1 3 "(b) TABLE OF CONTENTS.-The table of contents 2 for this Act is as follows: "Sec. 1. Short title; table of contents. "Sec. 2. Findings. "Sec. 3. Declaration of health objectives. "Sec. 4. Definitions. "TITLE I-INDIAN HEALTH, HUMAN RESOURCES AND "Sec. 101. Purpose. DEVELOPMENT "Sec. 102. General requirements. "Sec. 103. Health professions recruitment program for Indians. "Sec. 104. Health professions preparatory scholarship program for Indi ans. "Sec. 105. Indian health professions scholarships. "Sec. 106. American Indians into psychology program. "Sec. 108. Continuing education allowances. "Sec. 109. Community health representative program. "Sec. 110. Indian Health Service loan repayment program. "Sec. 112. Recruitment activities. "Sec. 113. Tribal recruitment and retention program. "Sec. 114. Advanced training and research. "Sec. 115. Nursing programs; Quentin N. Burdick American Indians into Nursing Program. "Sec. 116. Tribal culture and history. "Sec. 117. INMED program. "Sec. 118. Health training programs of community colleges. "Sec. 119. Retention bonus. "Sec. 120. Nursing residency program. "Sec. 121. Community health aide program for Alaska. "Sec. 122. Tribal health program administration. "Sec. 123. Health professional chronic shortage demonstration project. "Sec. 124. Scholarships. "Sec. 125. National Health Service Corps. "Sec. 126. Substance abuse counselor education demonstration project. "Sec. 127. Mental health training and community education. "Sec. 128. Authorization of appropriations. "TITLE II-HEALTH SERVICES "Sec. 201. Indian Health Care Improvement Fund. "Sec. 202. Catastrophic Health Emergency Fund. "Sec. 203. Health promotion and disease prevention services. "Sec. 204. Diabetes prevention, treatment, and control. "Sec. 205. Shared services. "Sec. 206. Health services research. "Sec. 207. Mammography and other cancer screening. "Sec. 208. Patient travel costs. "Sec. 209. Epidemiology centers. "Sec. 210. Comprehensive school health education programs. 4 "Sec. 212. Prevention, control, and elimination of communicable and infec tious diseases. "Sec. 213. Authority for provision of other services. "Sec. 214. Indian women's health care. "Sec. 215. Environmental and nuclear health hazards. "Sec. 216. Arizona as a contract health service delivery area. "Sec. 216A. North Dakota as a contract health service delivery area. "Sec. 216B. South Dakota as a contract health service delivery area. "Sec. 217. California contract health services demonstration program. "Sec. 218. California as a contract health service delivery area. "Sec. 219. Contract health services for the Trenton service area. "Sec. 220. Programs operated by Indian tribes and tribal organizations. "Sec. 221. Licensing. "Sec. 222. Authorization for emergency contract health services. "Sec. 223. Prompt action on payment of claims. "Sec. 224. Liability for payment. "Sec. 225. Authorization of appropriations. "TITLE III-FACILITIES "Sec. 301. Consultation, construction and renovation of facilities; reports. "Sec. 302. Safe water and sanitary waste disposal facilities. "Sec. 303. Preference to Indians and Indian firms. "Sec. 304. Soboba sanitation facilities. "Sec. 305. Expenditure of nonservice funds for renovation. "Sec. 306. Funding for the construction, expansion, and modernization of small ambulatory care facilities. "Sec. 307. Indian health care delivery demonstration project. "Sec. 308. Land transfer. "Sec. 309. Leases. "Sec. 310. Loans, loan guarantees and loan repayment. "Sec. 311. Tribal leasing. "Sec. 312. Indian Health Service/tribal facilities joint venture program. "Sec. 313. Location of facilities. "Sec. 314. Maintenance and improvement of health care facilities. "Sec. 315. Tribal management of federally-owned quarters. "Sec. 316. Applicability of buy American requirement. "Sec. 317. Other funding for facilities. "Sec. 318. Authorization of appropriations. "TITLE IV-ACCESS TO HEALTH SERVICES "Sec. 401. Treatment of payments under medicare program. "Sec. 402. Treatment of payments under medicaid program. "Sec. 403. Report. "Sec. 404. Grants to and funding agreements with the service, Indian tribes or tribal organizations, and urban Indian organizations. "Sec. 405. Direct billing and reimbursement of medicare, medicaid, and other third party payors. "Sec. 406. Reimbursement from certain third parties of costs of health services. "Sec. 407. Crediting of reimbursements. "Sec. 408. Purchasing health care coverage. "Sec. 409. Indian Health Service, Department of Veteran's Affairs, and other Federal agency health facilities and services sharing. 