USC Subchapter I

USC Subchapter I
in effect

25 U.S.C. § 1611 Congressional statement of purpose

The purpose of this subchapter is to increase the number of Indians entering the health professions and to assure an adequate supply of health professionals to the Service, Indian tribes, tribal organizations, and urban Indian organizations involved in the provision of health care to Indian people.

25 U.S.C. § 1612 Health professions recruitment program for Indians

(a) Grants for education and trainingThe Secretary, acting through the Service, shall make grants to public or nonprofit private health or educational entities or Indian tribes or tribal organizations to assist such entities in meeting the costs of—(1) identifying Indians with a potential for education or training in the health professions and encouraging and assisting them—(A) to enroll in courses of study in such health professions; or (B) if they are not qualified to enroll in any such courses of study, to undertake such postsecondary education or training as may be required to qualify them for enrollment; (2) publicizing existing sources of financial aid available to Indians enrolled in any course of study referred to in paragraph (1) of this subsection or who are undertaking training necessary to qualify them to enroll in any such course of study; or (3) establishing other programs which the Secretary determines will enhance and facilitate the enrollment of Indians in, and the subsequent pursuit and completion by them of, courses of study referred to in paragraph (1) of this subsection. (b) Application for grant; submittal and approval; preference; payment(1) No grant may be made under this section unless an application therefor has been submitted to, and approved by, the Secretary. Such application shall be in such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe. The Secretary shall give a preference to applications submitted by Indian tribes or tribal organizations. (2) The amount of any grant under this section shall be determined by the Secretary. Payments pursuant to grants under this section may be made in advance or by way of reimbursement, and at such intervals and on such conditions as the Secretary finds necessary.

25 U.S.C. § 1613 Health professions preparatory scholarship program for Indians

(a) RequirementsThe Secretary, acting through the Service, shall make scholarship grants to Indians who—(1) have successfully completed their high school education or high school equivalency; and (2) have demonstrated the capability to successfully complete courses of study in the health professions. (b) Purposes and duration of grants; preprofessional and pregraduate educationScholarship grants made pursuant to this section shall be for the following purposes:(1) Compensatory preprofessional education of any grantee, such scholarship not to exceed two years on a full-time basis (or the part-time equivalent thereof, as determined by the Secretary). (2) Pregraduate education of any grantee leading to a baccalaureate degree in an approved course of study preparatory to a field of study in a health profession, such scholarship not to exceed 4 years (or the part-time equivalent thereof, as determined by the Secretary). (c) Covered expensesScholarship grants made under this section may cover costs of tuition, books, transportation, board, and other necessary related expenses of a grantee while attending school. (d) Basis for denial of assistanceThe Secretary shall not deny scholarship assistance to an eligible applicant under this section solely on the basis of the applicant’s scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution. (e) Eligibility for assistance under other Federal programsThe Secretary shall not deny scholarship assistance to an eligible applicant under this section solely by reason of such applicant’s eligibility for assistance or benefits under any other Federal program.

25 U.S.C. § 1613a Indian health professions scholarships

(a) General authorityIn order to provide health professionals to Indians, Indian tribes, tribal organizations, and urban Indian organizations, the Secretary, acting through the Service and in accordance with this section, shall make scholarship grants to Indians who are enrolled full or part time in appropriately accredited schools and pursuing courses of study in the health professions. Such scholarships shall be designated Indian Health Scholarships and shall be made in accordance with section 254l of title 42, except as provided in subsection (b) of this section. (b) Recipients; active duty service obligation(1) The Secretary, acting through the Service, shall determine who shall receive scholarships under subsection (a) and shall determine the distribution of such scholarships among such health professions on the basis of the relative needs of Indians for additional service in such health professions. (2) An individual shall be eligible for a scholarship under subsection (a) in any year in which such individual is enrolled full or part time in a course of study referred to in subsection (a) of this section. (3)(A) The active duty service obligation under a written contract with the Secretary under section 254l of title 42 that an individual has entered into under that section shall, if that individual is a recipient of an Indian Health Scholarship, be met in full-time practice, by service—(i) in the Indian Health Service; (ii) in a program conducted under a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]; (iii) in a program assisted under subchapter IV of this chapter; 11 So in original. Probably should be followed by “or”. (iv) in the private practice of the applicable profession if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians; or 22 So in original. The “; or” probably should be a period. (B) At the request of any individual who has entered into a contract referred to in subparagraph (A) and who receives a degree in medicine (including osteopathic or allopathic medicine), dentistry, optometry, podiatry, or pharmacy, the Secretary shall defer the active duty service obligation of that individual under that contract, in order that such individual may complete any internship, residency, or other advanced clinical training that is required for the practice of that health profession, for an appropriate period (in years, as determined by the Secretary), subject to the following conditions:(i) No period of internship, residency, or other advanced clinical training shall be counted as satisfying any period of obligated service that is required under this section. (ii) The active duty service obligation of that individual shall commence not later than 90 days after the completion of that advanced clinical training (or by a date specified by the Secretary). (iii) The active duty service obligation will be served in the health profession of that individual, in a manner consistent with clauses (i) through (v) of subparagraph (A). (C) A recipient of an Indian Health Scholarship may, at the election of the recipient, meet the active duty service obligation described in subparagraph (A) by service in a program specified in that subparagraph that—(i) is located on the reservation of the tribe in which the recipient is enrolled; or (ii) serves the tribe in which the recipient is enrolled. (D) Subject to subparagraph (C), the Secretary, in making assignments of Indian Health Scholarship recipients required to meet the active duty service obligation described in subparagraph (A), shall give priority to assigning individuals to service in those programs specified in subparagraph (A) that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. (4) In the case of an individual receiving a scholarship under this section who is enrolled part time in an approved course of study—(A) such scholarship shall be for a period of years not to exceed the part-time equivalent of 4 years, as determined by the Secretary; (B) the period of obligated service described in paragraph (3)(A) shall be equal to the greater of—(i) the part-time equivalent of one year for each year for which the individual was provided a scholarship (as determined by the Secretary); or (ii) two years; and (C) the amount of the monthly stipend specified in section 254l(g)(1)(B) of title 42 shall be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled. (5)(A) An individual who has, on or after October 29, 1992, entered into a written contract with the Secretary under this section and who—(i) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary), (ii) is dismissed from such educational institution for disciplinary reasons, (iii) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or (iv) fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract, shall be liable to the United States for the amount which has been paid to him, or on his behalf, under the contract. (B) If for any reason not specified in subparagraph (A) an individual breaches his written contract by failing either to begin such individual’s service obligation under this section or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 1616a of this title in the manner provided for in such subsection. (C) Upon the death of an individual who receives an Indian Health Scholarship, any obligation of that individual for service or payment that relates to that scholarship shall be canceled. (D) The Secretary shall provide for the partial or total waiver or suspension of any obligation of service or payment of a recipient of an Indian Health Scholarship if the Secretary determines that—(i) it is not possible for the recipient to meet that obligation or make that payment; (ii) requiring that recipient to meet that obligation or make that payment would result in extreme hardship to the recipient; or (iii) the enforcement of the requirement to meet the obligation or make the payment would be unconscionable. (E) Notwithstanding any other provision of law, in any case of extreme hardship or for other good cause shown, the Secretary may waive, in whole or in part, the right of the United States to recover funds made available under this section. (F) Notwithstanding any other provision of law, with respect to a recipient of an Indian Health Scholarship, no obligation for payment may be released by a discharge in bankruptcy under title 11, unless that discharge is granted after the expiration of the 5-year period beginning on the initial date on which that payment is due, and only if the bankruptcy court finds that the nondischarge of the obligation would be unconscionable. (c) Placement OfficeThe Secretary shall, acting through the Service, establish a Placement Office to develop and implement a national policy for the placement, to available vacancies within the Service, of Indian Health Scholarship recipients required to meet the active duty service obligation prescribed under section 254m of title 42 without regard to any competitive personnel system, agency personnel limitation, or Indian preference policy.

