S
556 IS
108th CONGRESS
1st Session
S. 556
Mr. CAMPBELL (for himself, Mr. INOUYE, and Mr. MCCAIN)
introduced the following bill; which was read twice and referred to the
Committee on Indian Affairs
A BILL
Be it
enacted by the Senate and House of Representatives of the United States of
America in Congress assembled,
(a) SHORT
TITLE- This Act may be cited as the `Indian Health Care Improvement Act
Reauthorization of 2003'.
(b) TABLE OF
CONTENTS- The table of contents for this Act is as follows:
Sec. 1. Short
title.
Sec. 101.
Amendment to the Indian Health Care Improvement Act.
Sec. 201.
Limitations on charges.
Sec. 202.
Qualified Indian health program.
Sec. 211.
State consultation with Indian health programs.
Sec. 212.
FMAP for services provided by Indian health programs.
Sec. 213.
Indian Health Service programs.
Sec. 221.
Enhanced FMAP for State children's health insurance program.
Sec. 222.
Direct funding of State children's health insurance program.
Sec. 231.
Authorization of appropriations.
Sec. 301.
Repeals.
Sec. 302.
Severability provisions.
Sec. 303.
Effective date.
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; table of contents.
`Sec. 2. Findings.
`Sec. 3. Declaration of health objectives.
`Sec. 4. Definitions.
`Sec. 101. Purpose.
`Sec. 102. General requirements.
`Sec. 103. Health professions recruitment program for Indians.
`Sec. 104. Health professions preparatory scholarship program for
Indians.
`Sec. 105. Indian health professions scholarships.
`Sec. 106. American Indians into psychology program.
`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. 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.
`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.
`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 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.
`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.
`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.
`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.
`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. 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. Memorandum 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 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.
`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
Entitlement.
`Sec. 815. Appropriations; availability.
`Sec. 816. Authorization of appropriations.
…
`(a)
PURPOSES- It is the purpose of this section to--
`(1)
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) 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) assist
Indian tribes to identify services and resources available to address mental
illness and dysfunctional and self-destructive behavior;
`(4) provide
authority and opportunities for Indian tribes to develop and implement, and
coordinate with, community-based programs which include identification,
prevention, education, referral, and treatment services, including through
multi-disciplinary resource teams;
`(5) 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; and
`(6) modify
or supplement existing programs and authorities in the areas identified in
paragraph (2).
`(b)
BEHAVIORAL HEALTH PLANNING-
`(1)
AREA-WIDE PLANS- 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, encourage urban Indian
organizations to develop local plans, and encourage all such groups to
participate in developing area-wide plans for Indian Behavioral Health
Services. The plans shall, to the extent feasible, include--
`(A) an
assessment of the scope of the problem of alcohol or other substance abuse,
mental illness, 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; and
`(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); and
`(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 shall establish a national clearinghouse of plans
and reports on the outcomes of such plans developed under this section by
Indian tribes, tribal organizations and by areas relating to behavioral health.
The Secretary shall ensure access to such 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 utilized and adopted locally.
