---
kind: "section"
citation: "25 U.S.C. § 1653"
title: "25"
title_heading: "Indians"
number: "1653"
heading: "Contracts and grants for provision of health care and referral services"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/25/1653"
units:
  - "Chapter 18 — Indian Health Care"
  - "Subchapter IV — Health Services for Urban Indians"
---

# §1653. Contracts and grants for provision of health care and referral services

- (a) **Requirements—** Under authority of [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17), through the [Service](/usc/25/1603.md?p=18), shall enter into contracts with, or make grants to, [urban Indian organizations](/usc/25/1603.md?p=29) for the provision of health care and referral [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28) residing in the [urban centers](/usc/25/1603.md?p=27) in which such organizations are situated. Any such contract or grant shall include requirements that the [urban Indian organization](/usc/25/1603.md?p=29) successfully undertake to—
  - (1) estimate the population of [urban Indians](/usc/25/1603.md?p=28) residing in the [urban center](/usc/25/1603.md?p=27) in which such organization is situated who are or could be recipients of health care or referral [services](/usc/25/1603.md?p=18);
  - (2) estimate the current health status of [urban Indians](/usc/25/1603.md?p=28) residing in such [urban center](/usc/25/1603.md?p=27);
  - (3) estimate the current health care needs of [urban Indians](/usc/25/1603.md?p=28) residing in such [urban center](/usc/25/1603.md?p=27);
  - (4) identify all public and private health [services](/usc/25/1603.md?p=18) resources within such [urban center](/usc/25/1603.md?p=27) which are or may be available to [urban Indians](/usc/25/1603.md?p=28);
  - (5) determine the use of public and private health [services](/usc/25/1603.md?p=18) resources by the [urban Indians](/usc/25/1603.md?p=28) residing in such [urban center](/usc/25/1603.md?p=27);
  - (6) assist such health [services](/usc/25/1603.md?p=18) resources in providing [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/1603.md?p=28);
  - (7) assist [urban Indians](/usc/25/1603.md?p=28) in becoming familiar with and utilizing such health [services](/usc/25/1603.md?p=18) resources;
  - (8) provide basic health education, including [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) education, to [urban Indians](/usc/25/1603.md?p=28);
  - (9) establish and implement training programs to accomplish the referral and education tasks set forth in paragraphs (6) through (8) of this subsection;
  - (10) identify gaps between unmet health needs of [urban Indians](/usc/25/1603.md?p=28) and the resources available to meet such needs;
  - (11) make recommendations to the [Secretary](/usc/25/1603.md?p=17) and Federal, State, local, and other resource agencies on methods of improving health [service](/usc/25/1603.md?p=18) programs to meet the needs of [urban Indians](/usc/25/1603.md?p=28); and
  - (12) where necessary, provide, or enter into contracts for the provision of, health care [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28).
- (b) **Criteria for selection of organizations to enter into contracts or receive grants—** The [Secretary](/usc/25/1603.md?p=17), through the [Service](/usc/25/1603.md?p=18), shall by regulation prescribe the criteria for selecting [urban Indian organizations](/usc/25/1603.md?p=29) to enter into contracts or receive grants under this section. Such criteria shall, among other factors, include—
  - (1) the extent of unmet health care needs of [urban Indians](/usc/25/1603.md?p=28) in the [urban center](/usc/25/1603.md?p=27) involved;
  - (2) the size of the [urban Indian](/usc/25/1603.md?p=28) population in the [urban center](/usc/25/1603.md?p=27) involved;
  - (3) the accessibility to, and utilization of, health care [services](/usc/25/1603.md?p=18) (other than [services](/usc/25/1603.md?p=18) provided under this subchapter) by [urban Indians](/usc/25/1603.md?p=28) in the [urban center](/usc/25/1603.md?p=27) involved;
  - (4) the extent, if any, to which the activities set forth in [subsection (a)](#a) would duplicate—
    - (A) any previous or current public or private health [services](/usc/25/1603.md?p=18) project in an [urban center](/usc/25/1603.md?p=27) that was or is funded in a manner other than pursuant to this subchapter; or
    - (B) any project funded under this subchapter;
  - (5) the capability of an [urban Indian organization](/usc/25/1603.md?p=29) to perform the activities set forth in [subsection (a)](#a) and to enter into a contract with the [Secretary](/usc/25/1603.md?p=17) or to meet the requirements for receiving a grant under this section;
  - (6) the satisfactory performance and successful completion by an [urban Indian organization](/usc/25/1603.md?p=29) of other contracts with the [Secretary](/usc/25/1603.md?p=17) under this subchapter;
  - (7) the appropriateness and likely effectiveness of conducting the activities set forth in [subsection (a)](#a) in an [urban center](/usc/25/1603.md?p=27); and
  - (8) the extent of existing or likely future participation in the activities set forth in [subsection (a)](#a) by appropriate health and health-related Federal, State, local, and other agencies.
- (c) **Grants for health promotion and disease prevention services—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall facilitate access to, or provide, [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28) through grants made to [urban Indian organizations](/usc/25/1603.md?p=29) administering contracts entered into pursuant to this section or receiving grants under [subsection (a)](#a).
- (d) **Grants for immunization services—**
  - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall facilitate access to, or provide, immunization [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28) through grants made to [urban Indian organizations](/usc/25/1603.md?p=29) administering contracts entered into pursuant to this section or receiving grants under [subsection (a)](#a).
