--- kind: "range" citation: "25 U.S.C. §§ 479a–1661" title: "25" from: "479a" to: "1661" count: 1000 release: "119-102" url: "https://uscodex.org/usc/25/479a..1" --- # [§479a. Transferred — transferred] # [§479a–1. Transferred — transferred] # [§480. Transferred — transferred] # [§481. Omitted — omitted] # [§482. Transferred — transferred] # [§483. Transferred — transferred] # [§483a. Transferred — transferred] # [§484. Omitted — omitted] # [§485. Omitted — omitted] # [§486. Omitted — omitted] # [§487. Omitted — omitted] # [§488. Transferred — transferred] # [§488a. Transferred — transferred] # [§489. Transferred — transferred] # [§490. Transferred — transferred] # [§491. Transferred — transferred] # [§492. Transferred — transferred] # [§493. Transferred — transferred] # [§494. Transferred — transferred] # [§494a. Transferred — transferred] # [§495. Omitted — omitted] # [§496. Repealed. Pub. L. 94–579, title VII, § 704(a), Oct. 21, 1976, 90 Stat. 2792 — repealed] # [§497. Repealed. Pub. L. 94–579, title VII, § 704(a), Oct. 21, 1976, 90 Stat. 2792 — repealed] # [§500. Omitted — omitted] # [§500a. Omitted — omitted] # [§500b. Omitted — omitted] # [§500c. Omitted — omitted] # [§500d. Omitted — omitted] # [§500e. Omitted — omitted] # [§500f. Omitted — omitted] # [§500g. Omitted — omitted] # [§500h. Omitted — omitted] # [§500i. Omitted — omitted] # [§500j. Omitted — omitted] # [§500k. Omitted — omitted] # [§500l. Omitted — omitted] # [§500m. Omitted — omitted] # [§500n. Omitted — omitted] # [§501. Transferred — transferred] # [§502. Transferred — transferred] # [§503. Transferred — transferred] # [§504. Transferred — transferred] # [§505. Transferred — transferred] # [§506. Transferred — transferred] # [§507. Transferred — transferred] # [§508. Transferred — transferred] # [§509. Transferred — transferred] # [§510. Transferred — transferred] # [§530. Omitted — omitted] # [§§531 to 535. Repealed. Aug. 13, 1954, ch. 732, § 12, 68 Stat. 721 — repealed] # [§541. Omitted — omitted] # [§542. Omitted — omitted] # [§543. Omitted — omitted] # [§544. Omitted — omitted] # [§545. Omitted — omitted] # [§551. Omitted — omitted] # [§552. Omitted — omitted] # [§553. Omitted — omitted] # [§554. Omitted — omitted] # [§555. Repealed. Aug. 13, 1954, ch. 732, § 9(c), 68 Stat. 721 — repealed] # [§556. Omitted — omitted] # [§561. Omitted — omitted] # [§562. Omitted — omitted] # [§563. Omitted — omitted] # [§564. Omitted — omitted] # [§564a. Omitted — omitted] # [§564b. Omitted — omitted] # [§564c. Omitted — omitted] # [§564d. Omitted — omitted] # [§564e. Omitted — omitted] # [§564f. Omitted — omitted] # [§564g. Omitted — omitted] # [§564h. Omitted — omitted] # [§564i. Omitted — omitted] # [§564j. Omitted — omitted] # [§564k. Omitted — omitted] # [§564l. Omitted — omitted] # [§564m. Omitted — omitted] # [§564n. Omitted — omitted] # [§564o. Omitted — omitted] # [§564p. Omitted — omitted] # [§564q. Omitted — omitted] # [§564r. Omitted — omitted] # [§564s. Omitted — omitted] # [§564t. Omitted — omitted] # [§564u. Omitted — omitted] # [§564v. Omitted — omitted] # [§564w. Omitted — omitted] # [§564w–1. Omitted — omitted] # [§564w–2. Omitted — omitted] # [§564x. Omitted — omitted] # [§565. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565a. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565b. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565c. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565d. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565e. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565f. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§565g. Repealed. Pub. L. 117–261, § 2, Dec. 21, 2022, 136 Stat. 2393 — repealed] # [§566. Omitted — omitted] # [§566a. Omitted — omitted] # [§566b. Omitted — omitted] # [§566c. Omitted — omitted] # [§566d. Omitted — omitted] # [§566e. Omitted — omitted] # [§566f. Omitted — omitted] # [§566g. Omitted — omitted] # [§566h. Omitted — omitted] # [§571. Omitted — omitted] # [§572. Omitted — omitted] # [§573. Omitted — omitted] # [§574. Omitted — omitted] # [§574a. Omitted — omitted] # [§575. Omitted — omitted] # [§576. Omitted — omitted] # [§577. Omitted — omitted] # [§581. Omitted — omitted] # [§582. Omitted — omitted] # [§583. Omitted — omitted] # [§584. Omitted — omitted] # [§585. Omitted — omitted] # [§586. Omitted — omitted] # [§587. Omitted — omitted] # [§588. Omitted — omitted] # [§589. Omitted — omitted] # [§590. Omitted — omitted] # [§590a. Omitted — omitted] # [§590b. Omitted — omitted] # [§590c. Omitted — omitted] # [§591. Omitted — omitted] # [§592. Omitted — omitted] # [§593. Omitted — omitted] # [§594. Omitted — omitted] # [§594a. Omitted — omitted] # [§601. Omitted — omitted] # [§602. Omitted — omitted] # [§603. Omitted — omitted] # [§604. Omitted — omitted] # [§605. Omitted — omitted] # [§606. Omitted — omitted] # [§607. Omitted — omitted] # [§608. Omitted — omitted] # [§608a. Omitted — omitted] # [§608b. Omitted — omitted] # [§608c. Omitted — omitted] # [§609. Omitted — omitted] # [§609a. Omitted — omitted] # [§609b. Omitted — omitted] # [§609b–1. Omitted — omitted] # [§609c. Omitted — omitted] # [§609c–1. Omitted — omitted] # [§610. Omitted — omitted] # [§610a. Omitted — omitted] # [§610b. Omitted — omitted] # [§610c. Omitted — omitted] # [§610d. Omitted — omitted] # [§610e. Omitted — omitted] # [§611. Omitted — omitted] # [§612. Omitted — omitted] # [§613. Omitted — omitted] # [§621. Omitted — omitted] # [§622. Omitted — omitted] # [§623. Omitted — omitted] # [§624. Omitted — omitted] # [§631. Omitted — omitted] # [§632. Omitted — omitted] # [§633. Omitted — omitted] # [§634. Omitted — omitted] # [§635. Omitted — omitted] # [§636. Omitted — omitted] # [§637. Omitted — omitted] # [§638. Omitted — omitted] # [§639. Repealed. Pub. L. 104–193, title I, § 110(u), Aug. 22, 1996, 110 Stat. 2175 — repealed] # [§640. Repealed. Pub. L. 93–531, § 26, Dec. 22, 1974, 88 Stat. 1723 — repealed] # [§640a. Omitted — omitted] # [§640b. Omitted — omitted] # [§640c. Omitted — omitted] # [§640c–1. Omitted — omitted] # [§640c–2. Omitted — omitted] # [§640c–3. Omitted — omitted] # [§640d. Omitted — omitted] # [§640d–1. Omitted — omitted] # [§640d–2. Omitted — omitted] # [§640d–3. Omitted — omitted] # [§640d–4. Omitted — omitted] # [§640d–5. Omitted — omitted] # [§640d–6. Omitted — omitted] # [§640d–7. Omitted — omitted] # [§640d–8. Omitted — omitted] # [§640d–9. Omitted — omitted] # [§640d–10. Omitted — omitted] # [§640d–11. Omitted — omitted] # [§640d–12. Omitted — omitted] # [§640d–13. Omitted — omitted] # [§640d–14. Omitted — omitted] # [§640d–15. Omitted — omitted] # [§640d–16. Omitted — omitted] # [§640d–17. Omitted — omitted] # [§640d–18. Omitted — omitted] # [§640d–19. Omitted — omitted] # [§640d–20. Omitted — omitted] # [§640d–21. Omitted — omitted] # [§640d–22. Omitted — omitted] # [§640d–23. Omitted — omitted] # [§640d–24. Omitted — omitted] # [§640d–25. Omitted — omitted] # [§640d–26. Omitted — omitted] # [§640d–27. Omitted — omitted] # [§640d–28. Omitted — omitted] # [§640d–29. Omitted — omitted] # [§640d–30. Omitted — omitted] # [§640d–31. Omitted — omitted] # [§641. Omitted — omitted] # [§642. Omitted — omitted] # [§643. Omitted — omitted] # [§644. Omitted — omitted] # [§645. Omitted — omitted] # [§646. Omitted — omitted] # [§647. Omitted — omitted] # [§648. Omitted — omitted] # [§649. Omitted — omitted] # [§651. Omitted — omitted] # [§652. Omitted — omitted] # [§653. Omitted — omitted] # [§654. Omitted — omitted] # [§655. Omitted — omitted] # [§656. Omitted — omitted] # [§657. Omitted — omitted] # [§658. Omitted — omitted] # [§659. Omitted — omitted] # [§660. Omitted — omitted] # [§661. Omitted — omitted] # [§662. Omitted — omitted] # [§663. Omitted — omitted] # [§668. Omitted — omitted] # [§669. Omitted — omitted] # [§670. Omitted — omitted] # [§671. Omitted — omitted] # [§672. Omitted — omitted] # [§673. Repealed. Pub. L. 97–375, title I, § 108(b), Dec. 21, 1982, 96 Stat. 1820 — repealed] # [§674. Omitted — omitted] # [§675. Omitted — omitted] # [§676. Omitted — omitted] # [§676a. Omitted — omitted] # [§676b. Omitted — omitted] # [§676b–1. Omitted — omitted] # [§677. Omitted — omitted] # [§677a. Omitted — omitted] # [§677b. Omitted — omitted] # [§677c. Omitted — omitted] # [§677d. Omitted — omitted] # [§677e. Omitted — omitted] # [§677f. Omitted — omitted] # [§677g. Omitted — omitted] # [§677h. Omitted — omitted] # [§677i. Omitted — omitted] # [§677j. Omitted — omitted] # [§677k. Omitted — omitted] # [§677l. Omitted — omitted] # [§677m. Omitted — omitted] # [§677n. Omitted — omitted] # [§677o. Omitted — omitted] # [§677p. Omitted — omitted] # [§677q. Omitted — omitted] # [§677r. Omitted — omitted] # [§677s. Omitted — omitted] # [§677t. Omitted — omitted] # [§677u. Omitted — omitted] # [§677v. Omitted — omitted] # [§677w. Omitted — omitted] # [§677x. Omitted — omitted] # [§677y. Omitted — omitted] # [§677z. Omitted — omitted] # [§677aa. Omitted — omitted] # [§681. Omitted — omitted] # [§682. Omitted — omitted] # [§683. Omitted — omitted] # [§684. Omitted — omitted] # [§685. Omitted — omitted] # [§686. Omitted — omitted] # [§687. Omitted — omitted] # [§688. Omitted — omitted] # [§689. Omitted — omitted] # [§690. Omitted — omitted] # [§691. Omitted — omitted] # [§692. Omitted — omitted] # [§693. Omitted — omitted] # [§694. Omitted — omitted] # [§695. Omitted — omitted] # [§696. Omitted — omitted] # [§697. Omitted — omitted] # [§698. Omitted — omitted] # [§699. Omitted — omitted] # [§700. Omitted — omitted] # [§701. Omitted — omitted] # [§702. Omitted — omitted] # [§703. Omitted — omitted] # [§704. Omitted — omitted] # [§705. Omitted — omitted] # [§706. Omitted — omitted] # [§707. Omitted — omitted] # [§708. Omitted — omitted] # [§711. Omitted — omitted] # [§711a. Omitted — omitted] # [§711b. Omitted — omitted] # [§711c. Omitted — omitted] # [§711d. Omitted — omitted] # [§711e. Omitted — omitted] # [§711f. Omitted — omitted] # [§712. Omitted — omitted] # [§712a. Omitted — omitted] # [§712b. Omitted — omitted] # [§712c. Omitted — omitted] # [§712d. Omitted — omitted] # [§712e. Omitted — omitted] # [§713. Omitted — omitted] # [§713a. Omitted — omitted] # [§713b. Omitted — omitted] # [§713c. Omitted — omitted] # [§713d. Omitted — omitted] # [§713e. Omitted — omitted] # [§713f. Omitted — omitted] # [§713g. Omitted — omitted] # [§714. Omitted — omitted] # [§714a. Omitted — omitted] # [§714b. Omitted — omitted] # [§714c. Omitted — omitted] # [§714d. Omitted — omitted] # [§714e. Omitted — omitted] # [§714f. Omitted — omitted] # [§715. Omitted — omitted] # [§715a. Omitted — omitted] # [§715b. Omitted — omitted] # [§715c. Omitted — omitted] # [§715d. Omitted — omitted] # [§715e. Omitted — omitted] # [§715f. Omitted — omitted] # [§715g. Omitted — omitted] # [§715h. Omitted — omitted] # [§721. Omitted — omitted] # [§722. Omitted — omitted] # [§723. Omitted — omitted] # [§724. Omitted — omitted] # [§725. Omitted — omitted] # [§726. Omitted — omitted] # [§727. Omitted — omitted] # [§728. Omitted — omitted] # [§731. Omitted — omitted] # [§732. Omitted — omitted] # [§733. Omitted — omitted] # [§734. Omitted — omitted] # [§735. Omitted — omitted] # [§736. Omitted — omitted] # [§737. Omitted — omitted] # [§741. Omitted — omitted] # [§742. Omitted — omitted] # [§743. Omitted — omitted] # [§744. Omitted — omitted] # [§745. Omitted — omitted] # [§746. Omitted — omitted] # [§747. Omitted — omitted] # [§748. Omitted — omitted] # [§749. Omitted — omitted] # [§750. Omitted — omitted] # [§751. Omitted — omitted] # [§752. Omitted — omitted] # [§753. Omitted — omitted] # [§754. Omitted — omitted] # [§755. Omitted — omitted] # [§756. Omitted — omitted] # [§757. Omitted — omitted] # [§758. Omitted — omitted] # [§759. Omitted — omitted] # [§760. Omitted — omitted] # [§761. Omitted — omitted] # [§762. Omitted — omitted] # [§763. Omitted — omitted] # [§764. Omitted — omitted] # [§765. Omitted — omitted] # [§766. Omitted — omitted] # [§767. Omitted — omitted] # [§768. Omitted — omitted] # [§771. Omitted — omitted] # [§772. Omitted — omitted] # [§773. Omitted — omitted] # [§774. Omitted — omitted] # [§775. Omitted — omitted] # [§781. Omitted — omitted] # [§782. Omitted — omitted] # [§783. Omitted — omitted] # [§784. Omitted — omitted] # [§785. Omitted — omitted] # [§786. Omitted — omitted] # [§787. Omitted — omitted] # [§788. Omitted — omitted] # [§788a. Omitted — omitted] # [§788b. Omitted — omitted] # [§788c. Omitted — omitted] # [§788d. Omitted — omitted] # [§788e. Omitted — omitted] # [§788f. Omitted — omitted] # [§788g. Omitted — omitted] # [§788h. Omitted — omitted] # [§791. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§792. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§793. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§794. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§795. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§796. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§797. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§798. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§799. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§800. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§801. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§802. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§803. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§804. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§805. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§806. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§807. Repealed. Pub. L. 95–281, § 1(b)(1), May 15, 1978, 92 Stat. 246 — repealed] # [§821. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§822. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§823. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§824. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§825. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§826. Repealed. Pub. L. 95–281, § 1(b)(2), May 15, 1978, 92 Stat. 246 — repealed] # [§841. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§842. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§843. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§844. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§845. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§846. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§847. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§848. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§849. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§850. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§851. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§852. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§853. Repealed. Pub. L. 95–281, § 1(b)(3), May 15, 1978, 92 Stat. 246 — repealed] # [§861. Omitted — omitted] # [§861a. Omitted — omitted] # [§861b. Omitted — omitted] # [§861c. Omitted — omitted] # [§871. Omitted — omitted] # [§872. Omitted — omitted] # [§873. Omitted — omitted] # [§874. Omitted — omitted] # [§875. Omitted — omitted] # [§876. Omitted — omitted] # [§881. Omitted — omitted] # [§881a. Omitted — omitted] # [§882. Omitted — omitted] # [§882a. Omitted — omitted] # [§883. Omitted — omitted] # [§883a. Omitted — omitted] # [§883b. Omitted — omitted] # [§883c. Omitted — omitted] # [§883d. Omitted — omitted] # [§891. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§892. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§893. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§894. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§895. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§896. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§897. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§898. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§899. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§900. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§901. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§902. Repealed. Pub. L. 93–197, § 3(b), Dec. 22, 1973, 87 Stat. 770 — repealed] # [§903. Omitted — omitted] # [§903a. Omitted — omitted] # [§903b. Omitted — omitted] # [§903c. Omitted — omitted] # [§903d. Omitted — omitted] # [§903e. Omitted — omitted] # [§903f. Omitted — omitted] # [§903g. Omitted — omitted] # [§911. Omitted — omitted] # [§912. Omitted — omitted] # [§913. Omitted — omitted] # [§914. Omitted — omitted] # [§931. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§932. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§933. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§934. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§935. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§936. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§937. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§938. Repealed. Pub. L. 103–116, § 4(c), Oct. 27, 1993, 107 Stat. 1121 — repealed] # [§941. Omitted — omitted] # [§941a. Omitted — omitted] # [§941b. Omitted — omitted] # [§941c. Omitted — omitted] # [§941d. Omitted — omitted] # [§941e. Omitted — omitted] # [§941f. Omitted — omitted] # [§941g. Omitted — omitted] # [§941h. Omitted — omitted] # [§941i. Omitted — omitted] # [§941j. Omitted — omitted] # [§941k. Omitted — omitted] # [§941l. Omitted — omitted] # [§941m. Omitted — omitted] # [§941n. Omitted — omitted] # [§951. Omitted — omitted] # [§952. Omitted — omitted] # [§953. Omitted — omitted] # [§954. Omitted — omitted] # [§955. Omitted — omitted] # [§956. Omitted — omitted] # [§957. Omitted — omitted] # [§958. Omitted — omitted] # [§961. Omitted — omitted] # [§962. Omitted — omitted] # [§963. Omitted — omitted] # [§964. Omitted — omitted] # [§965. Omitted — omitted] # [§966. Omitted — omitted] # [§967. Omitted — omitted] # [§967a. Omitted — omitted] # [§967b. Omitted — omitted] # [§967c. Omitted — omitted] # [§967d. Omitted — omitted] # [§971. Omitted — omitted] # [§972. Omitted — omitted] # [§973. Omitted — omitted] # [§974. Omitted — omitted] # [§975. Omitted — omitted] # [§976. Omitted — omitted] # [§977. Omitted — omitted] # [§978. Omitted — omitted] # [§979. Omitted — omitted] # [§980. Omitted — omitted] # [§983. Omitted — omitted] # [§983a. Omitted — omitted] # [§983b. Omitted — omitted] # [§983c. Omitted — omitted] # [§983d. Omitted — omitted] # [§983e. Omitted — omitted] # [§983f. Omitted — omitted] # [§983g. Omitted — omitted] # [§983h. Omitted — omitted] # [§991. Omitted — omitted] # [§992. Omitted — omitted] # [§993. Omitted — omitted] # [§994. Omitted — omitted] # [§995. Omitted — omitted] # [§996. Omitted — omitted] # [§997. Omitted — omitted] # [§998. Omitted — omitted] # [§1011. Omitted — omitted] # [§1012. Omitted — omitted] # [§1013. Omitted — omitted] # [§1014. Omitted — omitted] # [§1015. Omitted — omitted] # [§1031. Omitted — omitted] # [§1032. Omitted — omitted] # [§1033. Omitted — omitted] # [§1034. Omitted — omitted] # [§1035. Omitted — omitted] # [§1036. Omitted — omitted] # [§1037. Omitted — omitted] # [§1038. Omitted — omitted] # [§1041. Omitted — omitted] # [§1041a. Omitted — omitted] # [§1041b. Omitted — omitted] # [§1041c. Omitted — omitted] # [§1041d. Omitted — omitted] # [§1041e. Omitted — omitted] # [§1041f. Omitted — omitted] # [§1041g. Omitted — omitted] # [§1041h. Omitted — omitted] # [§1051. Omitted — omitted] # [§1052. Omitted — omitted] # [§1053. Omitted — omitted] # [§1054. Omitted — omitted] # [§1055. Omitted — omitted] # [§1071. Omitted — omitted] # [§1072. Omitted — omitted] # [§1073. Omitted — omitted] # [§1081. Omitted — omitted] # [§1082. Omitted — omitted] # [§1083. Omitted — omitted] # [§1084. Omitted — omitted] # [§1085. Omitted — omitted] # [§1086. Omitted — omitted] # [§1087. Omitted — omitted] # [§1088. Omitted — omitted] # [§1101. Omitted — omitted] # [§1102. Omitted — omitted] # [§1103. Omitted — omitted] # [§1104. Omitted — omitted] # [§1105. Omitted — omitted] # [§1111. Omitted — omitted] # [§1112. Omitted — omitted] # [§1113. Omitted — omitted] # [§1114. Omitted — omitted] # [§1115. Omitted — omitted] # [§1116. Omitted — omitted] # [§1117. Omitted — omitted] # [§1118. Omitted — omitted] # [§1119. Omitted — omitted] # [§1120. Omitted — omitted] # [§1121. Omitted — omitted] # [§1122. Omitted — omitted] # [§1123. Omitted — omitted] # [§1124. Omitted — omitted] # [§1125. Omitted — omitted] # [§1126. Omitted — omitted] # [§1127. Omitted — omitted] # [§1128. Omitted — omitted] # [§1129. Omitted — omitted] # [§1130. Omitted — omitted] # [§1131. Omitted — omitted] # [§1132. Omitted — omitted] # [§1133. Omitted — omitted] # [§1134. Omitted — omitted] # [§1135. Omitted — omitted] # [§1141. Omitted — omitted] # [§1142. Omitted — omitted] # [§1143. Omitted — omitted] # [§1144. Omitted — omitted] # [§1145. Omitted — omitted] # [§1146. Omitted — omitted] # [§1147. Omitted — omitted] # [§1151. Omitted — omitted] # [§1152. Omitted — omitted] # [§1153. Omitted — omitted] # [§1154. Omitted — omitted] # [§1155. Omitted — omitted] # [§1161. Omitted — omitted] # [§1162. Omitted — omitted] # [§1163. Omitted — omitted] # [§1164. Omitted — omitted] # [§1165. Omitted — omitted] # [§1166. Omitted — omitted] # [§1167. Omitted — omitted] # [§1171. Omitted — omitted] # [§1181. Omitted — omitted] # [§1182. Omitted — omitted] # [§1183. Omitted — omitted] # [§1184. Omitted — omitted] # [§1185. Omitted — omitted] # [§1186. Omitted — omitted] # [§1191. Omitted — omitted] # [§1192. Omitted — omitted] # [§1193. Omitted — omitted] # [§1194. Omitted — omitted] # [§1195. Omitted — omitted] # [§1201. Omitted — omitted] # [§1202. Omitted — omitted] # [§1203. Omitted — omitted] # [§1204. Omitted — omitted] # [§1205. Omitted — omitted] # [§1211. Omitted — omitted] # [§1212. Omitted — omitted] # [§1213. Omitted — omitted] # [§1214. Omitted — omitted] # [§1215. Omitted — omitted] # [§1221. Omitted — omitted] # [§1222. Omitted — omitted] # [§1223. Omitted — omitted] # [§1224. Omitted — omitted] # [§1225. Omitted — omitted] # [§1226. Omitted — omitted] # [§1227. Omitted — omitted] # [§1231. Omitted — omitted] # [§1232. Omitted — omitted] # [§1233. Omitted — omitted] # [§1234. Omitted — omitted] # [§1235. Omitted — omitted] # [§1236. Omitted — omitted] # [§1241. Omitted — omitted] # [§1242. Omitted — omitted] # [§1243. Omitted — omitted] # [§1244. Omitted — omitted] # [§1245. Omitted — omitted] # [§1246. Omitted — omitted] # [§1247. Omitted — omitted] # [§1248. Omitted — omitted] # [§1251. Omitted — omitted] # [§1252. Omitted — omitted] # [§1253. Omitted — omitted] # [§1261. Omitted — omitted] # [§1262. Omitted — omitted] # [§1263. Omitted — omitted] # [§1264. Omitted — omitted] # [§1265. Omitted — omitted] # [§1271. Omitted — omitted] # [§1272. Omitted — omitted] # [§1273. Omitted — omitted] # [§1274. Omitted — omitted] # [§1281. Omitted — omitted] # [§1282. Omitted — omitted] # [§1283. Omitted — omitted] # [§1284. Omitted — omitted] # [§1291. Omitted — omitted] # [§1292. Omitted — omitted] # [§1293. Omitted — omitted] # [§1294. Omitted — omitted] # [§1295. Omitted — omitted] # [§1296. Omitted — omitted] # [§1297. Omitted — omitted] # [§1300. Omitted — omitted] # [§1300a. Omitted — omitted] # [§1300a–1. Omitted — omitted] # [§1300a–2. Omitted — omitted] # [§1300a–3. Omitted — omitted] # [§1300a–4. Omitted — omitted] # [§1300b. Omitted — omitted] # [§1300b–1. Omitted — omitted] # [§1300b–2. Omitted — omitted] # [§1300b–3. Omitted — omitted] # [§1300b–4. Omitted — omitted] # [§1300b–5. Omitted — omitted] # [§1300b–11. Omitted — omitted] # [§1300b–12. Omitted — omitted] # [§1300b–13. Omitted — omitted] # [§1300b–14. Omitted — omitted] # [§1300b–15. Omitted — omitted] # [§1300b–16. Omitted — omitted] # [§1300c. Omitted — omitted] # [§1300c–1. Omitted — omitted] # [§1300c–2. Omitted — omitted] # [§1300c–3. Omitted — omitted] # [§1300c–4. Omitted — omitted] # [§1300c–5. Omitted — omitted] # [§1300d. Omitted — omitted] # [§1300d–1. Omitted — omitted] # [§1300d–2. Omitted — omitted] # [§1300d–3. Omitted — omitted] # [§1300d–4. Omitted — omitted] # [§1300d–5. Omitted — omitted] # [§1300d–6. Omitted — omitted] # [§1300d–7. Omitted — omitted] # [§1300d–8. Omitted — omitted] # [§1300d–9. Omitted — omitted] # [§1300d–10. Omitted — omitted] # [§1300d–21. Omitted — omitted] # [§1300d–22. Omitted — omitted] # [§1300d–23. Omitted — omitted] # [§1300d–24. Omitted — omitted] # [§1300d–25. Omitted — omitted] # [§1300d–26. Omitted — omitted] # [§1300d–27. Omitted — omitted] # [§1300e. Omitted — omitted] # [§1300e–1. Omitted — omitted] # [§1300e–2. Omitted — omitted] # [§1300e–3. Omitted — omitted] # [§1300e–4. Omitted — omitted] # [§1300e–5. Omitted — omitted] # [§1300e–6. Omitted — omitted] # [§1300e–7. Omitted — omitted] # [§1300f. Omitted — omitted] # [§1300f–1. Omitted — omitted] # [§1300f–2. Omitted — omitted] # [§1300f–3. Omitted — omitted] # [§1300g. Omitted — omitted] # [§1300g–1. Omitted — omitted] # [§1300g–2. Omitted — omitted] # [§1300g–3. Omitted — omitted] # [§1300g–4. Omitted — omitted] # [§1300g–5. Omitted — omitted] # [§1300g–6. Omitted — omitted] # [§1300g–7. Omitted — omitted] # [§1300h. Omitted — omitted] # [§1300h–1. Omitted — omitted] # [§1300h–2. Omitted — omitted] # [§1300h–3. Omitted — omitted] # [§1300h–4. Omitted — omitted] # [§1300h–5. Omitted — omitted] # [§1300h–6. Omitted — omitted] # [§1300h–7. Omitted — omitted] # [§1300h–8. Omitted — omitted] # [§1300i. Omitted — omitted] # [§1300i–1. Omitted — omitted] # [§1300i–2. Omitted — omitted] # [§1300i–3. Omitted — omitted] # [§1300i–4. Omitted — omitted] # [§1300i–5. Omitted — omitted] # [§1300i–6. Omitted — omitted] # [§1300i–7. Omitted — omitted] # [§1300i–8. Omitted — omitted] # [§1300i–9. Omitted — omitted] # [§1300i–10. Omitted — omitted] # [§1300i–11. Omitted — omitted] # [§1300j. Omitted — omitted] # [§1300j–1. Omitted — omitted] # [§1300j–2. Omitted — omitted] # [§1300j–3. Omitted — omitted] # [§1300j–4. Omitted — omitted] # [§1300j–5. Omitted — omitted] # [§1300j–6. Omitted — omitted] # [§1300j–7. Omitted — omitted] # [§1300j–7a. Omitted — omitted] # [§1300j–8. Omitted — omitted] # [§1300k. Omitted — omitted] # [§1300k–1. Omitted — omitted] # [§1300k–2. Omitted — omitted] # [§1300k–3. Omitted — omitted] # [§1300k–4. Omitted — omitted] # [§1300k–5. Omitted — omitted] # [§1300k–6. Omitted — omitted] # [§1300k–7. Omitted — omitted] # [§1300l. Omitted — omitted] # [§1300l–1. Omitted — omitted] # [§1300l–2. Omitted — omitted] # [§1300l–3. Omitted — omitted] # [§1300l–4. Omitted — omitted] # [§1300l–5. Omitted — omitted] # [§1300l–6. Omitted — omitted] # [§1300l–7. Omitted — omitted] # [§1300m. Omitted — omitted] # [§1300m–1. Omitted — omitted] # [§1300m–2. Omitted — omitted] # [§1300m–3. Omitted — omitted] # [§1300m–4. Omitted — omitted] # [§1300m–5. Omitted — omitted] # [§1300m–6. Omitted — omitted] # [§1300m–7. Omitted — omitted] # [§1300n. Omitted — omitted] # [§1300n–1. Omitted — omitted] # [§1300n–2. Omitted — omitted] # [§1300n–3. Omitted — omitted] # [§1300n–4. Omitted — omitted] # [§1300n–5. Omitted — omitted] # [§1300n–6. Omitted — omitted] # §1301. Definitions For purposes of this subchapter, the term— - (1) “Indian tribe” means any [tribe](/usc/25/3402.md?p=2-A), band, or other group of [Indians](#4) subject to the jurisdiction of the United States and recognized as possessing [powers of self-government](#2); - (2) “powers of self-government” means and includes all governmental powers possessed by an [Indian tribe](#1), executive, legislative, and judicial, and all [offices](/usc/25/4001.md?p=4), bodies, and tribunals by and through which they are executed, including courts of [Indian](#4) offenses; and means the inherent power of [Indian tribes](#1), hereby recognized and affirmed, to exercise criminal jurisdiction over all [Indians](#4); - (3) “Indian court” means any [Indian](#4) tribal court or court of [Indian](#4) offense; and - (4) “Indian” means any person who would be subject to the jurisdiction of the United States as an Indian under [section 1153](/usc/25/1153.md), [title 18](/usc/18.md), if that person were to commit an offense listed in that section in Indian country to which that section applies. # §1302. Constitutional rights - (a) **In general—** No [Indian tribe](/usc/25/1301.md?p=1) in exercising [powers of self-government](/usc/25/1301.md?p=2) shall— - (1) make or enforce any law prohibiting the free exercise of religion, or abridging the freedom of speech, or of the press, or the right of the people peaceably to assemble and to petition for a redress of grievances; - (2) violate the right of the people to be secure in their persons, houses, papers, and effects against unreasonable search and seizures, nor issue warrants, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched and the person or thing to be seized; - (3) subject any person for the same [offense](#e) to be twice put in jeopardy; - (4) compel any person in any criminal case to be a witness against himself; - (5) take any private property for a public use without just compensation; - (6) deny to any person in a criminal proceeding the right to a speedy and public trial, to be informed of the nature and cause of the accusation, to be confronted with the witnesses against him, to have compulsory process for obtaining witnesses in his favor, and at his own expense to have the assistance of counsel for his defense (except as provided in [subsection (b)](#b)); - (7) - (A) require excessive bail, impose excessive fines, or inflict cruel and unusual punishments; - (B) except as provided in [subparagraph (C)](#a-7-C), impose for conviction of any 1 [offense](#e) any penalty or punishment greater than imprisonment for a term of 1 year or a fine of $5,000, or both; - (C) subject to [subsection (b)](#b), impose for conviction of any 1 [offense](#e) any penalty or punishment greater than imprisonment for a term of 3 years or a fine of $15,000, or both; or - (D) impose on a person in a criminal proceeding a total penalty or punishment greater than imprisonment for a term of 9 years; - (8) deny to any person within its jurisdiction the equal protection of its laws or deprive any person of liberty or property without due process of law; - (9) pass any bill of attainder or ex post facto law; or - (10) deny to any person accused of an [offense](#e) punishable by imprisonment the right, upon request, to a trial by jury of not less than six persons. - (b) **Offenses subject to greater than 1-year imprisonment or a fine greater than $5,000—** A tribal court may subject a defendant to a term of imprisonment greater than 1 year but not to exceed 3 years for any 1 [offense](#e), or a fine greater than $5,000 but not to exceed $15,000, or both, if the defendant is a person accused of a criminal [offense](#e) who— - (1) has been previously convicted of the same or a comparable [offense](#e) by any jurisdiction in the United States; or - (2) is being prosecuted for an [offense](#e) comparable to an [offense](#e) that would be punishable by more than 1 year of imprisonment if prosecuted by the United States or any of the States. - (c) **Rights of defendants—** In a criminal proceeding in which an [Indian tribe](/usc/25/1301.md?p=1), in exercising [powers of self-government](/usc/25/1301.md?p=2), imposes a total term of imprisonment of more than 1 year on a defendant, the [Indian tribe](/usc/25/1301.md?p=1) shall— - (1) provide to the defendant the right to effective assistance of counsel at least equal to that guaranteed by the United States Constitution; and - (2) at the expense of the tribal government, provide an indigent defendant the assistance of a defense attorney licensed to practice law by any jurisdiction in the United States that applies appropriate professional licensing standards and effectively ensures the competence and professional responsibility of its licensed attorneys; - (3) require that the judge presiding over the criminal proceeding— - (A) has sufficient legal training to preside over criminal proceedings; and - (B) is licensed to practice law by any jurisdiction in the United States; - (4) prior to charging the defendant, make publicly available the criminal laws (including regulations and interpretative documents), rules of evidence, and rules of criminal procedure (including rules governing the recusal of judges in appropriate circumstances) of the tribal government; and - (5) maintain a record of the criminal proceeding, including an audio or other recording of the trial proceeding. - (d) **Sentences—** In the case of a defendant sentenced in accordance with subsections [(b)](#b) and [(c)](#c), a tribal court may require the defendant— - (1) to serve the sentence— - (A) in a tribal correctional center that has been approved by the Bureau of [Indian](/usc/25/1301.md?p=4) Affairs for long-term incarceration, in accordance with guidelines to be developed by the Bureau of [Indian](/usc/25/1301.md?p=4) Affairs (in consultation with [Indian tribes](/usc/25/1301.md?p=1)) not later than 180 days after July 29, 2010; - (B) in the nearest appropriate Federal facility, at the expense of the United States pursuant to the Bureau of Prisons tribal prisoner pilot [program](/usc/25/3402.md?p=4) described in [section 304(c)](/usc/25/304.md)[^1] of the Tribal Law and Order Act of 2010; - (C) in a State or local government-approved detention or correctional center pursuant to an agreement between the [Indian tribe](/usc/25/1301.md?p=1) and the State or local government; or - (D) in an alternative rehabilitation center of an [Indian tribe](/usc/25/1301.md?p=1); or - (2) to serve another alternative form of punishment, as determined by the tribal court judge pursuant to tribal law. - (e) **Definition of offense—** In this section, the term “offense” means a violation of a criminal law. - (f) **Effect of section—** Nothing in this section affects the obligation of the United States, or any State government that has been delegated authority by the United States, to investigate and prosecute any criminal violation in [Indian](/usc/25/1301.md?p=4) country. # §1302a. Bureau of Prisons tribal prisoner program - (1) **In general—** Not later than 120 days after March 15, 2022, the [Director](/usc/25/4302.md?p=1) of the Bureau of Prisons shall establish a [program](/usc/25/3402.md?p=4) under which the Bureau of Prisons shall accept offenders convicted in tribal court pursuant to [section 1302 of this title](/usc/25/1302.md) (as amended by this section), subject to the conditions described in [paragraph (2)](#2). - (2) **Conditions—** - (A) **In general—** As a condition of participation in the [program](/usc/25/3402.md?p=4) described in [paragraph (1)](#1), the tribal court shall submit to the Attorney General a request for confinement of the offender, for approval by the Attorney General (or a designee) by not later than 30 days after the date of submission. - (B) **Limitations—** Requests for confinement shall be limited to offenders convicted of a violent crime (comparable to the violent crimes described in [section 1153(a) of title 18](/usc/18/1153.md?p=a)) for which the sentence includes a term of imprisonment of 1 or more years. - (C) **Custody conditions—** The imprisonment by the Bureau of Prisons shall be subject to the conditions described in [section 5003 of title 18](/usc/18/5003.md), regarding the custody of State offenders, except that the offender shall be placed in the nearest available and appropriate Federal facility, and imprisoned at the expense of the United States. - (D) **Cap—** The Bureau of Prisons shall confine not more than 100 tribal offenders at any time. - (3) **Rescinding requests—** - (A) **In general—** The applicable tribal government shall retain the authority to rescind the request for confinement of a tribal offender by the Bureau of Prisons under this paragraph at any time during the sentence of the offender. - (B) **Return to tribal custody—** On rescission of a request under [subparagraph (A)](#3-A), a tribal offender shall be returned to tribal custody. - (4) **Reassessment—** If tribal court demand for participation in this [program](/usc/25/3402.md?p=4) exceeds 100 tribal offenders, a representative of the Bureau of Prisons shall notify Congress. # §1303. Habeas corpus The privilege of the writ of habeas corpus shall be available to any person, in a court of the United States, to test the legality of his detention by order of an [Indian tribe](/usc/25/1301.md?p=1). # §1304. Tribal jurisdiction over covered crimes - (a) **Definitions—** In this section: - (1) **Assault of Tribal justice personnel—** The term “assault of Tribal justice personnel” means any violation of the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs that involves the use, attempted use, or threatened use of physical force against an individual authorized to act for, or on behalf of, that [Indian tribe](/usc/25/1301.md?p=1) or serving that [Indian tribe](/usc/25/1301.md?p=1) during, or because of, the performance or duties of that individual in— - (A) preventing, detecting, investigating, making arrests relating to, making apprehensions for, or prosecuting a [covered crime](#a-5); - (B) adjudicating, participating in the adjudication of, or supporting the adjudication of a [covered crime](#a-5); - (C) detaining, providing supervision for, or providing services for persons charged with a [covered crime](#a-5); or - (D) incarcerating, supervising, providing treatment for, providing rehabilitation services for, or providing reentry services for persons convicted of a [covered crime](#a-5). - (2) **Child—** The term “child” means a person who has not attained the lesser of— - (A) the age of 18; and - (B) except in the case of sexual abuse, the age specified by the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs. - (3) **Child violence—** The term “child violence” means the use, threatened use, or attempted use of violence against a [child](#a-2) proscribed by the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs. - (4) **Coercion; commercial sex act—** The terms “coercion” and “commercial sex act” have the meanings given the terms in [section 1591(e) of title 18](/usc/18/1591.md?p=e). - (5) **Covered crime—** The term “covered crime” means— - (A) [assault of Tribal justice personnel](#a-1); - (B) [child violence](#a-3); - (C) [dating violence](#a-6); - (D) [domestic violence](#a-7); - (E) [obstruction of justice](#a-9); - (F) [sexual violence](#a-13); - (G) [sex trafficking](#a-12); - (H) [stalking](#a-16); and - (I) a [violation of a protection order](#a-17). - (6) **Dating violence—** The term “dating violence” means any violation of the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs that is committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim, as determined by the length of the relationship, the type of relationship, and the frequency of interaction between the persons involved in the relationship. - (7) **Domestic violence—** The term “domestic violence” means any violation of the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs that is committed by— - (A) a current or former [spouse or intimate partner](#a-15) of the victim; - (B) a person with whom the victim shares a [child](#a-2) in common; - (C) a person who is cohabitating with or who has cohabitated with the victim as a [spouse or intimate partner](#a-15); or - (D) a person similarly situated to a spouse of the victim under the domestic- or family-violence laws of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs. - (8) **Indian country—** The term “Indian country” has the meaning given the term in [section 1151 of title 18](/usc/18/1151.md). - (9) **Obstruction of justice—** The term “obstruction of justice” means any violation of the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs that involves interfering with the administration or due process of the laws of the [Indian tribe](/usc/25/1301.md?p=1), including any Tribal criminal proceeding or investigation of a crime. - (10) **Participating tribe—** The term “participating tribe” means an [Indian tribe](/usc/25/1301.md?p=1) that elects to exercise [special Tribal criminal jurisdiction](#a-14) over the [Indian country](#a-8) of that [Indian tribe](/usc/25/1301.md?p=1). - (11) **Protection order—** The term “protection order”— - (A) means any injunction, restraining order, or other order issued by a civil or criminal court for the purpose of preventing violent or threatening acts or harassment against, [sexual violence](#a-13) against, contact or communication with, or physical proximity to, another person; and - (B) includes any temporary or final order issued by a civil or criminal court, whether obtained by filing an independent action or as a pendent lite order in another proceeding, if the civil or criminal order was issued in response to a complaint, petition, or motion filed by or on behalf of a person seeking protection. - (12) **Sex trafficking—** The term “sex trafficking” means conduct within the meaning of [section 1591(a) of title 18](/usc/18/1591.md?p=a). - (13) **Sexual violence—** The term “sexual violence” means any nonconsensual sexual act or contact proscribed by the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs, including in any case in which the victim lacks the capacity to consent to the act. - (14) **Special Tribal criminal jurisdiction—** The term “special Tribal criminal jurisdiction” means the criminal jurisdiction that a [participating tribe](#a-10) may exercise under this section but could not otherwise exercise. - (15) **Spouse or intimate partner—** The term “spouse or intimate partner” has the meaning given the term in [section 2266 of title 18](/usc/18/2266.md). - (16) **Stalking—** The term “stalking” means engaging in a course of conduct directed at a specific person proscribed by the criminal law of the [Indian tribe](/usc/25/1301.md?p=1) that has jurisdiction over the [Indian country](#a-8) where the violation occurs that would cause a reasonable person— - (A) to fear for the person’s safety or the safety of others; or - (B) to suffer substantial emotional distress. - (17) **Violation of a protection order—** The term “violation of a protection order” means an act that— - (A) occurs in the [Indian country](#a-8) of a [participating tribe](#a-10); and - (B) violates a provision of a [protection order](#a-11) that— - (i) prohibits or provides protection against violent or threatening acts or harassment against, [sexual violence](#a-13) against, contact or communication with, or physical proximity to, another person; - (ii) was issued against the defendant; - (iii) is enforceable by the [participating tribe](#a-10); and - (iv) is consistent with [section 2265(b) of title 18](/usc/18/2265.md?p=b). - (b) **Nature of the criminal jurisdiction—** - (1) **In general—** Notwithstanding any other provision of law, in addition to all [powers of self-government](/usc/25/1301.md?p=2) recognized and affirmed by sections [1301](/usc/25/1301.md) and [1303](/usc/25/1303.md) of this title, the [powers of self-government](/usc/25/1301.md?p=2) of a [participating tribe](#a-10), including any [participating tribes](#a-10) in the State of Maine, include the inherent power of that [tribe](/usc/25/3402.md?p=2-A), which is hereby recognized and affirmed, to exercise [special Tribal criminal jurisdiction](#a-14) over all persons. - (2) **Concurrent jurisdiction—** The exercise of [special Tribal criminal jurisdiction](#a-14) by a [participating tribe](#a-10) shall be concurrent with the jurisdiction of the United States, of a State, or of both. - (3) **Applicability—** Nothing in this section— - (A) creates or eliminates any Federal or State criminal jurisdiction over [Indian country](#a-8); or - (B) affects the authority of the United States or any State government that has been delegated authority by the United States to investigate and prosecute a criminal violation in [Indian country](#a-8). - (4) **Exception if victim and defendant are both non-Indians—** - (A) **In general—** A [participating tribe](#a-10) may not exercise [special Tribal criminal jurisdiction](#a-14) over an alleged offense, other than [obstruction of justice](#a-9) or [assault of Tribal justice personnel](#a-1), if neither the defendant nor the alleged [victim](#b-4-B) is an [Indian](/usc/25/1301.md?p=4). - (B) **Definition of victim—** In this paragraph and with respect to a criminal proceeding in which a [participating tribe](#a-10) exercises [special Tribal criminal jurisdiction](#a-14) based on a [violation of a protection order](#a-17), the term “victim” means a person specifically protected by a [protection order](#a-11) that the defendant allegedly violated. - (c) **Criminal conduct—** A [participating tribe](#a-10) may exercise [special Tribal criminal jurisdiction](#a-14) over a defendant for a [covered crime](#a-5) that occurs in the [Indian country](#a-8) of the [participating tribe](#a-10). - (d) **Rights of defendants—** In a criminal proceeding in which a [participating tribe](#a-10) exercises [special Tribal criminal jurisdiction](#a-14), the [participating tribe](#a-10) shall provide to the defendant— - (1) all applicable rights under this Act; - (2) if a term of imprisonment of any length may be imposed, all rights described in [section 1302(c) of this title](/usc/25/1302.md?p=c); - (3) the right to a trial by an impartial jury that is drawn from sources that— - (A) reflect a fair cross section of the community; and - (B) do not systematically exclude any distinctive group in the community, including non-[Indians](/usc/25/1301.md?p=4); and - (4) all other rights whose protection is necessary under the Constitution of the United States in order for Congress to recognize and affirm the inherent power of the [participating tribe](#a-10) to exercise [special Tribal criminal jurisdiction](#a-14) over the defendant. - (e) **Petitions to stay detention—** - (1) **In general—** A person who has filed a petition for a writ of habeas corpus in a court of the United States under [section 1303 of this title](/usc/25/1303.md) may petition that court to stay further detention of that person by the [participating tribe](#a-10). - (2) **Grant of stay—** A court shall grant a stay described in [paragraph (1)](#e-1) if the court— - (A) finds that there is a substantial likelihood that the habeas corpus petition will be granted; and - (B) after giving each alleged victim in the matter an opportunity to be heard, finds by clear and convincing evidence that under conditions imposed by the court, the petitioner is not likely to flee or pose a danger to any person or the community if released. - (f) **Petitions for writs of habeas corpus—** - (1) **In general—** After a defendant has been sentenced by a [participating tribe](#a-10), the defendant may file a petition for a writ of habeas corpus in a court of the United States under [section 1303 of this title](/usc/25/1303.md). - (2) **Requirement—** An application for a writ of habeas corpus on behalf of a person in custody pursuant to an order of a Tribal court shall not be granted unless — - (A) the applicant has exhausted the remedies available in the Tribal court system; - (B) there is an absence of an available Tribal corrective process; or - (C) circumstances exist that render the Tribal corrective process ineffective to protect the rights of the applicant. - (g) **Notice; habeas corpus petitions—** A [participating tribe](#a-10) that has ordered the detention of any person has a duty to timely notify in writing such person of their rights and privileges under this section and under [section 1303 of this title](/usc/25/1303.md). - (h) **Reimbursement and grants to Tribal governments—** - (1) **Reimbursement—** - (A) **In general—** The Attorney General may reimburse Tribal government authorities (or an authorized designee of a Tribal government) for expenses incurred in exercising [special Tribal criminal jurisdiction](#a-14). - (B) **Eligible expenses—** Eligible expenses for reimbursement under [subparagraph (A)](#h-1-A) shall include expenses and costs incurred in, relating to, or associated with— - (i) investigating, making arrests relating to, making apprehensions for, or prosecuting [covered crimes](#a-5) (including costs involving the purchasing, collecting, and processing of sexual assault forensic materials); - (ii) detaining, providing supervision of, or providing services for persons charged with [covered crimes](#a-5) (including costs associated with providing health care); - (iii) providing indigent defense services for 1 or more persons charged with 1 or more [covered crimes](#a-5); and - (iv) incarcerating, supervising, or providing treatment, rehabilitation, or reentry services for 1 or more persons charged with 1 or more [covered crimes](#a-5). - (C) **Procedure—** - (i) **In general—** Reimbursements authorized under [subparagraph (A)](#h-1-A) shall be in accordance with rules promulgated by the Attorney General, after consultation with [Indian tribes](/usc/25/1301.md?p=1), and within 1 year after March 15, 2022. - (ii) **Maximum reimbursement—** The rules promulgated by the Attorney General under [clause (i)](#h-1-C-i)— - (I) shall set a maximum allowable reimbursement to any Tribal government (or an authorized designee of any Tribal government) in a 1-year period; and - (II) may allow the Attorney General— - (aa) to establish conditions under which a Tribal government (or an authorized designee of a Tribal government) may seek a waiver to the maximum allowable reimbursement requirement established under [subclause (I)](#h-1-C-ii-I); and - (bb) to waive the maximum allowable reimbursement requirements established under [subclause (I)](#h-1-C-ii-I) for a Tribal government (or an authorized designee of a Tribal government) if the conditions established by the Attorney General under [item (aa)](#h-1-C-ii-II-aa) are met by that Tribal government (or authorized designee). - (iii) **Timeliness of reimbursements—** To the maximum extent practicable, the Attorney General shall— - (I) not later than 90 days after the date on which the Attorney General receives a qualifying reimbursement request from a Tribal government (or an authorized designee of a Tribal government)— - (aa) reimburse the Tribal government (or authorized designee); or - (bb) notify the Tribal government (or authorized designee) of the reason by which the Attorney General was unable to issue the reimbursement; and - (II) not later than 30 days after the date on which a Tribal government (or an authorized designee of a Tribal government) reaches the annual maximum allowable reimbursement for the Tribal government (or an authorized designee) established by the Attorney General under [clause (ii)(I)](#h-1-C-ii-I), notify the Tribal government (or authorized designee) that the Tribal government has reached its annual maximum allowable reimbursement. - (D) **Eligibility for participating tribes in Alaska—** A Tribal government (or an authorized designee of a Tribal Government) of an [Indian tribe](/usc/25/1301.md?p=1) designated as a [participating Tribe](#a-10) under subtitle B of title VIII of the Violence Against Women Act Reauthorization Act of 2022 shall be eligible for reimbursement, in accordance with this paragraph, of expenses incurred in exercising [special Tribal criminal jurisdiction](#a-14) under that subtitle. - (2) **Grants—** The Attorney General may award grants to Tribal governments (or authorized designees of Tribal governments), including a Tribal government (or an authorized designee of a Tribal government) of an [Indian tribe](/usc/25/1301.md?p=1) designated as a [participating Tribe](#a-10) under subtitle B of title VIII of the Violence Against Women Act Reauthorization Act of 2022— - (A) to strengthen Tribal criminal justice systems to assist [Indian tribes](/usc/25/1301.md?p=1) in exercising [special Tribal criminal jurisdiction](#a-14), including for— - (i) law enforcement (including the capacity of law enforcement, court personnel, or other non-law enforcement entities that have no Federal or State arrest authority agencies but have been designated by an [Indian tribe](/usc/25/1301.md?p=1) as responsible for maintaining public safety within the territorial jurisdiction of the [Indian tribe](/usc/25/1301.md?p=1), to enter information into and obtain information from national crime information databases); - (ii) prosecution; - (iii) trial and appellate courts (including facilities maintenance, renovation, and rehabilitation); - (iv) supervision systems; - (v) detention and corrections (including facilities maintenance, renovation, and rehabilitation); - (vi) treatment, rehabilitation, and reentry [programs](/usc/25/3402.md?p=4) and services; - (vii) culturally appropriate services and assistance for victims and their families; and - (viii) criminal codes and rules of criminal procedure, appellate procedure, and evidence; - (B) to provide indigent criminal defendants with licensed defense counsel, at no cost to the defendant, in criminal proceedings in which a [participating tribe](#a-10) prosecutes [covered crimes](#a-5); - (C) to ensure that, in criminal proceedings in which a [participating tribe](#a-10) exercises [special Tribal criminal jurisdiction](#a-14), jurors are summoned, selected, and instructed in a manner consistent with all applicable requirements; and - (D) to accord victims of [covered crimes](#a-5) rights that are similar to the rights of a crime victim described in [section 3771(a) of title 18](/usc/18/3771.md?p=a) consistent with Tribal law and custom. - (i) **Supplement, not supplant—** Amounts made available under this section shall supplement and not supplant any other Federal, State, or local government amounts made available to carry out activities described in this section. - (j) **Authorization of appropriations—** - (1) **In general—** There is authorized to be appropriated $25,000,000 for each of fiscal years 2023 through 2027— - (A) to carry out [subsection (h)](#h); and - (B) to provide training, technical assistance, data collection, and evaluation of the criminal justice systems of [participating tribes](#a-10). - (2) **Limitations—** Of the total amount made available under [paragraph (1)](#j-1) for each fiscal year, not more than 40 percent shall be used for reimbursements under [subsection (h)(1)](#h-1). # §1305. Tribal jurisdiction in Alaska - (a) **In general—** Subject to title II of Public Law 90–284 ([25 U.S.C. 1301](/usc/25/1301.md) et seq.) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”), Congress recognizes and affirms the inherent authority of any [Indian tribe](/usc/25/1301.md?p=1) occupying a Village in the State to exercise criminal and civil jurisdiction over all [Indians](/usc/25/1301.md?p=4) present in the Village. - (b) **Tribal civil jurisdiction to enforce protection orders—** - (1) **In general—** A court of any [Indian tribe](/usc/25/1301.md?p=1) in the State shall have full civil jurisdiction to issue and enforce protection orders involving any person in matters— - (A) arising within the Village of the [Indian tribe](/usc/25/1301.md?p=1); or - (B) otherwise within the authority of the [Indian tribe](/usc/25/1301.md?p=1). - (2) **Inclusions—** The full civil jurisdiction to issue and enforce protection orders under [paragraph (1)](#b-1) includes the authority to enforce protection orders through— - (A) civil contempt proceedings; - (B) exclusion of violators from the Village of the [Indian tribe](/usc/25/1301.md?p=1); and - (C) other appropriate mechanisms. - (c) **Special Tribal criminal jurisdiction—** - (1) **In general—** Notwithstanding any other provision of law, in addition to all [powers of self-government](/usc/25/1301.md?p=2) recognized and affirmed under [subsection (a)](#a), the [powers of self-government](/usc/25/1301.md?p=2) of a participating [Tribe](/usc/25/3402.md?p=2-A) include the inherent power of the participating [Tribe](/usc/25/3402.md?p=2-A), which is hereby recognized and affirmed, to exercise special Tribal criminal jurisdiction over a defendant for a covered crime that occurs in the Village of the participating [Tribe](/usc/25/3402.md?p=2-A). - (2) **Concurrent jurisdiction—** The exercise of special Tribal criminal jurisdiction by a participating [Tribe](/usc/25/3402.md?p=2-A) shall be concurrent with the jurisdiction of the United States, the State, or both. - (3) **Exception if victim and defendant are both non-Indians—** - (A) **In general—** A participating [Tribe](/usc/25/3402.md?p=2-A) may not exercise special Tribal criminal jurisdiction over an alleged offense of a covered crime, other than obstruction of justice or assault of Tribal justice personnel, if neither the defendant nor the alleged [victim](#c-3-B) is an [Indian](/usc/25/1301.md?p=4). - (B) **Definition of victim—** In this paragraph and with respect to a criminal proceeding in which a participating [Tribe](/usc/25/3402.md?p=2-A) exercises special Tribal criminal jurisdiction based on a violation of a protection order, the term “victim” means a person specifically protected by the protection order that the defendant allegedly violated. - (d) **Pilot program for special Tribal criminal jurisdiction over persons who are not Indians—** - (1) **Establishment—** Subject to title II of Public Law 90–284 ([25 U.S.C. 1301](/usc/25/1301.md) et seq.) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”), there is established a pilot [program](/usc/25/3402.md?p=4) under which the Attorney General, subject to [paragraph (5)](#d-5), shall designate not more than 5 [Indian tribes](/usc/25/1301.md?p=1) per calendar year as participating [Tribes](/usc/25/3402.md?p=2-A) to exercise the special Tribal criminal jurisdiction described in [paragraph (6)](#d-6) over all persons present in the Village of the [Indian tribe](/usc/25/1301.md?p=1). - (2) **Procedure—** At any time during the 1-year period beginning on March 15, 2022, and annually thereafter, an [Indian tribe](/usc/25/1301.md?p=1) may request the Attorney General to designate the [Indian tribe](/usc/25/1301.md?p=1) as a participating [Tribe](/usc/25/3402.md?p=2-A) under [paragraph (1)](#d-1). - (3) **Designation of participating tribes—** - (A) **In general—** The Attorney General, in consultation with the [Secretary](/usc/25/5130.md?p=1) of the Interior and affected [Indian tribes](/usc/25/1301.md?p=1), shall establish a process to designate [Indian tribes](/usc/25/1301.md?p=1) to participate in the pilot [program](/usc/25/3402.md?p=4), which process shall— - (i) require that preference shall be given to [Indian tribes](/usc/25/1301.md?p=1) occupying Villages— - (I) the populations of which are predominantly [Indian](/usc/25/1301.md?p=4); and - (II) that lack a permanent State law enforcement physical presence; - (ii) require that for each [Indian tribe](/usc/25/1301.md?p=1) requesting to be designated as a participating [Tribe](/usc/25/3402.md?p=2-A), the Attorney General makes a determination that the criminal justice system of the [Indian tribe](/usc/25/1301.md?p=1) has adequate safeguards in place to protect defendants’ rights, consistent with section 204(d) of Public Law 90–284 ([25 U.S.C. 1304(d)](/usc/25/1304.md?p=d)) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”); and - (iii) be subject to such other criteria as the Attorney General considers to be appropriate to achieve the purposes of this subtitle. - (B) **Designation—** The Attorney General shall designate [Indian tribes](/usc/25/1301.md?p=1) to participate in the pilot [program](/usc/25/3402.md?p=4) under [paragraph (1)](#d-1) using the process established under [subparagraph (A)](#d-3-A). - (4) **Intertribal participation—** - (A) **In general—** 2 or more participating [Tribes](/usc/25/3402.md?p=2-A) (or the [Tribal organization](/usc/25/2902.md?p=5) (as defined in [section 5304 of this title](/usc/25/5304.md)) of the participating [Tribe](/usc/25/3402.md?p=2-A), if the [Tribal organization](/usc/25/2902.md?p=5) is exercising delegated authority from the participating [Tribe](/usc/25/3402.md?p=2-A))— - (i) may elect to participate jointly in the pilot [program](/usc/25/3402.md?p=4) by providing shared resources to carry out the purposes of the pilot [program](/usc/25/3402.md?p=4); and - (ii) on making an election pursuant to [clause (i)](#d-4-A-i), shall be considered to be a single participating [Tribe](/usc/25/3402.md?p=2-A) for purposes of the maximum number of participating [Tribes](/usc/25/3402.md?p=2-A) under paragraphs [(1)](#d-1) and [(5)](#d-5). - (B) **Additional participating tribes—** - (i) **In general—** Additional participating [Tribes](/usc/25/3402.md?p=2-A) may elect to join an established intertribal partnership under [subparagraph (A)](#d-4-A) at any time after the intertribal partnership is established. - (ii) **Application—** An intertribal partnership that additional participating [Tribes](/usc/25/3402.md?p=2-A) elect to join pursuant to [clause (i)](#d-4-B-i) shall be considered to be a single participating [Tribe](/usc/25/3402.md?p=2-A) for purposes of the maximum number of participating [Tribes](/usc/25/3402.md?p=2-A) under paragraphs [(1)](#d-1) and [(5)](#d-5). - (5) **Maximum number of participating tribes—** - (A) **In general—** Except as provided in [subparagraph (B)](#d-5-B), the Attorney General may designate not more than 30 [Indian tribes](/usc/25/1301.md?p=1) to participate in the pilot [program](/usc/25/3402.md?p=4). - (B) **Exception—** The limitation under [subparagraph (A)](#d-5-A) shall not apply if the Attorney General submits to the [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1301.md?p=4) Affairs of the Senate and the [Committee](/usc/25/5411.md?p=3) on Natural Resources of the House of Representatives, and publishes in the Federal Register, a written notice of the intention to designate additional [Indian tribes](/usc/25/1301.md?p=1) as participating [Tribes](/usc/25/3402.md?p=2-A), including the rationale for the designation, by not later than the date that is 180 days before the date of designation. - (6) **Description of jurisdiction—** Congress recognizes and affirms that an [Indian tribe](/usc/25/1301.md?p=1) selected to participate in the pilot [program](/usc/25/3402.md?p=4) as a participating [Tribe](/usc/25/3402.md?p=2-A) may exercise, subject to [paragraph (7)](#d-7), special Tribal criminal jurisdiction with respect to covered crimes. - (7) **Rights of defendants—** In exercising special Tribal criminal jurisdiction under the pilot [program](/usc/25/3402.md?p=4), a participating [Tribe](/usc/25/3402.md?p=2-A) shall provide to each defendant all rights described in section 204(d) of Public Law 90–284 ([25 U.S.C. 1304(d)](/usc/25/1304.md?p=d)) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”). - (e) **Sentences—** In a criminal proceeding in which an [Indian court](/usc/25/1301.md?p=3) of a participating [Tribe](/usc/25/3402.md?p=2-A), in exercising special Tribal criminal jurisdiction with respect to a covered crime, imposes a sentence of imprisonment of more than 1 year on a defendant pursuant to section 202(b) of Public Law 90–284 ([25 U.S.C. 1302(b)](/usc/25/1302.md?p=b)) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”), the [Indian court](/usc/25/1301.md?p=3) may require the defendant— - (1) to serve a sentence— - (A) in a Tribal correctional center that has been approved by the Bureau of [Indian](/usc/25/1301.md?p=4) Affairs for long-term incarceration, in accordance with guidelines set by the Bureau of [Indian](/usc/25/1301.md?p=4) Affairs; - (B) at the expense of the United States, in the nearest appropriate Federal facility pursuant to the Bureau of Prisons Tribal Prisoner [Program](/usc/25/3402.md?p=4) established under [section 1302a(c)(1) of this title](/usc/25/1302a.md); or - (C) at the expense of the participating [Tribe](/usc/25/3402.md?p=2-A) and, subject to section 204(f)(1) of Public Law 90–284 ([25 U.S.C. 1304(f)(1)](/usc/25/1304.md?p=f-1)) (commonly known as the “[Indian](/usc/25/1301.md?p=4) Civil Rights Act of 1968”), reimbursable by the Attorney General, in a detention or correctional center approved by the State or a local government of the State pursuant to a memorandum of agreement between the participating [Tribe](/usc/25/3402.md?p=2-A) and the State or local government of the State; or - (2) to serve another alternative form of punishment, as determined by the [Indian court](/usc/25/1301.md?p=3) pursuant to Tribal law. - (f) **Memoranda of agreement—** The Attorney General and the [Secretary](/usc/25/5130.md?p=1) of the Interior may enter into such memoranda of agreement with participating [Tribes](/usc/25/3402.md?p=2-A) and the State as are necessary and appropriate— - (1) to coordinate respective law enforcement activities; - (2) to share equipment and other resources; - (3) to establish cross-deputization arrangements; - (4) to coordinate appropriate training activities; and - (5) to address any other matters that will facilitate the successful implementation of the pilot [program](/usc/25/3402.md?p=4), including intergovernmental agreements regarding— - (A) the incarceration of convicted persons; and - (B) cooperation in the investigation and prosecution of crimes. - (g) **Alaska Tribal Public Safety Advisory Committee—** - (1) **Establishment—** Not later than 1 year March 15, 2022, the Attorney General, in consultation with the [Secretary](/usc/25/5130.md?p=1) of the Interior, affected [Indian tribes](/usc/25/1301.md?p=1), and the State, shall establish a [committee](/usc/25/5411.md?p=3), to be known as the “Alaska Tribal Public Safety Advisory [Committee](/usc/25/5411.md?p=3)” (referred to in this subsection as the “[Committee](/usc/25/5411.md?p=3)”). - (2) **Membership—** The [Committee](/usc/25/5411.md?p=3) shall consist of 1 or more representatives from— - (A) participating [Tribes](/usc/25/3402.md?p=2-A) and [Indian tribes](/usc/25/1301.md?p=1) aspiring to participate in the pilot [program](/usc/25/3402.md?p=4); - (B) Federal, Tribal, State, and local law enforcement; and - (C) Tribal nonprofit organizations providing victim services. - (3) **Duties—** The [Committee](/usc/25/5411.md?p=3) shall focus on— - (A) improving the justice systems, crime prevention, and victim services of [Indian tribes](/usc/25/1301.md?p=1) and the State; and - (B) increasing coordination and communication among Federal, Tribal, State, and local law enforcement agencies. - (4) **Travel expenses—** A member of the [Committee](/usc/25/5411.md?p=3) shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of [chapter 57](/usc/5/chptIII-sptD-ch57.md) of title 5, while away from their homes or regular places of business in the performance of services for the [Committee](/usc/25/5411.md?p=3). - (5) **Nonapplicability of FACA—** The Federal Advisory Committee Act (5 U.S.C. App.)[^1] shall not apply to the [Committee](/usc/25/5411.md?p=3). - (6) **Authorization of appropriations—** There are authorized to be appropriated to carry out this subsection such sums as may be necessary for the period of fiscal years 2023 through 2027, to remain available until expended. - (h) **Report to Congress—** Not later than 5 years after March 15, 2022, the Attorney General, in consultation with the [Secretary](/usc/25/5130.md?p=1) of the Interior and affected [Indian tribes](/usc/25/1301.md?p=1), shall submit to Congress a report describing the results of the pilot [program](/usc/25/3402.md?p=4), including an explanation of any modifications to law necessary to facilitate improved law enforcement in Villages. - (i) **Applicability—** Nothing in this subtitle— - (1) limits, alters, expands, or diminishes the civil or criminal jurisdiction of the United States, the State, any subdivision of the State, or any [Indian tribe](/usc/25/1301.md?p=1) in the State; - (2) creates or eliminates any Federal or State criminal jurisdiction over a Village; or - (3) affects the authority of the United States or any authority delegated by the United States to the State to investigate and prosecute a criminal violation in a Village. # §1311. Model code The [Secretary](/usc/25/5130.md?p=1) of the Interior is authorized and directed to recommend to the Congress, on or before July 1, 1968, a model code to govern the administration of justice by courts of [Indian](/usc/25/1934.md) offenses on [Indian reservations](/usc/25/3653.md?p=3). Such code shall include provisions which will (1) assure that any individual being tried for an offense by a court of [Indian](/usc/25/1934.md) offenses shall have the same rights, privileges, and immunities under the United States Constitution as would be guaranteed any citizen of the United States being tried in a Federal court for any similar offense, (2) assure that any individual being tried for an offense by a court of [Indian](/usc/25/1934.md) offenses will be advised and made aware of his rights under the United States Constitution, and under any tribal constitution applicable to such individual, (3) establish proper qualifications for the [office](/usc/25/4001.md?p=4) of judge of the court of [Indian](/usc/25/1934.md) offenses, and (4) provide for the establishing of educational classes for the training of judges of courts of [Indian](/usc/25/1934.md) offenses. In carrying out the provisions of this subchapter, the [Secretary](/usc/25/5130.md?p=1) of the Interior shall consult with the [Indians](/usc/25/1934.md), [Indian tribes](/usc/25/81.md?p=a-2), and interested agencies of the United States. # §1312. Authorization of appropriations There is hereby authorized to be appropriated such sum as may be necessary to carry out the provisions of this subchapter. # §1321. Assumption by State of criminal jurisdiction - (a) **Consent of United States—** - (1) **In general—** The consent of the United States is hereby given to any State not having jurisdiction over criminal offenses committed by or against [Indians](/usc/25/1934.md) in the areas of [Indian](/usc/25/1934.md) country situated within such State to assume, with the consent of the [Indian tribe](/usc/25/81.md?p=a-2) occupying the particular [Indian](/usc/25/1934.md) country or part thereof which could be affected by such assumption, such measure of jurisdiction over any or all of such offenses committed within such [Indian](/usc/25/1934.md) country or any part thereof as may be determined by such State to the same extent that such State has jurisdiction over any such offense committed elsewhere within the State, and the criminal laws of such State shall have the same force and effect within such [Indian](/usc/25/1934.md) country or part thereof as they have elsewhere within that State. - (2) **Concurrent jurisdiction—** At the request of an [Indian tribe](/usc/25/81.md?p=a-2), and after consultation with and consent by the Attorney General, the United States shall accept concurrent jurisdiction to prosecute violations of sections [1152](/usc/18/1152.md) and [1153](/usc/18/1153.md) of title 18 within the [Indian](/usc/25/1934.md) country of the [Indian tribe](/usc/25/81.md?p=a-2). - (b) **Alienation, encumbrance, taxation, and use of property; hunting, trapping, or fishing—** Nothing in this section shall authorize the alienation, encumbrance, or taxation of any real or personal property, including water rights, belonging to any [Indian](/usc/25/1934.md) or any [Indian tribe](/usc/25/81.md?p=a-2), band, or community that is held in trust by the United States or is subject to a restriction against alienation imposed by the United States; or shall authorize regulation of the use of such property in a manner inconsistent with any Federal treaty, agreement, or statute or with any regulation made pursuant thereto; or shall deprive any [Indian](/usc/25/1934.md) or any [Indian tribe](/usc/25/81.md?p=a-2), band, or community of any right, privilege, or immunity afforded under Federal treaty, agreement, or statute with respect to hunting, trapping, or fishing or the control, licensing, or regulation thereof. # §1322. Assumption by State of civil jurisdiction - (a) **Consent of United States; force and effect of civil laws—** The consent of the United States is hereby given to any State not having jurisdiction over civil causes of action between [Indians](/usc/25/1934.md) or to which [Indians](/usc/25/1934.md) are parties which arise in the areas of [Indian](/usc/25/1934.md) country situated within such State to assume, with the consent of the [tribe](/usc/25/3402.md?p=2-A) occupying the particular [Indian](/usc/25/1934.md) country or part thereof which would be affected by such assumption, such measure of jurisdiction over any or all such civil causes of action arising within such [Indian](/usc/25/1934.md) country or any part thereof as may be determined by such State to the same extent that such State has jurisdiction over other civil causes of action, and those civil laws of such State that are of general application to private persons or private property shall have the same force and effect within such [Indian](/usc/25/1934.md) country or part thereof as they have elsewhere within that State. - (b) **Alienation, encumbrance, taxation, use, and probate of property—** Nothing in this section shall authorize the alienation, encumbrance, or taxation of any real or personal property, including water rights, belonging to any [Indian](/usc/25/1934.md) or any [Indian tribe](/usc/25/81.md?p=a-2), band, or community that is held in trust by the United States or is subject to a restriction against alienation imposed by the United States; or shall authorize regulation of the use of such property in a manner inconsistent with any Federal treaty, agreement, or statute, or with any regulation made pursuant thereto; or shall [confer](/usc/25/5702.md?p=1) jurisdiction upon the State to adjudicate, in probate proceedings or otherwise, the ownership or right to possession of such property or any interest therein. - (c) **Force and effect of tribal ordinances or customs—** Any tribal ordinance or custom heretofore or hereafter adopted by an [Indian tribe](/usc/25/81.md?p=a-2), band, or community in the exercise of any authority which it may possess shall, if not inconsistent with any applicable civil law of the State, be given full force and effect in the determination of civil causes of action pursuant to this section. # §1323. Retrocession of jurisdiction by State - (a) **Acceptance by United States—** The United States is authorized to accept a retrocession by any State of all or any measure of the criminal or civil jurisdiction, or both, acquired by such State pursuant to the provisions of [section 1162 of title 18](/usc/18/1162.md), [section 1360 of title 28](/usc/28/1360.md), or section 7 of the Act of August 15, 1953 (67 Stat. 588), as it was in effect prior to its repeal by [subsection (b)](#b) of this section. - (b) **Repeal of statutory provisions—** Section 7 of the Act of August 15, 1953 (67 Stat. 588), is hereby repealed, but such repeal shall not affect any cession of jurisdiction made pursuant to such section prior to its repeal. # §1324. Amendment of State constitutions or statutes to remove legal impediment; effective date Notwithstanding the provisions of any enabling Act for the admission of a State, the consent of the United States is hereby given to the people of any State to amend, where necessary, their State constitution or existing statutes, as the case may be, to remove any legal impediment to the assumption of civil or criminal jurisdiction in accordance with the provisions of this subchapter. The provisions of this subchapter shall not become effective with respect to such assumption of jurisdiction by any such State until the people thereof have appropriately amended their State constitution or statutes, as the case may be. # §1325. Abatement of actions - (a) **Pending actions or proceedings; effect of cession—** No action or proceeding pending before any court or agency of the United States immediately prior to any cession of jurisdiction by the United States pursuant to this subchapter shall abate by reason of that cession. For the purposes of any such action or proceeding, such cession shall take effect on the day following the date of final determination of such action or proceeding. - (b) **Criminal actions; effect of cession—** No cession made by the United States under this subchapter shall deprive any court of the United States of jurisdiction to hear, determine, render judgment, or impose sentence in any criminal action instituted against any person for any offense committed before the effective date of such cession, if the offense charged in such action was cognizable under any law of the United States at the time of the [commission](/usc/25/2703.md?p=3) of such offense. For the purposes of any such criminal action, such cession shall take effect on the day following the date of final determination of such action. # §1326. Special election State jurisdiction acquired pursuant to this subchapter with respect to criminal offenses or civil causes of action, or with respect to both, shall be applicable in [Indian](/usc/25/1934.md) country only where the enrolled [Indians](/usc/25/1934.md) within the affected area of such [Indian](/usc/25/1934.md) country accept such jurisdiction by a majority vote of the adult [Indians](/usc/25/1934.md) voting at a special election held for that purpose. The [Secretary](/usc/25/5130.md?p=1) of the Interior shall call such special election under such rules and regulations as he may prescribe, when requested to do so by the tribal council or other governing body, or by 20 per centum of such enrolled adults. # §1331. Approval Notwithstanding any other provision of law, if any application made by an [Indian](/usc/25/1934.md), [Indian tribe](/usc/25/81.md?p=a-2), [Indian](/usc/25/1934.md) council, or any band or group of [Indians](/usc/25/1934.md) under any law requiring the approval of the [Secretary](/usc/25/5130.md?p=1) of the Interior or the Commissioner of [Indian](/usc/25/1934.md) Affairs of contracts or agreements relating to the employment of legal counsel (including the choice of counsel and the fixing of fees) by any such [Indians](/usc/25/1934.md), [tribe](/usc/25/3402.md?p=2-A), council, band, or group is neither granted nor denied within ninety days following the making of such application, such approval shall be deemed to have been granted. # §1341. Authorization of Secretary - (a) **Revision of document on “Indian Affairs, Laws and Treaties” and treatise on “Federal Indian Laws”; compilation of official opinions; printing and republication—** In order that the constitutional rights of [Indians](/usc/25/1934.md) might be fully protected, the [Secretary](/usc/25/5130.md?p=1) of the Interior is authorized and directed to— - (1) have the document entitled “[Indian](/usc/25/1934.md) Affairs, Laws and Treaties” (Senate Document Numbered 319, volumes 1 and 2, Fifty-eighth Congress), revised and extended to include all treaties, laws, Executive orders, and regulations relating to [Indian](/usc/25/1934.md) affairs in force on September 1, 1967, and to have such revised document printed at the Government Publishing Office; - (2) have revised and republished the treatise entitled “Federal [Indian](/usc/25/1934.md) Law”; and - (3) have prepared, to the extent determined by the [Secretary](/usc/25/5130.md?p=1) of the Interior to be feasible, an accurate compilation of the official opinions, published and unpublished, of the Solicitor of the Department of the Interior relating to [Indian](/usc/25/1934.md) affairs rendered by the Solicitor prior to September 1, 1967, and to have such compilation printed as a Government publication at the Government Publishing Office. - (b) **Current services—** With respect to the document entitled “[Indian](/usc/25/1934.md) Affairs, Laws and Treaties” as revised and extended in accordance with [paragraph (1)](#a-1) of subsection (a), and the compilation prepared in accordance with [paragraph (3)](#a-3) of such subsection, the [Secretary](/usc/25/5130.md?p=1) of the Interior shall take such action as may be necessary to keep such document and compilation current on an annual basis. - (c) **Authorization of appropriations—** There is authorized to be appropriated for carrying out the provisions of this subchapter such sum as may be necessary. # §1401. Funds appropriated in satisfaction of judgments of Indian Claims Commission or United States Court of Federal Claims - (a) **Use and distribution—** Notwithstanding any other law, all use or distribution of funds appropriated in satisfaction of a judgment of the [Indian](/usc/25/1934.md) Claims [Commission](/usc/25/2703.md?p=3) or the United States Court of Federal Claims in favor of any [Indian tribe](/usc/25/81.md?p=a-2), band, group, pueblo, or community (hereinafter referred to as “[Indian tribe](/usc/25/81.md?p=a-2)”), together with any investment income earned thereon, after payment of attorney fees and litigation expenses, shall be made pursuant to the provisions of this chapter. - (b) **Amounts remaining to be held in trust unless otherwise provided—** Except as provided in sections [164](/usc/25/164.md) and [165](/usc/25/165.md) of this title, amounts which the [Secretary](/usc/25/5130.md?p=1) of the Interior has remaining after execution of either a plan under this chapter, or another Act enacted heretofore or hereafter providing for the use or distribution of amounts awarded in satisfaction of a judgment in favor of an [Indian tribe](/usc/25/81.md?p=a-2) or [tribes](/usc/25/3402.md?p=2-A), together with any investment income earned thereon and after payment of attorney fees and litigation expenses, shall be held in trust by the [Secretary](/usc/25/5130.md?p=1) for the [tribe](/usc/25/3402.md?p=2-A) or [tribes](/usc/25/3402.md?p=2-A) involved if the plan or Act does not otherwise provide for the use of such amounts. - (c) **Short title—** This chapter may be cited as the “[Indian](/usc/25/1934.md) Tribal Judgment Funds Use or Distribution Act”. # §1402. Plan for use or distribution of funds - (a) **Preparation and submission to Congress by Secretary of the Interior; contents; copy to affected Indian tribe—** Within one year after appropriation of funds to pay a judgment of the [Indian](/usc/25/1934.md) Claims [Commission](/usc/25/2703.md?p=3) or the United States Court of Federal Claims to any [Indian tribe](/usc/25/81.md?p=a-2), the [Secretary](/usc/25/5130.md?p=1) of the Interior shall prepare and submit to Congress a plan for the use and distribution of the funds. Such plan shall include identification of the present-day beneficiaries, a formula for the division of the funds among two or more beneficiary entities if such is warranted, and a proposal for the use and distribution of the funds. The [Secretary](/usc/25/5130.md?p=1) shall simultaneously submit a copy of such plan to each affected [tribe](/usc/25/3402.md?p=2-A) or group. - (b) **Time for preparation and submission of plan—** With respect to judgments, for which funds have been appropriated prior to January 12, 1983, but for which use or distribution has not been authorized by enactment of legislation or by an effective plan under this chapter, the [Secretary](/usc/25/5130.md?p=1) shall prepare and submit such plans within one year of January 12, 1983. - (c) **Submission of proposed legislation and report to Congress—** In any case where the [Secretary](/usc/25/5130.md?p=1) determines that the circumstances do not permit the preparation and submission of a plan as provided in this chapter, he shall submit to the Congress within the one-year period proposed legislation to authorize use or distribution of such funds, together with a report thereon. - (d) **Submission of proposed legislation and report to Congress in absence of consent of tribal governments to division of judgment funds between two or more beneficiary entities—** In cases where the [Secretary](/usc/25/5130.md?p=1) has to submit a plan dividing judgment funds between two or more beneficiary entities, he shall obtain the consent of the tribal governments involved to the proposed division. If the [Secretary](/usc/25/5130.md?p=1) cannot obtain such consent within one hundred and eighty days after appropriation of the funds for the award or within one hundred and eighty days of January 12, 1983, he shall submit proposed legislation to the Congress as provided in [subsection (c)](#c). - (e) **Extension of time for preparation and submission of plan—** An extension of the one-year period, not to exceed one hundred and eighty days, may be requested by the [Secretary](/usc/25/5130.md?p=1) or by the affected [Indian tribe](/usc/25/81.md?p=a-2), submitting such request to the [committees](/usc/25/5411.md?p=3) through the [Secretary](/usc/25/5130.md?p=1), and any such request will be subject to the approval of both the Senate [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs and the United States House of Representatives [Committee](/usc/25/5411.md?p=3) on Natural Resources. # §1403. Preparation of plan - (a) **Prerequisites for final preparation—** The [Secretary](/usc/25/5130.md?p=1) shall prepare a plan which shall best serve the interests of all those entities and individuals entitled to receive funds of each [Indian](/usc/25/1934.md) judgment. Prior to the final preparation of the plan, the [Secretary](/usc/25/5130.md?p=1) shall— - (1) receive and consider any resolution or communication, together with any suggested use or distribution plan, which any affected [Indian tribe](/usc/25/81.md?p=a-2) may wish to submit to him; and - (2) hold a hearing of record, after appropriate public notice, to obtain the testimony of leaders and members of the [Indian tribe](/usc/25/81.md?p=a-2) which may receive any portion, or be affected by the use or distribution, of such funds, in the area in which such [Indian tribe](/usc/25/81.md?p=a-2) is located and at a time which shall best serve the convenience of the eligible members thereof. - (b) **Guidelines—** In preparing a plan for the use or distribution of the funds of each [Indian](/usc/25/1934.md) judgment, the [Secretary](/usc/25/5130.md?p=1) shall, among other things, be assured that— - (1) legal, financial, and other expertise of the Department of the Interior has been made fully available in an advisory capacity to the [Indian tribe](/usc/25/81.md?p=a-2) which is entitled to such funds to assist it to develop and communicate to the [Secretary](/usc/25/5130.md?p=1) pursuant to [clause (1)](#a-1) of subsection (a) of this section its own suggested plan for the distribution and use of such funds; - (2) the needs and desires of any groups or individuals who are in a minority position, but who are also entitled to receive such funds, have been fully ascertained and considered; - (3) the interests of minors and other legally incompetent persons who are entitled to receive any portion of such funds as are subsequently distributed to them are and will be protected and preserved;[^1] Provided, That such funds may be disbursed to the parents or legal guardian of such minors or legal incompetents in such amounts as may be necessary for the minor or legal incompetent’s health, education, welfare, or emergencies under a plan or plans approved by the [Secretary](/usc/25/5130.md?p=1) and the tribal governing body of the [Indian tribe](/usc/25/81.md?p=a-2) involved.[^2] - (4) any provision, including enrollment provisions, of the constitution, bylaws, rules, and procedures of such [tribe](/usc/25/3402.md?p=2-A) which may affect the distribution or other use of such funds are in full accord with the principles of fairness and equity; - (5) a significant portion of such funds shall be set aside and programed to serve common tribal needs, educational requirements, and such other purposes as the circumstances of the affected [Indian tribe](/usc/25/81.md?p=a-2) may justify, except not less than 20 per centum of such funds shall be so set aside and programed unless the [Secretary](/usc/25/5130.md?p=1) determines that the particular circumstances of the pertinent [Indian tribe](/usc/25/81.md?p=a-2) clearly warrant otherwise: Provided, That in the development of such plan the [Secretary](/usc/25/5130.md?p=1) shall survey past and present plans of the [tribe](/usc/25/3402.md?p=2-A) for economic development, shall consider long range benefits which might accrue to the [tribe](/usc/25/3402.md?p=2-A) from such plans, and shall encourage programing of funds for economic development purposes where appropriate; and - (6) methods exist and will be employed to insure the proper performance of the plan once it becomes effective under [section 1405 of this title](/usc/25/1405.md). # §1404. Hearing transcripts and tribal support statements; submission to Congress with plan When submitting the plan as provided in [section 1402 of this title](/usc/25/1402.md), the [Secretary](/usc/25/5130.md?p=1) shall also submit to the Congress with such plan— - (1) copies of the transcripts of hearings held by him concerning the [Indian](/usc/25/1934.md) judgment pursuant to clause (2) of [section 1403(a) of this title](/usc/25/1403.md?p=a) and all other papers and documents considered by him in the preparation of such plan, including any resolution, communication, or suggested use or distribution plan of the pertinent [Indian tribe](/usc/25/81.md?p=a-2) submitted pursuant to clause (1) of [section 1403(a) of this title](/usc/25/1403.md?p=a); and - (2) a statement of the extent to which such plan reflects the desires of the [Indian tribe](/usc/25/81.md?p=a-2) or individuals who are entitled to such funds, which statement shall specify the alternatives, if any, proposed by such [Indian tribe](/usc/25/81.md?p=a-2) or individuals in lieu of such plan, together with an indication of the degree of support among the interested parties for each such alternative. # §1405. Effective date of plan; joint resolution of disapproval - (a) **Original plan—** The plan prepared by the [Secretary](/usc/25/5130.md?p=1) shall become effective, and he shall take immediate action to implement the plan for the use or distribution of such judgment funds, at the end of the sixty-day period (excluding days on which either the House of Representatives or the Senate is not in session because of an adjournment of more than three calendar days to a day certain) beginning on the day such plan is submitted to the Congress, unless during such sixty-day period a joint resolution is enacted disapproving such plans. - (b) **Proposed legislation and report to Congress following Congressional disapproval—** Within thirty calendar days after the date of enactment of a joint resolution disapproving a plan, the [Secretary](/usc/25/5130.md?p=1) shall submit to the Congress proposed legislation, together with a report thereon, authorizing use or distribution of such funds. - (c) **Successor plan previously withdrawn or amended prior to Congressional action; consent to amendments—** Within the sixty-day period and before the adoption of any resolution disapproving a plan, the [Secretary](/usc/25/5130.md?p=1) may withdraw or amend such plan: Provided, That any amendments affecting the division of an award between two or more beneficiary entities shall be subject to the consent of these entities as provided in [section 1402(d) of this title](/usc/25/1402.md?p=d). Any such amended plan shall become valid at the end of a sixty-day period beginning on the day such amendment is submitted to the Congress, unless during such sixty-day period, a joint resolution is enacted disapproving such plan as amended. - (d) **Resubmission of successor plan within prescribed period following withdrawal of plan—** Once a plan is withdrawn before the end of a sixty-day period, the [Secretary](/usc/25/5130.md?p=1) has until the expiration of the original one-year deadline to resubmit a plan to Congress. Such a plan shall become valid at the end of a sixty-day period beginning on the day such new plan is submitted to the Congress, unless during such sixty-day period, a joint resolution is enacted disapproving such plan. - (e) **Recomputation of sixty-day period from date of introduction of joint resolution of disapproval; reextension restriction—** Upon the introduction of the first such resolution of disapproval in either the House of Representatives or the Senate, the sixty-day period shall be recomputed from the date of such introduction and shall not again be extended. # §1406. Rules and regulations - (a) **Promulgation—** The [Secretary](/usc/25/5130.md?p=1) shall promulgate rules and regulations to implement this chapter no later than the end of the one hundred and eighty-day period beginning on October 19, 1973. Among other things, such rules and regulations shall provide for adequate notice to all entities and persons who may receive funds under any [Indian](/usc/25/1934.md) judgment of all relevant procedures pursuant to this chapter concerning any such judgment. - (b) **Publication in Federal Register—** No later than sixty days prior to the promulgation of such rules and regulations the [Secretary](/usc/25/5130.md?p=1) shall publish the proposed rules and regulations in the Federal Register. - (c) **Hearings—** No later than thirty days prior to the promulgation of such rules and regulations, the [Secretary](/usc/25/5130.md?p=1) shall provide, with adequate public notice, the opportunity for hearings on the proposed rules and regulations, once published, to all interested parties. # §1407. Tax exemption; resources exemption limitation None of the funds which— - (1) are distributed per capita or held in trust pursuant to a plan approved under the provisions of this chapter, or[^1] - (2) on January 12, 1983, are to be distributed per capita or are held in trust pursuant to a plan approved by the Congress prior to January 12, 1983, - (3) were distributed pursuant to a plan approved by Congress after December 31, 1981 but prior to January 12, 1983, and any purchases made with such funds, or - (4) are paid by the State of Minnesota to the Bois Forte Band of Chippewa [Indians](/usc/25/1934.md) or the Grand Portage Band of Lake Superior Chippewa [Indians](/usc/25/1934.md), or both, pursuant to the agreements of each Band to voluntarily restrict tribal rights to hunt and fish in territory cede[^2] under the Treaty of September 30, 1854 (10 Stat. 1109), including all interest accrued on such funds during any period in which such funds are held in a minor’s trust, including all interest and investment income accrued thereon while such funds are so held in trust, shall be subject to Federal or State income taxes, nor shall such funds nor their availability be considered as income or resources nor otherwise utilized as the basis for denying or reducing the financial assistance or other benefits to which such household or member would otherwise be entitled under the Social Security Act [[42 U.S.C. 301](/usc/42/301.md) et seq.] or, except for per capita shares in excess of $2,000, any Federal or federally assisted [program](/usc/25/3402.md?p=4). # §1408. Resources exemption Interests of individual [Indians](/usc/25/1934.md) in trust or restricted lands shall not be considered a resource, and up to $2,000 per year of income received by individual [Indians](/usc/25/1934.md) that is derived from such interests shall not be considered income, in determining eligibility for assistance under the Social Security Act [[42 U.S.C. 301](/usc/42/301.md) et seq.] or any other Federal or federally assisted [program](/usc/25/3402.md?p=4). # §1451. Congressional declaration of policy It is hereby declared to be the policy of Congress to provide capital on a reimbursable basis to help develop and utilize [Indian](/usc/25/1452.md?p=b) resources, both physical and human, to a point where the [Indians](/usc/25/1452.md?p=b) will fully exercise responsibility for the utilization and management of their own resources and where they will enjoy a standard of living from their own productive efforts comparable to that enjoyed by non-[Indians](/usc/25/1452.md?p=b) in neighboring communities. # §1452. Definitions For the purpose of this chapter, the term— - (a) “Secretary” means the Secretary of the Interior. - (b) “Indian” means any person who is a member of any [Indian tribe](/usc/25/81.md?p=a-2), band, group, pueblo, or community which is recognized by the Federal Government as eligible for services from the Bureau of Indian Affairs and any “[Native](/usc/25/5802.md?p=5)” as defined in the Alaska [Native](/usc/25/5802.md?p=5) Claims Settlement Act [[43 U.S.C. 1601](/usc/43/1601.md) et seq.]. - (c) “Tribe” means any [Indian tribe](/usc/25/81.md?p=a-2), band, group, pueblo, or community, including [Native](/usc/25/5802.md?p=5) villages and [Native](/usc/25/5802.md?p=5) groups (including corporations organized by Kenai, Juneau, Sitka, and Kodiak) as defined in the Alaska [Native](/usc/25/5802.md?p=5) Claims Settlement Act [[43 U.S.C. 1601](/usc/43/1601.md) et seq.], which is recognized by the Federal Government as eligible for services from the Bureau of [Indian](#b) Affairs. - (d) “Reservation” includes [Indian reservations](/usc/25/3653.md?p=3), public domain [Indian](#b) allotments, [former Indian reservations in Oklahoma](/usc/25/3653.md?p=3), and land held by incorporated [Native](/usc/25/5802.md?p=5) groups, regional corporations, and village corporations under the provisions of the Alaska [Native](/usc/25/5802.md?p=5) Claims Settlement Act [[43 U.S.C. 1601](/usc/43/1601.md) et seq.]. - (e) “Economic enterprise” means any [Indian](#b)-owned (as defined by the [Secretary](#a) of the Interior) commercial, industrial, or business activity established or organized for the purpose of profit: Provided, That such [Indian](#b) ownership shall constitute not less than 51 per centum of the enterprise. - (f) “Organization”, unless otherwise specified, shall be the governing body of any [Indian tribe](/usc/25/81.md?p=a-2), as defined in [subsection (c)](#c), or entity established or recognized by such governing body for the purpose of this chapter. - (g) “Other organizations” means any non-[Indian](#b) individual, firm, corporation, partnership, or association. - (h) “Surety” has the same meaning as in [section 694a of title 15](/usc/15/694a.md). - (i) “Surety Bond” means a bid bond, payment bond, or performance bond as those terms are defined in [section 694a of title 15](/usc/15/694a.md). # §1453. Assistance or activities of other Federal agencies unaffected No provision of this chapter or any other Act shall be construed to terminate or otherwise curtail the assistance or activities of the Small Business Administration or any other Federal agency with respect to any [Indian tribe](/usc/25/81.md?p=a-2), organization, or individual because of their eligibility for assistance under this chapter. # §1461. Administration as single Indian Revolving Loan Fund sums from diverse sources; availability of fund for loans to Indians and for administrative expenses In order to provide credit that is not available from private money markets, or to supplement funds from private lenders, including loans guaranteed by the [Secretary](/usc/25/1452.md?p=a) pursuant to [section 1481 of this title](/usc/25/1481.md), all funds that are now or hereafter a part of the revolving fund authorized by the Act of June 18, 1934 (48 Stat. 986) [[25 U.S.C. 5101](/usc/25/5101.md) et seq.], the Act of June 26, 1936 (49 Stat. 1968),[^1] and the Act of April 19, 1950 (64 Stat. 44), as amended and supplemented, including sums received in settlement of debts of livestock pursuant to sections [1545](/usc/25/1545.md) and [1546](/usc/25/1546.md) of this title, and sums collected in repayment of loans heretofore or hereafter made, and as interest or other charges on loans, shall hereafter be administered as a single [Indian](/usc/25/1452.md?p=b) Revolving Loan Fund. The fund shall be available for loans to [Indians](/usc/25/1452.md?p=b) having a form of organization that is satisfactory to the [Secretary](/usc/25/1452.md?p=a) and for loans to individual [Indians](/usc/25/1452.md?p=b): Provided, That, where the [Secretary](/usc/25/1452.md?p=a) determines a rejection of a loan application from a member of an organization making loans to its membership from moneys borrowed from the fund is unwarranted, he may, in his discretion, make a direct loan to such individual from the fund. The fund shall also be available for administrative expenses incurred in connection therewith, or, in the discretion of the [Secretary](/usc/25/1452.md?p=a) of the Interior, as a contribution to the [Indian](/usc/25/1452.md?p=b) Loan Guaranty and Insurance Fund authorized by [section 1497 of this title](/usc/25/1497.md), or for the payment of interest subsidies authorized by [section 1511 of this title](/usc/25/1511.md). # §1462. Economic development; educational loans; limitation of loans to or investments in non-Indian organizations Loans may be made for any purpose which will promote the economic development of (a) the individual [Indian](/usc/25/1452.md?p=b) borrower, including loans for educational purposes, and (b) the [Indian](/usc/25/1452.md?p=b) organization and its members including loans by such organizations to [other organizations](/usc/25/1452.md?p=g) and investments in [other organizations](/usc/25/1452.md?p=g) regardless of whether they are organizations of [Indians](/usc/25/1452.md?p=b): Provided, That not more than 50 per centum of loan made to an organization shall be used by such organization for the purpose of making loans to or investments in non-[Indian](/usc/25/1452.md?p=b) organizations. # §1463. Repayment of loan; financing from other sources Loans may be made only when, in the judgment of the [Secretary](/usc/25/1452.md?p=a), there is a reasonable prospect of repayment, and only to applicants who in the opinion of the [Secretary](/usc/25/1452.md?p=a) are unable to obtain financing from other sources on reasonable terms and conditions. # §1464. Maturity of loans; interest rate; interest deferral on educational loans Loans shall be for terms that do not exceed thirty years and shall bear interest at (a) a rate determined by the [Secretary](/usc/25/1452.md?p=a) of the Treasury taking into consideration the market yield on municipal bonds: Provided, That in no event shall the rate be greater than the rate determined by the [Secretary](/usc/25/1452.md?p=a) of the Treasury taking into consideration the current average yield on outstanding marketable obligations of the United States of comparable maturity, plus (b) such additional charge, if any, toward covering other costs of the [program](/usc/25/3402.md?p=4) as the [Secretary](/usc/25/1452.md?p=a) may determine to be consistent with its purpose: Provided, That educational loans may provide for interest to be deferred while the borrower is in school or in the military service. # §1465. Modification of amount of loan and document securing loan in collection of loan or in best interests of the United States The [Secretary](/usc/25/1452.md?p=a) may cancel, adjust, compromise, or reduce the amount of any loan or any portion thereof heretofore or hereafter made from the revolving loan fund established by this subchapter and its predecessor constituent funds which he determines to be uncollectable in whole or in part, or which is collectable only at an unreasonable cost, or when such action would, in his judgment, be in the best interests of the United States. He may also adjust, compromise, subordinate, or modify the terms of any mortgage, lease, assignment, contract, agreement, or other document taken to secure such loans. # §1466. Land and personal property title Title to any land purchased by a [tribe](/usc/25/1452.md?p=c) or by an individual [Indian](/usc/25/1452.md?p=b) with loans made from the revolving loan fund may be taken in trust unless the land is located outside the boundaries of a [reservation](/usc/25/1452.md?p=d) or a tribal consolidation area approved by the [Secretary](/usc/25/1452.md?p=a). Title to any land purchased by a [tribe](/usc/25/1452.md?p=c) or an individual [Indian](/usc/25/1452.md?p=b) which is outside the boundaries of the [reservation](/usc/25/1452.md?p=d) or approved consolidation area may be taken in trust if the purchaser was the owner of trust or restricted interests in the land before the purchase, otherwise title shall be taken in the name of the purchasers without any restriction on alienation, control, or use. Title to any personal property purchased with a loan from the revolving loan fund shall be taken in the name of the purchaser. # §1467. Security for loan; assignment of securities; reasonable assurance of repayment Any organization receiving a loan from the revolving loan fund shall be required to assign to the United States as security for the loan all securities acquired in connection with the loans made to its members from such funds unless the [Secretary](/usc/25/1452.md?p=a) determines that the repayment of the loan to the United States is otherwise reasonably assured. # §1468. Authorization of appropriations There is authorized to be appropriated, to provide capital and to restore any impairment of capital for the revolving loan fund $50,000,000 exclusive of prior authorizations and appropriations. # §1469. Rules and regulations The [Secretary](/usc/25/1452.md?p=a) shall promulgate rules and regulations to carry out the provisions of this subchapter. # §1481. Loan guaranties and insurance - (a) **In general—** In order to provide access to private money sources which otherwise would not be available, the [Secretary](/usc/25/1452.md?p=a) may— - (1) guarantee not to exceed 90 per centum of the unpaid principal and interest due on any loan made to any organization of [Indians](/usc/25/1452.md?p=b) having a form or organization satisfactory to the [Secretary](/usc/25/1452.md?p=a), and to individual [Indians](/usc/25/1452.md?p=b); or - (2) insure loans under an agreement approved by the [Secretary](/usc/25/1452.md?p=a) whereby the lender will be reimbursed for losses in an amount not to exceed 15 per centum of the aggregate of such loans made by it, but not to exceed 90 per centum of the loss on any one loan. - (b) **Eligible borrowers—** The [Secretary](/usc/25/1452.md?p=a) may guarantee or insure loans under [subsection (a)](#a) to both for-profit and nonprofit borrowers. # §1482. Premium charges; deposits in Indian Loan Guaranty and Insurance Fund The [Secretary](/usc/25/1452.md?p=a) shall fix such premium charges for the insurance and guarantee of loans as are in his judgment adequate to cover expenses and probable losses, and deposit receipts from such charges in the [Indian](/usc/25/1452.md?p=b) Loan Guaranty and Insurance Fund established pursuant to [section 1497(a) of this title](/usc/25/1497.md?p=a). # §1483. Interest rate Loans guaranteed or insured pursuant to this subchapter shall bear interest (exclusive of premium charges for insurance, and service charge, if any) at rates not to exceed such per centum per annum on the principal obligation outstanding as the [Secretary](/usc/25/1452.md?p=a) determines to be reasonable taking into consideration the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United States. # §1484. Application for loan; approval by Secretary; issuance of certificate; limitations on amount of loans to individual Indians or economic enterprises; review by Secretary The application for a loan to be guaranteed hereunder shall be submitted to the [Secretary](/usc/25/1452.md?p=a) for approval. The [Secretary](/usc/25/1452.md?p=a) may review each loan application individually and independently from the lender. Upon approval, the [Secretary](/usc/25/1452.md?p=a) shall issue a certificate as evidence of the guaranty. Such certificate shall be issued only when, in the judgment of the [Secretary](/usc/25/1452.md?p=a), there is a reasonable prospect of repayment. No loan to an individual [Indian](/usc/25/1452.md?p=b) may be guaranteed or insured which would cause the total unpaid principal indebtedness to exceed $500,000. No loan to an [economic enterprise](/usc/25/1452.md?p=e) (as defined in [section 1452 of this title](/usc/25/1452.md)) in excess of $250,000, or such lower amount as the [Secretary](/usc/25/1452.md?p=a) may determine to be appropriate, shall be insured unless prior approval of the loan is obtained from the [Secretary](/usc/25/1452.md?p=a). # §1485. Sale or assignment of loans and underlying security - (a) **In general—** All or any portion of a loan guaranteed or insured under this subchapter, including the security given for the loan— - (1) may be transferred by the lender by sale or assignment to any person; and - (2) may be retransferred by the transferee. - (b) **Transfers of loans—** With respect to a transfer described in [subsection (a)](#a)— - (1) the transfer shall be consistent with such regulations as the [Secretary](/usc/25/1452.md?p=a) shall promulgate under [subsection (h)](#h); and - (2) the transferee shall give notice of the transfer to the [Secretary](/usc/25/1452.md?p=a). - (c) **Full faith and credit—** - (1) **In general—** The full faith and credit of the United States is pledged to the payment of all loan guarantees and loan insurance made under this subchapter after December 13, 2002. - (2) **Validity—** Except as provided in regulations in effect on the date on which a loan is made, the validity of a guarantee or insurance of a loan under this subchapter shall be incontestable. - (d) **Damages—** Notwithstanding [section 3302 of title 31](/usc/31/3302.md), the [Secretary](/usc/25/1452.md?p=a) may recover from a lender of a loan under this subchapter any damages suffered by the [Secretary](/usc/25/1452.md?p=a) as a result of a material breach of the obligations of the lender with respect to a guarantee or insurance by the [Secretary](/usc/25/1452.md?p=a) of the loan. - (e) **Fees—** - (1) **In general—** The [Secretary](/usc/25/1452.md?p=a) may collect a fee for any loan or guaranteed or insured portion of a loan that is transferred in accordance with this section. - (2) **Compensation of fiscal transfer agent—** A fiscal transfer agent designated under [subsection (f)](#f) may be compensated through any of the fees assessed under this section and any interest earned on any funds or fees collected by the fiscal transfer agent while the funds or fees are in the control of the fiscal transfer agent and before the time at which the fiscal transfer agent is contractually required to transfer such funds to the [Secretary](/usc/25/1452.md?p=a) or to transferees or other holders. - (f) **Central registration of loans—** On promulgation of final regulations under [subsection (h)](#h), the [Secretary](/usc/25/1452.md?p=a) shall— - (1) provide for a central registration of all guaranteed or insured loans transferred under this section; and - (2) enter into 1 or more contracts with a fiscal transfer agent— - (A) to act as the designee of the [Secretary](/usc/25/1452.md?p=a) under this section; and - (B) to carry out on behalf of the [Secretary](/usc/25/1452.md?p=a) the central registration and fiscal transfer agent functions under this section. - (g) **Pooling of loans—** - (1) **In general—** Nothing in this subchapter prohibits the pooling of whole loans or interests in loans transferred under this section. - (2) **Regulations—** In promulgating regulations under subsection (i),[^1] the [Secretary](/usc/25/1452.md?p=a) may include such regulations to effect orderly and efficient pooling procedures as the [Secretary](/usc/25/1452.md?p=a) determines to be necessary. - (h) **Regulations—** Not later than 180 days after December 13, 2002, the [Secretary](/usc/25/1452.md?p=a) shall develop such procedures and promulgate such regulations as are necessary to facilitate, administer, and promote transfers of loans and guaranteed and insured portions of loans under this section. # §1486. Loans ineligible for guaranty or insurance Loans made by any agency or instrumentality of the Federal Government (not including an eligible Community Development Finance Institution), or by an organization of [Indians](/usc/25/1452.md?p=b) from funds borrowed from the United States, and loans the interest on which is not included in gross income for the purposes of [chapter 1](/usc/26/chstA-ch1.md) of title 26 shall not be eligible for guaranty or insurance hereunder. # §1487. Loans eligible for insurance Any loans insured hereunder shall be restricted to those made by a financial institution subject to examination and supervision by an agency of the United States, a State, or the District of Columbia, and to loans made by [Indian](/usc/25/1452.md?p=b) organizations from their own funds to other [tribes](/usc/25/1452.md?p=c) or organizations of [Indians](/usc/25/1452.md?p=b). # §1488. Lenders authorized to make loans; decrease or increase of liability under the guaranty Loans guaranteed hereunder may be made by any lender satisfactory to the [Secretary](/usc/25/1452.md?p=a), except as provided in [section 1486 of this title](/usc/25/1486.md). The liability under the guaranty shall decrease or increase pro rata with any decrease or increase in the unpaid portion of the obligation. # §1489. Loans made by certain financial institutions without regard to limitations and restrictions of other Federal statutes with respect to certain particulars Any loan made by any national bank or Federal savings and loan association, or by any bank, trust company, building and loan association, or insurance company authorized to do business in the District of Columbia, at least 20 per centum of which is guaranteed hereunder, may be made without regard to the limitations and restrictions of any other Federal statute with respect to (a) ratio of amount of loan to the value of the property; (b) maturity of loans; (c) requirement of mortgage or other security; (d) priority of lien; or (e) percentage of assets which may be invested in real estate loans. # §1490. Maturity of loans The maturity of any loan guaranteed or insured hereunder shall not exceed thirty years. # §1491. Defaults; written notification; pro rata payments; subrogation and assignment rights of Secretary; cancellation of uncollectable portion of obligations; forbearance for benefit of borrower; interest or charges cessation date In the event of a default of a loan guaranteed hereunder, the holder of the guaranty certificate may immediately notify the [Secretary](/usc/25/1452.md?p=a) in writing of such default and the [Secretary](/usc/25/1452.md?p=a) shall thereupon pay to such holder the pro rata portion of the amount guaranteed and shall be subrogated to the rights of the holder of the guaranty and receive an assignment of the obligation and security. The [Secretary](/usc/25/1452.md?p=a) may cancel the uncollectable portion of any obligation, to which he has an assignment or a subrogated right under this section. Nothing in this section shall be construed to preclude any forbearance for the benefit of the borrower as may be agreed upon by the parties to the loan and approved by the [Secretary](/usc/25/1452.md?p=a). The [Secretary](/usc/25/1452.md?p=a) may establish the date, not later than the date of judgment and decree of foreclosure or sale, upon which accrual of interest or charges shall cease. # §1492. Claims for losses; submission to Secretary; reimbursement: single and aggregate loss limitations, conditions; assignment of note or judgment; collection or cancellation by Secretary; interest or charges cessation date When a lender suffers a loss on a loan insured hereunder, including accrued interest, a claim therefor shall be submitted to the [Secretary](/usc/25/1452.md?p=a). If the [Secretary](/usc/25/1452.md?p=a) finds that the loss has been suffered, he shall reimburse the lender therefor: Provided, That the amount payable to the lender for a loss on any one loan shall not exceed 90 per centum of such loss: Provided further, That no reimbursement may be made for losses in excess of 15 per centum of the aggregate of insured loans made by the lender: Provided further, That before any reimbursement is made, all reasonable collection efforts shall have been exhausted by the lender, and the security for the loan shall have been liquidated to the extent feasible, and the proceeds applied on the debt. Upon reimbursement, in whole or in part, to the lender, the note or judgment evidencing the debt shall be assigned to the United States, and the lender shall have no further claim against the borrower or the United States. The [Secretary](/usc/25/1452.md?p=a) shall then take such further collection action as may be warranted, or may cancel the uncollectable portion of any debt assigned pursuant hereto. The [Secretary](/usc/25/1452.md?p=a) may establish a date upon which accrual of interest or charges shall cease. # §1493. Loan refusal; conditions; prohibition against acquisition of additional loans; payment of claims on loans made in good faith Whenever the [Secretary](/usc/25/1452.md?p=a) finds that any lender or holder of a guaranty certificate fails to maintain adequate accounting records, or to demonstrate proper ability to service adequately loans guaranteed or insured, or to exercise proper credit judgment, or has willfully or negligently engaged in practices otherwise detrimental to the interests of a borrower or of the United States, he may refuse, either temporarily or permanently, to guarantee or insure any further loans made by such lender or holder, and may bar such lender or holder from acquiring additional loans guaranteed or insured hereunder: Provided, That the [Secretary](/usc/25/1452.md?p=a) shall not refuse to pay a valid guaranty or insurance claim on loans previously made in good faith. # §1494. Evidence of eligibility of loan for and amount of guaranty or insurance; defenses and partial defenses against original lender Any evidence of guaranty or insurance issued by the [Secretary](/usc/25/1452.md?p=a) shall be conclusive evidence of the eligibility of the loan for guaranty or insurance under the provisions of this chapter and the amount of such guaranty or insurance: Provided, That nothing in this section shall preclude the [Secretary](/usc/25/1452.md?p=a) from establishing, as against the original lender, defenses based on fraud or material misrepresentation or bar him from establishing, by regulations in force at the date of such issuance or disbursement, whichever is the earlier, partial defenses to the amount payable on the guaranty or insurance. # §1495. Land and personal property titles Title to any land purchased by a [tribe](/usc/25/1452.md?p=c) or by an individual [Indian](/usc/25/1452.md?p=b) with loans guaranteed or insured pursuant to this subchapter may be taken in trust, unless the land is located outside the boundaries of a [reservation](/usc/25/1452.md?p=d) or a tribal consolidation area approved by the [Secretary](/usc/25/1452.md?p=a). Title to any land purchased by a [tribe](/usc/25/1452.md?p=c) or an individual [Indian](/usc/25/1452.md?p=b) which is outside the boundaries of the [reservation](/usc/25/1452.md?p=d) or approved consolidation area may be taken in trust if the purchaser was the owner of trust or restricted interests in the land before the purchase, otherwise title shall be taken in the name of the purchaser without any restriction on alienation, control, or use. Title to any personal property purchased with loans guaranteed or insured hereunder shall be taken in the name of the purchaser. # §1496. Powers of Secretary; finality of financial transactions and property acquisitions, management, and dispositions The financial transactions of the [Secretary](/usc/25/1452.md?p=a) incident to or arising out of the guarantee or insurance of loans and [surety bonds](/usc/25/1452.md?p=i), and the acquisition, management, and disposition of property, real, personal, or mixed, incident to such activities, shall be final and conclusive upon all officers of the Government. With respect to matters arising out of the guaranty or insurance [program](/usc/25/3402.md?p=4) authorized by this subchapter, and notwithstanding the provisions of any other laws, the [Secretary](/usc/25/1452.md?p=a) may— - (a) sue and be sued in his official capacity in any court of competent jurisdiction; - (b) subject to the specific limitations in this subchapter, consent to the modification, with respect to the rate of interest, time of payment on principal or interest or any portion thereof, security, or any other provisions of any note, contract, mortgage, or other instrument securing a loan or [surety bond](/usc/25/1452.md?p=i) which has been guaranteed or insured hereunder; - (c) subject to the specific limitations in this subchapter, pay, or compromise, any claim on, or arising because of any loan or [surety bond](/usc/25/1452.md?p=i) guaranty or insurance; - (d) subject to the specific limitations in this subchapter, pay, compromise, waive, or release any right, title, claim, lien, or demand, however acquired, including, but not limited to, any equity or right of redemption; - (e) purchase at any sale, public or private, upon such terms and for such prices as he determines to be reasonable, and take title to property, real, personal, or mixed; and similarly sell, at public or private sale, exchange, assign, convey, or otherwise dispose of such property; and - (f) complete, administer, operate, obtain, and pay for insurance on, and maintain, renovate, repair, modernize, lease, or otherwise deal with any property acquired or held pursuant to the guaranty or insurance [program](/usc/25/3402.md?p=4) authorized by this subchapter. # §1497. Indian Loan Guaranty and Insurance Fund - (a) **Establishment of revolving fund—** There is hereby created an [Indian](/usc/25/1452.md?p=b) Loan Guaranty and Insurance Fund (hereinafter referred to as the “fund”) which shall be available to the [Secretary](/usc/25/1452.md?p=a) as a revolving fund without fiscal year limitation for carrying out the provisions of this subchapter. - (b) **Aggregate loans or surety bonds limitation—** The [Secretary](/usc/25/1452.md?p=a) may use the fund for the purpose of fulfilling the obligations with respect to loans or [surety bonds](/usc/25/1452.md?p=i) guaranteed or insured under this subchapter, but the aggregate of such loans or [surety bonds](/usc/25/1452.md?p=i) which are insured or guaranteed by the [Secretary](/usc/25/1452.md?p=a) shall be limited to $1,500,000,000. - (c) **Assets, liabilities, and obligations of fund; loan and surety bond servicing and purchasing agreements: terms and conditions—** All funds, claims, notes, mortgages, contracts, and property acquired by the [Secretary](/usc/25/1452.md?p=a) under this section, and all collections and proceeds therefrom, shall constitute assets of the fund; and all liabilities and obligations of such assets shall be liabilities and obligations of the fund. The [Secretary](/usc/25/1452.md?p=a) is authorized to make agreements with respect to servicing loans or [surety bonds](/usc/25/1452.md?p=i) held, guaranteed, or insured by him under this subchapter and purchasing such guaranteed or insured loans or [surety bonds](/usc/25/1452.md?p=i) on such terms and conditions as he may prescribe. - (d) **Utilization of fund for diverse payments—** The [Secretary](/usc/25/1452.md?p=a) may also utilize the fund to pay taxes, insurance, prior liens, expenses necessary to make fiscal adjustments in connection with the application and transmittal of collections, and other expenses and advances to protect the [Secretary](/usc/25/1452.md?p=a) for loans or [surety bonds](/usc/25/1452.md?p=i) which are guaranteed or insured under this subchapter or held by the [Secretary](/usc/25/1452.md?p=a), to acquire such security property at foreclosure sale or otherwise, and to pay administrative expenses. - (e) **Authorization of appropriations—** There are authorized to be appropriated for each fiscal year beginning in fiscal year 1985 such sums as may be necessary to fulfill obligations with respect to losses on loans or [surety bonds](/usc/25/1452.md?p=i) guaranteed or insured under this subchapter. All collections and all moneys appropriated pursuant to the authority of this subsection shall remain available until expended. # §1497a. Supplemental surety bond guarantee - (a) **Amount; eligibility—** The [Secretary](/usc/25/1452.md?p=a) is authorized to provide a supplemental [surety bond](/usc/25/1452.md?p=i) guarantee, not to exceed 20 percent of any loss, for any [Indian](/usc/25/1452.md?p=b) individual or [economic enterprise](/usc/25/1452.md?p=e) eligible for a surety guarantee under [section 694b of title 15](/usc/15/694b.md), so that the aggregate of the two guarantees is 100 percent. - (b) **Conditions—** The [Secretary](/usc/25/1452.md?p=a) may provide a supplemental guarantee under this section only if the [Secretary](/usc/25/1452.md?p=a) determines that— - (1) the [Indian](/usc/25/1452.md?p=b) individual or [economic enterprise](/usc/25/1452.md?p=e) has secured or will likely secure a [surety bond](/usc/25/1452.md?p=i) guarantee under [section 694b of title 15](/usc/15/694b.md); - (2) the supplemental guarantee is necessary for the [Indian](/usc/25/1452.md?p=b) individual or [economic enterprise](/usc/25/1452.md?p=e) to secure a [surety bond](/usc/25/1452.md?p=i); - (3) no more than 25 percent of the surety’s business is comprised of bonds guaranteed pursuant to this section; and - (4) the surety will provide appropriate technical assistance and advice to, and monitor the performance of, the [Indian](/usc/25/1452.md?p=b) individual or [economic enterprise](/usc/25/1452.md?p=e) for the prevention or mitigation of a loss. - (c) **Fees and charges—** The rules and regulations promulgated by the [Secretary](/usc/25/1452.md?p=a) to carry out this section shall include the setting of reasonable fees to be paid by the [Indian](/usc/25/1452.md?p=b) individual or [economic enterprise](/usc/25/1452.md?p=e) and reasonable premium charges to be paid by sureties. In setting fees and charges, the [Secretary](/usc/25/1452.md?p=a) may take into consideration the cost to the surety of providing the services required by [paragraph (4)](#b-4) of subsection (b). The receipts from the fees and charges shall be deposited in the Fund established by [section 1497(a) of this title](/usc/25/1497.md?p=a). # §1498. Rules and regulations The [Secretary](/usc/25/1452.md?p=a) shall promulgate rules and regulations to carry out the provisions of this subchapter. # §1499. Limitation on guarantee of debt issues; approval of bond issue sale - (a) The [Secretary](/usc/25/1452.md?p=a) may guarantee not to exceed 90 percent of the unpaid principal and interest due on an issue of bonds, debentures, or similar obligations issued by an organization satisfactory to the [Secretary](/usc/25/1452.md?p=a). Such an issue shall be deemed a loan for purposes of sections [1482](/usc/25/1482.md), [1483](/usc/25/1483.md), [1484](/usc/25/1484.md), [1485](/usc/25/1485.md), [1486](/usc/25/1486.md), [1489](/usc/25/1489.md), [1490](/usc/25/1490.md), [1491](/usc/25/1491.md), [1493](/usc/25/1493.md), [1494](/usc/25/1494.md), [1495](/usc/25/1495.md), [1496](/usc/25/1496.md), and [1497](/usc/25/1497.md) of this title. - (b) The method by which an issue of bonds guaranteed under this section may be sold shall be subject to approval by the [Secretary](/usc/25/1452.md?p=a). # §1511. Interest subsidies; rules and regulations The [Secretary](/usc/25/1452.md?p=a) is authorized under such rules and regulations as he may prescribe to pay as an interest subsidy on loans which are guaranteed or insured under the provisions of subchapter II of this chapter amounts which are necessary to reduce the rate payable by the borrower to the rate determined under [section 1464 of this title](/usc/25/1464.md). # §1512. Authorization of appropriations for interest payments There are authorized to be appropriated for fiscal year 1985, and for each fiscal year thereafter, an amount which does not exceed $5,500,000 for purposes of making interest payments authorized under this subchapter. Sums appropriated under this section, shall remain available until expended. # §1521. Indian Business Development Program; establishment; statement of purpose There is established within the Department of the Interior the [Indian](/usc/25/1452.md?p=b) Business Development [Program](/usc/25/3402.md?p=4) whose purpose is to stimulate and increase [Indian](/usc/25/1452.md?p=b) entrepreneurship and employment by providing equity capital through nonreimbursable grants made by the [Secretary](/usc/25/1452.md?p=a) of the Interior to [Indians](/usc/25/1452.md?p=b) and [Indian tribes](/usc/25/81.md?p=a-2) to establish and expand profit-making [Indian](/usc/25/1452.md?p=b)-owned [economic enterprises](/usc/25/1452.md?p=e) on or near [reservations](/usc/25/1452.md?p=d). # §1522. Conditions - (a) **Limitation of amount—** No grant in excess of $100,000 in the case of an [Indian](/usc/25/1452.md?p=b) and $250,000 in the case of an [Indian tribe](/usc/25/81.md?p=a-2), or such lower amount as the [Secretary](/usc/25/1452.md?p=a) may determine to be appropriate, may be made under this subchapter. - (b) **Financing from other sources; inability to obtain funds; applicant’s financial resources—** A grant may be made only to an applicant who, in the opinion of the [Secretary](/usc/25/1452.md?p=a), is unable to obtain adequate financing for its [economic enterprise](/usc/25/1452.md?p=e) from other sources: Provided, That prior to making any grant under this subchapter, the [Secretary](/usc/25/1452.md?p=a) shall assure that, where practical, the applicant has reasonably made available for the [economic enterprise](/usc/25/1452.md?p=e) funds from the applicant’s own financial resources. - (c) **Percentage requirement—** No grant may be made to an applicant who is unable to obtain at least 60 per centum of the necessary funds for the [economic enterprise](/usc/25/1452.md?p=e) from other sources. # §1523. Authorization of appropriations There are authorized to be appropriated not to exceed the sum of $10,000,000 per year for fiscal year 1986 and each fiscal year thereafter for the purposes of this subchapter. # §1524. Rules and regulations The [Secretary](/usc/25/1452.md?p=a) of the Interior is authorized to prescribe such rules and regulations as may be necessary to carry out the purposes of this chapter. # §1541. Competent management and technical assistance for economic enterprises Prior to and concurrent with the making or guaranteeing of any loan under subchapters I and II of this chapter and with the making of a grant under subchapter IV of this chapter, the purpose of which is to fund the development of an [economic enterprise](/usc/25/1452.md?p=e), the [Secretary](/usc/25/1452.md?p=a) shall insure that the loan or grant applicant shall be provided competent management and technical assistance for preparation of the application and/or administration of funds granted consistent with the nature of the enterprise proposed to be or in fact funded. # §1542. Agency cooperation; private contracts for management services and technical assistance For the purpose of providing the assistance required under [section 1541 of this title](/usc/25/1541.md), the [Secretary](/usc/25/1452.md?p=a) is authorized to cooperate with the Small Business Administration and the Corporation for National and Community Service and other Federal agencies in the use of existing [programs](/usc/25/3402.md?p=4) of this character in those agencies. In addition, the [Secretary](/usc/25/1452.md?p=a) is authorized to enter into contracts with private organizations for providing such services and assistance. # §1543. Funds limitation for private contracts For the purpose of entering into contracts pursuant to [section 1542 of this title](/usc/25/1542.md) in fiscal year 1985, the [Secretary](/usc/25/1452.md?p=a) is authorized to use not to exceed 6 percent of any funds appropriated for any fiscal year pursuant to [section 1512 of this title](/usc/25/1512.md). For fiscal year 1986 and for each fiscal year thereafter, there are authorized to be appropriated such sums as may be necessary to carry out the provisions of this subchapter. # §1544. Additional compensation to contractors of Federal agency Notwithstanding any other provision of law, a contractor of a Federal agency under any Act of Congress may be allowed an additional amount of compensation equal to 5 percent of the amount paid, or to be paid, to a subcontractor or supplier, in carrying out the contract if such subcontractor or supplier is an [Indian](/usc/25/1452.md?p=b) organization or [Indian](/usc/25/1452.md?p=b)-owned [economic enterprise](/usc/25/1452.md?p=e) as defined in this chapter. # §1545. Livestock loans; cash settlements All acceptances of cash settlements by the Commissioner of [Indian](/usc/25/1452.md?p=b) Affairs for livestock lent by the United States to any individual [Indian](/usc/25/1452.md?p=b), or to any [tribe](/usc/25/1452.md?p=c), association, corporation, or other group of [Indians](/usc/25/1452.md?p=b), and all sales and relending of livestock repaid in kind to the United States on account of such loans are authorized and ratified: Provided, That on and after May 24, 1950, the value of such livestock for the purposes of any such cash settlement shall be based on prevailing market prices in the area and shall be ascertained by a [committee](/usc/25/5411.md?p=3) composed of three members, one of whom shall be selected by the superintendent of the particular agency, one of whom shall be selected by the chairman of the tribal council, and one of whom shall be selected by the other two members. # §1546. Disposition of cash settlements Any moneys received on and after May 24, 1950, in settlement of such debts or from the sale of livestock so repaid to the United States shall be deposited in the revolving fund established pursuant to the Acts of June 18, 1934 (48 Stat. 984) [[25 U.S.C. 5101](/usc/25/5101.md) et seq.], and June 26, 1936 (49 Stat. 1967), as amended and supplemented. # §1601. Congressional findings The Congress finds the following: - (1) Federal health [services](/usc/25/1603.md?p=18) to maintain and improve the health of the [Indians](/usc/25/1934.md) are consonant with and required by the Federal Government’s historical and unique legal relationship with, and resulting responsibility to, the American [Indian](/usc/25/1934.md) people. - (2) A major national goal of the United States is to provide the resources, processes, and structure that will enable [Indian tribes](/usc/25/1603.md?p=14) and tribal members to obtain the quantity and quality of health care [services](/usc/25/1603.md?p=18) and opportunities that will eradicate the health disparities between [Indians](/usc/25/1934.md) and the general population of the United States. - (3) A major national goal of the United States is to provide the quantity and quality of health [services](/usc/25/1603.md?p=18) which will permit the health status of [Indians](/usc/25/1934.md) to be raised to the highest possible level and to encourage the maximum participation of [Indians](/usc/25/1934.md) in the planning and management of those [services](/usc/25/1603.md?p=18). - (4) Federal health [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) have resulted in a reduction in the prevalence and incidence of preventable illnesses among, and unnecessary and premature deaths of, [Indians](/usc/25/1934.md). - (5) Despite such [services](/usc/25/1603.md?p=18), the unmet health needs of the American [Indian](/usc/25/1934.md) people are severe and the health status of the [Indians](/usc/25/1934.md) is far below that of the general population of the United States. # §1602. Declaration of national Indian health policy Congress declares that it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to [Indians](/usc/25/1934.md)— - (1) to ensure the highest possible health status for [Indians](/usc/25/1934.md) and [urban Indians](/usc/25/2403.md?p=6) and to provide all resources necessary to effect that policy; - (2) to raise the health status of [Indians](/usc/25/1934.md) and [urban Indians](/usc/25/2403.md?p=6) to at least the levels set forth in the goals contained within the Healthy People 2010 initiative or successor objectives; - (3) to ensure maximum [Indian](/usc/25/1934.md) participation in the direction of health care [services](/usc/25/1603.md?p=18) so as to render the persons administering such [services](/usc/25/1603.md?p=18) and the [services](/usc/25/1603.md?p=18) themselves more responsive to the needs and desires of [Indian](/usc/25/1934.md) communities; - (4) to increase the proportion of all degrees in the [health professions](/usc/25/1603.md?p=10) and allied and associated [health professions](/usc/25/1603.md?p=10) awarded to [Indians](/usc/25/1934.md) so that the proportion of [Indian](/usc/25/1934.md) health professionals in each [Service area](/usc/25/1603.md?p=19) is raised to at least the level of that of the general population; - (5) to require that all actions under this chapter shall be carried out with active and meaningful consultation with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26), and conference with [urban Indian organizations](/usc/25/1603.md?p=29), to implement this chapter and the national policy of [Indian](/usc/25/1934.md) self-determination; - (6) to ensure that the United States and [Indian tribes](/usc/25/1603.md?p=14) work in a government-to-government relationship to ensure quality health care for all tribal members; and - (7) to provide funding for [programs](/usc/25/3402.md?p=4) and facilities operated by [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) in amounts that are not less than the amounts provided to [programs](/usc/25/3402.md?p=4) and facilities operated directly by the [Service](/usc/25/1603.md?p=18). # §1603. Definitions In this chapter: - (1) **Area office—** The term “Area office” means an administrative entity including a [program](/usc/25/3402.md?p=4) [office](/usc/25/4001.md?p=4), within the [Indian](/usc/25/1934.md) Health [Service](#18) through which [services](#18) and funds are provided to the [service units](#20) within a defined geographic area. - (2) **Behavioral health—** - (A) **In general—** The term “behavioral health” means the blending of substance (alcohol, drugs, inhalants, and tobacco) abuse and mental health disorders prevention and treatment for the purpose of providing comprehensive [services](#18). - (B) **Inclusions—** The term “[behavioral health](#2-A)” includes the joint development of [substance abuse](#21) and mental health treatment planning and coordinated case management using a multidisciplinary approach. - (3) **California Indian—** The term “California Indian” means any [Indian](/usc/25/1934.md) who is eligible for health [services](#18) provided by the [Service](#18) pursuant to [section 1679 of this title](/usc/25/1679.md). - (4) **Community college—** The term “community college” means— - (A) a [tribal college or university](#24); or - (B) a [junior or community college](#15). - (5) **Contract health service—** The term “contract health service” means any health [service](#18) that is— - (A) delivered based on a referral by, or at the expense of, an [Indian health program](#12); and - (B) provided by a public or private medical provider or hospital that is not a provider or hospital of the [Indian health program](#12). - (6) **Department—** The term “Department”, unless otherwise designated, means the Department of Health and Human [Services](#18). - (7) **Disease prevention—** - (A) **In general—** The term “disease prevention” means any activity for— - (i) the reduction, limitation, and prevention of— - (I) disease; and - (II) complications of disease; and - (ii) the reduction of consequences of disease. - (B) **Inclusions—** The term “[disease prevention](#7-A)” includes an activity for— - (i) controlling— - (I) the development of diabetes; - (II) high blood pressure; - (III) infectious agents; - (IV) injuries; - (V) occupational hazards and disabilities; - (VI) sexually transmittable diseases; or - (VII) toxic agents; or - (ii) providing— - (I) fluoridation of water; or - (II) immunizations. - (8) **FAE—** The term “FAE” means fetal alcohol effect. - (9) **FAS—** The term “fetal alcohol syndrome” or “FAS” means a syndrome in which, with a history of maternal alcohol consumption during pregnancy, the following criteria are met: - (A) Central nervous system involvement such as mental retardation, developmental delay, intellectual deficit, microencephaly, or neurologic abnormalities. - (B) Craniofacial abnormalities with at least 2 of the following: microophthalmia, short palpebral fissures, poorly developed philtrum, thin upper lip, flat nasal bridge, and short upturned nose. - (C) Prenatal or postnatal growth delay. - (10) **Health profession—** The term “Health profession” means allopathic medicine, family medicine, internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology, podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy, optometry, pharmacy, psychology, public health, social work, marriage and family therapy, chiropractic medicine, environmental health and engineering, an allied health profession, or any other health profession. - (11) **Health promotion—** The term “health promotion” means any activity for— - (A) fostering social, economic, environmental, and personal factors conducive to health, including raising public awareness regarding health matters and enabling individuals to cope with health problems by increasing knowledge and providing valid information; - (B) encouraging adequate and appropriate diet, exercise, and sleep; - (C) promoting education and work in accordance with physical and mental capacity; - (D) making available safe water and sanitary facilities; - (E) improving the physical, economic, cultural, psychological, and social environment; - (F) promoting culturally competent care; and - (G) providing adequate and appropriate [programs](/usc/25/3402.md?p=4), including [programs](/usc/25/3402.md?p=4) for— - (i) abuse prevention (mental and physical); - (ii) community health; - (iii) community safety; - (iv) consumer health education; - (v) diet and nutrition; - (vi) immunization and other methods of prevention of communicable diseases, including HIV/AIDS; - (vii) environmental health; - (viii) exercise and physical fitness; - (ix) avoidance of fetal alcohol spectrum disorders; - (x) first aid and CPR education; - (xi) human growth and development; - (xii) injury prevention and personal safety; - (xiii) [behavioral health](#2-A); - (xiv) monitoring of disease indicators between [health care provider](/usc/25/1675.md?p=a-1) visits through appropriate means, including Internet-based health care management systems; - (xv) personal health and wellness practices; - (xvi) personal capacity building; - (xvii) prenatal, pregnancy, and infant care; - (xviii) psychological well-being; - (xix) reproductive health and family planning; - (xx) safe and adequate water; - (xxi) healthy work environments; - (xxii) elimination, reduction, and prevention of contaminants that create unhealthy household conditions (including mold and other allergens); - (xxiii) stress control; - (xxiv) [substance abuse](#21); - (xxv) sanitary facilities; - (xxvi) sudden infant death syndrome prevention; - (xxvii) tobacco use cessation and reduction; - (xxviii) violence prevention; and - (xxix) such other activities identified by the [Service](#18), a [tribal health program](#25), or an [urban Indian organization](#29) to promote achievement of any of the objectives referred to in [section 1602(2) of this title](/usc/25/1602.md?p=2). - (12) **Indian health program—** The term “Indian health program” means— - (A) any health [program](/usc/25/3402.md?p=4) administered directly by the [Service](#18); - (B) any [tribal health program](#25); and - (C) any [Indian tribe](#14) or [tribal organization](#26) to which the [Secretary](#17) provides funding pursuant to [section 47 of this title](/usc/25/47.md). - (13) **Indians or Indian—** The term “Indians” or “[Indian](/usc/25/1934.md)”, unless otherwise designated, means any person who is a member of an [Indian tribe](#14), as defined in subsection (d) hereof,[^1] except that, for the purpose of sections [1612](/usc/25/1612.md) and [1613](/usc/25/1613.md) of this title, such terms shall mean any individual who[^2] - (A) ,[^3] irrespective of whether he or she lives on or near a [reservation](#16-A), is a member of a [tribe](/usc/25/3402.md?p=2-A), band, or other organized group of Indians, including those [tribes](/usc/25/3402.md?p=2-A), bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member, or - (B) is an Eskimo or Aleut or other Alaska [Native](/usc/25/5802.md?p=5), or - (C) is considered by the [Secretary](#17) of the Interior to be an [Indian](/usc/25/1934.md) for any purpose, or - (D) is determined to be an [Indian](/usc/25/1934.md) under regulations promulgated by the [Secretary](#17). - (14) **Indian tribe—** The term “Indian tribe” means any Indian tribe, band, nation, or other organized group or community, including any Alaska [Native](/usc/25/5802.md?p=5) village or group or regional or village corporation as defined in or established pursuant to the Alaska [Native](/usc/25/5802.md?p=5) Claims Settlement Act (85 Stat. 688) [[43 U.S.C. 1601](/usc/43/1601.md) et seq.], which is recognized as eligible for the special [programs](/usc/25/3402.md?p=4) and [services](#18) provided by the United States to Indians because of their status as Indians. - (15) **Junior or community college—** The term “junior or community college” has the meaning given the term in section 1058(e)[^1] of [title 20](/usc/20.md). - (16) **Reservation—** - (A) **In general—** The term “reservation” means a reservation, Pueblo, or colony of any [Indian tribe](#14). - (B) **Inclusions—** The term “[reservation](#16-A)” includes— - (i) former [reservations](#16-A) in Oklahoma; - (ii) [Indian](/usc/25/1934.md) allotments; and - (iii) Alaska [Native](/usc/25/5802.md?p=5) Regions established pursuant to the Alaska [Native](/usc/25/5802.md?p=5) Claims Settlement Act ([43 U.S.C. 1601](/usc/43/1601.md) et seq.). - (17) **Secretary—** The term “Secretary”, unless otherwise designated, means the Secretary of Health and Human [Services](#18). - (18) **Service—** The term “Service” means the [Indian](/usc/25/1934.md) Health Service. - (19) **Service area—** The term “Service area” means the geographical area served by each [area office](#1). - (20) **Service unit—** The term “Service unit” means an administrative entity of the [Service](#18) or a [tribal health program](#25) through which [services](#18) are provided, directly or by contract, to eligible Indians within a defined geographic area. - (21) **Substance abuse—** The term “Substance abuse” includes inhalant abuse. - (22) **Telehealth—** The term “telehealth” has the meaning given the term in [section 254c–16(a) of title 42](/usc/42/254c–16.md?p=a). - (23) **Telemedicine—** The term “telemedicine” means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio, video, graphic, or other format for the purpose of providing improved health care [services](#18). - (24) **Tribal college or university—** The term “tribal college or university” has the meaning given the term in [section 1059c(b) of title 20](/usc/20/1059c.md?p=b). - (25) **Tribal health program—** The term “tribal health program” means an [Indian tribe](#14) or [tribal organization](#26) that operates any health [program](/usc/25/3402.md?p=4), [service](#18), function, activity, or facility funded, in whole or part, by the [Service](#18) through, or provided for in, a contract or [compact](/usc/25/5361.md?p=1) with the [Service](#18) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^1] - (26) **Tribal organization—** The term “tribal organization” has the meaning given the term in [section 4](/usc/25/4.md) of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450b](/usc/25/450b.md)).[^1] - (27) **Urban center—** The term “Urban center” means any community which has a sufficient [urban Indian](/usc/25/2403.md?p=6) population with unmet health needs to warrant assistance under subchapter IV, as determined by the [Secretary](#17). - (28) **Urban Indian—** The term “[Urban Indian](/usc/25/2403.md?p=6)” means any individual who resides in an [urban center](#27), as defined in subsection (g) hereof,[^1] and who meets one or more of the four criteria in [subsection (c)(1) through (4)](#c-1..c-4) of this section.[^1] - (29) **Urban Indian organization—** The term “Urban Indian organization” means a nonprofit corporate body situated in an [urban center](#27), governed by an [urban Indian](/usc/25/2403.md?p=6) controlled board of [directors](/usc/25/4302.md?p=1), and providing for the maximum participation of all interested [Indian](/usc/25/1934.md) groups and individuals, which body is capable of legally cooperating with other public and private entities for the purpose of performing the activities described in [section 1653(a) of this title](/usc/25/1653.md?p=a). # §1611. Congressional statement of purpose The purpose of this subchapter is to increase the number of [Indians](/usc/25/1934.md) entering the [health professions](/usc/25/1603.md?p=10) and to assure an adequate supply of health professionals to the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) involved in the provision of health care to [Indian](/usc/25/1934.md) people. # §1612. Health professions recruitment program for Indians - (a) **Grants for education and training—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make grants to public or nonprofit private health or educational entities or [Indian tribes](/usc/25/1603.md?p=14) or [tribal organizations](/usc/25/1603.md?p=26) to assist such entities in meeting the costs of— - (1) identifying [Indians](/usc/25/1934.md) with a potential for education or training in the [health professions](/usc/25/1603.md?p=10) and encouraging and assisting them— - (A) to enroll in courses of study in such [health professions](/usc/25/1603.md?p=10); or - (B) if they are not qualified to enroll in any such courses of study, to undertake such postsecondary education or training as may be required to qualify them for enrollment; - (2) publicizing existing sources of financial aid available to [Indians](/usc/25/1934.md) enrolled in any course of study referred to in paragraph (1) of this subsection or who are undertaking training necessary to qualify them to enroll in any such course of study; or - (3) establishing other [programs](/usc/25/3402.md?p=4) which the [Secretary](/usc/25/1603.md?p=17) determines will enhance and facilitate the enrollment of [Indians](/usc/25/1934.md) in, and the subsequent pursuit and completion by them of, courses of study referred to in paragraph (1) of this subsection. - (b) **Application for grant; submittal and approval; preference; payment—** - (1) No grant may be made under this section unless an application therefor has been submitted to, and approved by, the [Secretary](/usc/25/1603.md?p=17). Such application shall be in such form, submitted in such manner, and contain such information, as the [Secretary](/usc/25/1603.md?p=17) shall by regulation prescribe. The [Secretary](/usc/25/1603.md?p=17) shall give a preference to applications submitted by [Indian tribes](/usc/25/1603.md?p=14) or [tribal organizations](/usc/25/1603.md?p=26). - (2) The amount of any grant under this section shall be determined by the [Secretary](/usc/25/1603.md?p=17). Payments pursuant to grants under this section may be made in advance or by way of reimbursement, and at such intervals and on such conditions as the [Secretary](/usc/25/1603.md?p=17) finds necessary. # §1613. Health professions preparatory scholarship program for Indians - (a) **Requirements—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make scholarship grants to [Indians](/usc/25/1934.md) who— - (1) have successfully completed their high school education or high school equivalency; and - (2) have demonstrated the capability to successfully complete courses of study in the [health professions](/usc/25/1603.md?p=10). - (b) **Purposes and duration of grants; preprofessional and pregraduate education—** Scholarship grants made pursuant to this section shall be for the following purposes: - (1) Compensatory preprofessional education of any grantee, such scholarship not to exceed two years on a full-time basis (or the part-time equivalent thereof, as determined by the [Secretary](/usc/25/1603.md?p=17)). - (2) Pregraduate education of any grantee leading to a baccalaureate degree in an approved course of study preparatory to a field of study in a [health profession](/usc/25/1603.md?p=10), such scholarship not to exceed 4 years (or the part-time equivalent thereof, as determined by the [Secretary](/usc/25/1603.md?p=17)). - (c) **Covered expenses—** Scholarship grants made under this section may cover costs of tuition, books, transportation, board, and other necessary related expenses of a grantee while attending school. - (d) **Basis for denial of assistance—** The [Secretary](/usc/25/1603.md?p=17) shall not deny scholarship assistance to an [eligible applicant](/usc/25/5802.md?p=2) under this section solely on the basis of the applicant’s scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution. - (e) **Eligibility for assistance under other Federal programs—** The [Secretary](/usc/25/1603.md?p=17) shall not deny scholarship assistance to an [eligible applicant](/usc/25/5802.md?p=2) under this section solely by reason of such applicant’s eligibility for assistance or benefits under any other Federal [program](/usc/25/3402.md?p=4). # §1613a. Indian health professions scholarships - (a) **General authority—** In order to provide health professionals to [Indians](/usc/25/1934.md), [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and in accordance with this section, shall make scholarship grants to [Indians](/usc/25/1934.md) who are enrolled full or part time in appropriately accredited schools and pursuing courses of study in the [health professions](/usc/25/1603.md?p=10). Such scholarships shall be designated [Indian](/usc/25/1934.md) Health Scholarships and shall be made in accordance with [section 254l](/usc/42/254l.md) of title 42, except as provided in [subsection (b)](#b) of this section. - (b) **Recipients; active duty service obligation—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall determine who shall receive scholarships under [subsection (a)](#a) and shall determine the distribution of such scholarships among such [health professions](/usc/25/1603.md?p=10) on the basis of the relative needs of [Indians](/usc/25/1934.md) for additional [service](/usc/25/1603.md?p=18) in such [health professions](/usc/25/1603.md?p=10). - (2) An individual shall be eligible for a scholarship under [subsection (a)](#a) in any year in which such individual is enrolled full or part time in a course of study referred to in [subsection (a)](#a) of this section. - (3) - (A) The active duty [service](/usc/25/1603.md?p=18) obligation under a written contract with the [Secretary](/usc/25/1603.md?p=17) under [section 254l](/usc/42/254l.md) of title 42 that an individual has entered into under that section shall, if that individual is a recipient of an [Indian](/usc/25/1934.md) Health Scholarship, be met in full-time practice, by [service](/usc/25/1603.md?p=18)— - (i) in the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18); - (ii) in a [program](/usc/25/3402.md?p=4) conducted under a contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]; - (iii) in a [program](/usc/25/3402.md?p=4) assisted under subchapter IV of this chapter;[^1] - (iv) in the private practice of the applicable profession if, as determined by the [Secretary](/usc/25/1603.md?p=17), in accordance with guidelines promulgated by the [Secretary](/usc/25/1603.md?p=17), 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](/usc/25/1934.md); or[^2] - (B) At the request of any individual who has entered into a contract referred to in [subparagraph (A)](#b-3-A) and who receives a degree in medicine (including osteopathic or allopathic medicine), dentistry, optometry, podiatry, or pharmacy, the [Secretary](/usc/25/1603.md?p=17) shall defer the active duty [service](/usc/25/1603.md?p=18) obligation of that individual under that contract, in order that such individual may complete any internship, residency, or other advanced clinical training that is required for the practice of that [health profession](/usc/25/1603.md?p=10), for an appropriate period (in years, as determined by the [Secretary](/usc/25/1603.md?p=17)), subject to the following conditions: - (i) No period of internship, residency, or other advanced clinical training shall be counted as satisfying any period of obligated [service](/usc/25/1603.md?p=18) that is required under this section. - (ii) The active duty [service](/usc/25/1603.md?p=18) obligation of that individual shall commence not later than 90 days after the completion of that advanced clinical training (or by a date specified by the [Secretary](/usc/25/1603.md?p=17)). - (iii) The active duty [service](/usc/25/1603.md?p=18) obligation will be served in the [health profession](/usc/25/1603.md?p=10) of that individual, in a manner consistent with [clauses (i) through (v)](#b-3-A-i..b-3-A-v) of subparagraph (A). - (C) A recipient of an [Indian](/usc/25/1934.md) Health Scholarship may, at the election of the recipient, meet the active duty [service](/usc/25/1603.md?p=18) obligation described in [subparagraph (A)](#b-3-A) by [service](/usc/25/1603.md?p=18) in a [program](/usc/25/3402.md?p=4) specified in that subparagraph that— - (i) is located on the [reservation](/usc/25/1603.md?p=16-A) of the [tribe](/usc/25/3402.md?p=2-A) in which the recipient is enrolled; or - (ii) serves the [tribe](/usc/25/3402.md?p=2-A) in which the recipient is enrolled. - (D) Subject to [subparagraph (C)](#b-3-C), the [Secretary](/usc/25/1603.md?p=17), in making assignments of [Indian](/usc/25/1934.md) Health Scholarship recipients required to meet the active duty [service](/usc/25/1603.md?p=18) obligation described in [subparagraph (A)](#b-3-A), shall give priority to assigning individuals to [service](/usc/25/1603.md?p=18) in those [programs](/usc/25/3402.md?p=4) specified in [subparagraph (A)](#b-3-A) that have a need for health professionals to provide health care [services](/usc/25/1603.md?p=18) as a result of individuals having breached contracts entered into under this section. - (4) In the case of an individual receiving a scholarship under this section who is enrolled part time in an approved course of study— - (A) such scholarship shall be for a period of years not to exceed the part-time equivalent of 4 years, as determined by the [Secretary](/usc/25/1603.md?p=17); - (B) the period of obligated [service](/usc/25/1603.md?p=18) described in [paragraph (3)(A)](#b-3-A) shall be equal to the greater of— - (i) the part-time equivalent of one year for each year for which the individual was provided a scholarship (as determined by the [Secretary](/usc/25/1603.md?p=17)); or - (ii) two years; and - (C) the amount of the monthly stipend specified in [section 254l(g)(1)(B)](/usc/42/254l.md?p=g-1-B) of title 42 shall be reduced pro rata (as determined by the [Secretary](/usc/25/1603.md?p=17)) based on the number of hours such student is enrolled. - (5) - (A) An individual who has, on or after October 29, 1992, entered into a written contract with the [Secretary](/usc/25/1603.md?p=17) under this section and who— - (i) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the [Secretary](/usc/25/1603.md?p=17)), - (ii) is dismissed from such educational institution for disciplinary reasons, - (iii) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or - (iv) fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any [service](/usc/25/1603.md?p=18) obligation arising under such contract, shall be liable to the United States for the amount which has been paid to him, or on his behalf, under the contract. - (B) If for any reason not specified in [subparagraph (A)](#b-5-A) an individual breaches his written contract by failing either to begin such individual’s [service](/usc/25/1603.md?p=18) obligation under this section or to complete such [service](/usc/25/1603.md?p=18) obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of [section 1616a of this title](/usc/25/1616a.md) in the manner provided for in such subsection. - (C) Upon the death of an individual who receives an [Indian](/usc/25/1934.md) Health Scholarship, any obligation of that individual for [service](/usc/25/1603.md?p=18) or payment that relates to that scholarship shall be canceled. - (D) The [Secretary](/usc/25/1603.md?p=17) shall provide for the partial or total waiver or suspension of any obligation of [service](/usc/25/1603.md?p=18) or payment of a recipient of an [Indian](/usc/25/1934.md) Health Scholarship if the [Secretary](/usc/25/1603.md?p=17) determines that— - (i) it is not possible for the recipient to meet that obligation or make that payment; - (ii) requiring that recipient to meet that obligation or make that payment would result in extreme hardship to the recipient; or - (iii) the enforcement of the requirement to meet the obligation or make the payment would be unconscionable. - (E) Notwithstanding any other provision of law, in any case of extreme hardship or for other good cause shown, the [Secretary](/usc/25/1603.md?p=17) may waive, in whole or in part, the right of the United States to recover funds made available under this section. - (F) Notwithstanding any other provision of law, with respect to a recipient of an [Indian](/usc/25/1934.md) Health Scholarship, no obligation for payment may be released by a discharge in bankruptcy under [title 11](/usc/11.md), unless that discharge is granted after the expiration of the 5-year period beginning on the initial date on which that payment is due, and only if the bankruptcy court finds that the nondischarge of the obligation would be unconscionable. - (c) **Placement Office—** The [Secretary](/usc/25/1603.md?p=17) shall, acting through the [Service](/usc/25/1603.md?p=18), establish a Placement [Office](/usc/25/4001.md?p=4) to develop and implement a national policy for the placement, to