Indian Health Amendments of 1991

openUnited States· United States Congress· EN

Introduced

6 November 1991

Last action

8 October 1992 · Committee

Status

See S.2481.

Summary

Indian Health Amendments of 1991 - Amends the Indian Health Care Improvement Act to state that it is the intent of the Congress that the Nation meet specified health status objectives with respect to Indians and urban Indians by the year 2000. Directs the Secretary of Health and Human Services (Secretary) to report to the President, for transmission to the Congress, on the progress made in each area of the Indian Health Service (Service) toward meeting each stated objective. Title I: Indian Health Manpower - Directs the Secretary to make preparatory scholarship grants for: (1) up to two years on a full-time basis (or the part-time equivalent) to Indians who have demonstrated the capability to successfully complete courses of study in the health professions; and (2) up to four years (or the part-time equivalent) for pregraduate education of any grantee leading to a baccalaureate degree in an approved course of study preparatory to such health professions. Prohibits the Secretary from denying scholarship assistance to an eligible applicant solely by reason of such applicant's eligibility for assistance or benefits under any other Federal program. Authorizes the Secretary to grant health professions scholarships to Indians who are enrolled full or part-time in appropriately accredited schools and pursuing courses of study in the health professions, with an emphasis on certain ones. Makes an individual eligible for such scholarship in any year in which he or she is enrolled full or part-time in such course of study. Provides that the period for a part-time scholarship shall not exceed the part-time equivalent of four years. Directs the Secretary, acting through the Service, to establish a Placement Office to develop a national policy for the placement, to available vacancies within the Service, of health professionals required to meet the active duty obligation prescribed under the Public Health Service Act without regard to any competitive personnel system, agency personnel limitation, or Indian preference policy. Makes an individual liable to the United States for the amount paid to or on the individual's behalf under a written Indian health professions contract if it is breached in specified ways. Entitles the United States to recover an amount determined by a specified formula pursuant to the Indian Health Care Improvement Act, as amended, from any individual who breaches such contract by failing to begin or complete such service obligations. Authorizes the Secretary, acting through the Service, to provide: (1) continuing education allowances to nurses employed by the Service; and (2) grants to establish and develop clinics operated by nurses, nurse midwives, or nurse practitioners to provide primary health care services to Indians. Allocates funds for the training of nurse practitioners. Requires that at least 25 percent of retention bonuses awarded each year by the Secretary beginning in FY 1992 be awarded to nurses. Requires the Secretary, acting through the Service, to establish a program to enable licensed practical nurses, licensed vocational nurses, and registered nurses working in an Indian health program for at least one year to pursue advanced training in a residency program. Revises the Indian Health Service Loan Repayment Program with respect to: (1) eligibility requirements; (2) priority vacancy positions; (3) an individual's becoming a participant in the program; (4) extension of obligated service; (5) undergraduate loans; (6) repayment of loans; (7) tax liability reimbursements; and (8) the Secretary's annual report to the Congress. Directs the Secretary, acting through the Service, to assign one individual in each area office to be responsible on a full-time basis for recruitment activities. Requires the Secretary to provide a grant to a college or university to establish and maintain a program parallel to the Indians into Medicine Program (INMED) for the nursing and mental health professions. Directs the Secretary to provide matching grants to Indian tribes and tribal organizations to assist in educating Indians to serve as health professionals in Indian communities by providing them with scholarships, under specified conditions. Prohibits any scholarship recipient from discriminating against an individual seeking health care on the basis of ability to pay or that payment for such care will be provided by Medicare or Medicaid Programs under the Social Security Act. Directs the Secretary, under authority of the Snyder Act, to: (1) maintain a Community Health Aide Program in Alaska; and (2) provide, in a specified manner, a high standard of training to community health aides to ensure that they provide quality health care, health promotion, and disease prevention services to the villages served by the Program. Requires the Secretary, by contract or otherwise, to provide training for individuals in the administration and planning of tribal health programs. Authorizes appropriations. Title II: Health Services - Authorizes the Secretary to expend appropriated funds under this Act to eliminate the deficiencies in health status and resources of all Indian tribes. Changes the threshold