25 U.S.C. § 1621 — Indian Health Care Improvement Fund

Page 265 TITLE 25—INDIANS § 1621 1 See References in Text note below. § 1616p. Health professional chronic shortage demonstration programs (a) Demonstration programs The Secretary, acting through the Service, may fund demonstration programs for Indian health programs to address the chronic short- ages of health professionals. (b) Purposes of programs The purposes of demonstration programs under subsection (a) shall be— (1) to provide direct clinical and practical experience within an Indian health program to health profession students and residents from medical schools; (2) to improve the quality of health care for Indians by ensuring access to qualified health professionals; (3) to provide academic and scholarly oppor- tunities for health professionals serving Indi- ans by identifying all academic and scholarly resources of the region; and (4) to provide training and support for alter- native provider types, such as community health representatives, and community health aides. (c) Advisory board The demonstration programs established pur- suant to subsection (a) shall incorporate a pro- gram advisory board, which may be composed of representatives of tribal governments, Indian health programs, and Indian communities in the areas to be served by the demonstration pro- grams. (Pub. L. 94–437, title I, § 123, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes CODIFICATION Section 123 of Pub. L. 94–437 is based on section 112 of title I of S. 1790, One Hundred Eleventh Congress, as re- ported by the Committee on Indian Affairs of the Sen- ate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148. PRIOR PROVISIONS A prior section 1616p, Pub. L. 94–437, title I, § 123, as added Pub. L. 102–573, title I, § 117(a), Oct. 29, 1992, 106 Stat. 4544, authorized appropriations through fiscal year 2000 to carry out this subchapter, prior to repeal by Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935. The repeal is based on section 101(b)(1) of title I of S. 1790, One Hundred Eleventh Congress, as re- ported by the Committee on Indian Affairs of the Sen- ate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148. § 1616q. Exemption from payment of certain fees Employees of a tribal health program or urban Indian organization shall be exempt from pay- ment of licensing, registration, and any other fees imposed by a Federal agency to the same extent that officers of the commissioned corps of the Public Health Service and other employ- ees of the Service are exempt from those fees. (Pub. L. 94–437, title I, § 124, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.) Editorial Notes CODIFICATION Section 124 of Pub. L. 94–437 is based on section 113 of title I of S. 1790, One Hundred Eleventh Congress, as re- ported by the Committee on Indian Affairs of the Sen- ate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148. § 1616r. Repealed. Pub. L. 111–148, title X, § 10221(b)(2), Mar. 23, 2010, 124 Stat. 936 Section, Pub. L. 94–437, title I, § 125, as added Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935, was based on section 134(b) 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 en- acted into law by section 10221(a) of Pub. L. 111–148 and related to treatment of a scholarship provided to an in- dividual under this subchapter as a qualified scholar- ship for purposes of section 117 of Title 26, Internal Revenue Code. SUBCHAPTER II—HEALTH SERVICES § 1621. Indian Health Care Improvement Fund (a) Use of funds The Secretary, acting through the Service, is authorized to expend funds, directly or under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),1 which are appropriated under the author- ity of this section, for the purposes of— (1) eliminating the deficiencies in health status and health resources of all Indian tribes; (2) eliminating backlogs in the provision of health care services to Indians; (3) meeting the health needs of Indians in an efficient and equitable manner, including the use of telehealth and telemedicine when ap- propriate; (4) eliminating inequities in funding for both direct care and contract health service pro- grams; and (5) augmenting the ability of the Service to meet the following health service responsibil- ities with respect to those Indian tribes with the highest levels of health status deficiencies and resource deficiencies: (A) Clinical care, including inpatient care, outpatient care (including audiology, clin- ical eye, and vision care), primary care, sec- ondary and tertiary care, and long-term care. (B) Preventive health, including mammog- raphy and other cancer screening. (C) Dental care. (D) Mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treat- ment centers, and training of traditional health care practitioners. (E) Emergency medical services. (F) Treatment and control of, and rehabili- tative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians. (G) Injury prevention programs, including data collection and evaluation, demonstra- Page 266 TITLE 25—INDIANS § 1621 tion projects, training, and capacity build- ing. (H) Home health care. (I) Community health representatives. (J) Maintenance and improvement. (b) No offset or limitation Any funds appropriated under the authority of this section shall not be used to offset or limit any