TITLE 25 - US CODE - SUBCHAPTER II - HEALTH SERVICES

25 USC 1621 - Indian Health Care Improvement Fund

(a) Approved expenditures 
The Secretary is authorized to expend funds which are appropriated under the authority of this section, through the Service, for the purposes of
(1) eliminating the deficiencies in health status and resources of all Indian tribes,
(2) eliminating backlogs in the provision of health care services to Indians,
(3) meeting the health needs of Indians in an efficient and equitable manner, and

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(4) augmenting the ability of the Service to meet the following health service responsibilities, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.], with respect to those Indian tribes with the highest levels of health status and resource deficiencies:
(A) clinical care (direct and indirect) including clinical eye and vision care;
(B) preventive health, including screening mammography in accordance with section 1621k of this title;
(C) dental care (direct and indirect);
(D) mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treatment centers, and training of traditional Indian practitioners;
(E) emergency medical services;
(F) treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians;
(G) accident prevention programs;
(H) home health care;
(I) community health representatives; and

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(J) maintenance and repair.
(b) Effect on other appropriations; allocation to service units 

(1) Any funds appropriated under the authority of this section shall not be used to offset or limit any appropriations made to the Service under section 13 of this title, or any other provision of law.
(2) 
(A) Funds appropriated under the authority of this section may be allocated on a service unit basis. The funds allocated to each service unit under this subparagraph shall be used by the service unit to reduce the health status and resource deficiency of each tribe served by such service unit.
(B) The apportionment of funds allocated to a service unit under subparagraph (A) among the health service responsibilities described in subsection (a)(4) of this section shall be determined by the Service in consultation with, and with the active participation of, the affected Indian tribes.
(c) Health resources deficiency levels 
For purposes of this section
(1) The term health status and resource deficiency means the extent to which
(A) the health status objectives set forth in section 1602 (b) of this title are not being achieved; and
(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.
(2) The health resources available to an Indian tribe include health resources provided by the Service as well as health resources used by the Indian tribe, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments.
(3) The Secretary shall establish procedures which allow any Indian tribe to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such tribe.
(d) Programs administered by Indian tribe 

(1) Programs administered by any Indian tribe or tribal organization under the authority of the Indian Self-Determination Act [25 U.S.C. 450f et seq.] shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service.
(2) If any funds allocated to a tribe or service unit under the authority of this section are used for a contract entered into under the Indian Self-Determination Act, a reasonable portion of such funds may be used for health planning, training, technical assistance, and other administrative support functions.
(e) Report to Congress 
By no later than the date that is 3 years after October 29, 1992, the Secretary shall submit to the Congress the current health status and resource deficiency report of the Service for each Indian tribe or service unit, including newly recognized or acknowledged tribes. Such report shall set out
(1) the methodology then in use by the Service for determining tribal health status and resource deficiencies, as well as the most recent application of that methodology;
(2) the extent of the health status and resource deficiency of each Indian tribe served by the Service;
(3) the amount of funds necessary to eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and
(4) an estimate of
(A) the amount of health service funds appropriated under the authority of this chapter, or any other Act, including the amount of any funds transferred to the Service, for the preceding fiscal year which is allocated to each service unit, Indian tribe, or comparable entity;
(B) the number of Indians eligible for health services in each service unit or Indian tribe; and
(C) the number of Indians using the Service resources made available to each service unit or Indian tribe.
(f) Appropriated funds included in base budget of Service 
Funds appropriated under authority of this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years.
(g) Continuation of Service responsibilities for backlogs and parity 
Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve parity among Indian tribes.
(h) Authorization of appropriations 
Any funds appropriated under the authority of this section shall be designated as the Indian Health Care Improvement Fund.

25 USC 1621a - Catastrophic Health Emergency Fund

(a) Establishment; administration; purpose 

(1) There is hereby established an Indian Catastrophic Health Emergency Fund (hereafter in this section referred to as the Fund) consisting of
(A) the amounts deposited under subsection (d) of this section, and
(B) the amounts appropriated to the Fund under this section.
(2) The Fund shall be administered by the Secretary, acting through the central office of the Service, solely for the purpose of meeting the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the Service.
(3) The Fund shall not be allocated, apportioned, or delegated on a service unit, area office, or any other basis.
(4) No part of the Fund or its administration shall be subject to contract or grant under any law, including the Indian Self-Determination Act [25 U.S.C. 450f et seq.].
(b) Regulations; procedures for payment 
The Secretary shall, through the promulgation of regulations consistent with the provisions of this section
(1) establish a definition of disasters and catastrophic illnesses for which the cost of treatment provided under contract would qualify for payment from the Fund;
(2) provide that a service unit shall not be eligible for reimbursement for the cost of treatment from the Fund until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at
(A) for 1993, not less than $15,000 or not more than $25,000; 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 incurred by
(A) service units or facilities of the Service, or
(B) whenever otherwise authorized by the Service, non-Service facilities or providers,

in rendering treatment that exceeds such threshold cost;

(4) establish a procedure for payment from the Fund in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the Service; and
(5) establish a procedure that will ensure that no payment shall be made from the Fund 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.
(c) Effect on other appropriations 
Amounts appropriated to the Fund under this section shall not be used to offset or limit appropriations made to the Service under authority of section 13 of this title or any other law.
(d) Reimbursements to Fund 
There shall be deposited into the Fund all reimbursements to which the Service is entitled from any Federal, State, local, or private source (including third party insurance) by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from the Fund.

