Indian Health Care Amendments of 1987

(Reported to House from the Committee on Energy and Commerce with amendment, H. Rept. 100-222 (Part II))

Indian Health Care Amendments of 1987 - Title I: Indian Health Manpower - Amends the Indian Health Care Improvement Act to authorize appropriations for specified Indian health programs for FY 1988 through 1991, including scholarship programs and continuing education allowances.

Prohibits the Secretary of Health and Human Services (the Secretary) from denying scholarship assistance solely on the basis of an applicant's scholastic achievement if such applicant has been admitted to, or maintained good standing at, an accredited institution.

Directs the Secretary to grant Indian Health Scholarships to Indians enrolled full-time in certain schools for health professionals. States that the active duty service requirements of the Public Health Service Act can be met by service: (1) in the Indian Health Service (Service); (2) in a program conducted under a contract entered into under the Indian Self-Determination Act; (3) in a program assisted under the Indian Health Care Improvement Act; or (4) in the private practice of a health professional if such practice is in a health professional shortage area and addresses the health care needs of a substantial number of Indians.

Repeals the Indian Health Scholarship Program under the Public Health Service Act.

Amends the Public Health Service Act to make Native Hawaiians, subject to available appropriations, eligible for scholarships under the Indian Health Scholarship Program. Prohibits the Native Hawaiian Health Scholarship program from being administered by or through the Service. Authorizes appropriations for FY 1988 through 1991.

Amends the Snyder Act to direct the Secretary to maintain a Community Health Representative program to provide for the training and the use of Indians as health paraprofessionals to Indian communities.

Title II: Health Services - Enumerates the health services for which the Secretary is authorized to expend funds for the improvement of the health of Indians. Prohibits the use of such funds to offset or limit appropriations made under other Acts. Conditions the allocation of such funds upon the health resource deficiency level of the affected Indian tribes. Permits the allocation of such funds on a service unit basis.

Directs the Secretary to establish a review mechanism for tribal petitions regarding the health resource deficiency level of a tribe.

Makes programs administered by tribal organizations under the Indian Self-Determination Act eligible for specified funds on an equal basis with programs administered directly by the Indian Health Service.

Provides that any portion of funds from the Indian Health Care Improvement Fund that are used for contracts under the Indian Self-Determination may be used for health planning, training, technical assistance, and other administrative support functions.

Requires the Secretary to submit to the Congress a current health services priority system report, including the methodology for determining tribal health resources deficiencies, and the funds needed to raise all tribes to a zero level deficiency.

Requires the Secretary to annually provide for FY 1989 through 1991 an update of tribal specific health plans.

Directs the President to include with the submission of the budget a separate statement which specifies the amounts obligated to implement enumerated health services.

Authorizes appropriations for FY 1989 through 1991 for specified health services. Designates such appropriations and any amounts deposited under specified provisions of this Act as the Indian Health Care Improvement Fund.

Establishes an Indian Catastrophic Health Emergency Fund to meet the extraordinary medical costs for victims of disasters or catastrophic illness. Prohibits the use of such funds to offset or limit appropriations made under other Acts. Authorizes appropriations for such Fund for FY 1988 through 1991.

Requires the Secretary to provide health promotion and disease prevention services to Indians. Requires the Secretary to include in each health services priority system report an evaluation of the health promotion and disease prevention needs of Indians and the resources that are currently available to meet such needs.

Requires that the Secretary require each Indian tribe to include within any tribal specific health plan that such tribe is required to submit to the Secretary a comprehensive plan developed by such tribe for health promotion and disease prevention among its members.

Requires the Secretary to: (1) develop from such plans a comprehensive plan for the provision by the Service of health promotion and disease prevention services to Indians; and (2) provide for such services. Requires the Secretary to establish at least one demonstration project (but no more than four) to determine the most effective and cost-efficient means of providing health promotion and disease prevention services to Indians. Terminates such projects 30 months after enactment of this Act. Authorizes appropriations.

Directs the Secretary to make certain determinations regarding the incidence, complications, prevention, and treatment of diabetes among Indians and to prepare and transmit to the President and the Congress a report describing the determinations made and related measures taken.

Directs the Secretary to screen each Indian who receives services from the Service for diabetes.

Requires the Secretary to continue to maintain during FY 1988 through 1991 specified existing model diabetes peojects in the States of Oklahoma, North Dakota, Arizona, Nebraska, New Mexico, Maine, and Washington. Directs the Secretary to establish in FY 1988 and maintain through FY 1991 a model diabetes project in each of the Navajo, Papago, and Zuni Reservations, and in each of the States of Alaska, Minnesota, Montana, California, Oregon, and Utah.