5 "Sec. 410. Payor of last resort. "Sec. 411. Right to recover from Federal health care programs. "Sec. 412. Tuba City demonstration project. "Sec. 413. Access to Federal insurance. "Sec. 414. Consultation and rulemaking. "Sec. 415. Limitations on charges. "Sec. 416. Limitation on Secretary's waiver authority. "Sec. 417. Waiver of medicare and medicaid sanctions. "Sec. 418. Meaning of 'remuneration' for purposes of safe harbor provisions; antitrust immunity. "Sec. 419. Co-insurance, co-payments, deductibles and premiums. "Sec. 420. Inclusion of income and resources for purposes of medically needy medicaid eligibility. "Sec. 421. Estate recovery provisions. "Sec. 422. Medical child support. "Sec. 423. Provisions relating to managed care. "Sec. 424. Navajo Nation medicaid agency. "Sec. 425. Indian advisory committees. "Sec. 426. Authorization of appropriations. "TITLE V-HEALTH SERVICES FOR URBAN INDIANS "Sec. 501. Purpose. "Sec. 502. Contracts with, and grants to, urban Indian organizations. "Sec. 503. Contracts and grants for the provision of health care and refer ral services. "Sec. 504. Contracts and grants for the determination of unmet health care needs. "Sec. 505. Evaluations; renewals. "Sec. 506. Other contract and grant requirements. "Sec. 507. Reports and records. "Sec. 508. Limitation on contract authority. "Sec. 509. Facilities. "Sec. 510. Office of Urban Indian Health. "Sec. 511. Grants for alcohol and substance abuse related services. "Sec. 512. Treatment of certain demonstration projects. "Sec. 513. Urban NIAAA transferred programs. "Sec. 514. Consultation with urban Indian organizations. "Sec. 515. Federal Tort Claims Act coverage. "Sec. 516. Urban youth treatment center demonstration. "Sec. 517. Use of Federal government facilities and sources of supply. "Sec. 518. Grants for diabetes prevention, treatment and control. "Sec. 519. Community health representatives. "Sec. 520. Regulations. "Sec. 521. Authorization of appropriations. "TITLE VI-ORGANIZATIONAL IMPROVEMENTS "Sec. 601. Establishment of the Indian Health Service as an agency of the Public Health Service. "Sec. 602. Automated management information system. "Sec. 603. Authorization of appropriations. "TITLE VII-BEHAVIORAL HEALTH PROGRAMS "Sec. 701. Behavioral health prevention and treatment services. 6 "Sec. 702. Memorandum of agreement with the Department of the Inte rior. "Sec. 703. Comprehensive behavioral health prevention and treatment pro gram. "Sec. 704. Mental health technician program. "Sec. 705. Licensing requirement for mental health care workers. "Sec. 706. Indian women treatment programs. "Sec. 707. Indian youth program. "Sec. 708. Inpatient and community-based mental health facilities design, construction and staffing assessment. "Sec. 709. Training and community education. "Sec. 710. Behavioral health program. "Sec. 711. Fetal alcohol disorder funding. "Sec. 712. Child sexual abuse and prevention treatment programs. "Sec. 713. Behavioral mental health research. "Sec. 714. Definitions. "Sec. 715. Authorization of appropriations. "TITLE VIII-MISCELLANEOUS "Sec. 801. Reports. "Sec. 802. Regulations. "Sec. 803. Plan of implementation. "Sec. 804. Availability of funds. "Sec. 805. Limitation on use of funds appropriated to the Indian Health Service. "Sec. 806. Eligibility of California Indians. "Sec. 807. Health services for ineligible persons. "Sec. 808. Reallocation of base resources. "Sec. 809. Results of demonstration projects. "Sec. 810. Provision of services in Montana. "Sec. 811. Moratorium. "Sec. 812. Tribal employment. "Sec. 813. Prime vendor. "Sec. 814. National Bi-Partisan Commission on Indian Health Care Enti tlement. "Sec. 815. Appropriations; availability. "Sec. 816. Authorization of appropriations. 1 ❝SEC. 2. FINDINGS. 2 3 4 5 6 7 8 "Congress makes the following findings: "(1) Federal delivery of health services and funding of tribal and urban Indian health programs to maintain and improve the health of the Indians are consonant with and required by the Federal Gov ernment's historical and unique legal relationship with the American Indian people, as reflected in the 7 Constitution, treaties, Federal laws, and the course of dealings of the United States with Indian tribes, and the United States' resulting government to gov ernment and trust responsibility and obligations to the American Indian people. "(2) From the time of European occupation and colonization through the 20th century, the policies and practices of the United States caused or contributed to the severe health conditions of Indi ans. "(3) Indian tribes have, through the cession of over 400,000,000 acres of land to the United States in exchange for promises, often reflected in treaties, of health care secured a de facto contract that enti 15 tles Indians to health care in perpetuity, based on 16 the moral, legal, and historic obligation of the 678 17 18 United States. "(4) The population growth of the Indian peo ple that began in the later part of the 20th century increases the need for Federal health care services. “(5) A major national goal of the United States is to provide the quantity and quality of health services which will permit the health status of Indians, regardless of where they live, to be raised to the highest possible level, a level that is not less than |