25 USC 1621b - Health promotion and disease prevention services

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

25 USC 1621c - Diabetes prevention, treatment, and control

(a) Incidence and complications 
The Secretary, in consultation with the tribes, shall determine
(1) by tribe and by Service unit of the Service, the incidence of, and the types of complications resulting from, diabetes among Indians; and
(2) based on paragraph (1), the measures (including patient education) each Service unit should take to reduce the incidence of, and prevent, treat, and control the complications resulting from, diabetes among tribes within that Service unit.
(b) Screening 
The Secretary shall screen each Indian who receives services from the Service for diabetes and for conditions which indicate a high risk that the individual will become diabetic. Such screening may be done by a tribe or tribal organization operating health care programs or facilities with funds from the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.].
(c) Model diabetes projects 

(1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on October 29, 1992, and located
(A) at the Claremore Indian Hospital in Oklahoma;
(B) at the Fort Totten Health Center in North Dakota;
(C) at the Sacaton Indian Hospital in Arizona;
(D) at the Winnebago Indian Hospital in Nebraska;
(E) at the Albuquerque Indian Hospital in New Mexico;
(F) at the Perry, Princeton, and Old Town Health Centers in Maine;
(G) at the Bellingham Health Center in Washington;
(H) at the Fort Berthold Reservation;
(I) at the Navajo Reservation;
(J) at the Papago Reservation;
(K) at the Zuni Reservation; or
(L) in the States of Alaska, California, Minnesota, Montana, Oregon, or Utah.
(2) The Secretary may establish new model diabetes projects under this section taking into consideration applications received under this section from all service areas, except that the Secretary may not establish a greater number of such projects in one service area than in any other service area until there is an equal number of such projects established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).
(d) Control officer; registry of patients 
The Secretary shall
(1) employ in each area office of the Service at least one diabetes control officer who shall coordinate and manage on a full-time basis activities within that area office for the prevention, treatment, and control of diabetes;
(2) establish in each area office of the Service a registry of patients with diabetes to track the incidence of diabetes and the complications from diabetes in that area;
(3) ensure that data collected in each area office regarding diabetes and related complications among Indians is disseminated to all other area offices; and
(4) evaluate the effectiveness of services provided through model diabetes projects established under this section.
(e) Authorization of appropriations 
Funds appropriated under this section in any fiscal year shall be in addition to base resources appropriated to the Service for that year.

25 USC 1621d - Hospice care feasibility study

(a) Duty of Secretary 
The Secretary, acting through the Service and in consultation with representatives of Indian tribes, tribal organizations, Indian Health Service personnel, and hospice providers, shall conduct a study
(1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and
(2) to determine the most efficient and effective means of furnishing such care.
(b) Functions of study 
Such study shall
(1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians;
(2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals;
(3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care;
(4) identify and evaluate various means for providing hospice care, including
(A) the provision of such care by the personnel of a Service hospital pursuant to a hospice program established by the Secretary at such hospital; and
(B) the provision of such care by a community-based hospice program under contract to the Service; and
(5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties.
(c) Report to Congress 
Not later than the date which is 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report containing
(1) a detailed description of the study conducted pursuant to this section; and
(2) a discussion of the findings and conclusions of such study.
(d) Definitions 
For the purposes of this section
(1) the term terminally ill means any Indian who has a medical prognosis (as certified by a physician) of a life expectancy of six months or less; and
(2) the term hospice program means any program which satisfies the requirements of section 1395x (dd)((2) of title 42; and
(3) the term hospice care means the items and services specified in subparagraphs (A) through (H) of section 1395x (dd)(1) of title 42.

25 USC 1621e - Reimbursement from certain third parties of costs of health services

(a) Right of recovery 
Except as provided in subsection (f) of this section, the United States, an Indian tribe, or a tribal organization shall have the right to recover the reasonable expenses incurred by the Secretary, an Indian tribe, or a tribal organization in providing health services, through the Service, an Indian tribe, or a tribal organization, to any individual to the same extent that such individual, or any nongovernmental provider of such services, would be eligible to receive reimbursement or indemnification for such expenses if
(1) such services had been provided by a nongovernmental provider, and
(2) such individual had been required to pay such expenses and did pay such expenses.
(b) Recovery against State with workers’ compensation laws or no-fault automobile accident insurance program 
Subsection (a) of this section shall provide a right of recovery against any State only if the injury, illness, or disability for which health services were provided is covered under
(1) workers compensation laws, or
(2) a no-fault automobile accident insurance plan or program.
(c) Prohibition of State law or contract provision impeding right of recovery 
No law of any State, or of any political subdivision of a State, and no provision of any contract entered into or renewed after November 23, 1988, shall prevent or hinder the right of recovery of the United States, an Indian tribe, or a tribal organization under subsection (a) of this section.
(d) Right to damages 
No action taken by the United States, an Indian tribe, or a tribal organization to enforce the right of recovery provided under subsection (a) of this section shall affect the right of any person to any damages (other than damages for the cost of health services provided by the Secretary through the Service).
(e) Intervention or separate civil action 
The United States, an Indian tribe, or a tribal organization may enforce the right of recovery provided under subsection (a) of this section by
(1) intervening or joining in any civil action or proceeding brought
(A) by the individual for whom health services were provided by the Secretary, an Indian tribe, or a tribal organization, or
(B) by any representative or heirs of such individual, or
(2) instituting a separate civil action, after providing to such individual, or to the representative or heirs of such individual, notice of the intention of the United States, an Indian tribe, or a tribal organization to institute a separate civil action.
(f) Right of recovery for services when self-insurance plan provides coverage 
The United States shall not have a right of recovery under this section if the injury, illness, or disability for which health services were provided is covered under a self-insurance plan funded by an Indian tribe or tribal organization.