Authorizes appropriations for such measures related to diabetes.

Directs the Secretary to establish in the State of Hawaii, as a demonstration project, a Native Hawaiian Program for Health Promotion and Disease Prevention to meet the unique health care needs of Native Hawaiians. Authorizes the Secretary to enter into contracts with Native Hawaiian organizations to assist the Secretary in providing health care services under the Native Hawaiian demonstration project.

Requires the Secretary to enter into a contract with a Native Hawaiian organization to: (1) conduct a study to determine the incidence of diabetes among Native Hawaiians and ways to reduce its incidence; and (2) prepare an inventory of health care programs within Hawaii that are available for the treatment, prevention, or control of diabetes among Native Hawaiians. Requires such organization to prepare and transmit a report to the Secretary. Requires the Secretary to submit such report to the Congress and the President.

Directs the Secretary to enter into contracts with Native Hawaiian organizations to: (1) establish a diabetes control program; (2) promote coordination between all health care providers in the delivery of diabetes related services to Native Hawaiians; (3) establish a model diabetes program to serve Native Hawaiians in Hawaii; (4) develop an outreach program to assure the diagnosis, prevention, and treatment of diabetes among Native Hawaiians; (5) develop a standardized system to collect, analyze, and report diabetes data among Native Hawaiians; and (6) conduct diabetes research and coordinate such research with State agencies and the Department of Health and Human Services. Directs the Secretary to submit certain reports to the Congress.

Requires the Secretary to: (1) include in contracts with Native Hawaiian organizations such conditions to ensure that the objectives of such contracts are achieved; (2) develop procedures to evaluate compliance with, and performance of, contracts entered into by Native Hawaiian organizations; and (3) conduct an annual onsite evaluation of each Native Hawaiian organization. Sets forth specified actions the Secretary may take if a Native Hawaiian organization does not comply with the conditions of a contract. Permits the Secretary, at the request or consent of a Native Hawaiian organization, to amend contracts entered into with such organizations.

Requires each Native Hawaiian organization to submit to the Secretary a quarterly report of its activities. Authorizes appropriations for FY 1989 through 1992. Prohibits: (1) programs and services established by this Act relating to health promotion and disease prevention from being administered by or through the Indian Health Service; and (2) funds appropriated to the Service from being used to supplement funding of such programs and services.

Provides that the United States shall have the right to recover reasonable expenses incurred by the Secretary in the provision of health services, through the Service, to individuals. Requires all funds reimbursed to the United States by reason of the provision of such services to be deposited into the Indian Health Care Improvement Fund.

Title III: Health Facilities - Requires the Secretary to consult with any Indian tribe that might be affected by an expenditure for health facilities before the Secretary makes a commitment for such an expenditure. Conditions the closure of any health care facility upon the Secretary's submission to the Congress of an impact assessment one year prior to the contemplated closing. Directs the President to include with the budgets submitted for FY 1989 through 1991 program information documents for the construction of ten Indian health facilities. Requires the Secretary to submit to the Congress a report relating to the current health facility priority system.

Authorizes the Secretary to provide financial and technical assistance for the operation and maintenance of sanitation facilities, utility organizations, and emergency repairs of sanitation facilities. Directs the Secretary to implement a ten-year plan to provide safe water and sanitary sewage and solid waste disposal facilities to Indian homes and communities. Requires the Secretary to submit to the Congress a report with respect to current Indian sanitation. Authorizes appropriations for FY 1989 through 1991.

Permits tribes, subject to acceptance by the Secretary, to expend certain non-Indian Health Service funds for the renovation of Indian Health Service facilities, subject to specified conditions.

Authorizes the Secretary to exchange certain real property with the Bethel Native Corporation (Alaska).

Title IV: Access to Health Services - (sic)

Title V: Urban Indian Health Services - Directs the Secretary to contract with urban Indian organizations to establish and administer health services programs in urban areas. Sets forth specified requirements to be included in such contracts. Lists criteria for the selection of such organizations.

Authorizes the Secretary to enter into contracts with urban Indian organizations to determine the health status and unmet health care needs of urban Indians in affected urban areas. Delineates the requirements of such contracts.

