HR
2440 IH
108th CONGRESS
1st Session
H. R. 2440
IN THE HOUSE OF REPRESENTATIVES
Mr. YOUNG of Alaska (for himself, Mr. HAYWORTH, Mr. RENZI,
Mr. COLE, Mr. HUNTER, Mr. MCKEON, Mr. PALLONE, Mr. RAHALL, Mr. GEORGE MILLER of
California, Mr. KILDEE, Mr. DINGELL, Mr. WAXMAN, Mr. RANGEL, Mr. CONYERS, Mr.
OBERSTAR, Mr. GRIJALVA, Ms. MILLENDER-MCDONALD, Mr. FROST, Mr. KENNEDY of Rhode
Island, Mr. FRANK of Massachusetts, Mr. FILNER, Mr. HONDA, Mr. CARSON of
Oklahoma, Mr. ALLEN, Mr. ABERCROMBIE, Ms. LEE, Mrs. NAPOLITANO, Mr.
FALEOMAVAEGA, Ms. MCCOLLUM, Mr. TOWNS, Mr. UDALL of New Mexico, Mr. UDALL of
Colorado, Mr. KIND, Mr. LANTOS, Mr. INSLEE, Mr. STUPAK, Mr. BACA, Ms.
KILPATRICK, Mrs. CHRISTENSEN, Mr. BLUMENAUER, and Ms. NORTON) introduced the
following bill; which was referred to the Committee on Resources, and in
addition to the Committees on Energy and Commerce, and Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
Be it
enacted by the Senate and House of Representatives of the United States of
America in Congress assembled,
This Act may
be cited as the `Indian Health Care Improvement Act Amendments of 2003'.
The Indian
Health Care Improvement Act (25 U.S.C. 1601 et seq.) is amended to read as
follows:
`(a) SHORT
TITLE- This Act may be cited as the `Indian Health Care Improvement Act'.
`(b) TABLE OF
CONTENTS- The table of contents for this Act is as follows:
Sec. 1. Short
title.
Sec. 2. Indian
Health Care Improvement Act amended.
`Sec. 1. Short title; table of contents.
`Sec. 2. Findings.
`Sec. 3. Declaration of National Indian health policy.
`Sec. 4. Definitions.
`Sec. 101. Purpose.
`Sec. 102. Health Professions Recruitment Program for Indians.
`Sec. 103. Health Professions Preparatory Scholarship Program for
Indians.
`Sec. 104. Indian health professions scholarships.
`Sec. 105. American Indians into psychology program.
`Sec. 106. Funding for tribes for scholarship programs.
`Sec. 107. Indian Health Service extern programs.
`Sec. 108. Continuing education allowances.
`Sec. 109. Community Health Representative Program.
`Sec. 110. Indian Health Service Loan Repayment Program.
`Sec. 111. Scholarship and loan repayment recovery fund.
`Sec. 112. Recruitment activities.
`Sec. 113. Indian recruitment and retention program.
`Sec. 114. Advanced training and research.
`Sec. 115. Quentin N. Burdick American Indians into nursing program.
`Sec. 116. Tribal cultural orientation.
`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 programs.
`Sec. 124. Treatment of scholarships for certain purposes.
`Sec. 125. National Health Service Corps.
`Sec. 126. Substance abuse counselor educational curricula
demonstration programs.
`Sec. 127. Mental health training and community education programs.
`Sec. 128. Designation of shortage areas.
`Sec. 129. Authorization of appropriations.
`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 for long-term care.
`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.
`Sec. 211. Indian Youth Program.
`Sec. 212. Prevention, control, and elimination of communicable and
infectious 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 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. Notification of provision of emergency contract health
services.
`Sec. 223. Prompt action on payment of claims.
`Sec. 224. Liability for payment.
`Sec. 225. Authorization of appropriations.
`Sec. 301. Consultation; construction and renovation of facilities;
reports.
`Sec. 302. Sanitation facilities.
`Sec. 303. Preference to Indians and Indian firms.
`Sec. 304. Expenditure of nonservice funds for renovation.
`Sec. 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities.
`Sec. 306. Indian Health Care Delivery Demonstration Project.
`Sec. 307. Land transfer.
`Sec. 308. Leases, contracts, and other agreements.
`Sec. 309. Loans, loan guarantees, and loan repayment.
`Sec. 310. Tribal leasing.
`Sec. 311. Indian Health Service/tribal facilities joint venture
program.
`Sec. 312. Location of facilities.
`Sec. 313. Maintenance and improvement of health care facilities.
`Sec. 314. Tribal management of federally owned quarters.
`Sec. 315. Applicability of Buy American Act requirement.
`Sec. 316. Other funding for facilities.
