention, may make grants available to Indian tribes and tribal organizations for the following:(1) Projects for the prevention, control, and elimination of communicable and infectious diseases, including tuberculosis, hepatitis, HIV, respiratory syncytial virus, hanta virus, sexually transmitted diseases, and H. pylori. (2) Public information and education programs for the prevention, control, and elimination of communicable and infectious diseases. (3) Education, training, and clinical skills improvement activities in the prevention, control, and elimination of communicable and infectious diseases for health professionals, including allied health professionals. (4) Demonstration projects for the screening, treatment, and prevention of hepatitis C virus (HCV). (b) Application requiredThe Secretary may provide funding under subsection (a) only if an application or proposal for funding is submitted to the Secretary. (c) Coordination with health agenciesIndian tribes and tribal organizations receiving funding under this section are encouraged to coordinate their activities with the Centers for Disease Control and Prevention and State and local health agencies. (d) Technical assistance; reportIn carrying out this section, the Secretary—(1) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and (2) shall prepare and submit a report to Congress biennially on the use of funds under this section and on the progress made toward the prevention, control, and elimination of communicable and infectious diseases among Indians and urban Indians.

25 U.S.C. § 1621r Contract health services payment study

(a) Duty of SecretaryThe Secretary, acting through the Service and in consultation with representatives of Indian tribes and tribal organizations operating contract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) 11 See References in Text note below. or under self-governance compacts, Service personnel, private contract health services providers, the Indian Health Service Fiscal Intermediary, and other appropriate experts, shall conduct a study—(1) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary; (2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and (3) to determine the most efficient and effective means of improving the Service’s contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients’ rights and responsibilities. (b) Functions of studyThe study required by subsection (a) shall—(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers; (2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments; (3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians; (4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and (5) compare the Service’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers. (c) Report to CongressNot later than 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report that includes—(1) a detailed description of the study conducted pursuant to this section; and (2) a discussion of the findings and conclusions of such study.

25 U.S.C. § 1621s Prompt action on payment of claims

(a) Time of responseThe Service shall respond to a notification of a claim by a provider of a contract care service with either an individual purchase order or a denial of the claim within 5 working days after the receipt of such notification. (b) Failure to timely respondIf the Service fails to respond to a notification of a claim in accordance with subsection (a), the Service shall accept as valid the claim submitted by the provider of a contract care service. (c) Time of paymentThe Service shall pay a completed contract care service claim within 30 days after completion of the claim.

25 U.S.C. § 1621t Licensing

Licensed health professionals employed by a tribal health program shall be exempt, if licensed in any State, from the licensing requirements of the State in which the tribal health program performs the services described in the contract or compact of the tribal health program under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).11 See References in Text note below.

25 U.S.C. § 1621u Liability for payment

(a) No patient liabilityA patient who receives contract health care services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services. (b) NotificationThe Secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services not later than 5 business days after receipt of a notification of a claim by a provider of contract care services. (c) No recourseFollowing receipt of the notice provided under subsection (b), or, if a claim has been deemed accepted under section 1621s(b) of this title, the provider shall have no further recourse against the patient who received the services.

25 U.S.C. § 1621v Offices of Indian Men’s Health and Indian Women’s Health

(a) Office of Indian Men’s Health(1) EstablishmentThe Secretary may establish within the Service an office, to be known as the “Office of Indian Men’s Health”. (2) Director(A) In generalThe Office of Indian Men’s Health shall be headed by a director, to be appointed by the Secretary. (B) DutiesThe director shall coordinate and promote the health status of Indian men in the United States. (3) ReportNot later than 2 years after March 23, 2010, the Secretary, acting through the Service, shall submit to Congress a report describing—(A) any activity carried out by the director as of the date on which the report is prepared; and (B) any finding of the director with respect to the health of Indian men. (b) Office of Indian Women’s HealthThe Secretary, acting through the Service, shall establish an office, to be known as the “Office of Indian Women’s Health”, to monitor and improve the quality of health care for Indian women (including urban Indian women) of all ages through the planning and delivery of programs administered by the Service, in order to improve and enhance the treatment models of care for Indian women.

25 U.S.C. § 1621x Limitation on use of funds

Amounts appropriated to carry out this subchapter may not be used in a manner inconsistent with the Assisted Suicide Funding Restriction Act of 1997 [42 U.S.C. 14401 et seq.].

25 U.S.C. § 1621y Contract health service administration and disbursement formula

(a) Submission of reportAs soon as practicable after March 23, 2010, the Comptroller General of the United States shall submit to the Secretary, the Committee on Indian Affairs of the Senate, and the Committee on Natural Resources of the House of Representatives, and make available to each Indian tribe, a report describing the results of the study of the Comptroller General regarding the funding of the contract health service program (including historic funding levels and a recommendation of the funding level needed for the program) and the administration of the contract health service program (including the distribution of funds pursuant to the program), as requested by Congress in March 2009, or pursuant to section 1680t of this title. (b) Consultation with tribesOn receipt of the report under subsection (a), the Secretary shall consult with Indian tribes regarding the contract health service program, including the distribution of funds pursuant to the program—(1) to determine whether the current distribution formula would require modification if the contract health service program were funded at the level recommended by the Comptroller General; (2) to identify any inequities in the current distribution formula under the current funding level or inequitable results for any Indian tribe under the funding level recommended by the Comptroller General; (3) to identify any areas of program administration that may result in the inefficient or ineffective management of the program; and (4) to identify any other issues and recommendations to improve the administration of the contract health services program and correct any unfair results or funding disparities identified under paragraph (2). (c) Subsequent action by SecretaryIf, after consultation with Indian tribes under subsection (b), the Secretary determines that any issue described in subsection (b)(2) exists, the Secretary may initiate procedures under subchapter III of chapter 5 of title 5 to negotiate or promulgate regulations to establish a disbursement formula for the contract health service program funding.

25 U.S.C. § 1623 Special rules relating to Indians

(a) No Cost-sharing for Indians with income at or below 300 percent of poverty enrolled in coverage through a State ExchangeFor provisions prohibiting cost sharing for Indians enrolled in any qualified health plan in the individual market through an Exchange, see section 18071(d) of title 42. (b) Payer of last resortHealth programs operated by the Indian Health Service, Indian tribes, tribal organizations, and Urban Indian organizations (as those terms are defined in section 1603 of this title) shall be the payer of last resort for services provided by such Service, tribes, or organizations to individuals eligible for services through such programs, notwithstanding any Federal, State, or local law to the contrary.

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