---
kind: "section"
citation: "25 U.S.C. § 1637"
title: "25"
title_heading: "Indians"
number: "1637"
heading: "Indian health care delivery demonstration projects"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/25/1637"
units:
  - "Chapter 18 — Indian Health Care"
  - "Subchapter III — Health Facilities"
---

# §1637. Indian health care delivery demonstration projects

- (a) **Purpose and general authority—**
  - (1) **Purpose—** The purpose of this section is to encourage the establishment of [demonstration projects](/usc/25/1667a.md?p=2) that meet the applicable criteria of this section to be carried out by the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), or [Indian tribes](/usc/25/1603.md?p=14) or [tribal organizations](/usc/25/1603.md?p=26) acting pursuant to contracts or compacts under the [Indian](/usc/25/1603.md?p=13) Self Determination[^1] and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)—[^2]
    - (A) to test alternative means of delivering health care and [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1603.md?p=13) through facilities; or
    - (B) to use alternative or innovative methods or models of delivering health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1603.md?p=13) (including primary care [services](/usc/25/1603.md?p=18), [contract health services](/usc/25/1603.md?p=5), or any other program or [service](/usc/25/1603.md?p=18) authorized by this chapter) through convenient care [services](/usc/25/1603.md?p=18) (as defined in [subsection (c)](#c)), community health centers, or cooperative agreements or arrangements with other health care providers that share or coordinate the use of facilities, funding, or other resources, or otherwise coordinate or improve the coordination of activities of the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), or [tribal organizations](/usc/25/1603.md?p=26), with those of the other health care providers.
  - (2) **Authority—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to carry out, or to enter into contracts or compacts under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^2] with [Indian tribes](/usc/25/1603.md?p=14) or [tribal organizations](/usc/25/1603.md?p=26) to carry out, health care delivery [demonstration projects](/usc/25/1667a.md?p=2) that—
    - (A) test alternative means of delivering health care and [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1603.md?p=13) through facilities; or
    - (B) otherwise carry out the purposes of this section.
- (b) **Use of funds—** The [Secretary](/usc/25/1603.md?p=17), in approving projects pursuant to this section—
  - (1) may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care [services](/usc/25/1603.md?p=18); and
  - (2) is authorized—
    - (A) to waive any leasing prohibition;
    - (B) to permit use and carryover of funds appropriated for the provision of health care [services](/usc/25/1603.md?p=18) under this chapter (including for the purchase of health benefits coverage, as authorized by [section 1642(a) of this title](/usc/25/1642.md?p=a));
    - (C) to permit the use of other available funds, including other Federal funds, funds from third-party collections in accordance with sections [1621e](/usc/25/1621e.md), [1621f](/usc/25/1621f.md), and [1641](/usc/25/1641.md) of this title, and non-Federal funds contributed by State or local governmental agencies or facilities or private health care providers pursuant to cooperative or other agreements with the [Service](/usc/25/1603.md?p=18), 1 or more [Indian tribes](/usc/25/1603.md?p=14), or [tribal organizations](/usc/25/1603.md?p=26);
    - (D) to permit the use of funds or property donated or otherwise provided from any source for project purposes;
    - (E) to provide for the reversion of donated real or personal property to the donor; and
    - (F) to permit the use of [Service](/usc/25/1603.md?p=18) funds to match other funds, including Federal funds.
- (c) **Health care demonstration projects—**
  - (1) **Definition of convenient care service—** In this subsection, the term “convenient care [service](/usc/25/1603.md?p=18)” means any primary health care [service](/usc/25/1603.md?p=18), such as urgent care [services](/usc/25/1603.md?p=18), nonemergent care [services](/usc/25/1603.md?p=18), prevention [services](/usc/25/1603.md?p=18) and screenings, and any [service](/usc/25/1603.md?p=18) authorized by [section 1621b of this title](/usc/25/1621b.md) or [1621d(d)](/usc/25/1621d.md?p=d) of this title, that is offered—
    - (A) at an alternative setting; or
    - (B) during hours other than regular working hours.
  - (2) **General projects—**
    - (A) **Criteria—** The [Secretary](/usc/25/1603.md?p=17) may approve under this section [demonstration projects](/usc/25/1667a.md?p=2) that meet the following criteria:
      - (i) There is a need for a new facility or program, such as a program for convenient care [services](/usc/25/1603.md?p=18), or an improvement in, increased efficiency at, or reorientation of an existing facility or program.
      - (ii) A significant number of [Indians](/usc/25/1603.md?p=13), including [Indians](/usc/25/1603.md?p=13) with low health status, will be served by the project.
      - (iii) The project has the potential to deliver [services](/usc/25/1603.md?p=18) in an efficient and effective manner.
      - (iv) The project is economically viable.
