USC Subchapter VI

in effect

25 U.S.C. § 1671 Reports

The President shall, at the time the budget is submitted under section 1105 of title 31, for each fiscal year transmit to the Congress a report containing— (1) a report on the progress made in meeting the objectives of this chapter, including a review of programs established or assisted pursuant to this chapter and an assessment and recommendations of additional programs or additional assistance necessary to, at a minimum, provide health services to Indians, and ensure a health status for Indians, which are at a parity with the health services available to and the health status of, the general population; (2) a report on whether, and to what extent, new national health care programs, benefits, initiatives, or financing systems have had an impact on the purposes of this chapter and any steps that the Secretary may have taken to consult with Indian tribes to address such impact; (3) a report on the use of health services by Indians—(A) on a national and area or other relevant geographical basis; (B) by gender and age; (C) by source of payment and type of service; and (D) comparing such rates of use with rates of use among comparable non-Indian populations.11 So in original. The period probably should be a semicolon. (4) a separate statement which specifies the amount of funds requested to carry out the provisions of section 1621 of this title; (5) a separate statement of the total amount obligated or expended in the most recently completed fiscal year to achieve each of the objectives described in section 1680d of this title, relating to infant and maternal mortality and fetal alcohol syndrome; (6) the reports required by sections 1602(d),22 See References in Text note below. 1616a(n), 1621b(b), 1621h(j), 1631(c), 1632(g), 1634(a)(3), 1643, 1665g(e),2 and 1680g(a), and 1680l(f) 2 of this title; (7) for fiscal year 1995, the report required by sections 1665a(c)(3) 2 and 1665l(b) 2 of this title; (8) for fiscal year 1997, the interim report required by section 1637(h)(1) 2 of this title; and (9) for fiscal year 1999, the reports required by sections 1637(h)(2),2 1660b(b),2 1665j(f),2 and 1680k(g) 2 of this title.

25 U.S.C. § 1672 Regulations

Prior to any revision of or amendment to rules or regulations promulgated pursuant to this chapter, the Secretary shall consult with Indian tribes and 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.

25 U.S.C. § 1674 Leases with Indian tribes

(a) Notwithstanding any other provision of law, the Secretary is authorized, in carrying out the purposes of this chapter, to enter into leases with Indian tribes for periods not in excess of twenty years. Property leased by the Secretary from an Indian tribe may be reconstructed or renovated by the Secretary pursuant to an agreement with such Indian tribe. (b) The Secretary may enter into leases, contracts, and other legal agreements with Indian tribes or tribal organizations which hold—(1) title to; (2) a leasehold interest in; or (3) a beneficial interest in (where title is held by the United States in trust for the benefit of a tribe); facilities used for the administration and delivery of health services by the Service or by programs operated by Indian tribes or tribal organizations to compensate such Indian tribes or tribal organizations for costs associated with the use of such facilities for such purposes. Such costs include rent, depreciation based on the useful life of the building, principal and interest paid or accrued, operation and maintenance expenses, and other expenses determined by regulation to be allowable.

25 U.S.C. § 1675 Confidentiality of medical quality assurance records; qualified immunity for participants

(a) DefinitionsIn this section:(1) Health care providerThe term “health care provider” means any health care professional, including community health aides and practitioners certified under section 1616l of this title, who is—(A) granted clinical practice privileges or employed to provide health care services at—(i) an Indian health program; or (ii) a health program of an urban Indian organization; and (B) licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization. (2) Medical quality assurance programThe term “medical quality assurance program” means any activity carried out before, on, or after March 23, 2010, by or for any Indian health program or urban Indian organization to assess the quality of medical care, including activities conducted by or on behalf of individuals, Indian health program or urban Indian organization medical or dental treatment review committees, or other review bodies responsible for quality assurance, credentials, infection control, patient safety, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review, and identification and prevention of medical or dental incidents and risks. (3) Medical quality assurance recordThe term “medical quality assurance record” means the proceedings, records, minutes, and reports that—(A) emanate from quality assurance program activities described in paragraph (2); and (B) are produced or compiled by or for an Indian health program or urban Indian organization as part of a medical quality assurance program. (b) Confidentiality of recordsMedical quality assurance records created by or for any Indian health program or a health program of an urban Indian organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection (d). (c) Prohibition on disclosure and testimony(1) In generalNo part of any medical quality assurance record described in subsection (b) may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection (d). (2) TestimonyAn individual who reviews or creates medical quality assurance records for any Indian health program or urban Indian organization who participates in any proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding, recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in this section. (d) Authorized disclosure and testimony(1) In generalSubject to paragraph (2), a medical quality assurance record described in subsection (b) may be disclosed, and an individual referred to in subsection (c) may give testimony in connection with such a record, only as follows:(A) To a Federal agency or private organization, if such medical quality assurance record or testimony is needed by such agency or organization to perform licensing or accreditation functions related to any Indian health program or to a health program of an urban Indian organization to perform monitoring, required by law, of such program or organization. (B) To an administrative or judicial proceeding commenced by a present or former Indian health program or urban Indian organization provider concerning the termination, suspension, or limitation of clinical privileges of such health care provider. (C) To a governmental board or agency or to a professional health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency, society, or organization to perform licensing, credentialing, or the monitoring of professional standards with respect to any health care provider who is or was an employee of any Indian health program or urban Indian organization. (D) To a hospital, medical center, or other institution that provides health care services, if such medical quality assurance record or testimony is needed by such institution to assess the professional qualifications of any health care provider who is or was an employee of any Indian health program or urban Indian organization and who has applied for or been granted authority or employment to provide health care services in or on behalf of such program or organization. (E) To an officer, employee, or contractor of the Indian health program or urban Indian organization that created the records or for which the records were created. If 11 So in original. Probably should be “were created, if”. that officer, employee, or contractor has a need for such record or testimony to perform official duties. (F) To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of the public health or safety, if a qualified representative of such agency or instrumentality makes a written request that such record or testimony be provided for a purpose authorized by law. (G) In an administrative or judicial proceeding commenced by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to the subject of such proceeding. (2) Identity of participantsWith the exception of the subject of a quality assurance action, the identity of any person receiving health care services from any Indian health program or urban Indian organization or the identity of any other person associated with such program or organization for purposes of a medical quality assurance program that is disclosed in a medical quality assurance record described in subsection (b) shall be deleted from that record or document before any disclosure of such record is made outside such program or organization. (e) Disclosure for certain purposes(1) In generalNothing in this section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information regarding the results of any Indian health program or urban Indian organization’s medical quality assurance programs. (2) Withholding from CongressNothing in this section shall be construed as authority to withhold any medical quality assurance record from a committee of either House of Congress, any joint committee of Congress, or the Government Accountability Office if such record pertains to any matter within their respective jurisdictions. (f) Prohibition on disclosure of record or testimonyAn individual or entity having possession of or access to a record or testimony described by this section may not disclose the contents of such record or testimony in any manner or for any purpose except as provided in this section. (g) Exemption from Freedom of Information ActMedical quality assurance records described in subsection (b) may not be made available to any person under section 552 of title 5. (h) Limitation on civil liabilityAn individual who participates in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (b) shall not be civilly liable for such participation or for providing such information if the participation or provision of information was in good faith based on prevailing professional standards at the time the medical quality assurance program activity took place. (i) Application to information in certain other recordsNothing in this section shall be construed as limiting access to the information in a record created and maintained outside a medical quality assurance program, including a patient’s medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical quality assurance program. (j) RegulationsThe Secretary, acting through the Service, shall promulgate regulations pursuant to section 1672 of this title. (k) Continued protectionDisclosure under subsection (d) does not permit redisclosure except to the extent such further disclosure is authorized under subsection (d) or is otherwise authorized to be disclosed under this section. (l) InconsistenciesTo the extent that the protections under part C of title IX of the Public Health Service Act (42 U.S.C. 229b–21 et seq.) [42 U.S.C. 299b–21 et seq.] (as amended by the Patient Safety and Quality Improvement Act of 2005 (Public Law 109–41; 119 Stat. 424)) and this section are inconsistent, the provisions of whichever is more protective shall control. (m) Relationship to other lawThis section shall continue in force and effect, except as otherwise specifically provided in any Federal law enacted after March 23, 2010.

