Free Response to Motion [Dispositive] - District Court of Federal Claims - federal

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90 STAT. 1400

PUBLIC LAW 94-437-SEPT.

30. 1976

Public Law 94-437 94th Congress An Act
S e ~ t 309 -

1976

[s. 5221

To implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum pai-ticipation of Indians in such programs, and for other purposes.

Indian Health Care Improvement

Be i t enacted b y the Sena.te und Home of IZeprese?~tati,ues the of United States of America in Congress assembled, That this Act may be cited as the "Indian Health Care Improvement Act".
FINDINGS

Aci 25 USC 1601
note.

25 USC 1601.

(a) Federal health services to maintnin and improve the health of the Indians are consonant with and required by the Federal Government's historical and unique legal relationship with, and resulting responsibility to, the American Indian people. (b) A major national goal of the United States is to provide the quantity and quality of health services which will permit the health status of Indians to be raised to the highest possible level and to encourage the maximum participation of Indians in the planning and management of those services. (c) FederaI health services to Indians have resulted in a reduction in the prevalence and incidence of preventabIe illnesses among, and unnecessary and premature deaths of, Indians. (d) Despite such services, the unmet health needs of the American Indian people are severe and the health status of the Indians is far below that of the general population of the United States. For example, for Indians compared to all Americans in 1971, the tuberculosis death rate was over four and one-half times greater, the influenza and pneumonia death rate over one and one-half times greater, and the infant death rate a p roximatel y 20 per centum greater. (e) All ot er Federal services and programs in fulfillment of the Federal responsibility to Indians are jeopardized by the low health status of the American Indian people. ( f ) Further improvement in Indian health is imperiled by(1) inadequate, outdated, inefficient, and undermanned facilities. F o r example, only twenty-four of fifty-one Indian Health Service hospitals are accredited by the Joint Commission on Accreditation of Hospitals ;only thirty-one meet national fire and safety codes; and fifty-two locations with Indian populations have been identified as requiring either new or replacement heaIth centers and stations, or clinics remodeled for improved or additional service ; (2) shortage of personnel. For example, about one-half of the Service hospitals, four-fifths of the Service hospital oi~tputient clinics, and one-half of the Service health clinics meet only 80 per centum of staffing standards for their respective services; (3) insufficient services in such areas as laboratory, hospital inpatient and outpatient, eye care and mental health services, and services available through contracts with private physicians, clinics, and agencies. For example, about 90 per centurn of the surgical operations needed for otitis media have not been performed, over 57 per centum of required dental services remain to be provided, and about 95 per centum of hearing aid requirements are unmet ; (4) related support factors. For example, over seven hundred housing units are needed for staff a t remote Service facilities;

SEC. The Congress finds that2.

E

EXHIBIT 33
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PUBLIC LAW 94-437-SEPT.

30, 1976

90 STAT. 14-01

(5) lack of access of Indians to health services due to remote residences, undeveloped or underdeveloped communication and transportation systems, and difficult, sometimes severe, climate conditions; and (6) lack of safe water and sanitary waste disposal services. For example, over thirty-seven thousand four hundred existing and forty-eight thousand nine hundred and sixty planned replacement and renovated Indian housing units need new or upgraded water and sanitation facilities. (g) The Indian people's growth of confidence in Federal Indian health services is revealed by their. increasingly heavy use of such services. Progress toward the goal of better Indian health is dependent on this continued growth of confidence. Both such progress and such confidence are dependent on improved Federal Indian health services.
UE~;LAKX'~'~VN UF k'UL1C;i

SEC. 3. The Congress hereby declares that it is the policy of this 25 USC 1602. Nation, i fulfillment of its special responsibilities and legal obligan tion to the American Indian people, to meet the national goal of providing the highest possible health status to Indians and to provide existing Indian health services with all resources necessary to effect that policy.
DEFINITIONS

SEC. For purposes of this Act4.

25 USC 1603.

(a) "Secretary", u~lless otherwise designated, means the Secretary of Health, Education, and Welfare. (b) "Service" means the Indian Health Service. (c) "Indians" or "Indian", unless otherwise designated, means any person who is a member of an Indian tribe, as defined in subsection (d) hereof, except that, for the purpose of sections 102, 103, and 201 (c) (5),such terms shall mean any individual who (1) ,irrespective of whether he or she lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, in the first or second degree, of any such member, or (2) is an Eskimo or AIeut or other Alaska Native, or (3) is considered by the Secretary of the Interior to be an Indian for any purpose, or (4) is determined to be an Indian under regulations promulgated by the Secretary. (d) "Indian tribe" means any Indian tribe, band, nation, or other organized group or community, including any ,4laska Native village or group or regional or village corporation as defined in or established pursuant to the -4laska Native Claims Settlement Act (85 Stat. 688), 43 USC 1601 which is recognized as eligible for the special programs and services noteprovided by the United States to Indians because of their status as Indians. (e) "Tribal organization" means the elected g?verning body of any Indian tribe or any legally established organization of Tndl.ans which is controlled by one or more snch bodies or by n board of directors elected or selected by one or more such bodies (or elected by the Indian population to be served by such qrganization) and which includes the maximum ~articivationof Indians in all phases of its activities. ( f ) "Urban Indian" means any individual who resides in an urban center, as defined in subsection (g) hereof, and who m e s one or more et
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90 STAT. 1402

PUBLIC LAW 94-437-SEPT.