`(c)
CONTINUUM OF CARE- The Secretary, acting through the Service, Indian tribes and
tribal organizations, shall provide, to the extent feasible and to the extent
that funding is available, for the implementation of programs including--
`(1) a
comprehensive continuum of behavioral health care that provides for--
`(A)
community based prevention, intervention, outpatient and behavioral health
aftercare;
`(B) detoxification
(social and medical);
`(C) acute
hospitalization;
`(D)
intensive outpatient or day treatment;
`(E)
residential treatment;
`(F)
transitional living for those needing a temporary stable living environment
that is supportive of treatment or recovery goals;
`(G)
emergency shelter;
`(H)
intensive case management;
`(I)
traditional health care practices; and
`(J)
diagnostic services, including the utilization of neurological assessment
technology; and
`(2)
behavioral health services for particular populations, including--
`(A) for
persons from birth through age 17, child behavioral health services, that
include--
`(i)
pre-school and school age fetal alcohol disorder services, including assessment
and behavioral intervention);
`(ii) mental
health or substance abuse services (emotional, organic, alcohol, drug, inhalant
and tobacco);
`(iii)
services for co-occurring disorders (multiple diagnosis);
`(iv)
prevention services that are focused on individuals ages 5 years through 10
years (alcohol, drug, inhalant and tobacco);
`(v) early
intervention, treatment and aftercare services that are focused on individuals
ages 11 years through 17 years;
`(vi) healthy
choices or life style services (related to STD's, domestic violence, sexual
abuse, suicide, teen pregnancy, obesity, and other risk or safety issues);
`(vii)
co-morbidity services;
`(B) for
persons ages 18 years through 55 years, adult behavioral health services that
include--
`(i) early
intervention, treatment and aftercare services;
`(ii) mental
health and substance abuse services (emotional, alcohol, drug, inhalant and
tobacco);
`(iii)
services for co-occurring disorders (dual diagnosis) and co-morbidity;
`(iv) healthy
choices and life style services (related to parenting, partners, domestic
violence, sexual abuse, suicide, obesity, and other risk related behavior);
`(v) female
specific treatment services for--
`(I) women at
risk of giving birth to a child with a fetal alcohol disorder;
`(II)
substance abuse requiring gender specific services;
`(III) sexual
assault and domestic violence; and
`(IV) healthy
choices and life style (parenting, partners, obesity, suicide and other related
behavioral risk); and
`(vi) male
specific treatment services for--
`(I)
substance abuse requiring gender specific services;
`(II) sexual
assault and domestic violence; and
`(III) healthy choices and life style (parenting,
partners, obesity,suicide and other risk related behavior);
`(C) family
behavioral health services, including--
`(i) early
intervention, treatment and aftercare for affected families;
`(ii)
treatment for sexual assault and domestic violence; and
`(iii)
healthy choices and life style (related to parenting, partners, domestic
violence and other abuse issues);
`(D) for
persons age 56 years and older, elder behavioral health services including--
`(i) early
intervention, treatment and aftercare services that include--
`(I) mental
health and substance abuse services (emotional, alcohol, drug, inhalant and
tobacco);
`(II)
services for co-occurring disorders (dual diagnosis) and co-morbidity; and
`(III)
healthy choices and life style services (managing conditions related to aging);
`(ii) elder
women specific services that include--
`(I)
treatment for substance abuse requiring gender specific services and
`(II)
treatment for sexual assault, domestic violence and neglect;
`(iii) elder
men specific services that include--
`(I)
treatment for substance abuse requiring gender specific services; and
`(II)
treatment for sexual assault, domestic violence and neglect; and
`(iv)
services for dementia regardless of cause.
`(d)
COMMUNITY BEHAVIORAL HEALTH PLAN-
`(1) IN
GENERAL- The governing body of any Indian tribe or tribal organization or urban
Indian organization may, at its discretion, 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 alcohol and other substance abuse, mental illness
or dysfunctional and self-destructive behavior, including child abuse and
family violence, among its members or its service population. Such plan should
include behavioral health services, social services, intensive outpatient services,
and continuing after care.
`(2)
TECHNICAL ASSISTANCE- In furtherance of a plan established pursuant to
paragraph (1) and at the request of a tribe, the appropriate agency, service
unit, or other officials of the Bureau of Indian Affairs and the Service shall
cooperate with, and provide technical assistance to, the Indian tribe or tribal
organization in the development of a plan under paragraph (1). Upon the
establishment of such a plan and at the request of the Indian tribe or tribal
organization, such officials shall cooperate with the Indian tribe or tribal
organization in the implementation of such plan.
`(3) FUNDING-
The Secretary, acting through the Service, may make funding available to Indian
tribes and tribal organizations adopting 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)
COORDINATED PLANNING- 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 and
State agencies, to ensure that comprehensive behavioral health services are
available to Indians without regard to their place of residence.
`(f)
FACILITIES ASSESSMENT- Not later than 1 year after the date of enactment of
this Act, 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, under-utilized service hospital beds into psychiatric units to meet
such need.
`(a) IN
GENERAL- Not later than 1 year after the date of enactment of this Act, the
Secretary and the Secretary of the Interior shall develop and enter into a memorandum
of agreement, or review and update any existing memoranda of agreement as
required under section 4205 of the Indian Alcohol and Substance Abuse
Prevention
and
Treatment Act of 1986 (25 U.S.C. 2411), and under which the Secretaries
address--
`(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;
and
`(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 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 needs
identified pursuant to paragraph (1), including--
`(A) the
coordination of alcohol and substance abuse programs of the Service, the Bureau
of Indian Affairs, and the various Indian tribes (developed under the Indian
Alcohol and Substance Abuse Prevention and Treatment Act of 1986) with the
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 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) direct appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at theagency 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); and
`(8) provide
for an annual review of such agreement by the 2 Secretaries and a report which
shall be submitted to Congress and made available to the Indian tribes.