Requires the Secretary to: (1) develop evaluation procedures for the performance of the contracts entered into under this title; and (2) conduct annual onsite evaluations of each contracting urban Indian organization. Prescribes guidelines for the renewal of health care or referral services contracts. Prohibits renewal of contracts for determination of unmet health needs if such an organization's performance has been noncompliant or otherwise unsatisfactory and problems cannot be resolved. Sets forth other specified contract requirements. Requires urban Indian organizations to submit a quarterly report to the Secretary.

Redefines "urban Indian organization" to mean a nonprofit corporate body situated in an urban center and governed by an urban Indian controlled board of directors.

Title VI: Organizational Improvements - Establishes the Indian Health Service (Service) within the Public Health Service of the Department of Health and Human Services to provide health care services to Indians and Indian Tribes. Requires the Service to be administered by a Director, appointed by the President with the consent of the Senate. Prohibits the Service from being a part of any other agency of such Department. Sets forth the functions of the Service, including: (1) all functions being carried out by the Indian Health Service on the day before enactment of this Act; and (2) all health programs under which health care is provided to Indians based upon their status as Indians. Prohibits the Secretary from reorganizing or discontinuing the Service or reallocating certain of its functions, except with the approval of the Service's Director.

Requires the Secretary to: (1) establish an automated management information system for the Indian Health Service; and (2) provide Indian tribes and tribal organizations that provide health services under contracts with the Service with such systems. Directs the Secretary to reimburse each tribe and tribal organization for the cost of the operation of such system that is used for the treatment of Service patients. Requires the Secretary to provide such systems.

Transfers all personnel, records, equipment, facilities, and interests in property administered by the Service on the day before certain amendments made by this Act take effect to the Service established by this Act. Authorizes the Secretary to waive the Indian preference laws on a case-by-case basis for certain transfers. Adds the Director of the Service to level V of the Executive Schedule.

Title VII: Miscellaneous Provisions - Authorizes the Secretary to enter into legal agreements with Indian tribes or tribal organizations in order to provide compensation for facility space costs associated with the administration and delivery of health services by the Indian Health Service tribally operated programs.

Extends to FY 1990 the time during which Arizona is designated as a contract health service delivery area.

Requires the Secretary to prepare and submit to the Congress a report with specified contents relating to the eligibility of California Indians for health services provided by the Service.

Specifies eligibility requirements for Indians in the State of California for health services provided by the Service.

Designates the State of California as a contract health service delivery area.

Lists programs eligible for Service funds.

Prohibits the Secretary from removing a member or withdrawing funding used to support a member of the National Health Service Corps from a health facility operated by the Service unless the Secretary, through the Service, has ensured that the Indians receiving services from the member will experience no reduction in services.

Authorizes the Secretary under certain circumstances to provide medical care or benefits by the Service to otherwise ineligible persons.

Sets a deadline by which the Secretary must develop and implement a plan to reduce Indian infant, maternal, and fetal alcohol syndrome mortality rates to a certain level.

Directs the Secretary to provide contract health services to the Turtle Mountain Band of Chippewa Indians who reside in the Trenton Service Area of specified counties in the States of North Dakota and Montana.

Requires the Secretary to examine the feasibility of the sharing of medical facilities and services between the Service and the Veterans Administration.

Requires the Secretary to provide health care services for Indians in Montana.

Requires the Secretary to make grants to the Tohono O'odham Tribe of Arizona for a demonstration project regarding assumption by such tribe of the health care delivery system of the Service for certain members of such tribe. Authorizes appropriations for FY 1988 through 1990.

Directs the Secretary, through the Service, to make grants to San Juan Pueblo, New Mexico, for substance abuse treatment services to Indians. Authorizes appropriations for FY 1988 and 1989.

Directs the Secretary of Health and Human Services, acting through the Director of the Indian Health Service, the Secretary of the Interior, acting through the Bureau of Indian Affairs, and the Secretary of Energy to jointly conduct a study regarding: (1) nuclear resource development sites on Indian lands; (2) Federal agencies involved with each site; (3) health hazards resulting from such sites; (4) remedial actions which have been taken or are needed; and (5) funds necessary each year to implement needed remedial actions. Requires that a report be submitted to the Congress describing the findings and conclusions of the study.

States that, unless otherwise provided, restrictions on the use of appropriations for Indian health services shall not be interpreted to apply to the use of funds other than such appropriated funds by an entity having a contract with the Service. Prohibits the Service from offsetting or limiting funds obligated to such an entity because of the use of such other funds.