25 U.S.C. § 1614 Indian health service extern programs

(a) Employment of scholarship grantees during non­academic periodsAny individual who receives a scholarship grant pursuant to section 1613a of this title shall be entitled to employment in the Service during any nonacademic period of the year. Periods of employment pursuant to this subsection shall not be counted in determining the fulfillment of the service obligation incurred as a condition of the scholarship grant. (b) Employment of medical and other students during nonacademic periodsAny individual enrolled in a course of study in the health professions may be employed by the Service during any nonacademic period of the year. Any such employment shall not exceed one hundred and twenty days during any calendar year. (c) Employment without regard to competitive personnel system or agency personnel limitation; compensationAny employment pursuant to this section shall be made without regard to any competitive personnel system or agency personnel limitation and to a position which will enable the individual so employed to receive practical experience in the health profession in which he or she is engaged in study. Any individual so employed shall receive payment for his or her services comparable to the salary he or she would receive if he or she were employed in the competitive system. Any individual so employed shall not be counted against any employment ceiling affecting the Service or the Department of Health and Human Services.

25 U.S.C. § 1615 Continuing education allowances

In order to encourage scholarship and stipend recipients under sections 1613a, 1614, and 1616h of this title and health professionals, including community health representatives and emergency medical technicians, to join or continue in an Indian health program and to provide services in the rural and remote areas in which a significant portion of Indians reside, the Secretary, acting through the Service, may— (1) provide programs or allowances to transition into an Indian health program, including licensing, board or certification examination assistance, and technical assistance in fulfilling service obligations under sections 1613a, 1614, and 1616h of this title; and (2) provide programs or allowances to health professionals employed in an Indian health program to enable those professionals, for a period of time each year prescribed by regulation of the Secretary, to take leave of the duty stations of the professionals for professional consultation, management, leadership, and refresher training courses.

25 U.S.C. § 1616 Community Health Representative Program

(a) Under the authority of section 13 of this title, the Secretary shall maintain a Community Health Representative Program under which the Service—(1) provides for the training of Indians as health paraprofessionals, and (2) uses such paraprofessionals in the provision of health care, health promotion, and disease prevention services to Indian communities. (b) The Secretary, acting through the Community Health Representative Program of the Service, shall—(1) provide a high standard of training for paraprofessionals to Community Health Representatives to ensure that the Community Health Representatives provide quality health care, health promotion, and disease prevention services to the Indian communities served by such Program, (2) in order to provide such training, develop and maintain a curriculum that—(A) combines education in the theory of health care with supervised practical experience in the provision of health care, and (B) provides instruction and practical experience in health promotion and disease prevention activities, with appropriate consideration given to lifestyle factors that have an impact on Indian health status, such as alcoholism, family dysfunction, and poverty, (3) maintain a system which identifies the needs of Community Health Representatives for continuing education in health care, health promotion, and disease prevention and maintain programs that meet the needs for such continuing education, (4) maintain a system that provides close supervision of Community Health Representatives, (5) maintain a system under which the work of Community Health Representatives is reviewed and evaluated, and (6) promote traditional health care practices of the Indian tribes served consistent with the Service standards for the provision of health care, health promotion, and disease prevention.