30, 1976

of the four criteria in subsection (c) (1) through (4) of this section. (g) "Urban center" means any community which has a sufficient urban Indian population with unmet health needs to warrant assistance under title V, as determined by the Secretary. (h) lLUrbanIndian organization" means a nonprofit corporate body situated in an urban center, composed of urban Indians, and providing for the maximum participation of all interested Indian groups aitd individuals, which body is capable of legally cooperating with other public and private entities for the plirpose of performing the activities 03a. described in section 5 ' ( ) 'I'ITLE I-INDI-4N

HEALTH MANPOWER
PURPOSE

~ E C .i U i . 'The purpose of t-his titie is to augment the inadequate number of health professionals serving Indians and remove the multiple barriers to the entrance of health professionals into the Service and private practice amollg Indians.
HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR I N D I A N S

Grants. 25 USC 1612.

Application, submittal and approval.

Amount and payment. Appropriation authorization.

SEC. 102. (a) Tlte Secretary, acting through the Service, shall make grants to public or nonprofit private health or educational entities or Indian tribes or tribal organizations to assist such entities in meeting the costs of(1) identifying Indians with a potential for edrtcation or training in the health professio~ls and encouraging and assisting them ( A ) to enroll in schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, pharmacy, public health, nursing, or allied health professions; or (B), if they are not qualified to enroll i n m y such school, to undertake such postsecondary education or training as may be required to qualify them for enrollment ; (2) publicizing existing sources of financial aid available to Indians enrolled in any school referred to in clause (1) (A) of this subsection or who are undertaking training necessary to qualify then1 to enroll in any such school ; or ( 3 ) establishing other programs which the Secretary determines will enhance and facilitate the enrollment of Indians, and the subsequent pursuit and completion by them of courses of study, in any school referred to in clause (1) ( A ) of this subsection. (b) (1) No grarnt may be made under this section unless an application therefor has been submitted to, and approved by, the Secretary. Such application shall be in sltch form, submitted in such manner, and contain such information, as the Secretary shall by r e ~ l a t i o nprescribe: P~ovided,That the Secretary shall give a preference to applications submitted by Indian tribes or tribal organizations. (2) The amount of any grant u~lder this section shall be determined by the Secretary. Payments pursuant to grants under this section may be made in advance or by way of reimbursement, and at such intervals s and on such conditions a the Secretary finds necessary. (c) For the purpose of making payments pursuant to grants under this section, there are authorized to be appropriated $900,000 for fiscal year 1978, $1,500,000 for fiscal year 1979, and $1,800,000 for fiscal year 1980. For fiscal years 1981, 198.2, 1983, and 1984 there are authorized to be appropriated for such payments such sums as may be specifically authorized by an Act enacted after this Act.

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PUBLIC LAW 94-437-SEPT.

30,1976

90 STAT. 1403

HEALTH I'ROWSSIONS PREPARATORY SCHOLARSHlP PROGFLXM FOR INDIANS

SEC. 103. (a) The Secretary, acting through the Scrvice, shall make scholarship grants to Indians who(1) have successfuIIy completed their high school education or high school equivalency; and (2) have demonstrated the capability to successfully complete courses of study in schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, pharmacy, public health, nursing, or allied health professions. (b) Each scholarship grant made under this section shal'l be for a period not to exceed two academic years, which years shall be for compensatory preprofessional education of any grantee. (c) Scholarship gramts made under this section may cover costs of tuition, books, transportation, board, and other necessary related

Scholarship grants, eligibility

; 1 " 5 ~ ~ ~ ~ ~ ~ ' -

Two-year limitation.

------.--GApGllJG3.

(d) There are authorized to be appropriated for the purpose of this Appropriation section: $800.000 for fiscal year 1978, $1,000,000 for fiscal vear 1979, and $1,360,000 for fiscal year 1980. fiscal years 1981,1982; 1983, and 1984 there are authorized to be appropriated for the purpose of this section such sums as may be specifically authorized by an Act enacted after this Act.

or

HEALTH PROFESSIONS SCHOLARSHIP PROGRAM

SEC. 104. Section 225(i) of the Public Health Service Act ( 4 2 U.S.C. 234(i)) is amended (1) by inserting "(1)" after "(i)", and (2) by adding a t the end the following: "(2) (A) I n addition to the suns authorized to be appropriated under paragraph (1) to carry out the Program, there are authorized to be appropriated for the fiscal year ending September 30, 1978, $5,450,000; for the fiscal ye.ar ending September 30, 1979, $6,300,000; for the fiscal year ending Septelnber SO, 1980, $7:200,000; and for fiscal years 1981,1982, 1983, and 1981such sums as may be specifically authorized by an Act enacted after the Indian Health Care Improvement Act, to provide scholarships under the P r o g r m to provide physicia~ls,osteopaths, dentists, veterinarians, nurses, optometrists, podiatrists, pharmacists, public health personnel, and allied health professionals to provide services to Indians. Such scholarships shall be designated Ijidiall Health Scholarships and shall be made in accorcla~~ce this section except as provided in subparagraph (B). wit11 '(R) (i) The Secretary, acting through the Indian Health Service, shall determine t.he individuals who receive the Indian Health Scholarships, shall accord priority to applicants who are Indians, and shall determine the distribution of the scholarships on t-he basis of the relative needs of Indians for additional service in specific health professions. ''(ii) The active duty service obligation prescribed by subsection (e) shall be mct by the recipient of an Indian Health Schola-rship by servlce in the Indian Health Service, in a program assisted under title V of the Indian Hea-lth Care Improvement Act. or in the private practice of his profession if, as determined bv the Secretary in accordance with guidelines promulgated by him, 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. " ( C ) For purposes of t.his paragraph, the term 'Indians' has the same meaning given that term by subsection (c) of section 4 of the

Appropriation authorization.