`Sec. 317. Authorization of appropriations.
`Sec. 401. Treatment of payments under Social Security Act health care
programs.
`Sec. 402. Grants to and funding agreements with the Service, Indian
tribes, tribal organizations, and urban Indian organizations.
`Sec. 403. Reimbursement from certain third parties of costs of health
services.
`Sec. 404. Crediting of reimbursements.
`Sec. 405. Purchasing health care coverage.
`Sec. 406. Sharing arrangements with Federal agencies.
`Sec. 407. Payor of last resort.
`Sec. 408. Nondiscrimination in qualifications for reimbursement for
services.
`Sec. 409. Consultation.
`Sec. 410. State children's health insurance program (SCHIP).
`Sec. 411. Social Security Act sanctions.
`Sec. 412. Cost sharing.
`Sec. 413. Treatment under medicaid managed care.
`Sec. 414. Navajo nation medicaid agency.
`Sec. 415. Authorization of appropriations.
`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
referral 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. Eligibility for services.
`Sec. 522. Authorization of appropriations.
`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.
`Sec. 701. Behavioral health prevention and treatment services.
`Sec. 702. Memoranda of agreement with the Department of the Interior.
`Sec. 703. Comprehensive behavioral health prevention and treatment
program.
`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.
`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 health research.
`Sec. 714. Definitions.
`Sec. 715. Authorization of appropriations.
`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. Severability provisions.
`Sec. 815. Establishment of National Bipartisan Commission on Indian
Health Care Entitlement.
`Sec. 816. Appropriations; availability.
`Sec. 817. Confidentiality of medical quality assurance records:
qualified immunity for participants.
`Sec. 818. Authorization of appropriations.
Sec. 3.
Soboba sanitation facilities.
Sec. 4.
Amendments to medicare program.
Sec. 5.
Amendments to medicaid program and State Children's Health Insurance Program
(SCHIP).
***
`(a)
PURPOSES- The purposes of this section are as follows:
`(1) To
authorize and direct the Secretary, acting through the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations, to develop a
comprehensive behavioral health prevention and treatment program which
emphasizes collaboration among alcohol and substance abuse, social services,
and mental health programs.
`(2) To
provide information, direction, and guidance relating to mental illness and
dysfunction and self-destructive behavior, including child abuse and family
violence, to those Federal, tribal, State, and local agencies responsible for
programs in Indian communities in areas of health care, education, social
services, child and family welfare, alcohol and substance abuse, law
enforcement, and judicial services.
`(3) To
assist Indian Tribes to identify services and resources available to address
mental illness and dysfunctional and self-destructive behavior.
`(4) To
provide authority and opportunities for Indian Tribes and Tribal Organizations
to develop, implement, and coordinate with community-based programs which
include identification, prevention, education, referral, and treatment
services, including through multidisciplinary resource teams.
`(5) To
ensure that Indians, as citizens of the United States and of the States in
which they reside, have the same access to behavioral health services to which
all citizens have access.
`(6) To
modify or supplement existing programs and authorities in the areas identified
in paragraph (2).
`(b) PLANS-
`(1)
DEVELOPMENT- The Secretary, acting through the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall encourage Indian Tribes
and Tribal Organizations to develop tribal plans, and Urban Indian
Organizations to develop local plans, and for all such groups to participate in
developing areawide plans for Indian Behavioral Health Services. The plans
shall include, to the extent feasible, the following components:
`(A) An
assessment of the scope of alcohol or other substance abuse, mental illness,
and dysfunctional and self-destructive behavior, including suicide, child
abuse, and family violence, among Indians, including--
`(i) the
number of Indians served who are directly or indirectly affected by such
illness or behavior; or
`(ii) an
estimate of the financial and human cost attributable to such illness or
behavior.
`(B) An
assessment of the existing and additional resources necessary for the
prevention and treatment of such illness and behavior, including an assessment
of the progress toward achieving the availability of the full continuum of care
described in subsection (c).
`(C) An
estimate of the additional funding needed by the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations to meet their responsibilities
under the plans.
`(2) NATIONAL
CLEARINGHOUSE- The Secretary, acting through the Service, shall establish a
national clearinghouse of plans and reports on the outcomes of such plans
developed by Indian Tribes, Tribal Organizations, Urban Indian Organizations,
and Service Areas relating to behavioral health. The Secretary shall ensure
access to these plans and outcomes by any Indian Tribe, Tribal Organization,
Urban Indian Organization, or the Service.
`(3)
TECHNICAL ASSISTANCE- The Secretary shall provide technical assistance to
Indian Tribes, Tribal Organizations, and Urban Indian Organizations in
preparation of plans under this section and in developing standards of care
that may be used and adopted locally.