available vacancies within the [Service](/usc/25/1603.md?p=18), of [Indian](/usc/25/1934.md) Health Scholarship recipients required to meet the active duty [service](/usc/25/1603.md?p=18) obligation prescribed under [section 254m of title 42](/usc/42/254m.md) without regard to any competitive personnel system, agency personnel limitation, or [Indian](/usc/25/1934.md) preference policy. # §1614. Indian health service extern programs - (a) **Employment of scholarship grantees during non­academic periods—** Any individual who receives a scholarship grant pursuant to [section 1613a of this title](/usc/25/1613a.md) shall be entitled to employment in the [Service](/usc/25/1603.md?p=18) during any nonacademic period of the year. Periods of employment pursuant to this subsection shall not be counted in determining the fulfillment of the [service](/usc/25/1603.md?p=18) obligation incurred as a condition of the scholarship grant. - (b) **Employment of medical and other students during nonacademic periods—** Any individual enrolled in a course of study in the [health professions](/usc/25/1603.md?p=10) may be employed by the [Service](/usc/25/1603.md?p=18) during any nonacademic period of the year. Any such employment shall not exceed one hundred and twenty days during any calendar year. - (c) **Employment without regard to competitive personnel system or agency personnel limitation; compensation—** Any employment pursuant to this section shall be made without regard to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the [health profession](/usc/25/1603.md?p=10) in which he or she is engaged in study. Any individual so employed shall receive payment for his or her [services](/usc/25/1603.md?p=18) comparable to the salary he or she would receive if he or she were employed in the competitive system. Any individual so employed shall not be counted against any employment ceiling affecting the [Service](/usc/25/1603.md?p=18) or the [Department](/usc/25/1603.md?p=6) of Health and Human [Services](/usc/25/1603.md?p=18). # §1615. Continuing education allowances In order to encourage scholarship and stipend recipients under sections [1613a](/usc/25/1613a.md), [1614](/usc/25/1614.md), and [1616h](/usc/25/1616h.md) of this title and health professionals, including community health representatives and emergency medical technicians, to join or continue in an [Indian health program](/usc/25/1603.md?p=12) and to provide [services](/usc/25/1603.md?p=18) in the rural and remote areas in which a significant portion of [Indians](/usc/25/1934.md) reside, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may— - (1) provide [programs](/usc/25/3402.md?p=4) or allowances to transition into an [Indian health program](/usc/25/1603.md?p=12), including licensing, board or certification examination assistance, and technical assistance in fulfilling [service](/usc/25/1603.md?p=18) obligations under sections [1613a](/usc/25/1613a.md), [1614](/usc/25/1614.md), and [1616h](/usc/25/1616h.md) of this title; and - (2) provide [programs](/usc/25/3402.md?p=4) or allowances to health professionals employed in an [Indian health program](/usc/25/1603.md?p=12) to enable those professionals, for a period of time each year prescribed by regulation of the [Secretary](/usc/25/1603.md?p=17), to take leave of the duty stations of the professionals for professional consultation, management, leadership, and refresher training courses. # §1616. Community Health Representative Program - (a) Under the authority of [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17) shall maintain a Community Health Representative [Program](/usc/25/3402.md?p=4) under which the [Service](/usc/25/1603.md?p=18)— - (1) provides for the training of [Indians](/usc/25/1934.md) as health paraprofessionals, and - (2) uses such paraprofessionals in the provision of health care, [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) to [Indian](/usc/25/1934.md) communities. - (b) The [Secretary](/usc/25/1603.md?p=17), acting through the Community Health Representative [Program](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18), shall— - (1) provide a high standard of training for paraprofessionals to Community Health Representatives to ensure that the Community Health Representatives provide quality health care, [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) to the [Indian](/usc/25/1934.md) communities served by such [Program](/usc/25/3402.md?p=4), - (2) in order to provide such training, develop and maintain a curriculum that— - (A) combines education in the theory of health care with supervised practical experience in the provision of health care, and - (B) provides instruction and practical experience in [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) activities, with appropriate consideration given to lifestyle factors that have an impact on [Indian](/usc/25/1934.md) health status, such as alcoholism, family dysfunction, and poverty, - (3) maintain a system which identifies the needs of Community Health Representatives for continuing education in health care, [health promotion](/usc/25/1603.md?p=11), and [disease prevention](/usc/25/1603.md?p=7-A) and maintain [programs](/usc/25/3402.md?p=4) that meet the needs for such continuing education, - (4) maintain a system that provides close supervision of Community Health Representatives, - (5) maintain a system under which the work of Community Health Representatives is reviewed and evaluated, and - (6) promote traditional health care practices of the [Indian tribes](/usc/25/1603.md?p=14) served consistent with the [Service](/usc/25/1603.md?p=18) standards for the provision of health care, [health promotion](/usc/25/1603.md?p=11), and [disease prevention](/usc/25/1603.md?p=7-A). # §1616a. Indian Health Service Loan Repayment Program - (a) **Establishment—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a [program](/usc/25/3402.md?p=4) to be known as the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) Loan Repayment [Program](/usc/25/3402.md?p=4) (hereinafter referred to as the “Loan Repayment [Program](/usc/25/3402.md?p=4)”) in order to assure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) through, [Indian health programs](#a-2-A). - (2) For the purposes of this section— - (A) the term “Indian health program” means any health [program](/usc/25/3402.md?p=4) or facility funded, in whole or part, by the [Service](/usc/25/1603.md?p=18) for the benefit of [Indians](/usc/25/1934.md) and administered— - (i) directly by the [Service](/usc/25/1603.md?p=18); - (ii) by any [Indian tribe](/usc/25/1603.md?p=14) or tribal or [Indian](/usc/25/1934.md) organization pursuant to a contract under— - (I) the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.], or - (II) section 23 of the Act of April 30, 1908[^1] ([25 U.S.C. 47](/usc/25/47.md)), popularly known as the “Buy-[Indian](/usc/25/1934.md)” Act; or - (iii) by an [urban Indian organization](/usc/25/1603.md?p=29) pursuant to subchapter IV of this chapter; and - (B) the term “State” has the same meaning given such term in section 254d(i)(4)[^1] of [title 42](/usc/42.md). - (b) **Eligibility—** To be eligible to participate in the Loan Repayment [Program](/usc/25/3402.md?p=4), an individual must— - (1) - (A) be enrolled— - (i) in a course of study or [program](/usc/25/3402.md?p=4) in an accredited institution, as determined by the [Secretary](/usc/25/1603.md?p=17), within any [State](#a-2-B) and be scheduled to complete such course of study in the same year such individual applies to participate in such [program](/usc/25/3402.md?p=4); or - (ii) in an approved graduate training [program](/usc/25/3402.md?p=4) in a [health profession](/usc/25/1603.md?p=10); or - (B) have— - (i) a degree in a [health profession](/usc/25/1603.md?p=10); and - (ii) a license to practice a [health profession](/usc/25/1603.md?p=10) in a [State](#a-2-B); - (2) - (A) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps[^2] of the Public Health [Service](/usc/25/1603.md?p=18); - (B) be eligible for selection for civilian [service](/usc/25/1603.md?p=18) in the Regular or Reserve Corps[^2] of the Public Health [Service](/usc/25/1603.md?p=18); - (C) meet the professional standards for civil [service](/usc/25/1603.md?p=18) employment in the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18); or - (D) be employed in an [Indian health program](#a-2-A) without a [service](/usc/25/1603.md?p=18) obligation; and - (3) submit to the [Secretary](/usc/25/1603.md?p=17) an application for a contract described in [subsection (f)](#f). - (c) **Application and contract forms—** - (1) In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment [Program](/usc/25/3402.md?p=4), the [Secretary](/usc/25/1603.md?p=17) shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the [Secretary](/usc/25/1603.md?p=17), including in the summary a clear explanation of the damages to which the United States is entitled under [subsection (l)](#l) in the case of the individual’s breach of the contract. The [Secretary](/usc/25/1603.md?p=17) shall provide such individuals with sufficient information regarding the advantages and disadvantages of [service](/usc/25/1603.md?p=18) as a commissioned officer in the Regular or Reserve Corps[^2] of the Public Health [Service](/usc/25/1603.md?p=18) or a civilian employee of the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) to enable the individual to make a decision on an informed basis. - (2) The application form, contract form, and all other information furnished by the [Secretary](/usc/25/1603.md?p=17) under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment [Program](/usc/25/3402.md?p=4). - (3) The [Secretary](/usc/25/1603.md?p=17) shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment [Program](/usc/25/3402.md?p=4) on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information. - (d) **Vacancies; priority—** - (1) Consistent with [paragraph (3)](#d-3), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and in accordance with [subsection (k)](#k), shall annually— - (A) identify the positions in each [Indian health program](#a-2-A) for which there is a need or a vacancy, and - (B) rank those positions in order of priority. - (2) Consistent with the priority determined under [paragraph (1)](#d-1), the [Secretary](/usc/25/1603.md?p=17), in determining which applications under the Loan Repayment [Program](/usc/25/3402.md?p=4) to approve (and which contracts to accept), shall give priority to applications made by— - (A) [Indians](/usc/25/1934.md); and - (B) individuals recruited through the efforts of [Indian tribes](/usc/25/1603.md?p=14) or tribal or [Indian](/usc/25/1934.md) organizations. - (3) - (A) Subject to [subparagraph (B)](#d-3-B), of the total amounts appropriated for each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts under this section, the [Secretary](/usc/25/1603.md?p=17) shall provide that— - (i) not less than 25 percent be provided to applicants who are nurses, nurse practitioners, or nurse midwives; and - (ii) not less than 10 percent be provided to applicants who are mental health professionals (other than applicants described in [clause (i)](#d-3-A-i)). - (B) The requirements specified in [clause (i)](#i) or [clause (ii)](#d-3-A-ii) of subparagraph (A) shall not apply if the [Secretary](/usc/25/1603.md?p=17) does not receive the number of applications from the individuals described in [clause (i)](#d-3-A-i) or [clause (ii)](#d-3-A-ii), respectively, necessary to meet such requirements. - (e) **Approval—** - (1) An individual becomes a participant in the Loan Repayment [Program](/usc/25/3402.md?p=4) only upon the [Secretary](/usc/25/1603.md?p=17) and the individual entering into a written contract described in [subsection (f)](#f). - (2) The [Secretary](/usc/25/1603.md?p=17) shall provide written notice to an individual promptly on— - (A) the [Secretary](/usc/25/1603.md?p=17)’s approving, under [paragraph (1)](#e-1), of the individual’s participation in the Loan Repayment [Program](/usc/25/3402.md?p=4), including extensions resulting in an aggregate period of obligated [service](/usc/25/1603.md?p=18) in excess of 4 years; or - (B) the [Secretary](/usc/25/1603.md?p=17)’s disapproving an individual’s participation in such [Program](/usc/25/3402.md?p=4). - (f) **Contract terms—** The written contract referred to in this section between the [Secretary](/usc/25/1603.md?p=17) and an individual shall contain— - (1) an agreement under which— - (A) subject to [paragraph (3)](#f-3), the [Secretary](/usc/25/1603.md?p=17) agrees— - (i) to pay loans on behalf of the individual in accordance with the provisions of this section, and - (ii) to accept (subject to the availability of appropriated funds for carrying out this section) the individual into the [Service](/usc/25/1603.md?p=18) or place the individual with a [tribe](/usc/25/3402.md?p=2-A) or [Indian](/usc/25/1934.md) organization as provided in [subparagraph (B)(iii)](#f-1-B-iii), and - (B) subject to [paragraph (3)](#f-3), the individual agrees— - (i) to accept loan payments on behalf of the individual; - (ii) in the case of an individual described in [subsection (b)(1)](#b-1)— - (I) to maintain enrollment in a course of study or training described in [subsection (b)(1)(A)](#b-1-A) until the individual completes the course of study or training, and - (II) while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the [Secretary](/usc/25/1603.md?p=17) by the educational institution offering such course of study or training); - (iii) to serve for a time period (hereinafter in this section referred to as the “period of obligated [service](/usc/25/1603.md?p=18)”) equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual’s profession in an [Indian health program](#a-2-A) to which the individual may be assigned by the [Secretary](/usc/25/1603.md?p=17); - (2) a provision permitting the [Secretary](/usc/25/1603.md?p=17) to extend for such longer additional periods, as the individual may agree to, the period of obligated [service](/usc/25/1603.md?p=18) agreed to by the individual under [paragraph (1)(B)(iii)](#f-1-B-iii); - (3) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this section; - (4) a statement of the damages to which the United States is entitled under [subsection (l)](#l) for the individual’s breach of the contract; and - (5) such other statements of the rights and liabilities of the [Secretary](/usc/25/1603.md?p=17) and of the individual, not inconsistent with this section. - (g) **Loan repayment purposes; maximum amount; tax liability reimbursement; schedule of payments—** - (1) A loan repayment provided for an individual under a written contract under the Loan Repayment [Program](/usc/25/3402.md?p=4) shall consist of payment, in accordance with [paragraph (2)](#g-2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for— - (A) tuition expenses; - (B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and - (C) reasonable living expenses as determined by the [Secretary](/usc/25/1603.md?p=17). - (2) - (A) For each year of obligated [service](/usc/25/1603.md?p=18) that an individual contracts to serve under [subsection (f)](#f) the [Secretary](/usc/25/1603.md?p=17) may pay up to $35,000 (or an amount equal to the amount specified in [section 254l–1(g)(2)(A)](/usc/42/254l–1.md?p=g-2-A) of title 42) on behalf of the individual for loans described in [paragraph (1)](#g-1). In making a determination of the amount to pay for a year of such [service](/usc/25/1603.md?p=18) by an individual, the [Secretary](/usc/25/1603.md?p=17) shall consider the extent to which each such determination— - (i) affects the ability of the [Secretary](/usc/25/1603.md?p=17) to maximize the number of contracts that can be provided under the Loan Repayment [Program](/usc/25/3402.md?p=4) from the amounts appropriated for such contracts; - (ii) provides an incentive to serve in [Indian health programs](#a-2-A) with the greatest shortages of health professionals; and - (iii) provides an incentive with respect to the health professional involved remaining in an [Indian health program](#a-2-A) with such a health professional shortage, and continuing to provide primary health [services](/usc/25/1603.md?p=18), after the completion of the period of obligated [service](/usc/25/1603.md?p=18) under the Loan Repayment [Program](/usc/25/3402.md?p=4). - (B) Any arrangement made by the [Secretary](/usc/25/1603.md?p=17) for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated [service](/usc/25/1603.md?p=18) shall be made no later than the end of the fiscal year in which the individual completes such year of [service](/usc/25/1603.md?p=18). - (3) For the purpose of providing reimbursements for tax liability resulting from payments under [paragraph (2)](#g-2) on behalf of an individual, the [Secretary](/usc/25/1603.md?p=17)— - (A) in addition to such payments, may make payments to the individual in an amount not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and - (B) may make such additional payments as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate with respect to such purpose. - (4) The [Secretary](/usc/25/1603.md?p=17) may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment [Program](/usc/25/3402.md?p=4) to establish a schedule for the making of such payments. - (h) **Effect on employment ceiling of Department of Health and Human Services—** Notwithstanding any other provision of law, individuals who have entered into written contracts with the [Secretary](/usc/25/1603.md?p=17) under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the [Department](/usc/25/1603.md?p=6) of Health and Human [Services](/usc/25/1603.md?p=18). - (i) **Recruiting programs—** The [Secretary](/usc/25/1603.md?p=17) shall conduct recruiting [programs](/usc/25/3402.md?p=4) for the Loan Repayment [Program](/usc/25/3402.md?p=4) and other health professional [programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18) at educational institutions training health professionals or specialists identified in [subsection (a)](#a). - (j) **Prohibition of assignment to other government departments—** [Section 215 of title 42](/usc/42/215.md) shall not apply to individuals during their period of obligated [service](/usc/25/1603.md?p=18) under the Loan Repayment [Program](/usc/25/3402.md?p=4). - (k) **Staff needs of health programs administered by Indian tribes—** The [Secretary](/usc/25/1603.md?p=17), in assigning individuals to serve in [Indian health programs](#a-2-A) pursuant to contracts entered into under this section, shall— - (1) ensure that the staffing needs of [Indian health programs](#a-2-A) administered by an [Indian tribe](/usc/25/1603.md?p=14) or tribal or health organization receive consideration on an equal basis with [programs](/usc/25/3402.md?p=4) that are administered directly by the [Service](/usc/25/1603.md?p=18); and - (2) give priority to assigning individuals to [Indian health programs](#a-2-A) that have a need for health professionals to provide health care [services](/usc/25/1603.md?p=18) as a result of individuals having breached contracts entered into under this section. - (l) **Voluntary termination of study or dismissal from educational institution; collection of damages—** - (1) An individual who has entered into a written contract with the [Secretary](/usc/25/1603.md?p=17) under this section and who— - (A) is enrolled in the final year of a course of study and who— - (i) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the [Secretary](/usc/25/1603.md?p=17)); - (ii) voluntarily terminates such enrollment; or - (iii) is dismissed from such educational institution before completion of such course of study; or - (B) is enrolled in a graduate training [program](/usc/25/3402.md?p=4), fails to complete such training [program](/usc/25/3402.md?p=4), and does not receive a waiver from the [Secretary](/usc/25/1603.md?p=17) under [subsection (b)(1)(B)(ii)](#b-1-B-ii), shall be liable, in lieu of any [service](/usc/25/1603.md?p=18) obligation arising under such contract, to the United States for the amount which has been paid on such individual’s behalf under the contract. - (2) If, for any reason not specified in [paragraph (1)](#l-1), an individual breaches his written contract under this section by failing either to begin, or complete, such individual’s period of obligated [service](/usc/25/1603.md?p=18) in accordance with [subsection (f)](#f), the United States shall be entitled to recover from such individual an amount to be determined in accordance with the following formula: A=3Z(t-s/t) in which— - (A) “A” is the amount the United States is entitled to recover; - (B) “Z” is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; - (C) “t” is the total number of months in the individual’s period of obligated [service](/usc/25/1603.md?p=18) in accordance with [subsection (f)](#f); and - (D) “s” is the number of months of such period served by such individual in accordance with this section. Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to [section 1395ccc of title 42](/usc/42/1395ccc.md). - (3) - (A) Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the [Secretary](/usc/25/1603.md?p=17). - (B) If damages described in [subparagraph (A)](#l-3-A) are delinquent for 3 months, the [Secretary](/usc/25/1603.md?p=17) shall, for the purpose of recovering such damages— - (i) utilize collection agencies contracted with by the Administrator of the General [Services](/usc/25/1603.md?p=18) Administration; or - (ii) enter into contracts for the recovery of such damages with collection agencies selected by the [Secretary](/usc/25/1603.md?p=17). - (C) Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the [Secretary](/usc/25/1603.md?p=17) a status report on the success of the contractor in collecting such damages. [Section 3718 of title 31](/usc/31/3718.md) shall apply to any such contract to the extent not inconsistent with this subsection. - (m) **Cancellation or waiver of obligations; bankruptcy discharge—** - (1) Any obligation of an individual under the Loan Repayment [Program](/usc/25/3402.md?p=4) for [service](/usc/25/1603.md?p=18) or payment of damages shall be canceled upon the death of the individual. - (2) The [Secretary](/usc/25/1603.md?p=17) shall by regulation provide for the partial or total waiver or suspension of any obligation of [service](/usc/25/1603.md?p=18) or payment by an individual under the Loan Repayment [Program](/usc/25/3402.md?p=4) whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable. - (3) The [Secretary](/usc/25/1603.md?p=17) may waive, in whole or in part, the rights of the United States to recover amounts under this section in any case of extreme hardship or other good cause shown, as determined by the [Secretary](/usc/25/1603.md?p=17). - (4) Any obligation of an individual under the Loan Repayment [Program](/usc/25/3402.md?p=4) for payment of damages may be released by a discharge in bankruptcy under [title 11](/usc/11.md) only if such discharge is granted after the expiration of the 5-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable. - (n) **Annual report—** The [Secretary](/usc/25/1603.md?p=17) shall submit to the President, for inclusion in each report required to be submitted to the Congress under [section 1671 of this title](/usc/25/1671.md), a report concerning the previous fiscal year which sets forth— - (1) the health professional positions maintained by the [Service](/usc/25/1603.md?p=18) or by tribal or [Indian](/usc/25/1934.md) organizations for which recruitment or retention is difficult; - (2) the number of Loan Repayment [Program](/usc/25/3402.md?p=4) applications filed with respect to each type of [health profession](/usc/25/1603.md?p=10); - (3) the number of contracts described in [subsection (f)](#f) that are entered into with respect to each [health profession](/usc/25/1603.md?p=10); - (4) the amount of loan payments made under this section, in total and by [health profession](/usc/25/1603.md?p=10); - (5) the number of scholarship grants that are provided under [section 1613a of this title](/usc/25/1613a.md) with respect to each [health profession](/usc/25/1603.md?p=10); - (6) the amount of scholarship grants provided under [section 1613a of this title](/usc/25/1613a.md), in total and by [health profession](/usc/25/1603.md?p=10); - (7) the number of providers of health care that will be needed by [Indian health programs](#a-2-A), by location and profession, during the three fiscal years beginning after the date the report is filed; and - (8) the measures the [Secretary](/usc/25/1603.md?p=17) plans to take to fill the health professional positions maintained by the [Service](/usc/25/1603.md?p=18) or by [tribes](/usc/25/3402.md?p=2-A) or tribal or [Indian](/usc/25/1934.md) organizations for which recruitment or retention is difficult. # §1616a–1. Scholarship and Loan Repayment Recovery Fund - (a) **Establishment—** There is established in the Treasury of the United States a fund to be known as the [Indian](/usc/25/1934.md) Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the “Fund”). The Fund shall consist of such amounts as may be appropriated to the Fund under [subsection (b)](#b). Amounts appropriated for the Fund shall remain available until expended. - (b) **Authorization of appropriations—** For each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of— - (1) the amount collected during the preceding fiscal year by the Federal Government pursuant to— - (A) the liability of individuals under subparagraph (A) or (B) of [section 1613a(b)(5) of this title](/usc/25/1613a.md?p=b-5) for the breach of contracts entered into under [section 1613a of this title](/usc/25/1613a.md); and - (B) the liability of individuals under [section 1616a(l)](/usc/25/1616a.md?p=l) of this title for the breach of contracts entered into under [section 1616a of this title](/usc/25/1616a.md); and - (2) the aggregate amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to [subsection (d)](#d) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year. - (c) **Use of funds—** - (1) Amounts in the Fund and available pursuant to appropriation Acts may be expended by the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), to make payments to an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) administering a health care [program](/usc/25/3402.md?p=4) pursuant to a contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]— - (A) to which a scholarship recipient under [section 1613a of this title](/usc/25/1613a.md) or a loan repayment [program](/usc/25/3402.md?p=4) participant under [section 1616a of this title](/usc/25/1616a.md) has been assigned to meet the obligated [service](/usc/25/1603.md?p=18) requirements pursuant to[^1] sections; and - (B) that has a need for a health professional to provide health care [services](/usc/25/1603.md?p=18) as a result of such recipient or participant having breached the contract entered into under [section 1613a of this title](/usc/25/1613a.md) or [section 1616a of this title](/usc/25/1616a.md). - (2) An [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) receiving payments pursuant to [paragraph (1)](#c-1) may expend the payments to recruit and employ, directly or by contract, health professionals to provide health care [services](/usc/25/1603.md?p=18). - (d) **Investment of excess funds—** - (1) The [Secretary](/usc/25/1603.md?p=17) of the Treasury shall invest such amounts of the Fund as such [Secretary](/usc/25/1603.md?p=17) determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price. - (2) Any obligation acquired by the Fund may be sold by the [Secretary](/usc/25/1603.md?p=17) of the Treasury at the market price. # §1616b. Recruitment activities - (a) The [Secretary](/usc/25/1603.md?p=17) may reimburse health professionals seeking positions in the [Service](/usc/25/1603.md?p=18), including individuals considering entering into a contract under [section 1616a of this title](/usc/25/1616a.md), and their spouses, for actual and reasonable expenses incurred in traveling to and from their places of residence to an area in which they may be assigned for the purpose of evaluating such area with respect to such assignment. - (b) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall assign one individual in each [area office](/usc/25/1603.md?p=1) to be responsible on a full-time basis for recruitment activities. # §1616c. Tribal recruitment and retention program - (a) **Projects funded on competitive basis—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall fund, on a competitive basis, [projects](/usc/25/5611.md?p=2) to enable [Indian tribes](/usc/25/1603.md?p=14) and tribal and [Indian](/usc/25/1934.md) organizations to recruit, place, and retain health professionals to meet the staffing needs of [Indian health programs](/usc/25/1603.md?p=12) (as defined in [section 1616a(a)(2) of this title](/usc/25/1616a.md?p=a-2)). - (b) **Eligibility—** - (1) Any [Indian tribe](/usc/25/1603.md?p=14) or tribal or [Indian](/usc/25/1934.md) organization may submit an application for funding of a [project](/usc/25/5611.md?p=2) pursuant to this section. - (2) [Indian tribes](/usc/25/1603.md?p=14) and tribal and [Indian](/usc/25/1934.md) organizations under the authority of the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.] shall be given an equal opportunity with [programs](/usc/25/3402.md?p=4) that are administered directly by the [Service](/usc/25/1603.md?p=18) to compete for, and receive, grants under [subsection (a)](#a) for such [projects](/usc/25/5611.md?p=2). # §1616d. Advanced training and research - (a) **Establishment of program—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a [program](/usc/25/3402.md?p=4) to enable health professionals to pursue advanced training or research in areas of study for which the [Secretary](/usc/25/1603.md?p=17) determines a need exists. In selecting participants for a [program](/usc/25/3402.md?p=4) established under this subsection, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall give priority to applicants who are employed by the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29), at the time of the submission of the applications. - (b) **Obligated service—** An individual who participates in a [program](/usc/25/3402.md?p=4) under [subsection (a)](#a), where the educational costs are borne by the [Service](/usc/25/1603.md?p=18), shall incur an obligation to serve in an [Indian health program](/usc/25/1603.md?p=12) (as defined in [section 1616a(a)(2) of this title](/usc/25/1616a.md?p=a-2)) for a period of obligated [service](/usc/25/1603.md?p=18) equal to at least the period of time during which the individual participates in such [program](/usc/25/3402.md?p=4). In the event that the individual fails to complete such obligated [service](/usc/25/1603.md?p=18), the individual shall be liable to the United States for the period of [service](/usc/25/1603.md?p=18) remaining. In such event, with respect to individuals entering the [program](/usc/25/3402.md?p=4) after October 29, 1992, the United States shall be entitled to recover from such individual an amount to be determined in accordance with the formula specified in subsection (l) of [section 1616a of this title](/usc/25/1616a.md) in the manner provided for in such subsection. - (c) **Eligibility—** Health professionals from [Indian tribes](/usc/25/1603.md?p=14) and tribal and [Indian](/usc/25/1934.md) organizations under the authority of the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.] shall be given an equal opportunity to participate in the [program](/usc/25/3402.md?p=4) under [subsection (a)](#a). # §1616e. Nursing program - (a) **Grants—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall provide grants to— - (1) public or private schools of nursing, - (2) tribally controlled [community colleges](/usc/25/1603.md?p=4) and tribally controlled postsecondary vocational institutions (as defined in section 2397h(2)[^1] of [title 20](/usc/20.md)), and - (3) nurse midwife [programs](/usc/25/3402.md?p=4), and nurse practitioner [programs](/usc/25/3402.md?p=4), that are provided by any public or private institution, for the purpose of increasing the number of nurses, nurse midwives, and nurse practitioners who deliver health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md). - (b) **Purposes—** Grants provided under [subsection (a)](#a) may be used to— - (1) recruit individuals for [programs](/usc/25/3402.md?p=4) which train individuals to be nurses, nurse midwives, or nurse practitioners, - (2) provide scholarships to individuals enrolled in such [programs](/usc/25/3402.md?p=4) that may pay the tuition charged for such [program](/usc/25/3402.md?p=4) and other expenses incurred in connection with such [program](/usc/25/3402.md?p=4), including books, fees, room and board, and stipends for living expenses, - (3) provide a [program](/usc/25/3402.md?p=4) that encourages nurses, nurse midwives, and nurse practitioners to provide, or continue to provide, health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md), - (4) provide a [program](/usc/25/3402.md?p=4) that increases the skills of, and provides continuing education to, nurses, nurse midwives, and nurse practitioners, or - (5) provide any [program](/usc/25/3402.md?p=4) that is designed to achieve the purpose described in [subsection (a)](#a). - (c) **Application—** Each application for a grant under [subsection (a)](#a) shall include such information as the [Secretary](/usc/25/1603.md?p=17) may require to establish the connection between the [program](/usc/25/3402.md?p=4) of the applicant and a health care facility that primarily serves [Indians](/usc/25/1934.md). - (d) **Preference—** In providing grants under [subsection (a)](#a), the [Secretary](/usc/25/1603.md?p=17) shall extend a preference to— - (1) [programs](/usc/25/3402.md?p=4) that provide a preference to [Indians](/usc/25/1934.md), - (2) [programs](/usc/25/3402.md?p=4) that train nurse midwives or nurse practitioners, - (3) [programs](/usc/25/3402.md?p=4) that are interdisciplinary, and - (4) [programs](/usc/25/3402.md?p=4) that are conducted in cooperation with a center for gifted and talented [Indian](/usc/25/1934.md) students established under section 2624(a)[^1] of this title. - (e) **Quentin N. Burdick American Indians Into Nursing Program—** The [Secretary](/usc/25/1603.md?p=17) shall provide one of the grants authorized under [subsection (a)](#a) to establish and maintain a [program](/usc/25/3402.md?p=4) at the University of North Dakota to be known as the “Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Nursing [Program](/usc/25/3402.md?p=4)”. Such [program](/usc/25/3402.md?p=4) shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick [Indian Health Programs](/usc/25/1603.md?p=12) established under [section 1616g(b) of this title](/usc/25/1616g.md?p=b) and the Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Psychology [Program](/usc/25/3402.md?p=4) established under [section 1621p(b) of this title](/usc/25/1621p.md?p=b). - (f) **Service obligation—** The active duty [service](/usc/25/1603.md?p=18) obligation prescribed under [section 254m of title 42](/usc/42/254m.md) shall be met by each individual who receives training or assistance described in paragraph [(1)](#b-1) or [(2)](#b-2) of subsection (b) that is funded by a grant provided under [subsection (a)](#a). Such obligation shall be met by [service](/usc/25/1603.md?p=18)— - (A) in the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18); - (B) in a [program](/usc/25/3402.md?p=4) conducted under a contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]; - (C) in a [program](/usc/25/3402.md?p=4) assisted under subchapter IV of this chapter; or - (D) in the private practice of nursing if, as determined by the [Secretary](/usc/25/1603.md?p=17), in accordance with guidelines promulgated by the [Secretary](/usc/25/1603.md?p=17), 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](/usc/25/1934.md). - (g) **Authorization of appropriations—** Beginning with fiscal year 1993, of the amounts appropriated under the authority of this subchapter for each fiscal year to be used to carry out this section, not less than $1,000,000 shall be used to provide grants under [subsection (a)](#a) for the training of nurse midwives, nurse anesthetists, and nurse practitioners. # §1616e–1. Nursing school clinics - (a) **Grants—** In addition to the authority of the [Secretary](/usc/25/1603.md?p=17) under [section 1616e(a)(1) of this title](/usc/25/1616e.md?p=a-1), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to provide grants to public or private schools of nursing for the purpose of establishing, developing, operating, and administering clinics to address the health care needs of [Indians](/usc/25/1934.md), and to provide primary health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) who reside on or within 50 miles of [Indian](/usc/25/1934.md) country, as defined in [section 1151 of title 18](/usc/18/1151.md). - (b) **Purposes—** Grants provided under [subsection (a)](#a) may be used to— - (1) establish clinics, to be run and staffed by the faculty and students of a grantee school, to provide primary care [services](/usc/25/1603.md?p=18) in areas in or within 50 miles of [Indian](/usc/25/1934.md) country (as defined in [section 1151 of title 18](/usc/18/1151.md)); - (2) provide clinical training, [program](/usc/25/3402.md?p=4) development, faculty enhancement, and student scholarships in a manner that would benefit such clinics; and - (3) carry out any other activities determined appropriate by the [Secretary](/usc/25/1603.md?p=17). - (c) **Amount and conditions—** The [Secretary](/usc/25/1603.md?p=17) may award grants under this section in such amounts and subject to such conditions as the [Secretary](/usc/25/1603.md?p=17) deems appropriate. - (d) **Design—** The clinics established under this section shall be designed to provide nursing students with a structured clinical experience that is similar in nature to that provided by residency training [programs](/usc/25/3402.md?p=4) for physicians. - (e) **Regulations—** The [Secretary](/usc/25/1603.md?p=17) shall prescribe such regulations as may be necessary to carry out the provisions of this section. - (f) **Authorization to use amounts—** Out of amounts appropriated to carry out this subchapter for each of the fiscal years 1993 through 2000 not more than $5,000,000 may be used to carry out this section. # §1616f. Tribal culture and history - (a) **Program established—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a [program](/usc/25/3402.md?p=4) under which appropriate employees of the [Service](/usc/25/1603.md?p=18) who serve particular [Indian tribes](/usc/25/1603.md?p=14) shall receive educational instruction in the history and culture of such [tribes](/usc/25/3402.md?p=2-A) and in the history of the [Service](/usc/25/1603.md?p=18). - (b) **Tribally controlled institutions—** To the extent feasible, the [program](/usc/25/3402.md?p=4) established under [subsection (a)](#a) shall— - (1) be carried out through tribally controlled colleges or universities (within the meaning of [section 1801(a)(4) of this title](/usc/25/1801.md?p=a-4)) and tribally controlled postsecondary vocational institutions (as defined in section 2397h(2)[^1] of [title 20](/usc/20.md)), - (2) be developed in consultation with the affected tribal government, and - (3) include instruction in [Native American](/usc/25/5802.md?p=5) studies. # §1616g. INMED program - (a) **Grants—** The [Secretary](/usc/25/1603.md?p=17) is authorized to provide grants to at least 3 colleges and universities for the purpose of maintaining and expanding the [Native American](/usc/25/5802.md?p=5) health careers recruitment [program](/usc/25/3402.md?p=4) known as the “[Indians](/usc/25/1934.md) into Medicine [Program](/usc/25/3402.md?p=4)” (hereinafter in this section referred to as “INMED”) as a means of encouraging [Indians](/usc/25/1934.md) to enter the [health professions](/usc/25/1603.md?p=10). - (b) **University of North Dakota—** The [Secretary](/usc/25/1603.md?p=17) shall provide one of the grants authorized under [subsection (a)](#a) to maintain the INMED [program](/usc/25/3402.md?p=4) at the University of North Dakota, to be known as the “Quentin N. Burdick [Indian Health Programs](/usc/25/1603.md?p=12)”, unless the [Secretary](/usc/25/1603.md?p=17) makes a determination, based upon [program](/usc/25/3402.md?p=4) reviews, that the [program](/usc/25/3402.md?p=4) is not meeting the purposes of this section. Such [program](/usc/25/3402.md?p=4) shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Psychology [Program](/usc/25/3402.md?p=4) established under [section 1621p(b) of this title](/usc/25/1621p.md?p=b) and the Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Nursing [Program](/usc/25/3402.md?p=4) established under [section 1616e(e) of this title](/usc/25/1616e.md?p=e). - (c) **Regulations; contents of recruitment program—** - (1) The [Secretary](/usc/25/1603.md?p=17) shall develop regulations for the competitive awarding of the grants provided under this section. - (2) Applicants for grants provided under this section shall agree to provide a [program](/usc/25/3402.md?p=4) which— - (A) provides outreach and recruitment for [health professions](/usc/25/1603.md?p=10) to [Indian](/usc/25/1934.md) communities including elementary, secondary and [community colleges](/usc/25/1603.md?p=4) located on [Indian reservations](/usc/25/3653.md?p=3) which will be served by the [program](/usc/25/3402.md?p=4), - (B) incorporates a [program](/usc/25/3402.md?p=4) advisory board comprised of representatives from the [tribes](/usc/25/3402.md?p=2-A) and communities which will be served by the [program](/usc/25/3402.md?p=4), - (C) provides summer preparatory [programs](/usc/25/3402.md?p=4) for [Indian](/usc/25/1934.md) students who need enrichment in the subjects of math and science in order to pursue training in the [health professions](/usc/25/1603.md?p=10), - (D) provides tutoring, counseling and support to students who are enrolled in a health career [program](/usc/25/3402.md?p=4) of study at the respective college or university, and - (E) to the maximum extent feasible, employs qualified [Indians](/usc/25/1934.md) in the [program](/usc/25/3402.md?p=4). - (d) **Report to Congress—** By no later than the date that is 3 years after November 23, 1988, the [Secretary](/usc/25/1603.md?p=17) shall submit a report to the Congress on the [program](/usc/25/3402.md?p=4) established under this section including recommendations for expansion or changes to the [program](/usc/25/3402.md?p=4). # §1616h. Health training programs of community colleges - (a) **Grants—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall award grants to [community colleges](#e-1) for the purpose of assisting the [community college](#e-1) in the establishment of [programs](/usc/25/3402.md?p=4) which provide education in a [health profession](/usc/25/1603.md?p=10) leading to a degree or diploma in a [health profession](/usc/25/1603.md?p=10) for individuals who desire to practice such profession on an [Indian reservation](/usc/25/2902.md?p=8) or in a tribal clinic. - (2) The amount of any grant awarded to a [community college](#e-1) under [paragraph (1)](#a-1) for the first year in which such a grant is provided to the [community college](#e-1) shall not exceed $100,000. - (b) **Eligibility—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall award grants to [community colleges](#e-1) that have established a [program](/usc/25/3402.md?p=4) described in [subsection (a)(1)](#a-1) for the purpose of maintaining the [program](/usc/25/3402.md?p=4) and recruiting students for the [program](/usc/25/3402.md?p=4). - (2) Grants may only be made under this section to a [community college](#e-1) which— - (A) is accredited, - (B) has access to a hospital facility, [Service](/usc/25/1603.md?p=18) facility, or hospital that could provide training of nurses or health professionals, - (C) has entered into an agreement with an accredited college or university medical school, the terms of which— - (i) provide a [program](/usc/25/3402.md?p=4) that enhances the transition and recruitment of students into advanced baccalaureate or graduate [programs](/usc/25/3402.md?p=4) which train health professionals, and - (ii) stipulate certifications necessary to approve internship and field placement opportunities at [service unit](/usc/25/1603.md?p=20) facilities of the [Service](/usc/25/1603.md?p=18) or at tribal health facilities, - (D) has a qualified staff which has the appropriate certifications, and - (E) is capable of obtaining State or regional accreditation of the [program](/usc/25/3402.md?p=4) described in [subsection (a)(1)](#a-1). - (c) **Agreements and technical assistance—** The [Secretary](/usc/25/1603.md?p=17) shall encourage [community colleges](#e-1) described in [subsection (b)(2)](#b-2) to establish and maintain [programs](/usc/25/3402.md?p=4) described in [subsection (a)(1)](#a-1) by— - (1) entering into agreements with such colleges for the provision of qualified personnel of the [Service](/usc/25/1603.md?p=18) to teach courses of study in such [programs](/usc/25/3402.md?p=4), and - (2) providing technical assistance and support to such colleges. - (d) **Advanced training—** Any [program](/usc/25/3402.md?p=4) receiving assistance under this section that is conducted with respect to a [health profession](/usc/25/1603.md?p=10) shall also offer courses of study which provide advanced training for any health professional who— - (1) has already received a degree or diploma in such [health profession](/usc/25/1603.md?p=10), and - (2) provides clinical [services](/usc/25/1603.md?p=18) on an [Indian reservation](/usc/25/2902.md?p=8), at a [Service](/usc/25/1603.md?p=18) facility, or at a tribal clinic. Such courses of study may be offered in conjunction with the college or university with which the [community college](#e-1) has entered into the agreement required under [subsection (b)(2)(C)](#b-2-C). - (e) **Definitions—** For purposes of this section— - (1) The term “community college” means— - (A) a [junior or community college](#e-3) that is a [tribally controlled college or university](#e-2), or - (B) a [junior or community college](#e-3). - (2) The term “tribally controlled college or university” has the meaning given to such term by [section 1801(a)(4) of this title](/usc/25/1801.md?p=a-4). - (3) The term “junior or community college” has the meaning given to such term by section 1058(e)[^1] of [title 20](/usc/20.md). # §1616i. Additional incentives for health professionals - (a) **Incentive special pay—** The [Secretary](/usc/25/1603.md?p=17) may provide the incentive special pay authorized under section [302(b)](/usc/37/302.md?p=b) or [335(b)](/usc/37/335.md?p=b) of title 37 to civilian medical officers of the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) who are assigned to, and serving in, positions included in the [list](/usc/25/5130.md?p=3) established under [subsection (b)(1)](#b-1) for which recruitment or retention of personnel is difficult. - (b) **List of positions; bonus pay—** - (1) The [Secretary](/usc/25/1603.md?p=17) shall establish and update on an annual basis a [list](/usc/25/5130.md?p=3) of positions of health care professionals employed by, or assigned to, the [Service](/usc/25/1603.md?p=18) for which recruitment or retention is difficult. - (2) - (A) The [Secretary](/usc/25/1603.md?p=17) may pay a bonus to any commissioned officer or civil [service](/usc/25/1603.md?p=18) employee, other than a commissioned medical officer, dental officer, optometrist, and veterinarian, who is employed in or assigned to, and serving in, a position in the [Service](/usc/25/1603.md?p=18) included in the [list](/usc/25/5130.md?p=3) established by the [Secretary](/usc/25/1603.md?p=17) under [paragraph (1)](#b-1). - (B) The total amount of bonus payments made by the [Secretary](/usc/25/1603.md?p=17) under this paragraph to any employee during any 1-year period shall not exceed $2,000. - (c) **Work schedules—** The [Secretary](/usc/25/1603.md?p=17) may establish [programs](/usc/25/3402.md?p=4) to allow the use of flexible work schedules, and compressed work schedules, in accordance with the provisions of subchapter II of [chapter 61](/usc/5/chptIII-sptE-ch61.md) of title 5, for health professionals employed by, or assigned to, the [Service](/usc/25/1603.md?p=18). # §1616j. Retention bonus - (a) **Eligibility—** The [Secretary](/usc/25/1603.md?p=17) may pay a retention bonus to any physician or nurse employed by, or assigned to, and serving in, the [Service](/usc/25/1603.md?p=18) either as a civilian employee or as a commissioned officer in the Regular or Reserve Corps[^1] of the Public Health [Service](/usc/25/1603.md?p=18) who— - (1) is assigned to, and serving in, a position included in the [list](/usc/25/5130.md?p=3) established under [section 1616i(b)(1) of this title](/usc/25/1616i.md?p=b-1) for which recruitment or retention of personnel is difficult, - (2) the [Secretary](/usc/25/1603.md?p=17) determines is needed by the [Service](/usc/25/1603.md?p=18), - (3) has— - (A) completed 3 years of employment with the [Service](/usc/25/1603.md?p=18), or - (B) completed any [service](/usc/25/1603.md?p=18) obligations incurred as a requirement of— - (i) any Federal scholarship [program](/usc/25/3402.md?p=4), or - (ii) any Federal education loan repayment [program](/usc/25/3402.md?p=4), and - (4) enters into an agreement with the [Service](/usc/25/1603.md?p=18) for continued employment for a period of not less than 1 year. - (b) **Minimum award percentage to nurses—** Beginning with fiscal year 1993, not less than 25 percent of the retention bonuses awarded each year under [subsection (a)](#a) shall be awarded to nurses. - (c) **Rates; maximum rate—** The [Secretary](/usc/25/1603.md?p=17) may establish rates for the retention bonus which shall provide for a higher annual rate for multiyear agreements than for single year agreements referred to in [subsection (a)(4)](#a-4), but in no event shall the annual rate be more than $25,000 per annum. - (d) **Time of payment—** The retention bonus for the entire period covered by the agreement described in [subsection (a)(4)](#a-4) shall be paid at the beginning of the agreed upon term of [service](/usc/25/1603.md?p=18). - (e) **Refund; interest—** Any physician or nurse failing to complete the agreed upon term of [service](/usc/25/1603.md?p=18), except where such failure is through no fault of the individual, shall be obligated to refund to the Government the full amount of the retention bonus for the period covered by the agreement, plus interest as determined by the [Secretary](/usc/25/1603.md?p=17) in accordance with [section 1616a(l)(2)(B)](/usc/25/1616a.md) of this title. - (f) **Physicians and nurses employed under Indian Self-Determination Act—** The [Secretary](/usc/25/1603.md?p=17) may pay a retention bonus to any physician or nurse employed by an organization providing health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) pursuant to a contract under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.] if such physician or nurse is serving in a position which the [Secretary](/usc/25/1603.md?p=17) determines is— - (1) a position for which recruitment or retention is difficult; and - (2) necessary for providing health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md). # §1616k. Nursing residency program - (a) **Establishment—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a [program](/usc/25/3402.md?p=4) to enable licensed practical nurses, licensed vocational nurses, and registered nurses who are working in an [Indian health program](/usc/25/1603.md?p=12) (as defined in [section 1616a(a)(2)(A) of this title](/usc/25/1616a.md?p=a-2-A)), and have done so for a period of not less than one year, to pursue advanced training. - (b) **Program components—** Such [program](/usc/25/3402.md?p=4) shall include a combination of education and work study in an [Indian health program](/usc/25/1603.md?p=12) (as defined in [section 1616a(a)(2)(A) of this title](/usc/25/1616a.md?p=a-2-A)) leading to an associate or bachelor’s degree (in the case of a licensed practical nurse or licensed vocational nurse) or a bachelor’s degree (in the case of a registered nurse) or a Master’s degree. - (c) **Service obligation of program participant—** An individual who participates in a [program](/usc/25/3402.md?p=4) under [subsection (a)](#a), where the educational costs are paid by the [Service](/usc/25/1603.md?p=18), shall incur an obligation to serve in an [Indian health program](/usc/25/1603.md?p=12) for a period of obligated [service](/usc/25/1603.md?p=18) equal to at least three times the period of time during which the individual participates in such [program](/usc/25/3402.md?p=4). In the event that the individual fails to complete such obligated [service](/usc/25/1603.md?p=18), the United States shall be entitled to recover from such individual an amount determined in accordance with the formula specified in subsection (l) of [section 1616a of this title](/usc/25/1616a.md) in the manner provided for in such subsection. # §1616l. Community health aide program - (a) **General purposes of program—** Pursuant to [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall develop and operate a Community Health Aide [Program](/usc/25/3402.md?p=4) in the State of Alaska under which the [Service](/usc/25/1603.md?p=18)— - (1) provides for the training of Alaska [Natives](/usc/25/5802.md?p=5) as health aides or community health practitioners; - (2) uses those aides or practitioners in the provision of health care, [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) to Alaska [Natives](/usc/25/5802.md?p=5) living in villages in rural Alaska; and - (3) provides for the establishment of teleconferencing capacity in health clinics located in or near those villages for use by community health aides