25 U.S.C. § 1676 Limitation on use of funds appropriated to Indian Health Service

(a) HHS appropriationsAny limitation on the use of funds contained in an Act providing appropriations for the Department of Health and Human Services for a period with respect to the performance of abortions shall apply for that period with respect to the performance of abortions using funds contained in an Act providing appropriations for the Indian Health Service. (b) Limitations pursuant to other Federal lawAny limitation pursuant to other Federal laws on the use of Federal funds appropriated to the Service shall apply with respect to the performance or coverage of abortions.

25 U.S.C. § 1677 Nuclear resource development health hazards

(a) StudyThe Secretary and the Service shall conduct, in conjunction with other appropriate Federal agencies and in consultation with concerned Indian tribes and organizations, a study of the health hazards to Indian miners and Indians on or near Indian reservations and in Indian communities as a result of nuclear resource development. Such study shall include—(1) an evaluation of the nature and extent of nuclear resource development related health problems currently exhibited among Indians and the causes of such health problems; (2) an analysis of the potential effect of ongoing and future nuclear resource development on or near Indian reservations and communities; (3) an evaluation of the types and nature of activities, practices, and conditions causing or affecting such health problems, including uranium mining and milling, uranium mine tailing deposits, nuclear powerplant operation and construction, and nuclear waste disposal; (4) a summary of any findings and recommendations provided in Federal and State studies, reports, investigations, and inspections during the five years prior to December 17, 1980, that directly or indirectly relate to the activities, practices, and conditions affecting the health or safety of such Indians; and (5) the efforts that have been made by Federal and State agencies and mining and milling companies to effectively carry out an education program for such Indians regarding the health and safety hazards of such nuclear resource development. (b) Health care plan; developmentUpon completion of such study the Secretary and the Service shall take into account the results of such study and develop a health care plan to address the health problems studied under subsection (a). The plan shall include—(1) methods for diagnosing and treating Indians currently exhibiting such health problems; (2) preventive care for Indians who may be exposed to such health hazards, including the monitoring of the health of individuals who have or may have been exposed to excessive amounts of radiation, or affected by other nuclear development activities that have had or could have a serious impact upon the health of such individuals; and (3) a program of education for Indians who, by reason of their work or geographic proximity to such nuclear development activities, may experience health problems. (c) Reports to CongressThe Secretary and the Service shall submit to Congress the study prepared under subsection (a) no later than the date eighteen months after December 17, 1980. The health care plan prepared under subsection (b) shall be submitted in a report no later than the date one year after the date that the study prepared under subsection (a) is submitted to Congress. Such report shall include recommended activities for the implementation of the plan, as well as an evaluation of any activities previously undertaken by the Service to address such health problems. (d) Intergovernmental Task Force; establishment and functions(1) There is established an Intergovernmental Task Force to be composed of the following individuals (or their designees): the Secretary of Energy, the Administrator of the Environmental Protection Agency, the Director of the United States Bureau of Mines, the Assistant Secretary for Occupational Safety and Health, and the Secretary of the Interior. (2) The Task Force shall identify existing and potential operations related to nuclear resource development that affect or may affect the health of Indians on or near an Indian reservation or in an Indian community and enter into activities to correct existing health hazards and insure that current and future health problems resulting from nuclear resource development activities are minimized or reduced. (3) The Secretary shall be Chairman of the Task Force. The Task Force shall meet at least twice each year. Each member of the Task Force shall furnish necessary assistance to the Task Force. (e) Medical careIn the case of any Indian who—(1) as a result of employment in or near a uranium mine or mill, suffers from a work related illness or condition; (2) is eligible to receive diagnosis and treatment services from a Service facility; and (3) by reason of such Indian’s employment, is entitled to medical care at the expense of such mine or mill operator; the Service shall, at the request of such Indian, render appropriate medical care to such Indian for such illness or condition and may recover the costs of any medical care so rendered to which such Indian is entitled at the expense of such operator from such operator. Nothing in this subsection shall affect the rights of such Indian to recover damages other than such costs paid to the Service from the employer for such illness or condition.