25 USC 1621f - Crediting of reimbursements

(a) Except as provided in section 1621a (d) of this title, subchapter IIIA of this chapter, and section 1680c of this title, all reimbursements received or recovered, under authority of this chapter, Public Law 87693 (42 U.S.C. 2651, et seq.), or any other provision of law, by reason of the provision of health services by the Service or by a tribe or tribal organization under a contract pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.] shall be retained by the Service or that tribe or tribal organization and shall be available for the facilities, and to carry out the programs, of the Service or that tribe or tribal organization to provide health care services to Indians.
(b) The Service may not offset or limit the amount of funds obligated to any service unit or any entity under contract with the Service because of the receipt of reimbursements under subsection (a) of this section.

25 USC 1621g - Health services research

Of the amounts appropriated for the Service in any fiscal year, other than amounts made available for the Indian Health Care Improvement Fund, not less than $200,000 shall be available only for research to further the performance of the health service responsibilities of the Service. Indian tribes and tribal organizations contracting with the Service under the authority of the Indian Self-Determination Act [25 U.S.C. 450f et seq.] shall be given an equal opportunity to compete for, and receive, research funds under this section.

25 USC 1621h - Mental health prevention and treatment services

(a) National plan for Indian Mental Health Services 

(1) Not later than 120 days after November 28, 1990, the Secretary, acting through the Service, shall develop and publish in the Federal Register a final national plan for Indian Mental Health Services. The plan shall include
(A) an assessment of the scope of the problem of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians, including
(i) the number of Indians served by the Service who are directly or indirectly affected by such illness or behavior, and
(ii) an estimate of the financial and human cost attributable to such illness or behavior;
(B) an assessment of the existing and additional resources necessary for the prevention and treatment of such illness and behavior; and
(C) an estimate of the additional funding needed by the Service to meet its responsibilities under the plan.
(2) The Secretary shall submit a copy of the national plan to the Congress.
(b) Memorandum of agreement 
Not later than 180 days after November 28, 1990, the Secretary and the Secretary of the Interior shall develop and enter into a memorandum of agreement under which the Secretaries shall, among other things
(1) determine and define the scope and nature of mental illness and dysfunctional and self-destructive behavior, including child abuse and family violence, among Indians;
(2) make an assessment of the existing Federal, tribal, State, local, and private services, resources, and programs available to provide mental health services for Indians;
(3) make an initial determination of the unmet need for additional services, resources, and programs necessary to meet the needs identified pursuant to paragraph (1);
(4) 
(A) ensure that Indians, as citizens of the United States and of the States in which they reside, have access to mental health services to which all citizens have access;
(B) determine the right of Indians to participate in, and receive the benefit of, such services; and
(C) take actions necessary to protect the exercise of such right;
(5) delineate the responsibilities of the Bureau of Indian Affairs and the Service, including mental health identification, prevention, education, referral, and treatment services (including services through multidisciplinary resource teams), at the central, area, and agency and service unit levels to address the problems identified in paragraph (1);
(6) provide a strategy for the comprehensive coordination of the mental health services provided by the Bureau of Indian Affairs and the Service to meet the needs identified pursuant to paragraph (1), including
(A) the coordination of alcohol and substance abuse programs of the Service, the Bureau of Indian Affairs, and the various tribes (developed under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 [25 U.S.C. 2401 et seq.]) with the mental health initiatives pursuant to this chapter, particularly with respect to the referral and treatment of dually-diagnosed individuals requiring mental health and substance abuse treatment; and
(B) ensuring that Bureau of Indian Affairs and Service programs and services (including multidisciplinary resource teams) addressing child abuse and family violence are coordinated with such non-Federal programs and services;
(7) direct appropriate officials of the Bureau of Indian Affairs and the Service, particularly at the agency and service unit levels, to cooperate fully with tribal requests made pursuant to subsection (d) of this section; and
(8) provide for an annual review of such agreement by the two Secretaries.
(c) Community mental health plan 

(1) The governing body of any Indian tribe may, at its discretion, adopt a resolution for the establishment of a community mental health plan providing for the identification and coordination of available resources and programs to identify, prevent, or treat mental illness or dysfunctional and self-destructive behavior, including child abuse and family violence, among its members.
(2) In furtherance of a plan established pursuant to paragraph (1) and at the request of a tribe, the appropriate agency, service unit, or other officials of the Bureau of Indian Affairs and the Service shall cooperate with, and provide technical assistance to, the tribe in the development of such plan. Upon the establishment of such a plan and at the request of the tribe, such officials, as directed by the memorandum of agreement developed pursuant to subsection (c) of this section, shall cooperate with the tribe in the implementation of such plan.
(3) Two or more Indian tribes may form a coalition for the adoption of resolutions and the establishment and development of a joint community mental health plan under this subsection.
(4) The Secretary, acting through the Service, may make grants to Indian tribes adopting a resolution pursuant to paragraph (1) to obtain technical assistance for the development of a community mental health plan and to provide administrative support in the implementation of such plan.
(d) Mental health training and community education programs 