Distribution.

Active duty
senice

obligation.

"Indians."

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90 STAT. 1404
Ante, p- 14.01.

PUBLIC LAW 94437--SEPT. 30, 1976
Indian Health Care Improvement Act and includes individuals described in clauses (1) through (4) of that sub~ection.~~.
INDIAN HULTH SEEVICE EXTERN PROGRAMS

25 USC 1614.

Appropriation authorization.

SEG. (a) Any individual who receives a scholarship grant pur105. suant to section 104 shall be entitled to employment in the Service during any nonacademic period of the year. Periods of employment pursuant to this subsection shall not be counted in determining the fulfillment of the service obligation incurred as a condition of the scholarship grant. (b) Any individual enroIled in a schooI of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatrv, pharmacy, public health, nursing, or allied health professions may be employed by the Service during any nonacademic period of the year. Any such employment shall not exceed one hundred and twenty days during any calendar year. (c) Any employment pursuant to this section shall be made without r e p r d to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the health professio~tin which he or she is engaged in study. Any individual so employed shall receive payment for his or her services comparable to the salary he or she would receive if he or she were employed in the competitive system. Any individual so emplo ed shall not be counted a-gainst any employment ceiling affecting the ervice or the Department of Health, Education, and Welfare. (d) There are authorized to be appropriated for the purpose of this section : $600,000 for fiscal gear 1978, $800,000 for fiscal year 1979, and $1,000,000 for h a 1 year 1980. For fiscal years 1981, 1982, 1983, and 1984 there are authorized to be appropriated for the purpose of this section such sums as may be spec~fically authorized by an Act enacted after this Act.

B

CONTINUING EDUCATION ALLOWANCES

25 USC 1615.

Appropriation authorization.

SEC. 106. (a) In order to encourage physicians, dentists, and other health professionals to join o r continue in the Service and to provide their services in the rural and remote areas where a significant portion of the Indian people resides, the Secretary, acting through the Service, may provide allowances to health professionals employed in the Service to enable them for a period of time each year prescribed by regulation of the Secretary to take leave of their duty stations for professional consultation and refresher training courses. (b) There are authorized to be appropriated for the purpose of this section: $100,000 for fiscal year 1978, $200,000 for fiscal year 1979, and $250,000 for fiscal year 1980. For fscal years 1981, 1982, 1983, and 1984 there are authorized to be appropriated for the purpose of this section such sums as may be specifically authorized by an Act enacted after this Act.
TITLE 11-HEALTH SERVICES

HE.UTH SERVICES

25 USC 1621.

SEC. 201. (a) For the purpose of eliminating backlogs in Indian health care services and to supply known, unmet medical, surgical,

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30, 1976

90 STAT. 14.05

dental, optometrical, and other Indian health needs, the Secretary is authorized to expend, through the Service, over the se~en-fiscal-year period beginning after the date of the enactment of this Act the :tmounts authorized to be appropriated by subsection (c). Funds appropriated p~usliantto this section for each fiscal year shall not be used to otfset or limit the appropriations required by t.he Service under ot.her Federal laws to continue to serve the health needs of Indians dnring and subsequent to such seven-fiscal-year period, but shall be in addition to the le\-el of ~ppropriationsprovided to the Service under this ,4ct and sudi other Federal laws in the preceding fiscal year plus an amount eqnal to the amount required to cover pay increases and employee benefits for personnel employed under this Act and such laws and increases in the costs of serving the health needs of Indians under this Act and such laxs, which incl.eases are caused by inflation. ( 6 ) The Secretary, acting through the Service, is authorized to Employment employ persons to implement the l~rorisions this section during tile during sevenof seven-fiscal-pear period in rrccorda~lcen-it11 the sclledule provided in bl-~ear~eriodsubsection (c). Such positions autllorized each fiscal year pursuant to this sectioil shall not be considered as offsetting or limiting the personnel required by the Service to serve the health needs of Indians during and subsequent to such seven-fiscal-year period bnt shall be in addition to the positions autllorized in the previous fiscal year. amounts and positions are authorized, in accord- Appropriation (c) The f o l l o ~ v i n ~ ance with the provlsiolls of subsections ( a ) and (b), for the specific authorizationpurposes noted : ( 1) Patient care (direct and indirect) : sums and positions as provided in subsection (e) for fiscal year 1978, $8,500,000 and ttvo 11nndr.ed and twenty-fire positions for fiscal year 1979, and $lB.fOO.OC)O and three l~t~nclred positions for fiscal pear 1980. (2) Field health, excluding dental care (direct and indirect) : sums and positions as provided in subsection ( e ) for fiscal year 1978. $3.350,000 and eighty-five positions for fiscal year 1979, and $5,550.000 and one hun'dred and thirteen positions for fiscal year 1980. (3) Dental care (direct and indirect) : sums and positions as provided in subsection ( e ) for fiscal year 1978, $1,500,000 and eighty positions for fiscal year 1979, and $1,500,000 and fifty positions for fiscal year 1980. (1)Jlental Ilealth : (-2) Community mental health services : slims and positions as provided in subsection (e) for fiscal year 19B, $1,300,000 and thirty positions for fiscal year 1979, and $2.000,000 and thirty positions for fiscal year 19S0. ( R ) Inpatient mental health services: sums and positions a s provided in subsection (e) for fiscal vear 1978, $400.000 and fifteen positioils for fiscal year 1979, and $600,000 and fifteen positions for fiscal year 1980. ( C ) Ibfode.l dormitory mental health services: sums and posit.ions as proviclecl in sltbsection (e) for fiscal year 1978. $1,250,000 and fifty positions for fiscal year 1979, and $1,875,000 and fifty positions for fiscal year 1980. (D) Therapeutic and residential treatment centers: sums and positions as provided in subseet.ion ( e ) for fiscal gear 1978, $300,000 and ten ositions for fiscal year 1979, and $400,000 and fire positions for scal year l9S0. (E) Training of tratlitioilal Indian practitioners in mental health: sunls as rovided in subsection (e for fiscal year 1978, ! $150,000 for fisca year 1979, and $200,000 i or fiscal year 1980.