25 U.S.C. § 1678 Arizona as contract health service delivery area

(a) In generalThe State of Arizona shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of Indian tribes in the State of Arizona. (b) Maintenance of servicesThe Service shall not curtail any health care services provided to Indians residing on reservations in the State of Arizona if the curtailment is due to the provision of contract services in that State pursuant to the designation of the State as a contract health service delivery area by subsection (a).

25 U.S.C. § 1678a North Dakota and South Dakota as contract health service delivery area

(a) In generalThe States of North Dakota and South Dakota shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health care services to members of Indian tribes in the States of North Dakota and South Dakota. (b) Maintenance of servicesThe Service shall not curtail any health care services provided to Indians residing on any reservation, or in any county that has a common boundary with any reservation, in the State of North Dakota or South Dakota if the curtailment is due to the provision of contract services in those States pursuant to the designation of the States as a contract health service delivery area by subsection (a).

25 U.S.C. § 1679 Eligibility of California Indians

(a) In generalThe following California Indians shall be eligible for health services provided by the Service:(1) Any member of a federally recognized Indian tribe. (2) Any descendant of an Indian who was residing in California on June 1, 1852, if such descendant—(A) is a member of the Indian community served by a local program of the Service; and (B) is regarded as an Indian by the community in which such descendant lives. (3) Any Indian who holds trust interests in public domain, national forest, or reservation allotments in California. (4) Any Indian of California who is listed on the plans for distribution of the assets of rancherias and reservations located within the State of California under the Act of August 18, 1958 (72 Stat. 619), and any descendant of such an Indian. (b) ClarificationNothing in this section may be construed as expanding the eligibility of California Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986.

25 U.S.C. § 1680 California as a contract health service delivery area

The State of California, excluding the counties of Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura shall be designated as a contract health service delivery area by the Service for the purpose of providing contract health services to Indians in such State.

25 U.S.C. § 1680a Contract health facilities

The Service shall provide funds for health care programs and facilities operated by tribes and tribal organizations under contracts with the Service entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]— (1) for the maintenance and repair of clinics owned or leased by such tribes or tribal organizations, (2) for employee training, (3) for cost-of-living increases for employees, and (4) for any other expenses relating to the provision of health services, on the same basis as such funds are provided to programs and facilities operated directly by the Service.

25 U.S.C. § 1680b National Health Service Corps

(a) No reduction in servicesThe Secretary shall not remove a member of the National Health Service Corps from an Indian health program or urban Indian organization or withdraw funding used to support such a member, unless the Secretary, acting through the Service, has ensured that the Indians receiving services from the member will experience no reduction in services. (b) Treatment of Indian health programsAt the request of an Indian health program, the services of a member of the National Health Service Corps assigned to the Indian health program may be limited to the individuals who are eligible for services from that Indian health program.