25 U.S.C. § 1616a Indian Health Service Loan Repayment Program

(a) Establishment(1) The Secretary, acting through the Service, shall establish a program to be known as the Indian Health Service Loan Repayment Program (hereinafter referred to as the “Loan Repayment Program”) in order to assure an adequate supply of trained health professionals necessary to maintain accreditation of, and provide health care services to Indians through, Indian health programs. (2) For the purposes of this section—(A) the term “Indian health program” means any health program or facility funded, in whole or part, by the Service for the benefit of Indians and administered—(i) directly by the Service; (ii) by any Indian tribe or tribal or Indian organization pursuant to a contract under—(I) the Indian Self-Determination Act [25 U.S.C. 5321 et seq.], or (II) section 23 of the Act of April 30, 1908 11 See References in Text note below. (25 U.S.C. 47), popularly known as the “Buy-Indian” Act; or (iii) by an urban Indian organization pursuant to subchapter IV of this chapter; and (B) the term “State” has the same meaning given such term in section 254d(i)(4) 1 of title 42. (b) EligibilityTo be eligible to participate in the Loan Repayment Program, an individual must—(1)(A) be enrolled—(i) in a course of study or program in an accredited institution, as determined by the Secretary, within any State and be scheduled to complete such course of study in the same year such individual applies to participate in such program; or (ii) in an approved graduate training program in a health profession; or (B) have—(i) a degree in a health profession; and (ii) a license to practice a health profession in a State; (2)(A) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps 22 See Change of Name note below. of the Public Health Service; (B) be eligible for selection for civilian service in the Regular or Reserve Corps 2 of the Public Health Service; (C) meet the professional standards for civil service employment in the Indian Health Service; or (D) be employed in an Indian health program without a service obligation; and (3) submit to the Secretary an application for a contract described in subsection (f). (c) Application and contract forms(1) In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall include with such forms a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled under subsection (l) in the case of the individual’s breach of the contract. The Secretary shall provide such individuals with sufficient information regarding the advantages and disadvantages of service as a commissioned officer in the Regular or Reserve Corps 2 of the Public Health Service or a civilian employee of the Indian Health Service to enable the individual to make a decision on an informed basis. (2) The application form, contract form, and all other information furnished by the Secretary under this section shall be written in a manner calculated to be understood by the average individual applying to participate in the Loan Repayment Program. (3) The Secretary shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such forms and information. (d) Vacancies; priority(1) Consistent with paragraph (3), the Secretary, acting through the Service and in accordance with subsection (k), shall annually—(A) identify the positions in each Indian health program for which there is a need or a vacancy, and (B) rank those positions in order of priority. (2) Consistent with the priority determined under paragraph (1), the Secretary, in determining which applications under the Loan Repayment Program to approve (and which contracts to accept), shall give priority to applications made by—(A) Indians; and (B) individuals recruited through the efforts of Indian tribes or tribal or Indian organizations. (3)(A) Subject to subparagraph (B), of the total amounts appropriated for each of the fiscal years 1993, 1994, and 1995 for loan repayment contracts under this section, the Secretary shall provide that—(i) not less than 25 percent be provided to applicants who are nurses, nurse practitioners, or nurse midwives; and (ii) not less than 10 percent be provided to applicants who are mental health professionals (other than applicants described in clause (i)). (B) The requirements specified in clause (i) or clause (ii) of subparagraph (A) shall not apply if the Secretary does not receive the number of applications from the individuals described in clause (i) or clause (ii), respectively, necessary to meet such requirements. (e) Approval(1) An individual becomes a participant in the Loan Repayment Program only upon the Secretary and the individual entering into a written contract described in subsection (f). (2) The Secretary shall provide written notice to an individual promptly on—(A) the Secretary’s approving, under paragraph (1), of the individual’s participation in the Loan Repayment Program, including extensions resulting in an aggregate period of obligated service in excess of 4 years; or (B) the Secretary’s disapproving an individual’s participation in such Program. (f) Contract termsThe written contract referred to in this section between the Secretary and an individual shall contain—(1) an agreement under which—(A) subject to paragraph (3), the Secretary agrees—(i) to pay loans on behalf of the individual in accordance with the provisions of this section, and (ii) to accept (subject to the availability of appropriated funds for carrying out this section) the individual into the Service or place the individual with a tribe or Indian organization as provided in subparagraph (B)(iii), and (B) subject to paragraph (3), the individual agrees—(i) to accept loan payments on behalf of the individual; (ii) in the case of an individual described in subsection (b)(1)—(I) to maintain enrollment in a course of study or training described in subsection (b)(1)(A) until the individual completes the course of study or training, and (II) while enrolled in such course of study or training, to maintain an acceptable level of academic standing (as determined under regulations of the Secretary by the educational institution offering such course of study or training); (iii) to serve for a time period (hereinafter in this section referred to as the “period of obligated service”) equal to 2 years or such longer period as the individual may agree to serve in the full-time clinical practice of such individual’s profession in an Indian health program to which the individual may be assigned by the Secretary; (2) a provision permitting the Secretary to extend for such longer additional periods, as the individual may agree to, the period of obligated service agreed to by the individual under paragraph (1)(B)(iii); (3) a provision that any financial obligation of the United States arising out of a contract entered into under this section and any obligation of the individual which is conditioned thereon is contingent upon funds being appropriated for loan repayments under this section; (4) a statement of the damages to which the United States is entitled under subsection (l) for the individual’s breach of the contract; and (5) such other statements of the rights and liabilities of the Secretary and of the individual, not inconsistent with this section. (g) Loan repayment purposes; maximum amount; tax liability reimbursement; schedule of payments(1) A loan repayment provided for an individual under a written contract under the Loan Repayment Program shall consist of payment, in accordance with paragraph (2), on behalf of the individual of the principal, interest, and related expenses on government and commercial loans received by the individual regarding the undergraduate or graduate education of the individual (or both), which loans were made for—(A) tuition expenses; (B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the individual; and (C) reasonable living expenses as determined by the Secretary. (2)(A) For each year of obligated service that an individual contracts to serve under subsection (f) the Secretary may pay up to $35,000 (or an amount equal to the amount specified in section 254l–1(g)(2)(A) of title 42) on behalf of the individual for loans described in paragraph (1). In making a determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination—(i) affects the ability of the Secretary to maximize the number of contracts that can be provided under the Loan Repayment Program from the amounts appropriated for such contracts; (ii) provides an incentive to serve in Indian health programs with the greatest shortages of health professionals; and (iii) provides an incentive with respect to the health professional involved remaining in an Indian health program with such a health professional shortage, and continuing to provide primary health services, after the completion of the period of obligated service under the Loan Repayment Program. (B) Any arrangement made by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later than the end of the fiscal year in which the individual completes such year of service. (3) For the purpose of providing reimbursements for tax liability resulting from payments under paragraph (2) on behalf of an individual, the Secretary—(A) in addition to such payments, may make payments to the individual in an amount not less than 20 percent and not more than 39 percent of the total amount of loan repayments made for the taxable year involved; and (B) may make such additional payments as the Secretary determines to be appropriate with respect to such purpose. (4) The Secretary may enter into an agreement with the holder of any loan for which payments are made under the Loan Repayment Program to establish a schedule for the making of such payments. (h) Effect on employment ceiling of Department of Health and Human ServicesNotwithstanding any other provision of law, individuals who have entered into written contracts with the Secretary under this section, while undergoing academic training, shall not be counted against any employment ceiling affecting the Department of Health and Human Services. (i) Recruiting programsThe Secretary shall conduct recruiting programs for the Loan Repayment Program and other health professional programs of the Service at educational institutions training health professionals or specialists identified in subsection (a). (j) Prohibition of assignment to other government departmentsSection 215 of title 42 shall not apply to individuals during their period of obligated service under the Loan Repayment Program. (k) Staff needs of health programs administered by Indian tribesThe Secretary, in assigning individuals to serve in Indian health programs pursuant to contracts entered into under this section, shall—(1) ensure that the staffing needs of Indian health programs administered by an Indian tribe or tribal or health organization receive consideration on an equal basis with programs that are administered directly by the Service; and (2) give priority to assigning individuals to Indian health programs that have a need for health professionals to provide health care services as a result of individuals having breached contracts entered into under this section. (l) Voluntary termination of study or dismissal from educational institution; collection of damages(1) An individual who has entered into a written contract with the Secretary under this section and who—(A) is enrolled in the final year of a course of study and who—(i) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary); (ii) voluntarily terminates such enrollment; or (iii) is dismissed from such educational institution before completion of such course of study; or (B) is enrolled in a graduate training program, fails to complete such training program, and does not receive a waiver from the Secretary under subsection (b)(1)(B)(ii), shall be liable, in lieu of any service obligation arising under such contract, to the United States for the amount which has been paid on such individual’s behalf under the contract. (2) If, for any reason not specified in paragraph (1), an individual breaches his written contract under this section by failing either to begin, or complete, such individual’s period of obligated service in accordance with subsection (f), the United States shall be entitled to recover from such individual an amount to be determined in accordance with the following formula: A=3Z(t-s/t) in which— (A) “A” is the amount the United States is entitled to recover; (B) “Z” is the sum of the amounts paid under this section to, or on behalf of, the individual and the interest on such amounts which would be payable if, at the time the amounts were paid, they were loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; (C) “t” is the total number of months in the individual’s period of obligated service in accordance with subsection (f); and (D) “s” is the number of months of such period served by such individual in accordance with this section. Amounts not paid within such period shall be subject to collection through deductions in Medicare payments pursuant to section 1395ccc of title 42. (3)(A) Any amount of damages which the United States is entitled to recover under this subsection shall be paid to the United States within the 1-year period beginning on the date of the breach or such longer period beginning on such date as shall be specified by the Secretary. (B) If damages described in subparagraph (A) are delinquent for 3 months, the Secretary shall, for the purpose of recovering such damages—(i) utilize collection agencies contracted with by the Administrator of the General Services Administration; or (ii) enter into contracts for the recovery of such damages with collection agencies selected by the Secretary. (C) Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages. Section 3718 of title 31 shall apply to any such contract to the extent not inconsistent with this subsection. (m) Cancellation or waiver of obligations; bankruptcy discharge(1) Any obligation of an individual under the Loan Repayment Program for service or payment of damages shall be canceled upon the death of the individual. (2) The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Loan Repayment Program whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable. (3) The Secretary may waive, in whole or in part, the rights of the United States to recover amounts under this section in any case of extreme hardship or other good cause shown, as determined by the Secretary. (4) Any obligation of an individual under the Loan Repayment Program for payment of damages may be released by a discharge in bankruptcy under title 11 only if such discharge is granted after the expiration of the 5-year period beginning on the first date that payment of such damages is required, and only if the bankruptcy court finds that nondischarge of the obligation would be unconscionable. (n) Annual reportThe Secretary shall submit to the President, for inclusion in each report required to be submitted to the Congress under section 1671 of this title, a report concerning the previous fiscal year which sets forth—(1) the health professional positions maintained by the Service or by tribal or Indian organizations for which recruitment or retention is difficult; (2) the number of Loan Repayment Program applications filed with respect to each type of health profession; (3) the number of contracts described in subsection (f) that are entered into with respect to each health profession; (4) the amount of loan payments made under this section, in total and by health profession; (5) the number of scholarship grants that are provided under section 1613a of this title with respect to each health profession; (6) the amount of scholarship grants provided under section 1613a of this title, in total and by health profession; (7) the number of providers of health care that will be needed by Indian health programs, by location and profession, during the three fiscal years beginning after the date the report is filed; and (8) the measures the Secretary plans to take to fill the health professional positions maintained by the Service or by tribes or tribal or Indian organizations for which recruitment or retention is difficult.