`(c)
PROGRAMS- The Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, shall provide, to the extent feasible and if funding is
available, programs including the following:
`(1)
COMPREHENSIVE CARE- A comprehensive continuum of behavioral health care which
provides--
`(A)
community-based prevention, intervention, outpatient, and behavioral health
aftercare;
`(B)
detoxification (social and medical);
`(C) acute
hospitalization;
`(D)
intensive outpatient/day treatment;
`(E)
residential treatment;
`(F)
transitional living for those needing a temporary, stable living environment
that is supportive of treatment and recovery goals;
`(G)
emergency shelter;
`(H)
intensive case management; and
`(I)
Traditional Health Care Practices.
`(2) CHILD
CARE- Behavioral health services for Indians from birth through age 17,
including the following:
`(A)
Preschool and school age fetal alcohol disorder services, including assessment
and behavioral intervention.
`(B) Mental
health and substance abuse services (emotional, organic, alcohol, drug,
inhalant, and tobacco).
`(C)
Identification and treatment of co-occurring disorders and comorbidity.
`(D)
Prevention of alcohol, drug, inhalant, and tobacco use.
`(E) Early
intervention, treatment, and aftercare.
`(F)
Promotion of healthy choices and lifestyle (related to sexually transmitted
diseases, domestic violence, sexual abuse, suicide, teen pregnancy, obesity,
and other risk/safety issues).
`(G)
Identification and treatment of neglect and physical, mental, and sexual abuse.
`(3) ADULT
CARE- Behavioral health services for Indians from age 18 through 55, including
the following:
`(A) Early
intervention, treatment, and aftercare.
`(B) Mental
health and substance abuse services (emotional, alcohol, drug, inhalant, and
tobacco), including gender specific services.
`(C)
Identification and treatment of co-occurring disorders (dual diagnosis) and
comorbidity.
`(D)
Promotion of gender specific healthy choices and lifestyle (related to
parenting, partners, domestic violence, sexual abuse, suicide, obesity, and
other risk-related behavior).
`(E)
Treatment services for women at risk of giving birth to a child with a fetal
alcohol disorder.
`(F) Gender
specific treatment for sexual assault and domestic violence.
`(4) FAMILY
CARE- Behavioral health services for families, including the following:
`(A) Early
intervention, treatment, and aftercare for affected families.
`(B)
Treatment for sexual assault and domestic violence.
`(C)
Promotion of healthy choices and lifestyle (related to parenting, partners,
domestic violence, and other abuse issues).
`(5) ELDER
CARE- Behavioral health services for Indians 56 years of age and older,
including the following:
`(A) Early
intervention, treatment, and aftercare.
`(B) Mental
health and substance abuse services (emotional, alcohol, drug, inhalant, and
tobacco), including gender specific services.
`(C) Identification
and treatment of co-occurring disorders (dual diagnosis) and comorbidity.
`(D)
Promotion of healthy choices and lifestyle (managing conditions related to
aging).
`(E) Gender
specific treatment for sexual assault, domestic violence, neglect, physical and
mental abuse and exploitation.
`(F)
Identification and treatment of dementias regardless of cause.
`(d)
COMMUNITY BEHAVIORAL HEALTH PLAN-
`(1)
ESTABLISHMENT- The governing body of any Indian Tribe, Tribal Organization, or
Urban Indian Organization may adopt a resolution for the establishment of a
community behavioral health plan providing for the identification and
coordination of available resources and programs to identify, prevent, or treat
substance abuse, mental illness, or dysfunctional and self-destructive
behavior, including child abuse and family violence, among its members or its
service population. This plan should include behavioral health services, social
services, intensive outpatient services, and continuing aftercare.
`(2)
TECHNICAL ASSISTANCE- At the request of an Indian Tribe, Tribal Organization,
or Urban Indian Organization, the Bureau of Indian Affairs and the Service
shall cooperate with and provide technical assistance to the Indian Tribe,
Tribal Organization, or Urban Indian Organization in the development and
implementation of such plan.
`(3) FUNDING-
The Secretary, acting through the Service, may make funding available to Indian
Tribes and Tribal Organizations which adopt a resolution pursuant to paragraph
(1) to obtain technical assistance for the development of a community
behavioral health plan and to provide administrative support in the
implementation of such plan.
`(e)
COORDINATION FOR AVAILABILITY OF SERVICES- The Secretary, acting through the
Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations,
shall coordinate behavioral health planning, to the extent feasible, with other
Federal agencies and with State
agencies, to encourage comprehensive behavioral health
services for Indians regardless of their place of residence.