      - (v) For projects carried out by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) has the administrative and financial capability to administer the project.
      - (vi) The project is integrated with providers of related health or social [services](/usc/25/1603.md?p=18) (including State and local health care agencies or other health care providers) and is coordinated with, and avoids duplication of, existing [services](/usc/25/1603.md?p=18) in order to expand the availability of [services](/usc/25/1603.md?p=18).
    - (B) **Priority—** In approving [demonstration projects](/usc/25/1667a.md?p=2) under this paragraph, the [Secretary](/usc/25/1603.md?p=17) shall give priority to [demonstration projects](/usc/25/1667a.md?p=2), to the extent the projects meet the criteria described in [subparagraph (A)](#c-2-A), located in any of the following [Service units](/usc/25/1603.md?p=20):
      - (i) Cass Lake, Minnesota.
      - (ii) Mescalero, New Mexico.
      - (iii) Owyhee and Elko, Nevada.
      - (iv) Schurz, Nevada.
      - (v) Ft. Yuma, California.
  - (3) **Innovative health services delivery demonstration project—**
    - (A) **Application or request—** On receipt of an application or request from an [Indian tribe](/usc/25/1603.md?p=14), a consortium of [Indian tribes](/usc/25/1603.md?p=14), or a [tribal organization](/usc/25/1603.md?p=26) within a [Service area](/usc/25/1603.md?p=19), the [Secretary](/usc/25/1603.md?p=17) shall take into consideration alternative or innovated[^3] methods to deliver health care [services](/usc/25/1603.md?p=18) within the [Service area](/usc/25/1603.md?p=19) (or a portion of, or facility within, the [Service area](/usc/25/1603.md?p=19)) as described in the application or request, including medical, dental, pharmaceutical, nursing, clinical laboratory, [contract health services](/usc/25/1603.md?p=5), convenient care [services](/usc/25/1603.md?p=18), community health centers, or any other health care [services](/usc/25/1603.md?p=18) delivery models designed to improve access to, or efficiency or quality of, the health care, [health promotion](/usc/25/1603.md?p=11), or [disease prevention](/usc/25/1603.md?p=7-A) [services](/usc/25/1603.md?p=18) and programs under this chapter.
    - (B) **Approval—** In addition to projects described in [paragraph (2)](#c-2), in any fiscal year, the [Secretary](/usc/25/1603.md?p=17) is authorized under this paragraph to approve not more than 10 applications for health care delivery [demonstration projects](/usc/25/1667a.md?p=2) that meet the criteria described in [subparagraph (C)](#c-3-C).
    - (C) **Criteria—** The [Secretary](/usc/25/1603.md?p=17) shall approve under [subparagraph (B)](#c-3-B) [demonstration projects](/usc/25/1667a.md?p=2) that meet all of the following criteria:
      - (i) The criteria set forth in [paragraph (2)(A)](#c-2-A).
      - (ii) There is a lack of access to health care [services](/usc/25/1603.md?p=18) at existing health care facilities, which may be due to limited hours of operation at those facilities or other factors.
      - (iii) The project—
        - (I) expands the availability of [services](/usc/25/1603.md?p=18); or
        - (II) reduces—
          - (aa) the burden on [Contract Health Services](/usc/25/1603.md?p=5); or
          - (bb) the need for emergency room visits.
- (d) **Technical assistance—** On receipt of an application or request from an [Indian tribe](/usc/25/1603.md?p=14), a consortium of [Indian tribes](/usc/25/1603.md?p=14), or a [tribal organization](/usc/25/1603.md?p=26), the [Secretary](/usc/25/1603.md?p=17) shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section, including information regarding the [Service unit](/usc/25/1603.md?p=20) budget and available funding for carrying out the proposed [demonstration project](/usc/25/1667a.md?p=2).
- (e) **Service to ineligible persons—** Subject to [section 1680c of this title](/usc/25/1680c.md), the authority to provide [services](/usc/25/1603.md?p=18) to persons otherwise ineligible for the health care benefits of the [Service](/usc/25/1603.md?p=18), and the authority to extend hospital privileges in [Service](/usc/25/1603.md?p=18) facilities to non-[Service](/usc/25/1603.md?p=18) health practitioners as provided in [section 1680c of this title](/usc/25/1680c.md), may be included, subject to the terms of that section, in any [demonstration project](/usc/25/1667a.md?p=2) approved pursuant to this section.
- (f) **Equitable treatment—** For purposes of [subsection (c)](#c), the [Secretary](/usc/25/1603.md?p=17), in evaluating facilities operated under any contract or compact under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^2] shall use the same criteria that the [Secretary](/usc/25/1603.md?p=17) uses in evaluating facilities operated directly by the [Service](/usc/25/1603.md?p=18).
- (g) **Equitable integration of facilities—** The [Secretary](/usc/25/1603.md?p=17) shall ensure that the planning, design, construction, renovation, and expansion needs of [Service](/usc/25/1603.md?p=18) and non-[Service](/usc/25/1603.md?p=18) facilities that are the subject of a contract or compact under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^2] for health [services](/usc/25/1603.md?p=18) are fully and equitably integrated into the implementation of the health care delivery [demonstration projects](/usc/25/1667a.md?p=2) under this section.