cost established by the Secretary: (1) for FY 1992 to a minimum of $20,000 (currently a minimum of $10,000 to a maximum of $20,000) before a service unit can be eligible for reimbursement from the Catastrophic Health Emergency Fund for the cost of treatment of an individual; and (2) for each succeeding year to the cost of the previous year increased by the percentage increase in the medical care expenditure category of the consumer price index for all urban consumers. Directs the Secretary, acting through the Service, to provide health promotion and disease prevention services to Indians to achieve the health objectives set forth in this Act. Repeals the requirement that the Secretary establish from one to four demonstration projects to discover the most effective and cost-efficient means of providing health promotion and disease prevention services to Indians. Directs the Secretary to continue to maintain specified model diabetes projects in existence through FY 2000. Authorizes the Secretary to establish new model diabetes projects. Prohibits the establishment of a greater number of them in one service area than in another until there is an equal number established with respect to all service areas. Adds to the duties of the diabetes control officer employed in each area office of the Service the task of evaluating the effectiveness of services provided through model diabetes projects established under this Act. Requires the Service to report annually to the President for transmission to the Congress, on the mental health status of Indians. Requires any person employed as a psychologist or as a social worker to provide mental health care services to Indians in a clinical setting, under this Act or through a contract under the Indian Self-Determination Act, to be licensed as such or working under the direct supervision of a licensed clinical psychologist or social worker. Directs the Secretary to study and report to the Congress on the: (1) feasibility and desirability of furnishing hospice care to terminally ill Indians; (2) the determination of the most efficient and effective means of furnishing such care; and (3) the feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage under certain circumstances. Authorizes appropriations. Title III: Health Facilities - Requires the Secretary, when evaluating for the Congress the likely impact of the closure of an Indian Health Service hospital or one of its outpatient health care facilities, to specify: (1) the level of use of such hospital or facility by all eligible Indians; and (2) the distance between such hospital or facility and the nearest operating Service hospital. Requires the Secretary for health care delivery demonstration projects, as of October 1, 1995, to enter into contracts or award grants taking into consideration applications received from all service areas. Prohibits the award of a greater number of such contracts or grants in one service area than in another until there is an equal number of them with respect to all service areas for which the Secretary receives applications under certain conditions. Requires the Secretary to submit to the President (currently, the Congress) for inclusion in the budget submittal for: (1) FY 1997, an interim report on such established demonstration projects; and (2) FY 1999, a final report. Authorizes appropriations. Title IV: Access to Health Services - Amends the Social Security Act to prohibit any payments received by a hospital or skilled nursing facility of the Service for services provided to Indians eligible for Medicare benefits from being considered in determining appropriations for health care and services to Indians. Declares that the Secretary has no authority to provide services to an Indian beneficiary with coverage under Medicare in preference to an Indian beneficiary without such coverage. Requires payments to any Service facility made under the Medicaid program to be placed in a special fund to be held by the Secretary and used, in a specified manner, exclusively for making any improvements in the facilities of such Service to achieve compliance with the applicable conditions and requirements of the Social Security Act. Terminates this requirement when the Secretary determines and certifies that substantially all Service health facilities are in compliance with such conditions and requirements. Prohibits payments received by such facility for services provided to Indians eligible for benefits under Medicaid from being considered in determining appropriations for the provision of health care and services to Indians. Requires the Secretary to submit to the President, instead of the Congress, for submission with the budget, an accounting of the amount and use of funds reimbursed through Medicare and Medicaid made available to Indian Health Services. Authorizes appropriations. Title V: Health Services for Urban Indians - Authorizes appropriations to make health services more accessible to the urban Indian population. Title VI: Organizational Improvements - Requires the Secretary to carry out, through the Director of the Service, all scholarship and loan functions under this Act. Authorizes appropriations. Title VII: Substance Abuse Programs - Redesignates Title VII of the Indian Health Care Improvement Act as Title VIII. Expands the responsibilities of the