or community health practitioners. - (b) **Specific program requirements—** The [Secretary](/usc/25/1603.md?p=17), acting through the Community Health Aide [Program](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18), shall— - (1) using trainers accredited by the [Program](/usc/25/3402.md?p=4), provide a high standard of training to community health aides and community health practitioners to ensure that those aides and practitioners provide quality health care, [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) to the villages served by the [Program](/usc/25/3402.md?p=4); - (2) in order to provide such training, develop a curriculum that— - (A) combines education regarding the theory of health care with supervised practical experience in the provision of health care; - (B) provides instruction and practical experience in the provision of acute care, emergency care, [health promotion](/usc/25/1603.md?p=11), [disease prevention](/usc/25/1603.md?p=7-A), and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and - (C) promotes the achievement of the health status objectives specified in [section 1602(2) of this title](/usc/25/1602.md?p=2); - (3) establish and maintain a Community Health Aide Certification Board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in [paragraph (1)](#b-1) or can demonstrate equivalent experience; - (4) develop and maintain a system that identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care, including the areas described in [paragraph (2)(B)](#b-2-B), and develop [programs](/usc/25/3402.md?p=4) that meet the needs for such continuing education; - (5) develop and maintain a system that provides close supervision of community health aides and community health practitioners; - (6) develop a system under which the work of community health aides and community health practitioners is reviewed and evaluated to ensure the provision of quality health care, [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); and - (7) ensure that— - (A) pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment; and - (B) dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries, subject to the condition that uncomplicated extractions shall not be considered oral surgery under this section. - (c) **Program review—** - (1) **Neutral panel—** - (A) **Establishment—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a neutral panel to carry out the study under [paragraph (2)](#c-2). - (B) **Membership—** Members of the neutral panel shall be appointed by the [Secretary](/usc/25/1603.md?p=17) from among clinicians, economists, community practitioners, oral epidemiologists, and Alaska [Natives](/usc/25/5802.md?p=5). - (2) **Study—** - (A) **In general—** The neutral panel established under [paragraph (1)](#c-1) shall conduct a study of the dental health aide therapist [services](/usc/25/1603.md?p=18) provided by the Community Health Aide [Program](/usc/25/3402.md?p=4) under this section to ensure that the quality of care provided through those [services](/usc/25/1603.md?p=18) is adequate and appropriate. - (B) **Parameters of study—** The [Secretary](/usc/25/1603.md?p=17), in consultation with interested parties, including professional dental organizations, shall develop the parameters of the study. - (C) **Inclusions—** The study shall include a determination by the neutral panel with respect to— - (i) the ability of the dental health aide therapist [services](/usc/25/1603.md?p=18) under this section to address the dental care needs of Alaska [Natives](/usc/25/5802.md?p=5); - (ii) the quality of care provided through those [services](/usc/25/1603.md?p=18), including any training, improvement, or additional oversight required to improve the quality of care; and - (iii) whether safer and less costly alternatives to the dental health aide therapist [services](/usc/25/1603.md?p=18) exist. - (D) **Consultation—** In carrying out the study under this paragraph, the neutral panel shall consult with Alaska [tribal organizations](/usc/25/1603.md?p=26) with respect to the adequacy and accuracy of the study. - (3) **Report—** The neutral panel shall submit to the [Secretary](/usc/25/1603.md?p=17), the [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs of the Senate, and the [Committee](/usc/25/5411.md?p=3) on Natural Resources of the House of Representatives a report describing the results of the study under [paragraph (2)](#c-2), including a description of— - (A) any determination of the neutral panel under [paragraph (2)(C)](#c-2-C); and - (B) any comments received from Alaska [tribal organizations](/usc/25/1603.md?p=26) under [paragraph (2)(D)](#c-2-D). - (d) **Nationalization of program—** - (1) **In general—** Except as provided in [paragraph (2)](#d-2), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may establish a national Community Health Aide [Program](/usc/25/3402.md?p=4) in accordance with the [program](/usc/25/3402.md?p=4) under this section, as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate. - (2) **Requirement; exclusion—** Subject to paragraphs [(3)](#d-3) and [(4)](#d-4), in establishing a national [program](/usc/25/3402.md?p=4) under [paragraph (1)](#d-1), the [Secretary](/usc/25/1603.md?p=17)— - (A) shall not reduce the amounts provided for the Community Health Aide [Program](/usc/25/3402.md?p=4) described in subsections [(a)](#a) and [(b)](#b); and - (B) shall exclude dental health aide therapist [services](/usc/25/1603.md?p=18) from [services](/usc/25/1603.md?p=18) covered under the [program](/usc/25/3402.md?p=4). - (3) **Election of Indian tribe or tribal organization—** - (A) **In general—** [Subparagraph (B)](#d-2-B) of paragraph (2) shall not apply in the case of an election made by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) located in a State (other than Alaska) in which the use of dental health aide therapist [services](/usc/25/1603.md?p=18) or midlevel dental health provider [services](/usc/25/1603.md?p=18) is authorized under State law to supply such [services](/usc/25/1603.md?p=18) in accordance with State law. - (B) **Action by Secretary—** On an election by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) under [subparagraph (A)](#d-3-A), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall facilitate implementation of the [services](/usc/25/1603.md?p=18) elected. - (4) **Vacancies—** The [Secretary](/usc/25/1603.md?p=17) shall not fill any vacancy for a certified dentist in a [program](/usc/25/3402.md?p=4) operated by the [Service](/usc/25/1603.md?p=18) with a dental health aide therapist. - (e) **Effect of section—** Nothing in this section shall restrict the ability of the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), or a [tribal organization](/usc/25/1603.md?p=26) to participate in any [program](/usc/25/3402.md?p=4) or to provide any [service](/usc/25/1603.md?p=18) authorized by any other Federal law. # §1616m. Matching grants to tribes for scholarship programs - (a) **In general—** - (1) The [Secretary](/usc/25/1603.md?p=17) shall make grants to [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) for the purpose of assisting such [tribes](/usc/25/3402.md?p=2-A) and [tribal organizations](/usc/25/1603.md?p=26) in educating [Indians](/usc/25/1934.md) to serve as health professionals in [Indian](/usc/25/1934.md) communities. - (2) Amounts available for grants under [paragraph (1)](#a-1) for any fiscal year shall not exceed 5 percent of amounts available for such fiscal year for [Indian](/usc/25/1934.md) Health Scholarships under [section 1613a of this title](/usc/25/1613a.md). - (3) An application for a grant under [paragraph (1)](#a-1) shall be in such form and contain such agreements, assurances, and information as the [Secretary](/usc/25/1603.md?p=17) determines are necessary to carry out this section. - (b) **Compliance with requirements—** - (1) An [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) receiving a grant under [subsection (a)](#a) shall agree to provide scholarships to [Indians](/usc/25/1934.md) pursuing education in the [health professions](/usc/25/1603.md?p=10) in accordance with the requirements of this section. - (2) With respect to the costs of providing any scholarship pursuant to [paragraph (1)](#b-1)— - (A) 80 percent of the costs of the scholarship shall be paid from the grant made under [subsection (a)](#a) to the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26); and - (B) 20 percent of such costs shall be paid from non-Federal contributions by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) through which the scholarship is provided. - (3) In determining the amount of non-Federal contributions that have been provided for purposes of [subparagraph (B)](#b-2-B) of paragraph (2), any amounts provided by the Federal Government to the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) involved or to any other entity shall not be included. - (4) Non-Federal contributions required by [subparagraph (B)](#b-2-B) of paragraph (2) may be provided directly by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) involved or through donations from public and private entities. - (c) **Course of study in health professions—** An [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) shall provide scholarships under [subsection (b)](#b) only to [Indians](/usc/25/1934.md) enrolled or accepted for enrollment in a course of study (approved by the [Secretary](/usc/25/1603.md?p=17)) in one of the [health professions](/usc/25/1603.md?p=10) described in [section 1613a(a) of this title](/usc/25/1613a.md?p=a). - (d) **Contract requirements—** In providing scholarships under [subsection (b)](#b), the [Secretary](/usc/25/1603.md?p=17) and the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) shall enter into a written contract with each recipient of such scholarship. Such contract shall— - (1) obligate such recipient to provide [service](/usc/25/1603.md?p=18) in an [Indian health program](/usc/25/1603.md?p=12) (as defined in [section 1616a(a)(2)(A) of this title](/usc/25/1616a.md?p=a-2-A)), in the same [service area](/usc/25/1603.md?p=19) where the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) providing the scholarship is located, for— - (A) a number of years equal to the number of years for which the scholarship is provided (or the part-time equivalent thereof, as determined by the [Secretary](/usc/25/1603.md?p=17)), or for a period of 2 years, whichever period is greater; or - (B) such greater period of time as the recipient and the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) may agree; - (2) provide that the amount of such scholarship— - (A) may be expended only for— - (i) tuition expenses, other reasonable educational expenses, and reasonable living expenses incurred in attendance at the educational institution; and - (ii) payment to the recipient of a monthly stipend of not more than the amount authorized by [section 254l(g)(1)(B)](/usc/42/254l.md?p=g-1-B) of title 42, such amount to be reduced pro rata (as determined by the [Secretary](/usc/25/1603.md?p=17)) based on the number of hours such student is enrolled; and - (B) may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in [subparagraph (A)](#d-2-A); - (3) require the recipient of such scholarship to maintain an acceptable level of academic standing (as determined by the educational institution in accordance with regulations issued by the [Secretary](/usc/25/1603.md?p=17)); and - (4) require the recipient of such scholarship to meet the educational and licensure requirements necessary to be a physician, certified nurse practitioner, certified nurse midwife, or physician assistant. - (e) **Breach of contract—** - (1) An individual who has entered into a written contract with the [Secretary](/usc/25/1603.md?p=17) and an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) under [subsection (d)](#d) and who— - (A) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the [Secretary](/usc/25/1603.md?p=17)), - (B) is dismissed from such educational institution for disciplinary reasons, - (C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or - (D) fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any [service](/usc/25/1603.md?p=18) obligation arising under such contract, shall be liable to the United States for the Federal share of the amount which has been paid to him, or on his behalf, under the contract. - (2) If for any reason not specified in [paragraph (1)](#e-1), an individual breaches his written contract by failing either to begin such individual’s [service](/usc/25/1603.md?p=18) obligation required under such contract or to complete such [service](/usc/25/1603.md?p=18) obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of [section 1616a of this title](/usc/25/1616a.md) in the manner provided for in such subsection. - (3) The [Secretary](/usc/25/1603.md?p=17) may carry out this subsection on the basis of information submitted by the [tribes](/usc/25/3402.md?p=2-A) or [tribal organizations](/usc/25/1603.md?p=26) involved, or on the basis of information collected through such other means as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate. - (f) **Nondiscriminatory practice—** The recipient of a scholarship under [subsection (b)](#b) shall agree, in providing health care pursuant to the requirements of [subsection (d)(1)](#d-1)— - (1) not to discriminate against an individual seeking such care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to the [program](/usc/25/3402.md?p=4) established in title XVIII of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.] or pursuant to the [program](/usc/25/3402.md?p=4) established in title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.]; and - (2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act [[42 U.S.C. 1395u(b)(3)(B)(ii)](/usc/42/1395u.md?p=b-3-B-ii)] for all [services](/usc/25/1603.md?p=18) for which payment may be made under part B of title XVIII of such Act [[42 U.S.C. 1395j](/usc/42/1395j.md) et seq.], and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] to provide [service](/usc/25/1603.md?p=18) to individuals entitled to medical assistance under the plan. - (g) **Payments for subsequent fiscal years—** The [Secretary](/usc/25/1603.md?p=17) may not make any payments under [subsection (a)](#a) to an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) for any fiscal year subsequent to the first fiscal year of such payments unless the [Secretary](/usc/25/1603.md?p=17) determines that, for the immediately preceding fiscal year, the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) has complied with requirements of this section. # §1616n. Tribal health program administration The [Secretary](/usc/25/1603.md?p=17) shall, by contract or otherwise, provide training for individuals in the administration and planning of [tribal health programs](/usc/25/1603.md?p=25). # §1616o. University of South Dakota pilot program - (a) **Establishment—** The [Secretary](/usc/25/1603.md?p=17) may make a grant to the School of Medicine of the University of South Dakota (hereafter in this section referred to as “USDSM”) to establish a pilot [program](/usc/25/3402.md?p=4) on an [Indian reservation](/usc/25/2902.md?p=8) at one or more [service units](/usc/25/1603.md?p=20) in South Dakota to address the chronic manpower shortage in the Aberdeen Area of the [Service](/usc/25/1603.md?p=18). - (b) **Purposes—** The purposes of the [program](/usc/25/3402.md?p=4) established pursuant to a grant provided under [subsection (a)](#a) are— - (1) to provide direct clinical and practical experience at a [service unit](/usc/25/1603.md?p=20) to medical students and residents from USDSM and other medical schools; - (2) to improve the quality of health care for [Indians](/usc/25/1934.md) by assuring access to qualified health care professionals; and - (3) to provide academic and scholarly opportunities for physicians, physician assistants, nurse practitioners, nurses, and other allied health professionals serving [Indian](/usc/25/1934.md) people by identifying and utilizing all academic and scholarly resources of the region. - (c) **Composition; designation—** The pilot [program](/usc/25/3402.md?p=4) established pursuant to a grant provided under [subsection (a)](#a) shall— - (1) incorporate a [program](/usc/25/3402.md?p=4) advisory board composed of representatives from the [tribes](/usc/25/3402.md?p=2-A) and communities in the area which will be served by the [program](/usc/25/3402.md?p=4); and - (2) shall be designated as an extension of the USDSM campus and [program](/usc/25/3402.md?p=4) participants shall be under the direct supervision and instruction of qualified medical staff serving at the [service unit](/usc/25/1603.md?p=20) who shall be members of the USDSM faculty. - (d) **Coordination with other schools—** The USDSM shall coordinate the [program](/usc/25/3402.md?p=4) established pursuant to a grant provided under [subsection (a)](#a) with other medical schools in the region, nursing schools, tribal [community colleges](/usc/25/1603.md?p=4), and other health professional schools. - (e) **Development of additional professional opportunities—** The USDSM, in cooperation with the [Service](/usc/25/1603.md?p=18), shall develop additional professional opportunities for [program](/usc/25/3402.md?p=4) participants on [Indian reservations](/usc/25/3653.md?p=3) in order to improve the recruitment and retention of qualified health professionals in the Aberdeen Area of the [Service](/usc/25/1603.md?p=18). # §1616p. Health professional chronic shortage demonstration programs - (a) **Demonstration programs—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may fund demonstration [programs](/usc/25/3402.md?p=4) for [Indian health programs](/usc/25/1603.md?p=12) to address the chronic shortages of health professionals. - (b) **Purposes of programs—** The purposes of demonstration [programs](/usc/25/3402.md?p=4) under [subsection (a)](#a) shall be— - (1) to provide direct clinical and practical experience within an [Indian health program](/usc/25/1603.md?p=12) to [health profession](/usc/25/1603.md?p=10) students and residents from medical schools; - (2) to improve the quality of health care for [Indians](/usc/25/1934.md) by ensuring access to qualified health professionals; - (3) to provide academic and scholarly opportunities for health professionals serving [Indians](/usc/25/1934.md) by identifying all academic and scholarly resources of the region; and - (4) to provide training and support for alternative provider types, such as community health representatives, and community health aides. - (c) **Advisory board—** The demonstration [programs](/usc/25/3402.md?p=4) established pursuant to [subsection (a)](#a) shall incorporate a [program](/usc/25/3402.md?p=4) advisory board, which may be composed of representatives of tribal governments, [Indian health programs](/usc/25/1603.md?p=12), and [Indian](/usc/25/1934.md) communities in the areas to be served by the demonstration [programs](/usc/25/3402.md?p=4). # §1616q. Exemption from payment of certain fees Employees of a [tribal health program](/usc/25/1603.md?p=25) or [urban Indian organization](/usc/25/1603.md?p=29) shall be exempt from payment of licensing, registration, and any other fees imposed by a Federal agency to the same extent that officers of the commissioned corps of the Public Health [Service](/usc/25/1603.md?p=18) and other employees of the [Service](/usc/25/1603.md?p=18) are exempt from those fees. # [§1616r. Repealed. Pub. L. 111–148, title X, § 10221(b)(2), Mar. 23, 2010, 124 Stat. 936 — repealed] # §1621. Indian Health Care Improvement Fund - (a) **Use of funds—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to expend funds, directly or under the authority of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] 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](/usc/25/1603.md?p=14); - (2) eliminating backlogs in the provision of health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md); - (3) meeting the health needs of [Indians](/usc/25/1934.md) in an efficient and equitable manner, including the use of [telehealth](/usc/25/1603.md?p=22) and [telemedicine](/usc/25/1603.md?p=23) when appropriate; - (4) eliminating inequities in funding for both direct care and [contract health service](/usc/25/1603.md?p=5) [programs](/usc/25/3402.md?p=4); and - (5) augmenting the ability of the [Service](/usc/25/1603.md?p=18) to meet the following health [service](/usc/25/1603.md?p=18) responsibilities with respect to those [Indian tribes](/usc/25/1603.md?p=14) 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](/usc/25/1603.md?p=18), inpatient mental health [services](/usc/25/1603.md?p=18), dormitory mental health [services](/usc/25/1603.md?p=18), therapeutic and residential treatment centers, and training of traditional health care practitioners. - (E) Emergency medical [services](/usc/25/1603.md?p=18). - (F) Treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including [fetal alcohol syndrome](/usc/25/1603.md?p=9)) among [Indians](/usc/25/1934.md). - (G) Injury prevention [programs](/usc/25/3402.md?p=4), including data collection and evaluation, [demonstration projects](/usc/25/1667a.md?p=2), training, and capacity building. - (H) Home health care. - (I) Community health representatives. - (J) Maintenance and improvement. - (b) **No offset or limitation—** Any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the [Service](/usc/25/1603.md?p=18) under this chapter or [section 13 of this title](/usc/25/13.md), or any other provision of law. - (c) **Allocation; use—** - (1) **In general—** Funds appropriated under the authority of this section shall be allocated to [Service units](/usc/25/1603.md?p=20), [Indian tribes](/usc/25/1603.md?p=14), or [tribal organizations](/usc/25/1603.md?p=26). The funds allocated to each [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [Service unit](/usc/25/1603.md?p=20) under this paragraph shall be used by the [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [Service unit](/usc/25/1603.md?p=20) under this paragraph to improve the health status and reduce the resource deficiency of each [Indian tribe](/usc/25/1603.md?p=14) served by such [Service unit](/usc/25/1603.md?p=20), [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26). - (2) **Apportionment of allocated funds—** The apportionment of funds allocated to a [Service unit](/usc/25/1603.md?p=20), [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) under [paragraph (1)](#c-1) among the health [service](/usc/25/1603.md?p=18) responsibilities described in [subsection (a)(5)](#a-5) shall be determined by the [Service](/usc/25/1603.md?p=18) in consultation with, and with the active participation of, the affected [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26). - (d) **Provisions relating to health status and resource deficiencies—** For the purposes of this section, the following definitions apply: - (1) **Definition—** The term “health status and resource deficiency” means the extent to which— - (A) the health status objectives set forth in sections [1602(1)](/usc/25/1602.md?p=1) and [1602(2)](/usc/25/1602.md?p=2) of this title are not being achieved; and - (B) the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) does not have available to it the health resources it needs, taking into account the actual cost of providing health care [services](/usc/25/1603.md?p=18) given local geographic, climatic, rural, or other circumstances. - (2) **Available resources—** The health resources available to an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) include health resources provided by the [Service](/usc/25/1603.md?p=18) as well as health resources used by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), including [services](/usc/25/1603.md?p=18) and financing systems provided by any Federal [programs](/usc/25/3402.md?p=4), private insurance, and [programs](/usc/25/3402.md?p=4) of State or local governments. - (3) **Process for review of determinations—** The [Secretary](/usc/25/1603.md?p=17) shall establish procedures which allow any [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) to petition the [Secretary](/usc/25/1603.md?p=17) for a review of any determination of the extent of the [health status and resource deficiency](#d-1) of such [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26). - (e) **Eligibility for funds—** [Tribal health programs](/usc/25/1603.md?p=25) shall be eligible for funds appropriated under the authority of this section on an equal basis with [programs](/usc/25/3402.md?p=4) that are administered directly by the [Service](/usc/25/1603.md?p=18). - (f) **Report—** By no later than the date that is 3 years after March 23, 2010, the [Secretary](/usc/25/1603.md?p=17) shall submit to Congress the current [health status and resource deficiency](#d-1) report of the [Service](/usc/25/1603.md?p=18) for each [Service unit](/usc/25/1603.md?p=20), including newly recognized or acknowledged [Indian tribes](/usc/25/1603.md?p=14). Such report shall set out— - (1) the methodology then in use by the [Service](/usc/25/1603.md?p=18) for determining tribal [health status and resource deficiencies](#d-1), as well as the most recent application of that methodology; - (2) the extent of the [health status and resource deficiency](#d-1) of each [Indian tribe](/usc/25/1603.md?p=14) served by the [Service](/usc/25/1603.md?p=18) or a [tribal health program](/usc/25/1603.md?p=25); - (3) the amount of funds necessary to eliminate the [health status and resource deficiencies](#d-1) of all [Indian tribes](/usc/25/1603.md?p=14) served by the [Service](/usc/25/1603.md?p=18) or a [tribal health program](/usc/25/1603.md?p=25); and - (4) an estimate of— - (A) the amount of health [service](/usc/25/1603.md?p=18) funds appropriated under the authority of this chapter, or any other Act, including the amount of any funds transferred to the [Service](/usc/25/1603.md?p=18) for the preceding fiscal year which is allocated to each [Service unit](/usc/25/1603.md?p=20), [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26); - (B) the number of [Indians](/usc/25/1934.md) eligible for health [services](/usc/25/1603.md?p=18) in each [Service unit](/usc/25/1603.md?p=20) or [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26); and - (C) the number of [Indians](/usc/25/1934.md) using the [Service](/usc/25/1603.md?p=18) resources made available to each [Service unit](/usc/25/1603.md?p=20), [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), and, to the extent available, information on the waiting [lists](/usc/25/5130.md?p=3) and number of [Indians](/usc/25/1934.md) turned away for [services](/usc/25/1603.md?p=18) due to lack of resources. - (g) **Inclusion in base budget—** Funds appropriated under this section for any fiscal year shall be included in the base budget of the [Service](/usc/25/1603.md?p=18) for the purpose of determining appropriations under this section in subsequent fiscal years. - (h) **Clarification—** Nothing in this section is intended to diminish the primary responsibility of the [Service](/usc/25/1603.md?p=18) to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the [Service](/usc/25/1603.md?p=18) from undertaking additional efforts to achieve equity among [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26). - (i) **Funding designation—** Any funds appropriated under the authority of this section shall be designated as the “[Indian](/usc/25/1934.md) Health Care Improvement Fund”. # §1621a. Catastrophic Health Emergency Fund - (a) **Establishment—** There is established an [Indian](/usc/25/1934.md) Catastrophic Health Emergency Fund (hereafter in this section referred to as the “CHEF”) consisting of— - (1) the amounts deposited under [subsection (f)](#f); and - (2) the amounts appropriated to CHEF under this section. - (b) **Administration—** CHEF shall be administered by the [Secretary](/usc/25/1603.md?p=17), acting through the headquarters of the [Service](/usc/25/1603.md?p=18), 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](/usc/25/1603.md?p=18). - (c) **Conditions on use of Fund—** No part of CHEF or its administration shall be subject to contract or grant under any law, including the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] nor shall CHEF funds be allocated, apportioned, or delegated on an [Area Office](/usc/25/1603.md?p=1), [Service Unit](/usc/25/1603.md?p=20), or other similar basis. - (d) **Regulations—** The [Secretary](/usc/25/1603.md?p=17) 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](/usc/25/1603.md?p=20) 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](/usc/25/1603.md?p=17) 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](/usc/25/1603.md?p=20); or - (B) whenever otherwise authorized by the [Service](/usc/25/1603.md?p=18), non-[Service](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=18); 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 limitation—** Amounts appropriated to CHEF under this section shall not be used to offset or limit appropriations made to the [Service](/usc/25/1603.md?p=18) under the authority of [section 13 of this title](/usc/25/13.md), or any other law. - (f) **Deposit of reimbursement funds—** There shall be deposited into CHEF all reimbursements to which the [Service](/usc/25/1603.md?p=18) 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. # §1621b. Health promotion and disease prevention services - (a) **Authorization—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall 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) to [Indians](/usc/25/1934.md) so as to achieve the health status objectives set forth in [section 1602(b)](/usc/25/1602.md)[^1] of this title. - (b) **Evaluation statement for Presidential budget—** The [Secretary](/usc/25/1603.md?p=17) 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](/usc/25/1671.md) an evaluation of— - (1) the [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) needs of [Indians](/usc/25/1934.md), - (2) the [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) activities which would best meet such needs, - (3) the internal capacity of the [Service](/usc/25/1603.md?p=18) to meet such needs, and - (4) the resources which would be required to enable the [Service](/usc/25/1603.md?p=18) to undertake the [health promotion](/usc/25/1603.md?p=11) and [disease prevention](/usc/25/1603.md?p=7-A) activities necessary to meet such needs. # §1621c. Diabetes prevention, treatment, and control - (a) **Determinations regarding diabetes—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), and in consultation with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26), shall determine— - (1) by [Indian tribe](/usc/25/1603.md?p=14) and by [Service unit](/usc/25/1603.md?p=20), the incidence of, and the types of complications resulting from, diabetes among [Indians](/usc/25/1934.md); and - (2) based on the determinations made pursuant to [paragraph (1)](#a-1), the measures (including patient education and effective ongoing monitoring of disease indicators) each [Service unit](/usc/25/1603.md?p=20) should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among [Indian tribes](/usc/25/1603.md?p=14) within that [Service unit](/usc/25/1603.md?p=20). - (b) **Diabetes screening—** To the extent medically indicated and with informed consent, the [Secretary](/usc/25/1603.md?p=17) shall screen each [Indian](/usc/25/1934.md) who receives [services](/usc/25/1603.md?p=18) from the [Service](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=25) and may be conducted through appropriate Internet-based health care management [programs](/usc/25/3402.md?p=4). - (c) **Diabetes projects—** The [Secretary](/usc/25/1603.md?p=17) shall continue to maintain each model diabetes [project](/usc/25/5611.md?p=2) in existence on March 23, 2010, any such other diabetes [programs](/usc/25/3402.md?p=4) operated by the [Service](/usc/25/1603.md?p=18) or [tribal health programs](/usc/25/1603.md?p=25), and any additional diabetes [projects](/usc/25/5611.md?p=2), such as the Medical Vanguard [program](/usc/25/3402.md?p=4) provided for in title IV of Public Law 108–87, as implemented to serve [Indian tribes](/usc/25/1603.md?p=14). tribal[^1] health [programs](/usc/25/3402.md?p=4) shall receive recurring funding for the diabetes [projects](/usc/25/5611.md?p=2) that they operate pursuant to this section, both at March 23, 2010, and for [projects](/usc/25/5611.md?p=2) which are added and funded thereafter. - (d) **Dialysis programs—** The [Secretary](/usc/25/1603.md?p=17) is authorized to provide, through the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26), dialysis [programs](/usc/25/3402.md?p=4), including the purchase of dialysis equipment and the provision of necessary staffing. - (e) **Other duties of the Secretary—** - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17) shall, to the extent funding is available— - (A) in each [area office](/usc/25/1603.md?p=1), consult with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) regarding [programs](/usc/25/3402.md?p=4) for the prevention, treatment, and control of diabetes; - (B) establish in each [area office](/usc/25/1603.md?p=1) 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](/usc/25/1603.md?p=1) regarding diabetes and related complications among [Indians](/usc/25/1934.md) are disseminated to all other [area offices](/usc/25/1603.md?p=1), subject to applicable patient privacy laws. - (2) **Diabetes control officers—** - (A) **In general—** The [Secretary](/usc/25/1603.md?p=17) may establish and maintain in each [area office](/usc/25/1603.md?p=1) a position of diabetes control officer to coordinate and manage any activity of that [area office](/usc/25/1603.md?p=1) relating to the prevention, treatment, or control of diabetes to assist the [Secretary](/usc/25/1603.md?p=17) in carrying out a [program](/usc/25/3402.md?p=4) under this section or [section 254c–3 of title 42](/usc/42/254c–3.md). - (B) **Certain activities—** Any activity carried out by a diabetes control officer under [subparagraph (A)](#e-2-A) that is the subject of a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^2] and any funds made available to carry out such an activity, shall not be divisible for purposes of that Act. # §1621d. Other authority for provision of services - (a) **Definitions—** In this section: - (1) **Assisted living service—** The term “assisted living service” means any [service](/usc/25/1603.md?p=18) provided by an assisted living facility (as defined in [section 1715w(b) of title 12](/usc/12/1715w.md?p=b)), 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 service—** The term “home- and community-based service” means 1 or more of the [services](/usc/25/1603.md?p=18) specified in paragraphs (1) through (9) of [section 1396t(a) of title 42](/usc/42/1396t.md?p=a) (whether provided by the [Service](/usc/25/1603.md?p=18) or by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) pursuant to the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.))[^1] that are or will be provided in accordance with applicable standards. - (3) **Hospice care—** The term “hospice care” means— - (A) the items and [services](/usc/25/1603.md?p=18) specified in subparagraphs (A) through (H) of [section 1395x(dd)(1) of title 42](/usc/42/1395x.md?p=dd-1); and - (B) such other [services](/usc/25/1603.md?p=18) as an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) determines are necessary and appropriate to provide in furtherance of that care. - (4) **Long-term care services—** The term “long-term care services” has the meaning given the term “qualified long-term care services” in [section 7702B(c) of title 26](/usc/26/7702B.md?p=c). - (b) **Funding authorized—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26), may provide funding under this chapter to meet the objectives set forth in [section 1602 of this title](/usc/25/1602.md) through health care-related [services](/usc/25/1603.md?p=18) and [programs](/usc/25/3402.md?p=4) not otherwise described in this chapter for the following [services](/usc/25/1603.md?p=18): - (1) [Hospice care](#a-3). - (2) [Assisted living services](#a-1). - (3) [Long-term care services](#a-4). - (4) [Home- and community-based services](#a-2). - (c) **Eligibility—** The following individuals shall be eligible to receive [long-term care services](#a-4) 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](/usc/25/1603.md?p=25) determines to be appropriate. - (d) **Authorization of convenient care services—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26), may also provide funding under this chapter to meet the objectives set forth in [section 1602 of this title](/usc/25/1602.md) for convenient care [services](/usc/25/1603.md?p=18) [programs](/usc/25/3402.md?p=4) pursuant to [section 1637(c)(2)(A) of this title](/usc/25/1637.md?p=c-2-A). # §1621e. Reimbursement from certain third parties of costs of health services - (a) **Right of recovery—** Except as provided in [subsection (f)](#f), the United States, an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) 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](/usc/25/1603.md?p=17), an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) in providing health [services](/usc/25/1603.md?p=18) through the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26), or, if higher, the highest amount the third party would pay for care and [services](/usc/25/1603.md?p=18) furnished by providers other than governmental entities, to any individual to the same extent that such individual, or any nongovernmental provider of such [services](/usc/25/1603.md?p=18), would be eligible to receive damages, reimbursement, or indemnification for such charges or expenses if— - (1) such [services](/usc/25/1603.md?p=18) 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 States—** [Subsection (a)](#a) shall provide a right of recovery against any State, only if the injury, illness, or disability for which health [services](/usc/25/1603.md?p=18) were provided is covered under— - (1) workers’ compensation laws; or - (2) a no-fault automobile accident insurance plan or [program](/usc/25/3402.md?p=4). - (c) **Nonapplicability of other laws—** No 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](/usc/25/3402.md?p=4) entered into or renewed after November 23, 1988, shall prevent or hinder the right of recovery of the United States, an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) under [subsection (a)](#a). - (d) **No effect on private rights of action—** No action taken by the United States, an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) 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 general—** The United States, an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) may enforce the right of recovery provided under [subsection (a)](#a) by— - (A) intervening or joining in any civil action or proceeding brought— - (i) by the individual for whom health [services](/usc/25/1603.md?p=18) were provided by the [Secretary](/usc/25/1603.md?p=17), an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26); 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) **Notice—** All reasonable efforts shall be made to provide notice of action instituted under [paragraph (1)(B)](#e-1-B) to the individual to whom health [services](/usc/25/1603.md?p=18) were provided, either before or during the pendency of such action. - (3) **Recovery from tortfeasors—** - (A) **In general—** In any case in which an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) that is authorized or required under a [compact](/usc/25/5361.md?p=1) or contract issued pursuant to the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^1] to furnish or pay for health [services](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) shall have a right to recover from the tortfeasor (or an insurer of the tortfeasor) the reasonable value of the health [services](/usc/25/1603.md?p=18) so furnished, paid for, or to be paid for, in accordance with the Federal Medical Care Recovery Act ([42 U.S.C. 2651](/usc/42/2651.md) et seq.), to the same extent and under the same circumstances as the United States may recover under that Act. - (B) **Treatment—** The right of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) to recover under [subparagraph (A)](#e-3-A) shall be independent of the rights of the injured or diseased person served by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26). - (f) **Limitation—** Absent specific written authorization by the governing body of an [Indian tribe](/usc/25/1603.md?p=14) 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](/usc/25/1603.md?p=18)), the United States shall not have a right of recovery under this section if the injury, illness, or disability for which health [services](/usc/25/1603.md?p=18) were provided is covered under a self-insurance plan funded by an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29). Where such authorization is provided, the [Service](/usc/25/1603.md?p=18) may receive and expend such amounts for the provision of additional health [services](/usc/25/1603.md?p=18) consistent with such authorization. - (g) **Costs and attorney’s fees—** In 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 requirements—** An insurance company, health maintenance organization, self-insurance plan, managed care plan, or other health care plan or [program](/usc/25/3402.md?p=4) (under the Social Security Act [[42 U.S.C. 301](/usc/42/301.md) et seq.] or otherwise) may not deny a claim for benefits submitted by the [Service](/usc/25/1603.md?p=18) or by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) 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](/usc/42/1395.md) et seq.] or recognized under section 1175 of such Act [[42 U.S.C. 1320d–4](/usc/42/1320d–4.md)]. - (i) **Application to urban Indian organizations—** The previous provisions of this section shall apply to [urban Indian organizations](/usc/25/1603.md?p=29) with respect to populations served by such Organizations[^1] in the same manner they apply to [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) with respect to populations served by such [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26). - (j) **Statute of limitations—** The provisions of [section 2415 of title 28](/usc/28/2415.md) shall apply to all actions commenced under this section, and the references therein to the United States are deemed to include [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29). - (k) **Savings—** Nothing in this section shall be construed to limit any right of recovery available to the United States, an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26) under the provisions of any applicable, Federal, State, or tribal law, including medical lien laws. # §1621f. Crediting of reimbursements - (a) **Use of amounts—** - (1) **Retention by program—** Except as provided in sections [1621a(a)(2)](/usc/25/1621a.md?p=a-2) and [1680c](/usc/25/1680c.md) of this title, all reimbursements received or recovered under any of the [programs](/usc/25/3402.md?p=4) described in [paragraph (2)](#a-2), including under [section 1680c of this title](/usc/25/1680c.md), by reason of the provision of health [services](/usc/25/1603.md?p=18) by the [Service](/usc/25/1603.md?p=18), by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), or by an [urban Indian organization](/usc/25/1603.md?p=29), shall be credited to the [Service](/usc/25/1603.md?p=18), such [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), or such [urban Indian organization](/usc/25/1603.md?p=29), respectively, and may be used as provided in [section 1641 of this title](/usc/25/1641.md). In the case of such a [service](/usc/25/1603.md?p=18) provided by or through a [Service Unit](/usc/25/1603.md?p=20), such amounts shall be credited to such unit and used for such purposes. - (2) **Programs covered—** The [programs](/usc/25/3402.md?p=4) referred to in [paragraph (1)](#a-1) are the following: - (A) Titles XVIII, XIX, and XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.]. - (B) This chapter, including [section 1680c of this title](/usc/25/1680c.md). - (C) Public Law 87–693 [[42 U.S.C. 2651](/usc/42/2651.md) et seq.]. - (D) Any other provision of law. - (b) **No offset of amounts—** The [Service](/usc/25/1603.md?p=18) may not offset or limit any amount obligated to any [Service Unit](/usc/25/1603.md?p=20) or entity receiving funding from the [Service](/usc/25/1603.md?p=18) because of the receipt of reimbursements under [subsection (a)](#a). # §1621g. Health services research Of the amounts appropriated for the [Service](/usc/25/1603.md?p=18) in any fiscal year, other than amounts made available for the [Indian](/usc/25/1934.md) Health Care Improvement Fund, not less than $200,000 shall be available only for research to further the performance of the health [service](/usc/25/1603.md?p=18) responsibilities of the [Service](/usc/25/1603.md?p=18). [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) contracting with the [Service](/usc/25/1603.md?p=18) under the authority of the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.] shall be given an equal opportunity to compete for, and receive, research funds under this section. # §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](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall develop and publish in the Federal Register a final national plan for [Indian](/usc/25/1934.md) Mental Health [Services](/usc/25/1603.md?p=18). 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](/usc/25/1934.md), including— - (i) the number of [Indians](/usc/25/1934.md) served by the [Service](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=18) to meet its responsibilities under the plan. - (2) The [Secretary](/usc/25/1603.md?p=17) shall submit a copy of the national plan to the Congress. - (b) **Memorandum of agreement—** Not later than 180 days after November 28, 1990, the [Secretary](/usc/25/1603.md?p=17) and the [Secretary](/usc/25/1603.md?p=17) of the Interior shall develop and enter into a memorandum of agreement under which the [Secretaries](/usc/25/1603.md?p=17) 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](/usc/25/1934.md); - (2) make an assessment of the existing Federal, tribal, State, local, and private [services](/usc/25/1603.md?p=18), resources, and [programs](/usc/25/3402.md?p=4) available to provide mental health [services](/usc/25/1603.md?p=18) for [Indians](/usc/25/1934.md); - (3) make an initial determination of the unmet need for additional [services](/usc/25/1603.md?p=18), resources, and [programs](/usc/25/3402.md?p=4) necessary to meet the needs identified pursuant to [paragraph (1)](#b-1); - (4) - (A) ensure that [Indians](/usc/25/1934.md), as citizens of the United States and of the States in which they reside, have access to mental health [services](/usc/25/1603.md?p=18) to which all citizens have access; - (B) determine the right of [Indians](/usc/25/1934.md) to participate in, and receive the benefit of, such [services](/usc/25/1603.md?p=18); and - (C) take actions necessary to protect the exercise of such right; - (5) delineate the responsibilities of the Bureau of [Indian](/usc/25/1934.md) Affairs and the [Service](/usc/25/1603.md?p=18), including mental health identification, prevention, education, referral, and treatment [services](/usc/25/1603.md?p=18) (including [services](/usc/25/1603.md?p=18) through multidisciplinary resource teams), at the central, area, and agency and [service unit](/usc/25/1603.md?p=20) levels to address the problems identified in [paragraph (1)](#b-1); - (6) provide a strategy for the comprehensive coordination of the mental health [services](/usc/25/1603.md?p=18) provided by the Bureau of [Indian](/usc/25/1934.md) Affairs and the [Service](/usc/25/1603.md?p=18) to meet the needs identified pursuant to [paragraph (1)](#b-1), including— - (A) the coordination of alcohol and [substance abuse](/usc/25/1603.md?p=21) [programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18), the Bureau of [Indian](/usc/25/1934.md) Affairs, and the various [tribes](/usc/25/3402.md?p=2-A) (developed under the [Indian](/usc/25/1934.md) Alcohol and [Substance Abuse](/usc/25/1603.md?p=21) Prevention and Treatment Act of 1986 [[25 U.S.C. 2401](/usc/25/2401.md) 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](/usc/25/1603.md?p=21) treatment; and - (B) ensuring that Bureau of [Indian](/usc/25/1934.md) Affairs and [Service](/usc/25/1603.md?p=18) [programs](/usc/25/3402.md?p=4) and [services](/usc/25/1603.md?p=18) (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal [programs](/usc/25/3402.md?p=4) and [services](/usc/25/1603.md?p=18); - (7) direct appropriate officials of the Bureau of [Indian](/usc/25/1934.md) Affairs and the [Service](/usc/25/1603.md?p=18), particularly at the agency and [service unit](/usc/25/1603.md?p=20) levels, to cooperate fully with tribal requests made pursuant to [subsection (d)](#d); and - (8) provide for an annual review of such agreement by the two [Secretaries](/usc/25/1603.md?p=17). - (c) **Community mental health plan—** - (1) The governing body of any [Indian tribe](/usc/25/1603.md?p=14) 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](/usc/25/3402.md?p=4) 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)](#c-1) and at the request of a [tribe](/usc/25/3402.md?p=2-A), the appropriate agency, [service unit](/usc/25/1603.md?p=20), or other officials of the Bureau of [Indian](/usc/25/1934.md) Affairs and the [Service](/usc/25/1603.md?p=18) shall cooperate with, and provide technical assistance to, the [tribe](/usc/25/3402.md?p=2-A) in the development of such plan. Upon the establishment of such a plan and at the request of the [tribe](/usc/25/3402.md?p=2-A), such officials, as directed by the memorandum of agreement developed pursuant to [subsection (c)](#c), shall cooperate with the [tribe](/usc/25/3402.md?p=2-A) in the implementation of such plan. - (3) Two or more [Indian tribes](/usc/25/1603.md?p=14) 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](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may make grants to [Indian tribes](/usc/25/1603.md?p=14) adopting a resolution pursuant to [paragraph (1)](#c-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; list—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), and the [Secretary](/usc/25/1603.md?p=17) of the Interior, in consultation with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26), shall conduct a study and compile a [list](/usc/25/5130.md?p=3) of the types of staff positions specified in [paragraph (2)](#d-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) **Positions—** The positions referred to in [paragraph (1)](#d-1) are— - (A) staff positions within the Bureau of [Indian](/usc/25/1934.md) Affairs, including existing positions, in the fields of— - (i) elementary and secondary education; - (ii) social [services](/usc/25/1603.md?p=18) and family and child welfare; - (iii) law enforcement and judicial [services](/usc/25/1603.md?p=18); and - (iv) alcohol and [substance abuse](/usc/25/1603.md?p=21); - (B) staff positions within the [Service](/usc/25/1603.md?p=18); and - (C) staff positions similar to those identified in subparagraphs [(A)](#d-2-A) and [(B)](#d-2-B) established and maintained by [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) (without regard to the funding source). - (3) **Training criteria—** - (A) **In general—** The appropriate [Secretary](/usc/25/1603.md?p=17) shall provide training criteria appropriate to each type of position identified in paragraphs [(2)(A)](#d-2-A) and [(2)(B)](#d-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)](#d-2-C), the respective [Secretaries](/usc/25/1603.md?p=17) shall provide appropriate training to, or provide funds to, an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) for training of appropriate individuals. In the case of positions funded under a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] the appropriate [Secretary](/usc/25/1603.md?p=17) shall ensure that such training costs are included in the contract or [compact](/usc/25/5361.md?p=1), as the [Secretary](/usc/25/1603.md?p=17) determines necessary. - (B) **Position specific training criteria—** Position specific training criteria shall be culturally relevant to [Indians](/usc/25/1934.md) and [Indian tribes](/usc/25/1603.md?p=14) and shall ensure that appropriate information regarding traditional health care practices is provided. - (4) **Community education on mental illness—** The [Service](/usc/25/1603.md?p=18) shall develop and implement, on request of an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29), or assist the [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) to develop and implement, a [program](/usc/25/3402.md?p=4) of community education on mental illness. In carrying out this paragraph, the [Service](/usc/25/1603.md?p=18) shall, upon request of an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29), provide technical assistance to the [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) to obtain and develop community educational materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior. - (5) **Plan—** Not later than 90 days after March 23, 2010, the [Secretary](/usc/25/1603.md?p=17) shall develop a plan under which the [Service](/usc/25/1603.md?p=18) will increase the health care staff providing [behavioral health](/usc/25/1603.md?p=2-A) [services](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=18). The plan developed under this paragraph shall be implemented under [section 13 of this title](/usc/25/13.md). - (e) **Staffing—** - (1) Within 90 days after November 28, 1990, the [Secretary](/usc/25/1603.md?p=17) shall develop a plan under which the [Service](/usc/25/1603.md?p=18) will increase the health care staff providing mental health [services](/usc/25/1603.md?p=18) 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](/usc/25/1603.md?p=18). Such