USC Subchapter III

in effect

25 U.S.C. § 1631 Consultation; closure of facilities; reports

(a) Consultation; standards for accreditationPrior to the expenditure of, or the making of any firm commitment to expend, any funds appropriated for the planning, design, construction, or renovation of facilities pursuant to section 13 of this title, the Secretary, acting through the Service, shall—(1) consult with any Indian tribe that would be significantly affected by such expenditure for the purpose of determining and, whenever practicable, honoring tribal preferences concerning size, location, type, and other characteristics of any facility on which such expenditure is to be made, and (2) ensure, whenever practicable, that such facility meets the standards of the Joint Commission on Accreditation of Health Care Organizations by not later than 1 year after the date on which the construction or renovation of such facility is completed. (b) Closure; report on proposed closure(1) Notwithstanding any provision of law other than this subsection, no Service hospital or outpatient health care facility of the Service, or any portion of such a hospital or facility, may be closed if the Secretary has not submitted to the Congress at least 1 year prior to the date such hospital or facility (or portion thereof) is proposed to be closed an evaluation of the impact of such proposed closure which specifies, in addition to other considerations—(A) the accessibility of alternative health care resources for the population served by such hospital or facility; (B) the cost effectiveness of such closure; (C) the quality of health care to be provided to the population served by such hospital or facility after such closure; (D) the availability of contract health care funds to maintain existing levels of service; (E) the views of the Indian tribes served by such hospital or facility concerning such closure; (F) the level of utilization of such hospital or facility by all eligible Indians; and (G) the distance between such hospital or facility and the nearest operating Service hospital. (2) Paragraph (1) shall not apply to any temporary closure of a facility or of any portion of a facility if such closure is necessary for medical, environmental, or safety reasons. (c) Health care facility priority system(1) In general(A) Priority systemThe Secretary, acting through the Service, shall maintain a health care facility priority system, which—(i) shall be developed in consultation with Indian tribes and tribal organizations; (ii) shall give Indian tribes’ needs the highest priority; (iii)(I) may include the lists required in paragraph (2)(B)(ii); and (II) shall include the methodology required in paragraph (2)(B)(v); and (III) may include such health care facilities, and such renovation or expansion needs of any health care facility, as the Service may identify; and (iv) shall provide an opportunity for the nomination of planning, design, and construction projects by the Service, Indian tribes, and tribal organizations for consideration under the priority system at least once every 3 years, or more frequently as the Secretary determines to be appropriate. (B) Needs of facilities under ISDEAA agreementsThe Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities operated under contracts or compacts in accordance with the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 11 See References in Text note below. are fully and equitably integrated into the health care facility priority system. (C) Criteria for evaluating needsFor purposes of this subsection, the Secretary, in evaluating the needs of facilities operated under a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),1 shall use the criteria used by the Secretary in evaluating the needs of facilities operated directly by the Service. (D) Priority of certain projects protectedThe priority of any project established under the construction priority system in effect on March 23, 2010, shall not be affected by any change in the construction priority system taking place after that date if the project—(i) was identified in the fiscal year 2008 Service budget justification as—(I) 1 of the 10 top-priority inpatient projects; (II) 1 of the 10 top-priority outpatient projects; (III) 1 of the 10 top-priority staff quarters developments; or (IV) 1 of the 10 top-priority Youth Regional Treatment Centers; (ii) had completed both Phase I and Phase II of the construction priority system in effect on March 23, 2010; or (iii) is not included in clause (i) or (ii) and is selected, as determined by the Secretary—(I) on the initiative of the Secretary; or (II) pursuant to a request of an Indian tribe or tribal organization. (2) Report; contents(A) Initial comprehensive report(i) DefinitionsIn this subparagraph:(I) Facilities Appropriation Advisory BoardThe term “Facilities Appropriation Advisory Board” means the advisory board, comprised of 12 members representing Indian tribes and 2 members representing the Service, established at the discretion of the Director—(aa) to provide advice and recommendations for policies and procedures of the programs funded pursuant to facilities appropriations; and (bb) to address other facilities issues. (II) Facilities Needs Assessment WorkgroupThe term “Facilities Needs Assessment Workgroup” means the workgroup established at the discretion of the Director—(aa) to review the health care facilities construction priority system; and (bb) to make recommendations to the Facilities Appropriation Advisory Board for revising the priority system. (ii) Initial report(I) In generalNot later than 1 year 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 the comprehensive, national, ranked list of all health care facilities needs for the Service, Indian tribes, and tribal organizations (including inpatient health care facilities, outpatient health care facilities, specialized health care facilities (such as for long-term care and alcohol and drug abuse treatment), wellness centers, and staff quarters, and the renovation and expansion needs, if any, of such facilities) developed by the Service, Indian tribes, and tribal organizations for the Facilities Needs Assessment Workgroup and the Facilities Appropriation Advisory Board. (II) InclusionsThe initial report shall include—(aa) the methodology and criteria used by the Service in determining the needs and establishing the ranking of the facilities needs; and (bb) such other information as the Secretary determines to be appropriate. (iii) Updates of reportBeginning in calendar year 2011, the Secretary shall—(I) update the report under clause (ii) not less frequently that once every 5 years; and (II) include the updated report in the appropriate annual report under subparagraph (B) for submission to Congress under section 1671 of this title. (B) Annual reportsThe Secretary shall submit to the President, for inclusion in the report required to be transmitted to Congress under section 1671 of this title, a report which sets forth the following:(i) A description of the health care facility priority system of the Service established under paragraph (1). (ii) Health care facilities lists, which may include—(I) the 10 top-priority inpatient health care facilities; (II) the 10 top-priority outpatient health care facilities; (III) the 10 top-priority specialized health care facilities (such as long-term care and alcohol and drug abuse treatment); and (IV) the 10 top-priority staff quarters developments associated with health care facilities. (iii) The justification for such order of priority. (iv) The projected cost of such projects. (v) The methodology adopted by the Service in establishing priorities under its health care facility priority system. (3) Requirements for preparation of reportsIn preparing the report required under paragraph (2), the Secretary shall—(A) consult with and obtain information on all health care facilities needs from Indian tribes and tribal organizations; and (B) review the total unmet needs of all Indian tribes and tribal organizations for health care facilities (including staff quarters), including needs for renovation and expansion of existing facilities. (d) Review of methodology used for health facilities construction priority system(1) In generalNot later than 1 year after the establishment of the priority system under subsection (c)(1)(A), the Comptroller General of the United States shall prepare and finalize a report reviewing the methodologies applied, and the processes followed, by the Service in making each assessment of needs for the list under subsection (c)(2)(A)(ii) and developing the priority system under subsection (c)(1), including a review of—(A) the recommendations of the Facilities Appropriation Advisory Board and the Facilities Needs Assessment Workgroup (as those terms are defined in subsection (c)(2)(A)(i)); and (B) the relevant criteria used in ranking or prioritizing facilities other than hospitals or clinics. (2) Submission to CongressThe Comptroller General of the United States shall submit the report under paragraph (1) to—(A) the Committees on Indian Affairs and Appropriations of the Senate; (B) the Committees on Natural Resources and Appropriations of the House of Representatives; and (C) the Secretary. (e) Funding conditionAll funds appropriated under section 13 of this title, for the planning, design, construction, or renovation of health facilities for the benefit of 1 or more Indian Tribes shall be subject to the provisions of section 102 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450f) 1 or sections 504 and 505 of that Act (25 U.S.C. 458aaa–3, 458aaa–4).1 (f) Development of innovative approachesThe Secretary shall consult and cooperate with Indian tribes and tribal organizations, and confer with urban Indian organizations, in developing innovative approaches to address all or part of the total unmet need for construction of health facilities, that may include—(1) the establishment of an area distribution fund in which a portion of health facility construction funding could be devoted to all Service areas; (2) approaches provided for in other provisions of this subchapter; and (3) other approaches, as the Secretary determines to be appropriate. (h) 22 So in original. Subsec. (g) is set out below. Funds appropriated subject to section 5321 of this titleAll funds appropriated under section 13 of this title for the planning, design, construction, or renovation of health facilities for the benefit of an Indian tribe or tribes shall be subject to the provisions of section 102 of the Indian Self-Determination Act [25 U.S.C. 5321]. (g) 33 So in original. Subsec. (h) is set out above. Priority of certain projects protectedThe priority of any project established under the construction priority system in effect on March 23, 2010, shall not be affected by any change in the construction priority system taking place after that date if the project—(1) was identified in the fiscal year 2008 Service budget justification as—(A) 1 of the 10 top-priority inpatient projects; (B) 1 of the 10 top-priority outpatient projects; (C) 1 of the 10 top-priority staff quarters developments; or (D) 1 of the 10 top-priority Youth Regional Treatment Centers; (2) had completed both Phase I and Phase II of the construction priority system in effect on March 23, 2010; or (3) is not included in clause (i) or (ii) 44 So in original. Probably should be “paragraph (1) or (2)”. and is selected, as determined by the Secretary—(A) on the initiative of the Secretary; or (B) pursuant to a request of an Indian tribe or tribal organization.