25 U.S.C. § 1616a–1 Scholarship and Loan Repayment Recovery Fund

(a) EstablishmentThere is established in the Treasury of the United States a fund to be known as the Indian Health Scholarship and Loan Repayment Recovery Fund (hereafter in this section referred to as the “Fund”). The Fund shall consist of such amounts as may be appropriated to the Fund under subsection (b). Amounts appropriated for the Fund shall remain available until expended. (b) Authorization of appropriationsFor each fiscal year, there is authorized to be appropriated to the Fund an amount equal to the sum of—(1) the amount collected during the preceding fiscal year by the Federal Government pursuant to—(A) the liability of individuals under subparagraph (A) or (B) of section 1613a(b)(5) of this title for the breach of contracts entered into under section 1613a of this title; and (B) the liability of individuals under section 1616a(l) of this title for the breach of contracts entered into under section 1616a of this title; and (2) the aggregate amount of interest accruing during the preceding fiscal year on obligations held in the Fund pursuant to subsection (d) and the amount of proceeds from the sale or redemption of such obligations during such fiscal year. (c) Use of funds(1) Amounts in the Fund and available pursuant to appropriation Acts may be expended by the Secretary, acting through the Service, to make payments to an Indian tribe or tribal organization administering a health care program pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]—(A) to which a scholarship recipient under section 1613a of this title or a loan repayment program participant under section 1616a of this title has been assigned to meet the obligated service requirements pursuant to 11 So in original. Probably should be “to such”. sections; and (B) that has a need for a health professional to provide health care services as a result of such recipient or participant having breached the contract entered into under section 1613a of this title or section 1616a of this title. (2) An Indian tribe or tribal organization receiving payments pursuant to paragraph (1) may expend the payments to recruit and employ, directly or by contract, health professionals to provide health care services. (d) Investment of excess funds(1) The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price. (2) Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price.

25 U.S.C. § 1616b Recruitment activities

(a) The Secretary may reimburse health professionals seeking positions in the Service, including individuals considering entering into a contract under section 1616a of this title, and their spouses, for actual and reasonable expenses incurred in traveling to and from their places of residence to an area in which they may be assigned for the purpose of evaluating such area with respect to such assignment. (b) The Secretary, acting through the Service, shall assign one individual in each area office to be responsible on a full-time basis for recruitment activities.

25 U.S.C. § 1616c Tribal recruitment and retention program

(a) Projects funded on competitive basisThe Secretary, acting through the Service, shall fund, on a competitive basis, projects to enable Indian tribes and tribal and Indian organizations to recruit, place, and retain health professionals to meet the staffing needs of Indian health programs (as defined in section 1616a(a)(2) of this title). (b) Eligibility(1) Any Indian tribe or tribal or Indian organization may submit an application for funding of a project pursuant to this section. (2) Indian tribes and tribal and Indian organizations under the authority of the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] shall be given an equal opportunity with programs that are administered directly by the Service to compete for, and receive, grants under subsection (a) for such projects.

25 U.S.C. § 1616d Advanced training and research

(a) Establishment of programThe Secretary, acting through the Service, shall establish a program to enable health professionals to pursue advanced training or research in areas of study for which the Secretary determines a need exists. In selecting participants for a program established under this subsection, the Secretary, acting through the Service, shall give priority to applicants who are employed by the Indian Health Service, Indian tribes, tribal organizations, and urban Indian organizations, at the time of the submission of the applications. (b) Obligated serviceAn individual who participates in a program under subsection (a), where the educational costs are borne by the Service, shall incur an obligation to serve in an Indian health program (as defined in section 1616a(a)(2) of this title) for a period of obligated service equal to at least the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the individual shall be liable to the United States for the period of service remaining. In such event, with respect to individuals entering the program after October 29, 1992, the United States shall be entitled to recover from such individual an amount to be determined in accordance with the formula specified in subsection (l) of section 1616a of this title in the manner provided for in such subsection. (c) EligibilityHealth professionals from Indian tribes and tribal and Indian organizations under the authority of the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] shall be given an equal opportunity to participate in the program under subsection (a).

