TITLE 25 - US CODE - SUBCHAPTER III - HEALTH FACILITIES

25 USC 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, the Secretary, acting through the Service, shall
(1) consult with any Indian tribe 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 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 


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(1) Notwithstanding any provision of law other than this subsection, no Service hospital or outpatient health care facility of the Service, or any portion of such a hospital or facility, may be closed if the Secretary 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;
(E) the views of the Indian tribes served by such hospital or facility concerning such closure;
(F) the level of utilization of such hospital or facility by all eligible Indians; and
(G) the distance between such hospital or facility and the nearest operating Service hospital.
(2) Paragraph (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) Annual report on health facility priority system 


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(1) The Secretary 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 which sets forth
(A) the current health facility priority system of the Service,
(B) the planning, design, construction, and renovation needs for the 10 top-priority inpatient care facilities and the 10 top-priority ambulatory care facilities (together with required staff quarters),
(C) the justification for such order of priority,
(D) the projected cost of such projects, and
(E) the methodology adopted by the Service in establishing priorities under its health facility priority system.
(2) In preparing each report required under paragraph (1) (other than the initial report), the Secretary shall
(A) consult with Indian tribes and tribal organizations including those tribes or tribal organizations operating health programs or facilities under any contract entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.], and
(B) review the needs of such tribes and tribal organizations for inpatient and outpatient facilities, including their needs for renovation and expansion of existing facilities.
(3) For purposes of this subsection, the Secretary shall, in evaluating the needs of facilities operated under any contract entered into with the Service under the Indian Self-Determination Act, use the same criteria that the Secretary uses in evaluating the needs of facilities operated directly by the Service.
(4) The Secretary shall ensure that the planning, design, construction, and renovation needs of Service and non-Service facilities which are the subject of a contract for health services entered into with the Service under the Indian Self-Determination Act are fully and equitably integrated into the development of the health facility priority system.
(d) Funds appropriated subject to section 450f of this title 
All funds appropriated under section 13 of this title for the planning, design, construction, or renovation of health facilities for the benefit of an Indian tribe or tribes shall be subject to the provisions of section 102 of the Indian Self-Determination Act [25 U.S.C. 450f].

25 USC 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 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 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 communities and Indian 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) of this section, Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services as provided in section 2004a of title 42.
(2) The Secretary, acting through the Service, is authorized to provide under section 2004a of title 42
(A) financial and technical assistance to Indian tribes and communities in the establishment, training, and equipping of utility organizations to operate and maintain Indian 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 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, et seq.) to the Secretary of Health and Human Services, and
(B) the Secretary of Health and Human Services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for Indians under section 2004a of title 42.
(c) 10-year plan 
Beginning in fiscal year 1990, the Secretary, acting through the Service, 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 homes and communities and to new and renovated Indian homes.
(d) Tribal capability 
The financial and technical capability of an Indian tribe 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.
(e) Amount of assistance 

(1) The Secretary is authorized to provide financial assistance to Indian tribes and communities in an amount equal to the Federal share of the costs of operating, managing, and maintaining the facilities provided under the plan described in subsection (c) of this section.
(2) For the purposes of paragraph (1), the term Federal share means 80 percent of the costs described in paragraph (1).
(3) With respect to Indian tribes 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 administered by Indian tribes or tribal organizations under the authority of the Indian Self-Determination Act [25 U.S.C. 450f 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,

on an equal basis with programs that are administered directly by the Service.

(g) Annual report; sanitation deficiency levels 

(1) The Secretary 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 which sets forth
(A) the current Indian sanitation facility priority system of the Service;
(B) the methodology for determining sanitation deficiencies;
(C) the level of sanitation deficiency for each sanitation facilities project of each Indian tribe or community;
(D) the amount of funds necessary to raise all Indian tribes and communities to a level I sanitation deficiency; and
(E) the amount of funds necessary to raise all Indian tribes and communities to zero sanitation deficiency.
(2) In preparing each report required under paragraph (1) (other than the initial report), the Secretary shall consult with Indian tribes and tribal organizations (including those tribes or tribal organizations operating health care programs or facilities under any contract entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.]) to determine the sanitation needs of each tribe.
(3) The methodology used by the Secretary in determining sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian tribes and communities.
(4) For purposes of this subsection, the sanitation deficiency levels for an Indian tribe or community are as follows:
(A) level I is an Indian tribe 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 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 or community for domestic sanitation facilities;
(C) level III is an Indian tribe 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 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 or community that lacks a safe water supply and a sewage disposal system.
(5) For purposes of this subsection, any Indian tribe 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.