25 U.S.C. § 1632 Safe water and sanitary waste disposal facilities

(a) Congressional findingsThe Congress hereby finds and declares that—(1) the provision of safe water supply systems and sanitary sewage and solid waste disposal systems is primarily a health consideration and function; (2) Indian people suffer an inordinately high incidence of disease, injury, and illness directly attributable to the absence or inadequacy of such systems; (3) the long-term cost to the United States of treating and curing such disease, injury, and illness is substantially greater than the short-term cost of providing such systems and other preventive health measures; (4) many Indian homes and communities still lack safe water supply systems and sanitary sewage and solid waste disposal systems; and (5) it is in the interest of the United States, and it is the policy of the United States, that all Indian communities and Indian homes, new and existing, be provided with safe and adequate water supply systems and sanitary sewage waste disposal systems as soon as possible. (b) Authority; assistance; transfer of funds(1) In furtherance of the findings and declarations made in subsection (a), Congress reaffirms the primary responsibility and authority of the Service to provide the necessary sanitation facilities and services as provided in section 2004a of title 42. (2) The Secretary, acting through the Service, is authorized to provide under section 2004a of title 42—(A) financial and technical assistance to Indian tribes and communities in the establishment, training, and equipping of utility organizations to operate and maintain Indian sanitation facilities; (B) ongoing technical assistance and training in the management of utility organizations which operate and maintain sanitation facilities; and (C) operation and maintenance assistance for, and emergency repairs to, tribal sanitation facilities when necessary to avoid a health hazard or to protect the Federal investment in sanitation facilities. (3) Notwithstanding any other provision of law—(A) the Secretary of Housing and Urban Affairs is authorized to transfer funds appropriated under the Housing and Community Development Act of 1974 (42 U.S.C. 5301, et seq.) to the Secretary of Health and Human Services, and (B) the Secretary of Health and Human Services is authorized to accept and use such funds for the purpose of providing sanitation facilities and services for Indians under section 2004a of title 42. (c) 10-year planBeginning in fiscal year 1990, the Secretary, acting through the Service, shall develop and begin implementation of a 10-year plan to provide safe water supply and sanitation sewage and solid waste disposal facilities to existing Indian homes and communities and to new and renovated Indian homes. (d) Tribal capabilityThe financial and technical capability of an Indian tribe or community to safely operate and maintain a sanitation facility shall not be a prerequisite to the provision or construction of sanitation facilities by the Secretary. (e) Amount of assistance(1) The Secretary is authorized to provide financial assistance to Indian tribes and communities in an amount equal to the Federal share of the costs of operating, managing, and maintaining the facilities provided under the plan described in subsection (c). (2) For the purposes of paragraph (1), the term “Federal share” means 80 percent of the costs described in paragraph (1). (3) With respect to Indian tribes with fewer than 1,000 enrolled members, the non-Federal portion of the costs of operating, managing, and maintaining such facilities may be provided, in part, through cash donations or in kind property, fairly evaluated. (f) Eligibility of programs administered by Indian tribesPrograms administered by Indian tribes or tribal organizations under the authority of the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] shall be eligible for—(1) any funds appropriated pursuant to this section, and (2) any funds appropriated for the purpose of providing water supply or sewage disposal services, on an equal basis with programs that are administered directly by the Service. (g) Annual report; sanitation deficiency levels(1) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, a report which sets forth—(A) the current Indian sanitation facility priority system of the Service; (B) the methodology for determining sanitation deficiencies; (C) the level of sanitation deficiency for each sanitation facilities project of each Indian tribe or community; (D) the amount of funds necessary to raise all Indian tribes and communities to a level I sanitation deficiency; and (E) the amount of funds necessary to raise all Indian tribes and communities to zero sanitation deficiency. (2) In preparing each report required under paragraph (1) (other than the initial report), the Secretary shall consult with Indian tribes and tribal organizations (including those tribes or tribal organizations operating health care programs or facilities under any contract entered into with the Service under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]) to determine the sanitation needs of each tribe. (3) The methodology used by the Secretary in determining sanitation deficiencies for purposes of paragraph (1) shall be applied uniformly to all Indian tribes and communities. (4) For purposes of this subsection, the sanitation deficiency levels for an Indian tribe or community are as follows:(A) level I is an Indian tribe or community with a sanitation system—(i) which complies with all applicable water supply and pollution control laws, and (ii) in which the deficiencies relate to routine replacement, repair, or maintenance needs; (B) level II is an Indian tribe or community with a sanitation system—(i) which complies with all applicable water supply and pollution control laws, and (ii) in which the deficiencies relate to capital improvements that are necessary to improve the facilities in order to meet the needs of such tribe or community for domestic sanitation facilities; (C) level III is an Indian tribe or community with a sanitation system which—(i) has an inadequate or partial water supply and a sewage disposal facility that does not comply with applicable water supply and pollution control laws, or (ii) has no solid waste disposal facility; (D) level IV is an Indian tribe or community with a sanitation system which lacks either a safe water supply system or a sewage disposal system; and (E) level V is an Indian tribe or community that lacks a safe water supply and a sewage disposal system. (5) For purposes of this subsection, any Indian tribe or community that lacks the operation and maintenance capability to enable its sanitation system to meet pollution control laws may not be treated as having a level I or II sanitation deficiency.