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90 STAT. 14( 36

PUBLIC LAW 94437-SEPT.

30,1976

Ap ropriation auJorization.

(5) Treatment and control of alcoholism among Indians: $4,000,000 for fiscal year 1978, $9,000,000 for fiscal year 1979, and $9,200,000 for fiscal year 1980. (6) Maintenance and repair (direct and indirect) : sums and osit.ions as provided in subsection (e) for fiscal year 1978, 3,000,000 and twenty positions for fiscal year 1979, and $4,000,000 and thirty positions for fiscal-year1980. (7) For fiscal years 1981, 1982, 1983, and 1984 there are authorized to be appropriated for the items referred to in the. preceding paragraphs such surns as may be specifically authori.zed by an Act enacted after this Act. For such fiscal yea*, positions are authorized for such items (other than the items referfed to in paragraphs (4) (E) and (5)) as may be specified in an Act enacted after the date of the enactment of this Act. (2) Tb sctizg $&ez-bL ttLeSB-+Le "!I=!! STSC=A. A l ~ ~ ^"c'l = ' ^ j . s or by contract not fzss than 1 per centuln of the funds appropriated under the authorizations in each of the clauses (1) through (5) of subsection (c) for research in each of the-areas of Indian health care for which such funds are authorized to be appropriated. (e) For fiscal year 1978, the Secretary is authorized to apportion not to exceed a total of $10,025,000 and 425 positions for the programs enumerated in clauses (c) (1) through (4) and (c) (6) of this section.

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TITLE 111-HEALTH

FACILITIES

CONSTRUCTION A N D RENOVATION O F SERVICE FACILITIES

25 USC 1631.

Appropriation authorization.

Consultation.

SEC. 301. (a) The Secretary, acting through the Service, is authorized to expend over the seven-fiscal-year period beginning a f t q the date of the enact.ment of this Act the sums authorized by subsection (b) for the construction and renovation of hospitals, health centers, health stations, and other facilities of the Service. (b) The following amounts are authorized to be appropriated for : purposes of subsection (a) (1) Hospitals: $67,180,000 for fiscal year 1978, $73,256,000 for fiscal year 1979, and $49,742,000 for h e a l year 1980. For fiscal years 1981,1982,1983, and 1984, there are authorized to be appropriated for hospitals such surns as may be specifically authorized by an Act enacted after this Act. (2) Health centers and health stations: $6,960,000 for fiscal year 1978, $6,226,000 for fiscal year 1979, and $3,720,000 for fiscal year 1980. For fiscal years 1981, 1982, 1983, and 1984, khere are authorized to be appropriated for health centers and 11ealth stations such sums as may be specifically authorized by an Act enacted after this Act. (3) Staff housing: $1,242,000 for fiscal year 1978, $21,'i25,000 for fkcal year 1979, and $4,116,000 for fiscal year 1980. For fiscal years 1981,1982,1983, and 1984, there are authorized to be appropriated for staff housing such sums as may be specifically authorized by an Act enacted after this Act. (c) Prior to the expenditure of, or the making of any firm commitment to expend, any funds authorized in subsection (a), the Secretary, acting through the Service shall(1) consult with any Indian tribe to be significantly affected by any such expenditure for the purpose of determining and, wherever practicable, honoring tribal preferences concerning the

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90 STAT. 1407

size, location, type, and other characteristics of any facility on which such expenditure is to be made ; and (2) be assured that, wherever practicable, such facility, not later than one year after its construction or renovation. shall meet the standards of the Joint Committee on Accreditation of Hospitals.
CONSTRUCTIOS WATER OF SAFE
AND SANITARY WASTE DISPOSAL FACILITIES