(1) The Secretary and the Secretary of the Interior, in consultation with representatives of Indian tribes, shall conduct a study and compile a list, of the types of staff positions specified in paragraph (2) whose qualifications include, or should include, training in the identification, prevention, education, referral, or treatment of mental illness or dysfunctional and self-destructive behavior.
(2) The positions referred to in paragraph (1) are
(A) staff positions within the Bureau of Indian Affairs, including existing positions, in the fields of
(i) elementary and secondary education;
(ii) social services and family and child welfare;
(iii) law enforcement and judicial services; and
(iv) alcohol and substance abuse;
(B) staff positions with the Service; and
(C) staff positions similar to those identified in subparagraphs (A) and (B) established and maintained by Indian tribes, including positions established in contracts entered into under the Indian Self-Determination Act [25 U.S.C. 450f et seq.].
(3) 
(A) The appropriate Secretary shall provide training criteria appropriate to each type of position identified in paragraph (2)(A) and ensure that appropriate training has been, or will be, provided to any individual in any such position. With respect to any such individual in a position identified pursuant to paragraph (2)(C), the respective Secretaries shall provide appropriate training to, or provide funds to an Indian tribe for the training of, such individual. In the case of positions funded under a contract entered into under the Indian Self-Determination Act, the appropriate Secretary shall ensure that such training costs are included in the contract, if necessary.
(B) Funds authorized to be appropriated pursuant to this section may be used to provide training authorized by this paragraph for community education programs described in paragraph (5) if a plan adopted pursuant to subsection (d) of this section identifies individuals or employment categories, other than those identified pursuant to paragraph (1), for which such training or community education is deemed necessary or desirable.
(4) Position-specific training criteria described in paragraph (3) shall be culturally relevant to Indians and Indian tribes and shall ensure that appropriate information regarding traditional Indian healing and treatment practices is provided.
(5) The Service shall develop and implement or, upon the request of an Indian tribe, assist such tribe to develop and implement, a program of community education on mental illness and dysfunctional and self-destructive behavior for individuals, as determined in a plan adopted pursuant to subsection (d) of this section. In carrying out this paragraph, the Service shall provide, upon the request of an Indian tribe, technical assistance to the Indian tribe to obtain or develop community education and training materials on the identification, prevention, referral, and treatment of mental illness and dysfunctional and self-destructive behavior.
(e) Staffing 

(1) Within 90 days after November 28, 1990, the Secretary shall develop a plan under which the Service will increase the health care staff providing mental health services by at least 500 positions within five years after November 28, 1990, with at least 200 of such positions devoted to child, adolescent, and family services. Such additional staff shall be primarily assigned to the service unit level for services which shall include outpatient, emergency, aftercare and follow-up, and prevention and education services.
(2) The plan developed under paragraph (1) shall be implemented under section 13 of this title.
(f) Staff recruitment and retention 

(1) The Secretary shall provide for the recruitment of the additional personnel required by subsection (f) of this section and the retention of all Service personnel providing mental health services. In carrying out this subsection, the Secretary shall give priority to practitioners providing mental health services to children and adolescents with mental health problems.
(2) In carrying out paragraph (1), the Secretary shall develop a program providing for
(A) the payment of bonuses (which shall not be more favorable than those provided for under sections 1616i and 1616j of this title) for service in hardship posts;
(B) the repayment of loans (for which the provisions of repayment contracts shall not be more favorable than the repayment contracts under section 1616a of this title) for health professions education as a recruitment incentive; and
(C) a system of postgraduate rotations as a retention incentive.
(3) This subsection shall be carried out in coordination with the recruitment and retention programs under subchapter I of this chapter.
(g) Mental Health Technician program 

(1) Under the authority of section 13 of this title, the Secretary shall establish and maintain a Mental Health Technician program within the Service which
(A) provides for the training of Indians as mental health technicians; and
(B) employs such technicians in the provision of community-based mental health care that includes identification, prevention, education, referral, and treatment services.
(2) In carrying out paragraph (1)(A), the Secretary shall provide high standard paraprofessional training in mental health care necessary to provide quality care to the Indian communities to be served. Such training shall be based upon a curriculum developed or approved by the Secretary which combines education in the theory of mental health care with supervised practical experience in the provision of such care.
(3) The Secretary shall supervise and evaluate the mental health technicians in the training program.
(4) The Secretary shall ensure that the program established pursuant to this subsection involves the utilization and promotion of the traditional Indian health care and treatment practices of the Indian tribes to be served.
(h) Mental health research 
The Secretary, acting through the Service and in consultation with the National Institute of Mental Health, shall enter into contracts with, or make grants to, appropriate institutions for the conduct of research on the incidence and prevalence of mental disorders among Indians on Indian reservations and in urban areas. Research priorities under this subsection shall include
(1) the inter-relationship and inter-dependence of mental disorders with alcoholism, suicide, homicides, accidents, and the incidence of family violence, and
(2) the development of models of prevention techniques.