25 U.S.C. § 1633 Preferences to Indians and Indian firms

(a) Discretionary authority; covered activitiesThe Secretary, acting through the Service, may utilize the negotiating authority of section 47 of this title, to give preference to any Indian or any enterprise, partnership, corporation, or other type of business organization owned and controlled by an Indian or Indians including former or currently federally recognized Indian tribes in the State of New York (hereinafter referred to as an “Indian firm”) in the construction and renovation of Service facilities pursuant to section 1631 of this title and in the construction of safe water and sanitary waste disposal facilities pursuant to section 1632 of this title. Such preference may be accorded by the Secretary unless he finds, pursuant to rules and regulations promulgated by him, that the project or function to be contracted for will not be satisfactory or such project or function cannot be properly completed or maintained under the proposed contract. The Secretary, in arriving at his finding, shall consider whether the Indian or Indian firm will be deficient with respect to (1) ownership and control by Indians, (2) equipment, (3) bookkeeping and accounting procedures, (4) substantive knowledge of the project or function to be contracted for, (5) adequately trained personnel, or (6) other necessary components of contract performance. (b) Pay ratesFor the purpose of implementing the provisions of this subchapter, the Secretary shall assure that the rates of pay for personnel engaged in the construction or renovation of facilities constructed or renovated in whole or in part by funds made available pursuant to this subchapter are not less than the prevailing local wage rates for similar work as determined in accordance with sections 3141–3144, 3146, and 3147 of title 40.

25 U.S.C. § 1634 Expenditure of non-Service funds for renovation

(a) Authority of Secretary(1) Notwithstanding any other provision of law, the Secretary is authorized to accept any major renovation or modernization by any Indian tribe of any Service facility, or of any other Indian health facility operated pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.], including—(A) any plans or designs for such renovation or modernization; and (B) any renovation or modernization for which funds appropriated under any Federal law were lawfully expended, but only if the requirements of subsection (b) are met. (2) The Secretary shall maintain a separate priority list to address the needs of such facilities for personnel or equipment. (3) The Secretary shall submit to the President, for inclusion in each report required to be transmitted to the Congress under section 1671 of this title, the priority list maintained pursuant to paragraph (2). (b) RequirementsThe requirements of this subsection are met with respect to any renovation or modernization if—(1) the tribe or tribal organization—(A) provides notice to the Secretary of its intent to renovate or modernize; and (B) applies to the Secretary to be placed on a separate priority list to address the needs of such new facilities for personnel or equipment; and (2) the renovation or modernization—(A) is approved by the appropriate area director of the Service; and (B) is administered by the tribe in accordance with the rules and regulations prescribed by the Secretary with respect to construction or renovation of Service facilities. (c) Recovery for non-use as Service facilityIf any Service facility which has been renovated or modernized by an Indian tribe under this section ceases to be used as a Service facility during the 20-year period beginning on the date such renovation or modernization is completed, such Indian tribe shall be entitled to recover from the United States an amount which bears the same ratio to the value of such facility at the time of such cessation as the value of such renovation or modernization (less the total amount of any funds provided specifically for such facility under any Federal program that were expended for such renovation or modernization) bore to the value of such facility at the time of the completion of such renovation or modernization.