`(b) SPECIFIC
PROVISIONS- The memorandum 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
Indian people, 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 and the Secretary of the Interior shall, in
developing the memorandum of agreement under subsection (a), consult with and
solicit the comments of--
`(1) Indian
tribes and tribal organizations;
`(2) Indian
individuals;
`(3) urban
Indian organizations and other Indian organizations;
`(4)
behavioral health service providers.
`(d)
PUBLICATION- The memorandum of agreement under subsection (a) shall be
published in the Federal Register. At the same time as the publication of such
agreement in the Federal Register, the Secretary shall provide a copy of such
memorandum 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 consistent with section 701, shall provide a program of comprehensive
behavioral health prevention and treatment and aftercare, including systems of
care and traditional health care practices, which shall include--
`(A)
prevention, through educational intervention, in Indian communities;
`(B) acute
detoxification or psychiatric hospitalization and treatment (residential and
intensive outpatient);
`(C)
community-based rehabilitation and aftercare;
`(D)
community education and involvement, including extensive training of health
care, educational, and community-based personnel;
`(E)
specialized residential treatment programs for high risk populations including
pregnant and post partum women and their children;
`(F)
diagnostic services utilizing, when appropriate, neuropsychiatric assessments
which include the use of the most advances technology available; and
`(G) a
telepsychiatry program that uses experts in the field of pediatric psychiatry,
and that incorporates assessment, diagnosis and treatment for children,
including those children with concurrent neurological disorders.
`(2) TARGET
POPULATIONS- The target population of the program under paragraph (1) 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 (with the consent of the
Indian tribe to be served), 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)
TRAINING- In carrying out subsection (a)(1), the Secretary 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- The Secretary shall supervise and evaluate the
mental health technicians in the training program under this section.
`(d) TRADITIONAL CARE- The Secretary shall ensure
that the program established pursuant to this section involves the utilization
and promotion of the traditional
Indian
health care and treatment practices of the Indian tribes to be served.
`Subject to
section 220, 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 the authority of this Act or through a
funding agreement pursuant to the Indian Self-Determination and Education
Assistance Act shall--
`(1) in the
case of a person employed as a psychologist to provide health care services, be
licensed as a clinical or counseling psychologist, or working under the direct
supervision of a clinical or counseling psychologist;
`(2) in the
case of a person employed as a social worker, be licensed as a social worker or
working under the direct supervision of a licensed social worker; or
`(3) in the
case of a person employed as a marriage and family therapist, be licensed as a
marriage and family therapist or working under the direct supervision of a
licensed marriage and family therapist.
`(a) FUNDING-
The Secretary, consistent with section 701, shall make funding available to
Indian tribes, tribal organizations and urban Indian organization 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- Funding provided 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 amounts appropriated to carry out this
section shall be used to make grants to urban Indian organizations funded under
title V.
`(a)
DETOXIFICATION AND REHABILITATION- The Secretary shall, consistent with section
701, develop and implement a program for acute detoxification and treatment for
Indian youth that includes 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, or 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 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 centers or facilities under this
subsection, funding shall be made available pursuant to the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the Snyder Act).
`(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) that is agreed upon (by appropriate tribal resolution) by a
majority of the 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;
`(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));
`(iii) the
Southern Indian Health Council, for the purpose of staffing, operating, and
maintaining a residential youth treatment facility in San Diego County,
California; and
`(iv) the
Navajo Nation, for the staffing, operation, and maintenance of the Four Corners
Regional Adolescent Treatment Center, a residential youth treatment facility in
New Mexico.
`(B)
PROVISION OF SERVICES TO ELIGIBLE YOUTH- 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 youth 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) pre-treatment
assistance;
`(B)
inpatient, outpatient, and after-care 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; and
`(D) to make
renovations and hire appropriate staff to convert existing hospital beds into
adolescent psychiatric units; and
`(E) to
provide intensive home- and community-based services, including collaborative
systems of care.