25 USC 1633 - Preferences to Indians and Indian firms

(a) Discretionary authority; covered activities 
The Secretary, acting through the Service, may utilize the negotiating authority of section 47 of this title, to give preference to any Indian or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an Indian or Indians including former or currently federally recognized Indian tribes in the State of New York (hereinafter referred to as an Indian firm) in the construction and renovation of Service facilities pursuant to section 1631 of this title and in the construction of safe water and sanitary waste disposal facilities pursuant to section 1632 of this title. Such preference may be accorded by the Secretary unless he finds, pursuant to rules and regulations promulgated by him, that the project 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, in arriving at his finding, shall consider whether the Indian or Indian firm will be deficient with respect to
(1)  ownership and control by Indians,
(2)  equipment,
(3)  bookkeeping and accounting procedures,
(4)  substantive knowledge of the project 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 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, and 3147 of title 40.

25 USC 1634 - Expenditure of non-Service funds for renovation

(a) Authority of Secretary 

(1) Notwithstanding any other provision of law, the Secretary is authorized to accept any major renovation or modernization by any Indian tribe of any Service facility, or of any other Indian health facility operated pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 450f 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) of this section are met.

(2) The Secretary shall maintain a separate priority list to address the needs of such facilities for personnel or equipment.
(3) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, the priority list maintained pursuant to paragraph (2).
(b) Requirements 
The requirements of this subsection are met with respect to any renovation or modernization if
(1) the tribe or tribal organization
(A) provides notice to the Secretary of its intent to renovate or modernize; and
(B) applies to the Secretary to be placed on a separate priority list 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 of the Service; and
(B) is administered by the tribe in accordance with the rules and regulations prescribed by the Secretary with respect to construction or renovation of Service facilities.
(c) Recovery for non-use as Service facility 
If any Service facility which has been renovated or modernized by an Indian tribe under this section ceases to be used as a Service facility during the 20-year period beginning on the date such renovation or modernization is completed, such Indian tribe 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 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.

25 USC 1635 - Repealed. Pub. L. 100713, title III, 303(b), Nov. 23, 1988, 102 Stat. 4817

Section, Pub. L. 98–473, title I, § 101(c) [title II, 201], Oct. 12, 1984, 98 Stat. 1837, 1865, related to renovation and modernization of facilities.

25 USC 1636 - Grant program for construction, expansion, and modernization of small ambulatory care facilities

(a) Authorization 

(1) The Secretary, acting through the Service, shall make grants to tribes and tribal organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons as provided in subsection (c)(1)(C) of this section). 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) may only be made to a tribe or tribal organization operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to a tribe or tribal organization) pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 450f 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 or section 1637 of this title; and
(C) which, upon completion of such construction, expansion, or modernization will
(i) have a total capacity appropriate to its projected service population;
(ii) serve no less than 500 eligible Indians annually; and
(iii) provide ambulatory care in a service area (specified in the contract entered into under the Indian Self-Determination Act [25 U.S.C. 450f et seq.]) with a population of not less than 2,000 eligible Indians.
(2) The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to a tribe or tribal organization applying for a grant under this section whose tribal government offices 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. An application for a grant under this section shall be submitted in such form and manner as the Secretary shall by regulation prescribe and shall set forth reasonable assurance by the applicant that, at all times after the construction, 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 at such facility;
(B) such facility will be available to eligible Indians 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 provided to eligible Indians, serve noneligible persons on a cost basis.
(2) In awarding grants under this section, the Secretary shall give priority to tribes and tribal organizations that demonstrate
(A) a need for increased ambulatory care services; and
(B) insufficient capacity to deliver such services.
(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 to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States.

25 USC 1637 - Indian health care delivery demonstration project

(a) Health care delivery demonstration projects 
The Secretary, acting through the Service, is authorized to enter into contracts with, or make grants to, Indian tribes or tribal organizations for the purpose of carrying out a health care delivery demonstration project to test alternative means of delivering health care and services through health facilities to Indians.
(b) Use of funds 
The Secretary, in approving projects pursuant to this section, may authorize funding for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services and is authorized to
(1) waive any leasing prohibition;
(2) permit carryover of funds appropriated for the provision of health care services;
(3) permit the use of non-Service Federal funds and non-Federal funds;
(4) permit the use of funds or property donated from any source for project purposes; and
(5) provide for the reversion of donated real or personal property to the donor.
(c) Criteria 