## Footnotes

[^1]: So in original. Probably should be “Self-Determination”.
[^2]: See References in Text note below.
[^3]: So in original. Probably should be “innovative”.

## Source credit

(Pub. L. 94–437, title III, § 307, as added Pub. L. 101–630, title V, § 504, Nov. 28, 1990, 104 Stat. 4562; amended Pub. L. 102–573, title III, §§ 304, 307(b)(2), title VII, § 701(c)(2), title IX, § 902(4)(A), Oct. 29, 1992, 106 Stat. 4562, 4564, 4572, 4591; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)

## Notes

### Editorial Notes

### References in Text

This chapter, referred to in subsecs. (a)(1)(B), (b)(2)(B), (c)(3)(A), was in the original “this Act”, meaning Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400, known as the Indian Health Care Improvement Act, which is classified principally to this chapter. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of this title and Tables.

The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), referred to in subsecs. (a), (f), and (g), is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§ 450 et seq.) of chapter 14 of this title prior to editorial reclassification as chapter 46 (§ 5301 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables.

### Codification

Amendment by Pub. L. 111–148 is based on section 143 of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148.

### Amendments

2010—Pub. L. 111–148 amended section generally. Prior to amendment, section authorized contracts and grants to carry out an Indian health care delivery demonstration project and related to use of funds, criteria, technical assistance, service to ineligible persons, equitable treatment, equitable integration of facilities, and report to Congress.

1992—Pub. L. 102–573, § 902(4)(A), made technical amendment to section catchline.

Subsec. (c)(1)(A). Pub. L. 102–573, § 304(a)(1), inserted “or program” after “facility” in two places.

Subsec. (c)(3)(A). Pub. L. 102–573, § 304(a)(2), substituted “On or before September 30, 1995, the” for “The” and inserted “and for which a completed application has been received by the Secretary” after “paragraph (1)”.

Subsec. (c)(3)(B). Pub. L. 102–573, § 304(a)(3), which directed amendment of subsec. (c) by striking subpar. (B) and inserting a new subpar. (B), was executed by making the amendment in par. (3) of subsec. (c) to reflect the probable intent of Congress. Prior to amendment, subpar. (B) read as follows: “After entering into contracts or awarding grants in accordance with subparagraph (A), and taking into account contracts entered into and grants awarded under such subparagraph, the Secretary may only enter into one contract or award one grant under this subsection with respect to a service area until the Secretary has entered into contracts or 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 developed under paragraph (1).”

Subsec. (e). Pub. L. 102–573, § 701(c)(2), made technical amendment to the reference to section 1680c of this title to reflect renumbering of corresponding section of original act.

Subsec. (h). Pub. L. 102–573, § 304(b), amended subsec. (h) generally. Prior to amendment, subsec. (h) read as follows: “Within 90 days after the end of the period set out in subsection (a) of this section, the Secretary shall prepare and submit to Congress a report, together with legislative recommendations, on the findings and conclusions derived from the demonstration projects.”

Subsec. (i). Pub. L. 102–573, § 307(b)(2), struck out subsec. (i) which authorized appropriation of such sums as necessary for fiscal years 1991 and 1992 for purpose of carrying out this section.