The effect of the inter-relationships and interdependencies referred to in paragraph (1) on children, and the development of prevention techniques under paragraph (2) applicable to children, shall be emphasized.

(i) Facilities assessment 
Within one year after November 28, 1990, the Secretary, acting through the Service, shall make an assessment of the need for inpatient mental health care among Indians and the availability and cost of inpatient mental health facilities which can meet such need. In making such assessment, the Secretary shall consider the possible conversion of existing, under-utilized service hospital beds into psychiatric units to meet such need.
(j) Annual report 
The Service shall develop methods for analyzing and evaluating the overall status of mental health programs and services for Indians and shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, a report on the mental health status of Indians which shall describe the progress being made to address mental health problems of Indian communities.
(k) Mental health demonstration grant program 

(1) The Secretary, acting through the Service, is authorized to make grants to Indian tribes and inter-tribal consortia to pay 75 percent of the cost of planning, developing, and implementing programs to deliver innovative community-based mental health services to Indians. The 25 percent tribal share of such cost may be provided in cash or through the provision of property or services.
(2) The Secretary may award a grant for a project under paragraph (1) to an Indian tribe or inter-tribal consortium which meets the following criteria:
(A) The project will address significant unmet mental health needs among Indians.
(B) The project will serve a significant number of Indians.
(C) The project has the potential to deliver services in an efficient and effective manner.
(D) The tribe or consortium has the administrative and financial capability to administer the project.
(E) The project will deliver services in a manner consistent with traditional Indian healing and treatment practices.
(F) The project is coordinated with, and avoids duplication of, existing services.
(3) For purposes of this subsection, the Secretary shall, in evaluating applications for grants for projects to be operated under any contract entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.], use the same criteria that the Secretary uses in evaluating any other application for such a grant.
(4) The Secretary may only award one grant under this subsection with respect to a service area until the Secretary has awarded grants for all service areas with respect to which the Secretary receives applications during the application period, as determined by the Secretary, which meet the criteria specified in paragraph (2).
(5) Not later than 180 days after the close of the term of the last grant awarded pursuant to this subsection, the Secretary shall submit to the Congress a report evaluating the effectiveness of the innovative community-based projects demonstrated pursuant to this subsection. Such report shall include findings and recommendations, if any, relating to the reorganization of the programs of the Service for delivery of mental health services to Indians.
(6) Grants made pursuant to this section may be expended over a period of three years and no grant may exceed $1,000,000 for the fiscal years involved.
(l) Licensing requirement for mental health care workers 
Any person employed as a psychologist, social worker, or marriage and family therapist for the purpose of providing mental health care services to Indians in a clinical setting under the authority of this chapter or through a contract pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.] shall
(1) in the case of a person employed as a psychologist, be licensed as a clinical psychologist or working under the direct supervision of a licensed clinical psychologist;
(2) in the case of a person employed as a social worker, be licensed as a social worker or working under the direct supervision of a licensed social worker; or
(3) in the case of a person employed as a marriage and family therapist, be licensed as a marriage and family therapist or working under the direct supervision of a licensed marriage and family therapist.
(m) Intermediate adolescent mental health services 

(1) The Secretary, acting through the Service, may make grants to Indian tribes and tribal organizations to provide intermediate mental health services to Indian children and adolescents, including
(A) inpatient and outpatient services;
(B) emergency care;
(C) suicide prevention and crisis intervention; and
(D) prevention and treatment of mental illness, and dysfunctional and self-destructive behavior, including child abuse and family violence.
(2) Funds provided under this subsection may be used
(A) to construct or renovate an existing health facility to provide intermediate mental health services;
(B) to hire mental health professionals;
(C) to staff, operate, and maintain an intermediate mental health facility, group home, or youth shelter where intermediate mental health services are being provided; and
(D) to make renovations and hire appropriate staff to convert existing hospital beds into adolescent psychiatric units.
(3) Funds provided under this subsection may not be used for the purposes described in section 1621o (b)(1) of this title.
(4) An Indian tribe or tribal organization receiving a grant under this subsection shall ensure that intermediate adolescent mental health services are coordinated with other tribal, Service, and Bureau of Indian Affairs mental health, alcohol and substance abuse, and social services programs on the reservation of such tribe or tribal organization.
(5) The Secretary shall establish criteria for the review and approval of applications for grants made pursuant to this subsection.
(6) There are authorized to be appropriated to carry out this section $10,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.