`(f) MENTAL
HEALTH CARE NEED ASSESSMENT- Not later than 1 year after the date of the
enactment of the Indian Health Care Improvement Act Amendments of 2003, the
Secretary, acting through the Service, shall make an assessment of the need for
inpatient mental health care among Indians and the availability and cost of
inpatient mental health facilities which can meet such need. In making such
assessment, the Secretary shall consider the possible conversion of existing,
underused Service hospital beds into psychiatric units to meet such need.
`(a)
CONTENTS- Not later than 12 months after the date of the enactment of the
Indian Health Care Improvement Act Amendments of 2003, the Secretary, acting
through the Service, and the Secretary of the Interior shall develop and enter
into a memoranda of agreement, or review and update any existing memoranda of
agreement, as required by section 4205 of the Indian Alcohol and Substance
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2411) under which the
Secretaries address the following:
`(1) The
scope and nature of mental illness and dysfunctional and self-destructive
behavior, including child abuse and family violence, among Indians.
`(2) The
existing Federal, tribal, State, local, and private services, resources, and
programs available to provide mental health services for Indians.
`(3) The
unmet need for additional services, resources, and programs necessary to meet
the needs identified pursuant to paragraph (1).
`(4)(A) The
right of Indians, as citizens of the United States and of the States in which
they reside, to have access to mental health services to which all citizens
have access.
`(B) The
right of Indians to participate in, and receive the benefit of, such services.
`(C) The
actions necessary to protect the exercise of such right.
`(5) The
responsibilities of the Bureau of Indian Affairs and the Service, including
mental health identification, prevention, education, referral, and treatment
services (including services through multidisciplinary resource teams), at the
central, area, and agency and Service Unit, Service Area, and headquarters
levels to address the problems identified in paragraph (1).
`(6) A
strategy for the comprehensive coordination of the mental health services
provided by the Bureau of Indian Affairs and the Service to meet the problems
identified pursuant to paragraph (1), including--
`(A) the
coordination of alcohol and substance abuse programs of the Service, the Bureau
of Indian Affairs, and Indian Tribes and Tribal Organizations (developed under
the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986)
with mental health initiatives pursuant to this Act, particularly with respect
to the referral and treatment of dually diagnosed individuals requiring mental
health and substance abuse treatment; and
`(B) ensuring
that the Bureau of Indian Affairs and Service programs and services (including
multidisciplinary resource teams) addressing child abuse and family violence
are coordinated with such non-Federal programs and services.
`(7)
Directing appropriate officials of the Bureau of Indian Affairs and the
Service, particularly at the agency and Service Unit levels, to cooperate fully
with tribal requests made pursuant to community behavioral health plans adopted
under section 701(c) and section 4206 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2412).
`(8)
Providing for an annual review of such agreement by the Secretaries which shall
be provided to Congress and Indian Tribes and Tribal Organizations.
`(b) SPECIFIC
PROVISIONS REQUIRED- The memoranda of agreement updated or entered into
pursuant to subsection (a) shall include specific provisions pursuant to which
the Service shall assume responsibility for--
`(1) the
determination of the scope of the problem of alcohol and substance abuse among
Indians, including the number of Indians within the jurisdiction of the Service
who are directly or indirectly affected by alcohol and substance abuse and the
financial and human cost;
`(2) an
assessment of the existing and needed resources necessary for the prevention of
alcohol and substance abuse and the treatment of Indians affected by alcohol
and substance abuse; and
`(3) an
estimate of the funding necessary to adequately support a program of prevention
of alcohol and substance abuse and treatment of Indians affected by alcohol and
substance abuse.
`(c)
CONSULTATION- The Secretary, acting through the Service, and the Secretary of
the Interior shall, in developing the memoranda of agreement under subsection
(a), consult with and solicit the comments from--
`(1) Indian
Tribes and Tribal Organizations;
`(2) Indians;
`(3) Urban
Indian Organizations and other Indian organizations; and
`(4)
behavioral health service providers.
`(d)
PUBLICATION- Each memorandum of agreement entered into or renewed (and
amendments or modifications thereto) under subsection (a) shall be published in
the Federal Register. At the same time as publication in the Federal Register,
the Secretary shall provide a copy of such memoranda, amendment, or
modification to each Indian Tribe, Tribal Organization, and Urban Indian
Organization.
`(a)
ESTABLISHMENT-
`(1) IN GENERAL- The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall provide a program of
comprehensive behavioral health, prevention, treatment, and aftercare,
including Traditional Health Care Practices, which shall include--
`(A)
prevention, through educational intervention, in Indian communities;
`(B) acute
detoxification, psychiatric hospitalization, and residential and intensive
outpatient treatment;
`(C)
community-based rehabilitation and aftercare;
`(D)
community education and involvement, including extensive training of health
care, educational, and community-based personnel; and
`(E)
specialized residential treatment programs for high-risk populations, including
but not limited to pregnant and postpartum women and their children.
