§1621. Indian Health Care Improvement Fund

(a) Approved expenditures

The Secretary is authorized to expend funds which are appropriated under the authority of this section, through the Service, for the purposes of-

(1) eliminating the deficiencies in health status and 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, and

(4) augmenting the ability of the Service to meet the following health service responsibilities, either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act [25 U.S.C. 450f et seq.], with respect to those Indian tribes with the highest levels of health status and resource deficiencies:

(A) clinical care (direct and indirect) including clinical eye and vision care;

(B) preventive health, including screening mammography in accordance with section 1621k of this title;

(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 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) Effect on other appropriations; allocation to service units

(1) Any funds appropriated under the authority of this section shall not be used to offset or limit any appropriations made to the Service under section 13 of this title, or any other provision of law.

(2)(A) Funds appropriated under the authority of this section may be allocated on a service unit basis. The funds allocated to each service unit under this subparagraph shall be used by the service unit to reduce the health status and resource deficiency 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) of this section shall be determined by the Service in consultation with, and with the active participation of, the affected Indian tribes.

(c) Health resources deficiency levels

For purposes of this section-

(1) The term "health status and resource deficiency" means the extent to which-

(A) the health status objectives set forth in section 1602(b) of this title are not being achieved; and

(B) the Indian tribe does not have available to it the health resources it needs, taking into account the actual cost of providing health care services given local geographic, climatic, rural, or other circumstances.

(2) 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.

(3) The Secretary shall establish procedures which allow any Indian tribe to petition the Secretary for a review of any determination of the extent of the health status and resource deficiency of such tribe.

(d) Programs administered by Indian tribe

(1) Programs administered by any Indian tribe or tribal organization under the authority of the Indian Self-Determination Act [25 U.S.C. 450f et seq.] 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.

(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) Report to Congress

By no later than the date that is 3 years after October 29, 1992, the Secretary shall submit to the Congress the current health status and resource deficiency 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 status and resource deficiencies, as well as the most recent application of that methodology;

(2) the extent of the health status and resource deficiency of each Indian tribe served by the Service;

(3) the amount of funds necessary to eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and

(4) an estimate of-

(A) the amount of health service funds appropriated under the authority of this chapter, 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) Appropriated funds included in base budget of Service

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) Continuation of Service responsibilities for backlogs and parity

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.

(h) Authorization of appropriations

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.)

References in Text

The Indian Self-Determination Act, referred to in subsecs. (a)(4) and (d), is title I of Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2206 , as amended, which is classified principally to part A (§450f et seq.) of subchapter II of chapter 14 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 450 of this title and Tables.

Amendments

1992-Pub. L. 102–573, §201(c), amended section catchline generally.

Subsec. (a). Pub. L. 102–573, §201(a)(1)(A), substituted "this section" for "subsection (h) of this section" in introductory 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 introductory provisions inserted ", either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act," after "responsibilities" and substituted "status and resource deficiencies" 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 "preventive health".

Subsec. (b)(1). Pub. L. 102–573, §201(a)(2)(A), substituted "this section" for "subsection (h) of this section".

Subsec. (b)(2). Pub. L. 102–573, §201(a)(2)(B), redesignated 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 appropriated under the authority of subsection (h) of this section to raise all Indian tribes to health resources deficiency 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 requirement of paragraph (2) is met" after "service unit basis" and, in second sentence, struck out "(in accordance with paragraph (2))" after "the service unit" and substituted "reduce the health status and resource deficiency" for "raise the deficiency level".

Subsec. (b)(2)(B). Pub. L. 102–573, §201(a)(2)(D), inserted ", and with the active participation of," after "in consultation with".

Subsec. (b)(3). Pub. L. 102–573, §201(a)(2)(B), redesignated 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 provisions 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), redesignated par. (3) as (2). Former par. (2) redesignated (1).

Subsec. (c)(3). Pub. L. 102–573, §201(a)(3)(A), (C), redesignated 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), redesignated 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 introductory 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 priority system report".

Subsec. (e)(1). Pub. L. 102–573, §201(a)(5)(B), substituted "health status and resource deficiencies" for "health resources deficiencies".

Subsec. (e)(2). Pub. L. 102–573, §201(a)(5)(C), substituted "the extent of the health status and resource deficiency of" for "the level of health resources deficiency for".

Subsec. (e)(3). Pub. L. 102–573, §201(a)(5)(D), substituted "eliminate the health status and resource deficiencies 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), redesignated 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 deficiency; 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 section 1105 of title 31 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."

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, substituting subsecs. (a) to (h) relating to improvement of Indian health status for former subsecs. (a) to (e) relating 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(2). Pub. L. 96–537, §4(a)(2), 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(3). Pub. L. 96–537, §4(a)(3), 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(A). Pub. L. 96–537, §4(b)(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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(B). Pub. L. 96–537, §4(b)(2), 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(C). Pub. L. 96–537, §4(b)(3), 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(D). Pub. L. 96–537, §4(b)(4), 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(4)(E). Pub. L. 96–537, §4(b)(5), inserted provisions 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 provisions 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 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 authorizing additional positions as may be necessary for each such fiscal year.

Subsec. (c)(7). Pub. L. 96–537, §4(c)(3), struck out par. (7) which authorized appropriation for the items referred 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.

Effective Date of 1992 Amendments

Section 201(b) of Pub. L. 102–573 provided that: "Except with respect to the amendments made by subsection (a)(5) [amending this section], the amendments made by subsection (a) [amending 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."

Section Referred to in Other Sections

This section is referred to in sections 1660a, 1671 of this title.