SEC. (a) During the seven-fiscal-year period beginning after the 25 USC 1632. 302. date of the eilactment of this Act. the Secretary is authorized to expend under section 7 of the Act of August 5, 1954 (42 -U.S.C. 2004a), the sums authorized under subsection (b) to supply unmet needs for safe . water and sanitary waste disposal facilities in existing and new Indian homes and communities. (b) For expenditures of the Secretary authorized by subsection (a) Appropriation for facilities in existing Indian homes and communities .there are authorization. authorized to be appropriated $23,000.000 for fiscal year 1978, $30,000,000 for fiscal pear 1979. and $30,000,000 for fiscal year 1980. For expenditures of the Secretary authorized by subsection (a) for facilities in new -Indian h o m e and communities there are authorized t o be appropriated such sums as map be necessary for 'fiscal gears 1978, 1979, and 1980:For fiscal years 1981;198*2, 1983, and 1984 for expenditures authorized by subsection (a) there are nuthori7nd to be. appropriated such sums as may be specifically authorized in an Act enacted after this Act. (c) Former and currentlg'federally recognized Indian tribes in the New York 1ndian State of New York shall be eligible for assistance under tlris section. tribes, eligibility
for assistance.
PREFEREKCE TO l S D l A N S A N D I N D I A h ' FIRMS

SEC. (a) The Secretary. acting-through the Service, may-utilize 303. the negotiating authority of the Act of dll~ie 1910 (25 U.S.C. 47), 85. to give preference to any Tlidia11 or any enterprise. partllership, corporation. or other tvpe of business organization owned and controlled by an Indian or Indians including fornvr or currently federally recognized Indian tribes ill the State of New York (hereinafter referred to as : n "Indian firm") in the constr~ietion L and renovation of Service facilities pnrsuarit to section 301 anrl in the construction of safe water and sanitary waste disposal facilities pursuant to section 302. Snch preference may be accorded by the Secretary llnless he finds, pursuant to rules and regnlat.ions promulgated bv him. that the project or functiou to be contracted for will not be satisfactory or such project or function cantlot be properly completed or maintained under the proposed contract. The Secretary, in arrivinq at his finding. shall consider mhethcr the Indian or Indian firm mill be deficient with respect to (1) owne~.jhipand control by Indians, (2) equipment. (3) hokkeeping and accounting procedures. (4) s i ~ b s t a ~ ~ t i v e knowledge of the project or function to be contracted for. (5) adequately trained personnel, or (6) other necessary components of contract performance. (b) For the purpose of implementing the provisions of this title, the Secretary shall assure that the rates of pay for personnel engaged in the constrllction or renovation of facilities construct.ed or renovated in whole or ill part by funds made available pursuant to this title are not less than t.he prevailing local wage rates for similar work as determined in accordance with the Act of March 3, 1931 (40 U.S.C. 276a-276a-5, known as the Davis-'Bacon Act).

25 USC 1633.

Construction personnel, pay
rates.

40 USC 276a note.

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PUBLIC LAW 94-437-SEPT.

30, 1976

SOBOBA SANITATION FACILI'ITES

42 USC 2004a.

SEC. 304. The Act of December 17, 1970 (84 Stat. 1465), is hereby amended by adding the following new section 9 a t the end thereof: L L S9. Nothing in this Act shall preclude the Soboba Band of ~~. JIission Indians and the Soboba Indian Reservatio~~ from being provided with sanitation facilities and services under the authority of section 7 of the Act of August 5. 1954 (68 Stat. 6T4), as amended by the Act of July 31,1959 (73 Stat. 267) .".
T I T L E IV-ACCESS

TO H E A L T H SERVICES

ELIGIBILITY O F I K D I A N FIE.\LTII SERVICE FACILITIES UNDER BIEDICSRE PROGRAM

42 USC 13952 1395n. 42 USC 1395x.

~ ~ d ~ 1 4 (~ ) ~ ~ 3 5 - ~ of itie Siicia; it^ 1 ; Fitid1 . ; d ) ~ Act are each amended by striking out LLNo payment" and inserting in lieu thereof "Subject to section 1880, no payment". (b) P a r t C of title XVIII of such Act is amended by adding a t the end thereof the following new section :
(%)
LL

sEz. 40;.

INDI-IN HEALTH SERVICE FACILITIES

Hospital or skilled nursing facility, eligibility for payments. 42 USC 1395qq.

"SEC. 1880. (a) A hospital or skilled nlirsing facility of the Indian Health Service, whether operated by such Service or by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act), shall be eligible for payments under this title, notwithstanding sections 1814(c) and 1835(d), if and for so long as it meets all of the eollditions and reqnirements for such payments which are applicable geilerally to hospitals or skilled nursing facilities (as the case may be) under this title. Ineligible " (b) Sotwithstanding subsection (a), a hospital or skilled nursing hospital or skilled facility of the Indian Health Service which does not meet all of the nursing facility, conditions and requirements of this title which are applicable ensubmittal of plan erally to hospitals or skilled nursing: facilities (as the case may i e ) , for compliance. hut which submits to the Secretary wlthin six months after the date of the enactment of this section an acceptable plan for achieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for payments under this title), without regard to the extent of its actual compliance with such conditions and requirements, during the first 12 months after the month in which such plan is submitted. Fund for "(c) Kotwitl~standing any other provision of this title, payments to improvements. which any hospital or skilled nursing facility of the Indlan Health Serb ice is elititlet1 by leasoil of Lllis section shall be placed in a special fund to be held by the Secretary and used by him (to such extent or in such anlolints as are provided in appropriation Acts) exclusi\rely for the purpose of making any improveme~ltsin the hospitals and skilled nursing facilities of such Service which may be necessary to achieve compliance with the applicable conditions and requirements of this title. The preceding sentence shall cease to appl when the Secretary determines and certifies that substantially all o f t e hospitals and skilled nursing facilities of such Service in the United States are in compliance with such conditions and requirements. "(d) The anllnsl report of the Secretary which is required b;y secPost, p. 1413. tion 701 of the Indian Health Care Improvement Act shall include Post, p. 1410. (along with the matters specified in section 403 of such Act) a detailed