`(2) TARGET
POPULATIONS- The target population of such program shall be members of Indian
Tribes. Efforts to train and educate key members of the Indian community shall
target employees of health, education, judicial, law enforcement, legal, and
social service programs.
`(b) CONTRACT
HEALTH SERVICES-
`(1) IN
GENERAL- The Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, may enter into contracts with public or private providers of
behavioral health treatment services for the purpose of carrying out the
program required under subsection (a).
`(2)
PROVISION OF ASSISTANCE- In carrying out this subsection, the Secretary shall
provide assistance to Indian Tribes and Tribal Organizations to develop
criteria for the certification of behavioral health service providers and
accreditation of service facilities which meet minimum standards for such
services and facilities.
`(a) IN
GENERAL- Under the authority of the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the Snyder Act), the Secretary shall establish and maintain
a mental health technician program within the Service which--
`(1) provides
for the training of Indians as mental health technicians; and
`(2) employs
such technicians in the provision of community-based mental health care that
includes identification, prevention, education, referral, and treatment
services.
`(b)
PARAPROFESSIONAL TRAINING- In carrying out subsection (a), the Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations, shall
provide high-standard paraprofessional training in mental health care necessary
to provide quality care to the Indian communities to be served. Such training
shall be based upon a curriculum developed or approved by the Secretary which
combines education in the theory of mental health care with supervised
practical experience in the provision of such care.
`(c)
SUPERVISION AND EVALUATION OF TECHNICIANS- The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall supervise and evaluate
the mental health technicians in the training program.
`(d)
TRADITIONAL HEALTH CARE PRACTICES- The Secretary, acting through the Service,
shall ensure that the program established pursuant to this subsection involves
the use and promotion of the Traditional Health Care Practices of the Indian
Tribes to be served.
`Subject to
the provisions of section 221, any person employed as a psychologist, social
worker, or marriage and family therapist for the purpose of providing mental
health care services to Indians in a clinical setting under this Act or through
a Funding Agreement shall, in the case of a person employed as a psychologist,
social worker, or marriage and family therapist, be licensed as a clinical
psychologist, social worker, or marriage and family therapist, respectively, or
working under the direct supervision of a licensed clinical psychologist,
social worker, or marriage and family therapist, respectively.
`(a) FUNDING-
The Secretary, consistent with section 701, shall make funds available to
Indian Tribes, Tribal Organizations, and Urban Indian Organizations to develop
and implement a comprehensive behavioral health program of prevention,
intervention, treatment, and relapse prevention services that specifically
addresses the spiritual, cultural, historical, social, and child care needs of
Indian women, regardless of age.
`(b) USE OF
FUNDS- Funds made available pursuant to this section may be used to--
`(1) develop
and provide community training, education, and prevention programs for Indian
women relating to behavioral health issues, including fetal alcohol disorders;
`(2) identify
and provide psychological services, counseling, advocacy, support, and relapse
prevention to Indian women and their families; and
`(3) develop
prevention and intervention models for Indian women which incorporate
Traditional Health Care Practices, cultural values, and community and family
involvement.
`(c)
CRITERIA- The Secretary, in consultation with Indian Tribes and Tribal
Organizations, shall establish criteria for the review and approval of
applications and proposals for funding under this section.
`(d) EARMARK
OF CERTAIN FUNDS- Twenty percent of the funds appropriated pursuant to this
section shall be used to make grants to Urban Indian Organizations.
`(a)
DETOXIFICATION AND REHABILITATION- The Secretary, acting through the Service,
consistent with section 701, shall develop and implement a program for acute
detoxification and treatment for Indian youths, including behavioral health
services. The program shall include regional treatment centers designed to
include detoxification and rehabilitation for both sexes on a referral basis
and programs developed and implemented by Indian Tribes or Tribal Organizations
at the local level under the Indian
Self-Determination and Education Assistance Act. Regional
centers shall be integrated with the intake and rehabilitation programs based
in the referring Indian community.
`(b) ALCOHOL
AND SUBSTANCE ABUSE TREATMENT CENTERS OR FACILITIES-
`(1)
ESTABLISHMENT-
`(A) IN
GENERAL- The Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, shall construct, renovate, or, as necessary, purchase, and
appropriately staff and operate, at least 1 youth regional treatment center or
treatment network in each area under the jurisdiction of an Area Office.
`(B) AREA
OFFICE IN CALIFORNIA- For the purposes of this subsection, the Area Office in
California shall be considered to be 2 Area Offices, 1 office whose
jurisdiction shall be considered to encompass the northern area of the State of
California, and 1 office whose jurisdiction shall be considered to encompass
the remainder of the State of California for the purpose of implementing
California treatment networks.
