USC Subchapter IV

in effect

25 U.S.C. § 1651 Purpose

The purpose of this subchapter is to establish programs in urban centers to make health services more accessible to urban Indians.

25 U.S.C. § 1652 Contracts with, and grants to, urban Indian organizations

(a) In generalPursuant to section 13 of this title, the Secretary, acting through the Service, shall enter into contracts with, or make grants to, urban Indian organizations to assist the urban Indian organizations in the establishment and administration, within urban centers, of programs that meet the requirements of this subchapter. (b) ConditionsSubject to section 1656 of this title, the Secretary, acting through the Service, shall include such conditions as the Secretary considers necessary to effect the purpose of this subchapter in any contract into which the Secretary enters with, or in any grant the Secretary makes to, any urban Indian organization pursuant to this subchapter.

25 U.S.C. § 1653 Contracts and grants for provision of health care and referral services

(a) RequirementsUnder authority of section 13 of this title, the Secretary, through the Service, shall enter into contracts with, or make grants to, urban Indian organizations for the provision of health care and referral services for urban Indians residing in the urban centers in which such organizations are situated. Any such contract or grant shall include requirements that the urban Indian organization successfully undertake to—(1) estimate the population of urban Indians residing in the urban center in which such organization is situated who are or could be recipients of health care or referral services; (2) estimate the current health status of urban Indians residing in such urban center; (3) estimate the current health care needs of urban Indians residing in such urban center; (4) identify all public and private health services resources within such urban center which are or may be available to urban Indians; (5) determine the use of public and private health services resources by the urban Indians residing in such urban center; (6) assist such health services resources in providing services to urban Indians; (7) assist urban Indians in becoming familiar with and utilizing such health services resources; (8) provide basic health education, including health promotion and disease prevention education, to urban Indians; (9) establish and implement training programs to accomplish the referral and education tasks set forth in paragraphs (6) through (8) of this subsection; (10) identify gaps between unmet health needs of urban Indians and the resources available to meet such needs; (11) make recommendations to the Secretary and Federal, State, local, and other resource agencies on methods of improving health service programs to meet the needs of urban Indians; and (12) where necessary, provide, or enter into contracts for the provision of, health care services for urban Indians. (b) Criteria for selection of organizations to enter into contracts or receive grantsThe Secretary, through the Service, shall by regulation prescribe the criteria for selecting urban Indian organizations to enter into contracts or receive grants under this section. Such criteria shall, among other factors, include—(1) the extent of unmet health care needs of urban Indians in the urban center involved; (2) the size of the urban Indian population in the urban center involved; (3) the accessibility to, and utilization of, health care services (other than services provided under this subchapter) by urban Indians in the urban center involved; (4) the extent, if any, to which the activities set forth in subsection (a) would duplicate—(A) any previous or current public or private health services project in an urban center that was or is funded in a manner other than pursuant to this subchapter; or (B) any project funded under this subchapter; (5) the capability of an urban Indian organization to perform the activities set forth in subsection (a) and to enter into a contract with the Secretary or to meet the requirements for receiving a grant under this section; (6) the satisfactory performance and successful completion by an urban Indian organization of other contracts with the Secretary under this subchapter; (7) the appropriateness and likely effectiveness of conducting the activities set forth in subsection (a) in an urban center; and (8) 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 agencies. (c) Grants for health promotion and disease prevention servicesThe Secretary, acting through the Service, shall facilitate access to, or provide, health promotion and disease prevention services for urban Indians through grants made to urban Indian organizations administering contracts entered into pursuant to this section or receiving grants under subsection (a). (d) Grants for immunization services(1) The Secretary, acting through the Service, shall facilitate access to, or provide, immunization services for urban Indians through grants made to urban Indian organizations administering contracts entered into pursuant to this section or receiving grants under subsection (a). (2) In making any grant to carry out this subsection, the Secretary shall take into consideration—(A) the size of the urban Indian population to be served; (B) the immunization levels of the urban Indian population, particularly the immunization levels of infants, children, and the elderly; (C) the utilization by the urban Indians of alternative resources from State and local governments for no-cost or low-cost immunization services to the general population; and (D) the capability of the urban Indian organization to carry out services pursuant to this subsection. (3) For purposes of this subsection, the term “immunization services” means services to provide without charge immunizations against vaccine-preventable diseases. (e) Grants for mental health services(1) The Secretary, acting through the Service, shall facilitate access to, or provide, mental health services for urban Indians through grants made to urban Indian organizations administering contracts entered into pursuant to this section or receiving grants under subsection (a). (2) A grant may not be made under this subsection to an urban Indian organization until that organization has prepared, and the Service has approved, an assessment of the mental health needs of the urban Indian population concerned, the mental health services and other related resources available to that population, the barriers to obtaining those services and resources, and the needs that are unmet by such services and resources. (3) Grants may be made under this subsection—(A) to prepare assessments required under paragraph (2); (B) to provide outreach, educational, and referral services to urban Indians regarding the availability of direct mental health services, to educate urban Indians about mental health issues and services, and effect coordination with existing mental health providers in order to improve services to urban Indians; (C) to provide outpatient mental health services to urban Indians, including the identification and assessment of illness, therapeutic treatments, case management, support groups, family treatment, and other treatment; and (D) to develop innovative mental health service delivery models which incorporate Indian cultural support systems and resources. (f) Grants for prevention and treatment of child abuse(1) The Secretary, acting through the Service, shall facilitate access to, or provide, services for urban Indians through grants to urban Indian organizations administering contracts entered into pursuant to this section or receiving grants under subsection (a) to prevent and treat child abuse (including sexual abuse) among urban Indians. (2) A grant may not be made under this subsection to an urban Indian organization until that organization has prepared, and the Service has approved, an assessment that documents the prevalence of child abuse in the urban Indian population concerned and specifies the services and programs (which may not duplicate existing services and programs) for which the grant is requested. (3) Grants may be made under this subsection—(A) to prepare assessments required under paragraph (2); (B) for the development of prevention, training, and education programs for urban Indian populations, including child education, parent education, provider training on identification and intervention, education on reporting requirements, prevention campaigns, and establishing service networks of all those involved in Indian child protection; and (C) to provide direct outpatient treatment services (including individual treatment, family treatment, group therapy, and support groups) to urban Indians who are child victims of abuse (including sexual abuse) or adult survivors of child sexual abuse, to the families of such child victims, and to urban Indian perpetrators of child abuse (including sexual abuse). (4) In making grants to carry out this subsection, the Secretary shall take into consideration—(A) the support for the urban Indian organization demonstrated by the child protection authorities in the area, including committees or other services funded under the Indian Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if any; (B) the capability and expertise demonstrated by the urban Indian organization to address the complex problem of child sexual abuse in the community; and (C) the assessment required under paragraph (2).