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30, 1976

9 0 STAT. 1409

statement of the status of tlie hospitals and skilled nursing facilities of the Service in terms of their complia.nce with the applicable conditioiis and requirenients of this title and of t.he progress being made by such hospitals and facilities (under plans submitted under subsection ( b ) and otherwise) toward the achievement of such compliance.". (c) Any payments received for services provided to beneficiaries hereunder shall not be considered in determining appropriations for health care and services to Indians. ( d ) Sotliing herein authorizes the ,Secretary to provide services t o an Indian beneficiary witli coverage under title X V I I I of the Social Security Act, as amended, in preference to a n Indian beneficiary without such coverage.
SERVICES PROVIDED TO J f E D I C A I D ELIGIBLE I X D I A N S

42 USC 1395qq note-

Services to an Indian
42 USC 1395qq note. 42 USC 1395.

SEC.P2. j a j Titie XIX of tile .Sociai Security Act is amenued by 4 adding a t the end thereof the following new section:
"ISDIAX

IIE.~LTH SERVICE FACILITIES

L ' S ~ ~ . (a) A facility of tlie Indian Health Service (including Eligibility for 1911. a hospital, intermediate care faci1it.y: or skilled nursing facility), " ~ ~ b u r ~ ~ ~ e n t . whether operated by such Service or by an Indian tribe or t.riba1 orga- 42 USC 1396Jilization (as those terms are defined in section 4 of the Indian Health Care Improvement Act), shall be eligible for reimbursement for Ante, p. 1401medical assistance provided under a State plan if and for so long as it meets all of the conditions and requirements which are applicable general1 to such facilities under this title. ( b) s o t withstanding subsection ( a ) , a facility of the Indian Facilities. Health Service (includin a hospital, intermediate care facility, o r submittal of plan cOm~lianaskilled n ~ ~ r s i n g facilit.7) n%ch does not meet all of the conditions and I3%j requil.ements of this title wlticli are a.pplicable generally to such facil- 42 ity, bnt. which submits to the Secretary within six mont.hs after the "Ote. clate of the enactment of tliis sectioxi an acceptable plan for acl~ieving compliance with such conditions and requirements, shall be deemed to meet such conditions and requirements (and to be eligible for reimbursement under this tit.le): without regard to the extent of its actual compliance with such conditions and requirements, dllring the fix-st twelve months after the month in which such plan is submitted.". (b) The Secretary is authorized to enter into agreements with the 42 USC 1396j appropriate State agency for the ptirpose of reimbursing such agency note. for health cart? and services pr-ovided in Service facilities to I~lclians n-ho are eligible for medical assistaiice under title X I X of tlie Socit~l 42 USC 1396. Security Act, as amended. (c) Notmithstanding any other provision of law, payments to \vhich any facilit? of the Indian Health Service (including a hospital, intermediate care facility, o r skilled nursing facility) is e~ititleclunder n State plan approred under title S I X of the Social Security Act by reason of section 1911 of such -Set. shall be placed in a special fund to Supra be held by the Secretary axid used by him ( t o such extent or in such amounts as are provided in appropriation Acts) exclusively for the purlmse of making any improvements in the facilities of such Service which may be necessary t o %.hieve compliance with the applicable coriditions and 1-equirementsof such title. The preceding sentence shall cease to apply when the Secretary determines and certifies that substantially all of the health facil:ties of such Service in the United States are in compliance mith such conditions and requirements.

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42 USC 1396j note. Federal medical assistance percentage. 42 USC 13%d.

PUBLIC LAW 94437-SEPT.

30, 1976

Ante, p. 14Q1.

(d) Any payments -received for services provided recipients hereunder shall not be considered in determining appropriations for the provision of health care and services to Indians. ( e ) Section 1905(b) of the Social Security Act is amended by inserting at the end thereof the following: "Notwithstanding the first sentence of this section, the Federal medical assistance percentage shall be 100 per centum with respect to amouilts expended as medical assistance for services which are received through an Indian Health Service facility whether operated by the Indian HeaIth Service or by an Indian tribe or tribal organization (as defined in section 4 of the Indian Health Care Improvement Act)

.".