25 U.S.C. § 1680c Health services for ineligible persons

(a) ChildrenAny individual who—(1) has not attained 19 years of age; (2) is the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible Indian; and (3) is not otherwise eligible for health services provided by the Service, shall be eligible for all health services provided by the Service on the same basis and subject to the same rules that apply to eligible Indians until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the Service in determining the need for, or the allocation of, the health resources of the Service. If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such services until 1 year after the date of a determination of competency. (b) SpousesAny spouse of an eligible Indian who is not an Indian, or who is of Indian descent but is not otherwise eligible for the health services provided by the Service, shall be eligible for such health services if all such spouses or spouses who are married to members of each Indian tribe being served are made eligible, as a class, by an appropriate resolution of the governing body of the Indian tribe or tribal organization providing such services. The health needs of persons made eligible under this paragraph shall not be taken into consideration by the Service in determining the need for, or allocation of, its health resources. (c) Health facilities providing health services(1) In generalThe Secretary is authorized to provide health services under this subsection through health facilities operated directly by the Service to individuals who reside within the Service unit and who are not otherwise eligible for such health services if—(A) the Indian tribes served by such Service unit requests such provision of health services to such individuals, and (B) the Secretary and the served Indian tribes have jointly determined that the provision of such health services will not result in a denial or diminution of health services to eligible Indians. (2) ISDEAA programsIn the case of health facilities operated under a contract or compact entered into under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),11 See References in Text note below. the governing body of the Indian tribe or tribal organization providing health services under such contract or compact is authorized to determine whether health services should be provided under such contract or compact to individuals who are not eligible for such health services under any other subsection of this section or under any other provision of law. In making such determinations, the governing body of the Indian tribe or tribal organization shall take into account the consideration described in paragraph (1)(B). Any services provided by the Indian tribe or tribal organization pursuant to a determination made under this subparagraph shall be deemed to be provided under the agreement entered into by the Indian tribe or tribal organization under the Indian Self-Determination and Education Assistance Act. The provisions of section 314 of Public Law 101–512 (104 Stat. 1959), as amended by section 308 of Public Law 103–138 (107 Stat. 1416), shall apply to any services provided by the Indian tribe or tribal organization pursuant to a determination made under this subparagraph. (3) Payment for services(A) In generalPersons receiving health services provided by the Service under this subsection shall be liable for payment of such health services under a schedule of charges prescribed by the Secretary which, in the judgment of the Secretary, results in reimbursement in an amount not less than the actual cost of providing the health services. Notwithstanding section 1621f of this title or any other provision of law, amounts collected under this subsection, including Medicare, Medicaid, or children’s health insurance program reimbursements under titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. 1395 et seq., 1396 et seq., 1397aa et seq.], shall be credited to the account of the program providing the service and shall be used for the purposes listed in section 1641(d)(2) of this title and amounts collected under this subsection shall be available for expenditure within such program. (B) Indigent peopleHealth services may be provided by the Secretary through the Service under this subsection to an indigent individual who would not be otherwise eligible for such health services but for the provisions of paragraph (1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the Service for the expenses incurred by the Service in providing such health services to such indigent individual. (4) Revocation of consent for services(A) Single tribe service areaIn the case of a Service Area which serves only 1 Indian tribe, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the Indian tribe revokes its concurrence to the provision of such health services. (B) Multitribal service areaIn the case of a multitribal Service Area, the authority of the Secretary to provide health services under paragraph (1) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of Indian tribes in the Service Area revoke their concurrence to the provisions of such health services. (d) Other servicesThe Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other provision of law in order to—(1) achieve stability in a medical emergency; (2) prevent the spread of a communicable disease or otherwise deal with a public health hazard; (3) provide care to non-Indian women pregnant with an eligible Indian’s child for the duration of the pregnancy through postpartum; or (4) provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual. (e) Hospital privileges for practitioners(1) In generalHospital privileges in health facilities operated and maintained by the Service or operated under a contract or compact pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 1 may be extended to non-Service health care practitioners who provide services to individuals described in subsection (a), (b), (c), or (d). Such non-Service health care practitioners may, as part of the privileging process, be designated as employees of the Federal Government for purposes of section 1346(b) and chapter 171 of title 28 (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing services to eligible individuals as a part of the conditions under which such hospital privileges are extended. (2) DefinitionFor purposes of this subsection, the term “non-Service health care practitioner” means a practitioner who is not—(A) an employee of the Service; or (B) an employee of an Indian tribe or tribal organization operating a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 1 or an individual who provides health care services pursuant to a personal services contract with such Indian tribe or tribal organization. (f) Eligible IndianFor purposes of this section, the term “eligible Indian” means any Indian who is eligible for health services provided by the Service without regard to the provisions of this section.

25 U.S.C. § 1680d Infant and maternal mortality; fetal alcohol syndrome

By no later than January 1, 1990, the Secretary shall develop and begin implementation of a plan to achieve the following objectives by January 1, 1994: (1) reduction of the rate of Indian infant mortality in each area office of the Service to the lower of—(A) twelve deaths per one thousand live births, or (B) the rate of infant mortality applicable to the United States population as a whole; (2) reduction of the rate of maternal mortality in each area office of the Service to the lower of—(A) five deaths per one hundred thousand live births, or (B) the rate of maternal mortality applicable to the United States population as a whole; and (3) reduction of the rate of fetal alcohol syndrome among Indians served by, or on behalf of, the Service to one per one thousand live births.

25 U.S.C. § 1680e Contract health services for the Trenton Service Area

(a) Service to Turtle Mountain BandThe Secretary, acting through the Service, is directed to provide contract health services to members of the Turtle Mountain Band of Chippewa Indians that reside in the Trenton Service Area of Divide, McKenzie, and Williams counties in the State of North Dakota and the adjoining counties of Richland, Roosevelt, and Sheridan in the State of Montana. (b) Band member eligibility not expandedNothing in this section may be construed as expanding the eligibility of members of the Turtle Mountain Band of Chippewa Indians for health services provided by the Service beyond the scope of eligibility for such health services that applied on May 1, 1986.

25 U.S.C. § 1680f Indian Health Service and Department of Veterans Affairs health facilities and services sharing

(a) Feasibility study and reportThe Secretary shall examine the feasibility of entering into an arrangement for the sharing of medical facilities and services between the Indian Health Service and the Department of Veterans Affairs and shall, in accordance with subsection (b), prepare a report on the feasibility of such an arrangement and submit such report to the Congress by no later than September 30, 1990. (b) Nonimpairment of service quality, eligibility, or priority of accessThe Secretary shall not take any action under this section or under subchapter IV of chapter 81 of title 38 which would impair—(1) the priority access of any Indian to health care services provided through the Indian Health Service; (2) the quality of health care services provided to any Indian through the Indian Health Service; (3) the priority access of any veteran to health care services provided by the Department of Veterans Affairs; (4) the quality of health care services provided to any veteran by the Department of Veterans Affairs; (5) the eligibility of any Indian to receive health services through the Indian Health Service; or (6) the eligibility of any Indian who is a veteran to receive health services through the Department of Veterans Affairs. (c) Cross utilization of services(1) Not later than December 23, 1988, the Director of the Indian Health Service and the Secretary of Veterans Affairs shall implement an agreement under which—(A) individuals in the vicinity of Roosevelt, Utah, who are eligible for health care from the Department of Veterans Affairs could obtain health care services at the facilities of the Indian Health Service located at Fort Duchesne, Utah; and (B) individuals eligible for health care from the Indian Health Service at Fort Duchesne, Utah, could obtain health care services at the George E. Wahlen Department of Veterans Affairs Medical Center located in Salt Lake City, Utah. (2) Not later than November 23, 1990, the Secretary and the Secretary of Veterans Affairs shall jointly submit a report to the Congress on the health care services provided as a result of paragraph (1). (d) Right to health servicesNothing in this section may be construed as creating any right of a veteran to obtain health services from the Indian Health Service except as provided in an agreement under subsection (c).