25 U.S.C. § 1654 Contracts and grants for determination of unmet health care needs

(a) AuthorityUnder authority of section 13 of this title, the Secretary, through the Service, may enter into contracts with, or make grants to, urban Indian organizations situated in urban centers for which contracts have not been entered into, or grants have not been made, under section 1653 of this title. The purpose of a contract or grant made under this section shall be the determination of the matters described in subsection (b)(1) in order to assist the Secretary in assessing the health status and health care needs of urban Indians in the urban center involved and determining whether the Secretary should enter into a contract or make a grant under section 1653 of this title with respect to the urban Indian organization which the Secretary has entered into a contract with, or made a grant to, under this section. (b) RequirementsAny contract entered into, or grant made, by the Secretary under this section shall include requirements that—(1) the urban Indian organization successfully undertake to—(A) document the health care status and unmet health care needs of urban Indians in the urban center involved; and (B) with respect to urban Indians in the urban center involved, determine the matters described in clauses (2), (3), (4), and (8) of section 1653(b) of this title; and (2) the urban Indian organization complete performance of the contract, or carry out the requirements of the grant, within one year after the date on which the Secretary and such organization enter into such contract, or within one year after such organization receives such grant, whichever is applicable. (c) RenewalThe Secretary may not renew any contract entered into, or grant made, under this section.

