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106 STAT.4526
PUBLIC LAW 102-573-0@r. 29, 1992
Public Law 102-573 102d Congress
Oct. 2 . 1992 9
An Act
To amend the Indian Health Care Improvement Act to authorize appropriations
for Indian health programs, and for other purpoees.
[S. 24811
Indian Health Amendments of 1992. 2 USC 1601 5 note.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1 SHORT TLTLE. . This Act may be cited as the "Indian Health Amendments of 1992". SEC. 2. AMENLMENTS TO INDIAN HEALTH CARE TMPROVEMENT ACT,
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A t a section or other provision is amended or repealed, such c
amendment or repeal shall be considered to be made to that section or other provision of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).
SEC. 3 FINDINGS; P O L I a AND DEFINITIONS. .
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(a) Fwmcs.--Section 2 of the Act (25 U.S.C. 1601) is amended(1) in the matter ereceding paragraph (a), by striking "finds that--" and inserting finds the following:"; (2) in paragraph (dl, by striking out the second sentence; and (3) by striking out paragraphs (el, (0, (g). and (b) DECLARATION P o ~ ~ c ~ . - S e c t i3 of the Act (25 U.S.C. OF on 1602)is amended to read as follows:
"DECLARATION OF HEALTH OBJECTIVES
"SEC. (a) The Congress hereby declares that it is the policy 3. of this Nation, in fulfillment of its special responsibilities and legal obligation to the American Indian people, to assure the highest possible health status for Indians and urban Indians and to provide al resources necessary to effect that policy. l "(b) It is the intent of the Congress that the Nation meet the following health status objectives with respect to Indians and urban Indians by the year 2000: "(1)Reduce coronary heart disease deaths to a level of no more than 100 per 100,000. "(2) Reduce the prevalence of overweight individuals to no more than 30 percent. "(3) Reduce the prevalence of anemia to less than 10 percent among children aged 1through 5. "(4) Reduce the level of cancer deaths to a rate of no more than 130 per 100,000. "(5) Reduce the level of lung cancer deaths to a rate of no more than 42 per 100,000. "(6) Reduce the level of chronic obstructive pulmonary disease related deaths to a rate of no more than 25 per 100,000.
EXHIBIT 36
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PUBLIC LAW 102-573-OCT. 29, 1992
106 STAT. 4527
'Y7) Reduce deaths among men caused by alcohol-related motor vehicle crashes to no more than 44.8 per 100,000. "(8) Reduce cirrhosis deaths to no more than 13 per 100,000. "(9) Reduce drug-related deaths to no more than 3 per 100,000. "(10) Reduce pregnancies among girls aged 17 and younger to no more than 50 per 1,000 adolescents. "(11) Reduce suicide among men to no more than 12.8 per 100,000. ''(12) Reduce by 15 percent the incidence of injurious suicide 7 attempts among adolescents aged 14 through 1 . "(13) Reduce to less than 10 percent the prevalence of mental disorders among children and adolescents. "(14) the j~l_~ii?~~_~ nf &!id fir fi9g!ect te less than 25.2 per 1,000 children under age 18. "(15) Reduce physical abuse directed a t women by male partners to no more than 27 per 1,000 couples. "(16) Increase years of healthy life to a t Ieast 65 years. "(17) Reduce deaths caused by unintentional injuries to no more than 66.1 per 100,000. "(18)Reduce deaths caused by motor vehicle crashes to no more than 39.2 per 100,000. "(19) Among children aged 6 months through 5 years, reduce the prevalence of blood lead levels exceeding 15 ug/dl and reduce to zero the prevalence of blood lead levels exceeding 25 ugldl. "(20) Reduce dental caries (cavities) so that the proportion of children with one or more caries (in permanent or primary teeth) is no more than 45 percent among children aged 6 through 8 and no more than 60 percent among adolescents aged 15. "(21) Reduce untreated dental caries so that the proportion of children with untreated caries (in permanent or primary teeth) is no more than 20 percent among children aged 6 through 8 and no more than 40 percent among adolescents aged 15. "(22) Reduce to no more than 20 percent the proportion of individuals aged 65 and older who have lost all of their natural teeth. "(23) Increase to a t Ieast 45 percent the proportion of individuals aged 35 to 44 who have never lost a permanent tooth due to dental caries or periodontal disease. "(24) Reduce destructive periodontal disease to a prevalence of no more than 15 percent among individuals aged 35 to
44.
"(25) Increase to a t least 50 percent the proportion of children who have received protective sealants on the occlusal (chewing) surfaces of permanent molar teeth. "(26) Reduce the prevalence of gingivitis among individuals aged 35 to 44 to no more than 50 percent. "(27) Reduce the infant mortality rate to no more than 8.5 per 1,000 live births. "(28) Reduce the fetal death rate (20 or more weeks of gestation) to no more than 4 per 1,000 live births plus fetal deaths.