25 U.S.C. § 1636 Grant program for construction, expansion, and modernization of small ambulatory care facilities

(a) Authorization(1) The Secretary, acting through the Service, shall make grants to tribes and tribal organizations for the construction, expansion, or modernization of facilities for the provision of ambulatory care services to eligible Indians (and noneligible persons as provided in subsection (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such construction, expansion, or modernization. For the purposes of this section, the term “construction” includes the replacement of an existing facility. (2) A grant under paragraph (1) may only be made to a tribe or tribal organization operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to a tribe or tribal organization) pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]. (b) Use of grant(1) A grant provided under this section may be used only for the construction, expansion, or modernization (including the planning and design of such construction, expansion, or modernization) of an ambulatory care facility—(A) located apart from a hospital; (B) not funded under section 1631 of this title or section 1637 of this title; and (C) which, upon completion of such construction, expansion, or modernization will—(i) have a total capacity appropriate to its projected service population; (ii) serve no less than 500 eligible Indians annually; and (iii) provide ambulatory care in a service area (specified in the contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]) with a population of not less than 2,000 eligible Indians. (2) The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to a tribe or tribal organization applying for a grant under this section whose tribal government offices are located on an island. (c) Application for grant(1) No grant may be made under this section unless an application for such a grant has been submitted to and approved by the Secretary. An application for a grant under this section shall be submitted in such form and manner as the Secretary shall by regulation prescribe and shall set forth reasonable assurance by the applicant that, at all times after the construction, expansion, or modernization of a facility carried out pursuant to a grant received under this section—(A) adequate financial support will be available for the provision of services at such facility; (B) such facility will be available to eligible Indians without regard to ability to pay or source of payment; and (C) such facility will, as feasible without diminishing the quality or quantity of services provided to eligible Indians, serve noneligible persons on a cost basis. (2) In awarding grants under this section, the Secretary shall give priority to tribes and tribal organizations that demonstrate—(A) a need for increased ambulatory care services; and (B) insufficient capacity to deliver such services. (d) Transfer of interest to United States upon cessation of facilityIf any facility (or portion thereof) with respect to which funds have been paid under this section, ceases, at any time after completion of the construction, expansion, or modernization carried out with such funds, to be utilized for the purposes of providing ambulatory care services to eligible Indians, all of the right, title, and interest in and to such facility (or portion thereof) shall transfer to the United States.

25 U.S.C. § 1637 Indian health care delivery demonstration projects

(a) Purpose and general authority(1) PurposeThe purpose of this section is to encourage the establishment of demonstration projects that meet the applicable criteria of this section to be carried out by the Secretary, acting through the Service, or Indian tribes or tribal organizations acting pursuant to contracts or compacts under the Indian Self Determination 11 So in original. Probably should be “Self-Determination”. and Education Assistance Act (25 U.S.C. 450 et seq.)— 22 See References in Text note below.(A) to test alternative means of delivering health care and services to Indians through facilities; or (B) to use alternative or innovative methods or models of delivering health care services to Indians (including primary care services, contract health services, or any other program or service authorized by this chapter) through convenient care services (as defined in subsection (c)), community health centers, or cooperative agreements or arrangements with other health care providers that share or coordinate the use of facilities, funding, or other resources, or otherwise coordinate or improve the coordination of activities of the Service, Indian tribes, or tribal organizations, with those of the other health care providers. (2) AuthorityThe Secretary, acting through the Service, is authorized to carry out, or to enter into contracts or compacts under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 2 with Indian tribes or tribal organizations to carry out, health care delivery demonstration projects that—(A) test alternative means of delivering health care and services to Indians through facilities; or (B) otherwise carry out the purposes of this section. (b) Use of fundsThe Secretary, in approving projects pursuant to this section—(1) may authorize such contracts for the construction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services; and (2) is authorized—(A) to waive any leasing prohibition; (B) to permit use and carryover of funds appropriated for the provision of health care services under this chapter (including for the purchase of health benefits coverage, as authorized by section 1642(a) of this title); (C) to permit the use of other available funds, including other Federal funds, funds from third-party collections in accordance with sections 1621e, 1621f, and 1641 of this title, and non-Federal funds contributed by State or local governmental agencies or facilities or private health care providers pursuant to cooperative or other agreements with the Service, 1 or more Indian tribes, or tribal organizations; (D) to permit the use of funds or property donated or otherwise provided from any source for project purposes; (E) to provide for the reversion of donated real or personal property to the donor; and (F) to permit the use of Service funds to match other funds, including Federal funds. (c) Health care demonstration projects(1) Definition of convenient care serviceIn this subsection, the term “convenient care service” means any primary health care service, such as urgent care services, nonemergent care services, prevention services and screenings, and any service authorized by section 1621b of this title or 1621d(d) of this title, that is offered—(A) at an alternative setting; or (B) during hours other than regular working hours. (2) General projects(A) CriteriaThe Secretary may approve under this section demonstration projects that meet the following criteria:(i) There is a need for a new facility or program, such as a program for convenient care services, or an improvement in, increased efficiency at, or reorientation of an existing facility or program. (ii) A significant number of Indians, including Indians with low health status, will be served by the project. (iii) The project has the potential to deliver services in an efficient and effective manner. (iv) The project is economically viable. (v) For projects carried out by an Indian tribe or tribal organization, the Indian tribe or tribal organization has the administrative and financial capability to administer the project. (vi) The project is integrated with providers of related health or social services (including State and local health care agencies or other health care providers) and is coordinated with, and avoids duplication of, existing services in order to expand the availability of services. (B) PriorityIn approving demonstration projects under this paragraph, the Secretary shall give priority to demonstration projects, to the extent the projects meet the criteria described in subparagraph (A), located in any of the following Service units:(i) Cass Lake, Minnesota. (ii) Mescalero, New Mexico. (iii) Owyhee and Elko, Nevada. (iv) Schurz, Nevada. (v) Ft. Yuma, California. (3) Innovative health services delivery demonstration project(A) Application or requestOn receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization within a Service area, the Secretary shall take into consideration alternative or innovated 33 So in original. Probably should be “innovative”. methods to deliver health care services within the Service area (or a portion of, or facility within, the Service area) as described in the application or request, including medical, dental, pharmaceutical, nursing, clinical laboratory, contract health services, convenient care services, community health centers, or any other health care services delivery models designed to improve access to, or efficiency or quality of, the health care, health promotion, or disease prevention services and programs under this chapter. (B) ApprovalIn addition to projects described in paragraph (2), in any fiscal year, the Secretary is authorized under this paragraph to approve not more than 10 applications for health care delivery demonstration projects that meet the criteria described in subparagraph (C). (C) CriteriaThe Secretary shall approve under subparagraph (B) demonstration projects that meet all of the following criteria:(i) The criteria set forth in paragraph (2)(A). (ii) There is a lack of access to health care services at existing health care facilities, which may be due to limited hours of operation at those facilities or other factors. (iii) The project—(I) expands the availability of services; or (II) reduces—(aa) the burden on Contract Health Services; or (bb) the need for emergency room visits. (d) Technical assistanceOn receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization, the Secretary shall provide such technical and other assistance as may be necessary to enable applicants to comply with this section, including information regarding the Service unit budget and available funding for carrying out the proposed demonstration project. (e) Service to ineligible personsSubject to section 1680c of this title, the authority to provide services to persons otherwise ineligible for the health care benefits of the Service, and the authority to extend hospital privileges in Service facilities to non-Service health practitioners as provided in section 1680c of this title, may be included, subject to the terms of that section, in any demonstration project approved pursuant to this section. (f) Equitable treatmentFor purposes of subsection (c), the Secretary, in evaluating facilities operated under any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),2 shall use the same criteria that the Secretary uses in evaluating facilities operated directly by the Service. (g) Equitable integration of facilitiesThe Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities that are the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 2 for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section.