`(2) FUNDING-
For the purpose of staffing and operating such centers or facilities, funding
shall be pursuant to the Act of November 2, 1921 (25 U.S.C. 13).
`(3)
LOCATION- A youth treatment center constructed or purchased under this
subsection shall be constructed or purchased at a location within the area
described in paragraph (1) agreed upon (by appropriate tribal resolution) by a
majority of the Indian Tribes to be served by such center.
`(4) SPECIFIC
PROVISION OF FUNDS-
`(A) IN
GENERAL- Notwithstanding any other provision of this title, the Secretary may,
from amounts authorized to be appropriated for the purposes of carrying out
this section, make funds available to--
`(i) the
Tanana Chiefs Conference, Incorporated, for the purpose of leasing,
constructing, renovating, operating, and maintaining a residential youth
treatment facility in Fairbanks, Alaska; and
`(ii) the
Southeast Alaska Regional Health Corporation to staff and operate a residential
youth treatment facility without regard to the proviso set forth in section 4(l)
of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(l)).
`(B)
PROVISION OF SERVICES TO ELIGIBLE YOUTHS- Until additional residential youth
treatment facilities are established in Alaska pursuant to this section, the facilities
specified in subparagraph (A) shall make every effort to provide services to
all eligible Indian youths residing in such State.
`(c)
INTERMEDIATE ADOLESCENT BEHAVIORAL HEALTH SERVICES-
`(1) IN
GENERAL- The Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, may provide intermediate behavioral health services, which may
incorporate Traditional Health Care Practices, to Indian children and
adolescents, including--
`(A)
pretreatment assistance;
`(B)
inpatient, outpatient, and aftercare services;
`(C)
emergency care;
`(D) suicide
prevention and crisis intervention; and
`(E)
prevention and treatment of mental illness and dysfunctional and
self-destructive behavior, including child abuse and family violence.
`(2) USE OF
FUNDS- Funds provided under this subsection may be used--
`(A) to
construct or renovate an existing health facility to provide intermediate
behavioral health services;
`(B) to hire
behavioral health professionals;
`(C) to
staff, operate, and maintain an intermediate mental health facility, group
home, sober housing, transitional housing or similar facilities, or youth
shelter where intermediate behavioral health services are being provided;
`(D) to make
renovations and hire appropriate staff to convert existing hospital beds into
adolescent psychiatric units; and
`(E) for
intensive home- and community-based services.
`(3)
CRITERIA- The Secretary, acting through the Service, shall, in consultation
with Indian Tribes and Tribal Organizations, establish criteria for the review
and approval of applications or proposals for funding made available pursuant
to this subsection.
`(d)
FEDERALLY OWNED STRUCTURES-
`(1) IN
GENERAL- The Secretary, in consultation with Indian Tribes and Tribal
Organizations, shall--
`(A) identify
and use, where appropriate, federally owned structures suitable for local
residential or regional behavioral health treatment for Indian youths; and
`(B)
establish guidelines, in consultation with Indian Tribes and Tribal
Organizations, for determining the suitability of any such federally owned
structure to be used for local residential or regional behavioral health
treatment for Indian youths.
`(2) TERMS
AND CONDITIONS FOR USE OF STRUCTURE- Any structure described in paragraph (1)
may be used under such terms and conditions as may be agreed upon by the
Secretary and the agency having responsibility for the structure and any Indian
Tribe or Tribal Organization operating the program.
`(e)
REHABILITATION AND AFTERCARE SERVICES-
`(1) IN
GENERAL- The Secretary, Indian Tribes, or Tribal Organizations, in cooperation
with the Secretary of the Interior, shall develop and implement within each
Service Unit, community-based rehabilitation and follow-up services for Indian
youths who are having significant behavioral health problems, and require
long-term treatment, community reintegration, and monitoring to support the
Indian youths after their return to their home community.
`(2)
ADMINISTRATION- Services under paragraph (1) shall be provided by trained staff
within the community who can assist the Indian youths in their continuing
development of self-image, positive problem-solving skills, and nonalcohol or
substance abusing behaviors. Such staff may include alcohol and substance abuse
counselors, mental health professionals, and other health professionals and
paraprofessionals, including community health representatives.
`(f)
INCLUSION OF FAMILY IN YOUTH TREATMENT PROGRAM- In providing the treatment and
other services to Indian youths authorized by this section, the Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations, shall
provide for the inclusion of family members of such youths in the treatment
programs or other services as may be appropriate. Not less than 10 percent of
the funds appropriated for the purposes of carrying out subsection (e) shall be
used for outpatient care of adult family members related to the treatment of an
Indian youth under that subsection.