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106 STAT. 4528
PUBLIC LAW 102-573-OCT.
29, 1992
"(29) Reduce the maternal mortality rate to no more than 3.3 per 100,000 live births. "(30) Reduce the incidence of fetal alcohol syndrome to no more than 2 per 1,000 live births. "(31)Reduce stroke deaths to no more than 20 per 100,000. "(32) Reverse the increase in end-stage renal disease (requiring maintenance dialysis or transplantation) to attain an incidence of no more than 13 per 100,000. "(33) Reduce breast cancer deaths to no more than 20.6 per 100,000 women. "(34) Reduce deaths from cancer of the uterine cervix to no more than 1.3 per 100,000 women. "(35) Reduce colorectal cancer deaths to no more than 13.2 per 100,000. &% % 1;?_ percent &e - , r ~ p ~ ~ ~ ~ > "[3f;) b . 1 ~ 2Q , of individuals who experience a limitation in major activity due to chronic conditions. "(37) Reduce significant hearing impairment to a prevalence of no more than 82 per 1,000. " 3 )Reduce significant visual impairment to a prevalence (8 of no more than 30 er 1,000. "(39) Reduce Jabetes-related deaths to no more than 48 per 100,000. "(40) Reduce diabetes to an incidence of no more than 2.5 per 1,000 and a prevalence of no more than 62 er 1,000. "(41) Reduce the most severe complications o r diabetes as follows: "(A) End-stage renal disease, 1.9 per 1,000. YB) Blindness, 1.4 per 1,000. "(C) Lower extremity amputation, 4.9 per 1,000. "(D) Perinatal mortality, 2 percent. *(ElMajor congenital malformations, 4 percent. "(42) Confine annual incidence of diagnosed AIDS cases to no more than 1,000 cases. "(43) Confine the prevalence of H N infection to no more than 100 per 100,000. "(44) Reduce gonorrhea t an incidence of no more than o 225 cases per 100,000. "(45) Reduce chlamydia trachomatis infections, as measured by a decrease in the incidence of nongonococcal urethritis to no more than 170 cases per 100,000. "(46) Reduce primary and secondary syphilis to an incidence of no more than 10 cases per 100,000. "(47) Reduce the incidence of pelvic inflammatory disease, as measured by a reduction in hospitalization for pelvic inflammatory disease to no more than 250 per 100,000 women aged 15 through 44. "(48) Reduce viral hepatitis B infection to no more than 40 per 100,000 cases. "(49) Reduce indigenous cases of vaccine-preventable diseases as follows: "(A) Diphtheria among individuals aged 25 and younger, 0. "(B) Tetanus among individuals aged 25 and younger,
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YC) Polio (wild-type virus), 0. "(D) Measles, 0.
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PUBLIC LAW 102-5734)CT. 29, 1992
"(E)Rubella, 0. "(F)Congenital Rubella Syndrome, 0. "(GI Mumps, 500.
106 STAT.4529
" H Pertussis, 1,000. (I "(50) Reduce epidemic-related pneumonia and influenza deaths among inchduals aged 65 and older to no more than 7.3 per 100,000. "(51) Reduce the number of new carriers of viral hepatitis B among Alaska Natives to no more than 1case. "(52) Reduce tuberculosis to a n incidence of no more than 5 cases per 100,000. "(53) Reduce bacterial meningitis to no more than 8 cases per 100,000. "(54) Reduce infectious diarrhea by at least 25 percent among children "(55) Reduce acute middle ear infections among children aged 4 and younger, as measured by days of restricted activity or school absenteeism, to no more than 105 days per 100 children. "(56) Reduce cigarette smoking t o a prevalence of no more than 20 ercent. "(57r Reduce smokeless tobacco use by youth to a prevalence of no more than 10 percent. "(58) Increase to a t least 65 percent the proportion of arents and caregivers who use feeding practices that prevent gaby battle tooth decay. 759) Increase to at least 75 percent the proportion of mothers who breast feed their babies in the early postpartum period, and to at least 50 percent the proportion who continue breast feeding until their babies are 5 to 6 months old. Y60) Increase to at least 90 percent the proportion of pregnant women who receive prenatal care in the first trimester of pregnancy. 761) Increase to a t least 70 percent the proportion of individuals who have received, as a minimum within the appropriate interval, all of the screening and immunization services and a t least one of the counseling services appropriate for their age and gender as recommended by the United States Preventive Services Task Force. Yc) I t is the intent of the Congress that the Nation increase the proportion of all degrees in the health professions and allied and associated health profession fields awarded to Indians to 0.6 percent. "(d) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 801, a report on the progress made in each area of the Service toward meeting each of the objectives described in subsection (b).". (c) D E F I N I T I O N S 4 ~ ~ the Act (25 U.S.C. 1603) is . of ~ ~ ~ ~ ~ amended by adding at the end the following new subsections: "(m) 'Service area7means the geographical area served by each area ofEice. "(n) Wealth profession' means family medicine, internal medicine, pediatrics, geriatric medicine, obstetrics and gynecology, podiatric medicine, nursing, public health nursing, dentistry, psychiatry, osteopathy, optometry, pharmacy, psychology, public health, social work, marriage and family therapy, chiropractic medicine,
Reports.