25 USC 1621i - Managed care feasibility study

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

25 USC 1621j - California contract health services demonstration program

(a) Establishment 
The Secretary shall establish a demonstration program to evaluate the use of a contract care intermediary to improve the accessibility of health services to California Indians.
(b) Agreement with California Rural Indian Health Board 

(1) In establishing such program, the Secretary shall enter into an agreement with the California Rural Indian Health Board to reimburse the Board for costs (including reasonable administrative costs) incurred, during the period of the demonstration program, in providing medical treatment under contract to California Indians described in section 1679 (b) of this title throughout the California contract health services delivery area described in section 1680 of this title with respect to high-cost contract care cases.
(2) Not more than 5 percent of the amounts provided to the Board under this section for any fiscal year may be for reimbursement for administrative expenses incurred by the Board during such fiscal year.
(3) No payment may be made for treatment provided under the demonstration program to the extent payment may be made for such treatment under the Catastrophic Health Emergency Fund described in section 1621a of this title or from amounts appropriated or otherwise made available to the California contract health service delivery area for a fiscal year.
(c) Advisory board 
There is hereby established an advisory board which shall advise the California Rural Indian Health Board in carrying out the demonstration pursuant to this section. The advisory board shall be composed of representatives, selected by the California Rural Indian Health Board, from not less than 8 tribal health programs serving California Indians covered under such demonstration, at least one half of whom are not affiliated with the California Rural Indian Health Board.
(d) Commencement and termination dates 
The demonstration program 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 Health Board shall submit to the Secretary a report on the demonstration program carried out under this section, including a statement of its findings regarding the impact of using a contract care intermediary on
(1) access to needed health services;
(2) waiting periods for receiving such services; and
(3) the efficient management of high-cost contract care cases.
(f) “High-cost contract care cases” 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, except that the cost of such treatment does not meet the threshold cost requirement established pursuant to section 1621a (b)(2) of this title; and
(2) exceeds $1,000.
(g) Authorization of appropriations 
There are authorized to be appropriated for each of the fiscal years 1996 through 2000 such sums as may be necessary to carry out the purposes of this section.

25 USC 1621k - Coverage of screening mammography

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

25 USC 1621l - Patient travel costs

(a) The Secretary, acting through the Service, shall provide funds for the following patient travel costs associated with receiving health care services provided (either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.]) under this chapter
(1) emergency air transportation; and
(2) nonemergency air transportation where ground transportation is infeasible.
(b) 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.

25 USC 1621m - Epidemiology centers

(a) 
(1) The Secretary shall establish an epidemiology center in each Service area to carry out the functions described in paragraph (3).
(2) To assist such centers in carrying out such functions, the Secretary shall perform the following:
(A) In consultation with the Centers for Disease Control and Indian tribes, develop sets of data (which to the extent practicable, shall be consistent with the uniform data sets used by the States with respect to the year 2000 health objectives) for uniformly defining health status for purposes of the objectives specified in section 1602 (b) of this title. Such sets shall consist of one or more categories of information. The Secretary shall develop formats for the uniform collecting and reporting of information on such categories.
(B) Establish and maintain a system for monitoring the progress made toward meeting each of the health status objectives described in section 1602 (b) of this title.
(3) In consultation with Indian tribes and urban Indian communities, each area epidemiology center established under this subsection shall, with respect to such area
(A) collect data relating to, and monitor progress made toward meeting, each of the health status objectives described in section 1602 (b) of this title using the data sets and monitoring system developed by the Secretary pursuant to paragraph (2);
(B) evaluate existing delivery systems, data systems, and other systems that impact the improvement of Indian health;
(C) assist tribes and urban Indian communities in identifying their highest priority health status objectives and the services needed to achieve such objectives, based on epidemiological data;
(D) make recommendations for the targeting of services needed by tribal, urban, and other Indian communities;
(E) make recommendations to improve health care delivery systems for Indians and urban Indians;
(F) work cooperatively with tribal providers of health and social services in order to avoid duplication of existing services; and
(G) provide technical assistance to Indian tribes and urban Indian organizations in the development of local health service priorities and incidence and prevalence rates of disease and other illness in the community.
(4) Epidemiology centers established under this subsection shall be subject to the provisions of the Indian Self-Determination Act (25 U.S.C. 450f et seq.).
(5) The director of the Centers for Disease Control shall provide technical assistance to the centers in carrying out the requirements of this subsection.
(6) The Service shall assign one epidemiologist from each of its area offices to each area epidemiology center to provide such center with technical assistance necessary to carry out this subsection.
(b) 
(1) The Secretary may make grants to Indian tribes, tribal organizations, and eligible intertribal consortia or Indian organizations to conduct epidemiological studies of Indian communities.
(2) An intertribal consortia or Indian organization is eligible to receive a grant under this subsection if
(A) it is incorporated for the primary purpose of improving Indian health; and
(B) it is representative of the tribes or urban Indian communities in which it is located.
(3) An application for a grant under this subsection shall be submitted in such manner and at such time as the Secretary shall prescribe.
(4) Applicants for grants under this subsection shall
(A) demonstrate the technical, administrative, and financial expertise necessary to carry out the functions described in paragraph (5);
(B) consult and cooperate with providers of related health and social services in order to avoid duplication of existing services; and
(C) demonstrate cooperation from Indian tribes or urban Indian organizations in the area to be served.
(5) A grant awarded under paragraph (1) may be used to
(A) carry out the functions described in subsection (a)(3) of this section;
(B) provide information to and consult with tribal leaders, urban Indian community leaders, and related health staff, on health care and health services management issues; and
(C) provide, in collaboration with tribes and urban Indian communities, the Service with information regarding ways to improve the health status of Indian people.
(6) There are authorized to be appropriated to carry out the purposes of this subsection not more than $12,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.