`(g)
MULTIDRUG ABUSE PROGRAM- The Secretary, acting through the Service, Indian
Tribes, Tribal Organizations, and Urban Indian Organizations, shall provide,
consistent with section 701, programs and services to prevent and treat the
abuse of multiple forms of substances, including, but not limited to, alcohol,
drugs, inhalants, and tobacco, among Indian youths residing in Indian
communities, on or near reservations, and in urban areas and provide
appropriate mental health services to address the incidence of mental illness
among such youths.
`Not later
than 1 year after the date of the enactment of the Indian Health Care
Improvement Act Amendments of 2003, the Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide, in each area of the
Service, not less than 1 inpatient mental health care facility, or the
equivalent, for Indians with behavioral health problems. For the purposes of
this subsection, California shall be considered to be 2 Area Offices, 1 office
whose location shall be considered to encompass the northern area of the State
of California and 1 office whose jurisdiction shall be considered to encompass
the remainder of the State of California. The Secretary shall consider the
possible conversion of existing, underused Service hospital beds into
psychiatric units to meet such need.
`(a) PROGRAM-
The Secretary, in cooperation with the Secretary of the Interior, shall develop
and implement or provide funding for Indian Tribes and Tribal Organizations to
develop and implement, within each Service Unit or tribal program, a program of
community education and involvement which shall be designed to provide concise
and timely information to the community leadership of each tribal community.
Such program shall include education about behavioral health issues to
political leaders, Tribal judges, law enforcement personnel, members of tribal
health and education boards, health care providers including traditional
practitioners, and other critical members of each tribal community.
Community-based training (oriented toward local capacity development) shall
also include tribal community provider training (designed for adult learners
from the communities receiving services for prevention, intervention,
treatment, and aftercare).
`(b)
INSTRUCTION- The Secretary, acting through the Service, shall, either directly
or through Indian Tribes and Tribal Organizations, provide instruction in the
area of behavioral health issues, including instruction in crisis intervention
and family relations in the context of alcohol and substance abuse, child
sexual abuse, youth alcohol and substance abuse, and the causes and effects of
fetal alcohol disorders to appropriate employees of the Bureau of Indian
Affairs and the Service, and to personnel in schools or programs operated under
any contract with the Bureau of Indian Affairs or the Service, including supervisors
of emergency shelters and halfway houses described in section 4213 of the
Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (25
U.S.C. 2433).
`(c) TRAINING
MODELS- In carrying out the education and training programs required by this
section, the Secretary, in consultation with Indian Tribes, Tribal
Organizations, Indian behavioral health experts, and Indian alcohol and
substance abuse prevention experts, shall develop and provide community-based
training models. Such models shall address--
`(1) the
elevated risk of alcohol and behavioral health problems faced by children of
alcoholics;
`(2) the
cultural, spiritual, and multigenerational aspects of behavioral health problem
prevention and recovery; and
`(3)
community-based and multidisciplinary strategies for preventing and treating
behavioral health problems.
`(a)
INNOVATIVE PROGRAMS- The Secretary, acting through the Service, Indian Tribes,
and Tribal Organizations, consistent with section 701, may plan, develop,
implement, and carry out programs to deliver innovative community-based
behavioral health services to Indians.
`(b) FUNDING;
CRITERIA- The Secretary may award such funding for a project under subsection
(a) to an Indian Tribe or Tribal Organization and may consider the following
criteria:
`(1) The
project will address significant unmet behavioral health needs among Indians.
`(2) The
project will serve a significant number of Indians.
`(3) The
project has the potential to deliver services in an efficient and effective
manner.
`(4) The
Indian Tribe or Tribal Organization has the administrative and financial
capability to administer the project.
`(5) The
project may deliver services in a manner consistent with Traditional Health
Care Practices.
`(6) The
project is coordinated with, and avoids duplication of, existing services.
`(c)
EQUITABLE TREATMENT- For purposes of this subsection, the Secretary shall, in
evaluating applications or proposals for funding for projects to be operated
under any Funding Agreement, use the same criteria that the Secretary uses in
evaluating any other application or proposal for such funding.
`(a)
PROGRAMS-
`(1) ESTABLISHMENT-
The Secretary, consistent with section 701, acting through Indian Tribes and
Tribal Organizations, shall establish and operate fetal alcohol disorder
programs as provided in this section for the purposes of meeting the health
status objectives specified in section 3.
`(2) USE OF
FUNDS- Funding provided pursuant to this section shall be used for the
following:
`(A) To
develop and provide for Indians community and in school training, education,
and prevention programs relating to fetal alcohol disorders.