additional staff shall be primarily assigned to the [service unit](/usc/25/1603.md?p=20) level for [services](/usc/25/1603.md?p=18) which shall include outpatient, emergency, aftercare and follow-up, and prevention and education [services](/usc/25/1603.md?p=18). - (2) The plan developed under [paragraph (1)](#e-1) shall be implemented under [section 13 of this title](/usc/25/13.md). - (f) **Staff recruitment and retention—** - (1) The [Secretary](/usc/25/1603.md?p=17) shall provide for the recruitment of the additional personnel required by [subsection (f)](#f) and the retention of all [Service](/usc/25/1603.md?p=18) personnel providing mental health [services](/usc/25/1603.md?p=18). In carrying out this subsection, the [Secretary](/usc/25/1603.md?p=17) shall give priority to practitioners providing mental health [services](/usc/25/1603.md?p=18) to children and adolescents with mental health problems. - (2) In carrying out [paragraph (1)](#f-1), the [Secretary](/usc/25/1603.md?p=17) shall develop a [program](/usc/25/3402.md?p=4) providing for— - (A) the payment of bonuses (which shall not be more favorable than those provided for under sections [1616i](/usc/25/1616i.md) and [1616j](/usc/25/1616j.md) of this title) for [service](/usc/25/1603.md?p=18) 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](/usc/25/1616a.md)) for [health professions](/usc/25/1603.md?p=10) 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](/usc/25/3402.md?p=4) under subchapter I. - (g) **Mental Health Technician program—** - (1) Under the authority of [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17) shall establish and maintain a Mental Health Technician [program](/usc/25/3402.md?p=4) within the [Service](/usc/25/1603.md?p=18) which— - (A) provides for the training of [Indians](/usc/25/1934.md) 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](/usc/25/1603.md?p=18). - (2) In carrying out [paragraph (1)(A)](#g-1-A), the [Secretary](/usc/25/1603.md?p=17) shall provide high standard paraprofessional training in mental health care necessary to provide quality care to the [Indian](/usc/25/1934.md) communities to be served. Such training shall be based upon a curriculum developed or approved by the [Secretary](/usc/25/1603.md?p=17) which combines education in the theory of mental health care with supervised practical experience in the provision of such care. - (3) The [Secretary](/usc/25/1603.md?p=17) shall supervise and evaluate the mental health technicians in the training [program](/usc/25/3402.md?p=4). - (4) The [Secretary](/usc/25/1603.md?p=17) shall ensure that the [program](/usc/25/3402.md?p=4) established pursuant to this subsection involves the utilization and promotion of the traditional [Indian](/usc/25/1934.md) health care and treatment practices of the [Indian tribes](/usc/25/1603.md?p=14) to be served. - (h) **Mental health research—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) 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](/usc/25/1934.md) on [Indian reservations](/usc/25/3653.md?p=3) 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)](#h-1) on children, and the development of prevention techniques under [paragraph (2)](#h-2) applicable to children, shall be emphasized. - (i) **Facilities assessment—** Within one year after November 28, 1990, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make an assessment of the need for inpatient mental health care among [Indians](/usc/25/1934.md) and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the [Secretary](/usc/25/1603.md?p=17) shall consider the possible conversion of existing, under-utilized [service](/usc/25/1603.md?p=18) hospital beds into psychiatric units to meet such need. - (j) **Annual report—** The [Service](/usc/25/1603.md?p=18) shall develop methods for analyzing and evaluating the overall status of mental health [programs](/usc/25/3402.md?p=4) and [services](/usc/25/1603.md?p=18) for [Indians](/usc/25/1934.md) and shall submit to the President, for inclusion in each report required to be transmitted to the Congress under [section 1671 of this title](/usc/25/1671.md), a report on the mental health status of [Indians](/usc/25/1934.md) which shall describe the progress being made to address mental health problems of [Indian](/usc/25/1934.md) communities. - (k) **Mental health demonstration grant program—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to make grants to [Indian tribes](/usc/25/1603.md?p=14) and inter-tribal consortia to pay 75 percent of the cost of planning, developing, and implementing [programs](/usc/25/3402.md?p=4) to deliver innovative community-based mental health [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md). The 25 percent tribal share of such cost may be provided in cash or through the provision of property or [services](/usc/25/1603.md?p=18). - (2) The [Secretary](/usc/25/1603.md?p=17) may award a grant for a [project](/usc/25/5611.md?p=2) under [paragraph (1)](#k-1) to an [Indian tribe](/usc/25/1603.md?p=14) or inter-tribal consortium which meets the following criteria: - (A) The [project](/usc/25/5611.md?p=2) will address significant unmet mental health needs among [Indians](/usc/25/1934.md). - (B) The [project](/usc/25/5611.md?p=2) will serve a significant number of [Indians](/usc/25/1934.md). - (C) The [project](/usc/25/5611.md?p=2) has the potential to deliver [services](/usc/25/1603.md?p=18) in an efficient and effective manner. - (D) The [tribe](/usc/25/3402.md?p=2-A) or consortium has the administrative and financial capability to administer the [project](/usc/25/5611.md?p=2). - (E) The [project](/usc/25/5611.md?p=2) will deliver [services](/usc/25/1603.md?p=18) in a manner consistent with traditional [Indian](/usc/25/1934.md) healing and treatment practices. - (F) The [project](/usc/25/5611.md?p=2) is coordinated with, and avoids duplication of, existing [services](/usc/25/1603.md?p=18). - (3) For purposes of this subsection, the [Secretary](/usc/25/1603.md?p=17) shall, in evaluating applications for grants for [projects](/usc/25/5611.md?p=2) to be operated under any contract entered into with the [Service](/usc/25/1603.md?p=18) under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.], use the same criteria that the [Secretary](/usc/25/1603.md?p=17) uses in evaluating any other application for such a grant. - (4) The [Secretary](/usc/25/1603.md?p=17) may only award one grant under this subsection with respect to a [service area](/usc/25/1603.md?p=19) until the [Secretary](/usc/25/1603.md?p=17) has awarded grants for all [service areas](/usc/25/1603.md?p=19) with respect to which the [Secretary](/usc/25/1603.md?p=17) receives applications during the application period, as determined by the [Secretary](/usc/25/1603.md?p=17), which meet the criteria specified in [paragraph (2)](#k-2). - (5) Not later than 180 days after the close of the term of the last grant awarded pursuant to this subsection, the [Secretary](/usc/25/1603.md?p=17) shall submit to the Congress a report evaluating the effectiveness of the innovative community-based [projects](/usc/25/5611.md?p=2) demonstrated pursuant to this subsection. Such report shall include findings and recommendations, if any, relating to the reorganization of the [programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18) for delivery of mental health [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md). - (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 workers—** Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) in a clinical setting under the authority of this chapter or through a contract pursuant to the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) 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](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may make grants to [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) to provide intermediate mental health [services](/usc/25/1603.md?p=18) to Indian children and adolescents, including— - (A) inpatient and outpatient [services](/usc/25/1603.md?p=18); - (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](/usc/25/1603.md?p=18); - (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](/usc/25/1603.md?p=18) 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)](/usc/25/1621o.md?p=b-1) of this title. - (4) An [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) receiving a grant under this subsection shall ensure that intermediate adolescent mental health [services](/usc/25/1603.md?p=18) are coordinated with other tribal, [Service](/usc/25/1603.md?p=18), and Bureau of [Indian](/usc/25/1934.md) Affairs mental health, alcohol and [substance abuse](/usc/25/1603.md?p=21), and social [services](/usc/25/1603.md?p=18) [programs](/usc/25/3402.md?p=4) on the [reservation](/usc/25/1603.md?p=16-A) of such [tribe](/usc/25/3402.md?p=2-A) or [tribal organization](/usc/25/1603.md?p=26). - (5) The [Secretary](/usc/25/1603.md?p=17) shall establish criteria for the review and approval of applications for grants made pursuant to this subsection. # §1621i. Managed care feasibility study - (a) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall conduct a study to assess the feasibility of allowing an [Indian tribe](/usc/25/1603.md?p=14) to purchase, directly or through the [Service](/usc/25/1603.md?p=18), managed care coverage for all members of the [tribe](/usc/25/3402.md?p=2-A) 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](/usc/25/1603.md?p=17) 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. # §1621j. California contract health services demonstration program - (a) **Establishment—** The [Secretary](/usc/25/1603.md?p=17) shall establish a demonstration [program](/usc/25/3402.md?p=4) to evaluate the use of a contract care intermediary to improve the accessibility of health [services](/usc/25/1603.md?p=18) to [California Indians](/usc/25/1603.md?p=3). - (b) **Agreement with California Rural Indian Health Board—** - (1) In establishing such [program](/usc/25/3402.md?p=4), the [Secretary](/usc/25/1603.md?p=17) shall enter into an agreement with the California Rural [Indian](/usc/25/1934.md) Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration [program](/usc/25/3402.md?p=4), in providing medical treatment under contract to [California Indians](/usc/25/1603.md?p=3) described in [section 1679(b)](/usc/25/1679.md?p=b)[^1] of this title throughout the California [contract health services](/usc/25/1603.md?p=5) delivery area described in [section 1680 of this title](/usc/25/1680.md) with respect to [high-cost contract care cases](#f). - (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](/usc/25/3402.md?p=4) to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in [section 1621a of this title](/usc/25/1621a.md) or from amounts appropriated or otherwise made available to the California [contract health service](/usc/25/1603.md?p=5) delivery area for a fiscal year. - (c) **Advisory board—** There is hereby established an advisory board which shall advise the California Rural [Indian](/usc/25/1934.md) 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](/usc/25/1934.md) Health Board, from not less than 8 [tribal health programs](/usc/25/1603.md?p=25) serving [California Indians](/usc/25/1603.md?p=3) covered under such demonstration, at least one half of whom are not affiliated with the California Rural [Indian](/usc/25/1934.md) Health Board. - (d) **Commencement and termination dates—** The demonstration [program](/usc/25/3402.md?p=4) described in this section shall begin on January 1, 1993, and shall terminate on September 30, 1997. - (e) **Report—** Not later than July 1, 1998, the California Rural [Indian](/usc/25/1934.md) Health Board shall submit to the [Secretary](/usc/25/1603.md?p=17) a report on the demonstration [program](/usc/25/3402.md?p=4) 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](/usc/25/1603.md?p=18); - (2) waiting periods for receiving such [services](/usc/25/1603.md?p=18); and - (3) the efficient management of [high-cost contract care cases](#f). - (f) **“High-cost contract care cases” defined—** For 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](/usc/25/1621a.md), except that the cost of such treatment does not meet the threshold cost requirement established pursuant to [section 1621a(b)(2)](/usc/25/1621a.md)[^1] of this title; and - (2) exceeds $1,000. # §1621k. Coverage of screening mammography The [Secretary](/usc/25/1603.md?p=17), through the [Service](/usc/25/1603.md?p=18), shall provide for screening mammography (as defined in section 1861(jj) of the Social Security Act [[42 U.S.C. 1395x(jj)](/usc/42/1395x.md?p=jj)]) for [Indian](/usc/25/1934.md) and [urban Indian](/usc/25/2403.md?p=6) women 35 years of age or older at a frequency, determined by the [Secretary](/usc/25/1603.md?p=17) (in consultation with the [Director](/usc/25/4302.md?p=1) of the National Cancer Institute), appropriate to such women, and under such terms and conditions as are consistent with standards established by the [Secretary](/usc/25/1603.md?p=17) 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](/usc/42/1395j.md) et seq.] and other cancer screenings. # §1621l. Patient travel costs - (a) **Definition of qualified escort—** In 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](/usc/25/1603.md?p=17) or applicable [Indian Health Program](/usc/25/1603.md?p=12) determines to be appropriate. - (b) **Provision of funds—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and [Tribal Health Programs](/usc/25/1603.md?p=25), is authorized to provide funds for the following patient travel costs, including [qualified escorts](#a), associated with receiving health care [services](/usc/25/1603.md?p=18) provided (either through direct or contract care or through a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.))[^1] 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. # §1621m. Epidemiology centers - (a) **Establishment of centers—** - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17) shall establish an epidemiology center in each [Service area](/usc/25/1603.md?p=19) to carry out the functions described in [subsection (b)](#b). - (2) **New centers—** - (A) **In general—** Subject to [subparagraph (B)](#a-2-B), any new center established after March 23, 2010, may be operated under a grant authorized by [subsection (d)](#d). - (B) **Requirement—** Funding provided in a grant described in [subparagraph (A)](#a-2-A) shall not be divisible. - (3) **Funds not divisible—** An epidemiology center established under this subsection shall be subject to the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] but the funds for the center shall not be divisible. - (b) **Functions of centers—** In consultation with and on the request of [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29), each [Service area](/usc/25/1603.md?p=19) epidemiology center established under this section shall, with respect to the applicable [Service area](/usc/25/1603.md?p=19)— - (1) collect data relating to, and monitor progress made toward meeting, each of the health status objectives of the [Service](/usc/25/1603.md?p=18), the [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) in the [Service area](/usc/25/1603.md?p=19); - (2) evaluate existing delivery systems, data systems, and other systems that impact the improvement of [Indian](/usc/25/1934.md) health; - (3) assist [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) in identifying highest-priority health status objectives and the [services](/usc/25/1603.md?p=18) needed to achieve those objectives, based on epidemiological data; - (4) make recommendations for the targeting of [services](/usc/25/1603.md?p=18) needed by the populations served; - (5) make recommendations to improve health care delivery systems for [Indians](/usc/25/1934.md) and [urban Indians](/usc/25/2403.md?p=6); - (6) provide requested technical assistance to [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) in the development of local health [service](/usc/25/1603.md?p=18) priorities and incidence and prevalence rates of disease and other illness in the community; and - (7) provide disease surveillance and assist [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian](/usc/25/2403.md?p=6) communities to promote public health. - (c) **Technical assistance—** The [Director](/usc/25/4302.md?p=1) 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 general—** The [Secretary](/usc/25/1603.md?p=17) may make grants to [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), [Indian](/usc/25/1934.md) organizations, and eligible intertribal consortia to conduct epidemiological studies of [Indian](/usc/25/1934.md) communities. - (2) **Eligible intertribal consortia—** An intertribal consortium or [Indian](/usc/25/1934.md) 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](/usc/25/1934.md) health; and - (B) representative of the [Indian tribes](/usc/25/1603.md?p=14) or [urban Indian](/usc/25/2403.md?p=6) communities residing in the area in which the intertribal consortium is located. - (3) **Applications—** An application for a grant under this subsection shall be submitted in such manner and at such time as the [Secretary](/usc/25/1603.md?p=17) shall prescribe. - (4) **Requirements—** An 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)](#d-5); - (B) consult and cooperate with providers of related health and social [services](/usc/25/1603.md?p=18) in order to avoid duplication of existing [services](/usc/25/1603.md?p=18); and - (C) demonstrate cooperation from [Indian tribes](/usc/25/1603.md?p=14) or [urban Indian organizations](/usc/25/1603.md?p=29) in the area to be served. - (5) **Use of funds—** A grant provided under [paragraph (1)](#d-1) may be used— - (A) to carry out the functions described in [subsection (b)](#b); - (B) to provide information to, and consult with, tribal leaders, [urban Indian](/usc/25/2403.md?p=6) community leaders, and related health staff regarding health care and health [service](/usc/25/1603.md?p=18) management issues; and - (C) in collaboration with [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29), to provide to the [Service](/usc/25/1603.md?p=18) information regarding ways to improve the health status of [Indians](/usc/25/1934.md). - (e) **Access to information—** - (1) **In general—** An epidemiology center operated by a grantee pursuant to a grant awarded under [subsection (d)](#d) shall be treated as a public health authority (as defined in [section 164.501 of title 45, Code of Federal Regulations](/cfr/45/164.501.md) (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 information—** The [Secretary](/usc/25/1603.md?p=17) shall grant to each epidemiology center described in [paragraph (1)](#e-1) access to use of the data, data sets, monitoring systems, delivery systems, and other protected health information in the possession of the [Secretary](/usc/25/1603.md?p=17). - (3) **Requirement—** The activities of an epidemiology center described in [paragraph (1)](#e-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](/cfr/45/164.512.md) (or a successor regulation)), for purposes of the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191; 110 Stat. 1936). # §1621n. Comprehensive school health education programs - (a) **Award of grants—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and in consultation with the [Secretary](/usc/25/1603.md?p=17) of the Interior, may award grants to [Indian tribes](/usc/25/1603.md?p=14) to develop comprehensive school health education [programs](/usc/25/3402.md?p=4) for children from preschool through grade 12 in schools located on [Indian reservations](/usc/25/3653.md?p=3). - (b) **Use of grants—** Grants 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](/usc/25/1603.md?p=11) efforts; - (4) encourage healthy, tobacco-free school environments; - (5) coordinate school-based health [programs](/usc/25/3402.md?p=4) with existing [services](/usc/25/1603.md?p=18) and [programs](/usc/25/3402.md?p=4) available in the community; - (6) develop school [programs](/usc/25/3402.md?p=4) on nutrition education, personal health, and fitness; - (7) develop mental health wellness [programs](/usc/25/3402.md?p=4); - (8) develop chronic [disease prevention](/usc/25/1603.md?p=7-A) [programs](/usc/25/3402.md?p=4); - (9) develop [substance abuse](/usc/25/1603.md?p=21) prevention [programs](/usc/25/3402.md?p=4); - (10) develop accident prevention and safety education [programs](/usc/25/3402.md?p=4); - (11) develop activities for the prevention and control of communicable diseases; and - (12) develop community and environmental health education [programs](/usc/25/3402.md?p=4). - (c) **Assistance—** The [Secretary](/usc/25/1603.md?p=17) shall provide technical assistance to [Indian tribes](/usc/25/1603.md?p=14) in the development of health education plans, and the dissemination of health education materials and information on existing health [programs](/usc/25/3402.md?p=4) and resources. - (d) **Criteria for review and approval of applications—** The [Secretary](/usc/25/1603.md?p=17) shall establish criteria for the review and approval of applications for grants made pursuant to this section. - (e) **Report of recipient—** Recipients of grants under this section shall submit to the [Secretary](/usc/25/1603.md?p=17) 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](/usc/25/3402.md?p=4) established with funds provided under this section. - (f) **Program development—** - (1) The [Secretary](/usc/25/1603.md?p=17) of the Interior, acting through the Bureau of [Indian](/usc/25/1934.md) Affairs and in cooperation with the [Secretary](/usc/25/1603.md?p=17), shall develop a comprehensive school health education [program](/usc/25/3402.md?p=4) for children from preschool through grade 12 in schools operated by the Bureau of [Indian](/usc/25/1934.md) Affairs. - (2) Such [program](/usc/25/3402.md?p=4) shall include— - (A) school [programs](/usc/25/3402.md?p=4) on nutrition education, personal health, and fitness; - (B) mental health wellness [programs](/usc/25/3402.md?p=4); - (C) chronic [disease prevention](/usc/25/1603.md?p=7-A) [programs](/usc/25/3402.md?p=4); - (D) [substance abuse](/usc/25/1603.md?p=21) prevention [programs](/usc/25/3402.md?p=4); - (E) accident prevention and safety education [programs](/usc/25/3402.md?p=4); and - (F) activities for the prevention and control of communicable diseases. - (3) The [Secretary](/usc/25/1603.md?p=17) 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](/usc/25/3402.md?p=4) with existing [services](/usc/25/1603.md?p=18) and health [programs](/usc/25/3402.md?p=4) available in the community; and - (C) encourage healthy, tobacco-free school environments. - (g) **Authorization of appropriations—** There 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. # §1621o. Indian youth grant program - (a) **Grants—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to make grants to [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) for innovative mental and physical [disease prevention](/usc/25/1603.md?p=7-A) and [health promotion](/usc/25/1603.md?p=11) and treatment [programs](/usc/25/3402.md?p=4) for [Indian](/usc/25/1934.md) 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](/usc/25/3402.md?p=4) for [Indian](/usc/25/1934.md) 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](/usc/25/1603.md?p=18) described in [section 1665g(c) of this title](/usc/25/1665g.md?p=c). - (c) **Models for delivery of comprehensive health care services—** The [Secretary](/usc/25/1603.md?p=17) shall— - (1) disseminate to [Indian tribes](/usc/25/1603.md?p=14) information regarding models for the delivery of comprehensive health care [services](/usc/25/1603.md?p=18) to [Indian](/usc/25/1934.md) and [urban Indian](/usc/25/2403.md?p=6) adolescents; - (2) encourage the implementation of such models; and - (3) at the request of an [Indian tribe](/usc/25/1603.md?p=14), provide technical assistance in the implementation of such models. - (d) **Criteria for review and approval of applications—** The [Secretary](/usc/25/1603.md?p=17) shall establish criteria for the review and approval of applications under this section. # §1621p. American Indians Into Psychology Program - (a) **Grants authorized—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make grants of not more than $300,000 to each of 9 colleges and universities for the purpose of developing and maintaining [Indian](/usc/25/1934.md) psychology career recruitment [programs](/usc/25/3402.md?p=4) as a means of encouraging [Indians](/usc/25/1934.md) to enter the [behavioral health](/usc/25/1603.md?p=2-A) field. These [programs](/usc/25/3402.md?p=4) shall be located at various locations throughout the country to maximize their availability to [Indian](/usc/25/1934.md) students and new [programs](/usc/25/3402.md?p=4) shall be established in different locations from time to time. - (b) **Quentin N. Burdick program grant—** The [Secretary](/usc/25/1603.md?p=17) shall provide a grant authorized under [subsection (a)](#a) to develop and maintain a [program](/usc/25/3402.md?p=4) at the University of North Dakota to be known as the “Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Psychology [Program](/usc/25/3402.md?p=4)”. Such [program](/usc/25/3402.md?p=4) shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick [Indian health programs](/usc/25/1603.md?p=12) authorized under [section 1616j(b)](/usc/25/1616j.md?p=b)[^1] of this title, the Quentin N. Burdick American [Indians](/usc/25/1934.md) Into Nursing [Program](/usc/25/3402.md?p=4) authorized under [section 1616h(e)](/usc/25/1616h.md?p=e)[^1] of this title, and existing university research and communications networks. - (c) **Regulations—** The [Secretary](/usc/25/1603.md?p=17) shall issue regulations pursuant to this chapter for the competitive awarding of grants provided under this section. - (d) **Conditions of grant—** Applicants under this section shall agree to provide a [program](/usc/25/3402.md?p=4) which, at a minimum— - (1) provides outreach and recruitment for [health professions](/usc/25/1603.md?p=10) to [Indian](/usc/25/1934.md) communities including elementary, secondary, and accredited and accessible [community colleges](/usc/25/1603.md?p=4) that will be served by the [program](/usc/25/3402.md?p=4); - (2) incorporates a [program](/usc/25/3402.md?p=4) advisory board comprised of representatives from the [tribes](/usc/25/3402.md?p=2-A) and communities that will be served by the [program](/usc/25/3402.md?p=4); - (3) provides summer enrichment [programs](/usc/25/3402.md?p=4) to expose [Indian](/usc/25/1934.md) 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](/usc/25/1603.md?p=18), university affiliated [programs](/usc/25/3402.md?p=4), and other appropriate accredited and accessible entities to enhance the education of [Indian](/usc/25/1934.md) students; - (6) to the maximum extent feasible, uses existing university tutoring, counseling, and student support [services](/usc/25/1603.md?p=18); and - (7) to the maximum extent feasible, employs qualified [Indians](/usc/25/1934.md) in the [program](/usc/25/3402.md?p=4). - (e) **Active duty service requirement—** The active duty [service](/usc/25/1603.md?p=18) obligation prescribed under [section 254m of title 42](/usc/42/254m.md) shall be met by each graduate who receives a stipend described in [subsection (d)(4)](#d-4) that is funded under this section. Such obligation shall be met by [service](/usc/25/1603.md?p=18)— - (1) in an [Indian health program](/usc/25/1603.md?p=12); - (2) in a [program](/usc/25/3402.md?p=4) assisted under subchapter IV; or - (3) in the private practice of psychology if, as determined by the [Secretary](/usc/25/1603.md?p=17), in accordance with guidelines promulgated by the [Secretary](/usc/25/1603.md?p=17), 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](/usc/25/1934.md). - (f) **Authorization of appropriations—** There is authorized to be appropriated to carry out this section $2,700,000 for fiscal year 2010 and each fiscal year thereafter. # §1621q. Prevention, control, and elimination of communicable and infectious diseases - (a) **Grants authorized—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), and after consultation with the Centers for Disease Control and Prevention, may make grants available to [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) for the following: - (1) [Projects](/usc/25/5611.md?p=2) 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](/usc/25/3402.md?p=4) 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](/usc/25/1667a.md?p=2) for the screening, treatment, and prevention of hepatitis C virus (HCV). - (b) **Application required—** The [Secretary](/usc/25/1603.md?p=17) may provide funding under [subsection (a)](#a) only if an application or proposal for funding is submitted to the [Secretary](/usc/25/1603.md?p=17). - (c) **Coordination with health agencies—** [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) 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; report—** In carrying out this section, the [Secretary](/usc/25/1603.md?p=17)— - (1) may, at the request of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), 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](/usc/25/1934.md) and [urban Indians](/usc/25/2403.md?p=6). # §1621r. Contract health services payment study - (a) **Duty of Secretary—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and in consultation with representatives of [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) operating contract health care [programs](/usc/25/3402.md?p=4) under the [Indian](/usc/25/1934.md) Self-Determination Act ([25 U.S.C. 450f](/usc/25/450f.md) et seq.)[^1] or under [self-governance](/usc/25/5361.md?p=11) [compacts](/usc/25/5361.md?p=1), [Service](/usc/25/1603.md?p=18) personnel, private [contract health services](/usc/25/1603.md?p=5) providers, the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) Fiscal Intermediary, and other appropriate experts, shall conduct a study— - (1) to assess and identify administrative barriers that hinder the timely payment for [services](/usc/25/1603.md?p=18) delivered by private [contract health services](/usc/25/1603.md?p=5) providers to individual [Indians](/usc/25/1934.md) by the [Service](/usc/25/1603.md?p=18) and the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) Fiscal Intermediary; - (2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual [Indians](/usc/25/1934.md) who have been treated by such providers; and - (3) to determine the most efficient and effective means of improving the [Service](/usc/25/1603.md?p=18)’s [contract health services](/usc/25/1603.md?p=5) payment system and ensuring the development of appropriate consumer protection policies to protect individual [Indians](/usc/25/1934.md) who receive authorized [services](/usc/25/1603.md?p=18) from private [contract health services](/usc/25/1603.md?p=5) providers from billing and collection practices, including the development of materials and [programs](/usc/25/3402.md?p=4) explaining patients’ rights and responsibilities. - (b) **Functions of study—** The study required by [subsection (a)](#a) shall— - (1) assess the impact of the existing [contract health services](/usc/25/1603.md?p=5) regulations and policies upon the ability of the [Service](/usc/25/1603.md?p=18) and the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private [contract health services](/usc/25/1603.md?p=5) providers; - (2) assess the financial and any other burdens imposed upon individual [Indians](/usc/25/1934.md) and private [contract health services](/usc/25/1603.md?p=5) providers by delayed payments; - (3) survey the policies and practices of collection agencies used by [contract health services](/usc/25/1603.md?p=5) providers to collect payments for [services](/usc/25/1603.md?p=18) rendered to individual [Indians](/usc/25/1934.md); - (4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private [contract health services](/usc/25/1603.md?p=5) providers and individual [Indians](/usc/25/1934.md) as a result of delayed payments; and - (5) compare the [Service](/usc/25/1603.md?p=18)’s payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the [Service](/usc/25/1603.md?p=18) and private insurers. - (c) **Report to Congress—** Not later than 12 months after October 29, 1992, the [Secretary](/usc/25/1603.md?p=17) 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. # §1621s. Prompt action on payment of claims - (a) **Time of response—** The [Service](/usc/25/1603.md?p=18) shall respond to a notification of a claim by a provider of a contract care [service](/usc/25/1603.md?p=18) 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 respond—** If the [Service](/usc/25/1603.md?p=18) fails to respond to a notification of a claim in accordance with [subsection (a)](#a), the [Service](/usc/25/1603.md?p=18) shall accept as valid the claim submitted by the provider of a contract care [service](/usc/25/1603.md?p=18). - (c) **Time of payment—** The [Service](/usc/25/1603.md?p=18) shall pay a completed contract care [service](/usc/25/1603.md?p=18) claim within 30 days after completion of the claim. # §1621t. Licensing Licensed health professionals employed by a [tribal health program](/usc/25/1603.md?p=25) shall be exempt, if licensed in any State, from the licensing requirements of the State in which the [tribal health program](/usc/25/1603.md?p=25) performs the [services](/usc/25/1603.md?p=18) described in the contract or [compact](/usc/25/5361.md?p=1) of the [tribal health program](/usc/25/1603.md?p=25) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^1] # §1621u. Liability for payment - (a) **No patient liability—** A patient who receives contract health care [services](/usc/25/1603.md?p=18) that are authorized by the [Service](/usc/25/1603.md?p=18) shall not be liable for the payment of any charges or costs associated with the provision of such [services](/usc/25/1603.md?p=18). - (b) **Notification—** The [Secretary](/usc/25/1603.md?p=17) shall notify a contract care provider and any patient who receives contract health care [services](/usc/25/1603.md?p=18) authorized by the [Service](/usc/25/1603.md?p=18) that such patient is not liable for the payment of any charges or costs associated with the provision of such [services](/usc/25/1603.md?p=18) not later than 5 business days after receipt of a notification of a claim by a provider of contract care [services](/usc/25/1603.md?p=18). - (c) **No recourse—** Following receipt of the notice provided under [subsection (b)](#b), or, if a claim has been deemed accepted under [section 1621s(b) of this title](/usc/25/1621s.md?p=b), the provider shall have no further recourse against the patient who received the [services](/usc/25/1603.md?p=18). # §1621v. Offices of Indian Men’s Health and Indian Women’s Health - (a) **Office of Indian Men’s Health—** - (1) **Establishment—** The [Secretary](/usc/25/1603.md?p=17) may establish within the [Service](/usc/25/1603.md?p=18) an [office](/usc/25/4001.md?p=4), to be known as the “[Office](/usc/25/4001.md?p=4) of [Indian](/usc/25/1934.md) Men’s Health”. - (2) **Director—** - (A) **In general—** The [Office](/usc/25/4001.md?p=4) of [Indian](/usc/25/1934.md) Men’s Health shall be headed by a [director](/usc/25/4302.md?p=1), to be appointed by the [Secretary](/usc/25/1603.md?p=17). - (B) **Duties—** The [director](/usc/25/4302.md?p=1) shall coordinate and promote the health status of [Indian](/usc/25/1934.md) men in the United States. - (3) **Report—** Not later than 2 years after March 23, 2010, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall submit to Congress a report describing— - (A) any activity carried out by the [director](/usc/25/4302.md?p=1) as of the date on which the report is prepared; and - (B) any finding of the [director](/usc/25/4302.md?p=1) with respect to the health of [Indian](/usc/25/1934.md) men. - (b) **Office of Indian Women’s Health—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish an [office](/usc/25/4001.md?p=4), to be known as the “[Office](/usc/25/4001.md?p=4) of [Indian](/usc/25/1934.md) Women’s Health”, to monitor and improve the quality of health care for [Indian](/usc/25/1934.md) women (including [urban Indian](/usc/25/2403.md?p=6) women) of all ages through the planning and delivery of [programs](/usc/25/3402.md?p=4) administered by the [Service](/usc/25/1603.md?p=18), in order to improve and enhance the treatment models of care for [Indian](/usc/25/1934.md) women. # [§1621w. Repealed. Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935 — repealed] # §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](/usc/42/14401.md) et seq.]. # §1621y. Contract health service administration and disbursement formula - (a) **Submission of report—** As soon as practicable after March 23, 2010, the Comptroller General of the United States shall submit to the [Secretary](/usc/25/1603.md?p=17), the [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs of the Senate, and the [Committee](/usc/25/5411.md?p=3) on Natural Resources of the House of Representatives, and make available to each [Indian tribe](/usc/25/1603.md?p=14), a report describing the results of the study of the Comptroller General regarding the funding of the [contract health service](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4) (including historic funding levels and a recommendation of the funding level needed for the [program](/usc/25/3402.md?p=4)) and the administration of the [contract health service](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4) (including the distribution of funds pursuant to the [program](/usc/25/3402.md?p=4)), as requested by Congress in March 2009, or pursuant to [section 1680t of this title](/usc/25/1680t.md). - (b) **Consultation with tribes—** On receipt of the report under [subsection (a)](#a), the [Secretary](/usc/25/1603.md?p=17) shall consult with [Indian tribes](/usc/25/1603.md?p=14) regarding the [contract health service](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4), including the distribution of funds pursuant to the [program](/usc/25/3402.md?p=4)— - (1) to determine whether the current distribution formula would require modification if the [contract health service](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4) 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](/usc/25/1603.md?p=14) under the funding level recommended by the Comptroller General; - (3) to identify any areas of [program](/usc/25/3402.md?p=4) administration that may result in the inefficient or ineffective management of the [program](/usc/25/3402.md?p=4); and - (4) to identify any other issues and recommendations to improve the administration of the [contract health services](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4) and correct any unfair results or funding disparities identified under [paragraph (2)](#b-2). - (c) **Subsequent action by Secretary—** If, after consultation with [Indian tribes](/usc/25/1603.md?p=14) under [subsection (b)](#b), the [Secretary](/usc/25/1603.md?p=17) determines that any issue described in [subsection (b)(2)](#b-2) exists, the [Secretary](/usc/25/1603.md?p=17) may initiate procedures under subchapter III of [chapter 5](/usc/5/chptI-ch5.md) of title 5 to negotiate or promulgate regulations to establish a disbursement formula for the [contract health service](/usc/25/1603.md?p=5) [program](/usc/25/3402.md?p=4) funding. # [§1622. Transferred — transferred] # §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 Exchange—** For provisions prohibiting cost sharing for [Indians](/usc/25/1934.md) enrolled in any qualified health plan in the individual market through an Exchange, see [section 18071(d) of title 42](/usc/42/18071.md?p=d). - (b) **Payer of last resort—** Health [programs](/usc/25/3402.md?p=4) operated by the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [Urban Indian organizations](/usc/25/1603.md?p=29) (as those terms are defined in [section 1603 of this title](/usc/25/1603.md)) shall be the payer of last resort for [services](/usc/25/1603.md?p=18) provided by such [Service](/usc/25/1603.md?p=18), [tribes](/usc/25/3402.md?p=2-A), or organizations to individuals eligible for [services](/usc/25/1603.md?p=18) through such [programs](/usc/25/3402.md?p=4), notwithstanding any Federal, State, or local law to the contrary. # §1631. Consultation; closure of facilities; reports - (a) **Consultation; standards for accreditation—** Prior to the expenditure of, or the making of any firm commitment to expend, any funds appropriated for the planning, design, construction, or renovation of facilities pursuant to [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall— - (1) consult with any [Indian tribe](/usc/25/1603.md?p=14) that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made, and - (2) ensure, whenever practicable, that such facility meets the standards of the Joint [Commission](/usc/25/2703.md?p=3) on Accreditation of Health Care Organizations by not later than 1 year after the date on which the construction or renovation of such facility is completed. - (b) **Closure; report on proposed closure—** - (1) Notwithstanding any provision of law other than this subsection, no [Service](/usc/25/1603.md?p=18) hospital or outpatient health care facility of the [Service](/usc/25/1603.md?p=18), or any portion of such a hospital or facility, may be closed if the [Secretary](/usc/25/1603.md?p=17) has not submitted to the Congress at least 1 year prior to the date such hospital or facility (or portion thereof) is proposed to be closed an evaluation of the impact of such proposed closure which specifies, in addition to other considerations— - (A) the accessibility of alternative health care resources for the population served by such hospital or facility; - (B) the cost effectiveness of such closure; - (C) the quality of health care to be provided to the population served by such hospital or facility after such closure; - (D) the availability of contract health care funds to maintain existing levels of [service](/usc/25/1603.md?p=18); - (E) the views of the [Indian tribes](/usc/25/1603.md?p=14) served by such hospital or facility concerning such closure; - (F) the level of utilization of such hospital or facility by all eligible [Indians](/usc/25/1934.md); and - (G) the distance between such hospital or facility and the nearest operating [Service](/usc/25/1603.md?p=18) hospital. - (2) [Paragraph (1)](#b-1) shall not apply to any temporary closure of a facility or of any portion of a facility if such closure is necessary for medical, environmental, or safety reasons. - (c) **Health care facility priority system—** - (1) **In general—** - (A) **Priority system—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall maintain a health care facility priority system, which— - (i) shall be developed in consultation with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26); - (ii) shall give [Indian tribes](/usc/25/1603.md?p=14)’ needs the highest priority; - (iii) - (I) may include the [lists](/usc/25/5130.md?p=3) required in [paragraph (2)(B)(ii)](#c-2-B-ii); and - (II) shall include the methodology required in [paragraph (2)(B)(v)](#c-2-B-v); and - (III) may include such health care facilities, and such renovation or expansion needs of any health care facility, as the [Service](/usc/25/1603.md?p=18) may identify; and - (iv) shall provide an opportunity for the nomination of planning, design, and construction [projects](/usc/25/5611.md?p=2) by the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26) for consideration under the priority system at least once every 3 years, or more frequently as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate. - (B) **Needs of facilities under ISDEAA agreements—** 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 operated under contracts or [compacts](/usc/25/5361.md?p=1) in accordance with the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^1] are fully and equitably integrated into the health care facility priority system. - (C) **Criteria for evaluating needs—** For purposes of this subsection, the [Secretary](/usc/25/1603.md?p=17), in evaluating the needs of facilities operated under a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] shall use the criteria used by the [Secretary](/usc/25/1603.md?p=17) in evaluating the needs of facilities operated directly by the [Service](/usc/25/1603.md?p=18). - (D) **Priority of certain projects protected—** The priority of any [project](/usc/25/5611.md?p=2) established under the construction priority system in effect on March 23, 2010, shall not be affected by any change in the construction priority system taking place after that date if the [project](/usc/25/5611.md?p=2)— - (i) was identified in the fiscal year 2008 [Service](/usc/25/1603.md?p=18) budget justification as— - (I) 1 of the 10 top-priority inpatient [projects](/usc/25/5611.md?p=2); - (II) 1 of the 10 top-priority outpatient [projects](/usc/25/5611.md?p=2); - (III) 1 of the 10 top-priority staff quarters developments; or - (IV) 1 of the 10 top-priority Youth Regional Treatment Centers; - (ii) had completed both Phase I and Phase II of the construction priority system in effect on March 23, 2010; or - (iii) is not included in clause [(i)](#c-1-D-i) or [(ii)](#c-1-D-ii) and is selected, as determined by the [Secretary](/usc/25/1603.md?p=17)— - (I) on the initiative of the [Secretary](/usc/25/1603.md?p=17); or - (II) pursuant to a request of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26). - (2) **Report; contents—** - (A) **Initial comprehensive report—** - (i) **Definitions—** In this subparagraph: - (I) **Facilities Appropriation Advisory Board—** The term “Facilities Appropriation Advisory Board” means the advisory board, comprised of 12 members representing [Indian tribes](/usc/25/1603.md?p=14) and 2 members representing the [Service](/usc/25/1603.md?p=18), established at the discretion of the [Director](/usc/25/4302.md?p=1)— - (aa) to provide advice and recommendations for policies and procedures of the [programs](/usc/25/3402.md?p=4) funded pursuant to facilities appropriations; and - (bb) to address other facilities issues. - (II) **Facilities Needs Assessment Workgroup—** The term “Facilities Needs Assessment Workgroup” means the workgroup established at the discretion of the [Director](/usc/25/4302.md?p=1)— - (aa) to review the health care facilities construction priority system; and - (bb) to make recommendations to the [Facilities Appropriation Advisory Board](#c-2-A-i-I) for revising the priority system. - (ii) **Initial report—** - (I) **In general—** Not later than 1 year after March 23, 2010, the [Secretary](/usc/25/1603.md?p=17) shall submit to the [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs of the Senate and the [Committee](/usc/25/5411.md?p=3) on Natural Resources of the House of Representatives a report that describes the comprehensive, national, ranked [list](/usc/25/5130.md?p=3) of all health care facilities needs for the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26) (including inpatient health care facilities, outpatient health care facilities, specialized health care facilities (such as for long-term care and alcohol and drug abuse treatment), wellness centers, and staff quarters, and the renovation and expansion needs, if any, of such facilities) developed by the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), and [tribal organizations](/usc/25/1603.md?p=26) for the [Facilities Needs Assessment Workgroup](#c-2-A-i-II) and the [Facilities Appropriation Advisory Board](#c-2-A-i-I). - (II) **Inclusions—** The initial report shall include— - (aa) the methodology and criteria used by the [Service](/usc/25/1603.md?p=18) in determining the needs and establishing the ranking of the facilities needs; and - (bb) such other information as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate. - (iii) **Updates of report—** Beginning in calendar year 2011, the [Secretary](/usc/25/1603.md?p=17) shall— - (I) update the report under [clause (ii)](#c-2-A-ii) not less frequently that once every 5 years; and - (II) include the updated report in the appropriate annual report under [subparagraph (B)](#c-2-B) for submission to Congress under [section 1671 of this title](/usc/25/1671.md). - (B) **Annual reports—** The [Secretary](/usc/25/1603.md?p=17) shall submit to the President, for inclusion in the report required to be transmitted to Congress under [section 1671 of this title](/usc/25/1671.md), a report which sets forth the following: - (i) A description of the health care facility priority system of the [Service](/usc/25/1603.md?p=18) established under [paragraph (1)](#c-1). - (ii) Health care facilities [lists](/usc/25/5130.md?p=3), which may include— - (I) the 10 top-priority inpatient health care facilities; - (II) the 10 top-priority outpatient health care facilities; - (III) the 10 top-priority specialized health care facilities (such as long-term care and alcohol and drug abuse treatment); and - (IV) the 10 top-priority staff quarters developments associated with health care facilities. - (iii) The justification for such order of priority. - (iv) The projected cost of such [projects](/usc/25/5611.md?p=2). - (v) The methodology adopted by the [Service](/usc/25/1603.md?p=18) in establishing priorities under its health care facility priority system. - (3) **Requirements for preparation of reports—** In preparing the report required under [paragraph (2)](#c-2), the [Secretary](/usc/25/1603.md?p=17) shall— - (A) consult with and obtain information on all health care facilities needs from [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26); and - (B) review the total unmet needs of all [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) for health care facilities (including staff quarters), including needs for renovation and expansion of existing facilities. - (d) **Review of methodology used for health facilities construction priority system—** - (1) **In general—** Not later than 1 year after the establishment of the priority system under [subsection (c)(1)(A)](#c-1-A), the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the [Service](/usc/25/1603.md?p=18) in making each assessment of needs for the [list](/usc/25/5130.md?p=3) under [subsection (c)(2)(A)(ii)](#c-2-A-ii) and developing the priority system under [subsection (c)(1)](#c-1), including a review of— - (A) the recommendations of the Facilities Appropriation Advisory Board and the Facilities Needs Assessment Workgroup (as those terms are defined in [subsection (c)(2)(A)(i)](#c-2-A-i)); and - (B) the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics. - (2) **Submission to Congress—** The Comptroller General of the United States shall submit the report under [paragraph (1)](#d-1) to— - (A) the [Committees](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs and Appropriations of the Senate; - (B) the [Committees](/usc/25/5411.md?p=3) on Natural Resources and Appropriations of the House of Representatives; and - (C) the [Secretary](/usc/25/1603.md?p=17). - (e) **Funding condition—** All funds appropriated under [section 13 of this title](/usc/25/13.md), for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more [Indian Tribes](/usc/25/1603.md?p=14) shall be subject to the provisions of [section 102](/usc/25/102.md) of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450f](/usc/25/450f.md))[^1] or sections [504](/usc/25/504.md) and [505](/usc/25/505.md) of that Act ([25 U.S.C. 458aaa–3](/usc/25/458aaa–3.md), 458aaa–4).