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

Page 293 TITLE 25—INDIANS § 1637 1 So in original. Probably should be ‘‘Self-Determination’’. 2 See References in Text note below. tion’’ for ‘‘Authorization of appropriations’’ in section catchline and subsecs. (a) to (d) for former single unlet- tered par. § 1635. Repealed. Pub. L. 100–713, title III, § 303(b), Nov. 23, 1988, 102 Stat. 4817 Section, Pub. L. 98–473, title I, § 101(c) [title II, § 201], Oct. 12, 1984, 98 Stat. 1837, 1865, related to renovation and modernization of facilities. § 1636. Grant program for construction, expan- sion, and modernization of small ambulatory care facilities (a) Authorization (1) The Secretary, acting through the Service, shall make grants to tribes and tribal organiza- tions for the construction, expansion, or mod- ernization of facilities for the provision of am- bulatory care services to eligible Indians (and noneligible persons as provided in subsection (c)(1)(C)). A grant made under this section may cover up to 100 percent of the costs of such con- struction, expansion, or modernization. For the purposes of this section, the term ‘‘construc- tion’’ includes the replacement of an existing fa- cility. (2) A grant under paragraph (1) may only be made to a tribe or tribal organization operating an Indian health facility (other than a facility owned or constructed by the Service, including a facility originally owned or constructed by the Service and transferred to a tribe or tribal orga- nization) pursuant to a contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]. (b) Use of grant (1) A grant provided under this section may be used only for the construction, expansion, or modernization (including the planning and de- sign of such construction, expansion, or mod- ernization) of an ambulatory care facility— (A) located apart from a hospital; (B) not funded under section 1631 of this title or section 1637 of this title; and (C) which, upon completion of such construc- tion, expansion, or modernization will— (i) have a total capacity appropriate to its projected service population; (ii) serve no less than 500 eligible Indians annually; and (iii) provide ambulatory care in a service area (specified in the contract entered into under the Indian Self-Determination Act [25 U.S.C. 5321 et seq.]) with a population of not less than 2,000 eligible Indians. (2) The requirements of clauses (ii) and (iii) of paragraph (1)(C) shall not apply to a tribe or tribal organization applying for a grant under this section whose tribal government offices are located on an island. (c) Application for grant (1) No grant may be made under this section unless an application for such a grant has been submitted to and approved by the Secretary. An application for a grant under this section shall be submitted in such form and manner as the Secretary shall by regulation prescribe and shall set forth reasonable assurance by the applicant that, at all times after the construction, expan- sion, or modernization of a facility carried out pursuant to a grant received under this sec- tion— (A) adequate financial support will be avail- able for the provision of services at such facil- ity; (B) such facility will be available to eligible Indians without regard to ability to pay or source of payment; and (C) such facility will, as feasible without di- minishing the quality or quantity of services provided to eligible Indians, serve noneligible persons on a cost basis. (2) In awarding grants under this section, the Secretary shall give priority to tribes and tribal organizations that demonstrate— (A) a need for increased ambulatory care services; and (B) insufficient capacity to deliver such services. (d) Transfer of interest to United States upon cessation of facility If any facility (or portion thereof) with respect to which funds have been paid under this sec- tion, ceases, at any time after completion of the construction, expansion, or modernization car- ried out with such funds, to be utilized for the purposes of providing ambulatory care services to eligible Indians, all of the right, title, and in- terest in and to such facility (or portion thereof) shall transfer to the United States. (Pub. L. 94–437, title III, § 306, as added Pub. L. 100–713, title III, § 304, Nov. 23, 1988, 102 Stat. 4817; amended Pub. L. 102–573, title III, § 303, Oct. 29, 1992, 106 Stat. 4561.) Editorial Notes REFERENCES IN TEXT The Indian Self-Determination Act, referred to in subsecs. (a)(2) and (b)(1)(C)(iii), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206, which is classified principally to subchapter I (§ 5321 et seq.) of chapter 46 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables. AMENDMENTS 1992—Pub. L. 102–573 amended section generally, sub- stituting provisions relating to grant program for con- struction, expansion, and modernization of small am- bulatory care facilities for provisions relating to con- veyance of certain real property under Alaska Native Claims Settlement Act. § 1637. Indian health care delivery demonstration projects (a) Purpose and general authority (1) Purpose The purpose of this section is to encourage the establishment of demonstration projects that meet the applicable criteria of this sec- tion to be carried out by the Secretary, acting through the Service, or Indian tribes or tribal organizations acting pursuant to contracts or compacts under the Indian Self Determina- tion 1 and Education Assistance Act (25 U.S.C. 450 et seq.)