`(B) To
identify and provide behavioral health treatment to high-risk Indian women and
high-risk women pregnant with an Indian's child.
`(C) To
identify and provide appropriate psychological services, educational and
vocational support, counseling, advocacy, and information to fetal alcohol
disorder affected Indians and their families or caretakers.
`(D) To
develop and implement counseling and support programs in schools for fetal
alcohol disorder affected Indian children.
`(E) To
develop prevention and intervention models which incorporate practitioners of
Traditional Health Care Practices, cultural and spiritual values, and community
involvement.
`(F) To
develop, print, and disseminate education and prevention materials on fetal
alcohol disorder.
`(G) To
develop and implement, through the tribal consultation process, culturally
sensitive assessment and diagnostic tools including dysmorphology clinics and
multidisciplinary fetal alcohol disorder clinics for use in Indian communities
and Urban Centers.
`(H) To
develop early childhood intervention projects from birth on to mitigate the
effects of fetal alcohol disorder among Indians.
`(I) To
develop and fund community-based adult fetal alcohol disorder housing and
support services for Indians and for women pregnant with an Indian's child.
`(3) CRITERIA
FOR APPLICATIONS- The Secretary shall establish criteria for the review and
approval of applications for funding under this section.
`(b)
SERVICES- The Secretary, acting through the Service and Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall--
`(1) develop
and provide services for the prevention, intervention, treatment, and aftercare
for those affected by fetal alcohol disorder in Indian communities; and
`(2) provide
supportive services, directly or through an Indian Tribe, Tribal Organization,
or Urban Indian Organization, including services to meet the special
educational, vocational, school-to-work transition, and independent living
needs of adolescent and adult Indians with fetal alcohol disorder.
`(c) TASK
FORCE- The Secretary shall establish a task force to be known as the Fetal
Alcohol Disorder Task Force to advise the Secretary in carrying out subsection
(b). Such task force shall be composed of representatives from the following:
`(1) The
National Institute on Drug Abuse.
`(2) The
National Institute on Alcohol and Alcoholism.
`(3) The
Office of Substance Abuse Prevention.
`(4) The
National Institute of Mental Health.
`(5) The
Service.
`(6) The
Office of Minority Health of the Department of Health and Human Services.
`(7) The
Administration for Native Americans.
`(8) The
National Institute of Child Health and Human Development (NICHD).
`(9) The
Centers for Disease Control and Prevention.
`(10) The
Bureau of Indian Affairs.
`(11) Indian
Tribes.
`(12) Tribal
Organizations.
`(13) Urban
Indian Organizations.
`(14) Indian
fetal alcohol disorder experts.
`(d) APPLIED
RESEARCH PROJECTS- The Secretary, acting through the Substance Abuse and Mental
Health Services Administration, shall make funding available to Indian Tribes,
Tribal Organizations, and Urban Indian Organizations for applied research
projects which propose to elevate the understanding of methods to prevent,
intervene, treat, or provide rehabilitation and behavioral health aftercare for
Indians and Urban Indians affected by fetal alcohol disorder.
`(e) FUNDING
FOR URBAN INDIAN ORGANIZATIONS- Ten percent of the funds appropriated pursuant
to this section shall be used to make grants to Urban Indian Organizations
funded under title V.
`(a)
ESTABLISHMENT- The Secretary, acting through the Service, and the Secretary of
the Interior, Indian Tribes, and Tribal Organizations shall establish,
consistent with section 701, in every Service Area, programs involving
treatment for--
`(1) victims
of sexual abuse who are Indian children or children in an Indian household; and
`(2)
perpetrators of child sexual abuse who are Indian or members of an Indian
household.
`(b) USE OF
FUNDS- Funding provided pursuant to this section shall be used for the
following:
`(1) To
develop and provide community education and prevention programs related to
sexual abuse of Indian children or children in an Indian household.
`(2) To
identify and provide behavioral health treatment to victims of sexual abuse who
are Indian children or children in an Indian household, and to their family
members who are affected by sexual abuse.
`(3) To
develop prevention and intervention models which incorporate Traditional Health
Care Practices, cultural and spiritual values, and community involvement.
`(4) To
develop and implement, through the tribal consultation process, culturally
sensitive assessment and diagnostic tools for use in Indian communities and
Urban Centers.
`(5) To
identify and provide behavioral health treatment to Indian perpetrators and
perpetrators who are members of an Indian household--
`(A) making
efforts to begin offender and behavioral health treatment while the perpetrator
is incarcerated or at the earliest possible date if the perpetrator is not
incarcerated; and
`(B)
providing treatment after the perpetrator is released, until it is determined
that the perpetrator is not a threat to children.
`The Secretary, in consultation with appropriate Federal agencies, shall provi