Indian Health Service with respect to the Memorandum of Agreement entered into under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986. Directs the Secretary, acting through the Service, to provide a program of comprehensive alcohol and substance abuse prevention and treatment to members of Indian tribes. Authorizes the Secretary, acting through the Service, to enter into contracts with public or private providers of alcohol and substance abuse treatment services to assist the Service in carrying out such programs. Directs the Secretary to: (1) provide assistance to Indian tribes in developing criteria for the certification and accreditation of service facilities which meet certain minimum standards; (2) develop and implement a program for acute detoxification and treatment for Indian youth who are alcohol and substance abusers; and (3) construct or renovate, and appropriately staff and operate, a youth regional treatment center in each area under the jurisdiction of an area office. Considers the area offices of the Service in Tucson and Phoenix, Arizona, as one area office. Authorizes the Secretary to make funds available to the Tanana Chiefs Conference, Incorporated, to lease, construct, renovate, operate and maintain a residential youth treatment facility in Fairbanks, Alaska. Directs the Secretary, acting through the Service, to: (1) identify and use, where appropriate, federally-owned structures suitable as local residential or regional alcohol and substance abuse treatment centers for Indian youth; and (2) establish guidelines to determine their suitability for such purpose. Directs the Secretary, in cooperation with the Secretary of the Interior, to develop and implement, within each Health Service unit, community-based rehabilitation and follow-up services designed to integrate long-term treatment and to monitor and support Indian youth who are alcohol or substance abusers after their return home. Requires the Secretary to provide for the inclusion of family members of a youth in such treatment programs or other appropriate services. Earmarks at least ten percent of funds appropriated to carry out such programs for outpatient care of adult family members related to the treatment of an Indian youth. Directs the Secretary to study and report to the Congress on: (1) the incidence and prevalence of the abuse of multiple forms of drugs, including alcohol, among Indian youth residing on Indian reservations and in urban areas; and (2) the interrelationship of such abuse with the incidence of mental illness among such youth. Requires the Secretary, in cooperation with the Secretary of the Interior, to develop and implement, within each service unit, a program to provide training and community education in the areas of alcohol and substance abuse. Directs the Secretary, with respect to such programs, to take into consideration and make available, the results of the demonstration project for children of alcoholics funded by the Office of Minority Health of the Department of Health and Human Services. Requires the Secretary to make grants to the Navajo Nation to provide residential treatment for alcohol and substance abuse for the Tribe's adult and adolescent members and neighboring tribes. Directs the Navajo Nation to enter into a contract with a Gallup, New Mexico, area institution accredited by the Joint Commission of the Accreditation of Health Care Organizations to provide such comprehensive alcohol and drug treatment. Authorizes appropriations. Authorizes the Secretary to make grants to: (1) those urban Indian organizations with which the Secretary has entered into a contract under this Act for the provision of health-related services in prevention, treatment, or rehabilitation of, or school and community-based education in alcohol and substance abuse in urban centers; and (2) Indian tribes to establish fetal alcohol syndrome programs to meet the health status objective specified in this Act. Directs the Secretary to provide assistance to Indian tribes in the development, printing, and dissemination of education and prevention materials on fetal alcohol syndrome. Directs the Secretary, acting through the Service, to continue making grants through FY 1995 to the Eight Northern Indian Pueblos Council, San Juan Pueblo, New Mexico, to provide substance abuse treatment services to Indians in need of them. Authorizes appropriations. Title VIII: Miscellaneous - Directs the President to include with submission of the budget certain reports and statements on meeting the objectives of this Act. Extends to FY 2000 the time during which Arizona is designated as a contract health service delivery area. Continues through FY 1995 the demonstration programs involving treatment for child sexual abuse that were conducted in FY 1991 through the Hopi Tribe and the Asiniboine and Sioux Tribes of Fort Peck Reservation. Authorizes the Secretary and the Secretary of the Interior to establish such programs in any service area, except that the establishment of a greater number of them in one service area than in another is prohibited until there is an equal number established with respect to all service areas. Authorizes appropriations for Indian health care programs through FY 2000. Title IX: Technical Corrections - Makes technical corrections to the Indian Health Care Improvement Act.