25 U.S.C. § 1616e Nursing program

(a) GrantsThe Secretary, acting through the Service, shall provide grants to—(1) public or private schools of nursing, (2) tribally controlled community colleges and tribally controlled postsecondary vocational institutions (as defined in section 2397h(2) 11 See References in Text note below. of title 20), and (3) nurse midwife programs, and nurse practitioner programs, that are provided by any public or private institution, for the purpose of increasing the number of nurses, nurse midwives, and nurse practitioners who deliver health care services to Indians. (b) PurposesGrants provided under subsection (a) may be used to—(1) recruit individuals for programs which train individuals to be nurses, nurse midwives, or nurse practitioners, (2) provide scholarships to individuals enrolled in such programs that may pay the tuition charged for such program and other expenses incurred in connection with such program, including books, fees, room and board, and stipends for living expenses, (3) provide a program that encourages nurses, nurse midwives, and nurse practitioners to provide, or continue to provide, health care services to Indians, (4) provide a program that increases the skills of, and provides continuing education to, nurses, nurse midwives, and nurse practitioners, or (5) provide any program that is designed to achieve the purpose described in subsection (a). (c) ApplicationEach application for a grant under subsection (a) shall include such information as the Secretary may require to establish the connection between the program of the applicant and a health care facility that primarily serves Indians. (d) PreferenceIn providing grants under subsection (a), the Secretary shall extend a preference to—(1) programs that provide a preference to Indians, (2) programs that train nurse midwives or nurse practitioners, (3) programs that are interdisciplinary, and (4) programs that are conducted in cooperation with a center for gifted and talented Indian students established under section 2624(a) 1 of this title. (e) Quentin N. Burdick American Indians Into Nursing ProgramThe Secretary shall provide one of the grants authorized under subsection (a) to establish and maintain a program at the University of North Dakota to be known as the “Quentin N. Burdick American Indians Into Nursing Program”. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick Indian Health Programs established under section 1616g(b) of this title and the Quentin N. Burdick American Indians Into Psychology Program established under section 1621p(b) of this title. (f) Service obligationThe active duty service obligation prescribed under section 254m of title 42 shall be met by each individual who receives training or assistance described in paragraph (1) or (2) of subsection (b) that is funded by a grant provided under subsection (a). Such obligation shall be met by service—(A) in the Indian Health Service; (B) in a program conducted under a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]; (C) in a program assisted under subchapter IV of this chapter; or (D) in the private practice of nursing if, as determined by the Secretary, in accordance with guidelines promulgated by the Secretary, such practice is situated in a physician or other health professional shortage area and addresses the health care needs of a substantial number of Indians. (g) Authorization of appropriationsBeginning with fiscal year 1993, of the amounts appropriated under the authority of this subchapter for each fiscal year to be used to carry out this section, not less than $1,000,000 shall be used to provide grants under subsection (a) for the training of nurse midwives, nurse anesthetists, and nurse practitioners.

25 U.S.C. § 1616e–1 Nursing school clinics

(a) GrantsIn addition to the authority of the Secretary under section 1616e(a)(1) of this title, the Secretary, acting through the Service, is authorized to provide grants to public or private schools of nursing for the purpose of establishing, developing, operating, and administering clinics to address the health care needs of Indians, and to provide primary health care services to Indians who reside on or within 50 miles of Indian country, as defined in section 1151 of title 18. (b) PurposesGrants provided under subsection (a) may be used to—(1) establish clinics, to be run and staffed by the faculty and students of a grantee school, to provide primary care services in areas in or within 50 miles of Indian country (as defined in section 1151 of title 18); (2) provide clinical training, program development, faculty enhancement, and student scholarships in a manner that would benefit such clinics; and (3) carry out any other activities determined appropriate by the Secretary. (c) Amount and conditionsThe Secretary may award grants under this section in such amounts and subject to such conditions as the Secretary deems appropriate. (d) DesignThe clinics established under this section shall be designed to provide nursing students with a structured clinical experience that is similar in nature to that provided by residency training programs for physicians. (e) RegulationsThe Secretary shall prescribe such regulations as may be necessary to carry out the provisions of this section. (f) Authorization to use amountsOut of amounts appropriated to carry out this subchapter for each of the fiscal years 1993 through 2000 not more than $5,000,000 may be used to carry out this section.

25 U.S.C. § 1616f Tribal culture and history

(a) Program establishedThe Secretary, acting through the Service, shall establish a program under which appropriate employees of the Service who serve particular Indian tribes shall receive educational instruction in the history and culture of such tribes and in the history of the Service. (b) Tribally controlled institutionsTo the extent feasible, the program established under subsection (a) shall—(1) be carried out through tribally controlled colleges or universities (within the meaning of section 1801(a)(4) of this title) and tribally controlled postsecondary vocational institutions (as defined in section 2397h(2) 11 See References in Text note below. of title 20), (2) be developed in consultation with the affected tribal government, and (3) include instruction in Native American studies.

25 U.S.C. § 1616g INMED program

(a) GrantsThe Secretary is authorized to provide grants to at least 3 colleges and universities for the purpose of maintaining and expanding the Native American health careers recruitment program known as the “Indians into Medicine Program” (hereinafter in this section referred to as “INMED”) as a means of encouraging Indians to enter the health professions. (b) University of North DakotaThe Secretary shall provide one of the grants authorized under subsection (a) to maintain the INMED program at the University of North Dakota, to be known as the “Quentin N. Burdick Indian Health Programs”, unless the Secretary makes a determination, based upon program reviews, that the program is not meeting the purposes of this section. Such program shall, to the maximum extent feasible, coordinate with the Quentin N. Burdick American Indians Into Psychology Program established under section 1621p(b) of this title and the Quentin N. Burdick American Indians Into Nursing Program established under section 1616e(e) of this title. (c) Regulations; contents of recruitment program(1) The Secretary shall develop regulations for the competitive awarding of the grants provided under this section. (2) Applicants for grants provided under this section shall agree to provide a program which—(A) provides outreach and recruitment for health professions to Indian communities including elementary, secondary and community colleges located on Indian reservations which will be served by the program, (B) incorporates a program advisory board comprised of representatives from the tribes and communities which will be served by the program, (C) provides summer preparatory programs for Indian students who need enrichment in the subjects of math and science in order to pursue training in the health professions, (D) provides tutoring, counseling and support to students who are enrolled in a health career program of study at the respective college or university, and (E) to the maximum extent feasible, employs qualified Indians in the program. (d) Report to CongressBy no later than the date that is 3 years after November 23, 1988, the Secretary shall submit a report to the Congress on the program established under this section including recommendations for expansion or changes to the program.