25 U.S.C. § 1680g Reallocation of base resources

(a) Report to CongressNotwithstanding any other provision of law, any allocation of Service funds for a fiscal year that reduces by 5 percent or more from the previous fiscal year the funding for any recurring program, project, or activity of a service unit may be implemented only after the Secretary has submitted to the President, for inclusion in the report required to be transmitted to the Congress under section 1671 of this title, a report on the proposed change in allocation of funding, including the reasons for the change and its likely effects. (b) Appropriated amountsSubsection (a) shall not apply if the total amount appropriated to the Service for a fiscal year is less than the amount appropriated to the Service for previous fiscal year.

25 U.S.C. § 1680h Demonstration projects for tribal management of health care services

(a) Establishment; grants(1) The Secretary, acting through the Service, shall make grants to Indian tribes to establish demonstration projects under which the Indian tribe will develop and test a phased approach to assumption by the Indian tribe of the health care delivery system of the Service for members of the Indian tribe living on or near the reservations of the Indian tribe through the use of Service, tribal, and private sector resources. (2) A grant may be awarded to an Indian tribe under paragraph (1) only if the Secretary determines that the Indian tribe has the administrative and financial capabilities necessary to conduct a demonstration project described in paragraph (1). (b) Health care contractsDuring the period in which a demonstration project established under subsection (a) is being conducted by an Indian tribe, the Secretary shall award all health care contracts, including community, behavioral, and preventive health care contracts, to the Indian tribe in the form of a single grant to which the regulations prescribed under part A of title XIX of the Public Health Service Act [42 U.S.C. 300w et seq.] (as modified as necessary by any agreement entered into between the Secretary and the Indian tribe to achieve the purposes of the demonstration project established under subsection (a)) shall apply. (c) Waiver of procurement lawsThe Secretary may waive such provisions of Federal procurement law as are necessary to enable any Indian tribe to develop and test administrative systems under the demonstration project established under subsection (a), but only if such waiver does not diminish or endanger the delivery of health care services to Indians. (d) Termination; evaluation and report(1) The demonstration project established under subsection (a) shall terminate on September 30, 1993, or, in the case of a demonstration project for which a grant is made after September 30, 1990, three years after the date on which such grant is made. (2) By no later than September 30, 1996, the Secretary shall evaluate the performance of each Indian tribe that has participated in a demonstration project established under subsection (a) and shall submit to the Congress a report on such evaluations and demonstration projects. (e) Joint venture demonstration projects(1) The Secretary, acting through the Service, shall make arrangements with Indian tribes to establish joint venture demonstration projects under which an Indian tribe shall expend tribal, private, or other available nontribal funds, for the acquisition or construction of a health facility for a minimum of 20 years, under a no-cost lease, in exchange for agreement by the Service to provide the equipment, supplies, and staffing for the operation and maintenance of such a health facility. A tribe may utilize tribal funds, private sector, or other available resources, including loan guarantees, to fulfill its commitment under this subsection. (2) The Secretary shall make such an arrangement with an Indian tribe only if the Secretary first determines that the Indian tribe has the administrative and financial capabilities necessary to complete the timely acquisition or construction of the health facility described in paragraph (1). (3) An Indian tribe or tribal organization that has entered into a written agreement with the Secretary under this subsection, and that breaches or terminates without cause such agreement, shall be liable to the United States for the amount that has been paid to the tribe, or paid to a third party on the tribe’s behalf, under the agreement. The Secretary has the right to recover tangible property (including supplies), and equipment, less depreciation, and any funds expended for operations and maintenance under this section. The preceding sentence does not apply to any funds expended for the delivery of health care services, or for personnel or staffing, shall be recoverable.11 So in original. The words “, shall be recoverable” probably should not appear.

25 U.S.C. § 1680i Child sexual abuse treatment programs

(a) Continuation of existing demonstration programsThe Secretary and the Secretary of the Interior shall, for each fiscal year through fiscal year 1995, continue the demonstration programs involving treatment for child sexual abuse provided through the Hopi Tribe and the Assiniboine and Sioux Tribes of the Fort Peck Reservation. (b) Establishment of new demonstration programsBeginning October 1, 1995, the Secretary and the Secretary of the Interior may establish, in any service area, demonstration programs involving treatment for child sexual abuse, except that the Secretaries may not establish a greater number of such programs in one service area than in any other service area until there is an equal number of such programs established with respect to all service areas from which the Secretary receives qualified applications during the application period (as determined by the Secretary).

25 U.S.C. § 1680j Tribal leasing

Indian tribes providing health care services pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] may lease permanent structures for the purpose of providing such health care services without obtaining advance approval in appropriation Acts.

25 U.S.C. § 1680l Shared services for long-term care

(a) Long-term care(1) In generalNotwithstanding any other provision of law, the Secretary, acting through the Service, is authorized to provide directly, or enter into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 11 See References in Text note below. with Indian tribes or tribal organizations for, the delivery of long-term care (including health care services associated with long-term care) provided in a facility to Indians. (2) InclusionsEach agreement under paragraph (1) shall provide for the sharing of staff or other services between the Service or a tribal health program and a long-term care or related facility owned and operated (directly or through a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)) 1 by the Indian tribe or tribal organization. (b) Contents of agreementsAn agreement entered into pursuant to subsection (a)—(1) may, at the request of the Indian tribe or tribal organization, delegate to the Indian tribe or tribal organization such powers of supervision and control over Service employees as the Secretary determines to be necessary to carry out the purposes of this section; (2) shall provide that expenses (including salaries) relating to services that are shared between the Service and the tribal health program be allocated proportionately between the Service and the Indian tribe or tribal organization; and (3) may authorize the Indian tribe or tribal organization to construct, renovate, or expand a long-term care or other similar facility (including the construction of a facility attached to a Service facility). (c) Minimum requirementAny nursing facility provided for under this section shall meet the requirements for nursing facilities under section 1396r of title 42. (d) Other assistanceThe Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section. (e) Use of existing or underused facilitiesThe Secretary shall encourage the use of existing facilities that are underused, or allow the use of swing beds, for long-term or similar care.