25 U.S.C. § 1638 Land transfer

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

25 U.S.C. § 1638a Tribal management of federally owned quarters

(a) Rental rates(1) EstablishmentNotwithstanding any other provision of law, a tribal health program that operates a hospital or other health facility and the federally owned quarters associated with such a facility pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 11 See References in Text note below. may establish the rental rates charged to the occupants of those quarters, on providing notice to the Secretary. (2) ObjectivesIn establishing rental rates under this subsection, a tribal health program shall attempt—(A) to base the rental rates on the reasonable value of the quarters to the occupants of the quarters; and (B) to generate sufficient funds to prudently provide for the operation and maintenance of the quarters, and at the discretion of the tribal health program, to supply reserve funds for capital repairs and replacement of the quarters. (3) Equitable fundingA federally owned quarters the rental rates for which are established by a tribal health program under this subsection shall remain eligible to receive improvement and repair funds to the same extent that all federally owned quarters used to house personnel in programs of the Service are eligible to receive those funds. (4) Notice of rate changeA tribal health program that establishes a rental rate under this subsection shall provide occupants of the federally owned quarters a notice of any change in the rental rate by not later than the date that is 60 days notice before the effective date of the change. (5) Rates in AlaskaA rental rate established by a tribal health program under this section for a federally owned quarters in the State of Alaska may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of 1,500 or more individuals. (b) Direct collection of rent(1) In generalNotwithstanding any other provision of law, and subject to paragraph (2), a tribal health program may collect rent directly from Federal employees who occupy federally owned quarters if the tribal health program submits to the Secretary and the employees a notice of the election of the tribal health program to collect rents directly from the employees. (2) Action by employeesOn receipt of a notice described in paragraph (1)—(A) the affected Federal employees shall pay rent for occupancy of a federally owned quarters directly to the applicable tribal health program; and (B) the Secretary shall not have the authority to collect rent from the employees through payroll deduction or otherwise. (3) Use of paymentsThe rent payments under this subsection—(A) shall be retained by the applicable tribal health program in a separate account, which shall be used by the tribal health program for the maintenance (including capital repairs and replacement) and operation of the quarters, as the tribal health program determines to be appropriate; and (B) shall not be made payable to, or otherwise be deposited with, the United States. (4) Retrocession of authorityIf a tribal health program that elected to collect rent directly under paragraph (1) requests retrocession of the authority of the tribal health program to collect that rent, the retrocession shall take effect on the earlier of—(A) the first day of the month that begins not less than 180 days after the tribal health program submits the request; and (B) such other date as may be mutually agreed on by the Secretary and the tribal health program.