25 U.S.C. § 1655 Evaluations; renewals

(a) Contract compliance and performanceThe Secretary, through the Service, shall develop procedures to evaluate compliance with grant requirements under this subchapter and compliance with, and performance of contracts entered into by urban Indian organizations under this subchapter. Such procedures shall include provisions for carrying out the requirements of this section. (b) Annual onsite evaluationThe Secretary, through the Service, shall conduct an annual onsite evaluation of each urban Indian organization which has entered into a contract or received a grant under section 1653 of this title for purposes of determining the compliance of such organization with, and evaluating the performance of such organization under, such contract or the terms of such grant. (c) Noncompliance or unsatisfactory performanceIf, as a result of the evaluations conducted under this section, the Secretary determines that an urban Indian organization has not complied with the requirements of a grant or complied with or satisfactorily performed a contract under section 1653 of this title, the Secretary shall, prior to renewing such contract or grant, attempt to resolve with such organization the areas of noncompliance or unsatisfactory performance and modify such contract or grant to prevent future occurrences of such noncompliance or unsatisfactory performance. If the Secretary determines that such noncompliance or unsatisfactory performance cannot be resolved and prevented in the future, the Secretary shall not renew such contract or grant with such organization and is authorized to enter into a contract or make a grant under section 1653 of this title with another urban Indian organization which is situated in the same urban center as the urban Indian organization whose contract or grant is not renewed under this section. (d) Contract and grant renewalsIn determining whether to renew a contract or grant with an urban Indian organization under section 1653 of this title which has completed performance of a contract or grant under section 1654 of this title, the Secretary shall review the records of the urban Indian organization, the reports submitted under section 1657 of this title, and, in the case of a renewal of a contract or grant under section 1653 of this title, shall consider the results of the onsite evaluations conducted under subsection (b).

25 U.S.C. § 1656 Other contract and grant requirements

(a) Federal regulations; exceptionsContracts with urban Indian organizations entered into pursuant to this subchapter shall be in accordance with all Federal contracting 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 sections 3131 and 3133 of title 40. (b) PaymentPayments under any contracts or grants pursuant to this subchapter 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 subchapter. (c) Revision or amendmentNotwithstanding any provision of law to the contrary, the Secretary may, at the request or consent of an urban Indian organization, revise or amend any contract entered into by the Secretary with such organization under this subchapter as necessary to carry out the purposes of this subchapter. (d) Existing Government facilitiesIn connection with any contract or grant entered into pursuant to this subchapter, the Secretary may permit an urban Indian organization to utilize, in carrying out such contract or grant, existing facilities owned by the Federal Government within the Secretary’s jurisdiction under such terms and conditions as may be agreed upon for the use and maintenance of such facilities. (e) Uniform provision of services and assistanceContracts with, or grants to, urban Indian organizations and regulations adopted pursuant to this subchapter shall include provisions to assure the fair and uniform provision to urban Indians of services and assistance under such contracts or grants by such organizations. (f) Eligibility for health care or referral servicesUrban Indians, as defined in section 1603(f) 11 See References in Text note below. of this title, shall be eligible for health care or referral services provided pursuant to this subchapter.

25 U.S.C. § 1657 Reports and records

(a) Quarterly reportsFor each fiscal year during which an urban Indian organization receives or expends funds pursuant to a contract entered into, or a grant received, pursuant to this subchapter, such organization shall submit to the Secretary a quarterly report including—(1) in the case of a contract or grant under section 1653 of this title, information gathered pursuant to clauses (10) and (11) of subsection (a) of such section; (2) information on activities conducted by the organization pursuant to the contract or grant; (3) an accounting of the amounts and purposes for which Federal funds were expended; and (4) such other information as the Secretary may request. (b) Audit by Secretary and Comptroller GeneralThe reports and records of the urban Indian organization with respect to a contract or grant under this subchapter shall be subject to audit by the Secretary and the Comptroller General of the United States. (c) Cost of annual private auditThe Secretary shall allow as a cost of any contract or grant entered into under section 1653 of this title the cost of an annual private audit conducted by a certified public accountant. (d) Health status, services, and areas of unmet needs; child welfare(1) The Secretary, acting through the Service, shall submit a report to the Congress not later than March 31, 1992, evaluating—(A) the health status of urban Indians; (B) the services provided to Indians through this subchapter; (C) areas of unmet needs in urban areas served under this subchapter; and (D) areas of unmet needs in urban areas not served under this subchapter. (2) In preparing the report under paragraph (1), the Secretary shall consult with urban Indian health providers and may contract with a national organization representing urban Indian health concerns to conduct any aspect of the report. (3) The Secretary and the Secretary of the Interior shall—(A) assess the status of the welfare of urban Indian children, including the volume of child protection cases, the prevalence of child sexual abuse, and the extent of urban Indian coordination with tribal authorities with respect to child sexual abuse; and (B) submit a report on the assessment required under subparagraph (A), together with recommended legislation to improve Indian child protection in urban Indian populations, to the Congress no later than March 31, 1992.

