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Health Care Legislation - S. 522 (2)
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Health Care Legislation - S. 522 (2)
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The original documents are located in Box 2, folder "Health Care Legislation - S. 522 (2)"
of the Bradley H. Patterson Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Digitized from Box 2 of the Bradley H. Patterson Files
at the Gerald R. Ford Presidential Library
THE WHITE HOUSE
WASHINGTON
DATE 2/5/76
TO: Dr. marrs
FROM: SARAH MASSENGALE
E-5
HEALTH, EDUCATION, AND WELFARE
SUBJECT:
INDIAN HEALTH CARE
SENATE BILL: S. 522 (Jackson (D) Wash.)
HOUSE BILL : H.R. 2525 (Meeds (D) Wash.)
BACKGROUND: S. 522, as introduced, is identical to S. 2938
which was passed by the Senate (voice vote) on 11/25/74.
The Administration opposed S. 2938 last year for the
same reasons that it opposes S. 522 (see position below).
H.R. 2525 is similar to S. 522.
PROVISIONS: S. 522 and H.R. 2525 would authorize new
categorical programs and appropriation levels for
7-year and 5-year periods, respectively, to expand
and upgrade the services and facilities of Federal
Indian health programs. Specifically, the bills would:
-- establish new scholarship programs to recruit,
prepare and enroll Indians in health professions
schools,
-- provide specific authorization levels for health
services (including alcholism and mental health in
S. 522) and health facilities,
-- provide for Medicare and Medicaid reimbursements
for health services provided in IHS facilities, and
-- establish outreach programs in urban areas to
make health services more accessible to the urban Indian
population.
ADMINISTRATION OBJECTIONS: The bills would create over 20
new categorical programs for a specific population group.
This approach is contrary to the Administration's policy
of meeting the health needs of Americans through broad-
based programs such as Medicare and Medicaid. All the
program activities authorized by the bills can be con-
ducted under existing legislative authority. In addition,
the authorization levels are significantly higher than
warranted.
The Administration opposes the bills except for the
provisions requiring Medicare and Medicaid reimburse-
ments for services provided to eligible beneficiaries
in Indian Health Service facilities. Federal assistance
for health manpower, health services and upgrading
health facilities is being carried out through existing
Federal programs (e.g., Interior's Bureau of Indian
Affairs already conducts a scholarship program that
meets the objectives of the bills) and is adequately
funded in the 1976 budget.
FORD
11/26/75
GERALD
LIBRARY
E-5 (Cont'd)
SUBJECT: INDIAN HEALTH CARE (PAGE 2)
BUDGET IMPACT: S. 522 would authorize $213 million for the
first full year and would add new programs costing
$29 million in FY 1976. Over a 7-year period it would
authorize a total of $1.25 25 billion. H.R. 2525 would
authorize $191 million for FY 76 and $1.1 billion over
a 5-year period. The 1976 budget provides outlays of
$322 million for the Indian Health Service, a 175%
increase in six years.
STATUS: HEW reported not consistent with to Senate
Interior Cte. disapproving all but Title IV of S. 522.
5/16 Senate passed S. 522 (voice vote)
12/9 H. Interior and Insular Affairs subcte approved
H.R. 2525 amended
LIBRARY FORD y GERALD
12/10/75
PRESIDENT
JAMES B. GILLESPIE, M.D.
9 TENNIS COURT, N.W.
AMERICAN
DISTRICT CHAIRMEN
MERRITT B. LOW, M.D.
LA LUZ
GREENFIELD, MASSACHUSETTS
ALBUQUERQUE, NEW MEXICO 87120
STEWART C. WAGONER, M.D.
SCHENECTADY, NEW YORK
VICE-PRESIDENT
WILLIAM A. HOWARD, M.D.
JOHN C. MACQUEEN, M.D.
WASHINGTON, DISTRICT OF COLUMBIA
DEPT. OF PEDIATRICS
EDWIN L. KENDIG, JR., M.D.
UNIVERSITY OF IOWA HOSPITALS
PEDIATRIC
RICHMOND, VIRGINIA
@
BRUCE D. GRAHAM, M.D.
IOWA CITY, IOWA 52242
COLUMBUS, OHIO
EXECUTIVE DIRECTOR
R. DON BLIM, M.D.
ROBERT G. FRAZIER, M.D.
ASSOCIATE DIRECTORS
American Academy of Pedialrics
KANSAS CITY, MISSOURI
DAVID W. VAN GELDER, M.D.
BATON ROUGE, LOUISIANA
STANLEY L. HARRISON, M.D.
THOMAS C. cocK, M.D.
BELLEVUE, WASHINGTON
RICHARD W. OLMSTED, M.D.
P.O. BOX 1034
EVANSTON, ILLINOIS 60204
SAUL J. ROBINSON, M.D.
SECRETARY
SAN FRANCISCO, CALIFORNIA
GERALD E. HUGHES, M.D.
EVANSTON (312) 869-4255 CHICAGO (312) 273-3646
GUILLERMO GUILLEN-ALVAREZ, M.D.
SAN SALVADOR, EL SALVADOR
TREASURER
COMMITTEE ON INDIAN HEALTH
HELIO SABASTIAO DE MARTINO, M.D.
DANIEL A. DAMON
RIO DE JANEIRO, BRASIL
1601 N. TUCSON BLVD., #35
ULADISLAO LOZANO ZEGARRA, M.D.
LIMA, PERU
TUCSON, AZ. 85716
FEBRUARY 19, 1976
THE INDIAN HEALTH IMPROVEMENT BILL HAS BEEN PLACED ON THE
LIST OF "CONTROVERISAL BILLS" ON WHICH THE INTERIOR COMMITTEE
OF THE HOUSE IS HOLDING MONDAY. AND TUESDAY MEETINGS.
MR. JOE SKUBITZ, LEADING MINORITY MEMBER OF THE COMMITTE,
HAS BEEN LEADING THE OPPOSITION TO THE BILL. I BELIEVE THAT
HE HAS BEEN MISINFORMED BY THE ADMINISTRATION AS REGARDS THE
NEEDS OF THE INDIAN PEOPLE. THE ADMINISTRATION'S POSITION
HAS ALWAYS BEEN THAT NEW LEGISLATION IS NOT NEEDED. THE CRISES
IN INDIAN HEALTH HAS DEVELOPED UNDER THE SAME GUIDELINES THAT
THE ADMINISTRATION SAYS IT CAN SOLVE. THIS ARGUMENT IS NOT
ONLY INCONSISTENT BUT UNREALISTIC. THE PROBLEM IN THE PAST
HAS BEEN THAT ONLY THE POLITICALLY POTENT TRIBES HAVE RECEIVED
MOST OF THE ATTENTION. THE INDIAN HEALTH BILL HAS ALREADY
BEEN COMPROMISED.
WE NATIONAL MEDICAL ORGANIZATIONS (A.A.P., A.C.O.G., A.A.F.P.
AND A.M.A.) HAVE BEEN ADVOCATING PASSAGE OF THIS BILL BECAUSE
FOR OVER TEN YEARS WE HAVE SEEN THE PROBLEMS DEVELOP AFTER
MANY PERSONAL VISITATIONS TO THE AREA INDIAN RESERVATIONS
AND ALASKA NATIVE VILLAGES.
AS CHAIRMAN OF THE A.A.P. COMMITTEE ON INDIAN HEALTH, I ASK
THAT YOU PLEASE HEED OUR ADVISE, WE ARE POLITICALLY BIPARTISAN
AND FEEL THAT THE BILL SHOULD HAVE REMAINED BIPARTISAN.
OBVIOUSLY, THE ONLY REAL OPPOSITION TO ADEQUATE INDIAN HEALTH
IMPROVEMENT ARE THE BUREAUCRATIC DIE-HARDS IN THE O.M.B. AND
W.E.W. WHO EITHER ARE BRUTALLY INDIFFERENT OR ACTIVELY RACIST
AGAINST THE AMERICAN INDIAN PEOPLE.
CINDIAN HEALTH CARE IMPROVEMENT ACT - A VERSION REPORTEDLY
CLOSE TO HR 7852)
FORD will LIBRARY GERALD
PRESIDENT
DISTRICT CHAIRMEN
JAMES B. GILLESPIE, M.D.
MERRITT B. LOW, M.D.
9 TENNIS COURT, N.W.
GREENFIELD, MASSACHUSETTS
LA LUZ
STEWART C. WAGONER, M.D.
ALBUQUERQUE, NEW MEXICO 87120
SCHENECTADY, NEW YORK
WILLIAM A. HOWARD, M.D.
VICE-PRESIDENT
WASHINGTON, DISTRICT OF COLUMBIA
JOHN C. MACQUEEN, M.D.
EDWIN L. KENDIG, JR., M.D.
DEPT. OF PEDIATRICS
UNIVERSITY OF IOWA HOSPITALS
. PEDIATRIC
RICHMOND, VIRGINIA
BRUCE D. GRAHAM, M.D.
IOWA CITY, IOWA 52242
COLUMBUS, OHIO
R. DON BLIM, M.D.
EXECUTIVE DIRECTOR
American Academy of Pediatrics
KANSAS CITY, MISSOURI
ROBERT G. FRAZIER, M.D.
DAVID W. VAN GELDER, M.D.
BATON ROUGE, LOUISIANA
ASSOCIATE DIRECTORS
THOMAS C. cocK, M.D.
STANLEY L. HARRISON, M.D.
BELLEVUE, WASHINGTON
RICHARD W. OLMSTED, M.D.
SAUL J. ROBINSON, M.D.
P.O. BOX 1034
EVANSTON, ILLINOIS 60204
SAN FRANCISCO, CALIFORNIA
SECRETARY
GERALD E. HUGHES, M.D.
EVANSTON (312) 869-4255 CHICAGO (312) 273-3646
GUILLERMO GUILLEN-ALVAREZ, M.D.
SAN SALVADOR, EL SALVADOR
TREASURER
HELIO SABASTIAO DE MARTINO, M.D.
COMMITTEE ON INDIAN HEALTH
DANIEL A. DAMON
RIO DE JANEIRO, BRASIL
1601 N. TUCSON BLVD. #35
ULADISLAO LOZANO ZEGARRA, M.D.
LIMA, PERU
TUCSON, AZ. 85716
MAY 12, 1976
DR. THEODORE MARRS
SPECIAL ASSISTANT TO THE PRESIDENT
THE WHITE HOUSE
WASHINGTON, D.C.
DEAR TED:
AS REQUESTED, HERE ARE THE ENCLOSURES ON THE INDIAN
HEALTH IMPROVEMENT BILL. I HOPE THE PRESIDENT CAN
BE PERSUADED NOT TO VETO THIS LEGISLATION.
SINCERELY,
Aid
SIDNEY R. KEMBERLING, M.D.
CHAIRMAN
FORD
SRK/MK
ENCLOSURES
10/14/75
October 9, 1975
Representative James P. Johnson
129 Cannon House Office Building
U.S. House of Representatives
Washington, D.C. 20515
Dear Mr. Johnson:
I'm writing to ask your support of HR 7852, the
Indian Improvement Bill, in the Sub-committee on
Indian Health. The bill has the endorsement of
the American Academy of Pediatrics. Ine scademy
believes that the passage of this legislation
would greatly enhance the health resources and
services available to Indian children.
As you know S 522 has passed the Senate by a sub-
stantial margin. I hope you will support committee
action to bring HR 7852 to the floor of the House
of Representatives.
Sincerely,
James E. Strain,
Chairman, District 8
Academy of Pediatrics
JES/rs
copy to Sidney kemberlin, N.D.
GERALD
FORD LIBRARY &
11/5/95
JAMES P. JOHNSON
OFFICE ADDRESS:
Ave DISTRICT, COLORADO
129 CANNON BUILDING
WASHINGTON, D.C. 20515
COMMITTEES
(202) 225-4676
AGRICUL TURE
Congress of the United States
DISTRICT OFFICES:
203 FEDERAL BUILDING
Form COLLINS, COLORADO 80521
INTERIOR AND INSULAR AFFAIRS
House of Representatives
(303) 493-9132
FEDERAL BUILDING
SELECT COMMITTEE ON
Mashington, D.C. 20515
GRAND JUNCTION, COLORADO 81501
INTELLIGENCE
(303) 243-1736
ROOM 9, 230 MAIN STREET
October 24, 1975
FORT MORGAN, COLORADO 80701
(303) 867-8909
719 GRAND AVENUE
GLENWOOD SPRINGS, COLORADO 81601
(303) 945-6491
P.O. Box 21203
DENVER, COLORADO 80221
James E. Strain, M.D., P.C.
(303) 427-6439
556 South Jersey Street
Denver, Colorado 80222
Dear Dr. Strain:
Thank you for your recent comments regarding the Indian Health Measure,
H.R. 7852. I appreciate your interest and concern.
As you may be aware, H.R. 7852 is substantively the same measure as the
original Indian Health legislation of this Congress, H.R. 2525, reflect-
ing the amendments added in the Senate. The Indians Subcommittee, of
which I am a member, is scheduled to "mark-up" the bill next week.
Several amendments are expected before the Subcommittee, including an
authorization for an American Indian School of Medicine and increased
funding for Indian mental health and alcoholism programs.
Staff counsel for the Subcommittee expects a bill to be reported to the
full House Interior Committee early in November. There is also a good
chance that the full committee will draft a "clean bill," or new piece of
legislation, encompassing all of the amendments from the House and Senate.
It should be ready for reporting to the floor before 1975 adjournment.
Given the strong bi-partisan support for this bill, in both chambers of
the Congress, and the seventy Members who have already co-sponsored one or
another of the versions, prospects for approval are very good.
Sincerely yours,
Member dames P. of Johnson Congress
JPJ/e
Sid - This. is Rep Jcknsons
24ply to my Letter
October 10, 1975
The Honorable Carl Albert
Speaker of the House
U.S. House of Representatives
The Speakers Rooms
Washington DC 20515
Dear Speaker Albert:
The American Academy of Pediatrics
Indian Health Committee, is very interested in the
Indian Health Improvement Bill, HR 7852.
I am a member of that Committee, and I
feel that we in Oklahoma, with our strong Indian
heritage, should give this bill strong support.
I respectfully seek and encourage your
support of this legislation.
Sincerely yours,
EMIL F. STRATTON, M. D.
EFS/lw
above letter sent to:
Ted Riwenhoover - Congress of the United States,
Tom Steed
House of Representatives
FORD LIBRA Givh
James R. Jones
Washington DC 20515
John Jarman
Glen English
TED RISENHOOVER
COMMITTEE ON PUBLIC WORKS
2D DISTRICT, OKLAHOMA
AND TRANSPORTATION
SUBCOMMITTEES:
JOE CARTER
ECONOMIC DEVELOPMENT
ADMINISTRATIVE ASSISTANT
WASHINGTON OFFICE:
Congress of the United States
INVESTIGATIONS AND REVIEW
PUBLIC BUILDINGS AND GROUNDS
1407 LONGWORTH BUILDING
(202) 225-2701
house of Representatives
COMMITTEE ON
INTERIOR AND INSULAR AFFAIRS
DISTRICT OFFICES:
Blashington, D.C. 20515
SUBCOMMITTEES:
PATRICK O'REILLY
PUBLIC LANDS
FEDERAL BUILDING, ROOM 102
INDIAN AFFAIRS
MUSKOGEE, OKLAHOMA 74401
WATER AND Power RESOURCES
(918) 687-7509
March 16, 1976
SELECT COMMITTEE ON AGING
BILL WILLIS
SUBCOMMITTEES:
109 EAST DELAWARE
FEDERAL, STATE AND COMMUNITY
TAHLEQUAH, OKLAHOMA 74464
SERVICES
(918) 456-0591
Emil F. Stratton, M.D., F.A.A.P.