25 U.S.C. § 1638b Applicability of Buy American requirement

(a) Duty of SecretaryThe Secretary shall ensure that the requirements of the Buy American Act apply to all procurements made with funds made available to carry out this subchapter. (b) Report to CongressThe Secretary shall submit to the Congress a report on the amount of procurements from foreign entities made in fiscal years 1993 and 1994 with funds made available to carry out this subchapter. Such report shall separately indicate the dollar value of items procured with such funds for which the Buy American Act was waived pursuant to the Trade Agreement Act of 1979 or any international agreement to which the United States is a party. (c) Fraudulent use of Made-in-America labelIf it has been finally determined by a court or Federal agency that any person intentionally affixed a label bearing a “Made in America” inscription, or any inscription with the same meaning, to any product sold in or shipped to the United States that is not made in the United States, such person shall be ineligible to receive any contract or subcontract made with funds made available to carry out this subchapter, pursuant to the debarment, suspension, and ineligibility procedures described in sections 9.400 through 9.409 of title 48, Code of Federal Regulations. (d) “Buy American Act” definedFor purposes of this section, the term “Buy American Act” means title III of the Act entitled “An Act making appropriations for the Treasury and Post Office Departments for the fiscal year ending June 30, 1934, and for other purposes”, approved March 3, 1933 (41 U.S.C. 10a et seq.) 11 See References in Text note below..

25 U.S.C. § 1638c Contracts for personal services in Indian Health Service facilities

In fiscal year 1995 and thereafter (a) the Secretary may enter into personal services contracts with entities, either individuals or organizations, for the provision of services in facilities owned, operated or constructed under the jurisdiction of the Indian Health Service; (b) the Secretary may exempt such a contract from competitive contracting requirements upon adequate notice of contracting opportunities to individuals and organizations residing in the geographic vicinity of the health facility; (c) consideration of individuals and organizations shall be based solely on the qualifications established for the contract and the proposed contract price; and (d) individuals providing health care services pursuant to these contracts are covered by the Federal Tort Claims Act.

25 U.S.C. § 1638d Credit to appropriations of money collected for meals at Indian Health Service facilities

Money before, on, and after September 30, 1994, collected for meals served at Indian Health Service facilities will be credited to the appropriations from which the services were furnished and shall be credited to the appropriation when received.

25 U.S.C. § 1638e Other funding, equipment, and supplies for facilities

(a) Authorization(1) Authority to transfer fundsThe head of any Federal agency to which funds, equipment, or other supplies are made available for the planning, design, construction, or operation of a health care or sanitation facility may transfer the funds, equipment, or supplies to the Secretary for the planning, design, construction, or operation of a health care or sanitation facility to achieve—(A) the purposes of this chapter; and (B) the purposes for which the funds, equipment, or supplies were made available to the Federal agency. (2) Authority to accept fundsThe Secretary may—(A) accept from any source, including Federal and State agencies, funds, equipment, or supplies that are available for the construction or operation of health care or sanitation facilities; and (B) use those funds, equipment, and supplies to plan, design,,11 So in original. construct, and operate health care or sanitation facilities for Indians, including pursuant to a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).22 See References in Text note below. (3) Effect of receiptReceipt of funds by the Secretary under this subsection shall not affect any priority established under section 1631 of this title. (b) Interagency agreementsThe Secretary may enter into interagency agreements with Federal or State agencies and other entities, and accept funds, equipment, or other supplies from those entities, to provide for the planning, design, construction, and operation of health care or sanitation facilities to be administered by Indian health programs to achieve—(1) the purposes of this chapter; and (2) the purposes for which the funds were appropriated or otherwise provided. (c) Establishment of standards(1) In generalThe Secretary, acting through the Service, shall establish, by regulation, standards for the planning, design, construction, and operation of health care or sanitation facilities serving Indians under this chapter. (2) Other regulationsNotwithstanding any other provision of law, any other applicable regulations of the Department shall apply in carrying out projects using funds transferred under this section. (d) Definition of sanitation facilityIn this section, the term “sanitation facility” means a safe and adequate water supply system, sanitary sewage disposal system, or sanitary solid waste system (including all related equipment and support infrastructure).