  - (2) In making any grant to carry out this subsection, the [Secretary](/usc/25/1603.md?p=17) shall take into consideration—
    - (A) the size of the [urban Indian](/usc/25/1603.md?p=28) population to be served;
    - (B) the immunization levels of the [urban Indian](/usc/25/1603.md?p=28) population, particularly the immunization levels of infants, children, and the elderly;
    - (C) the utilization by the [urban Indians](/usc/25/1603.md?p=28) of alternative resources from State and local governments for no-cost or low-cost immunization [services](/usc/25/1603.md?p=18) to the general population; and
    - (D) the capability of the [urban Indian organization](/usc/25/1603.md?p=29) to carry out [services](/usc/25/1603.md?p=18) pursuant to this subsection.
  - (3) For purposes of this subsection, the term “immunization [services](/usc/25/1603.md?p=18)” means [services](/usc/25/1603.md?p=18) to provide without charge immunizations against vaccine-preventable diseases.
- (e) **Grants for mental health services—**
  - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall facilitate access to, or provide, mental health [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28) through grants made to [urban Indian organizations](/usc/25/1603.md?p=29) administering contracts entered into pursuant to this section or receiving grants under [subsection (a)](#a).
  - (2) A grant may not be made under this subsection to an [urban Indian organization](/usc/25/1603.md?p=29) until that organization has prepared, and the [Service](/usc/25/1603.md?p=18) has approved, an [assessment](/usc/25/1665.md?p=2) of the mental health needs of the [urban Indian](/usc/25/1603.md?p=28) population concerned, the mental health [services](/usc/25/1603.md?p=18) and other related resources available to that population, the barriers to obtaining those [services](/usc/25/1603.md?p=18) and resources, and the needs that are unmet by such [services](/usc/25/1603.md?p=18) and resources.
  - (3) Grants may be made under this subsection—
    - (A) to prepare [assessments](/usc/25/1665.md?p=2) required under [paragraph (2)](#e-2);
    - (B) to provide outreach, educational, and referral [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/1603.md?p=28) regarding the availability of direct mental health [services](/usc/25/1603.md?p=18), to educate [urban Indians](/usc/25/1603.md?p=28) about mental health issues and [services](/usc/25/1603.md?p=18), and effect coordination with existing mental health providers in order to improve [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/1603.md?p=28);
    - (C) to provide outpatient mental health [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/1603.md?p=28), including the identification and [assessment](/usc/25/1665.md?p=2) of illness, therapeutic treatments, case management, support groups, family treatment, and other treatment; and
    - (D) to develop innovative mental health [service](/usc/25/1603.md?p=18) delivery models which incorporate [Indian](/usc/25/1603.md?p=13) cultural support systems and resources.
- (f) **Grants for prevention and treatment of child abuse—**
  - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall facilitate access to, or provide, [services](/usc/25/1603.md?p=18) for [urban Indians](/usc/25/1603.md?p=28) through grants to [urban Indian organizations](/usc/25/1603.md?p=29) administering contracts entered into pursuant to this section or receiving grants under [subsection (a)](#a) to prevent and treat child abuse (including sexual abuse) among [urban Indians](/usc/25/1603.md?p=28).
  - (2) A grant may not be made under this subsection to an [urban Indian organization](/usc/25/1603.md?p=29) until that organization has prepared, and the [Service](/usc/25/1603.md?p=18) has approved, an [assessment](/usc/25/1665.md?p=2) that documents the prevalence of child abuse in the [urban Indian](/usc/25/1603.md?p=28) population concerned and specifies the [services](/usc/25/1603.md?p=18) and programs (which may not duplicate existing [services](/usc/25/1603.md?p=18) and programs) for which the grant is requested.
  - (3) Grants may be made under this subsection—
    - (A) to prepare [assessments](/usc/25/1665.md?p=2) required under [paragraph (2)](#f-2);
    - (B) for the development of prevention, training, and education programs for [urban Indian](/usc/25/1603.md?p=28) populations, including child education, parent education, provider training on identification and intervention, education on reporting requirements, prevention campaigns, and establishing [service](/usc/25/1603.md?p=18) networks of all those involved in [Indian](/usc/25/1603.md?p=13) child protection; and
    - (C) to provide direct outpatient treatment [services](/usc/25/1603.md?p=18) (including individual treatment, family treatment, group therapy, and support groups) to [urban Indians](/usc/25/1603.md?p=28) who are child victims of abuse (including sexual abuse) or adult survivors of child sexual abuse, to the families of such child victims, and to [urban Indian](/usc/25/1603.md?p=28) perpetrators of child abuse (including sexual abuse).
  - (4) In making grants to carry out this subsection, the [Secretary](/usc/25/1603.md?p=17) shall take into consideration—
    - (A) the support for the [urban Indian organization](/usc/25/1603.md?p=29) demonstrated by the child protection authorities in the area, including committees or other [services](/usc/25/1603.md?p=18) funded under the [Indian](/usc/25/1603.md?p=13) Child Welfare Act of 1978 ([25 U.S.C. 1901](/usc/25/1901.md) et seq.), if any;
    - (B) the capability and expertise demonstrated by the [urban Indian organization](/usc/25/1603.md?p=29) to address the complex problem of child sexual abuse in the community; and
    - (C) the [assessment](/usc/25/1665.md?p=2) required under [paragraph (2)](#f-2).