25 U.S.C. § 1616h Health training programs of community colleges

(a) Grants(1) The Secretary, acting through the Service, shall award grants to community colleges for the purpose of assisting the community college in the establishment of programs which provide education in a health profession leading to a degree or diploma in a health profession for individuals who desire to practice such profession on an Indian reservation or in a tribal clinic. (2) The amount of any grant awarded to a community college under paragraph (1) for the first year in which such a grant is provided to the community college shall not exceed $100,000. (b) Eligibility(1) The Secretary, acting through the Service, shall award grants to community colleges that have established a program described in subsection (a)(1) for the purpose of maintaining the program and recruiting students for the program. (2) Grants may only be made under this section to a community college which—(A) is accredited, (B) has access to a hospital facility, Service facility, or hospital that could provide training of nurses or health professionals, (C) has entered into an agreement with an accredited college or university medical school, the terms of which—(i) provide a program that enhances the transition and recruitment of students into advanced baccalaureate or graduate programs which train health professionals, and (ii) stipulate certifications necessary to approve internship and field placement opportunities at service unit facilities of the Service or at tribal health facilities, (D) has a qualified staff which has the appropriate certifications, and (E) is capable of obtaining State or regional accreditation of the program described in subsection (a)(1). (c) Agreements and technical assistanceThe Secretary shall encourage community colleges described in subsection (b)(2) to establish and maintain programs described in subsection (a)(1) by—(1) entering into agreements with such colleges for the provision of qualified personnel of the Service to teach courses of study in such programs, and (2) providing technical assistance and support to such colleges. (d) Advanced trainingAny program receiving assistance under this section that is conducted with respect to a health profession shall also offer courses of study which provide advanced training for any health professional who—(1) has already received a degree or diploma in such health profession, and (2) provides clinical services on an Indian reservation, at a Service facility, or at a tribal clinic. Such courses of study may be offered in conjunction with the college or university with which the community college has entered into the agreement required under subsection (b)(2)(C). (e) DefinitionsFor purposes of this section—(1) The term “community college” means—(A) a junior or community college that is a tribally controlled college or university, or (B) a junior or community college. (2) The term “tribally controlled college or university” has the meaning given to such term by section 1801(a)(4) of this title. (3) The term “junior or community college” has the meaning given to such term by section 1058(e) 11 See References in Text note below. of title 20.

25 U.S.C. § 1616i Additional incentives for health professionals

(a) Incentive special payThe Secretary may provide the incentive special pay authorized under section 302(b) or 335(b) of title 37 to civilian medical officers of the Indian Health Service who are assigned to, and serving in, positions included in the list established under subsection (b)(1) for which recruitment or retention of personnel is difficult. (b) List of positions; bonus pay(1) The Secretary shall establish and update on an annual basis a list of positions of health care professionals employed by, or assigned to, the Service for which recruitment or retention is difficult. (2)(A) The Secretary may pay a bonus to any commissioned officer or civil service employee, other than a commissioned medical officer, dental officer, optometrist, and veterinarian, who is employed in or assigned to, and serving in, a position in the Service included in the list established by the Secretary under paragraph (1). (B) The total amount of bonus payments made by the Secretary under this paragraph to any employee during any 1-year period shall not exceed $2,000. (c) Work schedulesThe Secretary may establish programs to allow the use of flexible work schedules, and compressed work schedules, in accordance with the provisions of subchapter II of chapter 61 of title 5, for health professionals employed by, or assigned to, the Service.

25 U.S.C. § 1616j Retention bonus

(a) EligibilityThe Secretary may pay a retention bonus to any physician or nurse employed by, or assigned to, and serving in, the Service either as a civilian employee or as a commissioned officer in the Regular or Reserve Corps 11 See Change of Name note below. of the Public Health Service who—(1) is assigned to, and serving in, a position included in the list established under section 1616i(b)(1) of this title for which recruitment or retention of personnel is difficult, (2) the Secretary determines is needed by the Service, (3) has—(A) completed 3 years of employment with the Service, or (B) completed any service obligations incurred as a requirement of—(i) any Federal scholarship program, or (ii) any Federal education loan repayment program, and (4) enters into an agreement with the Service for continued employment for a period of not less than 1 year. (b) Minimum award percentage to nursesBeginning with fiscal year 1993, not less than 25 percent of the retention bonuses awarded each year under subsection (a) shall be awarded to nurses. (c) Rates; maximum rateThe Secretary may establish rates for the retention bonus which shall provide for a higher annual rate for multiyear agreements than for single year agreements referred to in subsection (a)(4), but in no event shall the annual rate be more than $25,000 per annum. (d) Time of paymentThe retention bonus for the entire period covered by the agreement described in subsection (a)(4) shall be paid at the beginning of the agreed upon term of service. (e) Refund; interestAny physician or nurse failing to complete the agreed upon term of service, except where such failure is through no fault of the individual, shall be obligated to refund to the Government the full amount of the retention bonus for the period covered by the agreement, plus interest as determined by the Secretary in accordance with section 1616a(l)(2)(B) of this title. (f) Physicians and nurses employed under Indian Self-Determination ActThe Secretary may pay a retention bonus to any physician or nurse employed by an organization providing health care services to Indians pursuant to a contract under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.] if such physician or nurse is serving in a position which the Secretary determines is—(1) a position for which recruitment or retention is difficult; and (2) necessary for providing health care services to Indians.

25 U.S.C. § 1616k Nursing residency program

(a) EstablishmentThe Secretary, acting through the Service, shall establish a program to enable licensed practical nurses, licensed vocational nurses, and registered nurses who are working in an Indian health program (as defined in section 1616a(a)(2)(A) of this title), and have done so for a period of not less than one year, to pursue advanced training. (b) Program componentsSuch program shall include a combination of education and work study in an Indian health program (as defined in section 1616a(a)(2)(A) of this title) leading to an associate or bachelor’s degree (in the case of a licensed practical nurse or licensed vocational nurse) or a bachelor’s degree (in the case of a registered nurse) or a Master’s degree. (c) Service obligation of program participantAn individual who participates in a program under subsection (a), where the educational costs are paid by the Service, shall incur an obligation to serve in an Indian health program for a period of obligated service equal to at least three times the period of time during which the individual participates in such program. In the event that the individual fails to complete such obligated service, the United States shall be entitled to recover from such individual an amount determined in accordance with the formula specified in subsection (l) of section 1616a of this title in the manner provided for in such subsection.