other appropriations made to the Service under this chapter or section 13 of this title, or any other provision of law. (c) Allocation; use (1) In general Funds appropriated under the authority of this section shall be allocated to Service units, Indian tribes, or tribal organizations. The funds allocated to each Indian tribe, trib- al organization, or Service unit under this paragraph shall be used by the Indian tribe, tribal organization, or Service unit under this paragraph to improve the health status and re- duce the resource deficiency of each Indian tribe served by such Service unit, Indian tribe, or tribal organization. (2) Apportionment of allocated funds The apportionment of funds allocated to a Service unit, Indian tribe, or tribal organiza- tion under paragraph (1) among the health service responsibilities described in subsection (a)(5) shall be determined by the Service in consultation with, and with the active partici- pation of, the affected Indian tribes and tribal organizations. (d) Provisions relating to health status and re- source deficiencies For the purposes of this section, the following definitions apply: (1) Definition The term ‘‘health status and resource defi- ciency’’ means the extent to which— (A) the health status objectives set forth in sections 1602(1) and 1602(2) of this title are not being achieved; and (B) the Indian tribe or tribal organization does not have available to it the health re- sources it needs, taking into account the ac- tual cost of providing health care services given local geographic, climatic, rural, or other circumstances. (2) Available resources The health resources available to an Indian tribe or tribal organization include health re- sources provided by the Service as well as health resources used by the Indian tribe or tribal organization, including services and fi- nancing systems provided by any Federal pro- grams, private insurance, and programs of State or local governments. (3) Process for review of determinations The Secretary shall establish procedures which allow any Indian tribe or tribal organi- zation to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such Indian tribe or tribal organization. (e) Eligibility for funds Tribal health programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service. (f) Report By no later than the date that is 3 years after March 23, 2010, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service unit, including newly recognized or acknowl- edged Indian tribes. Such report shall set out— (1) the methodology then in use by the Serv- ice for determining tribal health status and resource deficiencies, as well as the most re- cent application of that methodology; (2) the extent of the health status and re- source deficiency of each Indian tribe served by the Service or a tribal health program; (3) the amount of funds necessary to elimi- nate the health status and resource defi- ciencies of all Indian tribes served by the Service or a tribal health program; and (4) an estimate of— (A) the amount of health service funds ap- propriated under the authority of this chap- ter, or any other Act, including the amount of any funds transferred to the Service for the preceding fiscal year which is allocated to each Service unit, Indian tribe, or tribal organization; (B) the number of Indians eligible for health services in each Service unit or In- dian tribe or tribal organization; and (C) the number of Indians using the Serv- ice resources made available to each Service unit, Indian tribe or tribal organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of re- sources. (g) Inclusion in base budget Funds appropriated under this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining ap- propriations under this section in subsequent fiscal years. (h) Clarification Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from under- taking additional efforts to achieve equity among Indian tribes and tribal organizations. (i) Funding designation Any funds appropriated under the authority of this section shall be designated as the ‘‘Indian Health Care Improvement Fund’’. (Pub. L. 94–437, title II, § 201, Sept. 30, 1976, 90 Stat. 1404; Pub. L. 96–537, § 4, Dec. 17, 1980, 94 Stat. 3174; Pub. L. 100–713, title II, § 201(a), Nov. 23, 1988, 102 Stat. 4800; Pub. L. 102–573, title II, § 201(a), (c), 207(b), 217(b)(1), Oct. 29, 1992, 106 Stat. 4544, 4546, 4551, 4559; 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. Page 267 TITLE 25—INDIANS § 1621 (a), 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. This chapter, referred to in subsecs. (b) and (f)(4)(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 complete classification of this Act to the Code, see Short Title note set out under section 1601 of this title and Tables. CODIFICATION Amendment by Pub. L. 111–148 is based on section 121 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 consisted of subsecs. (a) to (h) relating to the Indian Health Care Improvement Fund. 1992—Pub. L. 102–573, § 201(c), amended section catch- line generally. Subsec. (a). Pub. L. 102–573, § 201(a)(1)(A), substituted ‘‘this section’’ for ‘‘subsection (h) of this section’’ in in- troductory provisions. Subsec. (a)(1). Pub. L. 102–573, § 201(a)(1)(B), amended par. (1) generally. Prior to amendment, par. (1) read as