— 2 Page 294 TITLE 25—INDIANS § 1637 3 So in original. Probably should be ‘‘innovative’’. (A) to test alternative means of delivering health care and services to Indians through facilities; or (B) to use alternative or innovative meth- ods or models of delivering health care serv- ices to Indians (including primary care serv- ices, contract health services, or any other program or service authorized by this chap- ter) through convenient care services (as de- fined in subsection (c)), community health centers, or cooperative agreements or ar- rangements with other health care providers that share or coordinate the use of facilities, funding, or other resources, or otherwise co- ordinate or improve the coordination of ac- tivities of the Service, Indian tribes, or trib- al organizations, with those of the other health care providers. (2) Authority The Secretary, acting through the Service, is authorized to carry out, or to enter into contracts or compacts under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 2 with Indian tribes or tribal organizations to carry out, health care delivery demonstration projects that— (A) test alternative means of delivering health care and services to Indians through facilities; or (B) otherwise carry out the purposes of this section. (b) Use of funds The Secretary, in approving projects pursuant to this section— (1) may authorize such contracts for the con- struction and renovation of hospitals, health centers, health stations, and other facilities to deliver health care services; and (2) is authorized— (A) to waive any leasing prohibition; (B) to permit use and carryover of funds appropriated for the provision of health care services under this chapter (including for the purchase of health benefits coverage, as authorized by section 1642(a) of this title); (C) to permit the use of other available funds, including other Federal funds, funds from third-party collections in accordance with sections 1621e, 1621f, and 1641 of this title, and non-Federal funds contributed by State or local governmental agencies or fa- cilities or private health care providers pur- suant to cooperative or other agreements with the Service, 1 or more Indian tribes, or tribal organizations; (D) to permit the use of funds or property donated or otherwise provided from any source for project purposes; (E) to provide for the reversion of donated real or personal property to the donor; and (F) to permit the use of Service funds to match other funds, including Federal funds. (c) Health care demonstration projects (1) Definition of convenient care service In this subsection, the term ‘‘convenient care service’’ means any primary health care service, such as urgent care services, nonemer- gent care services, prevention services and screenings, and any service authorized by sec- tion 1621b of this title or 1621d(d) of this title, that is offered— (A) at an alternative setting; or (B) during hours other than regular work- ing hours. (2) General projects (A) Criteria The Secretary may approve under this sec- tion demonstration projects that meet the following criteria: (i) There is a need for a new facility or program, such as a program for convenient care services, or an improvement in, in- creased efficiency at, or reorientation of an existing facility or program. (ii) A significant number of Indians, in- cluding Indians with low health status, will be served by the project. (iii) The project has the potential to de- liver services in an efficient and effective manner. (iv) The project is economically viable. (v) For projects carried out by an Indian tribe or tribal organization, the Indian tribe or tribal organization has the admin- istrative and financial capability to ad- minister the project. (vi) The project is integrated with pro- viders of related health or social services (including State and local health care agencies or other health care providers) and is coordinated with, and avoids dupli- cation of, existing services in order to ex- pand the availability of services. (B) Priority In approving demonstration projects under this paragraph, the Secretary shall give pri- ority to demonstration projects, to the ex- tent the projects meet the criteria described in subparagraph (A), located in any of the following Service units: (i) Cass Lake, Minnesota. (ii) Mescalero, New Mexico. (iii) Owyhee and Elko, Nevada. (iv) Schurz, Nevada. (v) Ft. Yuma, California. (3) Innovative health services delivery dem- onstration project (A) Application or request On receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization within a Service area, the Secretary shall take into consideration alternative or innovated 3 methods to deliver health care services with- in the Service area (or a portion of, or facil- ity within, the Service area) as described in the application or request, including med- ical, dental, pharmaceutical, nursing, clin- ical laboratory, contract health services, convenient care services, community health centers, or any other health care services de- livery models designed to improve access to, or efficiency or quality of, the health care, Page 295 TITLE 25—INDIANS § 1637 health promotion, or disease prevention services and programs under this chapter. (B) Approval In addition to projects described in para- graph (2), in any fiscal