25 USC 1621n - Comprehensive school health education programs

(a) Award of grants 
The Secretary, acting through the Service and in consultation with the Secretary of the Interior, may award grants to Indian tribes to develop comprehensive school health education programs for children from preschool through grade 12 in schools located on Indian reservations.
(b) Use of 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 efforts;
(4) encourage healthy, tobacco-free school environments;
(5) coordinate school-based health programs with existing services and programs available in the community;
(6) develop school programs on nutrition education, personal health, and fitness;
(7) develop mental health wellness programs;
(8) develop chronic disease prevention programs;
(9) develop substance abuse prevention programs;
(10) develop accident prevention and safety education programs;
(11) develop activities for the prevention and control of communicable diseases; and
(12) develop community and environmental health education programs.
(c) Assistance 
The Secretary shall provide technical assistance to Indian tribes in the development of health education plans, and the dissemination of health education materials and information on existing health programs and resources.
(d) Criteria for review and approval of applications 
The Secretary 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 an annual report on activities undertaken with funds provided under this section. Such reports shall include a statement of
(1) the number of preschools, elementary schools, and secondary schools served;
(2) the number of students served;
(3) any new curricula established with funds provided under this section;
(4) the number of teachers trained in the health curricula; and
(5) the involvement of parents, members of the community, and community health workers in programs established with funds provided under this section.
(f) Program development 

(1) The Secretary of the Interior, acting through the Bureau of Indian Affairs and in cooperation with the Secretary, shall develop a comprehensive school health education program for children from preschool through grade 12 in schools operated by the Bureau of Indian Affairs.
(2) Such program shall include
(A) school programs on nutrition education, personal health, and fitness;
(B) mental health wellness programs;
(C) chronic disease prevention programs;
(D) substance abuse prevention programs;
(E) accident prevention and safety education programs; and
(F) activities for the prevention and control of communicable diseases.
(3) The Secretary of the Interior shall
(A) provide training to teachers in comprehensive school health education curricula;
(B) ensure the integration and coordination of school-based programs with existing services and health programs available in the community; and
(C) encourage healthy, tobacco-free school environments.
(g) Authorization of 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.

25 USC 1621o - Indian youth grant program

(a) Grants 
The Secretary, acting through the Service, is authorized to make grants to Indian tribes, tribal organizations, and urban Indian organizations for innovative mental and physical disease prevention and health promotion and treatment programs for Indian preadolescent and adolescent youths.
(b) Use of funds 

(1) Funds made available under this section may be used to
(A) develop prevention and treatment programs for Indian youth which promote mental and physical health and incorporate cultural values, community and family involvement, and traditional healers; and
(B) develop and provide community training and education.
(2) Funds made available under this section may not be used to provide services described in section 1621h (m) of this title.
(c) Models for delivery of comprehensive health care services 
The Secretary shall
(1) disseminate to Indian tribes information regarding models for the delivery of comprehensive health care services to Indian and urban Indian adolescents;
(2) encourage the implementation of such models; and
(3) at the request of an Indian tribe, provide technical assistance in the implementation of such models.
(d) Criteria for review and approval of applications 
The Secretary shall establish criteria for the review and approval of applications under this section.
(e) Authorization of appropriations 
There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 1993 and such sums as may be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.

25 USC 1621p - American Indians Into Psychology Program

(a) Grants 
The Secretary may provide grants to at least 3 colleges and universities for the purpose of developing and maintaining American Indian psychology career recruitment programs as a means of encouraging Indians to enter the mental health field.
(b) Quentin N. Burdick American Indians Into Psychology Program 
The Secretary shall provide one of the grants authorized under subsection (a) of this section to develop and maintain a program at the University of North Dakota to be known as the Quentin N. Burdick American Indians Into Psychology Program. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs authorized under section 1616g (b) of this title, the Quentin N. Burdick American Indians Into Nursing Program authorized under section 1616e (e) of this title, and existing university research and communications networks.
(c) Issuance of regulations 

(1) The Secretary shall issue regulations for the competitive awarding of the grants provided under this section.
(2) Applicants for grants under this section shall agree to provide a program which, at a minimum
(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations that will be served by the program;
(B) incorporates a program advisory board comprised of representatives from the tribes and communities that will be served by the program;
(C) provides summer enrichment programs to expose Indian students to the varied fields of psychology through research, clinical, and experiential activities;
(D) provides stipends to undergraduate and graduate students to pursue a career in psychology;
(E) develops affiliation agreements with tribal community colleges, the Service, university affiliated programs, and other appropriate entities to enhance the education of Indian students;
(F) to the maximum extent feasible, utilizes existing university tutoring, counseling and student support services; and
(G) to the maximum extent feasible, employs qualified Indians in the program.
(d) Active duty service obligation 
The active duty service obligation prescribed under section 254m of title 42 shall be met by each graduate student who receives a stipend described in subsection (c)(2)(D) of this section that is funded by a grant provided under this section. Such obligation shall be met by service
(1) in the Indian Health Service;
(2) in a program conducted under a contract entered into under the Indian Self-Determination Act [25 U.S.C. 450f et seq.];
(3) in a program assisted under subchapter IV of this chapter; or
(4) in the private practice of psychology if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians.