[^1] - (f) **Development of innovative approaches—** The [Secretary](/usc/25/1603.md?p=17) shall consult and cooperate with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26), and [confer](/usc/25/5702.md?p=1) with [urban Indian organizations](/usc/25/1603.md?p=29), in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, that may include— - (1) the establishment of an area distribution fund in which a portion of health facility construction funding could be devoted to all [Service areas](/usc/25/1603.md?p=19); - (2) approaches provided for in other provisions of this subchapter; and - (3) other approaches, as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate. - (h) **[^2] Funds appropriated subject to section 5321 of this title—** All funds appropriated under [section 13 of this title](/usc/25/13.md) for the planning, design, construction, or renovation of health facilities for the benefit of an [Indian tribe](/usc/25/1603.md?p=14) or [tribes](/usc/25/3402.md?p=2-A) shall be subject to the provisions of [section 102](/usc/25/102.md) of the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md)]. - (g) **[^3] Priority of certain projects protected—** The priority of any [project](/usc/25/5611.md?p=2) established under the construction priority system in effect on March 23, 2010, shall not be affected by any change in the construction priority system taking place after that date if the [project](/usc/25/5611.md?p=2)— - (1) was identified in the fiscal year 2008 [Service](/usc/25/1603.md?p=18) budget justification as— - (A) 1 of the 10 top-priority inpatient [projects](/usc/25/5611.md?p=2); - (B) 1 of the 10 top-priority outpatient [projects](/usc/25/5611.md?p=2); - (C) 1 of the 10 top-priority staff quarters developments; or - (D) 1 of the 10 top-priority Youth Regional Treatment Centers; - (2) had completed both Phase I and Phase II of the construction priority system in effect on March 23, 2010; or - (3) is not included in clause (i) or (ii)[^4] and is selected, as determined by the [Secretary](/usc/25/1603.md?p=17)— - (A) on the initiative of the [Secretary](/usc/25/1603.md?p=17); or - (B) pursuant to a request of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26). # §1632. Safe water and sanitary waste disposal facilities - (a) **Congressional findings—** The Congress hereby finds and declares that— - (1) the provision of safe water supply systems and sanitary sewage and solid waste disposal systems is primarily a health consideration and function; - (2) [Indian](/usc/25/1934.md) people suffer an inordinately high incidence of disease, injury, and illness directly attributable to the absence or inadequacy of such systems; - (3) the long-term cost to the United States of treating and curing such disease, injury, and illness is substantially greater than the short-term cost of providing such systems and other preventive health measures; - (4) many [Indian](/usc/25/1934.md) homes and communities still lack safe water supply systems and sanitary sewage and solid waste disposal systems; and - (5) it is in the interest of the United States, and it is the policy of the United States, that all [Indian](/usc/25/1934.md) communities and [Indian](/usc/25/1934.md) homes, new and existing, be provided with safe and adequate water supply systems and sanitary sewage waste disposal systems as soon as possible. - (b) **Authority; assistance; transfer of funds—** - (1) In furtherance of the findings and declarations made in [subsection (a)](#a), Congress reaffirms the primary responsibility and authority of the [Service](/usc/25/1603.md?p=18) to provide the necessary sanitation facilities and [services](/usc/25/1603.md?p=18) as provided in [section 2004a of title 42](/usc/42/2004a.md). - (2) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to provide under [section 2004a of title 42](/usc/42/2004a.md)— - (A) financial and technical assistance to [Indian tribes](/usc/25/1603.md?p=14) and communities in the establishment, training, and equipping of utility organizations to operate and maintain [Indian](/usc/25/1934.md) sanitation facilities; - (B) ongoing technical assistance and training in the management of utility organizations which operate and maintain sanitation facilities; and - (C) operation and maintenance assistance for, and emergency repairs to, tribal sanitation facilities when necessary to avoid a health hazard or to protect the Federal investment in sanitation facilities. - (3) Notwithstanding any other provision of law— - (A) the [Secretary](/usc/25/1603.md?p=17) of Housing and Urban Affairs is authorized to transfer funds appropriated under the Housing and Community Development Act of 1974 ([42 U.S.C. 5301](/usc/42/5301.md), et seq.) to the [Secretary](/usc/25/1603.md?p=17) of Health and Human [Services](/usc/25/1603.md?p=18), and - (B) the [Secretary](/usc/25/1603.md?p=17) of Health and Human [Services](/usc/25/1603.md?p=18) is authorized to accept and use such funds for the purpose of providing sanitation facilities and [services](/usc/25/1603.md?p=18) for [Indians](/usc/25/1934.md) under [section 2004a of title 42](/usc/42/2004a.md). - (c) **10-year plan—** Beginning in fiscal year 1990, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall develop and begin implementation of a 10-year plan to provide safe water supply and sanitation sewage and solid waste disposal facilities to existing [Indian](/usc/25/1934.md) homes and communities and to new and renovated [Indian](/usc/25/1934.md) homes. - (d) **Tribal capability—** The financial and technical capability of an [Indian tribe](/usc/25/1603.md?p=14) or community to safely operate and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities by the [Secretary](/usc/25/1603.md?p=17). - (e) **Amount of assistance—** - (1) The [Secretary](/usc/25/1603.md?p=17) is authorized to provide financial assistance to [Indian tribes](/usc/25/1603.md?p=14) and communities in an amount equal to the [Federal share](#e-2) of the costs of operating, managing, and maintaining the facilities provided under the plan described in [subsection (c)](#c). - (2) For the purposes of [paragraph (1)](#e-1), the term “Federal share” means 80 percent of the costs described in [paragraph (1)](#e-1). - (3) With respect to [Indian tribes](/usc/25/1603.md?p=14) with fewer than 1,000 enrolled members, the non-Federal portion of the costs of operating, managing, and maintaining such facilities may be provided, in part, through cash donations or in kind property, fairly evaluated. - (f) **Eligibility of programs administered by Indian tribes—** [Programs](/usc/25/3402.md?p=4) administered by [Indian tribes](/usc/25/1603.md?p=14) or [tribal organizations](/usc/25/1603.md?p=26) under the authority of the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.] shall be eligible for— - (1) any funds appropriated pursuant to this section, and - (2) any funds appropriated for the purpose of providing water supply or sewage disposal [services](/usc/25/1603.md?p=18), on an equal basis with [programs](/usc/25/3402.md?p=4) that are administered directly by the [Service](/usc/25/1603.md?p=18). - (g) **Annual report; sanitation deficiency levels—** - (1) The [Secretary](/usc/25/1603.md?p=17) shall submit to the President, for inclusion in each report required to be transmitted to the Congress under [section 1671 of this title](/usc/25/1671.md), a report which sets forth— - (A) the current [Indian](/usc/25/1934.md) sanitation facility priority system of the [Service](/usc/25/1603.md?p=18); - (B) the methodology for determining sanitation deficiencies; - (C) the level of sanitation deficiency for each sanitation facilities [project](/usc/25/5611.md?p=2) of each [Indian tribe](/usc/25/1603.md?p=14) or community; - (D) the amount of funds necessary to raise all [Indian tribes](/usc/25/1603.md?p=14) and communities to a level I sanitation deficiency; and - (E) the amount of funds necessary to raise all [Indian tribes](/usc/25/1603.md?p=14) and communities to zero sanitation deficiency. - (2) In preparing each report required under [paragraph (1)](#g-1) (other than the initial report), the [Secretary](/usc/25/1603.md?p=17) shall consult with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) (including those [tribes](/usc/25/3402.md?p=2-A) or [tribal organizations](/usc/25/1603.md?p=26) operating health care [programs](/usc/25/3402.md?p=4) or facilities under any contract entered into with the [Service](/usc/25/1603.md?p=18) under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]) to determine the sanitation needs of each [tribe](/usc/25/3402.md?p=2-A). - (3) The methodology used by the [Secretary](/usc/25/1603.md?p=17) in determining sanitation deficiencies for purposes of [paragraph (1)](#g-1) shall be applied uniformly to all [Indian tribes](/usc/25/1603.md?p=14) and communities. - (4) For purposes of this subsection, the sanitation deficiency levels for an [Indian tribe](/usc/25/1603.md?p=14) or community are as follows: - (A) level I is an [Indian tribe](/usc/25/1603.md?p=14) or community with a sanitation system— - (i) which complies with all applicable water supply and pollution control laws, and - (ii) in which the deficiencies relate to routine replacement, repair, or maintenance needs; - (B) level II is an [Indian tribe](/usc/25/1603.md?p=14) or community with a sanitation system— - (i) which complies with all applicable water supply and pollution control laws, and - (ii) in which the deficiencies relate to capital improvements that are necessary to improve the facilities in order to meet the needs of such [tribe](/usc/25/3402.md?p=2-A) or community for domestic sanitation facilities; - (C) level III is an [Indian tribe](/usc/25/1603.md?p=14) or community with a sanitation system which— - (i) has an inadequate or partial water supply and a sewage disposal facility that does not comply with applicable water supply and pollution control laws, or - (ii) has no solid waste disposal facility; - (D) level IV is an [Indian tribe](/usc/25/1603.md?p=14) or community with a sanitation system which lacks either a safe water supply system or a sewage disposal system; and - (E) level V is an [Indian tribe](/usc/25/1603.md?p=14) or community that lacks a safe water supply and a sewage disposal system. - (5) For purposes of this subsection, any [Indian tribe](/usc/25/1603.md?p=14) or community that lacks the operation and maintenance capability to enable its sanitation system to meet pollution control laws may not be treated as having a level I or II sanitation deficiency. # §1633. Preferences to Indians and Indian firms - (a) **Discretionary authority; covered activities—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may utilize the negotiating authority of [section 47 of this title](/usc/25/47.md), to give preference to any [Indian](/usc/25/1934.md) or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an [Indian](/usc/25/1934.md) or [Indians](/usc/25/1934.md) including former or currently federally recognized [Indian tribes](/usc/25/1603.md?p=14) in the State of New York (hereinafter referred to as an “[Indian](/usc/25/1934.md) firm”) in the construction and renovation of [Service](/usc/25/1603.md?p=18) facilities pursuant to [section 1631 of this title](/usc/25/1631.md) and in the construction of safe water and sanitary waste disposal facilities pursuant to [section 1632 of this title](/usc/25/1632.md). Such preference may be accorded by the [Secretary](/usc/25/1603.md?p=17) unless he finds, pursuant to rules and regulations promulgated by him, that the [project](/usc/25/5611.md?p=2) or function to be contracted for will not be satisfactory or such proj­ect or function cannot be properly completed or maintained under the proposed contract. The [Secretary](/usc/25/1603.md?p=17), in arriving at his finding, shall consider whether the [Indian](/usc/25/1934.md) or [Indian](/usc/25/1934.md) firm will be deficient with respect to (1) ownership and control by [Indians](/usc/25/1934.md), (2) equipment, (3) bookkeeping and accounting procedures, (4) substantive knowledge of the [project](/usc/25/5611.md?p=2) or function to be contracted for, (5) adequately trained personnel, or (6) other necessary components of contract performance. - (b) **Pay rates—** For the purpose of implementing the provisions of this subchapter, the [Secretary](/usc/25/1603.md?p=17) shall assure that the rates of pay for personnel engaged in the construction or renovation of facilities constructed or renovated in whole or in part by funds made available pursuant to this subchapter are not less than the prevailing local wage rates for similar work as determined in accordance with sections 3141–3144, [3146](/usc/40/3146.md), and [3147](/usc/40/3147.md) of title 40. # §1634. Expenditure of non-Service funds for renovation - (a) **Authority of Secretary—** - (1) Notwithstanding any other provision of law, the [Secretary](/usc/25/1603.md?p=17) is authorized to accept any major renovation or modernization by any [Indian tribe](/usc/25/1603.md?p=14) of any [Service](/usc/25/1603.md?p=18) facility, or of any other [Indian](/usc/25/1934.md) health facility operated pursuant to a contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.], including— - (A) any plans or designs for such renovation or modernization; and - (B) any renovation or modernization for which funds appropriated under any Federal law were lawfully expended, but only if the requirements of [subsection (b)](#b) are met. - (2) The [Secretary](/usc/25/1603.md?p=17) shall maintain a separate priority [list](/usc/25/5130.md?p=3) to address the needs of such facilities for personnel or equipment. - (3) The [Secretary](/usc/25/1603.md?p=17) shall submit to the President, for inclusion in each report required to be transmitted to the Congress under [section 1671 of this title](/usc/25/1671.md), the priority [list](/usc/25/5130.md?p=3) maintained pursuant to [paragraph (2)](#a-2). - (b) **Requirements—** The requirements of this subsection are met with respect to any renovation or modernization if— - (1) the [tribe](/usc/25/3402.md?p=2-A) or [tribal organization](/usc/25/1603.md?p=26)— - (A) provides notice to the [Secretary](/usc/25/1603.md?p=17) of its intent to renovate or modernize; and - (B) applies to the [Secretary](/usc/25/1603.md?p=17) to be placed on a separate priority [list](/usc/25/5130.md?p=3) to address the needs of such new facilities for personnel or equipment; and - (2) the renovation or modernization— - (A) is approved by the appropriate area [director](/usc/25/4302.md?p=1) of the [Service](/usc/25/1603.md?p=18); and - (B) is administered by the [tribe](/usc/25/3402.md?p=2-A) in accordance with the rules and regulations prescribed by the [Secretary](/usc/25/1603.md?p=17) with respect to construction or renovation of [Service](/usc/25/1603.md?p=18) facilities. - (c) **Recovery for non-use as Service facility—** If any [Service](/usc/25/1603.md?p=18) facility which has been renovated or modernized by an [Indian tribe](/usc/25/1603.md?p=14) under this section ceases to be used as a [Service](/usc/25/1603.md?p=18) facility during the 20-year period beginning on the date such renovation or modernization is completed, such [Indian tribe](/usc/25/1603.md?p=14) shall be entitled to recover from the United States an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such renovation or modernization (less the total amount of any funds provided specifically for such facility under any Federal [program](/usc/25/3402.md?p=4) that were expended for such renovation or modernization) bore to the value of such facility at the time of the completion of such renovation or modernization. # [§1635. Repealed. Pub. L. 100–713, title III, § 303(b), Nov. 23, 1988, 102 Stat. 4817 — repealed] # §1636. Grant program for construction, expansion, and modernization of small ambulatory care facilities - (a) **Authorization—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make grants to [tribes](/usc/25/3402.md?p=2-A) and [tribal organizations](/usc/25/1603.md?p=26) for the construction, expansion, or modernization of facilities for the provision of ambulatory care [services](/usc/25/1603.md?p=18) to eligible [Indians](/usc/25/1934.md) (and noneligible persons as provided in [subsection (c)(1)(C)](#c-1-C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term “construction” includes the replacement of an existing facility. - (2) A grant under [paragraph (1)](#a-1) may only be made to a [tribe](/usc/25/3402.md?p=2-A) or [tribal organization](/usc/25/1603.md?p=26) operating an [Indian](/usc/25/1934.md) health facility (other than a facility owned or constructed by the [Service](/usc/25/1603.md?p=18), including a facility originally owned or constructed by the [Service](/usc/25/1603.md?p=18) and transferred to a [tribe](/usc/25/3402.md?p=2-A) or [tribal organization](/usc/25/1603.md?p=26)) pursuant to a contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]. - (b) **Use of grant—** - (1) A grant provided under this section may be used only for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility— - (A) located apart from a hospital; - (B) not funded under [section 1631 of this title](/usc/25/1631.md) or [section 1637 of this title](/usc/25/1637.md); and - (C) which, upon completion of such construction, expansion, or modernization will— - (i) have a total capacity appropriate to its projected [service](/usc/25/1603.md?p=18) population; - (ii) serve no less than 500 eligible [Indians](/usc/25/1934.md) annually; and - (iii) provide ambulatory care in a [service area](/usc/25/1603.md?p=19) (specified in the contract entered into under the [Indian](/usc/25/1934.md) Self-Determination Act [[25 U.S.C. 5321](/usc/25/5321.md) et seq.]) with a population of not less than 2,000 eligible [Indians](/usc/25/1934.md). - (2) The requirements of clauses [(ii)](#b-1-C-ii) and [(iii)](#b-1-C-iii) of paragraph (1)(C) shall not apply to a [tribe](/usc/25/3402.md?p=2-A) or [tribal organization](/usc/25/1603.md?p=26) applying for a grant under this section whose tribal government [offices](/usc/25/4001.md?p=4) are located on an island. - (c) **Application for grant—** - (1) No grant may be made under this section unless an application for such a grant has been submitted to and approved by the [Secretary](/usc/25/1603.md?p=17). An application for a grant under this section shall be submitted in such form and manner as the [Secretary](/usc/25/1603.md?p=17) shall by regulation prescribe and shall set forth reasonable assurance by the applicant that, at all times after the [construction](#a-1), expansion, or modernization of a facility carried out pursuant to a grant received under this section— - (A) adequate financial support will be available for the provision of [services](/usc/25/1603.md?p=18) at such facility; - (B) such facility will be available to eligible [Indians](/usc/25/1934.md) without regard to ability to pay or source of payment; and - (C) such facility will, as feasible without diminishing the quality or quantity of [services](/usc/25/1603.md?p=18) provided to eligible [Indians](/usc/25/1934.md), serve noneligible persons on a cost basis. - (2) In awarding grants under this section, the [Secretary](/usc/25/1603.md?p=17) shall give priority to [tribes](/usc/25/3402.md?p=2-A) and [tribal organizations](/usc/25/1603.md?p=26) that demonstrate— - (A) a need for increased ambulatory care [services](/usc/25/1603.md?p=18); and - (B) insufficient capacity to deliver such [services](/usc/25/1603.md?p=18). - (d) **Transfer of interest to United States upon cessation of facility—** If any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be utilized for the purposes of providing ambulatory care [services](/usc/25/1603.md?p=18) to eligible [Indians](/usc/25/1934.md), all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States. # §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](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) 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/25/1934.md) 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/25/1934.md) (including primary care [services](/usc/25/1603.md?p=18), [contract health services](/usc/25/1603.md?p=5), or any other [program](/usc/25/3402.md?p=4) or [service](/usc/25/1603.md?p=18) authorized by this chapter) through convenient care services (as defined in [subsection (c)](#c)), community health centers, or cooperative agreements or arrangements with other [health care providers](/usc/25/1675.md?p=a-1) 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](/usc/25/1675.md?p=a-1). - (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](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) 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/25/1934.md) 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](/usc/25/5611.md?p=2) 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](/usc/25/1675.md?p=a-1) 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](/usc/25/5611.md?p=2) 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” 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](/usc/25/3402.md?p=4), such as a [program](/usc/25/3402.md?p=4) for [convenient care services](#c-1), or an improvement in, increased efficiency at, or reorientation of an existing facility or [program](/usc/25/3402.md?p=4). - (ii) A significant number of [Indians](/usc/25/1934.md), including [Indians](/usc/25/1934.md) with low health status, will be served by the [project](/usc/25/5611.md?p=2). - (iii) The [project](/usc/25/5611.md?p=2) has the potential to deliver [services](/usc/25/1603.md?p=18) in an efficient and effective manner. - (iv) The [project](/usc/25/5611.md?p=2) is economically viable. - (v) For [projects](/usc/25/5611.md?p=2) 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](/usc/25/5611.md?p=2). - (vi) The [project](/usc/25/5611.md?p=2) 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](/usc/25/1675.md?p=a-1)) 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](/usc/25/5611.md?p=2) 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](#c-1), 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](/usc/25/3402.md?p=4) under this chapter. - (B) **Approval—** In addition to [projects](/usc/25/5611.md?p=2) 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](/usc/25/5611.md?p=2)— - (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](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) 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](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) 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. # §1638. Land transfer The Bureau of [Indian](/usc/25/1934.md) Affairs is authorized to transfer, at no cost, up to 5 acres of land at the Chemawa [Indian](/usc/25/1934.md) School, Salem, Oregon, to the [Service](/usc/25/1603.md?p=18) for the provision of health care [services](/usc/25/1603.md?p=18). The land authorized to be transferred by this section is that land adjacent to land under the jurisdiction of the [Service](/usc/25/1603.md?p=18) and occupied by the Chemawa [Indian](/usc/25/1934.md) Health Center. # §1638a. Tribal management of federally owned quarters - (a) **Rental rates—** - (1) **Establishment—** Notwithstanding any other provision of law, a [tribal health program](/usc/25/1603.md?p=25) that operates a hospital or other health facility and the federally owned quarters associated with such a facility pursuant to a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^1] may establish the rental rates charged to the occupants of those quarters, on providing notice to the [Secretary](/usc/25/1603.md?p=17). - (2) **Objectives—** In establishing rental rates under this subsection, a [tribal health program](/usc/25/1603.md?p=25) shall attempt— - (A) to base the rental rates on the reasonable value of the quarters to the occupants of the quarters; and - (B) to generate sufficient funds to prudently provide for the operation and maintenance of the quarters, and at the discretion of the [tribal health program](/usc/25/1603.md?p=25), to supply reserve funds for capital repairs and replacement of the quarters. - (3) **Equitable funding—** A federally owned quarters the rental rates for which are established by a [tribal health program](/usc/25/1603.md?p=25) under this subsection shall remain eligible to receive improvement and repair funds to the same extent that all federally owned quarters used to house personnel in [programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18) are eligible to receive those funds. - (4) **Notice of rate change—** A [tribal health program](/usc/25/1603.md?p=25) that establishes a rental rate under this subsection shall provide occupants of the federally owned quarters a notice of any change in the rental rate by not later than the date that is 60 days notice before the effective date of the change. - (5) **Rates in Alaska—** A rental rate established by a [tribal health program](/usc/25/1603.md?p=25) under this section for a federally owned quarters in the State of Alaska may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of 1,500 or more individuals. - (b) **Direct collection of rent—** - (1) **In general—** Notwithstanding any other provision of law, and subject to [paragraph (2)](#b-2), a [tribal health program](/usc/25/1603.md?p=25) may collect rent directly from Federal employees who occupy federally owned quarters if the [tribal health program](/usc/25/1603.md?p=25) submits to the [Secretary](/usc/25/1603.md?p=17) and the employees a notice of the election of the [tribal health program](/usc/25/1603.md?p=25) to collect rents directly from the employees. - (2) **Action by employees—** On receipt of a notice described in [paragraph (1)](#b-1)— - (A) the affected Federal employees shall pay rent for occupancy of a federally owned quarters directly to the applicable [tribal health program](/usc/25/1603.md?p=25); and - (B) the [Secretary](/usc/25/1603.md?p=17) shall not have the authority to collect rent from the employees through payroll deduction or otherwise. - (3) **Use of payments—** The rent payments under this subsection— - (A) shall be retained by the applicable [tribal health program](/usc/25/1603.md?p=25) in a separate account, which shall be used by the [tribal health program](/usc/25/1603.md?p=25) for the maintenance (including capital repairs and replacement) and operation of the quarters, as the [tribal health program](/usc/25/1603.md?p=25) determines to be appropriate; and - (B) shall not be made payable to, or otherwise be deposited with, the United States. - (4) **Retrocession of authority—** If a [tribal health program](/usc/25/1603.md?p=25) that elected to collect rent directly under [paragraph (1)](#b-1) requests retrocession of the authority of the [tribal health program](/usc/25/1603.md?p=25) to collect that rent, the retrocession shall take effect on the earlier of— - (A) the first day of the month that begins not less than 180 days after the [tribal health program](/usc/25/1603.md?p=25) submits the request; and - (B) such other date as may be mutually agreed on by the [Secretary](/usc/25/1603.md?p=17) and the [tribal health program](/usc/25/1603.md?p=25). # §1638b. Applicability of Buy American requirement - (a) **Duty of Secretary—** The [Secretary](/usc/25/1603.md?p=17) shall ensure that the requirements of the [Buy American Act](#d) apply to all procurements made with funds made available to carry out this subchapter. - (b) **Report to Congress—** The [Secretary](/usc/25/1603.md?p=17) shall submit to the Congress a report on the amount of procurements from foreign entities made in fiscal years 1993 and 1994 with funds made available to carry out this subchapter. Such report shall separately indicate the dollar value of items procured with such funds for which the [Buy American Act](#d) was waived pursuant to the Trade Agreement Act of 1979 or any international agreement to which the United States is a party. - (c) **Fraudulent use of Made-in-America label—** If it has been finally determined by a court or Federal agency that any person intentionally affixed a label bearing a “Made in America” inscription, or any inscription with the same meaning, to any product sold in or shipped to the United States that is not made in the United States, such person shall be ineligible to receive any contract or subcontract made with funds made available to carry out this subchapter, pursuant to the debarment, suspension, and ineligibility procedures described in [sections 9.400 through 9.409](/cfr/48/9.400..9.409.md) of title 48, Code of Federal Regulations. - (d) **“Buy American Act” defined—** For purposes of this section, the term “Buy American Act” means title III of the Act entitled “An Act making appropriations for the Treasury and Post [Office](/usc/25/4001.md?p=4) [Departments](/usc/25/1603.md?p=6) for the fiscal year ending June 30, 1934, and for other purposes”, approved March 3, 1933 ([41 U.S.C. 10a](https://uscode.house.gov/view.xhtml?req=(/us/usc/t41/s10a)) et seq.)[^1]. # §1638c. Contracts for personal services in Indian Health Service facilities In fiscal year 1995 and thereafter (a) the [Secretary](/usc/25/1603.md?p=17) may enter into personal [services](/usc/25/1603.md?p=18) contracts with entities, either individuals or organizations, for the provision of [services](/usc/25/1603.md?p=18) in facilities owned, operated or constructed under the jurisdiction of the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18); (b) the [Secretary](/usc/25/1603.md?p=17) may exempt such a contract from competitive contracting requirements upon adequate notice of contracting opportunities to individuals and organizations residing in the geographic vicinity of the health facility; (c) consideration of individuals and organizations shall be based solely on the qualifications established for the contract and the proposed contract price; and (d) individuals providing health care [services](/usc/25/1603.md?p=18) pursuant to these contracts are covered by the Federal Tort Claims Act. # §1638d. Credit to appropriations of money collected for meals at Indian Health Service facilities Money before, on, and after September 30, 1994, collected for meals served at [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) facilities will be credited to the appropriations from which the [services](/usc/25/1603.md?p=18) were furnished and shall be credited to the appropriation when received. # §1638e. Other funding, equipment, and supplies for facilities - (a) **Authorization—** - (1) **Authority to transfer funds—** The head of any Federal agency to which funds, equipment, or other supplies are made available for the planning, design, construction, or operation of a health care or [sanitation facility](#d) may transfer the funds, equipment, or supplies to the [Secretary](/usc/25/1603.md?p=17) for the planning, design, construction, or operation of a health care or [sanitation facility](#d) to achieve— - (A) the purposes of this chapter; and - (B) the purposes for which the funds, equipment, or supplies were made available to the Federal agency. - (2) **Authority to accept funds—** The [Secretary](/usc/25/1603.md?p=17) may— - (A) accept from any source, including Federal and State agencies, funds, equipment, or supplies that are available for the construction or operation of health care or [sanitation facilities](#d); and - (B) use those funds, equipment, and supplies to plan, design,,[^1] construct, and operate health care or [sanitation facilities](#d) for [Indians](/usc/25/1934.md), including pursuant to a contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^2] - (3) **Effect of receipt—** Receipt of funds by the [Secretary](/usc/25/1603.md?p=17) under this subsection shall not affect any priority established under [section 1631 of this title](/usc/25/1631.md). - (b) **Interagency agreements—** The [Secretary](/usc/25/1603.md?p=17) may enter into interagency agreements with Federal or State agencies and other entities, and accept funds, equipment, or other supplies from those entities, to provide for the planning, design, construction, and operation of health care or [sanitation facilities](#d) to be administered by [Indian health programs](/usc/25/1603.md?p=12) to achieve— - (1) the purposes of this chapter; and - (2) the purposes for which the funds were appropriated or otherwise provided. - (c) **Establishment of standards—** - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish, by regulation, standards for the planning, design, construction, and operation of health care or [sanitation facilities](#d) serving [Indians](/usc/25/1934.md) under this chapter. - (2) **Other regulations—** Notwithstanding any other provision of law, any other applicable regulations of the [Department](/usc/25/1603.md?p=6) shall apply in carrying out [projects](/usc/25/5611.md?p=2) using funds transferred under this section. - (d) **Definition of sanitation facility—** In this section, the term “sanitation facility” means a safe and adequate water supply system, sanitary sewage disposal system, or sanitary solid waste system (including all related equipment and support infrastructure). # §1638f. Indian country modular component facilities demonstration program - (a) **Definition of modular component health care facility—** In this section, the term “modular component health care facility” means a health care facility that is constructed— - (1) off-site using prefabricated component units for subsequent transport to the destination location; and - (2) represents[^1] a more economical method for provision of health care facility[^2] than a traditionally constructed health care building. - (b) **Establishment—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a demonstration [program](/usc/25/3402.md?p=4) under which the [Secretary](/usc/25/1603.md?p=17) shall award no less than 3 grants for purchase, installation and maintenance of [modular component health care facilities](#a) in [Indian](/usc/25/1934.md) communities for provision of health care [services](/usc/25/1603.md?p=18). - (c) **Selection of locations—** - (1) **Petitions—** - (A) **Solicitation—** The [Secretary](/usc/25/1603.md?p=17) shall solicit from [Indian tribes](/usc/25/1603.md?p=14) petitions for location of the [modular component health care facilities](#a) in the [Service areas](/usc/25/1603.md?p=19) of the petitioning [Indian tribes](/usc/25/1603.md?p=14). - (B) **Petition—** To be eligible to receive a grant under this section, an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) must submit to the [Secretary](/usc/25/1603.md?p=17) a petition to construct a [modular component health care facility](#a) in the [Indian](/usc/25/1934.md) community of the [Indian tribe](/usc/25/1603.md?p=14), at such time, in such manner, and containing such information as the [Secretary](/usc/25/1603.md?p=17) may require. - (2) **Selection—** In selecting the location of each [modular component health care facility](#a) to be provided under the demonstration [program](/usc/25/3402.md?p=4), the [Secretary](/usc/25/1603.md?p=17) shall give priority to [projects](/usc/25/5611.md?p=2) already on the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) facilities construction priority [list](/usc/25/5130.md?p=3) and petitions which demonstrate that erection of a modular component health facility— - (A) is more economical than construction of a traditionally constructed health care facility; - (B) can be constructed and erected on the selected location in less time than traditional construction; and - (C) can adequately house the health care [services](/usc/25/1603.md?p=18) needed by the [Indian](/usc/25/1934.md) population to be served. - (3) **Effect of selection—** A [modular component health care facility](#a) [project](/usc/25/5611.md?p=2) selected for participation in the demonstration [program](/usc/25/3402.md?p=4) shall not be eligible for entry on the facilities construction priorities [list](/usc/25/5130.md?p=3) entitled “IHS Health Care Facilities FY 2011 Planned Construction Budget” and dated May 7, 2009 (or any successor [list](/usc/25/5130.md?p=3)). - (d) **Eligibility—** - (1) **In general—** An [Indian tribe](/usc/25/1603.md?p=14) may submit a petition under [subsection (c)(1)(B)](#c-1-B) regardless of whether the [Indian tribe](/usc/25/1603.md?p=14) is a party to any contract or [compact](/usc/25/5361.md?p=1) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^3] - (2) **Administration—** At the election of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) selected for participation in the demonstration [program](/usc/25/3402.md?p=4), the funds provided for the [project](/usc/25/5611.md?p=2) shall be subject to the provisions of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act. - (e) **Reports—** Not later than 1 year after the date on which funds are made available for the demonstration [program](/usc/25/3402.md?p=4) and annually thereafter, the [Secretary](/usc/25/1603.md?p=17) shall submit to Congress a report describing— - (1) each activity carried out under the demonstration [program](/usc/25/3402.md?p=4), including an evaluation of the success of the activity; and - (2) the potential benefits of increased use of [modular component health care facilities](#a) in other [Indian](/usc/25/1934.md) communities. - (f) **Authorization of appropriations—** There are authorized to be appropriated $50,000,000 to carry out the demonstration [program](/usc/25/3402.md?p=4) under this section for the first 5 fiscal years, and such sums as may be necessary to carry out the [program](/usc/25/3402.md?p=4) in subsequent fiscal years. # §1638g. Mobile health stations demonstration program - (a) **Definitions—** In this section: - (1) **Eligible tribal consortium—** The term “eligible tribal consortium” means a consortium composed of 2 or more [Service units](/usc/25/1603.md?p=20) between which a [mobile health station](#a-2) can be transported by road in up to 8 hours. A [Service unit](/usc/25/1603.md?p=20) operated by the [Service](/usc/25/1603.md?p=18) or by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) shall be equally eligible for participation in such consortium. - (2) **Mobile health station—** The term “mobile health station” means a health care unit that— - (A) is constructed, maintained, and capable of being transported within a semi-trailer truck or similar vehicle; - (B) is equipped for the provision of 1 or more [specialty health care services](#a-3-A); and - (C) can be equipped to be docked to a stationary health care facility when appropriate. - (3) **Specialty health care service—** - (A) **In general—** The term “specialty health care service” means a health care [service](/usc/25/1603.md?p=18) which requires the [services](/usc/25/1603.md?p=18) of a health care professional with specialized knowledge or experience. - (B) **Inclusions—** The term “[specialty health care service](#a-3-A)” includes any [service](/usc/25/1603.md?p=18) relating to— - (i) dialysis; - (ii) surgery; - (iii) mammography; - (iv) dentistry; or - (v) any other [specialty health care service](#a-3-A). - (b) **Establishment—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall establish a demonstration [program](/usc/25/3402.md?p=4) under which the [Secretary](/usc/25/1603.md?p=17) shall provide at least 3 [mobile health station](#a-2) [projects](/usc/25/5611.md?p=2). - (c) **Petition—** To be eligible to receive a [mobile health station](#a-2) under the demonstration [program](/usc/25/3402.md?p=4), an [eligible tribal consortium](#a-1) shall submit to the [Secretary](/usc/25/1603.md?p=17),[^1] a petition at such time, in such manner, and containing— - (1) a description of the [Indian](/usc/25/1934.md) population to be served; - (2) a description of the specialty [service](/usc/25/1603.md?p=18) or [services](/usc/25/1603.md?p=18) for which the [mobile health station](#a-2) is requested and the extent to which such [service](/usc/25/1603.md?p=18) or [services](/usc/25/1603.md?p=18) are currently available to the [Indian](/usc/25/1934.md) population to be served; and - (3) such other information as the [Secretary](/usc/25/1603.md?p=17) may require. - (d) **Use of funds—** The [Secretary](/usc/25/1603.md?p=17) shall use amounts made available to carry out the demonstration [program](/usc/25/3402.md?p=4) under this section— - (1) - (A) to establish, purchase, lease, or maintain [mobile health stations](#a-2) for the eligible tribal consortia selected for [projects](/usc/25/5611.md?p=2); and - (B) to provide, through the [mobile health station](#a-2), such [specialty health care services](#a-3-A) as the affected [eligible tribal consortium](#a-1) determines to be necessary for the [Indian](/usc/25/1934.md) population served; - (2) to employ an existing [mobile health station](#a-2) (regardless of whether the [mobile health station](#a-2) is owned or rented and operated by the [Service](/usc/25/1603.md?p=18)) to provide [specialty health care services](#a-3-A) to an [eligible tribal consortium](#a-1); and - (3) to establish, purchase, or maintain docking equipment for a [mobile health station](#a-2), including the establishment or maintenance of such equipment at a modular component health care facility (as defined in [section 1638f(a) of this title](/usc/25/1638f.md?p=a)), if applicable. - (e) **Reports—** Not later than 1 year after the date on which the demonstration [program](/usc/25/3402.md?p=4) is established under [subsection (b)](#b) and annually thereafter, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall submit to Congress a report describing— - (1) each activity carried out under the demonstration [program](/usc/25/3402.md?p=4) including an evaluation of the success of the activity; and - (2) the potential benefits of increased use of [mobile health stations](#a-2) to provide [specialty health care services](#a-3-A) for [Indian](/usc/25/1934.md) communities. - (f) **Authorization of appropriations—** There are authorized to be appropriated $5,000,000 per year to carry out the demonstration [program](/usc/25/3402.md?p=4) under this section for the first 5 fiscal years, and such sums as may be needed to carry out the [program](/usc/25/3402.md?p=4) in subsequent fiscal years. # §1641. Treatment of payments under Social Security Act health benefits programs - (a) **Disregard of Medicare, Medicaid, and CHIP payments in determining appropriations—** Any payments received by an [Indian health program](/usc/25/1603.md?p=12) or by an [urban Indian organization](/usc/25/1603.md?p=29) under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.] for [services](/usc/25/1603.md?p=18) provided to [Indians](/usc/25/1934.md) eligible for benefits under such respective titles shall not be considered in determining appropriations for the provision of health care and [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md). - (b) **Nonpreferential treatment—** Nothing in this chapter authorizes the [Secretary](/usc/25/1603.md?p=17) to provide [services](/usc/25/1603.md?p=18) to an [Indian](/usc/25/1934.md) with coverage under title XVIII, XIX, or XI[^1] of the Social Security Act in preference to an [Indian](/usc/25/1934.md) without such coverage. - (c) **Use of funds—** - (1) **Special fund—** - (A) **100 percent pass-through of payments due to facilities—** Notwithstanding any other provision of law, but subject to [paragraph (2)](#c-2), payments to which a facility of the [Service](/usc/25/1603.md?p=18) is entitled by reason of a provision of title XVIII or XIX of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq.] shall be placed in a special fund to be held by the [Secretary](/usc/25/1603.md?p=17). In making payments from such fund, the [Secretary](/usc/25/1603.md?p=17) shall ensure that each [Service unit](/usc/25/1603.md?p=20) of the [Service](/usc/25/1603.md?p=18) receives 100 percent of the amount to which the facilities of the [Service](/usc/25/1603.md?p=18), for which such [Service unit](/usc/25/1603.md?p=20) makes collections, are entitled by reason of a provision of either such title. - (B) **Use of funds—** Amounts received by a facility of the [Service](/usc/25/1603.md?p=18) under [subparagraph (A)](#c-1-A) by reason of a provision of title XVIII or XIX of the Social Security Act shall first be used (to such extent or in such amounts as are provided in appropriation Acts) for the purpose of making any improvements in the [programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18) operated by or through such facility which may be necessary to achieve or maintain compliance with the applicable conditions and requirements of such respective title. Any amounts so received that are in excess of the amount necessary to achieve or maintain such conditions and requirements shall, subject to consultation with the [Indian tribes](/usc/25/1603.md?p=14) being served by the [Service unit](/usc/25/1603.md?p=20), be used for reducing the health resource deficiencies (as determined in [section 1621(c) of this title](/usc/25/1621.md?p=c)) of such [Indian tribes](/usc/25/1603.md?p=14), including the provision of [services](/usc/25/1603.md?p=18) pursuant to [section 1621d of this title](/usc/25/1621d.md). - (2) **Direct payment option—** [Paragraph (1)](#c-1) shall not apply to a [tribal health program](/usc/25/1603.md?p=25) upon the election of such [program](/usc/25/3402.md?p=4) under [subsection (d)](#d) to receive payments directly. No payment may be made out of the special fund described in such paragraph with respect to reimbursement made for [services](/usc/25/1603.md?p=18) provided by such [program](/usc/25/3402.md?p=4) during the period of such election. - (d) **Direct billing—** - (1) **In general—** Subject to complying with the requirements of [paragraph (2)](#d-2), a [tribal health program](/usc/25/1603.md?p=25) may elect to directly bill for, and receive payment for, health care items and [services](/usc/25/1603.md?p=18) provided by such [program](/usc/25/3402.md?p=4) for which payment is made under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.] or from any other third party payor. - (2) **Direct reimbursement—** - (A) **Use of funds—** Each [tribal health program](/usc/25/1603.md?p=25) making the election described in [paragraph (1)](#d-1) with respect to a [program](/usc/25/3402.md?p=4) under a title of the Social Security Act [[42 U.S.C. 301](/usc/42/301.md) et seq.] shall be reimbursed directly by that [program](/usc/25/3402.md?p=4) for items and [services](/usc/25/1603.md?p=18) furnished without regard to [subsection (c)(1)](#c-1), except that all amounts so reimbursed shall be used by the [tribal health program](/usc/25/1603.md?p=25) for the purpose of making any improvements in facilities of the [tribal health program](/usc/25/1603.md?p=25) that may be necessary to achieve or maintain compliance with the conditions and requirements applicable generally to such items and [services](/usc/25/1603.md?p=18) under the [program](/usc/25/3402.md?p=4) under such title and to provide additional health care [services](/usc/25/1603.md?p=18), improvements in health care facilities and [tribal health programs](/usc/25/1603.md?p=25), any health care-related purpose (including coverage for a [service](/usc/25/1603.md?p=18) or [service](/usc/25/1603.md?p=18) within a [contract health service](/usc/25/1603.md?p=5) delivery area or any portion of a [contract health service](/usc/25/1603.md?p=5) delivery area that would otherwise be provided as a [contract health service](/usc/25/1603.md?p=5)), or otherwise to achieve the objectives provided in [section 1602 of this title](/usc/25/1602.md). - (B) **Audits—** The amounts paid to a [tribal health program](/usc/25/1603.md?p=25) making the election described in [paragraph (1)](#d-1) with respect to a [program](/usc/25/3402.md?p=4) under title XVIII, XIX, or XXI of the Social Security Act shall be subject to all auditing requirements applicable to the [program](/usc/25/3402.md?p=4) under such title, as well as all auditing requirements applicable to [programs](/usc/25/3402.md?p=4) administered by an [Indian health program](/usc/25/1603.md?p=12). Nothing in the preceding sentence shall be construed as limiting the application of auditing requirements applicable to amounts paid under title XVIII, XIX, or XXI of the Social Security Act. - (C) **Identification of source of payments—** Any [tribal health program](/usc/25/1603.md?p=25) that receives reimbursements or payments under title XVIII, XIX, or XXI of the Social Security Act shall provide to the [Service](/usc/25/1603.md?p=18) a [list](/usc/25/5130.md?p=3) of each provider enrollment number (or other identifier) under which such [program](/usc/25/3402.md?p=4) receives such reimbursements or payments. - (3) **Examination and implementation of changes—** - (A) **In general—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18) and with the assistance of the Administrator of the Centers for Medicare & Medicaid [Services](/usc/25/1603.md?p=18), shall examine on an ongoing basis and implement any administrative changes that may be necessary to facilitate direct billing and reimbursement under the [program](/usc/25/3402.md?p=4) established under this subsection, including any agreements with States that may be necessary to provide for direct billing under a [program](/usc/25/3402.md?p=4) under title XIX or XXI of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq., 1397aa et seq.]. - (B) **Coordination of information—** The [Service](/usc/25/1603.md?p=18) shall provide the Administrator of the Centers for Medicare & Medicaid [Services](/usc/25/1603.md?p=18) with copies of the [lists](/usc/25/5130.md?p=3) submitted to the [Service](/usc/25/1603.md?p=18) under [paragraph (2)(C)](#d-2-C), enrollment data regarding patients served by the [Service](/usc/25/1603.md?p=18) (and by [tribal health programs](/usc/25/1603.md?p=25), to the extent such data is available to the [Service](/usc/25/1603.md?p=18)), and such other information as the Administrator may require for purposes of administering title XVIII, XIX, or XXI of the Social Security Act. - (4) **Withdrawal from program—** A [tribal health program](/usc/25/1603.md?p=25) that bills directly under the [program](/usc/25/3402.md?p=4) established under this subsection may withdraw from participation in the same manner and under the same conditions that an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) may retrocede a contracted [program](/usc/25/3402.md?p=4) to the [Secretary](/usc/25/1603.md?p=17) under the authority of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^2] All cost accounting and billing authority under the [program](/usc/25/3402.md?p=4) established under this subsection shall be returned to the [Secretary](/usc/25/1603.md?p=17) upon the [Secretary](/usc/25/1603.md?p=17)’s acceptance of the withdrawal of participation in this [program](/usc/25/3402.md?p=4). - (5) **Termination for failure to comply with requirements—** The [Secretary](/usc/25/1603.md?p=17) may terminate the participation of a [tribal health program](/usc/25/1603.md?p=25) or[^3] in the direct billing [program](/usc/25/3402.md?p=4) established under this subsection if the [Secretary](/usc/25/1603.md?p=17) determines that the [program](/usc/25/3402.md?p=4) has failed to comply with the requirements of [paragraph (2)](#d-2). The [Secretary](/usc/25/1603.md?p=17) shall provide a [tribal health program](/usc/25/1603.md?p=25) with notice of a determination that the [program](/usc/25/3402.md?p=4) has failed to comply with any such requirement and a reasonable opportunity to correct such noncompliance prior to terminating the [program](/usc/25/3402.md?p=4)’s participation in the direct billing [program](/usc/25/3402.md?p=4) established under this subsection. - (e) **Related provisions under the Social Security Act—** For provisions related to subsections [(c)](#c) and [(d)](#d), see sections 1880, [1911](/usc/25/1911.md), and [2107(e)(1)(D)](/usc/25/2107.md)[^2] of the Social Security Act [[42 U.S.C. 1395qq](/usc/42/1395qq.md), 1396j, 1397gg(e)(1)(D)]. # §1642. Purchasing health care coverage - (a) **In general—** Insofar as amounts are made available under law (including a provision of the Social Security Act [[42 U.S.C. 301](/usc/42/301.md) et seq.], the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] or other law, other than under [section 1644 of this title](/usc/25/1644.md)) to [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) for health benefits for [Service](/usc/25/1603.md?p=18) beneficiaries, [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), and [urban Indian organizations](/usc/25/1603.md?p=29) may use such amounts to purchase health benefits coverage (including coverage for a [service](/usc/25/1603.md?p=18), or [service](/usc/25/1603.md?p=18) within a [contract health service](/usc/25/1603.md?p=5) delivery area, or any portion of a [contract health service](/usc/25/1603.md?p=5) delivery area that would otherwise be provided as a [contract health service](/usc/25/1603.md?p=5)) for such beneficiaries in any manner, including through— - (1) a tribally owned and operated health care plan; - (2) a State or locally authorized or licensed health care plan; - (3) a health insurance provider or managed care organization; - (4) a self-insured plan; or - (5) a high deductible or health savings account plan. - (b) **Financial need—** The purchase of coverage under [subsection (a)](#a) by an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) may be based on the financial needs of such beneficiaries (as determined by the 1 or more [Indian tribes](/usc/25/1603.md?p=14) being served based on a schedule of income levels developed or implemented by such 1 ore[^2] more [Indian tribes](/usc/25/1603.md?p=14)). - (c) **Expenses for self-insured plan—** In the case of a self-insured plan under [subsection (a)(4)](#a-4), the amounts may be used for expenses of operating the plan, including administration and insurance to limit the financial risks to the entity offering the plan. - (d) **Construction—** Nothing in this section shall be construed as affecting the use of any amounts not referred to in [subsection (a)](#a). # §1643. Amount and use of funds reimbursed through medicare and medicaid available to Indian Health Service The [Secretary](/usc/25/1603.md?p=17) shall submit to the President, for inclusion in the report required to be transmitted to the Congress under [section 1671 of this title](/usc/25/1671.md), an accounting on the amount and use of funds made available to the [Service](/usc/25/1603.md?p=18) pursuant to this subchapter as a result of reimbursements through titles XVIII and XIX of the Social Security Act, as amended [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq.]