Memorial Medical Building
443 North 16th Street
Muskogee, Oklahoma 74401
Dear Dr. Stratton:
Thank you for taking the time to write informing me of your
concern for the future of the Indian Health Services Bill--
H. R. 2525.
It has been my opportunity to be one of the principal workers
on this bill as it was considered in both Indian Affairs Sub-
committee and full Interior and Insular Affairs Committee, both
of which I am a member. You can be assured that I have done
everything within my Congressional powers to insure passage
of this badly-needed legislation.
In full Interior Committee, we encountered little adamant
opposition---the strongest being from Congressman Joe Skubitz
of Kansas. We were able to avoid the inclusion of detrimental
amendments for the most part. However, I do foresee a consider-
able floor battle when this is brought to the Floor for final
consideration. I am working closely with the House Leadership
to enable us to have the greatest chance for success in passing
this bill.
Again, thanks for writing and if I may be of service or assistance
regarding this or any matter, please do not hesitate to call on
me. You have my kindest personal regards.
Sincerely,
Ted
Ted Risenhoover, M.C.
TR:Cjp
TED RISENHOOVER
COMMITTEE ON
2D DISTRICT, OKLAHOMA
EDUCATION AND LABOR
SUBCOMMITTEES:
JOE CARTER
LABOR STANDARDS
ADMINISTRATIVE ASSISTANT
WASHINGTON OFFICE:
Congress of the United States
COMPENSATION, MANPOWER, HEALTH
AND SAFETY
1407 LONGWORTH BUILDING
ELEMENTARY, SECONDARY AND
(202) 225-2701
VOCATIONAL EDUCATION
house of Representatives
BILL WILLIS
COMMITTEE ON
DISTRICT OFFICE DIRECTOR
ROOM 102, FEDERAL BUILDING
Mashington, D.C. 20515
INTERIOR AND INSULAR AFFAIRS
MUSKOGEE, OKLAHOMA 74401
SUBCOMMITTEES:
(918) 687-7509
PUBLIC LANDS
INDIAN AFFAIRS
JOHN TENNISON
WATER AND POWER RESOURCES
LABOR LIAISON
TAMLEQUAH DISTRICT OFFICE:
109 EAST DELAWARE
SELECT COMMITTEE ON AGING
TAHLEQUAH, OKLAHOMA 74464
October 28, 1975
SUBCOMMITTEE,
(918) 456-0591
FEDERAL STATE AND COMMUNITY
SERVICES
Dr. Emil F. Stratton, M. D.
Memorial Medical Building
443 North 16th Street
Muskogee, Oklahoma 74401
Dear Dr. Stratton:
Thank you for writing to inform me of your support for the Indian
Health Improvements Bill, H. R. 7852. Please know that I join you in
your support of this legislation.
You may be interested to know that I have co-sponsored similar legisla-
tion, H. R. 2525, which I have enclosed for your information. I feel
that Indians in general have been reluctant to enter health professions
at the same rate as other races.
Currently, H. R. 7852 is with the House Interior and Insular Committee's
subcommittee on Indian Affairs. I am a member of this subcommittee and
we finished hearings on the bill on September 26th. It is now awaiting
being reported out of subcommittee back to the full committee for their
consideration.
You may be assured that I will continue to do all I can to insure that
Indians have the best health opportunities available and to encourage
them to enter the health-care profession.
If I may be of service or assistance to you in the future, please do not
hesitate to let me know.
Sincerely,
Jed
Ted Risenhoover, M. C.
TR:Cvm
Enclosure
BOB ECKHARDT
COMMITTEE ON
8TH DISTRICT, TEXAS
INTERIOR AND INSULAR AFFAIRS
COMMITTEE ON
SUBCOMMITTEES:
INTERSTATE AND FOREIGN
NATIONAL PARKS AND RECREATION
COMMERCE
ENERGY AND THE ENVIRONMENT
MINES AND MINING
SUBCOMMITTEES:
CONSUMER PROTECTION AND FINANCE
ENERGY AND POWER
CONGRESS OF THE UNITED STATES
HOUSE OF REPRESENTATIVES
WASHINGTON, D.C. 20515
March 24, 1976
Dr. Emil F. Stratton
Memorial Medical Building
443 North 16th Street
Muskogee, Oklahoma
Dear Dr. Stratton:
Thank you for your letter concerning H.R. 2525, the
Indian Health Care Improvement Act. This landmark
legislation was approved by the House Interior Com-
mittee on March 2, 1976.
Sincerely,
Bob Eckhardt
ALAN STEELMAN
5TH DISTRICT, TEXAS
WASHINGTON OFFICE:
437 CANNON House OFFICE BUILDING
WASHINGTON, D.C. 20515
COMMITTEES:
(202) 225-2231
GOVERNMENT OPERATIONS
INTERIOR AND INSULAR AFFAIRS
Congress of the United States
DALLAS OFFICE:
1100 COMMERCE STREET, SUITE 9C60
house of Representatibes
DALLAS, TEXAS 75242
(214) 749-7277
Mashington, D.C. 20515
March 30, 1976
Dr. Emil F. Stratton
443 North 16th St.
Muskogee, Oklahoma
Dear Dr. Stratton:
Thank you for your letter regarding HR 2525.
I regret that I cannot give you a detailed reply because I have
neither the staff nor the facilities to answer mail received
from outside of Texas. Please be assured, however, I intend to
support on the floor the Indian Health Improvement Act as reported
by the full House Interior Committee.
Thank you again for writing.
Sincerely,
The
ALAN STEELMAN
Member of Congress
5th District, Texas
AS:wsc
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS
The Speaker's Rooms
H. $. House of Representatives
Washington, B. C. 20515
July 22, 1975
Emil F. Stratton, M.D.
Memorial Medical Building
443 N. 16th Street
Muskogee, Oklahoma 74401
Dear Dr. Stratton:
Thank you for your recent letter in support of the Indian
Health Care Improvement Act, S.522.
A similar bill, H.R.2525, is currently being considered by
the Subcommittee on Indian Affairs of the House Committee on
Interior and Insular Affairs. This Subcommittee has been
holding field hearings across the country which will wind up in
Washington, D.C., in September.
Thank you for having written. I am sure Congressman
Risenhoover will want to have your views on this important
legislation.
Best wishes.
Sincerely,
Carl albert
The Speaker
CA/km
JOHN JARMAN
COMMITTEE:
5TH DISTRICT, OKLAHOMA
SCIENCE AND TECHNOLOGY
Congress of the United States
house of Representatives
Hashington, D.C. 20515
October 15, 1975
Emil F. Stratton, M. D.
Memorial Medical Building
443 North 16th Street
Muskogee, Oklahoma
Dear Dr. Stratton:
This will acknowledge receipt of your letter of October 10th,
which I have read with care. In response, let me report to
you that the House Interior and Insular Affairs Committee has
completed its hearings on H. R. 7852, the Indian Health Improve-
ment bill and will be meeting in mark-up sessions during the
week of October 20th. I intend to discuss your letter with
Members serving on the Committee urging that every considera-
tion be given to your views. Rest assured that I will have
your position firmly in mind as and when the matter comes before
the House for debate and a vote.
With every good wish, I remain,
Sincerely,
JJ:wg
John Aarman JOHN JARYAN, M. C.
6/16/75
SAM STEIGER
COMMITTEES:
3RD DISTRICT, ARIZONA
INTERIOR AND INSULAR AFFAIRS
GOVERNMENT OPERATIONS
2432 RAYBURN BUILDING
WASHINGTON, D.C. 20515
202-225-4576
Congress of the United States
DISTRICT OFFICE:
5015 FEDERAL BUILDING
PHOENIX, ARIZONA 85025
house of Representatives
602-261-4041
Washington, D.C. 20515
June 10, 1975
Dr. Sidney R. Kemberling, M.D.
Committee on Indian Health
1601 N. Tucson Blvd., #35
Tucson, AZ 85716
Dear Dr. Kemberling
Thank you very much for your recent letter regarding legislation
for Indian Health Improvement.
You will be pleased to know that I am going to cosponsor the
Senate version.
Many thanks and best wishes.
Sincerely
Ean Enger
SAM STEIGER, M.C.
SS: jm
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS
81/6/74
MORRIS K. UDALL
COMMITTEES:
2D DISTRICT OF ARIZONA
INTERIOR AND INSULAR AFFAIRS
POST OFFICE AND CIVIL SERVICE
Congress of the United States
Douse of Representatives
Washington, D.C. 20515
August 13, 1974
Dr. Sidney R. Kemberling, M. D.
Chairman, American Academy of Pediatrics
Indian Health Committee
1601 North Tucson Boulevard, #35
Tucson, Arizona 85716
Dear Dr. Kemberling:
I greatly appreciated your recent letter regard-
ing my Indian Health Bill. I have pressed the Indian
Affairs Subcommittee to hold hearings on this bill as
soon as possible. However, as of this date, they have
not yet been scheduled.
Thank you for your continued support.
Sincerely,
em
ORD
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS
11/5/75
JAMES P. JOHNSON
4TH DISTRICT. COLORADO
OFFICE ADDRESS:
129 CANNON BUILDING
WASHINGTON D.C. 20515
COMMITTEES
(202) 225-4676
AGRICULTURE
Congress of the United States
DISTRICT OFFICES:
203 FEDERAL BUILDING
House of Representatives
FORT COLLINS. COLORADO 80521
INTERIOR AND INSULAR AFFAIRS
(303) 493-9132
FEDERAL BUILDING
SELECT COMMITTEE ON
INTELLIGENCE
Washington, D.C. 20515
GRAND JUNCTION, COLORADO 81501
(303) 243-1736
October 24, 1975
ROOM 9. 230 MAIN STREET
FORT MORGAN, COLORADO 80701
(303) 867-8909
719 GRAND AVENUE
GLENWOOD SPRINGS. COLORADO 81601
(303) 945-6491
P.O. Box 21203
James E. Strain, M.D., P.C.
DENVER, COLORADO 80221
(303) 427-6439
556 South Jersey Street
Denver, Colorado 80222
Dear Dr. Strain:
Thank you for your recent comments regarding the Indian Health Measure,
H.R. 7852. I appreciate your interest and concern.
As you may be aware, H.R. 7852 is substantively the same measure as the
original Indian Health legislation of this Congress, H.R. 2525, reflect-
ing the amendments added in the Senate. The Indians Subcommittee, of
which I am a member, is scheduled to "mark-up" the bill next week.
Several amendments are expected before the Subcommittee, including an
authorization for an American Indian School of Medicine and increased
funding for Indian mental health and alcoholism programs.
Staff counsel for the Subcommittee expects a bill to be reported to the
full House Interior Committee early in November. There is also a good
chance that the full committee will draft a "clean bill," or new piece of
legislation, encompassing all of the amendments from the House and Senate.
It should be ready for reporting to the floor before 1975 adjournment.
Given the strong bi-partisan support for this bill, in both chambers of
the Congress, and the seventy Members who have already co-sponsored one or
another of the versions, prospects for approval are very good.
Sincerely yours,
Jim James P, Johnson Johnson
Member of Congress
JPJ/e
Sid - This. is Rep Jekusons
reply to my Letter
9/15/75
NINETY-FOURTH CONGRESS
CHARLES CONKLIN
STAFF DIRECTOR
JAMES A. HALEY, FLA., CHAIRMAN
ROY A. TAYLOR, N.C.
JOE SKUBITZ, KANS.
LEE MC ELVAIN
MADOLD T. JOHNSON, CALIF.
SAM STEIGER, ARIZ.
GENERAL COUNSEL
MORRIS K. UDALL, ARIZ.
DON H. CLAUSEN, CALIF.
COMMITTEE ON INTERIOR AND INSULAR AFFAIRS
PHILLIP BURTON. CALIF.
PHILIP E. RUPPE, MICH.
MICHAEL C. MARDEN
ROBERT W. KASTENMEIER, WIS.
MANUEL LUJAN, JR., N. MEX.
KEITH G. SEBELIUS, KANS.
U.S. HOUSE OF REPRESENTATIVES
PATSY T. MINK, HAWAII
MINORITY COUNSEL
LLOYD MEEDS. WASH.
ALAN STEELMAN, TEX.
DON YOUNG, ALASKA
WASHINGTON, D.C. 20515
ABRAHAM KAZEN, JR., TEX.
ROBERT G. STEPHENS, JR., GA.
ROBERT E. BAUMAN, MD.
JOSEPH P. VIGORITO, PA.
STEVEN D. SYMMS, IDAHO
JOHN MELCHER, MONT.
JAMES P. (JIM) JOHNSON, COLO.
TENO RONCALIO, WYO.
ROBERT J. LAGOMARSINO, CALIF.
JONATHAN B. BINGHAM, N.Y.
VIRGINIA SMITH, NEBR.
JOHN F. SEIBERLING, OHIO
SHIRLEY N. PETTIS, CALIF.
HAROLD RUNNELS, N. MEX.
ANTONIO BORJA WON PAT, GUAM
RON DE LUGO, V.I.
BOB ECKHARDT, TEX.
GOODLOE E. BYRON, MD.
September 8, 1975
JAIME BENITEZ. P.R.
JIM SANTINI, NEV.
PAUL E. TSONGAS, MASS.
ALLAN T. HOWE, UTAH
Fill
JAMES WEAVER, OREG.
BOB CARR, MICH.
GEORGE MILLER, CALIF.
THEODORE M. (TED) RISENHOOVER,
OKLA.
WRIGHT PATMAN, TEX.
American Academy of Pediatrics
Sidney R. Kemberling, M.D.
1601 N. Tucson Blvd. Suite 35
Tucson, Arizona 85716
Dear Dr. Kemberling:
Thank you for accepting my invitation to testify
on H.R. 2525, and related legislation, the Indian Health
Care Improvement Act. I have scheduled your appearance
before my Subcommittee on September 25, 1975, Thursday,
at 10:45 A.M. in 1324 Longworth HOB (main Interior Committee
hearing room). As requested, I am scheduling Dr. Nichols,
of the American College of Obstetricians to follow you.
I look forward to your testimony, Dr. Kemberling,
and I thank you for your interest in this very important
piece of legislation.
Sincerely yours,
Lloyd Meeds,
Chairman,
Indian Affairs Subcommittee
LM/jp
CC: AAP-Va. office.
8/12/75
to
8/16/75
File Drgn Tody
Talbed
ACOG
people -
Me Cale. +
DISTRICT CHAIRMEN
PRESIDENT
MERRITT'S. LOW, M.D.
86 HIGH STREET
GREENFIELD, MASS. 01301
VICE-PRESIDENT
AMERICAN ACCORDANCE
SPRAGUE W. HAZARD, M.D.
WALTHAM, MASSACHUSETTS
MILTON GORDON, M.D.
HUNTINGTON, NEW YORK
DAVID W. VAN GELDER, M.D.
WILLIAM A. HOWARD, M.D.
888 TARA BOULEVARD
WASHINGTON, D.C.
BATON ROUGE, LOUISIANA 70806
PEDIATRIC
EDWIN L. KENDIG, JR., M.D.
EXECUTIVE DIRECTOR
RICHMOND, VIRGINIA
ROBERT G. FRAZIER, M.D.
BRUCE D. GRAHAM, M.D.
American Academy of Pediatrics
COLUMBUS, OHIO
ASSOCIATE DIRECTOR
RICHARD W. OLMSTED, M.D.
R. DON BLIM, M.D.
KANSAS CITY, MISSOURI
SECRETARY
GERALD E. HUGHES, M.D.
BLAIR E. BATSON, M.D.
JACKSON, MISSISSIPPI
TREASURER
P.O. BOX 1034
EVANSTON, ILLINOIS 60204
JAMES E. STRAIN, M.D.
GEORGE A. NAUMAN
EVANSTON (312) 869-4255 CHICAGO (312) 273-3646
DENVER, COLORADO
SAUL J. ROBINSON, M.D.
SAN FRANCISCO, CALIFORNIA
GUILLERMO GUILLEN-ALVAREZ, M.D.
SAN SALVADOR, EL SALVADOR
REPLY TO:
HELIO SEBASTIAO DE MARTINO, M.D.
R. Don Blim, M.D.
RIO DE JANEIRO, BRASIL
4320 Wornall Road
JOSE MARIA ALBORES: M.D.
