improvement of indian health status

improvement of indian health status Sec. 201. (a) Section 201 (25 U.S.C. 1621) is amended to read as follows: “improvement of indian health status “Sec. 201. (a) The Secretary is authorized to expend funds which are appropriated under the authority of subsection (h), through the Service, for the purposes of— “(1) raising the health status of Indians to zero deficiency, “(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, and “(4) augmenting the ability of the Service to meet the following health service responsibilities with respect to those Indian tribes with the highest levels of health resources deficiency: “(A) clinical care (direct and indirect) including clinical eye and vision care; “(B) preventive health; “(C) dental care (direct and indirect); “(D) mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential 102 STAT. 4801 treatment centers, and training of traditional Indian practitioners; “(E) emergency medical services; “(F) treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians; “(G) accident prevention programs; “(H) home health care; “(I) community health representatives; and “(J) maintenance and repair. “(b)(1) Any funds appropriated under the authority of subsection (h) shall not be used to offset or limit any appropriations made to the Service under the Act of November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, or any other provision of law. “(2) Funds which are appropriated under the authority of subsection (h) 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 appropriated under the authority of subsection (h) to raise all Indian tribes to health resources deficiency level 11. “(3)(A) Funds appropriated under the authority of subsection (h) may be allocated on a service unit basis but such allocation shall be made in a manner which ensures that the requirement of paragraph (2) is met. The funds allocated to each service unit under this subparagraph shall be used by the service unit (in accordance with paragraph (2)) to raise the deficiency level of each tribe served by such service unit. “(B) The apportionment of funds allocated to a service unit under subparagraph (A) among the health service responsibilities described in subsection (a)(4) shall be determined by the Service in consultation with the affected Indian tribes. “(c) For purposes of this section— “(1) The health resources deficiency levels of an Indian tribe are as follows: “(A) level I–0 to 20 percent health resources deficiency; “(B) level II–21 to 40 percent health resources deficiency; “(C) level III–41 to 60 percent health resources deficiency; “(D) level IV–61 to 80 percent health resources deficiency; and “(E) level V–81 to 100 percent health resources deficiency. “(2) The term ‘health resources deficiency’ means a percentage determined by dividing— “(A) the excess, if any, of— “(i) the value of the health resources that the Indian tribe needs, over “(ii) the value of the health resources available to the Indian tribe, by “(B) the value of the health resources that the Indian tribe needs. “(3) The health resources available to an Indian tribe include health resources provided by the Service as well as health resources used by the Indian tribe, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments. 102 STAT. 4802 “(4) Under regulations, the Secretary shall establish procedures which allow any Indian tribe to petition the Secretary for a review of any determination of the health resources deficiency level of such tribe. “(d)(1) Programs administered by any Indian tribe or tribal organization under the authority of the Indian Self-Determination Act shall be eligible for funds appropriated under the authority of subsection (h) on an equal basis with programs that are administered directly by the Service. “(2) If any funds allocated to a tribe or service unit under the authority of this section are used for a contract entered into under the Indian Self-Determination Act, a reasonable portion of such funds may be used for health planning, training, technical assistance, and other administrative support functions. “(e) By no later than the date that is 60 days after the date of enactment of the Indian Health Care Amendments of 1988, the Secretary shall submit to the Congress the current health services priority system report of the Service for each Indian tribe or service unit, including newly recognized or acknowledged tribes. Such report shall set out— “(1) the methodology then in use by the Service for determining tribal health resources deficiencies, as well as the most recent application of that methodology; “(2) the level of health resources deficiency for each Indian tribe served by the Service; “(3) the amount of funds necessary to raise all Indian tribes served by the Service below health resources deficiency level II to health resources deficiency level II; “(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 deficiency; and “(6) an estimate of— “(A) the amount of health service funds appropriated under the authority of this Act, 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 comparable entity; “(B) the number of Indians eligible for health services in each service unit or Indian tribe; and “(C) the number of Indians using the Service resources made available to each service unit or Indian tribe. “(f)(1) The President shall include with the budget submitted to the Congress under section 1105 of title 31, United States Code, for each fiscal year a separate statement which specifies the amount of funds requested to carry out the provisions of this section for such fiscal year. “(2) Funds appropriated under authority of this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years. “(g) 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 undertaking additional efforts to achieve parity among Indian tribes. 102 STAT. 4803 “(h) There are authorized to be appropriated for the purpose of carrying out the provisions of this section— “(1) $19,000,000 for fiscal year 1990, “(2) $19,000,000 for fiscal year 1991, and “(3) $20,000,000 for fiscal year 1992. Any funds appropriated under the authority of this subsection shall be designated as the ‘Indian Health Care Improvement Fund’.”. (b) Section 4 (25 U.S.C. 1603) is amended by striking out subsections (i), (j), and (k), and by inserting in lieu thereof the following new subsections: “(i) ‘Area office’ means an administrative entity including a program office, within the Indian Health Service through which services and funds are provided to the service units within a defined geographic area, “(j) ‘Service unit’ means— “(1) an administrative entity within the Indian Health Service, or “(2) a tribe or tribal organization operating health care programs or facilities with funds from the Service under the Indian Self-Determination Act, through which services are provided, directly or by contract, to the eligible Indian population within a defined geographic area.”.