`(3)
CRITERIA- The Secretary 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, acting through the Service, shall, in consultation with
Indian tribes and tribal organizations--
`(A) identify
and use, where appropriate, federally owned structures suitable for local
residential or regional behavioral health treatment for Indian youth; 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 youth.
`(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, an Indian tribe or tribal organization, 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
youth who have significant behavioral health problems, and require long-term
treatment, community reintegration, and monitoring to support the Indian youth
after their return to their home community.
`(2)
ADMINISTRATION- Services under paragraph (1) shall be administered within each
service unit or tribal program by trained staff within the community who can
assist the Indian youth in 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 youth authorized by this section, the Secretary, an
Indian tribe or tribal organization shall provide for the inclusion of family
members of such youth 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 alcohol, drugs, inhalants, and
tobacco, among Indian youth residing in Indian communities, on Indian
reservations, and in urban areas and provide appropriate mental health services
to address the incidence of mental illness among such youth.
`(a) IN
GENERAL- Not later than 1 year after the date of enactment of this section, 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.
`(b)
TREATMENT OF CALIFORNIA- For purposes of this section, California shall be
considered to be 2 areas of the Service, 1 area whose location shall be
considered to encompass the northern area of the State of California and 1 area
whose jurisdiction shall be considered to encompass the remainder of the State
of California.
`(c)
CONVERSION OF CERTAIN HOSPITAL BEDS- The Secretary shall consider the possible
conversion of existing, under-utilized Service hospital beds into psychiatric
units to meet needs under this section.
`(a)
COMMUNITY EDUCATION-
`(1) IN
GENERAL- The Secretary, in cooperation with the Secretary of the Interior,
shall develop and implement, or provide funding to enable Indian tribes and
tribal organization 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.
`(2)
EDUCATION- A program under paragraph (1) shall include education concerning
behavioral health for political leaders, tribal judges, law enforcement
personnel, members of tribal health and education boards, and other critical
members of each tribal community.
`(3)
TRAINING- Community-based training (oriented toward local capacity development)
under a program under paragraph (1) shall include tribal community provider
training (designed for adult learners from the communities receiving services
for prevention, intervention, treatment and aftercare).
`(b)
TRAINING- The Secretary shall, either directly or through Indian tribes or
tribal organization, 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)
COMMUNITY-BASED TRAINING MODELS- In carrying out the education and training
programs required by this section, the Secretary, acting through the Service
and 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) PROGRAMS
FOR INNOVATIVE SERVICES- The Secretary, acting through the Service, Indian
tribes or tribal organizations, consistent with Section 701, may develop,
implement, and carry out programs to deliver innovative community-based
behavioral health services to Indians.
`(b)
CRITERIA- The Secretary may award funding for a project under subsection (a) to
an Indian tribe or tribal organization and may consider the following criteria:
`(1) Whether
the project will address significant unmet behavioral health needs among
Indians.
`(2) Whether
the project will serve a significant number of Indians.
`(3) Whether
the project has the potential to deliver services in an efficient and effective
manner.
`(4) Whether
the tribe or tribal organization has the administrative and financial
capability to administer the project.
`(5) Whether
the project will deliver services in a manner consistent with traditional
health care.
`(6) Whether
the project is coordinated with, and avoids duplication of, existing services.
`(c) FUNDING
AGREEMENTS- For purposes of this subsection, the Secretary shall, in evaluating
applications or proposals for funding for projects to be operated under any
funding agreement entered into with the Service under the Indian
Self-Determination Act and Education Assistance Act, use the same criteria that
the Secretary uses in evaluating any other application or proposal for such
funding.
`(a) ESTABLISHMENT
OF PROGRAM-
`(1) IN
GENERAL- The Secretary, consistent with Section 701, acting through Indian
tribes, tribal organizations, and urban Indian organizations, shall establish
and operate fetal alcohol disorders programs as provided for in this section for
the purposes of meeting the health status objective specified in section 3(b).
`(2) USE OF
FUNDS- Funding provided pursuant to this section shall be used to--
`(A) develop
and provide community and in-school training, education, and prevention
programs relating to fetal alcohol disorders;
`(B) identify
and provide behavioral health treatment to high-risk women;
`(C) identify and provide appr