year, the Secretary is authorized under this paragraph to approve not more than 10 applications for health care delivery demonstration projects that meet the criteria described in subparagraph (C). (C) Criteria The Secretary shall approve under sub- paragraph (B) demonstration projects that meet all of the following criteria: (i) The criteria set forth in paragraph (2)(A). (ii) There is a lack of access to health care services at existing health care facili- ties, which may be due to limited hours of operation at those facilities or other fac- tors. (iii) The project— (I) expands the availability of services; or (II) reduces— (aa) the burden on Contract Health Services; or (bb) the need for emergency room visits. (d) Technical assistance On receipt of an application or request from an Indian tribe, a consortium of Indian tribes, or a tribal organization, the Secretary shall pro- vide such technical and other assistance as may be necessary to enable applicants to comply with this section, including information regard- ing the Service unit budget and available fund- ing for carrying out the proposed demonstration project. (e) Service to ineligible persons Subject to section 1680c of this title, the au- thority to provide services to persons otherwise ineligible for the health care benefits of the Service, and the authority to extend hospital privileges in Service facilities to non-Service health practitioners as provided in section 1680c of this title, may be included, subject to the terms of that section, in any demonstration project approved pursuant to this section. (f) Equitable treatment For purposes of subsection (c), the Secretary, in evaluating facilities operated under any con- tract or compact under the Indian Self-Deter- mination and Education Assistance Act (25 U.S.C. 450 et seq.),2 shall use the same criteria that the Secretary uses in evaluating facilities operated directly by the Service. (g) Equitable integration of facilities The Secretary shall ensure that the planning, design, construction, renovation, and expansion needs of Service and non-Service facilities that are the subject of a contract or compact under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 2 for health services are fully and equitably integrated into the implementation of the health care delivery demonstration projects under this section. (Pub. L. 94–437, title III, § 307, as added Pub. L. 101–630, title V, § 504, Nov. 28, 1990, 104 Stat. 4562; amended Pub. L. 102–573, title III, §§ 304, 307(b)(2), title VII, § 701(c)(2), title IX, § 902(4)(A), Oct. 29, 1992, 106 Stat. 4562, 4564, 4572, 4591; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes REFERENCES IN TEXT This chapter, referred to in subsecs. (a)(1)(B), (b)(2)(B), (c)(3)(A), was in the original ‘‘this Act’’, meaning Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400, known as the Indian Health Care Improvement Act, which is classified principally to this chapter. For com- plete classification of this Act to the Code, see Short Title note set out under section 1601 of this title and Tables. The Indian Self-Determination and Education Assist- ance Act (25 U.S.C. 450 et seq.), referred to in subsecs. (a), (f), and (g), is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§ 450 et seq.) of chapter 14 of this title prior to editorial reclassification as chapter 46 (§ 5301 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables. CODIFICATION Amendment by Pub. L. 111–148 is based on section 143 of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by sec- tion 10221(a) of Pub. L. 111–148. AMENDMENTS 2010—Pub. L. 111–148 amended section generally. Prior to amendment, section authorized contracts and grants to carry out an Indian health care delivery demonstra- tion project and related to use of funds, criteria, tech- nical assistance, service to ineligible persons, equitable treatment, equitable integration of facilities, and re- port to Congress. 1992—Pub. L. 102–573, § 902(4)(A), made technical amendment to section catchline. Subsec. (c)(1)(A). Pub. L. 102–573, § 304(a)(1), inserted ‘‘or program’’ after ‘‘facility’’ in two places. Subsec. (c)(3)(A). Pub. L. 102–573, § 304(a)(2), sub- stituted ‘‘On or before September 30, 1995, the’’ for ‘‘The’’ and inserted ‘‘and for which a completed appli- cation has been received by the Secretary’’ after ‘‘para- graph (1)’’. Subsec. (c)(3)(B). Pub. L. 102–573, § 304(a)(3), which di- rected amendment of subsec. (c) by striking subpar. (B) and inserting a new subpar. (B), was executed by mak- ing the amendment in par. (3) of subsec. (c) to reflect the probable intent of Congress. Prior to amendment, subpar. (B) read as follows: ‘‘After entering into con- tracts or awarding grants in accordance with subpara- graph (A), and taking into account contracts entered into and grants awarded under such subparagraph, the Secretary may only enter into one contract or award one grant under this subsection with respect to a serv- ice area until the Secretary has entered into contracts or awarded grants for all service areas with respect to which the Secretary receives applications during the application period, as determined by the Secretary, which meet the criteria developed under paragraph (1).’’ Subsec. (e). Pub. L. 102–573, § 701(c)(2), made technical amendment to the reference to section 1680c of this title to reflect renumbering of corresponding section of original act. Subsec. (h). Pub. L. 102–573, § 304(b), amended subsec. (h) generally. Prior to amendment, subsec. (h) read as follows: ‘‘Within 90 days after the end of the period set out in subsection (a) of this section, the Secretary shall prepare and submit to Congress a report, together with legislative recommendations, on the findings and con- clusions derived from the demonstration projects.’’ Page 296 TITLE 25—INDIANS § 1638 1 See References in Text note below. Subsec. (i). Pub. L. 102–573, § 307(b)(2), struck out sub- sec. (i) which authorized appropriation of such sums as necessary for fiscal years 1991 and 1992 for purpose of carrying out this section. § 1638. Land transfer The Bureau of Indian Affairs is authorized to transfer, at no cost, up to 5 acres of land at the Chemawa Indian School, Salem, Oregon, to the Service for the provision of health care services. The land authorized to be transferred by this section is that land adjacent to land under the jurisdiction of the Service and occupied by the Chemawa Indian Health Center. (Pub. L. 94–437, title III, § 308, as added Pub. L. 102–573, title III, § 306, Oct. 29, 1992, 106 Stat. 4564.) § 1638a. Tribal management of federally owned quarters (a) Rental rates (1) Establishment Notwithstanding any other provision of law, a tribal health program that operates a hos- pital or other health facility and the federally owned quarters associated with such a facility pursuant to a contract or compact under the Indian Self-Determination and Education As- sistance Act (25 U.S.C. 450 et seq.) 1 may estab- lish the rental rates charged to the occupants of those quarters, on providing notice to the Secretary. (2) Objectives In establishing rental rates under this sub- section, a tribal health program shall at- tempt— (A) to base the rental rates on the reason- able value of the quarters to the occupants of the quarters; and (B) to generate sufficient funds to pru- dently provide for the operation and mainte- nance of the quarters, and at the discretion of the tribal health program, to supply re- serve funds for capital repairs and replace- ment of the quarters. (3) Equitable funding A federally owned quarters the rental rates for which are established by a tribal health program under this subsection shall remain el- igible to receive improvement and repair funds to the same extent that all federally owned quarters used to house personnel in programs of the Service are eligible to receive those funds. (4) Notice of rate change A tribal health program that establishes a rental rate under this subsection shall provide occupants of the federally owned quarters a notice of any change in the rental rate by not later than the date that is 60 days notice be- fore the effective date of the change. (5) Rates in Alaska A rental rate established by a tribal health program under this section for a federally owned quarters in the State of Alaska may be based on the cost of comparable private rental housing in the nearest established community with a year-round population of 1,500 or more individuals. (b) Direct collection of rent (1) In general Notwithstanding any other provision of law, and subject to paragraph (2), a tribal health program may collect rent directly from Fed- eral employees who occupy federally owned quarters if the tribal health program submits to the Secretary and the employees a notice of the election of the tribal health program to collect rents directly from the employees. (2) Action by employees On receipt of a notice described in paragraph (1)— (A) the affected Federal employees shall pay rent for occupancy of a federally owned quarters directly to the applicable tribal health program; and (B) the Secretary shall not have the au- thority to collect rent from the employees through payroll deduction or otherwise. (3) Use of payments The rent payments under this subsection— (A) shall be retained by the applicable tribal health program in a separate account, which shall be used by the tribal health pro- gram for the maintenance (including capital repairs and replacement) and operation of the quarters, as the tribal health program determines to be appropriate; and (B) shall not be made payable to, or other- wise be deposited with, the United States. (4) Retrocession of authority If a tribal health program that elected to collect rent directly under paragraph (1) re- quests retrocession of the authority of the tribal health program to collect that rent, the retrocession shall take effect on the earlier of— (A) the first day of the month that begins not less than 180 days after the tribal health program submits the request; and (B) such other date as may be mutually agreed on by the Secretary and the tribal health program. (Pub. L. 94–437, title III, § 309, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes REFERENCES IN TEXT The Indian Self-Determination and Education Assist- ance Act (25 U.S.C. 450 et seq.), referred to in subsec. (a)(1), is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§ 450 et seq.) of chapter 14 of this title prior to editorial reclassifica- tion as chapter 46 (§ 5301 et seq.) of this title. For com- plete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables. CODIFICATION Section 309 of Pub. L. 94–437 is based on section 144 of title I of S. 1790, One Hundred Eleventh Congress, as re- ported by the Committee on Indian Affairs of the Sen-