BUENOS AIRES, ARGENTINA
Kansas City, Missouri 64111
22 March 1976
Willis F. Stanage, M.D.
Yankton Clinic
400 Park Avenue
Yankton, South Dakota 57078
Dear Bill:
Thank you for your letter of 5 March 1976, regarding the
Indian Health Bill. I was sorry that I didn't get a chance
to talk to you during our district meeting, but your message
arrived after the meeting and, when I called, I received a
recorded message from your clinic. I tried to get through
the answering service but your answering service is almost
as effective as is ours in avoiding such attempts. Never-
theless, I was unable to get through - thus missing your
message.
I am aware of the activities regarding the Indian Health Bill -
I am aware that it passed committee and is headed for the Ways
and Means Committee, subsequently the Rules Committee and ul-
timately to the House. It is my understanding that it will be
heard on the floor of the House sometime in April. To my know-
ledge there are 84 co-sponsors.
As you know, the AAP is becoming more involved in legislative
affairs, having formed the Legislative Issues Committee. This
committee was scheduled to meet in New Orleans a week or two
ago and, undoubtedly, this was one of the items on their agenda.
We are developing a mechansim whereby we can communicate with
key legislative leaders and indeed with all members of the legi-
slature when appropriate. The mechanisms are being sophisticated
by George Degnon and his office and will be coming increasingly
effective as demonstrated in the recent override of the Presidential
veto of 8063.
(Continued
22 March 1976
-2-
We 11 keep on top of it and do what we can to help the Indian
Health Committee.
Thanks very much for your continued interest. I am sorry you
won't be in Nebraska on the 27th, but hopefully will see you
in Philadelphia in April.
Sincerely,
Don
R. Don Blim, M.D., F.A.A.P.
Chairman, District VI
RDB/a
March 5, 1976
The Honorable Robert 11. Kastenmeier (D-Wisc)
House of Representatives
Washington, D.C. 20515
Dear Mr. Kastenmeier:
As a concerned private citizen and also as a member of the American
Academy of Pediatrics Committee on Indian Health, I am writing to
you concerning the Indian Health Improvement Bill. I would solicit
your support of this bill. As a personal observation, it would ap-
pear that the bill will alleviate problems that have developed over
the years. It is disappointing to see a measure so important in the
health and welfare of our Indian people becoming entangled in the web
of politics.
Sincerely yours,
W. F. Stanage, M.D.
WFS:fn
Same letter typed and mailed to the following:
Joe Skubitz, (R-Kan)
Keith G. Sebelium (R-Kan)
Virginia Smith, (R-Nebr)
March 5, 1976
R. Don Blim, M.D.
4320 Wornall Road
Kansas City, Missouri 64111
Dear Don:
I am writing to you concerning the Indian Health Bill that evidently is
now meeting some opposition in the House of Representatives. Evidently,
earlier, a noncontroversial bill, and has now become a controversial bill.
I did talk to you about this last October, at which time you had contact
with George Degnon, and he felt it was better to wait until the latter
part of the year to do anything about. it.
I called you last Friday, in Chicago, hoping that you could bring this to
the attention of all members of the district, but evidently my message did
not get through to you. I have written letters to Representatives Kasten-
meier, Skubitz, Sebelium, and Smith. I am sure if people from the states
where these representatives are from would write or contact them, this
would be more meaningful than anyone else.
I bring this to your attention at the request of Sid Kemberling, and trust
you will do what is necessary.
I see the Nebraska Pediatric Society is meeting on the 27th of March, and
you are going to be there. Unfortunately, I have a conflict at that time
so will not be able to attend.
Sincerely yours,
W. F. Stanage, M.D.
WFS:fn
November 7, 1975
Jean D. Lockhart, M.D.
Director
Department of Committees
The American Academy of Pediatrics
Executive Office
1801 Hinman Avenue
Evanston, Illinois 60204
Dear Jean:
Toby Zimmer called the other day and requested recommendations
from the Rapid City meeting. I have very little comment in
addition to what we discussed at our final meeting. It appears
that some of the major problems were not exactly health prob-
lems, except the general aspect they play in recruiting health
people. These problems were mainly related to housing and
schools. Certainly, these problems must be alleviated in order
to upgrade the health care. I think the Area should be com-
mended on using trained midwives and the pediatric nurse prac-
titioner. I would also recommend that the position that the
CHR plays in the health team should be evaluated. They should
have a more vital role than being used as chauffeurs. I think
Mr. Hank Bouker should be commended for presenting such a well
organized program. My only true disappointment was the pessi-
mism in the recruiting approach of the Public Health Nurse,
Mrs. McArdle.
Sincerely yours,
W. F. Stanage, M.D.
WFS:fn
LARRY PRESSLER
WASHINGTON OFFICE:
1ST DISTRICT. SOUTH DAKOTA
1238 LONGWORTH HOUSE OFFICE BUILDING
WASHINGTON, D.C. 20515
(202) 225-2801
RESIDENCE:
RURAL ROUTE No. 1
HUMBOLDT, SOUTH DAKOTA
Congress of the United States
DISTRICT OFFICES:
310 FEDERAL BUILDING
Douse of Representatives
ABEROEEN, SOUTH DAKOTA 57401
COMMITTEES:
(605) 225-0250 EXT. 471
EDUCATION AND LABOR
SCIENCE AND TECHNOLOGY
Washington, D.C. 20515
317 SOUTH PHILLIPS AVENUE
Sioux FALLS. SOUTH DAKOTA 57102
(605) 336-2980 EXT. 433
MOBILE VAN-ON THE ROAD
October 22, 1975
W. F. Stanage, M.D.
Yankton Clinic P.A.
400 Park Avenue
Yankton, South Dakota 57078
Dear Dr. Stanage:
Thank you for your letter expressing your support of H.R. 7852, the
Indian Health Improvement Act.
I share your views about the importance of improving health care to
Indians, and I was distressed at the statistics presented at the hearings
on this legislation showing the inadequacies of Indian health care services.
The per capita expenditures for Indian health care are 30 to 40 per cent
less than those in an average American community; more than half of the
Indian Health Service hospitals do not meet accreditation requirements.
These statistics are just some of the glaring examples supporting the
need for this legislation.
H.R. 7852 is presently pending before the Subcommittee on Indian Af-
airs of the House Interior Committee. Hearings were completed on this
bill September 26. It is expected that the Subcommittee will begin to
mark-up this legislation shortly.
I appreciate your taking the time from your busy day to let me hear
from you and I look forward to further correspondence on other issues of
mutual concern.
Sincerely,
Larry Lany Pressler
Member of Congress
LP:jr
11/12/75
INTERNAL MEDICINE
GENERAL SURGERY
T. H. SATTLER. M.D.
YANKTON CLINIC P.A.
C. B. MCVAY, M. D.
R. F. THOMPSON. M. D.
L. E. SAVAGE. M.D.
400 PARK AVENUE
R.I. PORTER, M. D.
K. HALVERSON. M.D.
W.W.QUICK,M.D.
YANKTON. SOUTH DAKOTA 57078
OBSTETRICS AND GYNECOLOGY
TELEPHONE 605/655-7822
ORTHOPEDIC SURGERY
BROOKS RANNEY. M. D.
J. K. JACKSON. M. D.
R. R. THORNTON. M D.
R. c. LESHER, M. D.
CLINIC MANAGER
D. R. HOLZWARTH. M.D.
S. A BRAASTAD
LABORATORY
J. G. HEEMSTRA. M. S.
PEDIATRICS
W. F. STANAGE. M.D.
C.ISBURG, M. D.
November 8, 1975
Sydney Kemberling, M.D.
1601 North Tucson Boulevard
Tucson, Arizona 85716
Dear Syd:
I am enclosing a copy of a letter that I received from
our Representative in Congress, Larry Pressler. I am
also enclosing a copy of a letter that I sent to Jean
Lockhart concerning recommendations at the Rapid City
meeting.
If there is anything that we can do out here to facili-
tate the work of Dr. Weil, in relating to any of the
reservations, I would be glad to help. I am sure this
also goes for Tom Aceto, who is Chairman of the Depart-
ment of Pediatrics at South Dakota.
Sill Sincerely yours,
W. F. Stanage, M.D.
WFS:fn
Enclosures
File c glass full
HENRY J. NOWAK
37TH DISTRICT, NEW YORK
ROOM 1223
LONGWORTH HOUSE OFFICE BUILDING
COMMITTEES:
TELEPHONE: (202) 225-3306
PUBLIC WORKS AND
TRANSPORTATION
Congress of the United States
HOME OFFICE:
U.S. COURTHOUSE
DISTRICT OF COLUMBIA
BUFFALO, N.Y. 14202
house of Representatives
TELEPHONE: (716) 853-4131
Washington, D.C. 20515
October 20, 1975
Dr. Henry P. Staub
Associate Professor of Pediatrics
SUNY at Buffalo
203 Woodbridge Avenue
Buffalo, New York 14214
Dear Dr. Staub:
Thank you for your letter calling my attention to H.R. 2525
and H. R. 7852.
As you may know, the House Subcommittee on Indian Affairs
has completed hearings on these and several other Indian health
bills, and markup is scheduled October 28 and 29. Although exact
predictions are chancey before a bill is reported out, my under-
standing is that the committee is leaning toward the language of
H. R. 7852. It is likely that a clean bill, with the broader
coverage of H. R. 7852 and some other refinements, will be intro-
duced when the legislation is reported to full committee.
I do appreciate hearing from you on this matter, and your
comments will be most helpful when it reaches the House floor
for consideration.
With best wishes and kindest regards,
Sincerely yours,
HENRY NOWAK
P.S. I have agreed to co-sponsor the clean bill when it is intro-
duced, and will send you a copy when it is printed.
H.J.N.
11/3/75
Edward J. Meyer Memorial Hospital
Owned and Operated by the County of Erie
462 GRIDER STREET
BUFFALO, NEW YORK 14215
AREA CODE 716 894-1212
ADVISORY BOARD
EDWARD V. REGAN
FREDERIC P. NORTON, Chairman
JEAN AUGUST MARTIN, Vice Chairman
ERIE COUNTY EXECUTIVE
MRS. RICHARD R. ROMANOWSKI, Secretary
GUY S. ALFANO, M.D.
EDWARD F. MARRA, M.D.
MARSHALL G. AUSE
BURNICE E. BALLARD
HOSPITAL DIRECTOR
MRS. FRANK A. SEDITA
Henry P. Staub, M.D., Director
Department of Pediatrics
October 28, 1975
Sidney Kemberling, M.D.
Committee on Indian Health
American Academy of Pediatrics
1601 N. Tucson Blvd. Suite 35
Tucson, Arizona 85716
Dear Sid:
Enclosed is a copy of the letter that I received from
Congressman Henry J. Nowak agreeing to sponsor the Indian Health
Care Improvement Act H.R. 2525 or H.R. 7852. I wrote to him
in response to your telephone call. I will check with Congressman
Nowak later regarding follow up.
Sincerely,
Henry
Henry P. Staub, M.D.
can
FORD
Enclosure
SEAL
3/5/2016
MANUEL LUJAN, JR.
DISTRICT OFFICES:
1ST DISTRICT, NEW MEXICO
3006 FEDERAL BUILDING AND POST OFFICE
SANTA FE, NEW MEXICO 87501
COMMITTEE:
AREA CODE 505: 988-6521
INTERIOR AND INSULAR AFFAIRS
Congress of the United States
10001 FEDERAL BUILDING
ALBUQUERQUE, NEW MEXICO 87103
JOINT COMMITTEE
ATOMIC ENERGY
house of Representatives
AREA CODE 503:766-2538
DOUGLAS AND GRAND AVE.
WASHINGTON OFFICE:
1323 LONGWORTH HOUSE OFFICE BUILDING
Washington, D.C. 20515
P.O. 1123
LAS VEGAS, NEW MEXICO 87701
AREA CODE 202:225-6316
AREA CODE 505: 425-7838
February 25, 1976
Alice H. Cushing, M.D.
Associate Professor
Department of Pediatrics
School of Medicine
The University of New Mexico
Albuquerque, New Mexico 87131
Dear Alice,
Thank you for your letter concerning the Indian Health
Improvement legislation.
I am not sure where you heard that the Interior Committee
is holding this up, but I am sure you will be happy to know
that this is not the case. As a matter of fact, it was the
subject of hearings yesterday and today by the full Committee,
and we will begin work on it again next Tuesday.
I appreciate your taking the time to write, and if I can
be of assistance in the future, don't hesitate to call on me.
Sincerely,
Mum
Manuel Lujan, Jr.
ML/pap
File
bree diass 3 Health AAP
DISTRICT CHAIRMEN
PRESIDENT
MERRITT B LOW. M.D.
86 HIGH STREET
THE AMERICAN
SPRAGUE W. HAZARD, M.D.
WALTHAM, MASSACHUSETTS
GREENFIELD. MASS. 01301
MILTON GORDON, M.D.
VICE-PRESIDENT
HUNTINGTON, NEW YORK
DAVID W. VAN GELDER. M.D.
WILLIAM A. HOWARD, M.D.
888 TARA BOULEVARD
WASHINGTON, DISTRICT OF COLUMBIA
BATON ROUGE, LOUISIANA 70806
OK
PEDIATRIC
EDWIN L. KENDIG, JR., M.D.
EXECUTIVE DIRECTOR
RICHMOND, VIRGINIA
ROBERT G. FRAZIER, M.D.
BRUCE D. GRAHAM, M.D.
ASSOCIATE DIRECTOR
American Academy of Pediatrics
COLUMBUS. OHIO
RICHARD W. OLMSTED. M.D.
R DON BLIM, MD
SECRE TARY
KANSAS CITY, MISSOURI
GERALD & HUGHES S. MD
BI AIR E. BATSON. M.D
JACKSON. MISSISSIPPI
THE ASURER
GEORGE A NAUMAN
DEPARTMENT OF GOVERNMENT LIAISON
JAMES E. STRAIN, M.D
DENVER, COLORADO
1800 N. KENT ST., SUITE 1102
SAUL J. ROBINSON, M.D.
ARLINGTON, VIRGINIA 22209
SAN FRANCISCO, CALIFORNIA
GUILLERMO GUILLEN-ALVAREZ M.D.
PHONE: 703-525-9560
SAN SALVADOR, EL SALVADOR
HELIO SEBASTIAO DE MARTINO, M D.
RIO DE JANEIRO, BRASIL
February 12, 1976
JOSE MARIA ALBORES, M.D.
BUENOS AIRES, ARGENTINA
Henry P. Staub, M. D.
Edward J. Meyer Memorial Hospital
462 Grider Street
Buffalo, NY 14215
Dear Dr. Staub:
To answer your letter of January 21, I wish I could send you a more
optimistic report than I can on the Indian Health Care Improvement Act.
The Subcommittee on Indian Affairs presented its report - a version
reportedly close to HR 7852 to the full Committee on Interior and
Insular Affairs on February 3. The next step is for the full Committee
to review it, make whatever changes, and to report to the House of
Representatives. Unfortunately, there will be a period of delay with
this step, apparently because the Administration has some problems with
the amounts of money and the time frame of the bill. The full Committee
may not consider the bill until Spring.
After the House of Representatives passes a bill, it still must go to
House-Senate Conference. Right now, the Indian Affairs staffers are
looking toward the summer for some resolution of this.
If I get other information to modify this lack-of-progress report, I
will certainly let you know.
Sincerely,
Rebecca Dinkel
Research Assistant
RD:cb
cc: Sidney R. Kemberling, M. D.
3/10/76
State of California
Department of Health
Memorandum
To
: Dr. Saul J. Robinson
Date : March 2, 1976
Dr. Melvin H. Schwartz
Dr. Milton L. Arnold
Subject: Information on the Indian
Dr. Alan E. Shumacher
Health Care Improvement Act
Dr. Carl A. Erickson
(HR, 2525).
Dr. S. Freudenberger
N
From : Theodore A. Montgomery, M.D.