. # §1644. Grants to and contracts with the Service, Indian tribes, tribal organizations, and urban Indian organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs - (a) **Indian tribes and tribal organizations—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall make grants to or enter into contracts with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) to assist such [tribes](/usc/25/3402.md?p=2-A) and [tribal organizations](/usc/25/1603.md?p=26) in establishing and administering [programs](/usc/25/3402.md?p=4) on or near [reservations](/usc/25/1603.md?p=16-A) and trust lands, including [programs](/usc/25/3402.md?p=4) to provide outreach and enrollment through video, electronic delivery methods, or telecommunication devices that allow real-time or time-delayed communication between individual [Indians](/usc/25/1934.md) and the benefit [program](/usc/25/3402.md?p=4), to assist individual [Indians](/usc/25/1934.md)— - (1) to enroll for benefits under a [program](/usc/25/3402.md?p=4) established under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.] and other health benefits [programs](/usc/25/3402.md?p=4); and - (2) with respect to such [programs](/usc/25/3402.md?p=4) for which the charging of [premiums](#f-1) and [cost sharing](#f-2) is not prohibited under such [programs](/usc/25/3402.md?p=4), to pay [premiums](#f-1) or [cost sharing](#f-2) for coverage for such benefits, which may be based on financial need (as determined by the [Indian tribe](/usc/25/1603.md?p=14) or [tribes](/usc/25/3402.md?p=2-A) or [tribal organizations](/usc/25/1603.md?p=26) being served based on a schedule of income levels developed or implemented by such [tribe](/usc/25/3402.md?p=2-A), [tribes](/usc/25/3402.md?p=2-A), or [tribal organizations](/usc/25/1603.md?p=26)). - (b) **Conditions—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall place conditions as deemed necessary to effect the purpose of this section in any grant or contract which the [Secretary](/usc/25/1603.md?p=17) makes with any [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) pursuant to this section. Such conditions shall include requirements that the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) successfully undertake— - (1) to determine the population of [Indians](/usc/25/1934.md) eligible for the benefits described in [subsection (a)](#a); - (2) to educate [Indians](/usc/25/1934.md) with respect to the benefits available under the respective [programs](/usc/25/3402.md?p=4); - (3) to provide transportation for such individual [Indians](/usc/25/1934.md) to the appropriate [offices](/usc/25/4001.md?p=4) for enrollment or applications for such benefits; and - (4) to develop and implement methods of improving the participation of [Indians](/usc/25/1934.md) in receiving benefits under such [programs](/usc/25/3402.md?p=4). - (c) **Application to urban Indian organizations—** - (1) **In general—** The provisions of [subsection (a)](#a) shall apply with respect to grants and other funding to [urban Indian organizations](/usc/25/1603.md?p=29) with respect to populations served by such organizations in the same manner they apply to grants and contracts with [Indian tribes](/usc/25/1603.md?p=14) and [tribal organizations](/usc/25/1603.md?p=26) with respect to [programs](/usc/25/3402.md?p=4) on or near [reservations](/usc/25/1603.md?p=16-A). - (2) **Requirements—** The [Secretary](/usc/25/1603.md?p=17) shall include in the grants or contracts made or provided under [paragraph (1)](#c-1) requirements that are— - (A) consistent with the requirements imposed by the [Secretary](/usc/25/1603.md?p=17) under [subsection (b)](#b); - (B) appropriate to [urban Indian organizations](/usc/25/1603.md?p=29) and [urban Indians](/usc/25/2403.md?p=6); and - (C) necessary to effect the purposes of this section. - (d) **Facilitating cooperation—** The [Secretary](/usc/25/1603.md?p=17), acting through the Centers for Medicare & Medicaid [Services](/usc/25/1603.md?p=18), shall develop and disseminate best practices that will serve to facilitate cooperation with, and agreements between, States and the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), [tribal organizations](/usc/25/1603.md?p=26), or [urban Indian organizations](/usc/25/1603.md?p=29) with respect to the provision of health care items and [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) under the [programs](/usc/25/3402.md?p=4) established under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.]. - (e) **Agreements relating to improving enrollment of Indians under Social Security Act health benefits programs—** For provisions relating to agreements of the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), for the collection, preparation, and submission of applications by [Indians](/usc/25/1934.md) for assistance under the Medicaid and children’s health insurance [programs](/usc/25/3402.md?p=4) established under titles XIX and XXI of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq., 1397aa et seq.], and benefits under the Medicare [program](/usc/25/3402.md?p=4) established under title XVIII of such Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.], see subsections (a) and (b) of section 1139 of the Social Security Act [[42 U.S.C. 1320b–9](/usc/42/1320b–9.md)]. - (f) **Definition of premiums and cost sharing—** In this section: - (1) **Premium—** The term “premium” includes any enrollment fee or similar charge. - (2) **Cost sharing—** The term “cost sharing” includes any deduction, deductible, copayment, coinsurance, or similar charge. # §1645. Sharing arrangements with Federal agencies - (a) **Authority—** - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17) may enter into (or expand) arrangements for the sharing of medical facilities and [services](/usc/25/1603.md?p=18) between the [Service](/usc/25/1603.md?p=18), [Indian tribes](/usc/25/1603.md?p=14), [urban Indian organizations](/usc/25/1603.md?p=29), and [tribal organizations](/usc/25/1603.md?p=26) and the Department of Veterans Affairs and the [Department](/usc/25/1603.md?p=6) of Defense. - (2) **Consultation by Secretary required—** The [Secretary](/usc/25/1603.md?p=17) may not finalize any arrangement between the [Service](/usc/25/1603.md?p=18) and a [Department](/usc/25/1603.md?p=6) described in [paragraph (1)](#a-1) without first consulting with the [Indian tribes](/usc/25/1603.md?p=14) which will be significantly affected by the arrangement. - (b) **Limitations—** The [Secretary](/usc/25/1603.md?p=17) shall not take any action under this section or under subchapter IV of [chapter 81](/usc/38/chptVI-ch81.md) of title 38 which would impair— - (1) the priority access of any [Indian](/usc/25/1934.md) to health care [services](/usc/25/1603.md?p=18) provided through the [Service](/usc/25/1603.md?p=18) and the eligibility of any [Indian](/usc/25/1934.md) to receive health [services](/usc/25/1603.md?p=18) through the [Service](/usc/25/1603.md?p=18); - (2) the quality of health care [services](/usc/25/1603.md?p=18) provided to any [Indian](/usc/25/1934.md) through the [Service](/usc/25/1603.md?p=18); - (3) the priority access of any veteran to health care [services](/usc/25/1603.md?p=18) provided by the Department of Veterans Affairs; - (4) the quality of health care [services](/usc/25/1603.md?p=18) provided by the Department of Veterans Affairs or the [Department](/usc/25/1603.md?p=6) of Defense; or - (5) the eligibility of any [Indian](/usc/25/1934.md) who is a veteran to receive health [services](/usc/25/1603.md?p=18) through the Department of Veterans Affairs. - (c) **Reimbursement—** The [Service](/usc/25/1603.md?p=18), [Indian tribe](/usc/25/1603.md?p=14), [urban Indian organization](/usc/25/1603.md?p=29), or [tribal organization](/usc/25/1603.md?p=26) shall be reimbursed by the Department of Veterans Affairs or the [Department](/usc/25/1603.md?p=6) of Defense (as the case may be) where [services](/usc/25/1603.md?p=18) are provided through the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), an [urban Indian organization](/usc/25/1603.md?p=29), or a [tribal organization](/usc/25/1603.md?p=26) to beneficiaries eligible for [services](/usc/25/1603.md?p=18) from either such [Department](/usc/25/1603.md?p=6), notwithstanding any other provision of law, regardless of whether such [services](/usc/25/1603.md?p=18) are provided directly by the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), or [tribal organization](/usc/25/1603.md?p=26), through purchased/referred care, or through a contract for travel described in [section 1621l(b)](/usc/25/1621l.md?p=b) of this title. - (d) **Construction—** Nothing in this section may be construed as creating any right of a non-[Indian](/usc/25/1934.md) veteran to obtain health [services](/usc/25/1603.md?p=18) from the [Service](/usc/25/1603.md?p=18). # §1646. Authorization for emergency contract health services With respect to an elderly or disabled [Indian](/usc/25/1934.md) receiving emergency medical care or [services](/usc/25/1603.md?p=18) from a non-[Service](/usc/25/1603.md?p=18) provider or in a non-[Service](/usc/25/1603.md?p=18) facility under the authority of this chapter, the time limitation (as a condition of payment) for notifying the [Service](/usc/25/1603.md?p=18) of such treatment or admission shall be 30 days. # §1647. Eligible Indian veteran services - (a) **Findings; purpose—** - (1) **Findings—** Congress finds that— - (A) collaborations between the [Secretary](/usc/25/1603.md?p=17) and the [Secretary](/usc/25/1603.md?p=17) of Veterans Affairs regarding the treatment of [Indian](/usc/25/1934.md) veterans at facilities of the [Service](/usc/25/1603.md?p=18) should be encouraged to the maximum extent practicable; and - (B) increased enrollment for [services](/usc/25/1603.md?p=18) of the Department of Veterans Affairs by veterans who are members of [Indian tribes](/usc/25/1603.md?p=14) should be encouraged to the maximum extent practicable. - (2) **Purpose—** The purpose of this section is to reaffirm the goals stated in the document entitled “Memorandum of Understanding Between the VA/Veterans Health Administration And HHS/[Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18)” and dated February 25, 2003 (relating to cooperation and resource sharing between the Veterans Health Administration and [Service](/usc/25/1603.md?p=18)). - (b) **Definitions—** In this section: - (1) **Eligible Indian veteran—** The term “eligible Indian veteran” means an [Indian](/usc/25/1934.md) or Alaska [Native](/usc/25/5802.md?p=5) veteran who receives any medical [service](/usc/25/1603.md?p=18) that is— - (A) authorized under the laws administered by the [Secretary](/usc/25/1603.md?p=17) of Veterans Affairs; and - (B) administered at a facility of the [Service](/usc/25/1603.md?p=18) (including a facility operated by an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) through a contract or [compact](/usc/25/5361.md?p=1) with the [Service](/usc/25/1603.md?p=18) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.))[^1] pursuant to a [local memorandum of understanding](#b-2). - (2) **Local memorandum of understanding—** The term “local memorandum of understanding” means a memorandum of understanding between the [Secretary](/usc/25/1603.md?p=17) (or a designee, including the [director](/usc/25/4302.md?p=1) of any [area office](/usc/25/1603.md?p=1) of the [Service](/usc/25/1603.md?p=18)) and the [Secretary](/usc/25/1603.md?p=17) of Veterans Affairs (or a designee) to implement the document entitled “Memorandum of Understanding Between the VA/Veterans Health Administration And HHS/[Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18)” and dated February 25, 2003 (relating to cooperation and resource sharing between the Veterans Health Administration and [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18)). - (c) **Eligible Indian veterans expenses—** - (1) **In general—** Notwithstanding any other provision of law, the [Secretary](/usc/25/1603.md?p=17) shall provide for veteran-related expenses incurred by [eligible Indian veterans](#b-1) as described in [subsection (b)(1)(B)](#b-1-B). - (2) **Method of payment—** The [Secretary](/usc/25/1603.md?p=17) shall establish such guidelines as the [Secretary](/usc/25/1603.md?p=17) determines to be appropriate regarding the method of payments to the [Secretary](/usc/25/1603.md?p=17) of Veterans Affairs under [paragraph (1)](#c-1). - (d) **Tribal approval of memoranda—** In negotiating a [local memorandum of understanding](#b-2) with the [Secretary](/usc/25/1603.md?p=17) of Veterans Affairs regarding the provision of [services](/usc/25/1603.md?p=18) to [eligible Indian veterans](#b-1), the [Secretary](/usc/25/1603.md?p=17) shall consult with each [Indian tribe](/usc/25/1603.md?p=14) that would be affected by the [local memorandum of understanding](#b-2). - (e) **Funding—** - (1) **Treatment—** Expenses incurred by the [Secretary](/usc/25/1603.md?p=17) in carrying out [subsection (c)(1)](#c-1) shall not be considered to be [Contract Health Service](/usc/25/1603.md?p=5) expenses. - (2) **Use of funds—** Of funds made available to the [Secretary](/usc/25/1603.md?p=17) in appropriations Acts for the [Service](/usc/25/1603.md?p=18) (excluding funds made available for facilities, [Contract Health Services](/usc/25/1603.md?p=5), or contract support costs), the [Secretary](/usc/25/1603.md?p=17) shall use such sums as are necessary to carry out this section. # §1647a. Nondiscrimination under Federal health care programs in qualifications for reimbursement for services - (a) **Requirement to satisfy generally applicable participation requirements—** - (1) **In general—** A Federal health care [program](/usc/25/3402.md?p=4) must accept an entity that is operated by the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) as a provider eligible to receive payment under the [program](/usc/25/3402.md?p=4) for health care [services](/usc/25/1603.md?p=18) furnished to an [Indian](/usc/25/1934.md) on the same basis as any other provider qualified to participate as a provider of health care [services](/usc/25/1603.md?p=18) under the [program](/usc/25/3402.md?p=4) if the entity meets generally applicable State or other requirements for participation as a provider of health care [services](/usc/25/1603.md?p=18) under the [program](/usc/25/3402.md?p=4). - (2) **Satisfaction of State or local licensure or recognition requirements—** Any requirement for participation as a provider of health care [services](/usc/25/1603.md?p=18) under a Federal health care [program](/usc/25/3402.md?p=4) that an entity be licensed or recognized under the State or local law where the entity is located to furnish health care [services](/usc/25/1603.md?p=18) shall be deemed to have been met in the case of an entity operated by the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) if the entity meets all the applicable standards for such licensure or recognition, regardless of whether the entity obtains a license or other documentation under such State or local law. In accordance with [section 1621t of this title](/usc/25/1621t.md), the absence of the licensure of a health professional employed by such an entity under the State or local law where the entity is located shall not be taken into account for purposes of determining whether the entity meets such standards, if the professional is licensed in another State. - (b) **Application of exclusion from participation in Federal health care programs—** - (1) **Excluded entities—** No entity operated by the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29) that has been excluded from participation in any Federal health care [program](/usc/25/3402.md?p=4) or for which a license is under suspension or has been revoked by the State where the entity is located shall be eligible to receive payment or reimbursement under any such [program](/usc/25/3402.md?p=4) for health care [services](/usc/25/1603.md?p=18) furnished to an [Indian](/usc/25/1934.md). - (2) **Excluded individuals—** No individual who has been excluded from participation in any Federal health care [program](/usc/25/3402.md?p=4) or whose State license is under suspension shall be eligible to receive payment or reimbursement under any such [program](/usc/25/3402.md?p=4) for health care [services](/usc/25/1603.md?p=18) furnished by that individual, directly or through an entity that is otherwise eligible to receive payment for health care [services](/usc/25/1603.md?p=18), to an [Indian](/usc/25/1934.md). - (3) **Federal health care program defined—** In this subsection, the term,[^1] “Federal health care [program](/usc/25/3402.md?p=4)” has the meaning given that term in [section 1320a–7b(f) of title 42](/usc/42/1320a–7b.md?p=f), except that, for purposes of this subsection, such term shall include the health insurance [program](/usc/25/3402.md?p=4) under [chapter 89](/usc/5/chptIII-sptG-ch89.md) of title 5. - (c) **Related provisions—** For provisions related to nondiscrimination against providers operated by the [Service](/usc/25/1603.md?p=18), an [Indian tribe](/usc/25/1603.md?p=14), [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29), see section 1320b–9(c)[^2] of [title 42](/usc/42.md). # §1647b. Access to Federal insurance Notwithstanding the provisions of [title 5](/usc/5.md), Executive order, or administrative regulation, an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) carrying out [programs](/usc/25/3402.md?p=4) under the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 5301](/usc/25/5301.md) et seq.) or the Tribally Controlled Schools Act of 1988 ([25 U.S.C. 2501](/usc/25/2501.md) et seq.) or an [urban Indian organization](/usc/25/1603.md?p=29) carrying out [programs](/usc/25/3402.md?p=4) under subchapter IV of this chapter shall be entitled to purchase coverage, rights, and benefits for the employees of such [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29), under [chapter 89](/usc/5/chptIII-sptG-ch89.md) of title 5 and chapter 87 of such title if necessary employee deductions and agency contributions in payment for the coverage, rights, and benefits for the period of employment with such [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), or [urban Indian organization](/usc/25/1603.md?p=29), are currently deposited in the applicable Employee’s Fund under such title. # §1647c. General exceptions The requirements of this subchapter shall not apply to any excepted benefits described in paragraph (1)(A) or (3) of [section 300gg–91(c) of title 42](/usc/42/300gg–91.md?p=c). # §1647d. Navajo Nation medicaid agency feasibility study - (a) **Study—** The [Secretary](/usc/25/1603.md?p=17) shall conduct a study to determine the feasibility of treating the Navajo Nation as a State for the purposes of title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.], to provide [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) living within the boundaries of the Navajo Nation through an entity established having the same authority and performing the same functions as single-State medicaid agencies responsible for the administration of the State plan under title XIX of the Social Security Act. - (b) **Considerations—** In conducting the study, the [Secretary](/usc/25/1603.md?p=17) shall consider the feasibility of— - (1) assigning and paying all expenditures for the provision of [services](/usc/25/1603.md?p=18) and related administration funds, under title XIX of the Social Security Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.], to [Indians](/usc/25/1934.md) living within the boundaries of the Navajo Nation that are currently paid to or would otherwise be paid to the State of Arizona, New Mexico, or Utah; - (2) providing assistance to the Navajo Nation in the development and implementation of such entity for the administration, eligibility, payment, and delivery of medical assistance under title XIX of the Social Security Act; - (3) providing an appropriate level of matching funds for Federal medical assistance with respect to amounts such entity expends for medical assistance for [services](/usc/25/1603.md?p=18) and related administrative costs; and - (4) authorizing the [Secretary](/usc/25/1603.md?p=17), at the option of the Navajo Nation, to treat the Navajo Nation as a State for the purposes of title XIX[^1] of the Social Security Act (relating to the State children’s health insurance [program](/usc/25/3402.md?p=4)) under terms equivalent to those described in [paragraphs (2) through (4)](#b-2..b-4).[^2] - (c) **Report—** Not later then 3 years after March 23, 2010, the [Secretary](/usc/25/1603.md?p=17) shall submit to the [Committee](/usc/25/5411.md?p=3) on [Indian](/usc/25/1934.md) Affairs and [Committee](/usc/25/5411.md?p=3) on Finance of the Senate and the [Committee](/usc/25/5411.md?p=3) on Natural Resources and [Committee](/usc/25/5411.md?p=3) on Energy and Commerce of the House of Representatives a report that includes— - (1) the results of the study under this section; - (2) a summary of any consultation that occurred between the [Secretary](/usc/25/1603.md?p=17) and the Navajo Nation, other [Indian Tribes](/usc/25/1603.md?p=14), the States of Arizona, New Mexico, and Utah, counties which include Navajo Lands, and other interested parties, in conducting this study; - (3) projected costs or savings associated with establishment of such entity, and any estimated impact on [services](/usc/25/1603.md?p=18) provided as described in this section in relation to probable costs or savings; and - (4) legislative actions that would be required to authorize the establishment of such entity if such entity is determined by the [Secretary](/usc/25/1603.md?p=17) to be feasible. # §1651. Purpose The purpose of this subchapter is to establish [programs](/usc/25/3402.md?p=4) in [urban centers](/usc/25/1603.md?p=27) to make health [services](/usc/25/1603.md?p=18) more accessible to [urban Indians](/usc/25/2403.md?p=6). # §1652. Contracts with, and grants to, urban Indian organizations - (a) **In general—** Pursuant to [section 13 of this title](/usc/25/13.md), the [Secretary](/usc/25/1603.md?p=17), acting 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) to assist the [urban Indian organizations](/usc/25/1603.md?p=29) in the establishment and administration, within [urban centers](/usc/25/1603.md?p=27), of [programs](/usc/25/3402.md?p=4) that meet the requirements of this subchapter. - (b) **Conditions—** Subject to [section 1656 of this title](/usc/25/1656.md), the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall include such conditions as the [Secretary](/usc/25/1603.md?p=17) considers necessary to effect the purpose of this subchapter in any contract into which the [Secretary](/usc/25/1603.md?p=17) enters with, or in any grant the [Secretary](/usc/25/1603.md?p=17) makes to, any [urban Indian organization](/usc/25/1603.md?p=29) pursuant to this subchapter. # §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/25/2403.md?p=6) 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/25/2403.md?p=6) 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/25/2403.md?p=6) residing in such [urban center](/usc/25/1603.md?p=27); - (3) estimate the current health care needs of [urban Indians](/usc/25/2403.md?p=6) 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/25/2403.md?p=6); - (5) determine the use of public and private health [services](/usc/25/1603.md?p=18) resources by the [urban Indians](/usc/25/2403.md?p=6) 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/25/2403.md?p=6); - (7) assist [urban Indians](/usc/25/2403.md?p=6) 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/25/2403.md?p=6); - (9) establish and implement training [programs](/usc/25/3402.md?p=4) to accomplish the referral and education tasks set forth in [paragraphs (6) through (8)](#6..8) of this subsection; - (10) identify gaps between unmet health needs of [urban Indians](/usc/25/2403.md?p=6) 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](/usc/25/3402.md?p=4) to meet the needs of [urban Indians](/usc/25/2403.md?p=6); 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/25/2403.md?p=6). - (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/25/2403.md?p=6) in the [urban center](/usc/25/1603.md?p=27) involved; - (2) the size of the [urban Indian](/usc/25/2403.md?p=6) 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/25/2403.md?p=6) 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](/usc/25/5611.md?p=2) 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](/usc/25/5611.md?p=2) 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/25/2403.md?p=6) 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](#d-3) for [urban Indians](/usc/25/2403.md?p=6) 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/25/2403.md?p=6) population to be served; - (B) the immunization levels of the [urban Indian](/usc/25/2403.md?p=6) population, particularly the immunization levels of infants, children, and the elderly; - (C) the utilization by the [urban Indians](/usc/25/2403.md?p=6) of alternative resources from State and local governments for no-cost or low-cost [immunization services](#d-3) 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” 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/25/2403.md?p=6) 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 of the mental health needs of the [urban Indian](/usc/25/2403.md?p=6) 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 required under [paragraph (2)](#e-2); - (B) to provide outreach, educational, and referral [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/2403.md?p=6) regarding the availability of direct mental health [services](/usc/25/1603.md?p=18), to educate [urban Indians](/usc/25/2403.md?p=6) 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/25/2403.md?p=6); - (C) to provide outpatient mental health [services](/usc/25/1603.md?p=18) to [urban Indians](/usc/25/2403.md?p=6), including the identification and assessment 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/25/1934.md) 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/25/2403.md?p=6) 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/25/2403.md?p=6). - (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 that documents the prevalence of child abuse in the [urban Indian](/usc/25/2403.md?p=6) population concerned and specifies the [services](/usc/25/1603.md?p=18) and [programs](/usc/25/3402.md?p=4) (which may not duplicate existing [services](/usc/25/1603.md?p=18) and [programs](/usc/25/3402.md?p=4)) for which the grant is requested. - (3) Grants may be made under this subsection— - (A) to prepare assessments required under [paragraph (2)](#f-2); - (B) for the development of prevention, training, and education [programs](/usc/25/3402.md?p=4) for [urban Indian](/usc/25/2403.md?p=6) 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 child](/usc/25/3202.md?p=7) 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/25/2403.md?p=6) 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/25/2403.md?p=6) 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](/usc/25/5411.md?p=3) or other [services](/usc/25/1603.md?p=18) funded under the [Indian Child](/usc/25/3202.md?p=7) 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 required under [paragraph (2)](#f-2). # §1654. Contracts and grants for determination of unmet health care needs - (a) **Authority—** 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), may enter into contracts with, or make grants to, [urban Indian organizations](/usc/25/1603.md?p=29) situated in [urban centers](/usc/25/1603.md?p=27) for which contracts have not been entered into, or grants have not been made, under [section 1653 of this title](/usc/25/1653.md). The purpose of a contract or grant made under this section shall be the determination of the matters described in [subsection (b)(1)](#b-1) in order to assist the [Secretary](/usc/25/1603.md?p=17) in assessing the health status and health care needs of [urban Indians](/usc/25/2403.md?p=6) in the [urban center](/usc/25/1603.md?p=27) involved and determining whether the [Secretary](/usc/25/1603.md?p=17) should enter into a contract or make a grant under [section 1653 of this title](/usc/25/1653.md) with respect to the [urban Indian organization](/usc/25/1603.md?p=29) which the [Secretary](/usc/25/1603.md?p=17) has entered into a contract with, or made a grant to, under this section. - (b) **Requirements—** Any contract entered into, or grant made, by the [Secretary](/usc/25/1603.md?p=17) under this section shall include requirements that— - (1) the [urban Indian organization](/usc/25/1603.md?p=29) successfully undertake to— - (A) document the health care status and unmet health care needs of [urban Indians](/usc/25/2403.md?p=6) in the [urban center](/usc/25/1603.md?p=27) involved; and - (B) with respect to [urban Indians](/usc/25/2403.md?p=6) in the [urban center](/usc/25/1603.md?p=27) involved, determine the matters described in clauses (2), (3), (4), and (8) of [section 1653(b) of this title](/usc/25/1653.md?p=b); and - (2) the [urban Indian organization](/usc/25/1603.md?p=29) complete performance of the contract, or carry out the requirements of the grant, within one year after the date on which the [Secretary](/usc/25/1603.md?p=17) and such organization enter into such contract, or within one year after such organization receives such grant, whichever is applicable. - (c) **Renewal—** The [Secretary](/usc/25/1603.md?p=17) may not renew any contract entered into, or grant made, under this section. # §1655. Evaluations; renewals - (a) **Contract compliance and performance—** The [Secretary](/usc/25/1603.md?p=17), through the [Service](/usc/25/1603.md?p=18), shall develop procedures to evaluate compliance with grant requirements under this subchapter and compliance with, and performance of contracts entered into by [urban Indian organizations](/usc/25/1603.md?p=29) under this subchapter. Such procedures shall include provisions for carrying out the requirements of this section. - (b) **Annual onsite evaluation—** The [Secretary](/usc/25/1603.md?p=17), through the [Service](/usc/25/1603.md?p=18), shall conduct an annual onsite evaluation of each [urban Indian organization](/usc/25/1603.md?p=29) which has entered into a contract or received a grant under [section 1653 of this title](/usc/25/1653.md) for purposes of determining the compliance of such organization with, and evaluating the performance of such organization under, such contract or the terms of such grant. - (c) **Noncompliance or unsatisfactory performance—** If, as a result of the evaluations conducted under this section, the [Secretary](/usc/25/1603.md?p=17) determines that an [urban Indian organization](/usc/25/1603.md?p=29) has not complied with the requirements of a grant or complied with or satisfactorily performed a contract under [section 1653 of this title](/usc/25/1653.md), the [Secretary](/usc/25/1603.md?p=17) shall, prior to renewing such contract or grant, attempt to resolve with such organization the areas of noncompliance or unsatisfactory performance and modify such contract or grant to prevent future occurrences of such noncompliance or unsatisfactory performance. If the [Secretary](/usc/25/1603.md?p=17) determines that such noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the [Secretary](/usc/25/1603.md?p=17) shall not renew such contract or grant with such organization and is authorized to enter into a contract or make a grant under [section 1653 of this title](/usc/25/1653.md) with another [urban Indian organization](/usc/25/1603.md?p=29) which is situated in the same [urban center](/usc/25/1603.md?p=27) as the [urban Indian organization](/usc/25/1603.md?p=29) whose contract or grant is not renewed under this section. - (d) **Contract and grant renewals—** In determining whether to renew a contract or grant with an [urban Indian organization](/usc/25/1603.md?p=29) under [section 1653 of this title](/usc/25/1653.md) which has completed performance of a contract or grant under [section 1654 of this title](/usc/25/1654.md), the [Secretary](/usc/25/1603.md?p=17) shall review the records of the [urban Indian organization](/usc/25/1603.md?p=29), the reports submitted under [section 1657 of this title](/usc/25/1657.md), and, in the case of a renewal of a contract or grant under [section 1653 of this title](/usc/25/1653.md), shall consider the results of the onsite evaluations conducted under [subsection (b)](#b). # §1656. Other contract and grant requirements - (a) **Federal regulations; exceptions—** Contracts with [urban Indian organizations](/usc/25/1603.md?p=29) entered into pursuant to this subchapter shall be in accordance with all Federal contracting laws and regulations except that, in the discretion of the [Secretary](/usc/25/1603.md?p=17), such contracts may be negotiated without advertising and need not conform to the provisions of sections [3131](/usc/40/3131.md) and [3133](/usc/40/3133.md) of title 40. - (b) **Payment—** Payments under any contracts or grants pursuant to this subchapter may be made in advance or by way of reimbursement and in such installments and on such conditions as the [Secretary](/usc/25/1603.md?p=17) deems necessary to carry out the purposes of this subchapter. - (c) **Revision or amendment—** Notwithstanding any provision of law to the contrary, the [Secretary](/usc/25/1603.md?p=17) may, at the request or consent of an [urban Indian organization](/usc/25/1603.md?p=29), revise or amend any contract entered into by the [Secretary](/usc/25/1603.md?p=17) with such organization under this subchapter as necessary to carry out the purposes of this subchapter. - (d) **Existing Government facilities—** In connection with any contract or grant entered into pursuant to this subchapter, the [Secretary](/usc/25/1603.md?p=17) may permit an [urban Indian organization](/usc/25/1603.md?p=29) to utilize, in carrying out such contract or grant, existing facilities owned by the Federal Government within the [Secretary](/usc/25/1603.md?p=17)’s jurisdiction under such terms and conditions as may be agreed upon for the use and maintenance of such facilities. - (e) **Uniform provision of services and assistance—** Contracts with, or grants to, [urban Indian organizations](/usc/25/1603.md?p=29) and regulations adopted pursuant to this subchapter shall include provisions to assure the fair and uniform provision to [urban Indians](/usc/25/2403.md?p=6) of [services](/usc/25/1603.md?p=18) and assistance under such contracts or grants by such organizations. - (f) **Eligibility for health care or referral services—** [Urban Indians](/usc/25/2403.md?p=6), as defined in [section 1603(f)](/usc/25/1603.md)[^1] of this title, shall be eligible for health care or referral [services](/usc/25/1603.md?p=18) provided pursuant to this subchapter. # §1657. Reports and records - (a) **Quarterly reports—** For each fiscal year during which an [urban Indian organization](/usc/25/1603.md?p=29) receives or expends funds pursuant to a contract entered into, or a grant received, pursuant to this subchapter, such organization shall submit to the [Secretary](/usc/25/1603.md?p=17) a quarterly report including— - (1) in the case of a contract or grant under [section 1653 of this title](/usc/25/1653.md), information gathered pursuant to clauses (10) and (11) of subsection (a) of such section; - (2) information on activities conducted by the organization pursuant to the contract or grant; - (3) an accounting of the amounts and purposes for which Federal funds were expended; and - (4) such other information as the [Secretary](/usc/25/1603.md?p=17) may request. - (b) **Audit by Secretary and Comptroller General—** The reports and records of the [urban Indian organization](/usc/25/1603.md?p=29) with respect to a contract or grant under this subchapter shall be subject to audit by the [Secretary](/usc/25/1603.md?p=17) and the Comptroller General of the United States. - (c) **Cost of annual private audit—** The [Secretary](/usc/25/1603.md?p=17) shall allow as a cost of any contract or grant entered into under [section 1653 of this title](/usc/25/1653.md) the cost of an annual private audit conducted by a certified public accountant. - (d) **Health status, services, and areas of unmet needs; child welfare—** - (1) The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), shall submit a report to the Congress not later than March 31, 1992, evaluating— - (A) the health status of [urban Indians](/usc/25/2403.md?p=6); - (B) the [services](/usc/25/1603.md?p=18) provided to [Indians](/usc/25/1934.md) through this subchapter; - (C) areas of unmet needs in urban areas served under this subchapter; and - (D) areas of unmet needs in urban areas not served under this subchapter. - (2) In preparing the report under [paragraph (1)](#d-1), the [Secretary](/usc/25/1603.md?p=17) shall consult with [urban Indian](/usc/25/2403.md?p=6) health providers and may contract with a national organization representing [urban Indian](/usc/25/2403.md?p=6) health concerns to conduct any aspect of the report. - (3) The [Secretary](/usc/25/1603.md?p=17) and the [Secretary](/usc/25/1603.md?p=17) of the Interior shall— - (A) assess the status of the welfare of [urban Indian](/usc/25/2403.md?p=6) children, including the volume of child protection cases, the prevalence of child sexual abuse, and the extent of [urban Indian](/usc/25/2403.md?p=6) coordination with tribal authorities with respect to child sexual abuse; and - (B) submit a report on the assessment required under [subparagraph (A)](#d-3-A), together with recommended legislation to improve [Indian child](/usc/25/3202.md?p=7) protection in [urban Indian](/usc/25/2403.md?p=6) populations, to the Congress no later than March 31, 1992. # §1658. Limitation on contract authority The authority of the [Secretary](/usc/25/1603.md?p=17) to enter into contracts under this subchapter shall be to the extent, and in an amount, provided for in appropriation Acts. # §1659. Facilities renovation The [Secretary](/usc/25/1603.md?p=17) may make funds available to contractors or grant recipients under this subchapter for renovations to facilities or construction or expansion of facilities, including leased facilities. # §1660. Urban Health Programs Branch - (a) **Establishment—** There is hereby established within the [Service](/usc/25/1603.md?p=18) a Branch of Urban Health [Programs](/usc/25/3402.md?p=4) which shall be responsible for carrying out the provisions of this subchapter and for providing central oversight of the [programs](/usc/25/3402.md?p=4) and [services](/usc/25/1603.md?p=18) authorized under this subchapter. - (b) **Staff, services, and equipment—** The [Secretary](/usc/25/1603.md?p=17) shall appoint such employees to work in the branch, including a [program](/usc/25/3402.md?p=4) [director](/usc/25/4302.md?p=1), and shall provide such [services](/usc/25/1603.md?p=18) and equipment, as may be necessary for it to carry out its responsibilities. The [Secretary](/usc/25/1603.md?p=17) shall also analyze the need to provide at least one urban health [program](/usc/25/3402.md?p=4) analyst for each [area office](/usc/25/1603.md?p=1) of the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18) and shall submit his findings to the Congress as a part of the [Department](/usc/25/1603.md?p=6)’s fiscal year 1993 budget request. # §1660a. Grants for alcohol and substance abuse related services - (a) **Grants—** The [Secretary](/usc/25/1603.md?p=17) may make grants for the provision of health-related [services](/usc/25/1603.md?p=18) in prevention of, treatment of, rehabilitation of, or school and community-based education in, alcohol and [substance abuse](/usc/25/1603.md?p=21) in [urban centers](/usc/25/1603.md?p=27) to those [urban Indian organizations](/usc/25/1603.md?p=29) with whom the [Secretary](/usc/25/1603.md?p=17) has entered into a contract under this subchapter or under [section 1621 of this title](/usc/25/1621.md). - (b) **Goals of grant—** Each grant made pursuant to [subsection (a)](#a) shall set forth the goals to be accomplished pursuant to the grant. The goals shall be specific to each grant as agreed to between the [Secretary](/usc/25/1603.md?p=17) and the grantee. - (c) **Criteria—** The [Secretary](/usc/25/1603.md?p=17) shall establish criteria for the grants made under [subsection (a)](#a), including criteria relating to the— - (1) size of the [urban Indian](/usc/25/2403.md?p=6) population; - (2) accessibility to, and utilization of, other health resources available to such population; - (3) duplication of existing [Service](/usc/25/1603.md?p=18) or other Federal grants or contracts; - (4) capability of the organization to adequately perform the activities required under the grant; - (5) satisfactory performance standards for the organization in meeting the goals set forth in such grant, which standards shall be negotiated and agreed to between the [Secretary](/usc/25/1603.md?p=17) and the grantee on a grant-by-grant basis; and - (6) identification of need for [services](/usc/25/1603.md?p=18). The [Secretary](/usc/25/1603.md?p=17) shall develop a methodology for allocating grants made pursuant to this section based on such criteria. - (d) **Treatment of funds received by urban Indian organizations—** Any funds received by an [urban Indian organization](/usc/25/1603.md?p=29) under this chapter for [substance abuse](/usc/25/1603.md?p=21) prevention, treatment, and rehabilitation shall be subject to the criteria set forth in [subsection (c)](#c). # §1660b. Treatment of certain demonstration projects Notwithstanding any other provision of law, the Tulsa Clinic and Oklahoma City Clinic [demonstration projects](/usc/25/1667a.md?p=2) shall— - (1) be permanent [programs](/usc/25/3402.md?p=4) within the [Service](/usc/25/1603.md?p=18)’s direct care [program](/usc/25/3402.md?p=4); - (2) continue to be treated as [Service units](/usc/25/1603.md?p=20) and operating units in the allocation of resources and coordination of care; and - (3) continue to meet the requirements and definitions of an [urban Indian organization](/usc/25/1603.md?p=29) in this chapter, and shall not be subject to the provisions of the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.).[^1] # §1660c. Urban NIAAA transferred programs - (a) **Duty of Secretary—** The [Secretary](/usc/25/1603.md?p=17) shall, within the Branch of Urban Health [Programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18), make grants or enter into contracts for the administration of [urban Indian](/usc/25/2403.md?p=6) alcohol [programs](/usc/25/3402.md?p=4) that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as “NIAAA”) and transferred to the [Service](/usc/25/1603.md?p=18). - (b) **Use of grants—** Grants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment [services](/usc/25/1603.md?p=18) for [urban Indian](/usc/25/2403.md?p=6) populations and such other objectives as are agreed upon between the [Service](/usc/25/1603.md?p=18) and a recipient of a grant or contract under this section. - (c) **Eligibility for grants—** [Urban Indian organizations](/usc/25/1603.md?p=29) that operate [Indian](/usc/25/1934.md) alcohol [programs](/usc/25/3402.md?p=4) originally funded under NIAAA and subsequently transferred to the [Service](/usc/25/1603.md?p=18) are eligible for grants or contracts under this section. - (d) **Combination of funds—** For the purpose of carrying out this section, the [Secretary](/usc/25/1603.md?p=17) may combine NIAAA alcohol funds with other [substance abuse](/usc/25/1603.md?p=21) funds currently administered through the Branch of Urban Health [Programs](/usc/25/3402.md?p=4) of the [Service](/usc/25/1603.md?p=18). - (e) **Evaluation and report to Congress—** The [Secretary](/usc/25/1603.md?p=17) shall evaluate and report to the Congress on the activities of [programs](/usc/25/3402.md?p=4) funded under this section at least every 5 years. # §1660d. Conferring with urban Indian organizations - (a) **Definition of confer—** In this section, the term “confer” means to engage in an open and free exchange of information and opinions that— - (1) leads to mutual understanding and comprehension; and - (2) emphasizes trust, respect, and shared responsibility. - (b) **Requirement—** The [Secretary](/usc/25/1603.md?p=17) shall ensure that the [Service](/usc/25/1603.md?p=18) [confers](#a), to the maximum extent practicable, with [urban Indian organizations](/usc/25/1603.md?p=29) in carrying out this chapter. # §1660e. Expanded program authority for urban Indian organizations Notwithstanding any other provision of this chapter, the [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), is authorized to establish [programs](/usc/25/3402.md?p=4), including [programs](/usc/25/3402.md?p=4) for awarding grants, for [urban Indian organizations](/usc/25/1603.md?p=29) that are identical to any [programs](/usc/25/3402.md?p=4) established pursuant to sections [1621q](/usc/25/1621q.md), [1665a](/usc/25/1665a.md), and [1665g(g)](/usc/25/1665g.md?p=g) of this title. # §1660f. Community Health Representatives The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may enter into contracts with, and make grants to, [urban Indian organizations](/usc/25/1603.md?p=29) for the employment of [Indians](/usc/25/1934.md) trained as health [service](/usc/25/1603.md?p=18) providers through the Community Health Representative [Program](/usc/25/3402.md?p=4) under [section 1616 of this title](/usc/25/1616.md) in the provision of health care, [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) to [urban Indians](/usc/25/2403.md?p=6). # §1660g. Use of Federal Government facilities and sources of supply - (a) **In general—** The [Secretary](/usc/25/1603.md?p=17) may permit an [urban Indian organization](/usc/25/1603.md?p=29) that has entered into a contract or received a grant pursuant to this subchapter, in carrying out the contract or grant, to use, in accordance with such terms and conditions for use and maintenance as are agreed on by the [Secretary](/usc/25/1603.md?p=17) and the [urban Indian organizations](/usc/25/1603.md?p=29)— - (1) any existing facility under the jurisdiction of the [Secretary](/usc/25/1603.md?p=17); - (2) all equipment contained in or pertaining to such an existing facility; and - (3) any other personal property of the Federal Government under the jurisdiction of the [Secretary](/usc/25/1603.md?p=17). - (b) **Donations—** Subject to [subsection (d)](#d), the [Secretary](/usc/25/1603.md?p=17) may donate to an [urban Indian organization](/usc/25/1603.md?p=29) that has entered into a contract or received a grant pursuant to this subchapter any personal or real property determined to be excess to the needs of the [Service](/usc/25/1603.md?p=18) or the General [Services](/usc/25/1603.md?p=18) Administration for the purposes of carrying out the contract or grant. - (c) **Acquisition of property—** The [Secretary](/usc/25/1603.md?p=17) may acquire excess or surplus personal or real property of the Federal Government for donation, subject to [subsection (d)](#d), to an [urban Indian organization](/usc/25/1603.md?p=29) that has entered into a contract or received a grant pursuant to this subchapter if the [Secretary](/usc/25/1603.md?p=17) determines that the property is appropriate for use by the [urban Indian organization](/usc/25/1603.md?p=29) for purposes of the contract or grant. - (d) **Priority—** If the [Secretary](/usc/25/1603.md?p=17) receives from an [urban Indian organization](/usc/25/1603.md?p=29) or an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) a request for a specific item of personal or real property described in subsection [(b)](#b) or [(c)](#c), the [Secretary](/usc/25/1603.md?p=17) shall give priority to the request for donation to the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26), if the [Secretary](/usc/25/1603.md?p=17) receives the request from the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) before the earlier of— - (1) the date on which the [Secretary](/usc/25/1603.md?p=17) transfers title to the property to the [urban Indian organization](/usc/25/1603.md?p=29); and - (2) the date on which the [Secretary](/usc/25/1603.md?p=17) transfers the property physically to the [urban Indian organization](/usc/25/1603.md?p=29). - (e) **Executive agency status—** For purposes of [section 501(a) of title 40](/usc/40/501.md?p=a), an [urban Indian organization](/usc/25/1603.md?p=29) that has entered into a contract or received a grant pursuant to this subchapter may be considered to be an Executive agency in carrying out the contract or grant. # §1660h. Health information technology The [Secretary](/usc/25/1603.md?p=17), acting through the [Service](/usc/25/1603.md?p=18), may make grants to [urban Indian organizations](/usc/25/1603.md?p=29) under this subchapter for the development, adoption, and implementation of health information technology (as defined in [section 300jj of title 42](/usc/42/300jj.md)), [telemedicine](/usc/25/1603.md?p=23) [services](/usc/25/1603.md?p=18) development, and related infrastructure. # §1660i. Deeming an Urban Indian organization and employees thereof to be a part of the public health service for the purposes of certain claims for personal injury [Section 5321(d) of this title](/usc/25/5321.md?p=d) shall apply— - (1) to an [Urban Indian organization](/usc/25/1603.md?p=29) to the same extent and in the same manner as such section applies to an [Indian tribe](/usc/25/1603.md?p=14), a [tribal organization](/usc/25/1603.md?p=26), and an [Indian](/usc/25/1934.md) contractor; and - (2) to the employees of an [Urban Indian organization](/usc/25/1603.md?p=29) to the same extent and in the same manner as such section applies to employees of an [Indian tribe](/usc/25/1603.md?p=14), a [tribal organization](/usc/25/1603.md?p=26), or an [Indian](/usc/25/1934.md) contractor. # §1661. Establishment of the Indian Health Service as an agency of the Public Health Service - (a) **Establishment—** - (1) **In general—** In order to more effectively and efficiently carry out the responsibilities, authorities, and functions of the United States to provide health care [services](/usc/25/1603.md?p=18) to [Indians](/usc/25/1934.md) and [Indian tribes](/usc/25/1603.md?p=14), as are or may be on and after November 23, 1988, provided by Federal statute or treaties, there is established within the Public Health [Service](/usc/25/1603.md?p=18) of the [Department](/usc/25/1603.md?p=6) the [Indian](/usc/25/1934.md) Health [Service](/usc/25/1603.md?p=18). - (2) **Director—** The [Service](/usc/25/1603.md?p=18) shall be administered by a [Director](/usc/25/4302.md?p=1), who shall be appointed by the President, by and with the advice and consent of the Senate. The [Director](/usc/25/4302.md?p=1) shall report to the [Secretary](/usc/25/1603.md?p=17). Effective with respect to an individual appointed by the President, by and with the advice and consent of the Senate, after January 1, 2008, the term of [service](/usc/25/1603.md?p=18) of the [Director](/usc/25/4302.md?p=1) shall be 4 years. A [Director](/usc/25/4302.md?p=1) may serve more than 1 term. - (3) **Incumbent—** The individual serving in the position of [Director](/usc/25/4302.md?p=1) of the [Service](/usc/25/1603.md?p=18) on the day before March 23, 2010, shall serve as [Director](/usc/25/4302.md?p=1). - (4) **Advocacy and consultation—** The position of [Director](/usc/25/4302.md?p=1) is established to, in a manner consistent with the government-to-government relationship between the United States and [Indian Tribes](/usc/25/1603.md?p=14)— - (A) facilitate advocacy for the development of appropriate [Indian](/usc/25/1934.md) health policy; and - (B) promote consultation on matters relating to [Indian](/usc/25/1934.md) health. - (b) **Agency—** The [Service](/usc/25/1603.md?p=18) shall be an agency within the Public Health [Service](/usc/25/1603.md?p=18) of the [Department](/usc/25/1603.md?p=6), and shall not be an [office](/usc/25/4001.md?p=4), component, or unit of any other agency of the [Department](/usc/25/1603.md?p=6). - (c) **Duties—** The [Director](/usc/25/4302.md?p=1) shall— - (1) perform all functions that were, on the day before March 23, 2010, carried out by or under the direction of the individual serving as [Director](/usc/25/4302.md?p=1) of the [Service](/usc/25/1603.md?p=18) on that day; - (2) perform all functions of the [Secretary](/usc/25/1603.md?p=17) relating to the maintenance and operation of hospital and health facilities for [Indians](/usc/25/1934.md) and the planning for, and provision and utilization of, health [services](/usc/25/1603.md?p=18) for [Indians](/usc/25/1934.md), including by ensuring that all agency [directors](/usc/25/4302.md?p=1), managers, and chief executive officers have appropriate and adequate training, experience, skill levels, knowledge, abilities, and education (including continuing training requirements) to competently fulfill the duties of the positions and the mission of the [Service](/usc/25/1603.md?p=18); - (3) administer all health [programs](/usc/25/3402.md?p=4) under which health care is provided to [Indians](/usc/25/1934.md) based upon their status as [Indians](/usc/25/1934.md) which are administered by the [Secretary](/usc/25/1603.md?p=17), including [programs](/usc/25/3402.md?p=4) under— - (A) this chapter; - (B) [section 13 of this title](/usc/25/13.md); - (C) the Act of August 5, 1954 ([42 U.S.C. 2001](/usc/42/2001.md) et seq.); - (D) the Act of August 16, 1957 ([42 U.S.C. 2005](/usc/42/2005.md) et seq.); and - (E) the [Indian](/usc/25/1934.md) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.);[^1] - (4) administer all scholarship and loan functions carried out under subchapter I; - (5) directly advise the [Secretary](/usc/25/1603.md?p=17) concerning the development of all policy- and budget-related matters affecting [Indian](/usc/25/1934.md) health; - (6) collaborate with the Assistant [Secretary](/usc/25/1603.md?p=17) for Health concerning appropriate matters of [Indian](/usc/25/1934.md) health that affect the agencies of the Public Health [Service](/usc/25/1603.md?p=18); - (7) advise each Assistant [Secretary](/usc/25/1603.md?p=17) of the [Department](/usc/25/1603.md?p=6) concerning matters of [Indian](/usc/25/1934.md) health with respect to which that Assistant [Secretary](/usc/25/1603.md?p=17) has authority and responsibility; - (8) advise the heads of other agencies and [programs](/usc/25/3402.md?p=4) of the [Department](/usc/25/1603.md?p=6) concerning matters of [Indian](/usc/25/1934.md) health with respect to which those heads have authority and responsibility; - (9) coordinate the activities of the [Department](/usc/25/1603.md?p=6) concerning matters of [Indian](/usc/25/1934.md) health; and - (10) perform such other functions as the [Secretary](/usc/25/1603.md?p=17) may designate. - (d) **Authority—** - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17), acting through the [Director](/usc/25/4302.md?p=1), shall have the authority— - (A) except to the extent provided for in [paragraph (2)](#d-2), to appoint and compensate employees for the [Service](/usc/25/1603.md?p=18) in accordance with [title 5](/usc/5.md); - (B) to enter into contracts for the procurement of goods and [services](/usc/25/1603.md?p=18) to carry out the functions of the [Service](/usc/25/1603.md?p=18); and - (C) to manage, expend, and obligate all funds appropriated for the [Service](/usc/25/1603.md?p=18). - (2) **Personnel actions—** Notwithstanding any other provision of law, the provisions of [section 5116 of this title](/usc/25/5116.md),[^2] shall apply to all personnel actions taken with respect to new positions created within the [Service](/usc/25/1603.md?p=18) as a result of its establishment under [subsection (a)](#a).