25 USC 1621q - Prevention, control, and elimination of tuberculosis

(a) Grants 
The Secretary, acting through the Service after consultation with the Centers for Disease Control, may make grants to Indian tribes and tribal organizations for
(1) projects for the prevention, control, and elimination of tuberculosis;
(2) public information and education programs for the prevention, control, and elimination of tuberculosis; and
(3) education, training, and clinical skills improvement activities in the prevention, control, and elimination of tuberculosis for health professionals, including allied health professionals.
(b) Application for grant 
The Secretary may make a grant under subsection (a) of this section only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains the assurances required by subsection (c) of this section and such other agreements, assurances, and information as the Secretary may require.
(c) Eligibility for grant 
To be eligible for a grant under subsection (a) of this section, an applicant must provide assurances satisfactory to the Secretary that
(1) the applicant will coordinate its activities for the prevention, control, and elimination of tuberculosis with activities of the Centers for Disease Control, and State and local health agencies; and
(2) the applicant will submit to the Secretary an annual report on its activities for the prevention, control, and elimination of tuberculosis.
(d) Duties of Secretary 
In carrying out this section, the Secretary
(1) shall establish criteria for the review and approval of applications for grants under subsection (a) of this section, including requirement of public health qualifications of applicants;
(2) shall, subject to available appropriations, make at least one grant under subsection (a) of this section within each area office;
(3) may, at the request of an Indian tribe or tribal organization, provide technical assistance; and
(4) shall prepare and submit a report to the Committee on Energy and Commerce and the Committee on Natural Resources of the House and the Committee on Indian Affairs of the Senate not later than February 1, 1994, and biennially thereafter, on the use of funds under this section and on the progress made toward the prevention, control, and elimination of tuberculosis among Indian tribes and tribal organizations.
(e) Reduction of amount of grant 
The Secretary may, at the request of a recipient of a grant under subsection (a) of this section, reduce the amount of such grant by
(1) the fair market value of any supplies or equipment furnished the grant recipient; and
(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee,

when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) of this section is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.

25 USC 1621r - Contract health services payment study

(a) Duty of Secretary 
The Secretary, acting through the Service and in consultation with representatives of Indian tribes and tribal organizations operating contract health care programs under the Indian Self-Determination Act (25 U.S.C. 450f et seq.) or under self-governance compacts, Service personnel, private contract health services providers, the Indian Health Service Fiscal Intermediary, and other appropriate experts, shall conduct a study
(1) to assess and identify administrative barriers that hinder the timely payment for services delivered by private contract health services providers to individual Indians by the Service and the Indian Health Service Fiscal Intermediary;
(2) to assess and identify the impact of such delayed payments upon the personal credit histories of individual Indians who have been treated by such providers; and
(3) to determine the most efficient and effective means of improving the Services contract health services payment system and ensuring the development of appropriate consumer protection policies to protect individual Indians who receive authorized services from private contract health services providers from billing and collection practices, including the development of materials and programs explaining patients rights and responsibilities.
(b) Functions of study 
The study required by subsection (a) of this section shall
(1) assess the impact of the existing contract health services regulations and policies upon the ability of the Service and the Indian Health Service Fiscal Intermediary to process, on a timely and efficient basis, the payment of bills submitted by private contract health services providers;
(2) assess the financial and any other burdens imposed upon individual Indians and private contract health services providers by delayed payments;
(3) survey the policies and practices of collection agencies used by contract health services providers to collect payments for services rendered to individual Indians;
(4) identify appropriate changes in Federal policies, administrative procedures, and regulations, to eliminate the problems experienced by private contract health services providers and individual Indians as a result of delayed payments; and
(5) compare the Services payment processing requirements with private insurance claims processing requirements to evaluate the systemic differences or similarities employed by the Service and private insurers.
(c) Report to Congress 
Not later than 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report that includes
(1) a detailed description of the study conducted pursuant to this section; and
(2) a discussion of the findings and conclusions of such study.

25 USC 1621s - Prompt action on payment of claims

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

25 USC 1621t - Demonstration of electronic claims processing

(a) Not later than June 15, 1993, the Secretary shall develop and implement, directly or by contract, 2 projects to demonstrate in a pilot setting the use of claims processing technology to improve the accuracy and timeliness of the billing for, and payment of, contract health services.
(b) The Secretary shall conduct one of the projects authorized in subsection (a) of this section in the Service area served by the area office located in Phoenix, Arizona.

25 USC 1621u - Liability for payment

(a) A patient who receives contract health care services that are authorized by the Service shall not be liable for the payment of any charges or costs associated with the provision of such services.
(b) The Secretary shall notify a contract care provider and any patient who receives contract health care services authorized by the Service that such patient is not liable for the payment of any charges or costs associated with the provision of such services.

25 USC 1621v - Office of Indian Womens Health Care

There is established within the Service an Office of Indian Womens Health Care to oversee efforts of the Service to monitor and improve the quality of health care for Indian women of all ages through the planning and delivery of programs administered by the Service, in order to improve and enhance the treatment models of care for Indian women.

25 USC 1621w - Authorization of appropriations

Except as provided in sections 1621h (m), 1621j, 1621l, 1621m (b)(5), 1621n, and 1621o of this title, there are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this subchapter.

25 USC 1621x - Limitation on use of funds

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

25 USC 1622 - Transferred