Recently I received a telephone call from Dr. Sid Kemberling, Chairman of
the National Committee on Indian Health, AAP, regarding the Indian Health
Care Improvement Act (HR 2525).
Attached is some further detail about the bill that I just received from the
Academy's Washington office.
The bill is stuck in the Interior Committee and as much help as can be
mustered is needed to get it moving again.
There are 5 California congressmen on the committee. Would you write to your
representative if he is on the committee. If you know him personally, so
much the better.
A copy of Sid Kemberling's letter that he plans to send to several congressmen
is attached.
TAM:gc
Attachment
cc: Dr. Kemberling
Fill
3/20/76
ALAN STEELMAN
WASHINGTON OFFICE:
5TH DISTRICT, TEXAS
437 CANNON HOUSE OFFICE BUILDING
WASHINGTON, D.C. 20515
COMMITTEES:
(202) 225-2231
GOVERNMENT OPERATIONS
INTERIOR AND INSULAR AFFAIRS
Congress of the United States
DALLAS OFFICE:
1100 COMMERCE STREET. SUITE 9C60
house of Representatives
DALLAS, TEXAS 75202
(214) 749-7277
Washington, D.C. 20515
March 10, 1976
William B. Brendel, M.D., F.A.A.P.
906 Basse Road
San Antonio, Texas 78212
Dear Dr. Brendel:
Thank you for your letter regarding HR 2525, the Indian Health
Care Improvement Act.
You will be glad to know that, even though this bill was placed
on the "controversial" calendar, it was approved by the full
Interior Committee on March 6. Floor action has not yet been
scheduled.
I voted in favor of this bill, which passed virtually intact.
The committee adopted one of the amendments offered by Mr. Skubitz,
which would reduce Title II (health services) authorizations by
$5.1 million (to $390 million over 7 fiscal years). I supported
Mr. Skubitz' amendment to reduce the program from seven to three
years, because I felt that it would be helpful to review the program,
and possibly increase funding, sooner than the bill provides for.
However, this amendment was defeated.
The only other amendments to the legislation were either minor or
of a technical nature. You may be interested to know that the
committee approved the bill with a two to one majority of Republicans
present for the markup.
Your views and suggestions are always welcome. Please feel free to
let me know if I may be of assistance in the future.
Sincerely,
t five Bill
ALAN STEELMAN
Member of Congress
5th District, Texas
AS/kb
THIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS
ABRAHAM KAZEN, JR.
Fill
COMMITTEES:
230 DISTRICT, TEXAS
ARMED SERVICES
INTERIOR AND INSULAR AFFAIRS
1514 LONGWORTH HOUSE OFFICE BUILDING
Congress of the United States
house of Representatives
Washington, D.C. 20515
March 30, 1976'
Dr. William B. Brendel
906 Basse Road
San Antonio, Texas 78212
Dear Dr. Brendel:
Thank you for your letter expressing interest in
H.R. 2525 -- Indian Health Care Improvment Act. This bill has
been favorably reported out of the Committee on the Interior, on
which I serve. When this measure came before the full Committee, I
gave it my full support, and will urge my colleagues in the House
to do likewise when it is brought to the House floor.
With every good wish, I am
Sincerely yours,
j
ABRAHAM KAZEN, JR. ,M.
AK,Jr:pm
TED RISENHOOVER
COMMITTEE ON
20 DISTRICT, OKLAHOMA
EDUCATION AND LADOR
SUBCOMMITTEES:
JOE CARTER
LABOR STANDARDS
ADMINISTRATIVE ASSISTANT
WASHINGTON OFFICE:
Congress of the United States
COMPENSATION, MANPOWER, HEALTH
AND SAFETY
1407 LONGWORTH BUILDING
ELEMENTARY, SECONDARY AND
(202) 225-2701
VOCATIONAL EDUCATION
house of Representatives
BILL WILLIS
COMMITTEE ON
DISTRICT OFFICE DIRECTOR
ROOM 102, FEDERAL BUILDING
Washington, D.C. 20515
INTERIOR AND INSULAR AFFAIRS
MUSKOGEE, OKLAHOMA 74401
SUBCOMMITTEES:
(918) 687-7509
PUBLIC LANDS
INDIAN AFFAIRS
JOHN TENNISON
WATER AND POWER RESOURCES
LABOR LIAISON
TAHLEQUAH DISTRICT OFFICE:
109 EAST DELAWARE
SELECT COMMITTEE ON AGING
TAHLEQUAH, OKLAHOMA 74464
SUBCOMMITTEE:
(918) 456-0591
March 29, 1976
FEDERAL, STATE AND COMMUNITY
SERVICES
Dr. Harris D. Riley, Jr., M.D.
The University of Oklahoma Health
Sciences Center
Department of Pediatrics
P. 0. Box 26901
Oklahoma City, Oklahoma 73190
Dear Dr. Riley:
Thank you for your good letter of 3 March expressing your concern for.
H. R. 2525, the Indian Health Improvement Bill.
You may rest assured I share your concern in this important matter. As
you may know, there are several Indian Health Clinics within my own
District, and even more are projected for the future. Providing proper
health care to the Indian people of Oklahoma is a matter of great im-
portance to me.
I am taking the liberty of forwarding to you a copy of H. R. 2525, on
which I am proud to say my name appears as a co-sponsor. Please know I
will lend my full support to the passage of this all-important legislation.
If I may be of any further assistance to you in this or any other matter,
please do not hesitate to let me know. You have my kindest regards and
my warmest best wishes.
Sincerely,
Ted
Ted Risenhoover, M. C.
TR:Vm
Enclosure
The Speaker's Rooms
11. S. Bonse of Representatives
Washington, D.C. 20313
March 26, 1976
Harris D. Riley, Jr. M.D.
The University of Oklahoma Health Sciences Center
Post Office Box 26901
Oklahoma City, Oklahoma 73190
Dear Dr. Riley:
Thank you for your letter urging me to support
H. R. 2525, the Indian Health Care Improvement legis-
lation.
You will be pleased to learn- that the House
Interior and Insular Affairs Committee has reported
this bill, but the report has not been sent to the
printers as yet. Undoubtedly, the bill will be filed
in the near future, and there will be a vote in the House.
Let me say that I have always been interested in
the welfare of our Indians and have helped to advance
legislation in their behalf whenever I could. I appre-
ciate hearing from you on this important legislation
and hope you will continue to make your views known to
me.
With best wishes, I am
Sincerely,
Carl albert
The Speaker
CA/vh
4/16/76
The
University of Oklahoma
Health Sciences Center
Post Office Box 26901 Oklahoma City, Oklahoma 73190
Department of Pediatrics
Children's Memorial Hospital
April 8, 1976
Sidney R. Kemberling, M.D.
Chairman
Committee on Indian Health
1601 North Tucson Boulevard
Tucson, Arizona 85716
Dear Sid:
I am very sorry that last minute developments prevented me from
attending the committee meeting in Asheville. I trust that you got
my message at the hotel pointing out what had developed and why I
could not attend. I hope you had a good meeting.
Enclosed is a copy of the letters of March 26, 1976 and March 29,
1976 from Speaker Albert and Congressman Risenhoover, respectively,
in response to my letters. I had these in the file to give to you in
Asheville.
Best regards.
Sincerely,
Pets
Harris D. Riley, Jr., M.D.
HDR:lmc
Enclosures (2)
HENRY J. NOWAK
37TH DISTRICT, NEW YORK
ROOM 1223
LONGWORTH HOUSE OFFICE BUILDING
TELEPHONE: (202) 225-3306
, COMMITTEES:
PUBLIC WORKS AND
TRANSPORTATION
Congress of the United States
HOME OFFICE:
U.S. COURTHOUSE
DISTRICT OF COLUMBIA
BUFFALO, N.Y. 14202
house of Representatives
TELEPHONE: (716) 853-4131
Washington, D.C. 20515
October 20, 1975
Dr. Henry P. Staub
Associate Professor of Pediatrics
SUNY at Buffalo
203 Woodbridge Avenue
Buffalo, New York 14214
Dear Dr. Staub:
Thank you for your letter calling my attention to H.R. 2525
and H. R. 7852.
As you may know, the House Subcommittee on Indian Affairs
has completed hearings on these and several other Indian health
bills, and markup is scheduled October 28 and 29. Although exact
predictions are chancey before a bill is reported out, my under-
standing is that the committee is leaning toward the language of
H. R. 7852. It is likely that a clean bill, with the broader
coverage of H. R. 7852 and some other refinements, will be intro-
duced when the legislation is reported to full committee.
I do appreciate hearing from you on this matter, and your
comments will be most helpful when it reaches the House floor
for consideration.
With best wishes and kindest regards,
Sincerely yours,
HENRY NOWAK
P.S. I have agreed to co-sponsor the clean bill when it is intro-
duced, and will send you a copy when it is printed.
H.J.N.
3/22/76
BOB ECKHARDT
COMMITTEE ON
8TH DISTRICT, TEXAS
INTERIOR AND INSULAR AFFAIRS
COMMITTEE ON
SUBCOMMITTEES:
INTERSTATE AND FOREIGN
NATIONAL PARKS AND RECREATION
COMMERCE
ENERGY AND THE ENVIRONMENT
SUBCOMMITTEES:
UNITED
MINES AND MINING
CONSUMER PROTECTION AND FINANCE
ENERGY AND POWER
CONGRESS OF THE UNITED STATES
HOUSE OF REPRESENTATIVES
WASHINGTON, D.C. 20515
March 15, 1976
Dr. William B. Brendel
906 Basse Road
San Antonio, Texas 78212
Dear Dr. Brendel:
Thank you for your letter concerning H.R. 2525, the
Indian Health Care Improvement Act. This landmark
legislation was approved by the House Interior Com-
mittee on March 2, 1976.
Sincerely,
Bob Eckhardt
3/19/76
WASHINGTON OFFICE:
HAROLD RUNNELS
1535 LONGWCH
LDING
20 DISTRICT, NEW MEXICO
AREA CODE 20.
5-2365
COMMITTEE ON THE BUDGET
DISTRICT OFFICES:
COMMITTEE ON
INTERIOR AND INSULAR AFFAIRS
Congress of the United States
SUITE A, MCCRORY BUILDING
LOVINGTON, NEW MEXICO 88260
SUBCOMMITTER
PUBLIC LANDS
Douse of Representatives
AREA CODE 605: 396-2252
WATER AND POWER RESOURCES
FEDERAL BUILDING, ROOM B201
MINES AND MINING
Washington, D.C. 20515
LAB CRUCES, NEW MEXICO 88001
AREA CODE non. "11 0022
March 15, 1976
FEDERAL Budding, HooM 100
GALLUP, NEW MEXICO 87301
AREA CODE 505: 063-3400
David B. Post, M.D., F.A.A.P.
La Mesa Medical Center
7000 Cutler, N.E., Suite E-3
Fill
post
Albuquerque, New Mexico 87110
Dear Dr. Post:
&
Thank you for your letter expressing your views on the
Indian Health Care Improvement Act.
H. R. 2525 was ordered from the Interior and Insular
Affairs Committee on March 2. It is now pending consider-
ation on the floor of the House of Representatives.
The bill would authorize $1.19 billion over seven fiscal years
to bring Indian Health Service to parity with other health
services. Programs would include scholarships for health
careers, hiring of patient care personnel for IHS facilities,
modernization and construction of facilities and construction
of a school of medicine for the training of Indian doctors.
I have supported this legislation, participated in both field
hearings in New Mexico and formal hearings in Washington, and
certainly recognize the importance of this legislation to the
Indian community.
As you know, similar legislation has already passed the Senate.
and 1 am confident that the House of Representatives will pass
a strong bill.
I appreciate your taking the time to make me aware of your
thoughts on this legislation.
Sincerely,
Heard
FORD
HAROLD RUNNELS, M.C.
lma
DISTRICT OFFICES:
MANUEL LUJAN. JR.
3006 FEDERAL BUILDING AND POST OFFICE
1ST DISTRICT, NEW MEXICO
SANTA FE, NEW MEXICO 87501
AREA CODE 505: 988-6521
COMMITTEE
INTERIOR AND INSUI AR AFFAIRS
Congress of the United States
10001 FEDERAL BUILDING
ALBUQUERQUE. New MEXICO 87103
JOINT COMMITTEE
AREA CODE 505: 766-2538
ATOMIC ENERGY
Douse of Representatives
Dougl AS AND GRAND AVE.
WASHINGTON world #.
Washington, D.C. 20515
PO 11211
1323 LONGWOR HOUSE OFFICE BUILDING
LAS VEGAS, NEW MEXICO 07701
AREA Code 202: 225-6316
AREA CODE E05: 425-7838
March 8, 1976
David B. Post, M. D.
La Mesa Medical Center
7000 Cutler, NE, Suite E-3
Albuquerque, New Mexico 87110
Dear Doctor Post:
Thank you for your letter urging my support for
H.R. 7852, the Indian Health Care Improvement bill.
I am sure you will be happy to know that I have
co-sponsored this bill, and I hope it is enacted.
Thanks for taking the time to contact me, and if I
can be of assistance in the future, don't hesitate to call
on me.
Sincerely,
Manuel Lujan, Jr.
ML/pck
3/26/96
The
DEPARTMENT OF PEDIATRICS
Universityof Oklahoma Health Sciences Center
Children's Memorial Hospital
Post Office Box 26901 Oklahoma City, Oklahoma 73190
March 8, 1976
Sidney R. Kemberling, M.D.
Chairman, Committee on Indian Health
1601 N. Tucsin Blvd.
Tucson, Arizona
Dear Sid:
Just a note to tell you that I have send ent off a letter to the
congressman as well as a letter to Speaker Albert regarding the
Indian Health Care Improvement legislation. Best regards.
Sincerely,
Pete
Harris D. Riley, Jr., M.D.
HDR:s1c
Tale
DAVID B. POST, M. D.
LA MESA MEDICAL CENTER
7000 CUTLER, N. E., SUITE E.3
ALBUQUERQUE, NEW MEXICO 87110
TELEPHONE 505 208-1928
March 3, 1976
Fonorable Manuel I'. Lujan
1323 Loneworth Building
Washington, D.C. 20515
Dear Mr. Lujan,
T AM writing to you to urge your complete and immediate support of the
Indian Health inprovement MIL Recent information which T. have oh-
tained Indicates the this bill has been placed on the list of contro-
versial bills, and T am urging tha this bill be brought before the full
body of the Interior Committee of the House of Representatives, SO that
full consideration can be given to this important legislation as soon
as possible.
For the unst twelve years I have been A member of the American Academy
of Pediatrics Indian Health Committee, and during this time I have been
honored and priveleced to support many of the programs that improve the
health and welfare conditions of the American Indian and Alaskan Native.
Not only our committee, but many other national medical organizations
have been supporting and advocating Indian Health And Welfare programs
80 that the Indian citizen standard of living may be brought up to that
of our other Americans. Here in New Mexico I have been supporting
programs and legislations during this period 80 that our Indians in this
State can achieve a high standard of living and realize the complete
extstence of a full and productive life. The American Academy of
Padiatrics Committee has been priveleged to visit and meet with various
Indian Tenders on vartous reservations through out the country, and
during this time we have seen many of the grave and profound archlems
which affect the overall welfare of the Average Indian. The Indians
needs are extremely great, and now for this reason I urge you to support
10 the fullest the passage of this important measure. Our committee
is a nolitically bi-partisan group and us feel that support should
regin -martisan basis and therefore the bill should receive
proport of all members of Congress who are interested in the
volfare of Indian people.
The Indian Health Improvement bill implements the responsibility of the
federal government for the care and the education of the Indian neonle
he to improve the services and the facilities of the
Indl mchealth brograms and also encouraging the conticipation
of the Indians themselves in such programs an 14- ... T "In 0'11
eventually inditive complete control and responsit flit" for bis nun
health and velfare. The bill embodies basic considerations such as
training education. construction of health facilities, etc., and T am
DAVID B. POST, M.D., F.A.A.P.