REPORT

25 USC 1671
itole.

42 USC 1395, 1396.

SEC. The Secretary shall include in his annual report required 403. by section 'Tui an accounting on tile anlounc and use of funcis maae available to the Service pursuant to this title as a result of reimbursements through titles XVII'I and X I X of the Social Security Act, as amended.
TITLE V-HEALTH SER.VICES FOR URBAN INDIANS
PURPOSE

25 USC 1651.

SEC. 501. The purpose of this title is to encourage the establishment of programs in urban areas to make health services more accessible to the urban Indian population.
CONTRACTS WITH URBAN INDL4N ORGANIZATIONS

25 USC 1652.

SEC. The Secretary, a.cting through the Service, shall enter into 502. contracts with urban Indian organizations to assist such organizations to establish and administer, in the urban centers in which such organizations are situated, programs which meet the requirements set foi.th in sections 503 and 504.
CONTRaCT ELIGIBILITY

25 USC 1653.

SEC. 503. (a) The Secretary, acting through the Service, shall pIace such conditions as he deems necessary to effect the purpose of this title in any contract which.he makes with any urban Indian organization pursuant to this title. Such conditions shall include, but are not limited to, requirements that the organization successfully undertake the following activities : (1) determine the population of urban Indians which are or could be recipients of health referral or care services; (2) identify all public and private health service resources within the urban center in which the organization is situated which are or may be available to urban 1nha.n~; (3) assist such resources in providing service to such urban Indians ; (4) assist such urban Indians in becoming familiar with and utilizing such resources ; (5) provide basic health education to such urban Indians; (6) establish and implement manpower training programs to accomplish the referral and education tasks set forth in clauses (3) through (5) of this subsection ; (7) identify gaps between unmet health needs of urban Indians and the resources available to meet such needs ;

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90 STAT. 1411

(8) make recommendations to the Secretary and Federal, State, local, and other resource agencies on methods of improving health service progralns to meet the needs of urban Indiruis; and (9) where necessary, provide or contract for health care services to urban Indians. (b) The Secretary, acting through the Service, shall by regulation Urban Indian prescribe the criteria for seleetiilg urban Indian organizations with organhtions. criteriawhich to contract pursuant to this title. Such criteria shall, among other factors, take into consideration : (1) the extent of the unmet health care needs of urban Indians in the urban center involved ; (2) the size of the urban Indian population which is to receive assistance; (3) the relative accessibility wliich such population has to health care services in such urban center; (4) fie extent, if EE-;, to Thichthe zctfv;iies sat gG;.t,4 i;; sii$section (a) mould duclicate any previous or current public or private health services project funded by another source in such urban center ; (5) the appropriateness and likely effectiveness of the activities set forth in subsection (a) in such urban center; (6) the existence of an urban Indian organization capable of performing the activities set forth in subsection (a) and of entering into a contract with the Secretarv pursuant to this title; and (7) the extent of existing or likely future participation in the activities set forth in subsection ( a ) by appropriate health and health-related Federal. 'State, local, and other resource agencies.
A

OTHER CONTRICT REQUIREMENTS

SEC. 504. ( a ) Contracts with urban Indian organizations pursuant to this title shall be in accordance mith all Federal wntracting laws and regulations except that., in the discretion of the Secretary, such contracts may be negotiated without advertising and need not conform to the provisions of the ,4ct of August 24, 1935 (48 Stat. 793); as amended. (b) Payments under any contracts pursuant to this title may be made in advance or by way of reimbursement and in such installments and on such conditions as the Secretary deems necessary to carry out the purposes of this title. (c) Xotwithstanding any provision of law to the contrary, the Secretary may, a t the request or consent of an urban Indian organization, revise or anlend any contract made by him mith such organization pursuant to this title as necessary to carry out the purposes of this title : Provided, however, That rrl~enever urban Indian orgaan nization requests retrocession of the Secretary for any contract entered into pursuant to this title, such retrocession shall become effective upon a date specified by the Secretary not more than one hundred and twenty days from the date of tlie request by the organization or at such later date a s may be mutually agreed to by the Secretary and the organization. (d) I n connection wit!) any contract made pursuant to this title, the Secretary may permit an urban Indian organization to utilize, in carrying out such contract, existing facilities owned by the Federal Government within his jurisdiction under such terms and conditions a s may be agreed upon for their use and maintenance.

25 USC 1654.

4 9 Stat. 793.

4 0 USC 270a. .
270d.

Contract revision or amendment.

Government facilities. use.

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PUBLIC LAW 94437-SEPT.

30,1976

(e) Contracts wit21 urban Indian organizations and regulations adopted pursuant to this title sllall include provisions to assure the fair and uniform provision to urban Indians of services and assistance rrnder such contracts by such organizations.
REPORTS AND RECORDS

Report to Secretary of the Interior. 25 USC 1655.

Audit.

SEC. For each fiscal year during which an urban Indian or a505. nization receives or expends funds pursuant to a contract under t is title, sudl organization shall submit to the Secretaiy a report including information gathered pursuant. to section 503(a) (7) and (8), information on activities conducted by the organization pursuant to the mntract, an ac.countingof the amounts and purposes for which Federal funds mere expended, and such other information as the Secretary may request. The reports and records of the urban Indian organization with respect to sucli contract shall be subject to m~dit. t.he Ser.reta~y hy and the Comptroller General of the United States.

%

AUTHORIZATIONS

25 USC 1656.

SEC. 506. There are authorized to be appropriated for the purpose of this title : $5,000,000 for fiscaI year 1978, $10,000;000 for fiscal year 1979, and $15,000,000 for fiscal year 1980.
REVIEW O F PROGEMM

Submittal to Congress. Legislative recommendations. 2 5 USC 1657.