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106 STAT. 4530
PUBLIC LAW 102-573-OCT.
29, 1992
environmental health and engineering, and allied health professions. "(0) 'Substance abuse' includes inhalant abuse. "(p) 'FAE' means fetal alcohol effect. "(q) 'PAS' means fetal alcohol syndrome.".
TITLE I-INDIAN HEALTH PROFESSIONALS
SEC. 101. PURPOSE.
Section 101 of the Act (25 U.S.C. 1611) is amended to read as follows:
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"SEC.101. The purpose of this title is to increase the number of Indians entering the health professions and to assure an adequate supply of health professionals to the Service, Indian tribes, tribal organizations, and urban Indian organizations involved in the provision of health care t Indian people.". o
SEC. 102. HEALTE PROFESSIONS.
(a) RECRUITMENT PROc~~~.--Section 102(a) of the Act (25 U.S.C. 1612(a))is amended(1)by amending paragraph (1) to read as follows: "(1) identifying Indians with a potential for education or training in the health professions and encouraging and assisting them"(A) to enroll in courses of study in such health professions; or "(B) if they are not qualified to enroll in any such courses of study, to undertake such postsecondary education or training as may be required to qualify them for enrollment;"; (2) in paragraph 2 ( ) (A) by stnlung out "school" both places it appears and inserting in lieu thereof the following: "course of study"; and (B) by striking out "clause (l)(A)" and inserting in lieu thereof the following: "paragraph (1)"; and (3) in paragraph -( 3 ) (A) by striking out "Indians," and inserting in lieu thereof "Indians in,"; (B) by inserting a comma before "courses"; (C) by striking out ",in any school"; and (D) by striking out "clause (l)(A)" and inserting in lieu thereof the following: "paragraph (1)". (b) PREPARATORY SCHOLARSHIP PROGRAEA----S~C~~O~ 103 of the Act (25 U.S.C. 1613) is amended(1) by amending subsection (a)(2) to read as follows: "(2) have demonstrated the capability to successfdy complete courses of study in the health professions."; (2) in subsection (bXl), by inserting before the period at the end the folIowing "on a full-time basis (or the part-time equivalent thereof, as determined by the Secretary)"; (3) by amending subsection (bH2) to read as follows:
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106 STAT. 4544
PUBLIC LAW 102-573--OCT. 29, 1992
"(dl The USDSM shall coordinate the program established pursuant to a grant provided under subsection (a) with other medical schools in the region, nursing schools, tribal community colleges, and other health professional schools. "(el The USDSM, in cooperation with the Service, shall develop additional professional opportunities for program participants on Indian reservations in order to improve the recruitment and retention of qualified health professionals in the Aberdeen Area of the Service.".
SEC. 117. AUTHORIZATION OF APPROPRIATIONS.
(a) AUTHORIZATION.-T~~~~ Act (as amended by section I of the 116 of this Act) is amended by adding a t the end the following new section:
"AUTHORIZATION O F APPROPRIATIONS
25 USC 1616p.
25 USC 1612. 25 USC 1614. 25 USC 1616a. 25 U C 1616~. S 25 USC 1616L 25 USC 1616g.
25 USC 1616h. 25 USC 1616.
"SEC. 123. There are authorized to be appropriated such sums as may be necessary for each fiscal year through fiscal year 2000 to carry out this title.". (b) CONFORMING AMENDMENTS.-T~~~~ Act is amendedI of the (I) in section 102, by striking out subsection (c); (2) in section 105, by striking out subsection (dl; (3)in section 108, by striking out subsection (0); (4) in section 110, by striking out subsection (c); (5) i n section 113, by striking out subsection (c); (6) in section 114, by striking out subsection (e); (7) in section 115, by striking out subsection (0; and (8) in section 116, by striking out subsection (e).