LA MESA MEDICAL CENTER
7000 CUTLER, N. E. - SUITE E-3
ALBUQUERQUE, NEW MEXICO 87110
Telephone 298-1928
sure that you are completely familiar with this bill. SO that T will
not go into detail. The only reason for my reiterating these important
nyovisions is that T feel these measures are completely basic and
responsible things that should be provided to the Indian people. T
feel that you. as a representative of the people of the State of New
"exteo. should have as one of your foremost responsibilities the mandate
to support legislation for this very important seement of our people
not only here in New Mexico. but all over the country. The crisis in
Indian health care and facilities for this basic right 18 here and now.
and T feel that the Congress and the Administration cannot side step
this responsibility any longer.
May T count on your support for this very important measure. If
testimony in support of this legislation is necessar: we have members
of our committee who are villing to testify in this behalf as we have
in the past. T. would appreciate not only your support but a response
to this letter.
Until I have the privelege of secing you again,
My kindest personal regards,
David B. Post, M.D.
Member of the Indian Health Committee
American Academy of Pediatrics
DAVID B. POST, M.D., F.A.A.P.
LA MESA MEDICAL CENTER
3/5/76
7000 CUTLER, N. E. SUITE E-3
ALBUQUERQUE, NEW MEXICO 87110
Telephone 298-1928
Frent
March 3. 1976
Honorable Harold Bunnels
1535 Lonevorth Building
Washingtong. D.C. 20515
Dear Mr. Runnels.
T am writing to you to urge your complete and immediate support of the
Indian Health improvement bill. Recent information which I have ob-
tained indicates that this bill has been placed on the list of contro-
versial bills. and i am orgins that this bill be brought before the full
body of the Interior Committee of the House of Representatives, 80 that
full consideration can be given to this important lesislation as soon
as possible.
For the past twelve years I have been a member of the American Academy
of Pediatrics Indian Health Committee, and during this time I have been
honored and priveleged to support many of the programs that improve the
health and welfare conditions of the American Indian and Alaskan Native.
Not only our committee. but many other national medical organizations
have been supporting and advocating Indian Health and Welfare programs
so that the Indian citizen standard of living may be brought up to that
of our other Americans. Here in New Mexico T have been supporting
programs and legislations during this period so that our Indians
State can achieve a high standard of living and realize the complete.
existence of a full and productive life. The American Academy of
Pediatrics Committee has been priveleged to visit and meet with various
Indian leaders on various reservations through out the country, and
during this time we have seen many of the grave and profound problems
which affect the overall welfare of the average Indian. The Indians
needs are extremely great, and now for this reason I urge you to support
to the fullent the passage of this important measure. Our committee
18 a politically bi-nartisan group and we feel that support should
remain on a h1 partisan basis and therefore, the bill should receive
complete support of all members of Congress who are interested in the
welfare of Indian people.
The Indian Health Improvement bill implements the responsibility of the
federal covernment for the care and the education of the Indian people
by quaranteeing to improve the services and the facilities of the
Indian health programs and also encouraging the maximum participation
of the Indians themselves in such programs 80 that the Indian will
eventually achieve complete control and responsibility for his own
health and welfare. The bill embodies basic considerations such ns
training. education, construction of health facilities. etc,, and T am
FORD
DAVID B. POST, M.D., F.A.A.P.
LA MESA MEDICAL CENTER
7000 CUTLER, N.E. - SUITE E-3
ALBUQUERQUE, NEW MEXICO 87110
Telephone 298-1928
sure that you are completely familiar with this bill, 80 that T will
not go into detail. The only reason for my reiterating these important
provisions 1A that I feel these measures are completely basic and
responsible things that should be provided to the Indian people. I
feel that you. as a representative of the people of the State of New
Mexico. should have AR one of your foremost responsibilities the mandate
to support legislation for this very important segment of our people
not only here in New Mexico, but all over the country. The crisis in
Indian health care and facilities for this basic right is here and now.
and I feel that the Congress and the Administration cannot side sten
this responsibility any longer.
May T count on your support for this very important measure. If
testimony in support of this legislation is necessary we have members
of our committee who are villing to testify in this behalf as we have
in the nast. I would appreciate not only your support but a response
to this letter.
Until T have the privelege of seeing you again,
Mv kindest personal regards.
David B. Post. M.D.
Member of the Indian Health Committee
American Academy of Pediatrics
S.R. KEMBERLING, M.D.
1601 N. TUCSON BLVD., #35
P
GATE 10 0
TUCSON, AZ. 85716
111 90 :
401%
28
DR. THEODORE MARRS
WHITE HOUSE MAIL
SPECIAL ASSISTANT TO THE PRESIDENT
RECEPTION & SECURITY
THE WHITE HOUSE
MAY 14 1976
Processed by:
5
WASHINGTON, D.C.
STATE
OF
United States Department of the Interior
BUREAU OF INDIAN AFFAIRS
WASHINGTON, D. C. 20245
March
1849
IN REPLY REFER TO:
APR 21 1975
Dear Dr. Marrs:
This is in response to your request for the views of this Department
on S. 522, a bill "To implement the Federal responsibility for
the care and education of the Indian people by improving the services
and facilities of Federal Indian health programs and encouraging
maximum participation of Indians in such programs, and for other
purposes.
"
While the administration of the Indian health care program is not
under the jurisdiction of the Bureau of Indian Affairs, we recognize
the urgent need to upgrade the quantity and quality of health services
sufficiently to insure adequate health care for Indians and Alaska
Natives. While we would support enactment of S. 522, we realize
that the President's announced moratorium on new Federal spending
initiatives in non-energy areas must be taken into consideration
/
in the formulation of an Administration position.
The unmet health needs of the American Indian and Alaska Native
people are severe and their health status is far below that of the
general population of the United States. In many cases, the poor
health status of these people affects their ability to fully partici-
pate in and derive the benefits that accrue to them from programs
administered by the Federal Government. Because the low health
status of the American Indian and Alaska Native people is one of
the most critical problems they confront, efforts to ameliorate
this condition are vitally necessary.
It is our understanding that the purpose of S. 522 is to insure a
significant improvement in the health status of the American Indian
and Alaska Native people. The bill would provide the direction
and financial resources needed to overcome the inadequacies in the
existing Indian health care program. Further, S. 522 would invite
the greatest possible participation of Indians and Alaska Natives
in the direction and management of that program. In view of the
legislative authorities handed down by the 93rd Congress in the Act
of January 4, 1975 (P.L. 93-638; 88 Stat. 2203), the "Indian Self-
Determination and Education Assistance Act", programs and authorities
CONSERVE
AMERICA'S
FORD
ENERGY
&
Save Energy and You Serve America!
such as those contained in S. 522 could not be more timely. We see
potential in Titles II and III of the bill whereby some of the
health services and health facility improvements proposed might
be performed under grant or contract with tribal governments instead
of directly by the Indian Health Service.
With regard to the specific provisions of the bill, we defer to the
Indian Health Service for their recommendations. However, we note
that sections 201(c)(4)(c); 201(c)(6) and 301(a)(4) include provisions
that involve the Bureau of Indian Affairs. We do have comments
regarding these three sections.
Section 201(c)(4)(c) provides for model dormitory mental health
services and authorizes $625,000 and 50 positions for the IHS for
each of the next five fiscal years following enactment of the Act
for this activity.
Section 201 (c) (6) provides for IHS health care personnel in primary
and secondary Bureau of Indian Affairs schools, and authorizes funds
in the amount of $1,000,000 for the first fiscal year after enactment
of the Act, and $1,200,000 for each of the four succeeding fiscal
years thereafter.
Section 301 (a) (4) of Title III authorizes the expenditure by the IHS
of $1,500,000 for each of the five fiscal years after enactment of
the Act for the construction and renovation of health facilities
for primary and secondary Bureau of Indian Affairs schools.
The Department supports all of the above provisions and the activities
they would provide. We look forward to working with IHS personnel
and tribes in implementation of the legislation should it be
enacted.
In addition, section 302 (a) authorizes the Secretary of Health,
Education and Welfare to expend, within a five-fiscal year period
following enactment of the Act, $378,000,000 to supply unmet needs
for safe water and sanitary waste disposal facilities in existing
and new Indian homes and communities. Subsection (c) of that section
directs the Secretary of Health, Education and Welfare, in cooperation
with the Secretaries of the Interior and of Housing & Urban Development,
and after consultation with Indian tribes, to develop a plan to meet
the schedule provided for in the bill for the construction of safe
2
FORD & LIBRARY GERALD
water and sanitary waste disposal facilities. The coordination
described has been, and will continue to be, necessary for the develop-
ment of adequate health standards in Indian housing. We are ready to
cooperate in any way possible to assist in making quality health
care for Indian and Alaska Native people a reality.
It is our understanding that S. 522 has received the overwhelming
support of the Indian people for whose benefit it is intended.
Sincerely yours,
Morris Chompson
Commissioner of Indian Affairs
Dr. Theodore C. Marrs
Special Assistant to the President
The White House
Washington, D. C. 20500
THE INTERIOR THE
United States Department of the Interior
BUREAU OF INDIAN AFFAIRS
March
3,
1849
WASHINGTON, D.C. 20242
IN REPLY REFER TO:
APR 2 1 1975
Dear Dr. Marrs:
This is in response to your request for the views of this Department
on S. 522, a bill "To implement the Federal responsibility for
the care and education of the Indian people by improving the services
and facilities of Federal Indian health programs and encouraging
maximum participation of Indians in such programs, and for other
purposes."
While the administration of the Indian health care program is not
under the jurisdiction of the Bureau of Indian Affairs, we recognize
the urgent need to upgrade the quantity and quality of health services
sufficiently to insure adequate health care for Indians and Alaska
Natives. While we would support enactment of S. 522, we realize
that the President's announced moratorium on new Federal spending
initiatives in non-energy areas must be taken into consideration
in the formulation of an Administration position.
The unmet health needs of the American Indian and Alaska Native
people are severe and their health status is far below that of the
general population of the United States. In many cases, the poor
health status of these people affects their ability to fully partici-
pate in and derive the benefits that accrue to them from programs
administered by the Federal Government. Because the low health
status of the American Indian and Alaska Native people is one of
the most critical problems they confront, efforts to ameliorate
this condition are vitally necessary.
It is our understanding that the purpose of S. 522 is to insure a
significant improvement in the health status of the American Indian
and Alaska Native people. The bill would provide the direction
and financial resources needed to overcome the inadequacies in the
existing Indian health care program. Further, S. 522 would invite
the greatest possible participation of Indians and Alaska Natives
in the direction and management of that program. In view of the
legislative authorities handed down by the 93rd Congress in the Act
of January 4, 1975 (P.L. 93-638; 88 Stat. 2203), the "Indian Self-
Determination and Education Assistance Act", programs and authorities
such as those contained in S. 522 could not be more timely. We see
potential in Titles II and III of the bill whereby some of the
health services and health facility improvements proposed might
be performed under grant or contract with tribal governments instead
of directly by the Indian Health Service.
With regard to the specific provisions of the bill, we defer to the
Indian Health Service for their recommendations. However, we note
that sections 201(c)(4)(c); 201(c)(6) and 301(a)(4) include provisions
that involve the Bureau of Indian Affairs. We do have comments
regarding these three sections.
Section 201(e)(4)(c) provides for model dormitory mental health
services and authorizes $625,000 and 50 positions for the IHS for
each of the next five fiscal years following enactment of the Act
for this activity.
Section 201(c)(6) provides for IHS health care personnel in primary
and secondary Bureau of Indian Affairs schools, and authorizes funds
in the amount of $1,000,000 for the first fiscal year after enactment
of the Act, and $1,200,000 for each of the four succeeding fiscal
years thereafter.
Section 301(a)(4) of Title III authorizes the expenditure by the IHS
of $1,500,000 for each of the five fiscal years after enactment of
the Act for the construction and renovation of health facilities
for primary and secondary Bureau of Indian Affairs schools.
The Department supports all of the above provisions and the activities
they would provide. We look forward to working with IHS personnel
and tribes in implementation of the legislation should it be
enacted.
In addition, section 302(a) authorises the Secretary of Health,
Education and Welfare to expend, within a five-fiscal year period
following enactment of the Act, $378,000,000 to supply unmet needs
for safe water and sanitary waste disposal facilities in existing
and new Indian homes and communities. Subsection (c) of that section
directs the Secretary of Health, Education and Welfare, in cooperation
with the Secretaries of the Interior and of Housing & Urban Development,
and after consultation with Indian tribes, to develop a plan to meet
the schedule provided for in the bill for the construction of safe
2
water and sanitary waste disposal facilities. The coordination
described has been, and will continue to be, necessary for the develop-
ment of adequate health standards in Indian housing. We are ready to
cooperate in any way possible to assist in making quality health
care for Indian and Alaska Native people a reality.
It is our understanding that S. 522 has received the overwhelming
support of the Indian people for whose benefit it is intended.
Sincerely yours,
/s/ Morris Thompson
Commissioner of Indian Affairs
Dr. Theodore C. Marrs
Special Assistant to the President
The White House
Washington, D. C. 20500
$ 1.10 FORD
THE WHITE HOUSE
WASHINGTON
March 12, 1975
634
MEMORANDUM FOR
THE SECRETARY OF THE INTERIOR
I would appreciate the views of Interior in regard to S-522 - the
Indian Health Care Improvement Act. This is currently being reviewed
in OMB and other offices and is needed as soon as reasonably possible.
Thanks.
Jed Mann
Theodore C. Marrs
Special Assistant to the President
634
FORD MOTOR LIBRARY
INTERIOR DEPT.
MAR 1 3 1975,237
LEGISLATIVE COUNSEL
13701
SUBJECT:
INDIAN HEALTH LEGISLATION
As a precis, the following points need to be
considered:
o Life is one of the guarantees provided by
the Declaration of Independence which can,
in this instance, be measured.
0 In 1974 the average age at death of Indians
and Alaskan natives was 48.3.
For white US citizens the average age at
death was 72.3. For others, the average age
WES 62.7.
O In addition to the Declaration of Independence
the IS is committed by treaty, trust responsi-
bility, stated policy, custom and expectation
to provide adequacy and equity in health care
for the Indian people.
FORD
D The quality of care in Indian Health Service
hospitals will be reduced in 1977 by other
factors. Two recent failures by IHS Hospitals
to meet accreditation standards have reduced to
23 out of 51 the number of such hospitals ap-
proved by the Joint Commission on Accreditation
of Hospitals. To a physician this is shocking.
2
O Predicted IHS hospital admissions (by HEW
figures) will be increased by 1000 in 1977.
Based on austere standards (i.e. the structure
determined by appropriation levels) 8500
employee positions were funded for FY '76
in IHS. Recission is reducing this level by
639 and the resultant level of 7861 positions
will be further stretched to man three new
hospitals in FY '77.
D Meanwhile, for contract medical care, a 14%
increase was allowed for hospital cost versus
an actual 18.6% increase in those areas. For
physician fees, a 9% increase has been allowed
in the face of an actual 19% increase. The
preceeding three factors mean lowered workload
and increased backlog or increased workload with
decreased quality of Indian health service in
1977. In either case higher morbidity and
mortality rates will result.
0 Outpatient care limits imposed for FY '77 by
budget restriction is about 35,000 less visits
than the actual number in FY '75. (The National
3
Tribal Chairmen's Association and the National
Indian Health Board place such ambulatory case
as their top priority.) This too contributes
to increased morbidity and mortality rates.
D While there has been improvement in health
status of Indians during the past fifteen
years, a loss of momentum can further slow
the already sluggish rate of approach to parity.
Increased momentum in health delivery and sani-
tation as insured by this bill speed the rate
of closing the existing gap in age at death.
O Our stated policy allows budgeting for expan-
sion of existing humane programs. Further,
existing humane programs over a seven year
period will decrease outyear costs of continuing
payments for care of: Neglected tuberculosis
with catastrophic dependency; neglected
alcoholism with resultant accidents and chronic
illnesses; neglected ear infections with re-
sultant deafness, school failure and limited
economic attainment, etc. These savings factors
have been variously estimated by some analysts
and ignored by others.