25 U.S.C. § 1616l Community health aide program

(a) General purposes of programPursuant to section 13 of this title, the Secretary, acting through the Service, shall develop and operate a Community Health Aide Program in the State of Alaska under which the Service—(1) provides for the training of Alaska Natives as health aides or community health practitioners; (2) uses those aides or practitioners in the provision of health care, health promotion, and disease prevention services to Alaska Natives living in villages in rural Alaska; and (3) provides for the establishment of teleconferencing capacity in health clinics located in or near those villages for use by community health aides or community health practitioners. (b) Specific program requirementsThe Secretary, acting through the Community Health Aide Program of the Service, shall—(1) using trainers accredited by the Program, provide a high standard of training to community health aides and community health practitioners to ensure that those aides and practitioners provide quality health care, health promotion, and disease prevention services to the villages served by the Program; (2) in order to provide such training, develop a curriculum that—(A) combines education regarding the theory of health care with supervised practical experience in the provision of health care; (B) provides instruction and practical experience in the provision of acute care, emergency care, health promotion, disease prevention, and the efficient and effective management of clinic pharmacies, supplies, equipment, and facilities; and (C) promotes the achievement of the health status objectives specified in section 1602(2) of this title; (3) establish and maintain a Community Health Aide Certification Board to certify as community health aides or community health practitioners individuals who have successfully completed the training described in paragraph (1) or can demonstrate equivalent experience; (4) develop and maintain a system that identifies the needs of community health aides and community health practitioners for continuing education in the provision of health care, including the areas described in paragraph (2)(B), and develop programs that meet the needs for such continuing education; (5) develop and maintain a system that provides close supervision of community health aides and community health practitioners; (6) develop a system under which the work of community health aides and community health practitioners is reviewed and evaluated to ensure the provision of quality health care, health promotion, and disease prevention services; and (7) ensure that—(A) pulpal therapy (not including pulpotomies on deciduous teeth) or extraction of adult teeth can be performed by a dental health aide therapist only after consultation with a licensed dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment; and (B) dental health aide therapists are strictly prohibited from performing all other oral or jaw surgeries, subject to the condition that uncomplicated extractions shall not be considered oral surgery under this section. (c) Program review(1) Neutral panel(A) EstablishmentThe Secretary, acting through the Service, shall establish a neutral panel to carry out the study under paragraph (2). (B) MembershipMembers of the neutral panel shall be appointed by the Secretary from among clinicians, economists, community practitioners, oral epidemiologists, and Alaska Natives. (2) Study(A) In generalThe neutral panel established under paragraph (1) shall conduct a study of the dental health aide therapist services provided by the Community Health Aide Program under this section to ensure that the quality of care provided through those services is adequate and appropriate. (B) Parameters of studyThe Secretary, in consultation with interested parties, including professional dental organizations, shall develop the parameters of the study. (C) InclusionsThe study shall include a determination by the neutral panel with respect to—(i) the ability of the dental health aide therapist services under this section to address the dental care needs of Alaska Natives; (ii) the quality of care provided through those services, including any training, improvement, or additional oversight required to improve the quality of care; and (iii) whether safer and less costly alternatives to the dental health aide therapist services exist. (D) ConsultationIn carrying out the study under this paragraph, the neutral panel shall consult with Alaska tribal organizations with respect to the adequacy and accuracy of the study. (3) ReportThe neutral panel shall submit to the Secretary, the Committee on Indian Affairs of the Senate, and the Committee on Natural Resources of the House of Representatives a report describing the results of the study under paragraph (2), including a description of—(A) any determination of the neutral panel under paragraph (2)(C); and (B) any comments received from Alaska tribal organizations under paragraph (2)(D). (d) Nationalization of program(1) In generalExcept as provided in paragraph (2), the Secretary, acting through the Service, may establish a national Community Health Aide Program in accordance with the program under this section, as the Secretary determines to be appropriate. (2) Requirement; exclusionSubject to paragraphs (3) and (4), in establishing a national program under paragraph (1), the Secretary—(A) shall not reduce the amounts provided for the Community Health Aide Program described in subsections (a) and (b); and (B) shall exclude dental health aide therapist services from services covered under the program. (3) Election of Indian tribe or tribal organization(A) In generalSubparagraph (B) of paragraph (2) shall not apply in the case of an election made by an Indian tribe or tribal organization located in a State (other than Alaska) in which the use of dental health aide therapist services or midlevel dental health provider services is authorized under State law to supply such services in accordance with State law. (B) Action by SecretaryOn an election by an Indian tribe or tribal organization under subparagraph (A), the Secretary, acting through the Service, shall facilitate implementation of the services elected. (4) VacanciesThe Secretary shall not fill any vacancy for a certified dentist in a program operated by the Service with a dental health aide therapist. (e) Effect of sectionNothing in this section shall restrict the ability of the Service, an Indian tribe, or a tribal organization to participate in any program or to provide any service authorized by any other Federal law.