25 U.S.C. § 1658 Limitation on contract authority

The authority of the Secretary to enter into contracts under this subchapter shall be to the extent, and in an amount, provided for in appropriation Acts.

25 U.S.C. § 1659 Facilities renovation

The Secretary may make funds available to contractors or grant recipients under this subchapter for renovations to facilities or construction or expansion of facilities, including leased facilities.

25 U.S.C. § 1660 Urban Health Programs Branch

(a) EstablishmentThere is hereby established within the Service a Branch of Urban Health Programs which shall be responsible for carrying out the provisions of this subchapter and for providing central oversight of the programs and services authorized under this subchapter. (b) Staff, services, and equipmentThe Secretary shall appoint such employees to work in the branch, including a program director, and shall provide such services and equipment, as may be necessary for it to carry out its responsibilities. The Secretary shall also analyze the need to provide at least one urban health program analyst for each area office of the Indian Health Service and shall submit his findings to the Congress as a part of the Department’s fiscal year 1993 budget request.

25 U.S.C. § 1660a Grants for alcohol and substance abuse related services

(a) GrantsThe Secretary may make grants for the provision of health-related services in prevention of, treatment of, rehabilitation of, or school and community-based education in, alcohol and substance abuse in urban centers to those urban Indian organizations with whom the Secretary has entered into a contract under this subchapter or under section 1621 of this title. (b) Goals of grantEach grant made pursuant to subsection (a) shall set forth the goals to be accomplished pursuant to the grant. The goals shall be specific to each grant as agreed to between the Secretary and the grantee. (c) CriteriaThe Secretary shall establish criteria for the grants made under subsection (a), including criteria relating to the—(1) size of the urban Indian population; (2) accessibility to, and utilization of, other health resources available to such population; (3) duplication of existing Service or other Federal grants or contracts; (4) capability of the organization to adequately perform the activities required under the grant; (5) satisfactory performance standards for the organization in meeting the goals set forth in such grant, which standards shall be negotiated and agreed to between the Secretary and the grantee on a grant-by-grant basis; and (6) identification of need for services. The Secretary shall develop a methodology for allocating grants made pursuant to this section based on such criteria. (d) Treatment of funds received by urban Indian organizationsAny funds received by an urban Indian organization under this chapter for substance abuse prevention, treatment, and rehabilitation shall be subject to the criteria set forth in subsection (c).

25 U.S.C. § 1660b Treatment of certain demonstration projects

Notwithstanding any other provision of law, the Tulsa Clinic and Oklahoma City Clinic demonstration projects shall— (1) be permanent programs within the Service’s direct care program; (2) continue to be treated as Service units and operating units in the allocation of resources and coordination of care; and (3) continue to meet the requirements and definitions of an urban Indian organization in this chapter, and shall not be subject to the provisions of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).11 See References in Text note below.