25 U.S.C. § 1680m Results of demonstration projects

The Secretary shall provide for the dissemination to Indian tribes of the findings and results of demonstration projects conducted under this chapter.

25 U.S.C. § 1680n Priority for Indian reservations

(a) Facilities and projectsBeginning on October 29, 1992, the Bureau of Indian Affairs and the Service shall, in all matters involving the reorganization or development of Service facilities, or in the establishment of related employment projects to address unemployment conditions in economically depressed areas, give priority to locating such facilities and projects on Indian lands if requested by the Indian tribe with jurisdiction over such lands. (b) “Indian lands” definedFor purposes of this section, the term “Indian lands” means—(1) all lands within the limits of any Indian reservation; and (2) any lands title which is held in trust by the United States for the benefit of any Indian tribe or individual Indian, or held by any Indian tribe or individual Indian subject to restriction by the United States against alienation and over which an Indian tribe exercises governmental power.

25 U.S.C. § 1680o Authorization of appropriations

There are authorized to be appropriated such sums as are necessary to carry out this chapter for fiscal year 2010 and each fiscal year thereafter, to remain available until expended.

25 U.S.C. § 1680p Annual budget submission

Effective beginning with the submission of the annual budget request to Congress for fiscal year 2011, the President shall include, in the amount requested and the budget justification, amounts that reflect any changes in— (1) the cost of health care services, as indexed for United States dollar inflation (as measured by the Consumer Price Index); and (2) the size of the population served by the Service.

25 U.S.C. § 1680q Prescription drug monitoring

(a) Monitoring(1) EstablishmentThe Secretary, in coordination with the Secretary of the Interior and the Attorney General, shall establish a prescription drug monitoring program, to be carried out at health care facilities of the Service, tribal health care facilities, and urban Indian health care facilities. (2) ReportNot later than 18 months after March 23, 2010, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes—(A) the needs of the Service, tribal health care facilities, and urban Indian health care facilities with respect to the prescription drug monitoring program under paragraph (1); (B) the planned development of that program, including any relevant statutory or administrative limitations; and (C) the means by which the program could be carried out in coordination with any State prescription drug monitoring program. (b) Abuse(1) In generalThe Attorney General, in conjunction with the Secretary and the Secretary of the Interior, shall conduct—(A) an assessment of the capacity of, and support required by, relevant Federal and tribal agencies—(i) to carry out data collection and analysis regarding incidents of prescription drug abuse in Indian communities; and (ii) to exchange among those agencies and Indian health programs information relating to prescription drug abuse in Indian communities, including statutory and administrative requirements and limitations relating to that abuse; and (B) training for Indian health care providers, tribal leaders, law enforcement officers, and school officials regarding awareness and prevention of prescription drug abuse and strategies for improving agency responses to addressing prescription drug abuse in Indian communities. (2) ReportNot later than 18 months after March 23, 2010, the Attorney General shall submit to the Committee on Indian Affairs of the Senate and the Committee on Natural Resources of the House of Representatives a report that describes—(A) the capacity of Federal and tribal agencies to carry out data collection and analysis and information exchanges as described in paragraph (1)(A); (B) the training conducted pursuant to paragraph (1)(B); (C) infrastructure enhancements required to carry out the activities described in paragraph (1), if any; and (D) any statutory or administrative barriers to carrying out those activities.

25 U.S.C. § 1680r Tribal health program option for cost sharing

(a) In generalNothing in this chapter limits the ability of a tribal health program operating any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a compact with the Service pursuant to title V of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 458aaa et seq.) 11 See References in Text note below. to charge an Indian for services provided by the tribal health program. (b) ServiceNothing in this chapter authorizes the Service—(1) to charge an Indian for services; or (2) to require any tribal health program to charge an Indian for services.

25 U.S.C. § 1680s Disease and injury prevention report

Not later than 18 months after March 23, 2010, the Secretary shall submit to the Committee on Indian Affairs of the Senate and the Committees on Natural Resources and Energy and Commerce of the House of Representatives 11 So in original. Probably should be followed by “a report”. describing— (1) all disease and injury prevention activities conducted by the Service, independently or in conjunction with other Federal departments and agencies and Indian tribes; and (2) the effectiveness of those activities, including the reductions of injury or disease conditions achieved by the activities.