SEC. 507. Within six months after the end of fiscal year 1979, the Secretary, acting through the Service and with the assistance of the urban Indian organizations which have entered into contracts pursuant to this title, shall review the pro-oram established under this title and submit to the Congress his assessment thereof and recommendations for any fnrther Iegslative efforts he deems necessary to meet the purpose of this title.
RURAL HE4LTH PROJECTS

2 5 USC 1658.

SEC.508. Not to exceed 1 per centum of the amounts authorized by section 506 shall be available for not to exceed two pilot projects providing outreach services to eligible Indians residing in rural comrnunititles near Indian reservat.ions.
TITLE VI-AMERICAX
INDIAN SCHOOL OF MEDICINE; FEASIBILITY STUDY
FEASIBILITY STUDY

25 USC 1661.
Report to Congress.

SEC.601. The Secretary, in consultation with Indian tribes and appropriate Indian or an~zations, shall conduct a study to determine the need for, and the gasibility of, establishing a school of medicine to train Indians to provide health services for Ind~ians.Within one year of the date of the enactment of this Act the Secretary shall complete such study and shall re ort to the Congress findings and recommendations based on such stu y.

s

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90 STAT. 1413

T I T L E VII-J.lISCELLA4PIU'EOUS
REPORTS

SEC.701. The Secretary shall report annually to the President and the Congress on progress made in effecting the purposes of this Act. Within three months after the end of fiscal year 19i9, the Secretary sliall review expenditures and progress made under this Act and make recommendations to the Congress concerning any additional authorizations for fiscal years 1981tllrough 1984 for programs authorized under this Act \vhich he deems appropriate. I n the event the Congress enacts legislation authorizing appropriations for programs under this Act for fiscal years 1981 through 1964, within three months after the end of fiscal year 1883, the Secretary shall review programs established or assisted pursuaiit to this Act and shall subnlit to the Congress his ass~.s3ment. n r e r n n n n e r ? ~ . n t i ~.rar)_iticrnn! ~ d nf ~ ~ ~ prcg2rr.s z r zddi+icnc! assistance necessary to, at n, minimurn, provlde health services to Indians, and i1)wu.e a health status for Indians, which are at a parity wit.h the health services avnilable. to, and the health status, of the general population.
REGOL%1?OKS

Repori to the President and

Program review, submittal to Con~ess-

SEC. 702. (it) (1) Within six 1~011th~ the date of enactment of from this Act, the Secretary shall, to the extent practicable, consult with national and regional Indian ol.ganizations to consider and formulate appropriate rules and regulations to implement the provisions of this Act. (2) Within eight months from the date of enactment of this Act, the Secretary shall publish proposed rules and regulations in the Federa1 Register for the purpose of receiving comments from interested parties. (3) Within ten months from the date of enactment of this ,4ct, the Secretary shall promulgate rules and regulations to implement the provisions of this Act. (b) The Secretary is authorized to revise and amend any rules or regulations promulgated pursuant to this Act: Provided, That, prior to any revision of or amendment to such rules or regulations, the Secretary shall, to the extent practicable, consult with appropriate national or regional Indian organizations and shall publish any proposed revision or amendment in the Federal Register not less than sixty days prior to the effective date of such revision or amendment in order to provide adequate notice to, and receive comments from, other interested parties.
PLAN O F IMPLEMEXTATION

Consultation.

25

1672

Publication in Federal Register.

Rules or re'egulations proposed revision

~

Federal Register.

~

~

i

?

~

~

~

SEC. Within two hundred and forty days after enactment of Submittal to '703. this Act, a plan will be prepared by the Secretary and will be sub- Congress. mitted to the Congress. The plan will explain the manner and schedule 25 USC 1673(including a schedule of appropriation requests), title and section, by which the Secretary will implement the prov~sionsof this Act.

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90 STAT. 1414
2 5 USC 1674.

PUBLIC LAW 94437-SEPT.

30, 1976

LEASE6 WITH INDIAN TRIBE8

SEC. Notwithstanding any other provision of law, .the Secretary 704. is authorized, in carrying out the purposes of this Act, t o enter illto leases with Indian tribes for periods not in excess of twenty years.

2 5 USC 1675.

SEC. The funds appropriated pursuant to this Act shall remain 705. available until expended.
Approved September 30, 1976.

LEGISLATIVE -

HISTORY:

HOUSE REPORTS: No. 94-1026 pt. 1 and 94-1026 part IV (Comm. on Interior and Insular Affairs), No. 94-1026 pt. II (Comm. on Ways and Means), and No. 94-1026 pt. I11 (Comm. on Interstate and Foreign Commerce) all accompanying H.R. 2525. SENATE REPORT No. 94-133 (Comm. on Interior and Insular Affairs). CONGRESSIONAL RECORD: Vol. 1 2 1 (1975): May L6, considered and passed Senate. Vol. 122 (1976): July 30, considered and passed House, amended, in lieu of H.R. 2525. S e p t 9, Senate concurred in House amendment with an amendment. Sept. 16, House concurred in Senate amendment. WEEKLY COMPILATION O F PRESlDENTIAL DOCUMENTS: Vol. 12, No. 40: Oct. 1, Presidential statement.

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