follows: ‘‘raising the health status of Indians to zero deficiency,’’. Subsec. (a)(4). Pub. L. 102–573, § 201(a)(1)(C), in intro- ductory provisions inserted ‘‘, either through direct or contract care or through contracts entered into pursu- ant to the Indian Self-Determination Act,’’ after ‘‘re- sponsibilities’’ and substituted ‘‘status and resource de- ficiencies’’ for ‘‘resources deficiency’’. Subsec. (a)(4)(B). Pub. L. 102–573, § 207(b), substituted ‘‘preventive health, including screening mammography in accordance with section 1621k of this title’’ for ‘‘pre- ventive health’’. Subsec. (b)(1). Pub. L. 102–573, § 201(a)(2)(A), sub- stituted ‘‘this section’’ for ‘‘subsection (h) of this sec- tion’’. Subsec. (b)(2). Pub. L. 102–573, § 201(a)(2)(B), redesig- nated par. (3) as (2) and struck out former par. (2) which read as follows: ‘‘Funds which are appropriated under the authority of subsection (h) of this section may be allocated to, or used for the benefit of, any Indian tribe which has a health resources deficiency level at level I or II only if a sufficient amount of funds have been ap- propriated under the authority of subsection (h) of this section to raise all Indian tribes to health resources de- ficiency level II.’’ Subsec. (b)(2)(A). Pub. L. 102–573, § 201(a)(2)(C), in first sentence, substituted ‘‘this section’’ for ‘‘subsection (h) of this section’’ and struck out ‘‘but such allocation shall be made in a manner which ensures that the re- quirement of paragraph (2) is met’’ after ‘‘service unit basis’’ and, in second sentence, struck out ‘‘(in accord- ance with paragraph (2))’’ after ‘‘the service unit’’ and substituted ‘‘reduce the health status and resource de- ficiency’’ for ‘‘raise the deficiency level’’. Subsec. (b)(2)(B). Pub. L. 102–573, § 201(a)(2)(D), in- serted ‘‘, and with the active participation of,’’ after ‘‘in consultation with’’. Subsec. (b)(3). Pub. L. 102–573, § 201(a)(2)(B), redesig- nated par. (3) as (2). Subsec. (c)(1). Pub. L. 102–573, § 201(a)(3)(B), amended par. (1) generally, substituting provisions defining ‘‘health status and resource deficiency’’ for former pro- visions defining ‘‘health resources deficiency’’. Pub. L. 102–573, § 201(a)(3)(A), redesignated par. (2) as (1) and struck out former par. (1) which specified the health resource deficiency levels of an Indian tribe. Subsec. (c)(2). Pub. L. 102–573, § 201(a)(3)(A), redesig- nated par. (3) as (2). Former par. (2) redesignated (1). Subsec. (c)(3). Pub. L. 102–573, § 201(a)(3)(A), (C), redes- ignated par. (4) as (3) and substituted ‘‘The’’ for ‘‘Under regulations, the’’ and ‘‘extent of the health status and resource deficiency’’ for ‘‘health resources deficiency level’’. Former par. (3) redesignated (2). Subsec. (c)(4). Pub. L. 102–573, § 201(a)(3)(A), redesig- nated par. (4) as (3). Subsec. (d)(1). Pub. L. 102–573, § 201(a)(4), substituted ‘‘this section’’ for ‘‘subsection (h) of this section’’. Subsec. (e). Pub. L. 102–573, § 201(a)(5)(A), in introduc- tory provisions, substituted ‘‘3 years after October 29, 1992, the Secretary shall submit to the Congress the current health status and resource deficiency report’’ for ‘‘60 days after November 23, 1988, the Secretary shall submit to the Congress the current health services pri- ority system report’’. Subsec. (e)(1). Pub. L. 102–573, § 201(a)(5)(B), sub- stituted ‘‘health status and resource deficiencies’’ for ‘‘health resources deficiencies’’. Subsec. (e)(2). Pub. L. 102–573, § 201(a)(5)(C), sub- stituted ‘‘the extent of the health status and resource deficiency of’’ for ‘‘the level of health resources defi- ciency for’’. Subsec. (e)(3). Pub. L. 102–573, § 201(a)(5)(D), sub- stituted ‘‘eliminate the health status and resource defi- ciencies of all Indian tribes served by the Service; and’’ for ‘‘raise all Indian tribes served by the Service below health resources deficiency level II to health resources deficiency level II;’’. Subsec. (e)(4) to (6). Pub. L. 102–573, § 201(a)(5)(E), re- designated par. (6) as (4) and struck out former pars. (4) and (5) which read as follows: ‘‘(4) the amount of funds necessary to raise all tribes served by the Service below health resources deficiency level I to health resources deficiency level I; ‘‘(5) the amount of funds necessary to raise all tribes served by the Service to zero health resources defi- ciency; and’’. Subsec. (f). Pub. L. 102–573, § 201(a)(6), redesignated par. (2) as entire subsec. and struck out former par. (1) which read as follows: ‘‘The President shall include with the budget submitted to the Congress under sec- tion 1105 of title 31 for each fiscal year a separate state- ment which specifies the amount of funds requested to carry out the provisions of this section for such fiscal year.’’ Subsec. (h). Pub. L. 102–573, § 217(b)(1), substituted ‘‘this section’’ for ‘‘this subsection’’ and struck out former first sentence which authorized appropriations for fiscal years 1990 to 1992. 1988—Pub. L. 100–713 amended section generally, sub- stituting subsecs. (a) to (h) relating to improvement of Indian health status for former subsecs. (a) to (e) relat- ing to direct patient care program. 