25 U.S.C. § 1660c Urban NIAAA transferred programs

(a) Duty of SecretaryThe Secretary shall, within the Branch of Urban Health Programs of the Service, make grants or enter into contracts for the administration of urban Indian alcohol programs that were originally established under the National Institute on Alcoholism and Alcohol Abuse (hereafter in this section referred to as “NIAAA”) and transferred to the Service. (b) Use of grantsGrants provided or contracts entered into under this section shall be used to provide support for the continuation of alcohol prevention and treatment services for urban Indian populations and such other objectives as are agreed upon between the Service and a recipient of a grant or contract under this section. (c) Eligibility for grantsUrban Indian organizations that operate Indian alcohol programs originally funded under NIAAA and subsequently transferred to the Service are eligible for grants or contracts under this section. (d) Combination of fundsFor the purpose of carrying out this section, the Secretary may combine NIAAA alcohol funds with other substance abuse funds currently administered through the Branch of Urban Health Programs of the Service. (e) Evaluation and report to CongressThe Secretary shall evaluate and report to the Congress on the activities of programs funded under this section at least every 5 years.

25 U.S.C. § 1660d Conferring with urban Indian organizations

(a) Definition of conferIn this section, the term “confer” means to engage in an open and free exchange of information and opinions that—(1) leads to mutual understanding and comprehension; and (2) emphasizes trust, respect, and shared responsibility. (b) RequirementThe Secretary shall ensure that the Service confers, to the maximum extent practicable, with urban Indian organizations in carrying out this chapter.

25 U.S.C. § 1660e Expanded program authority for urban Indian organizations

Notwithstanding any other provision of this chapter, the Secretary, acting through the Service, is authorized to establish programs, including programs for awarding grants, for urban Indian organizations that are identical to any programs established pursuant to sections 1621q, 1665a, and 1665g(g) of this title.

25 U.S.C. § 1660f Community Health Representatives

The Secretary, acting through the Service, may enter into contracts with, and make grants to, urban Indian organizations for the employment of Indians trained as health service providers through the Community Health Representative Program under section 1616 of this title in the provision of health care, health promotion, and disease prevention services to urban Indians.

25 U.S.C. § 1660g Use of Federal Government facilities and sources of supply

(a) In generalThe Secretary may permit an urban Indian organization that has entered into a contract or received a grant pursuant to this subchapter, in carrying out the contract or grant, to use, in accordance with such terms and conditions for use and maintenance as are agreed on by the Secretary and the urban Indian organizations—(1) any existing facility under the jurisdiction of the Secretary; (2) all equipment contained in or pertaining to such an existing facility; and (3) any other personal property of the Federal Government under the jurisdiction of the Secretary. (b) DonationsSubject to subsection (d), the Secretary may donate to an urban Indian organization that has entered into a contract or received a grant pursuant to this subchapter any personal or real property determined to be excess to the needs of the Service or the General Services Administration for the purposes of carrying out the contract or grant. (c) Acquisition of propertyThe Secretary may acquire excess or surplus personal or real property of the Federal Government for donation, subject to subsection (d), to an urban Indian organization that has entered into a contract or received a grant pursuant to this subchapter if the Secretary determines that the property is appropriate for use by the urban Indian organization for purposes of the contract or grant. (d) PriorityIf the Secretary receives from an urban Indian organization or an Indian tribe or tribal organization a request for a specific item of personal or real property described in subsection (b) or (c), the Secretary shall give priority to the request for donation to the Indian tribe or tribal organization, if the Secretary receives the request from the Indian tribe or tribal organization before the earlier of—(1) the date on which the Secretary transfers title to the property to the urban Indian organization; and (2) the date on which the Secretary transfers the property physically to the urban Indian organization. (e) Executive agency statusFor purposes of section 501(a) of title 40, an urban Indian organization that has entered into a contract or received a grant pursuant to this subchapter may be considered to be an Executive agency in carrying out the contract or grant.

25 U.S.C. § 1660h Health information technology

The Secretary, acting through the Service, may make grants to urban Indian organizations under this subchapter for the development, adoption, and implementation of health information technology (as defined in section 300jj of title 42), telemedicine services development, and related infrastructure.

25 U.S.C. § 1660i Deeming an Urban Indian organization and employees thereof to be a part of the public health service for the purposes of certain claims for personal injury

Section 5321(d) of this title shall apply— (1) to an Urban Indian organization to the same extent and in the same manner as such section applies to an Indian tribe, a tribal organization, and an Indian contractor; and (2) to the employees of an Urban Indian organization to the same extent and in the same manner as such section applies to employees of an Indian tribe, a tribal organization, or an Indian contractor.