25 U.S.C. § 1616m Matching grants to tribes for scholarship programs

(a) In general(1) The Secretary shall make grants to Indian tribes and tribal organizations for the purpose of assisting such tribes and tribal organizations in educating Indians to serve as health professionals in Indian communities. (2) Amounts available for grants under paragraph (1) for any fiscal year shall not exceed 5 percent of amounts available for such fiscal year for Indian Health Scholarships under section 1613a of this title. (3) An application for a grant under paragraph (1) shall be in such form and contain such agreements, assurances, and information as the Secretary determines are necessary to carry out this section. (b) Compliance with requirements(1) An Indian tribe or tribal organization receiving a grant under subsection (a) shall agree to provide scholarships to Indians pursuing education in the health professions in accordance with the requirements of this section. (2) With respect to the costs of providing any scholarship pursuant to paragraph (1)—(A) 80 percent of the costs of the scholarship shall be paid from the grant made under subsection (a) to the Indian tribe or tribal organization; and (B) 20 percent of such costs shall be paid from non-Federal contributions by the Indian tribe or tribal organization through which the scholarship is provided. (3) In determining the amount of non-Federal contributions that have been provided for purposes of subparagraph (B) of paragraph (2), any amounts provided by the Federal Government to the Indian tribe or tribal organization involved or to any other entity shall not be included. (4) Non-Federal contributions required by subparagraph (B) of paragraph (2) may be provided directly by the Indian tribe or tribal organization involved or through donations from public and private entities. (c) Course of study in health professionsAn Indian tribe or tribal organization shall provide scholarships under subsection (b) only to Indians enrolled or accepted for enrollment in a course of study (approved by the Secretary) in one of the health professions described in section 1613a(a) of this title. (d) Contract requirementsIn providing scholarships under subsection (b), the Secretary and the Indian tribe or tribal organization shall enter into a written contract with each recipient of such scholarship. Such contract shall—(1) obligate such recipient to provide service in an Indian health program (as defined in section 1616a(a)(2)(A) of this title), in the same service area where the Indian tribe or tribal organization providing the scholarship is located, for—(A) a number of years equal to the number of years for which the scholarship is provided (or the part-time equivalent thereof, as determined by the Secretary), or for a period of 2 years, whichever period is greater; or (B) such greater period of time as the recipient and the Indian tribe or tribal organization may agree; (2) provide that the amount of such scholarship—(A) may be expended only for—(i) tuition expenses, other reasonable educational expenses, and reasonable living expenses incurred in attendance at the educational institution; and (ii) payment to the recipient of a monthly stipend of not more than the amount authorized by section 254l(g)(1)(B) of title 42, such amount to be reduced pro rata (as determined by the Secretary) based on the number of hours such student is enrolled; and (B) may not exceed, for any year of attendance for which the scholarship is provided, the total amount required for the year for the purposes authorized in subparagraph (A); (3) require the recipient of such scholarship to maintain an acceptable level of academic standing (as determined by the educational institution in accordance with regulations issued by the Secretary); and (4) require the recipient of such scholarship to meet the educational and licensure requirements necessary to be a physician, certified nurse practitioner, certified nurse midwife, or physician assistant. (e) Breach of contract(1) An individual who has entered into a written contract with the Secretary and an Indian tribe or tribal organization under subsection (d) and who—(A) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such level determined by the educational institution under regulations of the Secretary), (B) is dismissed from such educational institution for disciplinary reasons, (C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship under such contract before the completion of such training, or (D) fails to accept payment, or instructs the educational institution in which he is enrolled not to accept payment, in whole or in part, of a scholarship under such contract, in lieu of any service obligation arising under such contract, shall be liable to the United States for the Federal share of the amount which has been paid to him, or on his behalf, under the contract. (2) If for any reason not specified in paragraph (1), an individual breaches his written contract by failing either to begin such individual’s service obligation required under such contract or to complete such service obligation, the United States shall be entitled to recover from the individual an amount determined in accordance with the formula specified in subsection (l) of section 1616a of this title in the manner provided for in such subsection. (3) The Secretary may carry out this subsection on the basis of information submitted by the tribes or tribal organizations involved, or on the basis of information collected through such other means as the Secretary determines to be appropriate. (f) Nondiscriminatory practiceThe recipient of a scholarship under subsection (b) shall agree, in providing health care pursuant to the requirements of subsection (d)(1)—(1) not to discriminate against an individual seeking such care on the basis of the ability of the individual to pay for such care or on the basis that payment for such care will be made pursuant to the program established in title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.] or pursuant to the program established in title XIX of such Act [42 U.S.C. 1396 et seq.]; and (2) to accept assignment under section 1842(b)(3)(B)(ii) of the Social Security Act [42 U.S.C. 1395u(b)(3)(B)(ii)] for all services for which payment may be made under part B of title XVIII of such Act [42 U.S.C. 1395j et seq.], and to enter into an appropriate agreement with the State agency that administers the State plan for medical assistance under title XIX of such Act [42 U.S.C. 1396 et seq.] to provide service to individuals entitled to medical assistance under the plan. (g) Payments for subsequent fiscal yearsThe Secretary may not make any payments under subsection (a) to an Indian tribe or tribal organization for any fiscal year subsequent to the first fiscal year of such payments unless the Secretary determines that, for the immediately preceding fiscal year, the Indian tribe or tribal organization has complied with requirements of this section.

25 U.S.C. § 1616n Tribal health program administration

The Secretary shall, by contract or otherwise, provide training for individuals in the administration and planning of tribal health programs.

25 U.S.C. § 1616o University of South Dakota pilot program

(a) EstablishmentThe Secretary may make a grant to the School of Medicine of the University of South Dakota (hereafter in this section referred to as “USDSM”) to establish a pilot program on an Indian reservation at one or more service units in South Dakota to address the chronic manpower shortage in the Aberdeen Area of the Service. (b) PurposesThe purposes of the program established pursuant to a grant provided under subsection (a) are—(1) to provide direct clinical and practical experience at a service unit to medical students and residents from USDSM and other medical schools; (2) to improve the quality of health care for Indians by assuring access to qualified health care professionals; and (3) to provide academic and scholarly opportunities for physicians, physician assistants, nurse practitioners, nurses, and other allied health professionals serving Indian people by identifying and utilizing all academic and scholarly resources of the region. (c) Composition; designationThe pilot program established pursuant to a grant provided under subsection (a) shall—(1) incorporate a program advisory board composed of representatives from the tribes and communities in the area which will be served by the program; and (2) shall be designated as an extension of the USDSM campus and program participants shall be under the direct supervision and instruction of qualified medical staff serving at the service unit who shall be members of the USDSM faculty. (d) Coordination with other schoolsThe USDSM shall coordinate the program established pursuant to a grant provided under subsection (a) with other medical schools in the region, nursing schools, tribal community colleges, and other health professional schools. (e) Development of additional professional opportunitiesThe USDSM, in cooperation with the Service, shall develop additional professional opportunities for program participants on Indian reservations in order to improve the recruitment and retention of qualified health professionals in the Aberdeen Area of the Service.

25 U.S.C. § 1616p Health professional chronic shortage demonstration programs

(a) Demonstration programsThe Secretary, acting through the Service, may fund demonstration programs for Indian health programs to address the chronic shortages of health professionals. (b) Purposes of programsThe purposes of demonstration programs under subsection (a) shall be—(1) to provide direct clinical and practical experience within an Indian health program to health profession students and residents from medical schools; (2) to improve the quality of health care for Indians by ensuring access to qualified health professionals; (3) to provide academic and scholarly opportunities for health professionals serving Indians by identifying all academic and scholarly resources of the region; and (4) to provide training and support for alternative provider types, such as community health representatives, and community health aides. (c) Advisory boardThe demonstration programs established pursuant to subsection (a) shall incorporate a program advisory board, which may be composed of representatives of tribal governments, Indian health programs, and Indian communities in the areas to be served by the demonstration programs.

25 U.S.C. § 1616q Exemption from payment of certain fees

Employees of a tribal health program or urban Indian organization shall be exempt from payment of licensing, registration, and any other fees imposed by a Federal agency to the same extent that officers of the commissioned corps of the Public Health Service and other employees of the Service are exempt from those fees.

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