This text is taken from the official record. PoliticalRepo does not editorialize.

Timeline

6 November 1991
Introduced
Referred to the House Committee on Energy and Commerce.
Source: IntroReferral
6 November 1991
Introduced
Introduced in House
Source: IntroReferral
6 November 1991
Introduced
Introduced in House
Source: IntroReferral
12 November 1991
Committee
Committee Hearings Held.
Source: Committee
12 November 1991
Referred
Referred to the Subcommittee on Health and the Environment.
Source: Committee
12 November 1991
Committee
Subcommittee Hearings Held.
Source: Committee
24 March 1992
Committee
Committee Hearings Held.
Source: Committee
26 March 1992
Committee
Subcommittee Consideration and Mark-up Session Held.
Source: Committee
26 March 1992
Committee
Forwarded by Subcommittee to Full Committee.
Source: Committee
7 April 1992
Committee
Committee Consideration and Mark-up Session Held.
Source: Committee
7 April 1992
Reported
Ordered to be Reported (Amended) by Voice Vote.
Source: Committee
29 April 1992
Committee
Committee Consideration and Mark-up Session Held.
Source: Committee
29 April 1992
Reported
Ordered to be Reported (Amended).
Source: Committee
1 July 1992
Reported
Reported (Amended) by the Committee on Interior and Insular Affairs. H. Rept. 102-643, Part I.
Source: Committee
1 July 1992
Reported
Reported (Amended) by the Committee on Interior and Insular Affairs. H. Rept. 102-643, Part I.
Source: Committee
28 July 1992
Calendars
Placed on the Union Calendar, Calendar No. 432.
Source: Calendars
28 July 1992
Reported
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 102-643, Part II.
Source: Committee
28 July 1992
Reported
Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 102-643, Part II.
Source: Committee
10 September 1992
Reported
Rules Committee Resolution H. Res. 562 Reported to House. Rule provides for consideration of H.R. 3724 with 1 hour of general debate. Previous question shall be considered as ordered except motion to recommit. Measure will be read by title. Bill is open to amendments. It shall be in order to consider an amendment in the nature of a substitute consisting of the text of H.R. 5752 as an original bill for the purpose of amendment under the five minute rule.
Source: Floor
15 September 1992
Floor
Considered under the provisions of rule H. Res. 562.
Source: Floor
15 September 1992
Passed
Motion to reconsider laid on the table Agreed to without objection.
Source: Floor
15 September 1992
Vote
On passage Passed by the Yeas and Nays: 330 - 36 (Roll no. 392).
Source: Floor
15 September 1992
Vote
Passed/agreed to in House: On passage Passed by the Yeas and Nays: 330 - 36 (Roll no. 392).
Source: Floor
15 September 1992
Passed
The House adopted the amendment in the nature of a substitute as agreed to by the Committee of the Whole House on the state of the Union.
Source: Floor
15 September 1992
Floor
The previous question was ordered pursuant to the rule.
Source: Floor
15 September 1992
Floor
The House rose from the Committee of the Whole House on the state of the Union to report H.R. 3724.
Source: Floor
15 September 1992
Floor
The Speaker designated the Honorable Patricia Schroeder to act as Chairwoman of the Committee.
Source: Floor
15 September 1992
Floor
House resolved itself into the Committee of the Whole House on the state of the Union pursuant to H. Res. 562 and Rule XXIII.
Source: Floor
15 September 1992
Floor
Rule provides for consideration of H.R. 3724 with 1 hour of general debate. Previous question shall be considered as ordered except motion to recommit. Measure will be read by title. Bill is open to amendments. It shall be in order to consider an amendment in the nature of a substitute consisting of the text of H.R. 5752 as an original bill for the purpose of amendment under the five minute rule.
Source: Floor
15 September 1992
Passed
Rule H. Res. 562 passed House.
Source: Floor
16 September 1992
Introduced
Received in the Senate and read twice and referred to the Committee on Indian Affairs.
Source: IntroReferral
29 September 1992
Committee
Executive Comment Received from HHS.
Source: Committee
8 October 1992
Committee
See S.2481.
Source: Committee

Votes

No vote records are attached yet.

Versions

Engrossed in House · undated · Official file
Introduced in House · undated · Official file
Referred in Senate · undated · Official file
Reported in House · undated · Official file

Documents

6 official files

Reported in House (text)

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Reported in House (text)
Reported in House · EN
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Referred in Senate (text)
Referred in Senate · EN
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Introduced in House (text)
Introduced in House · EN
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Engrossed in House (text)
Engrossed in House · EN
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Passed House amended
summary · EN · 15 September 1992
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Introduced in House
summary · EN · 6 November 1991
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Related records

related to → Comprehensive Indian Fetal Alcohol Syndrome Prevention and Treatment Act
related to → Providing for the consideration of the bill (H.R. 3724) to amend the Indian Health Care Improvement Act to authorize appropriations for Indian health programs, and for other purposes.
related to ← Indian Health Amendments of 1992
related to ← Indian Health Amendments of 1992

Sources

PoliticalRepo is an index and interpretation layer, not the authoritative legal source.

Official source: https://www.congress.gov/bill/102nd-congress/house-bill/3724
Open data entity: https://api.congress.gov/v3/bill/102/hr/3724
us · 102-hr-3724 · source updated 3 June 2026