Indian Health Care Amendments of 1988

(Conference report filed in House, H. Rept. 100-1075)

Indian Health Care Amendments of 1988 - Title I: Indian Health Manpower - Amends the Indian Health Care Improvement Act to authorize appropriations for specified Indian health programs for FY 1989 through 1992, 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 obligation 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 this Act; or (4) in private practice if such practice is in a health professional shortage area and addresses the health care needs of a substantial number of Indians.

Makes conforming amendments relating to the Indian Health Scholarship Program under the Public Health Service Act.

Amends the Public Health Service Act to grant Native Hawaiians, subject to available appropriations, scholarships pursuant to a contract with Kamehameha Schools Bishop Estate. Authorizes appropriations for FY 1990 through 1992.

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

Establishes the Indian Health Service Loan Repayment Program to assure an adequate supply of health professionals by allowing repayment of educational loans for obligated service in an Indian Health program. Requires annual reports to the Congress on operation of the program. Authorizes appropriations.

Authorizes the Secretary to reimburse health professionals seeking Service positions for travel expenses. Requires the Secretary to fund Indian projects to recruit, place, and retain health professionals. Authorizes appropriations.

Establishes a program of advanced training and research for Indian health professionals, requiring obligated service for at least the period in which the person participates in the program.

Establishes a nursing program to increase the number of nurses, nurse midwives, and nurse practitioners who deliver health care services to Indians. Authorizes appropriations, earmarking a specified amount for grants for training of nurse midwives.

Requires the Secretary to establish a program of training of Service employees in the history and culture of the tribes they serve and in the history of the Service. Authorizes appropriations.

Authorizes the Secretary to provide grants to at least three colleges and universities to expand the Native Americans health careers recruitment program (Indians into Medicine Program, INMED). Requires a program report to the Congress.

Directs the Secretary to award grants to community colleges to assist in establishing programs leading to a degree or diploma in a health profession for individuals desiring to practice on an Indian reservation or in a tribal clinic.

Authorizes additional incentives for health professionals, including: (1) special incentive pay to Service civilian medical officers; (2) bonus pay; and (3) flexible and compressed work schedules. Requires a report to the Congress on premium pay for overtime and budget impacts.

Authorizes payment of a retention bonus to physicians and nurses who agree to continue Service employment for not less than one year.

Requires the establishment of a health professions advisory council to investigate and report to the Congress on policies impeding recruitment and retention of physicians and other health professionals by the Service and the regulatory changes necessary to establish other pay grades.

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 and Education Assistance Act eligible for specified funds on an equal basis with programs administered directly by the Indian Health Service.

Provides that a reasonable portion of funds from the Indian Health Care Improvement Fund that are used for contracts under the Indian Self-Determination Act 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.

Directs the President to include with the submission of the budget a separate statement identifying funding requests.

Authorizes appropriations for FY 1990 through 1992 for specified health services. Designates such appropriations 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. Authorizes appropriations. Prohibits the use of such funds to offset or limit appropriations made under other Acts.

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 necessary to meet such needs. Requires the Secretary to establish at least one demonstration project to determine the most effective and cost-efficient means of providing health promotion and disease prevention services. Requires a report to the Congress on the project.

Establishes a diabetes prevention, treatment, and control program with diabetes screening, model diabetes project continuance and establishment, and diabetes control officer positions. Authorizes appropriations.

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 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 1990 through 1993.

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 retained and be available to carry out the programs to provide health care services to Indians.

Title III: Health Facilities - Requires the Secretary to consult with any Indian tribe that would be significantly 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 1990 through 1992 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.

Authorizes the Secretary of Housing and Urban Development to transfer funds from the Housing and Community Development Act of 1974 to the Secretary for the provision of sanitation facilities and services for Indians. 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 1990 through 1992.

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 - Amends title XIX (Medicaid) of the Social Security Act to make certain providers of the Indian Health Service eligible for payments. Directs the Secretary to ensure that each service unit of the Indian Health Service receives at least 50 percent of the amounts to which its facilities are entitled if such amounts are necessary to bring the facilities into compliance.

Directs the Secretary to establish a demonstration project in which certain Indian (and Alaska Native) health organizations which provide health care services shall bill for Medicare and Medicaid payments directly. Requires the Secretary to monitor such organizations and to require quarterly reports on their operations. Sets forth eligibility and participation guidelines for such health service facilities. Requires a final report to the Congress by the end of FY 1995.

Title V: Urban Indian Health Services - Directs the Secretary to contract with urban Indian organizations to 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 - 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.

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 1991 the time during which Arizona is designated as a contract health service delivery area.

Requires the Secretary to submit a report to the Congress containing specified data determining which Indians in California should be eligible for health services. Specifies those Indians considered eligible until such time as any subsequent law may otherwise provide.

Designates the State of California, excluding specified counties, as a contract health service delivery area.

Provides that the Service shall fund tribal contract facility costs for clinic repairs, employee training, employee cost-of-living increases, and other health services expenses on the same basis as such funds are provided to facilities operated directly by the Service.

Restricts circumstances under which the Secretary may remove a member of the National Health Service Corps who is performing obligated service in a health facility operated by or under the Service.

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 and maternal mortality and fetal alcohol syndrome rates.

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 implementation of an agreement allowing reciprocal care between IHS facilities at Fort Duchesne, Utah, and VA facilities at Salt Lake City, Utah.

Requires the Secretary to report certain reallocations of base resources to the Congress.

Requires that grants be made to Indian tribes to establish demonstration projects under which the tribes will develop a phased approach to assumption of the health care delivery system for tribal members. Terminates the demonstration projects in FY 1993 and requires a report to the Congress.

Amends the Public Health Service Act to authorize the Secretary to fund interdisciplinary projects using innovative methods to train health care practitioners in providing services in rural areas and provide other health care services to rural areas. Requires a study of manpower training needs in rural areas with emphasis on supply and demand elements. Requires reports to the Congress and establishment of peer review groups. Defines "rural area" to include a frontier area (with a population density of less than seven persons per square mile). Authorizes appropriations.

Directs that the demonstration programs involving treatment for child sexual abuse that were conducted in FY 1988 through the Hopi Tribe and the Asiniboine and Sioux Tribes of Fort Peck Reservation be continued through FY 1991.

Requires the Secretary to make grants to the Eight Northern Indian Pueblos Council, San Juan Pueblo, New Mexico, to provide substance abuse treatment.

Requires a study to determine the number of active nuclear resource development sites on Indian lands and the associated health hazards. Requires a report to the Congress.

States that any limitation on the use of funds contained in a Department of Health and Human Services appropriation Act with respect to the performance of abortions shall apply for the same period with respect to the performance of abortions using funds contained in an IHS appropriation Act.

States that during the period of moratorium imposed by the Department of the Interior and Related Agencies Appropriations Act, Fiscal Year 1989 the IHS shall provide services pursuant to the criteria in effect on September 15, 1987, subject to other specified provisions. (The moratorium prohibited the use of funds to implement a certain HHS final rule relating to eligibility for the health care services of the Indian Health Service). Directs the Secretary to conduct a study to determine the impact of the rule or any other proposed rules changing the eligibility criteria for IHS medical services. Requires the study to include consultations with Indian tribal governments, statistics, financial impact analyses, economic impact analyses, and other elements.

Title VIII: Severability Provision - States that if any portion of this Act is held to be invalid, the remainder shall not be affected.