TITLE 11-HEALTH SERVICES
SEC. 201. LNDIAN HEALTH CARE IMPROVEMENT FUND-
(a) ING~m~.A~.---Section of the Act (25 U.S.C. 1621) is 201 amended(I) subsection (atin (A) in the material preceding paragraph (I),by striking out "subsection (h)" and inserting in lieu thereof "this section"; (B) by amending aragraph (1) to read as follows: "(1) eliminating the eficiencies in health status and resources of all Indian tribes,"; and (C) in paragraph (41, in the material preceding subparagraph (At(i) by inserting after "responsibilities" the following: ", either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act,"; and (ii) by striking out "resources deficiency" and "status and inserting in lieu thereof the folloresource deficiencies"; (2) in subsection (bt(A) in paragraph (11, by striking out "subsection (h)" and inserting in lieu thereof "this sectionn; (B) by striking out aragraph (2) and redesignating paragraph (3)as paragrapP, (2); and
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PUBLIC LAW 102-573-Om.
29,1992
106 STAT.4545
( C ) in paragraph (2)(A) (as redesignated by subparagraph ( B I G (i) by striking out "subsection (h)" and inserting in lieu thereof "this section"; (ii) in the first sentence, by striking out "but such allocation" through "meP, (iii)in the second sentence(I) by striking out "(in accordance with paragraph (2))"; and (II) by striking out "raise the deficiency level" and inserting in lieu thereof the following: "reduce the health status and resource deficiency"; and (D) in paragraph (2XB) (as redesignated by subparagraph (B)), by inserting &er "consultation with" the following: ",and with the active participation of.": i3j in subsection ( c j (A) by striking out paragraph (1) and redesignating paragraphs (21, (3), and (4) as paragraphs (11, (2), and (3), respectively; (B) by amending paragraph (1) (as redesignated by subparagraph (A) above) to read as follows: "(1)The term %ealth status and resource deficiency' means the extent to which"(A) the health status objectives set forth in section 3(b) are not being achieved; and "03) 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."; and ( C ) in paragraph (3)(as redesignated by subparagraph (A) above& (i) by striking out "Under regulations, the" and inserting in lieu thereof "The"; and (ii) by striking out "health resources deficiency leveln and inserting in lieu thereof "extent of the health status and resource deficiency"; (4) in subsection (d)(l), by striking out "subsection (h)" and inserting in lieu thereof "this section"; ( 5 ) in subsection ( e t (A) in the material preceding paragraph (1)(i) by striking out "60 days" and inserting in lieu thereof "3 years"; (ii) by striking out Yndian Health Care Amendments of 1988" and inserting in lieu thereof "Indian Health Amendments of 1992"; and (iii) by striking out '%health services priority system" and inserting in lieu thereof "health status and resource deficiency"; (B) in paragraph (I),by striking out "health resources deficiencies" and inserting in Lieu thereof "health status and resource deficiencies"; ( C ) in paragraph (2), by striking out "the level of health resources deficiency for" and inserting in Lieu thereof the following. "the extent of the health status and resource deficiency of'; (D) in paragraph (3), by striking "raise alln and all that follows through the semicolon and insert in lieu thereof
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106 STAT. 4546
PUBLIC LAW 102-573-0@r.
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25 USC 1621 note.
the following: "eliminate the health status and resource l deficiencies of al Indian tribes served by the Service; andn; and (El by striking out paragraphs (4) and (5) and redesignating paragra h (6) as paragrath (4); and (6) in subsection (0, striking out (D(1)" and all that y ! follows through the paragraph designation for paragraph (2) and inserting in lieu thereof "(0". (b) EFFECTIVE ~ ~ ~ . - E x c e pwith respect to the amendments D t made by subsection (a)(5), the amendments made by subsection (a) shall take effect three years after the date of the enactment of this Act. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act. (c) TECHNICAL AMENDMENT.-T~~ heading for section 201 of the Act (25 U.S.C. 1621) is amended to read as follows:
"INDIAN HEALTH CARE IMPROVEMENT FUND".
SEC. 202. CATASTROPHIC aEALTE EMERGENCY FLJND.
25 USC L621a
note.
(a) IN G E N E R A L . - - ~ ~ c ~ ~ o ~ the Act (25 U.S.C. 1621a) 202 of is amended(1) in subsection
Section 203 of the Act (25 U.S.C. 1621b) is amended(1) in subsection (a), by inserting before the period a t the end the following: "so a s to achieve the health status objectives set forth in section 3(b)"; (2) in subsection (b), in the material preceding paragraph (I), by striking out "section 201.(0" and inserting in lieu thereof "section 801"; and (3)by striking out subsection (c).
SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.
Section 204 of the Act (25 U.S.C. 16214 is amended(I)by amending subsection (c) to read a s follows: "(cX1) The Secretary shall continue to maintain through fiscal year 2000 each model diabetes project in existence on the date of the enactment of the Indian Health Amendments of 1992 and located-
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