4
0 The "bottom Line" is that there are unavoidable
aspects of equity and morality when there is
a more than twenty year differential in age
at death between Indians and non-Indians.
April 26, 1976
MEMORANDUM FOR:
JIM LYNN
FROM:
TED MARRS
SUBJECT:
MANAGEMENT - INDIAN AFFAIRS
Thank you for maintaining our shared interest in im-
proved management of Indian matters with Jim Mitchell.
He and I have discussed the uniqueness of the treaty
and trust responsibilities of the United States gov-
ernment for Indian matters. Related to this, we share
recognition of the need to have a better overview and
coordination of the widely dispersed Indian activities
of the federal government.
As a first step I will appreciate your giving as much
priority as possible to an option paper on in-nouse
aspects of management of Indian matters. The options
touched on in meeting with Jim were the following:
1. The Zarb proposal of a Domestic Council Cabinet
Committee.
2. Assigning a federal overview responsibility
to Interior.
3. The Senate Policy Review Committee approach
(a full time White House management operation
with about 40 people.)
4. A small (3 to 5 person) White House Office:
BIA and "Indian Desk" people as resource; the
tribal chairmen and Governors as tribal oriented
advisors; representatives of various Indian or-
ganizations as consultants where relevant (in-
cluding non-reservation matters as appropriate.)
- 2 -
It would be appreciated if you will ask your staff
to shake these down and come up with any other ap-
propriate alternatives in the form of a draft option
paper or a staff decision paper by the tenth of May.
Janet Brown, Bobbie Kilberg and Brad Patterson and I
shall be glad to be available for discussion and as-
sistance during development. Jack Marsh, Phil Buchen
and Public Liaison would like to coordinate on a final
draft.
CC: J. Marsh
J. Mitchell
J. Brown
B. Kilberg
B. Patterson
TCM:mcp
FORD is LIBRAR
April 26, 1976
MEMORANDUM FOR:
THE SECRETARY OF THE INTERIOR
FROM:
TED MARRS
SUBJECT:
TRIBAL JURISDICTION WITHIN
RESERVATION BOUNDARIES
I am aware that Indian Tribes across the nation are
increasingly asserting their tribal governmental au-
thority within their external reservation boundaries
to all persons regardless of their membership in the
tribe which asserts the authority. I am also aware
that such assertion of governmental authority has not
included the extension of political rights to resident
non-members who live within those external boundaries.
The result of such extensions of tribal authority with-
out concurrently extending political rights to resident
non-members appears to deny resident non-members of the
equal protections and due process rights of the United
States Constitution and the Indian Bill of Rights.
Can you tell me what consideration we are giving to as-
sure that all persona who reside within the external
confines of an Indian reservation are accorded the
political rights preserved to them by law?
In view of the frequency with which this has recently
been called to my attention, I would appreciate your
coordinating the relevant Departments and services in
an effort to resolve this dilemma at an early date. It
will be appropriate if a proposed Administration posi-
tion be formulated within six weeks if that is practicable.
CC: The Attorney General
BCC: J. Mitchell
B. Kilberg
B. Patterson
J. Brown
TCM:mcp
THE WHITE HOUSE
WASHINGTON
April 26, 1976
MEMORANDUM FOR:
PAUL O'NEILL
FROM:
TED MARRS
SUBJECT:
INDIAN HEALTH LEGISLATION
The attached summary warrants your attention before
Ted Cooper's testimony on Wednesday. Based on these
facts I have to strongly non-concur in the OMB posi-
tion which has been imposed on HEW. After discussion
with Marge Lynch and Ted Cooper, it is my impression
that they would also like to see this changed.
How to change it? Let Ted Cooper testify on Wednesday
at the close of his testimony that we are (or will)
consider adjusting our "adamant" position if there
are certain changes: the stretch to a seven year per-
iod; limitation of first year expenditures to 50.0M;
elimination of the Indian Medical School.
I am confident that the involved committees would ac-
cept these adjustments while the House looks at the
Bill and that the Senate would "reluctantly" agree.
FORD LIBRARY &
Pragmatically, there will be a veto override. Polit-
ically, we can be made to look bad by not applying
the President's humane option in expanding funding for
what is basically an "existing program" -- i.e. Indian
Health Service. Politically too, we should not cver-
look John Rhodes' support (Colleague letters, etc.)
and the efforts of Fannin and others.
- 2 -
Admittedly, I am biased as a physician in favor of
equity in length of life so you will have to excuse
my considering the humanitarian aspect along with the
budgetary, pragmatic and political. Failure to adjust
the present course is in my opinion a flagrant depriva-
tion of human rights in a measurable as well as dramat-
ic way.
Thanks for agreeing to take another look after our
talk on Friday.
Enclosure
CC: J. Marsh
B. Barrody
BCC: J. Brown
J. Mitchell
B. Kilberg
FORD LIBRAR &
SUBJECT:
INDIAN HEALTH LEGISLATION
As a precis, the following points need to be
considered:
O Life is one of the guarantees provided by
the Declaration of Independence which can,
in this instance, be measured.
O In 1974 the average age at death of Indians
and Alaskan natives was 48.3.
For white US citizens the average age at
death was 72.3. For others, the average age
was 62.7.
I- addition to the Declaration of Independence
the IS is committed by treaty, trust responsi-
bility, stated policy, custom and expectation
to provide adequacy and equity in health care
for the Indian people.
The quality of care in Indian Health Service
hospitals will be reduced in 1977 by other
factors. Two recent. failures by IHS Hospitals
to meet accreditation standards have reduced to
23 out of 51 the number of such hospitals ap-
proved by the Joint Commission on Accreditation
of Hospitals. To a physician this is shocking.
2
O Predicted IHS hospital admissions (by HEW
figures) will be increased by 1000 in 1977.
Based on austere standards (i.e. the structure
determined by appropriation levels) 8500
employee positions were funded for FY '76
in IHS. Recission is reducing this level by
639 and the resultant level of 7861 positions
will be further stretched to man three new
hospitals in FY '77.
O Meanwhile, for contract medical care, a 14%
increase was allowed for hospital cost versus
an actual 18.6% increase in those areas. For
physician fees, a 9% increase has been allowed
in the face of an actual 19% increase. The
preceeding three factors mean lowered workload
and increased backlog or increased workload with
decreased quality of Indian health service in
FORD
1977. In either case higher morbidity and
&
JULY
ALD
mortality rates will result.
O
Outpatient care limits imposed for FY '77 by
budget restriction is about 35,000 less visits
than the actual number in FY '75. (The National
3
Tribal Chairmen's Association and the National
Indian Health Board place such ambulatory case
as their top priority.) This too contributes
to increased morbidity and mortality rates.
O While there has been improvement in health
status of Indians during the past fifteen
years, a loss of momentum can further slow
the already sluggish rate of approach to parity.
Increased momentum in health delivery and sani-
tation as insured by this bill speed the rate
of closing the existing gap in age at death.
o Our stated policy allows budgeting for expan-
sion of existing humane programs. Further,
existing humane programs over a seven year
period will decrease outyear costs of continuing
payments for care of: Neglected tuberculosis
with catastrophic dependency; neglected
alcoholism with resultant accidents and chronic
illnesses; neglected ear infections with re-
sultant deafness, school failure and limited
economic attainment, etc. These savings factors
have been variously estimated by some analysts
and ignored by others.
4
O The "bottom Line" is that there are unavoidable
aspects of equity and morality when there is
a more than twenty year differential in age
at death between Indians and non-Indians.
FORD LIBRARY & 028470
4/27/76
H.R. 2525, the "Indian Health Care Improvement Act"
Even after limiting first year expenditures to $50 million
and eliminating the Indian Medical School, H.R. 2525 is
still objectionable because:
/
-- it is unnecessary. HEW already has the authority
to accomplish the objectives of this bill through
the "Snyder Act" and other authorities;
1
-- it would add over 20 narrow categorical programs
for one population group at a time when the Admin-
istration is attempting to consolidate health
services programs. These categories and the
assignment of Federal positions to certain
program areas is undesirably restrictive;
3
-- the manpower and scholarship programs in Title
I can be accomplished through existing Federal
programs, e.g., the National Health Service Corps
and BIA scholarship programs for which $35 million
and $26 million, respectively, has been requested
in 1977;
4
-- the mental health and alcoholism programs authorized
in Title II duplicate existing HEW authorities
which provide services to Indians and Alaska
Natives;
-- it would expand Federal programs for categorical
outreach and health services to urban Indians
who are already entitled to Medicaid and other
programs on the same basis as any other citizen;
6
-- it would require the submission of unnecessary
reports by the Secretary of HEW; and
7
--- the authorizations--over $1 billion in 7 years--
are excessive as add-ons to the budget request of
$355 million in 1977.
FORD :- LIBEAR
4/27/76
H.R. 2525, the "Indian Health Care Improvement Act"
1977
1978
1979
1980
1981
1982
1983
I. Health Manpower
8
10
12
15
22
26
32
II. Health Services
5
24
41
55
73
88
105
(515)
(593)
(560)
(560)
(535)
(615)
III. Health Facilities
175
113
63
110
78
38
43
IV. Access to Health Services
--
--
--
--
--
--
--
V. Urban Indians
5
10
15
--
--
--
--
VI. Indian School of Medicine
--
1
2
3
3
3
3
VII. Reports
--
--
--
--
--
--
--
Total
193
158
133
183
176
155
183
New Positions
(515) (593) (560) (560) (535) (615)
8436
CONGRESSIONAL RECORD-SENATE
May 16, 1975
NOMINATIONS PLACED ON THE
TITLE IV-ACCESS TO HEALTH
(4) related support factors. For example,
SECRETARY'S DESK-AIR FORCE,
SERVICES
over seven hundred housing units are needed
NAVY, AND MARINE CORPS
Sec. 401. Services provided to medicare
for staff at remote Service facilities;
eligible Indians.
(5) lack of access of Indians to health
The second assistant legislative clerk
Sec. 402. Services provided. to medicaid
services due to remote residences, undevel-
proceeded to read sundry nominations in
eligible Indians.
oped or underdeveloped communication and
the Air Force, Navy, and Marine Corps
Sec. 403. Report.
transportation systems, and difficult, some-
which had been placed on the Secretary's
TITLE V-HEALTH SERVICES FOR
times severe, climatic conditions; and
desk.
URBAN INDIANS
(6) lack of safe water and sanitary waste
The ACTING PRESIDENT pro tem-
Sec. 501. Purpose.
disposal services. For example, over thirty-
pore. Without objection, the nominations
Sec. 502. Contracts with urban Indian or-
seven thousand four hundred existing and
are considered and confirmed.
ganizations.
forty-eight thousand nine hundred and sixty
planned replacement and renovated Indian
Mr. MANSFIELD. Mr. President, I ask
Sec. 503. Contract eligibility.
unanimous consent that the President
Sec. 504. Other contract requirements.
housing units need new or upgraded water
and sanitation facilities.
be notified.
Sec. 505. Reports and records.
Sec. 506. Authorizations.
(g) The Indian people's growth of confi-
The ACTING PRESIDENT pro tem-
dence in Federal Indian health services is re-
Sec. 507. Review of program.
pore. Without objection, it is so ordered.
vealed by their increasingly heavy use of
TITLE VI-MISCELLANEOUS
such services. Progress toward the goal of
Sec. 601. Reports:
better Indian health is dependent on this
LEGISLATIVE SESSION
Sec. 602. Regulations.
continued growth of confidence. Both such
Sec. 603. Leases with Indian tribes.
progress and such confidence are dependent
Mr. MANSFIELD. Mr. President, I
Sec. 604. Availability of funds.
on improved Federal Indian health services.
move that the Senate resume the con-
FINDINGS
DECLARATION OF POLICY
sideration of legislative business.
SEC. 2. The Congress finds that-
SEC. 3. The Congress hereby declares that
The motion was agreed to, and the
(a) Federal health services to maintain
it is the policy of this Nation, in fulfillment
Senate resumed the consideration of leg-
and improve the health of the Indians are
of its special responsibilities and legal obli-
islative business.
consonant with and required by the Fed-
gation to the American Indian people, to
eral Government's historical and unique
meet the national goal of providing the high-
legal relationship with, and resulting re-
est possible health status to Indians and to
CONSIDERATION OF CERTAIN
sponsibility to, the American Indian people.
provide existing Indian health services with
MEASURES ON THE CALENDAR
(b) A major national goal of the United
all resources necessary to effect that policy.
States is to provide the quantity and qual-
DEFINITIONS
Mr. MANSFIELD. Mr. President, I ask
Ity of health services which will permit the
SEC. 4. For purposes of this Act-
unanimous consent that the Senate turn
health status of Indians to be raised to
(a) "Secretary", unless otherwise desig-
to the consideration of Calendar Nos.
the highest possible level and to encourage
128, 130, and 131.
the maximum participation of Indians in
nated. means the Secretary of Health, Edu-
cation, and Welfare.
the planning and management of those
The ACTING PRESIDENT pro tem-
services.
(b) "Service" means the Indian Health
Service.
pore. Without objection, it is so ordered.
(c) Federal health services to Indians
have resulted in a reduction in the prev-
(c) "Indians" or "Indian", unless other-
alence and incidence of preventable ill-
wise designated, means any person who is a
INDIAN HEALTH CARE IM-
nesses among, and unnecessary and prema-
member of an Indian tribe, as defined in
PROVEMENT ACT
ture deaths of, Indians.
subsection (d) hereof, except that, for the
(d) Despite such services, the unmet
purpose of sections 102, 103, 104(b) (1) (1),
The Senate proceeded to consider the
health needs of the American Indian peo-
and 201 (c) (5), such terms shall mean any
bill (S. 522) to implement the Federal
ple are severe and the health status of the
individual who (1), irrespecitve of wheher
responsibility for the care and educa-
Indians is far below that of the general
he or she lives on or near a reservation, is a
tion of the Indian people by improving
population of the United States. For ex-
member of a tribe, band, or other organized
ample, for Indians compared to all Ameri-
group of Indians, including those tribes,
the services and facilities of Federal In-
cans in 1971, the tuberculosis death rate
bands, or groups terminated since 1940 and
dian health programs and encouraging
was over four and one-half times greater,
those recognized now or in the future by the
maximum participation of Indians in
the influenza and pneumonia death rate
State in which they reside, or who is & de-
such programs, and for other purposes,
over one and one-half times greater, and
scendant, in the first or second degree, of
which had been reported from the Com-
the infant death rate approximately 20 per
any such member, or (2) is an Eskimo or
mittee on Interior and Insular Affairs
centum greater.
Aleut or other Alaska Native, or (3) is con-
(e) All other Federal services and pro-
sidered by the Secretary of the Interior to be
with an amendment to strike all after
grams in fulfillment of the Federal respon-
an Indian for any purpose, or (4) is deter-
the enacting clause and insert:
That this Act may be cited as the "Indian
sibility to Indians are jeopardized by the
mined to be an Indian under regulations
low health status of the American Indian
promulgated by the Secretary.
Health Care Improvement Act"
people.
(d) "Indian tribe" means any Indian tribe,
TABLE OF CONTENTS
(f) Further improvement in Indian health
band, nation, or other organized group or
Sec. 1. Short title.
is imperiled by-
community, including any Alaska Native
Sec. 2. Findings.
(1) inadequate, outdated, inefficient, and
village or group as defined in the Alaska
Sec. 3. Declaration of policy.
under-manned facilities. For example, only
Native Claims Settlement Act (85 Stat. 688),
Sec. 4. Definitions.
twenty-four of fifty-one Indian Health Serv-
which is recognized as eligible for the special
TITLE I-INDIAN HEALTH MANPOWER
ice hospitals are accredited by the Joint
programs and services provided by the
Commission on Accreditation of Hospitals:
United States to Indians because of their
Sec. 101. Purpose.
only thirty-one meet national fire and safety
status as Indians.