25 U.S.C. § 1680t Other GAO reports

(a) Coordination of services(1) Study and evaluationThe Comptroller General of the United States shall conduct a study, and evaluate the effectiveness, of coordination of health care services provided to Indians—(A) through Medicare, Medicaid, or SCHIP; (B) by the Service; or (C) using funds provided by—(i) State or local governments; or (ii) Indian tribes. (2) ReportNot later than 18 months after March 23, 2010, the Comptroller General shall submit to Congress a report—(A) describing the results of the evaluation under paragraph (1); and (B) containing recommendations of the Comptroller General regarding measures to support and increase coordination of the provision of health care services to Indians as described in paragraph (1). (b) Payments for contract health services(1) In generalThe Comptroller General shall conduct a study on the use of health care furnished by health care providers under the contract health services program funded by the Service and operated by the Service, an Indian tribe, or a tribal organization. (2) AnalysisThe study conducted under paragraph (1) shall include an analysis of—(A) the amounts reimbursed under the contract health services program described in paragraph (1) for health care furnished by entities, individual providers, and suppliers, including a comparison of reimbursement for that health care through other public programs and in the private sector; (B) barriers to accessing care under such contract health services program, including barriers relating to travel distances, cultural differences, and public and private sector reluctance to furnish care to patients under the program; (C) the adequacy of existing Federal funding for health care under the contract health services program; (D) the administration of the contract health service program, including the distribution of funds to Indian health programs pursuant to the program; and (E) any other items determined appropriate by the Comptroller General. (3) ReportNot later than 18 months after March 23, 2010, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations regarding—(A) the appropriate level of Federal funding that should be established for health care under the contract health services program described in paragraph (1); (B) how to most efficiently use that funding; and (C) the identification of any inequities in the current distribution formula or inequitable results for any Indian tribe under the funding level, and any recommendations for addressing any inequities or inequitable results identified. (4) ConsultationIn conducting the study under paragraph (1) and preparing the report under paragraph (3), the Comptroller General shall consult with the Service, Indian tribes, and tribal organizations.

25 U.S.C. § 1680u Traditional health care practices

Although the Secretary may promote traditional health care practices, consistent with the Service standards for the provision of health care, health promotion, and disease prevention under this chapter, the United States is not liable for any provision of traditional health care practices pursuant to this chapter that results in damage, injury, or death to a patient. Nothing in this subsection shall be construed to alter any liability or other obligation that the United States may otherwise have under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 11 See References in Text note below. or this chapter.

25 U.S.C. § 1680v Director of HIV/AIDS Prevention and Treatment

(a) EstablishmentThe Secretary, acting through the Service, shall establish within the Service the position of the Director of HIV/AIDS Prevention and Treatment (referred to in this section as the “Director”). (b) DutiesThe Director shall—(1) coordinate and promote HIV/AIDS prevention and treatment activities specific to Indians; (2) provide technical assistance to Indian tribes, tribal organizations, and urban Indian organizations regarding existing HIV/AIDS prevention and treatment programs; and (3) ensure interagency coordination to facilitate the inclusion of Indians in Federal HIV/AIDS research and grant opportunities, with emphasis on the programs operated under the Ryan White Comprehensive Aids 11 So in original. Probably should be “AIDS”. Resources Emergency Act of 1990 (Public Law 101–381; 104 Stat. 576) and the amendments made by that Act. (c) ReportNot later than 2 years after March 23, 2010, and not less frequently than once every 2 years thereafter, the Director shall submit to Congress a report describing, with respect to the preceding 2-year period—(1) each activity carried out under this section; and (2) any findings of the Director with respect to HIV/AIDS prevention and treatment activities specific to Indians.

25 U.S.C. § 1682 Subrogation of claims by Indian Health Service

On and after October 18, 1986, the Indian Health Service may seek subrogation of claims including but not limited to auto accident claims, including no-fault claims, personal injury, disease, or disability claims, and worker’s compensation claims, the proceeds of which shall be credited to the funds established by sections 401 and 402 11 See References in Text note below. of the Indian Health Care Improvement Act.

25 U.S.C. § 1683 Indian Catastrophic Health Emergency Fund

$10,000,000 shall remain available until expended, for the establishment of an Indian Catastrophic Health Emergency Fund (hereinafter referred to as the “Fund”). On and after October 18, 1986, the Fund is to cover the Indian Health Service portion of the medical expenses of catastrophic illness falling within the responsibility of the Service and shall be administered by the Secretary of Health and Human Services, acting through the central office of the Indian Health Service. No part of the Fund or its administration shall be subject to contract or grant under the Indian Self-Determination and Education Assistance Act (Public Law 93–638) [25 U.S.C. 5301 et seq.]. There shall be deposited into the Fund all amounts recovered under the authority of the Federal Medical Care Recovery Act (42 U.S.C. 2651 et seq.), which shall become available for obligation upon receipt and which shall remain available for obligation until expended. The Fund shall not be used to pay for health services provided to eligible Indians to the extent that alternate Federal, State, local, or private insurance resources for payment: (1) are available and accessible to the beneficiary; or (2) would be available and accessible if the beneficiary were to apply for them; or (3) would be available and accessible to other citizens similarly situated under Federal, State, or local law or regulation or private insurance program notwithstanding Indian Health Service eligibility or residency on or off a Federal Indian reservation.