25 U.S.C. § 1638f Indian country modular component facilities demonstration program

(a) Definition of modular component health care facilityIn this section, the term “modular component health care facility” means a health care facility that is constructed—(1) off-site using prefabricated component units for subsequent transport to the destination location; and (2) represents 11 So in original. a more economical method for provision of health care facility 22 So in original. Probably should be “provision of a health care facility”. than a traditionally constructed health care building. (b) EstablishmentThe Secretary, acting through the Service, shall establish a demonstration program under which the Secretary shall award no less than 3 grants for purchase, installation and maintenance of modular component health care facilities in Indian communities for provision of health care services. (c) Selection of locations(1) Petitions(A) SolicitationThe Secretary shall solicit from Indian tribes petitions for location of the modular component health care facilities in the Service areas of the petitioning Indian tribes. (B) PetitionTo be eligible to receive a grant under this section, an Indian tribe or tribal organization must submit to the Secretary a petition to construct a modular component health care facility in the Indian community of the Indian tribe, at such time, in such manner, and containing such information as the Secretary may require. (2) SelectionIn selecting the location of each modular component health care facility to be provided under the demonstration program, the Secretary shall give priority to projects already on the Indian Health Service facilities construction priority list and petitions which demonstrate that erection of a modular component health facility—(A) is more economical than construction of a traditionally constructed health care facility; (B) can be constructed and erected on the selected location in less time than traditional construction; and (C) can adequately house the health care services needed by the Indian population to be served. (3) Effect of selectionA modular component health care facility project selected for participation in the demonstration program shall not be eligible for entry on the facilities construction priorities list entitled “IHS Health Care Facilities FY 2011 Planned Construction Budget” and dated May 7, 2009 (or any successor list). (d) Eligibility(1) In generalAn Indian tribe may submit a petition under subsection (c)(1)(B) regardless of whether the Indian tribe is a party to any contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).33 See References in Text note below. (2) AdministrationAt the election of an Indian tribe or tribal organization selected for participation in the demonstration program, the funds provided for the project shall be subject to the provisions of the Indian Self-Determination and Education Assistance Act. (e) ReportsNot later than 1 year after the date on which funds are made available for the demonstration program and annually thereafter, the Secretary shall submit to Congress a report describing—(1) each activity carried out under the demonstration program, including an evaluation of the success of the activity; and (2) the potential benefits of increased use of modular component health care facilities in other Indian communities. (f) Authorization of appropriationsThere are authorized to be appropriated $50,000,000 to carry out the demonstration program under this section for the first 5 fiscal years, and such sums as may be necessary to carry out the program in subsequent fiscal years.

25 U.S.C. § 1638g Mobile health stations demonstration program

(a) DefinitionsIn this section:(1) Eligible tribal consortiumThe term “eligible tribal consortium” means a consortium composed of 2 or more Service units between which a mobile health station can be transported by road in up to 8 hours. A Service unit operated by the Service or by an Indian tribe or tribal organization shall be equally eligible for participation in such consortium. (2) Mobile health stationThe term “mobile health station” means a health care unit that—(A) is constructed, maintained, and capable of being transported within a semi-trailer truck or similar vehicle; (B) is equipped for the provision of 1 or more specialty health care services; and (C) can be equipped to be docked to a stationary health care facility when appropriate. (3) Specialty health care service(A) In generalThe term “specialty health care service” means a health care service which requires the services of a health care professional with specialized knowledge or experience. (B) InclusionsThe term “specialty health care service” includes any service relating to—(i) dialysis; (ii) surgery; (iii) mammography; (iv) dentistry; or (v) any other specialty health care service. (b) EstablishmentThe Secretary, acting through the Service, shall establish a demonstration program under which the Secretary shall provide at least 3 mobile health station projects. (c) PetitionTo be eligible to receive a mobile health station under the demonstration program, an eligible tribal consortium shall submit to the Secretary,11 So in original. The comma probably should not appear. a petition at such time, in such manner, and containing—(1) a description of the Indian population to be served; (2) a description of the specialty service or services for which the mobile health station is requested and the extent to which such service or services are currently available to the Indian population to be served; and (3) such other information as the Secretary may require. (d) Use of fundsThe Secretary shall use amounts made available to carry out the demonstration program under this section—(1)(A) to establish, purchase, lease, or maintain mobile health stations for the eligible tribal consortia selected for projects; and (B) to provide, through the mobile health station, such specialty health care services as the affected eligible tribal consortium determines to be necessary for the Indian population served; (2) to employ an existing mobile health station (regardless of whether the mobile health station is owned or rented and operated by the Service) to provide specialty health care services to an eligible tribal consortium; and (3) to establish, purchase, or maintain docking equipment for a mobile health station, including the establishment or maintenance of such equipment at a modular component health care facility (as defined in section 1638f(a) of this title), if applicable. (e) ReportsNot later than 1 year after the date on which the demonstration program is established under subsection (b) and annually thereafter, the Secretary, acting through the Service, shall submit to Congress a report describing—(1) each activity carried out under the demonstration program including an evaluation of the success of the activity; and (2) the potential benefits of increased use of mobile health stations to provide specialty health care services for Indian communities. (f) Authorization of appropriationsThere are authorized to be appropriated $5,000,000 per year to carry out the demonstration program under this section for the first 5 fiscal years, and such sums as may be needed to carry out the program in subsequent fiscal years.