Sec. 102. Health professions recruitment
codes; and fifty-two locations with Indian
(e) "Tribal organization" means the
program for Indians.
populations have been identified as requiring
elected governing body of any Indian tribe
Sec. 103. Health professions preparatory
either new or replacement health centers
or any legally established organization of
scholarship program for Indians.
and stations, or clinics remodeled for im-
Indians which is controlled by one or more
Sec. 104. Health professions scholarship
proved or additional service;
such bodies or by a board of directors elected
program.
(2) shortage of personnel. For example,
or selected by one or more such bodies (or
Sec. 105. Indian Health Service extern pro-
about one-half of the Service hospitals, four-
elected by the Indian population to be served
grams.
fifths of the Service hospital outpatient
by such organization) and which includes
Sec. 106. Educational and training programs
clinics, and one-half of the Service health
the maximum participation of Indians in all
in environmental health, health
clinics meet only 80 per centum of staffing
phases of its activities.
education, and nutrition.
standards for their respective services;
(f) "Urban Indian" means any individual
Sec. 107. Continuing education allowances.
(3) insufficient services in such areas as
who resides in an urban center, as defined
TITLE II-HEALTH SERVICES
laboratory, hospital inpatient and outpa-
in subsection (g) hereof, and who meets one
Sec. 201. Health services.
tient, eye care and mental health services,
or more of the four criteria in subsection
and services available through contracts with
(c) (1) through (4) of this section.
TITLE III-HEALTH FACILITIES
private physicians, clinics, and agencies. For
(g) "Urban center" means any community
Sec. 301. Construction and renovation of
example, about 90 per centum of the surgical
which has a sufficient urban Indian popula-
Service facilities.
operations needed for otitis media have not
tion with unmet health needs to warrant
Sec. 302. Construction of safe water and
been performed, over 57 per centum of re-
assistance under title V, as determined by
sanitary waste disposal facilities.
quired dental services remain to be provided,
the Secretary.
Sec. 303. Preference to Indians and Indian
and about 98 per centum of hearing aid
(h) "Urban Indian organization" means a
firms.
requirements are unmet;
nonprofit corporate body situated in an
May 16, 1975
CONGRESSIONAL RECORD-SENATE
S 8437
urban center, composed of urban Indians,
transportation, board, and other necessary
1978, $9,000,000 for fiscal year 1979, $12,500,-
and providing for the maximum participa-
related expenses.
000 for fiscal year 1980, $19,000,000 for fiscal
tion of all interested Indian groups and
(d) There are authorized to be appro-
year 1981, $26,000,000 for fiscal year 1982,
individuals, which body is capable of legally
priated for the purpose of this section: $2,-
$30,000,000 for fiscal year 1983, and, for each
cooperating with other public and private
000,000 for fiscal year 1977, $2,500,000 for
succeeding fiscal year, such sums as may be
entities for the purpose of performing the
fiscal year 1978, $3,000,000 for fiscal year
necessary to continue to make scholarship
activities described in section 503 (a).
1979, $3,500,000 for fiscal year 1980, $4,000,000
grants under this section to individuals who
TITLE I-INDIAN HEALTH MANPOWER
for fiscal year 1981, $4,500,000 for fiscal year
have received such grants prior to the end
1982, and $4,500,000 for fiscal year 1983.
PURPOSE
of fiscal year 1983 and who are eligible for
HEALTH PROFESSIONS SCHOLARSHIP PROGRAM
such grants during each such succeeding
SEC. 101. The purpose of this title is to
fiscal year.
augment the inadequate number of health
SEC. 104. (a) The Secretary, acting through
professionals serving Indians and remove the
the Sedvice, shall make scholarship grants
INDIAN HEALTH SERVICE EXTERN PROGRAMS
multiple barriers to the entrance of health
to individuals (1) who are enrolled in schools
SEC. 195. (a) Any individual who receives
professionals into the Service and private
of medicine, osteopathy, dentistry, veterinary
a scholarship grant pursuant to section 104
practice among Indians.
medicine, optometry, podiatry, pharmacy,
shall be entitled to employment in the Serv-
public health, nursing, or allied health pro-
HEALTH PROFESSIONS RECRUITMENT PROGRAM
ice during any nonacademic period of the
fessions (including schools certified by the
FOR INDIANS
year. Periods of employment pursuant to
Secretary as capable of training individuals
this subsection shall not be counted in de-
SEC. 102. (a) The Secretary, acting through.
in Indian traditional medicine), and (ii)
termining the fulfillment of the service ob-
the Service, shall make grants to public or
who agree to provide their professional serv-
ligation incurred as-a condition of the schor-
nonprofit private health or educational en-
ices to Indians after the completion of their
tities or Indian tribes or tribal organizations
arship grant.
professional training.
to assist such entities in meeting the costs
(b) Any individual enrolled In a school of
(b) (1) The Secretary, acting through the
of-
medicine, osteopathy, dentistry, veterinary
Service, (1) shall accord priority for scholar-
(1) identifying Indians with a potential
medicine, optometry, podiatry, pharmacy,
ship grants under this section to applicants
for education or training in the health pro-
public health, nursing, or allied health pro-
who are Indians, and (ii) may determine dis-
fessions and encouraging and assisting them
fessions (including schools certified by the
tribution of scholarship grants on the basis
(A) to enroll in schools of medicine, osteop-
Secretary as capable of training individuals
of the relative needs of Indians for additional
athy, dentistry, veterinary medicine, optom-
in Indian traditional medicine) may be em-
service in specifice health profesions.
etry, podiatry, pharmacy, public health,
ployed by the Service during any nonaca-
(2) Each scholarship grant under this
nursing, or allied health professions; or (B),
demic period of the year. Any such employ-
section shall (i) fully cover the costs of tui-
if they are not qualified to enroll in any such
ment shall not exceed one hundred and
tion, and (ii), when taken together with the
school, to undertake such postsecondary
twenty days during any calendar year.
financial resources of the grantee, fully cover
education or training as may be required to
(c) Any employment pursuant to this
the costs of books, transportation, board, and
qualify them for enrollment;
section shall be made without regard to any
other necessary related expenses:- Provided,
(2) publicizing existing sources of finan-
competitive personnel system or agency per-
That the amount of grant funds available
cial aid available to Indians enrolled in any
sonnel limitation and to a position which
annually to each grantee under clause (II)
school referred to in clause (1) (A) of this
will enable the individual so employed to
shall not exceed $8,000, except where the
subsection or who are undertaking training
receive practical experience in the health
necessary to qualify them to enroll in any
scholarship grant is extended to cover the
profession in which he or she is engaged in
such school; or
period between academic years pursuant to
study. Any individual so employed shall re-
(3) establishing other programs which the
paragraph (3) of this subsection.
ceive payment for his or her services com-
Secretary determines will enhance and fa-
(3) Scholarship grants under this section
parable to the salary he or she would receive
cilitate the enrollment of Indians, and the
shall be made with respect to academic years,
if he or she were employed in the competi-
subsequent pursuit and completion by them
except that any such grant may be extended
tive system. Any individual so employed shall
of courses of study, in any school referred
and increased for the period. between aca-
demic years if the grantee is engaged in
not be counted against any employment
to in clause (1) (A) of this subsection.
clinical or other practical experience related
celling affecting the Service or the Depart-
(b) (1) No grant may be made under this
ment of Health, Education, and Welfare.
section unless an application therefor has
to his or her course of study and if further
grant assistance during such period is re-
(d) There are authorized to be appropri-
been submitted to, and approved by, the
ated for the purpose of this section: $800,000
Secretary. Such application shall be in such
quired by the grantee because of his or her
form, submitted in such manner, and con-
financial need.
for fiscal year 1977, $1,200,000 for fiscal year
1978, $1,600,000 for fiscal year 1979, $2,200,000
tain such information, as the Secretary shall
(c) (1) As a condition for any scholarship
for fiscal year 1980, $2,800,000 for fiscal year
by regulation prescribe.
grants under this section, each grantee shall
1981, $3,200,000 for fiscal year 1982, and
(2) The amount of any grant under this
be obligated to provide professional service
$3,550,000 for fiscal year 1983.
section shall be determined by the Secre-
to Indians for a period of years equal to the
tary. Payments pursuant to grants under
number of years during which he or she re-
EDUCATIONAL AND TRAINING PROGRAMS IN EN-
this section may be made in advance or by
celves such grants.
VIRONMENTAL HEALTH, HEALTH EDUCATION,
(2) For the purpose of clause (1) of this
AND NUTRITION
way of reimbursement, and at such inter-
vals and on such conditions, as the Secretary
subsection, "professional service to Indians"
SEC. 106. (a) The Secretary, acting through
finds necessary.
shall mean employment in the Service or in
the Service, shall make grants to individuals,
(c) For the purpose of making payments
private practice where, in the judgment of
nonprofit entitles, appropriate public or pri-
pursuant to grants under this section, there
the Secretary in accordance with guidelines
vate agencies, educational institutions, or In-
are authorized to be appropriated $1,500,000
promulgated by him, such practice is situated
dian tribes and tribal organizations to en-
for fiscal year 1977, $2,500,000 for fiscal year
in B physician or other health professional
able the recipients of such grants to estab-
1978, $3,000,000 for fiscal year 1979, $4,000,000
shortage area and addresses the health care
lish and carry out programs to train individ-
for fiscal year 1980, $4,500,000 for fiscal year
needs of a substantial number of Indians. Pe-
uals so as to enable them to provide their
1981, $5,000,000 for fiscal year 1982, and
riods of internship or residency, except resi-
services to Indians in the following areas:
$4,500,000 for fiscal year 1983.
dency served in a facility of the Service, shall
(1) environmental health, including proper
HEALTH PROFESSIONS PREPARATORY SCHOLAR-
not constitute fulfillment of this service
waste disposal, reduced pesticide inhalation,
SHIP PROGRAM FOR INDIANS
obligation.
proper sanitation, and vector control;
SEC. 103. (a) The Secretary, acting through
(3) (A) A service obligation of any indi-
(2) health education, including advising
the Service, shall make scholarship grants to
vidual pursuant to this section shall be
and training Indians with respect to personal
Indians who-
canceled upon the death of such individual.
hygiene, the essentials of first aid, the care
(1) have successfully completed their
(B) The Secretary shall by regulation pro-
of critically ill in the home and entitlements
high school education or high school equiv-
vide for the waiver or suspension of a service
of Indians to, and the availability of, health
alency; and
obligation of any individual whenever com-
care services and assistance; providing ade-
(2) have demonstrated the capability to
pliance by such individual is impossible or
quate health information to schools; and es-
successfully complete courses of study in
would involve extreme hardship to such in-
tablishing health courses in secondary
schools of medicine, osteopathy, dentistry,
dividual and if enforcement of such obliga--
schools encouraging entry by Indians into
veterinary medicine, optometry, podiatry,
tion with respect to any individual would
health-related professions; and
pharmacy, public health, nursing, or allied
be against equity and good conscience.
(3) nutrition, including advising and train-
health professions.
ing Indians with respect to child nutrition,
(d) Individuals receiving scholarship
(b) Each scholarship grant, made under
availability of nutrition programs (such as
grants under this section shall not be
this section shall be for a period not to ex-
hot school lunch programs), nutrition in
counted against any employment ceiling af-
ceed two academic years, which years shall
prenatal care, and nutrition education for the
fecting the Service or the Department of
be the final two years of the preprofessional
total population, particularly for those found
Health, Education, and Welfare.
education of any grantee.
to have or to be susceptible to, diabetes, hy-
(e) There are authorized to be appropriated
(c) Scholarship grants made under this
pertension, and heart disease.
for the purpose of this section: $6,000,000
section may cover costs of tuition, books,
(b) Grants pursuant to this section shall
for fiscal year 1977, $7,500,000 for fiscal year
be made in such manner and in such amounts
8438
CONGRESSIONAL RECORD-SENATE
May 16, 1975
and subject to such conditions as the Secre-
year 1981, $23,000,000 and one hnudred and
each of the clauses (1) through (5) of sub-
tary shall by regulation prescribe.
fifty positions for fiscal year 1982, and
section (c) for research in each of the areas
(c) There are authorized to be appropri-
$28,500,000 and one hundred and sixty-five
of Indian health care for which such funds
ated to carry out the provisions of this sec-
positions for fiscal year 1983.
are authorized to be appropriated.
tion: $500,000 for fiscal year 1977, $600,000
(3) Dental care (direct and indirect)
TITLE II-HEALTH FACILITIES
for fiscal year 1978, $700,000 for fiscal year
$800,000 and eighty positions for fiscal year
1979, $800,000 for fiscal year 1980, $900,000 for
1977, $1,500,000 and seventy positions for
CONSTRUCTION AND RENOVATION OF SERVICE
fiscal year 1978, $2,000,000 and fifty positions
FACILITIES
fiscal year 1981, $900,000 for fiscal year 1982,
and $600,000 for fiscal year 1983.
for fiscal year 1979, $2,500,000 and fifty posi-
SEC. 301. (a) For the purpose of eliminat-
CONTINUING EDUCATION ALLOWANCES
tions for fiscal year 1980, $2,900,000 and forty
ing inadequate, outdated, and otherwise un-
positions for fiscal year 1981, $3,200,000 and
satisfactory Service hospitals, health cen-
SEC. 107. (a) In order to encourage physl-
thirty positions for fiscal year 1982, and
ters, health stations, and other Service fa-
cians and other health professionals. to join
$3,500,000 and twenty-five positions for fiscal
cilities, the Secretary, acting through the
the Service and to provide their services in
year 1983.
Service, is authorized to expend $528,637,000
the rural and remote areas where a signif-
(4) Mental health: (A) Community men-
over a seven-fiscal-year period in accord-
icant portion of the Indian people resides,
tal health services: $900,000 and forty posi-
ance with the following schedule:
the Secretary, acting through the Service,
tions for fiscal year 1977, $1,700,000 and
(1) Hospitals: $123,880,000 for fiscal year
may provide allowances to health profes-
thirty positions for fiscal year 1978, $2,400,000
1977, $55,171,000 for fiscal year 1978, $24,703,-
sionals employed in the Service to enable
and thirty positions for fiscal year 1979,
000 for fiscal year 1979, $70,810,000 for fiscal
them for a period of time each year pre-
$3,000,000 and twenty-five positions for fiscal
year 1980, $45,652,000 for fiscal year 1981,
scribed by regulation of the Secretary to
year 1980, $3,500,000 and twenty positions
$29,675,000 for fiscal year 1982, and $33,779,-
take leave of their duty stations for profes-
for fiscal year 1981, $3,800,000 and ten posi-
000 for fiscal year 1983.
sional consultation and refresher training
tions for fiscal year 1982, and $4,100,000 and
(2) Health centers and health stations:
courses.
fifteen positions for fiscal year 1983.
$6,960,000 for fiscal year 1977, $6,226,000 for
(b) There are authorized to be appro-
(B) Inpatient mental health services:
fiscal year 1978, $3,720,000 for fiscal year
priated for the purpose of this section:
$200,000 and fifteen positions for fiscal year
1979, $4,440,000 for fiscal year 1980, $2,335,000
$100,000 for fiscal year 1977, $200,000 for
1977, $400,000 and fifteen positions for fiscal
for fiscal year 1981, $1,760,000 for fiscal year
fiscal year 1978, $250,000 for fiscal year 1979,
year 1978, $600,000 and fifteen positions for
1982 and $2,360,000 for fiscal year 1983.
$300,000 for fiscal year 1980, $350,000 for
fiscal year 1979, $800,000 and fifteen posi-
(3) Staff housing: $2, 484,000 for fiscal year
fiscal year 1981, $350,000 for fiscal year 1982,
tions for fiscal year 1980, $1,000,000 and fif-
1977, $43,450,000 for fiscal year 1978, $8,231,-
and $325,000 for fiscal year 1983.
teen positions for fiscal year 1981, $1,300,000
000 for fiscal year 1979, $9,390,000 for fiscal
TITLE II-HEALTH SERVICES
and twenty positions for fiscal year 1982,
year 1980, $20,140,000 for fiscal year 1981,
SEC. 201. (a) For the purpose of eliminat-
and $1,600,000 and twenty-five positions for
$12,267,000 for fiscal year 1982, and $13,704,-
ing backlogs in Indian health care services
fiscal year 1983.