25 U.S.C. § 1684 Emergency plan for Indian safety and health

(a) Establishment of FundThere is established in the Treasury of the United States a fund, to be known as the “Emergency Fund for Indian Safety and Health” (referred to in this section as the “Fund”), consisting of such amounts as are appropriated to the Fund under subsection (b). (b) Transfers to Fund(1) In generalThere is authorized to be appropriated to the Fund, out of funds of the Treasury not otherwise appropriated, $1,602,619,000 for the 5-year period beginning on October 1, 2008. (2) Availability of amountsAmounts deposited in the Fund under this section shall—(A) be made available without further appropriation; (B) be in addition to amounts made available under any other provision of law; and (C) remain available until expended. (c) Expenditures from FundOn request by the Attorney General, the Secretary of the Interior, or the Secretary of Health and Human Services, the Secretary of the Treasury shall transfer from the Fund to the Attorney General, the Secretary of the Interior, or the Secretary of Health and Human Services, as appropriate, such amounts as the Attorney General, the Secretary of the Interior, or the Secretary of Health and Human Services determines to be necessary to carry out the emergency plan under subsection (f). (d) Transfers of amounts(1) In generalThe amounts required to be transferred to the Fund under this section shall be transferred at least monthly from the general fund of the Treasury to the Fund on the basis of estimates made by the Secretary of the Treasury. (2) AdjustmentsProper adjustment shall be made in amounts subsequently transferred to the extent prior estimates were in excess of or less than the amounts required to be transferred. (e) Remaining amountsAny amounts remaining in the Fund on September 30 of an applicable fiscal year may be used by the Attorney General, the Secretary of the Interior, or the Secretary of Health and Human Services to carry out the emergency plan under subsection (f) for any subsequent fiscal year. (f) Emergency planNot later than 1 year after July 30, 2008, the Attorney General, the Secretary of the Interior, and the Secretary of Health and Human Services, in consultation with Indian tribes (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)),11 See References in Text note below. shall jointly establish an emergency plan that addresses law enforcement, water, and health care needs of Indian tribes under which, for each of fiscal years 2010 through 2019, of amounts in the Fund—(1) the Attorney General shall use—(A) 18.5 percent for the construction, rehabilitation, and replacement of Federal Indian detention facilities; (B) 1.5 percent to investigate and prosecute crimes in Indian country (as defined in section 1151 of title 18); (C) 1.5 percent for use by the Office of Justice Programs for Indian and Alaska Native programs; and (D) 0.5 percent to provide assistance to—(i) parties to cross-deputization or other cooperative agreements between State or local governments and Indian tribes (as defined in section 5130 of this title) carrying out law enforcement activities in Indian country; and (ii) the State of Alaska (including political subdivisions of that State) for carrying out the Village Public Safety Officer Program and law enforcement activities on Alaska Native land (as defined in section 3902 of this title); (2) the Secretary of the Interior shall—(A) deposit 15.5 percent in the public safety and justice account of the Bureau of Indian Affairs for use by the Office of Justice Services of the Bureau in providing law enforcement or detention services, directly or through contracts or compacts with Indian tribes under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.); 1 and (B) use not more than $602,619,000 to implement requirements of Indian water settlement agreements that are approved by Congress (or the legislation to implement such an agreement) under which the United States shall plan, design, rehabilitate, or construct, or provide financial assistance for the planning, design, rehabilitation, or construction of, water supply or delivery infrastructure that will serve an Indian tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)); 1 and (3) the Secretary of Health and Human Services, acting through the Director of the Indian Health Service, shall use 12.5 percent to provide, directly or through contracts or compacts with Indian tribes under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)— 1(A) contract health services; (B) construction, rehabilitation, and replacement of Indian health facilities; and (C) domestic and community sanitation facilities serving members of Indian tribes (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b)) 1 pursuant to section 2004a of title 42.

25 U.S.C. § 1685 Service of traditional foods in public facilities

(a) PurposesThe purposes of this section are—(1) to provide access to traditional foods in food service programs; (2) to encourage increased consumption of traditional foods to decrease health disparities among Indians, particularly Alaska Natives; and (3) to provide alternative food options for food service programs. (b) DefinitionsIn this section:(1) Alaska NativeThe term “Alaska Native” means a person who is a member of any Native village, Village Corporation, or Regional Corporation (as those terms are defined in section 1602 of title 43). (2) CommissionerThe term “Commissioner” means the Commissioner of Food and Drugs. (3) Food service programThe term “food service program” includes—(A) food service at residential child care facilities that have a license from an appropriate State agency; (B) any child nutrition program (as that term is defined in section 1769f(b) of title 42); (C) food service at hospitals, clinics, and long-term care facilities; and (D) senior meal programs. (4) Indian; Indian tribeThe terms “Indian” and “Indian tribe” have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).11 See References in Text note below. (5) Traditional food(A) In generalThe term “traditional food” means food that has traditionally been prepared and consumed by an Indian tribe. (B) InclusionsThe term “traditional food” includes—(i) wild game meat; (ii) fish; (iii) seafood; (iv) marine mammals; (v) plants; and (vi) berries. (6) Tribal organizationThe term “tribal organization” has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).1 (c) ProgramThe Secretary and the Commissioner shall allow the donation to and serving of traditional food through food service programs at public facilities and nonprofit facilities, including facilities operated by Indian tribes and facilities operated by tribal organizations, that primarily serve Indians if the operator of the food service program—(1) ensures that the food is received whole, gutted, gilled, as quarters, or as a roast, without further processing; (2) makes a reasonable determination that—(A) the animal was not diseased; (B) the food was butchered, dressed, transported, and stored to prevent contamination, undesirable microbial growth, or deterioration; and (C) the food will not cause a significant health hazard or potential for human illness; (3) carries out any further preparation or processing of the food at a different time or in a different space from the preparation or processing of other food for the applicable program to prevent cross-contamination; (4) cleans and sanitizes food-contact surfaces of equipment and utensils after processing the traditional food; (5) labels donated traditional food with the name of the food; (6) stores the traditional food separately from other food for the applicable program, including through storage in a separate freezer or refrigerator or in a separate compartment or shelf in the freezer or refrigerator; (7) follows Federal, State, local, county, tribal, or other non-Federal law regarding the safe preparation and service of food in public or nonprofit facilities; and (8) follows other such criteria as established by the Secretary and Commissioner. (d) Liability(1) In generalThe United States, an Indian tribe, a tribal organization, a State, a county or county equivalent, a local educational agency, and an entity or person authorized to facilitate the donation, storage, preparation, or serving of traditional food by the operator of a food service program shall not be liable in any civil action for any damage, injury, or death caused to any person by the donation to or storage, preparation, or serving of traditional foods through food service programs. (2) Rule of constructionNothing in paragraph (1) alters any liability or other obligation of the United States under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 1450 et seq.).1