## Source credit

(Pub. L. 94–437, title V, § 503, as added Pub. L. 100–713, title V, § 501, Nov. 23, 1988, 102 Stat. 4821; amended Pub. L. 101–630, title V, § 505, Nov. 28, 1990, 104 Stat. 4564; Pub. L. 102–573, title V, §§ 501(b)(1), 505(b)(1), Oct. 29, 1992, 106 Stat. 4567, 4570.)

## Notes

### Editorial Notes

### References in Text

The Indian Child Welfare Act of 1978, referred to in subsec. (f)(4)(A), is Pub. L. 95–608, Nov. 8, 1978, 92 Stat. 3069, which is classified principally to chapter 21 (§ 1901 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 1901 of this title and Tables.

### Prior Provisions

A prior section 1653, Pub. L. 94–437, title V, § 503, Sept. 30, 1976, 90 Stat. 1410; Pub. L. 96–537, § 7, Dec. 17, 1980, 94 Stat. 3177, related to contract eligibility, prior to the general revision of this subchapter by Pub. L. 100–713.

### Amendments

1992—Pub. L. 102–573, § 501(b)(1)(G), inserted “and grants” in section catchline.

Subsec. (a). Pub. L. 102–573, § 501(b)(1)(A), inserted “, or make grants to,” after “contracts with” and “or grant” after “such contract”.

Subsec. (b). Pub. L. 102–573, § 501(b)(1)(B), inserted “or receive grants” after “enter into contracts” in introductory provisions and “or to meet the requirements for receiving a grant” after “Secretary” in par. (5).

Subsec. (c). Pub. L. 102–573, § 505(b)(1)(A), struck out par. (1) designation before “The Secretary, acting” and struck out par. (2) which authorized appropriation of $1,000,000 for fiscal year 1992 to carry out this subsec.

Subsec. (c)(1). Pub. L. 102–573, § 501(b)(1)(C), inserted before period at end “or receiving grants under subsection (a)”.

Subsec. (d)(1). Pub. L. 102–573, § 501(b)(1)(D), inserted before period at end “or receiving grants under subsection (a)”.

Subsec. (d)(4). Pub. L. 102–573, § 505(b)(1)(B), struck out par. (4) which authorized appropriation of $1,000,000 for fiscal year 1992 to carry out this subsec.

Subsec. (e)(1). Pub. L. 102–573, § 501(b)(1)(E), inserted before period at end “or receiving grants under subsection (a)”.

Subsec. (e)(4). Pub. L. 102–573, § 505(b)(1)(C), struck out par. (4) which authorized appropriations of $500,000 for fiscal year 1991 and $2,000,000 for fiscal year 1992 to carry out this subsec.

Subsec. (f)(1). Pub. L. 102–573, § 501(b)(1)(F), inserted “or receiving grants under subsection (a)” after “pursuant to this section”.

Subsec. (f)(5). Pub. L. 102–573, § 505(b)(1)(D), struck out par. (5) which authorized appropriations of $500,000 for fiscal year 1991 and $2,000,000 for fiscal year 1992 to carry out this subsec.

1990—Subsecs. (c) to (f). Pub. L. 101–630 added subsecs. (c) to (f).

### Statutory Notes and Related Subsidiaries

### Facilities Assessment

Pub. L. 101–630, title V, § 506(a), (b), Nov. 28, 1990, 104 Stat. 4566, directed the Secretary to conduct a survey of all facilities used by contractors under title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.) and submit a report to Congress on the survey not later than one year after Nov. 28, 1990, containing information for each location on safety and building codes, lease restrictions and requirements, and an assessment of any building deficiencies and recommendations for improvements.