1980—Subsec. (c)(1). Pub. L. 96–537, § 4(a)(1), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further au- thorizing additional positions as may be necessary for each such fiscal year. Subsec. (c)(2). Pub. L. 96–537, § 4(a)(2), inserted provi- sions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(3). Pub. L. 96–537, § 4(a)(3), inserted provi- sions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(4)(A). Pub. L. 96–537, § 4(b)(1), inserted pro- visions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Page 268 TITLE 25—INDIANS § 1621a 1 See References in Text note below. Subsec. (c)(4)(B). Pub. L. 96–537, § 4(b)(2), inserted pro- visions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(4)(C). Pub. L. 96–537, § 4(b)(3), inserted pro- visions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(4)(D). Pub. L. 96–537, § 4(b)(4), inserted pro- visions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(4)(E). Pub. L. 96–537, § 4(b)(5), inserted pro- visions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984. Subsec. (c)(5). Pub. L. 96–537, § 4(c)(1), inserted provi- sions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984. Subsec. (c)(6). Pub. L. 96–537, § 4(c)(2), inserted provi- sions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing addi- tional positions as may be necessary for each such fis- cal year. Subsec. (c)(7). Pub. L. 96–537, § 4(c)(3), struck out par. (7) which authorized appropriation for the items re- ferred to in subsecs. (c)(1) to (c)(6) of such sums as may be specifically authorized by an act enacted after Sept. 30, 1976, for fiscal years 1981, 1982, 1983, and 1984, and which further authorized positions for items referred to in subsecs. (c)(1) to (c)(6) other than subsecs. (c)(4)(E) and (c)(5), as may be specified in an act enacted after Sept. 30, 1976. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1992 AMENDMENTS Pub. L. 102–573, title II, § 201(b), Oct. 29, 1992, 106 Stat. 4546, provided that: ‘‘Except with respect to the amend- ments made by subsection (a)(5) [amending this sec- tion], the amendments made by subsection (a) [amend- ing this section] shall take effect three years after the date of the enactment of this Act [Oct. 29, 1992]. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act.’’ CONTRACT MEDICAL CARE FUNDS Pub. L. 108–7, div. F, title II, Feb. 20, 2003, 117 Stat. 261, provided in part: ‘‘That contract medical care funds appropriated heretofore and hereafter for tribes recognized after January 1, 1995, may be used to provide medical services directly or through contract medical care’’. § 1621a. Catastrophic Health Emergency Fund (a) Establishment There is established an Indian Catastrophic Health Emergency Fund (hereafter in this sec- tion referred to as the ‘‘CHEF’’) consisting of— (1) the amounts deposited under subsection (f); and (2) the amounts appropriated to CHEF under this section. (b) Administration CHEF shall be administered by the Secretary, acting through the headquarters of the Service, solely for the purpose of meeting the extraor- dinary medical costs associated with the treat- ment of victims of disasters or catastrophic ill- nesses who are within the responsibility of the Service. (c) Conditions on use of Fund No part of CHEF or its administration shall be subject to contract or grant under any law, in- cluding the Indian Self-Determination and Edu- cation Assistance Act (25 U.S.C. 450 et seq.),1 nor shall CHEF funds be allocated, apportioned, or delegated on an Area Office, Service Unit, or other similar basis. (d) Regulations The Secretary shall promulgate regulations consistent with the provisions of this section to— (1) establish a definition of disasters and cat- astrophic illnesses for which the cost of the treatment provided under contract would qualify for payment from CHEF; (2) provide that a Service Unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treat- ing any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at— (A) the 2000 level of $19,000; and (B) for any subsequent year, not less than the threshold cost of the previous year in- creased by the percentage increase in the medical care expenditure category of the consumer price index for all urban con- sumers (United States city average) for the 12-month period ending with December of the previous year; (3) establish a procedure for the reimburse- ment of the portion of the costs that exceeds such threshold cost incurred by— (A) Service Units; or (B) whenever otherwise authorized by the Service, non-Service facilities or providers; (4) establish a procedure for payment from CHEF in cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment by the Service; and (5) establish a procedure that will ensure that no payment shall be made from CHEF to any provider of treatment to the extent that such provider is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimburse- ment for which the patient is eligible. (e) No offset or limitation Amounts appropriated to CHEF under this sec- tion shall not be used to offset or limit appro- priations made to the Service under the author- ity of section 13 of this title, or any other law. (f) Deposit of reimbursement funds There shall be deposited into CHEF all reim- bursements to which the Service is entitled from any Federal, State, local, or private source (including third party insurance) by reason of treatment rendered to any victim of a disaster or catastrophic illness the cost of which was paid from CHEF.