(1) Within 180 days after November 28, 1990, the Secretary, after consultation with Indian tribes and tribal organizations, shall develop and publish in the Federal Register criteria for the review and approval of applications submitted under this section. The Secretary may enter into a contract or award a grant under this section for projects which meet the following criteria:
(A) There is a need for a new facility or program or the reorientation of an existing facility or program.
(B) A significant number of Indians, including those with low health status, will be served by the project.
(C) The project has the potential to address the health needs of Indians in an innovative manner.
(D) The project has the potential to deliver services in an efficient and effective manner.
(E) The project is economically viable.
(F) The Indian tribe or tribal organization has the administrative and financial capability to administer the project.
(G) The project is integrated with providers of related health and social services and is coordinated with, and avoids duplication of, existing services.
(2) The Secretary may provide for the establishment of peer review panels, as necessary, to review and evaluate applications and to advise the Secretary regarding such applications using the criteria developed pursuant to paragraph (1).
(3) 
(A) On or before September 30, 1995, the Secretary shall enter into contracts or award grants under this section for a demonstration project in each of the following service units which meets the criteria specified in paragraph (1) and for which a completed application has been received by the Secretary:
(i) Cass Lake, Minnesota.
(ii) Clinton, Oklahoma.
(iii) Harlem, Montana.
(iv) Mescalero, New Mexico.
(v) Owyhee, Nevada.
(vi) Parker, Arizona.
(vii) Schurz, Nevada.
(viii) Winnebago, Nebraska.
(ix) Ft. Yuma, California.
(B) The Secretary may also enter into contracts or award grants under this section taking into consideration applications received under this section from all service areas. The Secretary may not award a greater number of such contracts or grants in one service area than in any other service area until there is an equal number of such contracts or grants awarded with respect to all service areas from which the Secretary receives applications during the application period (as determined by the Secretary) which meet the criteria specified in paragraph (1).
(d) Technical assistance 
The Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with the provisions of this section.
(e) Service to ineligible persons 
The authority to provide services to persons otherwise ineligible for the health care benefits of the Service and the authority to extend hospital privileges in service facilities to non-Service health care practitioners as provided in section 1680c of this title may be included, subject to the terms of such section, in any demonstration project approved pursuant to this section.
(f) Equitable treatment 
For purposes of subsection (c)(1)(A) of this section, the Secretary shall, in evaluating facilities 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 facilities operated directly by the Service.
(g) Equitable integration of facilities 
The Secretary shall ensure that the planning, design, construction, and renovation needs of Service and non-Service facilities which are the subject of a contract for health services entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 450f et seq.], are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section.
(h) Report to Congress 

(1) The Secretary shall submit to the President, for inclusion in the report which is required to be submitted to the Congress under section 1671 of this title for fiscal year 1997, an interim report on the findings and conclusions derived from the demonstration projects established under this section.
(2) The Secretary shall submit to the President, for inclusion in the report which is required to be submitted to the Congress under section 1671 of this title for fiscal year 1999, a final report on the findings and conclusions derived from the demonstration projects established under this section, together with legislative recommendations.

25 USC 1638 - Land transfer

The Bureau of Indian Affairs is authorized to transfer, at no cost, up to 5 acres of land at the Chemawa Indian School, Salem, Oregon, to the Service for the provision of health care services. The land authorized to be transferred by this section is that land adjacent to land under the jurisdiction of the Service and occupied by the Chemawa Indian Health Center.

25 USC 1638a - Authorization of appropriations

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 1638b - Applicability of Buy American requirement

(a) Duty of Secretary 
The Secretary shall ensure that the requirements of the Buy American Act [41 U.S.C. 10a et seq.] apply to all procurements made with funds provided pursuant to the authorization contained in section 1638a of this title.
(b) Report to Congress 
The Secretary shall submit to the Congress a report on the amount of procurements from foreign entities made in fiscal years 1993 and 1994 with funds provided pursuant to the authorization contained in section 1638a of this title. Such report shall separately indicate the dollar value of items procured with such funds for which the Buy American Act [41 U.S.C. 10a et seq.] 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 provided pursuant to the authorization contained in section 1638a of this title, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 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 Departments for the fiscal year ending June 30, 1934, and for other purposes, approved March 3, 1933 (41 U.S.C. 10a et seq.).

25 USC 1638c - Contracts for personal services in Indian Health Service facilities

In fiscal year 1995 and thereafter
(a)  the Secretary may enter into personal services contracts with entities, either individuals or organizations, for the provision of services in facilities owned, operated or constructed under the jurisdiction of the Indian Health Service;
(b)  the Secretary 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 pursuant to these contracts are covered by the Federal Tort Claims Act.

25 USC 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 Health Service facilities will be credited to the appropriations from which the services were furnished and shall be credited to the appropriation when received.