000 for fiscal year 1983.
and to supply known, unmet medical, surgi-
(C) Model dormitory mental health serv-
(4) Health facilities for primary and sec-
cal, dental. and other Indian health needs,
ices: $625,000 and fifty positions for fiscal
ondary Bureau of Indian Affairs schools:
the Secretary is authorized to expend $491,-
year 1977, $1,250,000 and fifty positions for
$1,500,000 for fiscal year 1977, $1,000,000 for
975,000 through the Service, over a seven-
fiscal year 1978, $1,875,000 and fifty positions
fiscal year 1978, $1,000,000 for fiscal year 1979,
fiscal-year period in accordance with the
for fiscal year 1979, and $2,500,000 and fifty
$1,000,000 for fiscal year 1980, $1,000,000 for
schedule provided in subsection (c). Funds
positions for fiscal year 1980.
fiscal year 1981, $1,000,000 for fiscal year 1982,
appropriated pursuant to-this section each
(D) Therapeutic and residential treat-
and $1,000,000 for fiscal year 1983.
fiscal year shall not be used to offset or limit
ment centers: $150,000 and ten positions for
(b) The Secretary acting through the Serv-
the appropriations required by the Service
fiscal year 1977, $300,000 and ten positions
ice, is authorized to equip and staff such
to continue to serve the health needs of
for fiscal year 1978, $400,000 and five posi-
Service facilities at levels commensurate with
Indians during and subsequent to such
tions for fiscal year 1979, $500,000 and five
their operation at optimum levels of effec-
seven-fiscal-year period, but shall be in ad-
positions for fiscal year 1980, $600,000 and
tiveness.
dition to the level of appropriations pro-
ten positions for fiscal year 1981, $700,000
(c) Prior to the expenditure of, or the
vided to the Service in fiscal year 1976 re-
and five positions for fiscal year 1982, and
making of any firm commitment to expend,
quired to continue the programs of the Serv-
$800,000 and five positions for fiscal year
any funds authorized in subsection (a), the
ice thereafter.
1983.
Secretary. acting through the Service, shall-
(b) The Secretary, acting through the
(E) Training of traditional Indian prac-
(1) consult with any Indian tribe to be
Service, is authorized to employ persons to
titioners in mental health: $75,000 for fis-
significantly affected by any such expendi-
implement the provisions of this section dur-
cal year 1977, $150,000 for fiscal year 1978,
ture for the purpose of determining and,
ing the seven-fiscal-year period in accord-
$200,000 for fiscal year 1979, $250,000 for fis-
wherever practicable, honoring tribal prefer-
ance with the schedule provided in subsec-
cal year 1980, $300,000 for fiscal year 1981,
ences concerning the size, location, type, and
tion (c). Such positions authorized each
$300,000 for fiscal year 1982, and $300,000 for
other characteristics of any facility on which
fiscal year pursuant to this section shall not
fiscal year 1983.
such expenditure is to be made; and
be considered as offsetting or limiting the
(5) Treatment and control of alcoholism
(2) be assured that, wherever practicable,
personnel required by the Service to serve
among Indians: $8,000,000 for fiscal year 1977,
the health needs of Indians during and sub-
such facility, not later than five years after
$10,500,000 for fiscal year 1978, $13,000,000
sequent to such seven-fiscal-year period but
its construction or renovation, shall meet the
for fiscal year 1979, $15,000,000 for fiscal year
standards of the Joint Commission on Ac-
shall be in addition to the positions au-
1980, $17,000,000 for fiscal year 1981, $18,-
creditation of Hospitals:
thorized in the previous fiscal year and to
500,000 for fiscal year 1982, and $20,000,000
the annual personnel levels required to con-
for fiscal year 1983.
CONSTRUCTION OF SAFE WATER AND SANITARY
tinue the programs of the Service.
(6) Provision of health care personnel in
WASTE DISPOSAL FACILITIES
(c) The following amounts and positions
primary-and secondary Bureau of Indian Af-
SEC. 302. (a) The Secretary is authorized
are authorized, in accordance with the pro-
fairs schools: $600,000 and thirty-three posi-
to expend, pursuant to the Act of July 31,
visions of subsections (a) and (b), for the
tions for fiscal year 1977, $1,000,000 and twen-
1959 (73 Stat. 267); $378,000,000 within a
specific purposes noted:
ty-two-positions for fiscal year 1978, $1,300,-
seven-fiscal-year petriod following the enact-
(1) Patient care (direct and indirect)
000 and sixteen positions for fiscal year 1979,
ment of this Act, in accordance with the
$4,000,000 and one hundred and fifty posi-
$1,700,000 and twenty-two positions for fis-
schedule provided in subsection (b), to sup-
tions for fiscal year 1977, $10,000,000 and two
cal year 1980, $2,500,000 and forty-four posi-
ply unmet needs for safe water and sanitary
hundred and twenty-five positions for fiscal
tions for fiscal year 1981, $3,900,000 and
waste disposal facilities in existing and new
year 1978, $18,000,000 and three hundred
seventy-six positions for fiscal year 1982, and
Indian homes and communities.
positions for fiscal year 1979, $26,500,000 and
$6,000,000 and one hundred and fifteen po-
(b) To effect the purpose of subsection (a),
three hundred and twenty positions for fiscal
sitions for fiscal year 1983.
there are authorized to be appropriated:
year 1980, $36,000,000 and three hundred and
(7) Maintenance and repair (direct and
$60,000,000 for fiscal year 1977, $60,000,000
sixty positions for fiscal year 1981, $46,000.-
indirect) $3,000,000 and twenty positions for
for fiscal year 1978, $60,000,000 for fiscal year
000, and three hundred and seventy-five po-
fiscal year 1977, $3,000,000 and twenty posi-
1979, $60,000,000 for fiscal year 1980, $60,000-
sitions for fiscal year 1982, and $58,000,000
tions for fiscal year 1978, $4,000,000 and thirty
000 for fiscal year 1981, $52,000,000 for fiscal
and four hundred and fifty positions for
positions for fiscal year 1979, $4,000,000 and
year 1982, and $26,000,000 for fiscal year 1983.
fiscal year 1983.
thirty positions for fiscal year 1980, $4,000,-
(c) The Secretary is authorized and dl-
(2) Field health, excluding dental care
000 and thirty positions for fiscal year 1981,
rected to develop a plan, together with the
(direct and indirect) $3,000,000 and ninety
$2,000,000 and fifteen positions for fiscal
Secretaries of the Interior and of Housing
positions for fiscal year 1977, $6,000,000 and
year 1982, and $1,000,000 and five positions
and Urban Development and upon consulta-
ninety positions for fiscal year 1978, $9,000,-
for fiscal year 1983.
tion with Indian tribes, to assure that the
000 and ninety positions for fiscal year 1979,
(d) The Secretary, acting through the
schedule provided for in subsection (b) will
$13,000,000 and one hundred and twenty
Service, shall expend directly or by contract
be met. Such plan shall be submitted to the
positions for fiscal year 1980, $18,000,000 and
not less than 1 per centum of the funds
Congress no later than ninety days from the
one hundred and fifty positions for fiscal
appropriated under the authorizations in
date of enactment of this Act.
May 16, 1975
CONGRESSIONAL RECORD-SENATE
8439
PREFERENCE TO INDIANS AND INDIAN FIRMS
skilled nursing facility, or intermediate care
this title in any contract which he makes
SEC. 303. (a) The Secretary, acting through
facility). whether operated by the Service
with any urban Indian organization pursuant
the Service, may utilize the negotiating au-
or by an Indian tribe or tribal organization,
to this title. Such conditions shall include,
thority of the Act of June 25, 1910 (36 Stat.
shall hereby be deemed to be a facility eli-
but are not limited to, requirements that the
861), to give preference to any Indian or any
gible for reimbursement under said title
organization successfully undertake the fol-
enterprise, partnership, corporation, or other
XIX: Provided, That the requirements of
lowing activities:
type of business organization owned and
subsection (c) are met.
(1) determine the population of urban In-
controlled by an Indian or Indians (herein-
(b) The Secretary is authorized to enter
dians which are or could be recipients of
after referred to as an "Indian firm") in
into agreements with the appropriate State
health referral or care services;
the construction and renovation of Service
agency for the purpose of reimbursing such
(2) identify all public and private health
facilities pursuant to section 301 and in
agency for health care and services pro-
service resources within the urban center in
the construction of safe water and sanitary
vided in Service facilities to Indians who
which the organization is situated which are
waste disposal facilities pursuant to section
are beneficiaries under title XIX of the So-
or may be available to urban Indians;
302. Such preference may be accorded by
cial Security Act, as amended.
(3) assist such resources in providing serv-
the Secretary unless he finds, pursuant to
(c) Prior to the provision of any care or
ice to such urban Indians:
rules and regulations promulgated by him,
service for which reimbursement may be
(4) assist such urban Indians in becoming
that the project or function to be contracted
made, the Secretary shall certify that the
familiar with and utilizing such resources;
for will not be satisfactory or such project
facility meets the standards applicable to
(5) provide basic health education to such
or function cannot be properly completed
other hospitals eligible for reimbursement
urban Indians;
or maintained under the proposed contract.
under title XIX of the Social Security Act,
(6) establish and implement manpower
The Secretary, in arriving at his finding,
as amended, or, in the case of any facility
training programs to accomplish the referral
shall consider whether the Indian or Indian
existing at the time of enactment of this
and education tasks set forth in-clauses (3)
firm will be deficient with respect to (1)
Act, that the Service has provided an ac-
through (5) of this subsection;
ownership and control by Indians, (2) equip-
ceptable written plan for bringing the fa-
(7). identify gaps between unmet health
ment. (3) bookkeeping and accounting pro-
cility into full compliance with such stand-
needs of urban Indians and the resources
cedures, (4) substantive knowledge of the
ards within two years from the date of ac-
available to meet such needs;
project or function to be contracted for, (5)
ceptance of the plan by the Secretary. The
(8) make recommendations to the Sec-
adequately trained personnel, or (8) other
Service facilities shall not be required to
retary and Federal, State, local, and other
necessary components of contract perform-
be licensed by any State or locality in which
resource agencies on methods of improving
ance.
they are located: Provided, however, That
health service programs to meet the needs
(b) For the purpose of implementing the
the Secretary shall include in his certifica-
of urban Indians; and
provisions of this title, the Secretary shall
tions appropriate assurances that such facil-
(9) where necessary, provide or contract
assure that the rates of pay for personnel
ities will meet standards equivalent to licen-
for health care services to urban Indians.
engaged in the construction or renovation
sure requireemnts.
(b) The Secretary, acting through the
of facilities constructed or renovated in
(d) Any payments received for services
Service, shall by regulation prescribe the cri-
whole or in part by funds made available
provided recipients hereunder shall not be
teria for selecting urban Indian organiza-
pursuant to this title are not less than the
considered in determining appropriations
tions with which to contract pursuant to
prevailing local wage rates for similar work
for the provision of health care and serv-
this title. Such criteria shall; among other
as determined in accordance with the Act
ices to Indians.
factors, take into consideration:
of March 3, 1921 (46 Stat. 1491), as amended.
(1) the extent of the unmet health care
(e) Notwithstanding any other provision of
TITLE IV-ACCESS TO HEALTH SERVICES
law, with respect to amounts expended dur-
needs of urban Indians in the urban center
involved;
SERVICES PROVIDED TO MEDICARE ELIGIBLE
ing any quarter as medical assistance under
INDIANS
title XIX of the Social Security Act, as
(2) the size of the urban Indian popula-
amended, for services which are included in
tion which is to receive assistance;
SEC. 401. (a) Notwithstanding any other
(3) the relative accessibility which such
provision of law, for purpose of title XVIII
the State plan and are received through a
of the Social Security Act, as amended, 8
Service facility, whether operated by the
population has to health care services in
such urban center;
Service facility (including a hospital or
Service or by an Indian tribe or tribal orga-
skilled nursing facility), whether operated
nization, to individuals who are (1) eligible
(4) the extent, if any, to which the project
by the Service or by any Indian tribe or
under the plan of the State under said title
would duplicate any previous or current pub-
XIX and (ii) eligible for comprehensive
lic or private health services project funded
tribal organization, shall hereby be deemed
health services under the Service program,
by another source in such urban center;
to be a facility eligible for reimbursement
under said title XVIII: Provided, That the
the Federal medical assistance percentage
(5) the appropriateness and likely effec--
requirements of subsection (b) are met.
under said title XIX shall be increased to 100
tiveness of a project assisted pursuant to this
title in such urban center;
(b) Prior to the provision of any care or
per centum.
(6) the existence of an urban Indian or-
service for which reimbursement may be
(f) Nothing in this section shall authorize
ganization capable of performing the activi-
made, the Secretary shall certify that the
the Secretary to provide services to an Indian
ties set forth in subsection (a) and of enter-
facility meets the standards applicable to
beneficiary with coverage under title XIX of
ing into a contract with the Secretary pur-
other hospitals and skilled nursing facilities
the Social Security Act, as amended, in
suant to this title; and
eligible for reimbursement under title XVIII
preference to an Indian beneficiary without
such coverage.
(7) the extent of existing or likely future
of the Social Security Act, as amended, or, in
the case of any facility existing at the time
REPORT
participation in such activities by appro-
priate health and health-related Federal,
of enactment of this Act, that the Service
SEC. 403. The Secretary shall include in his
State, local, and other resource agencies.
has provided an acceptable written plan for
annual report required by subsection (a) of
bringing the facility into full compliance
section 601 an accounting on the amount
OTHER CONTRACT REQUIREMENTS
with such standards within two years from
and use. of funds made available to the
SEC. 504. (a) Contracts with urban Indian
the date of acceptance of the plan by the
Service pursuant to this title as a result of
organizations pursuant to this title shall be
Secretary. The Service facilities shall not be
reimbursements through titles XVIII and
in accordance with all Federal contracting
required to be licensed by any State or lo-
XIX of the Social Security Act, as amended.
laws and regulations except that, in the dis-
cality in which they are located: Provided,
TITLE V-HEALTH SERVICES FOR URBAN
cretion of the Secretary, such contracts may
however, That the Secretary shall include
be negotiated without advertising and need
INDIANS
in his certifications appropriate assurances
not conform to the provisions of the Act of
that such facilities will meet standards
PURPOSE
August 24, 1935 (48 Stat. 793), as amended.
equivalent to licensure requirements.
SEC. 501. The purpose of this title is to
(b) Payments under any contracts pursu-
(c) Any payments received for services
encourage establishment of programs in
ant to this title may be made in advance or
provided to beneficiaries hereunder shall not
urban Indian areas to make health services
by way of reimbursement and in such install-
be considered in determining appropriations
more accessible to the urban Indian popula-
ments and on such conditions as the Secre-
for health care and services to Indians.
tion.
tary deems necessary to carry out the pur-
(d) Nothing herein authorizes the Secre-
CONTRACTS WITH URBAN INDIAN ORGANIZATIONS
poses of this title.
tary to provide services to an Indian bene-
SEC. 502. The Secretary, acting through the
(c) Notwithstanding any provision of law
ficiary with coverage under title XVIII of
Service, shall enter into contraets with urban
to the contrary, the Secretary may, at the re-
the Social Security Act, as amended, in pref-
Indian organizations to assist such organiza-
quest or consent of an urban Indian orga-
erence to an Indian beneficiary without such
tions to establish and administer, in the ur-
nization, revise or amend any contract
coverage.
ban centers in which such organizations are
made by him with such organization pursu-
SERVICES PROVIDED TO MEDICAID ELIGIBLE
situated, programs which meet the require-
ant to this title as necessary to carry out the
INDIANS
ments set forth in sections 503 and 504.
purposes of this title: Provided, however,
SEC. 402. (a) Notwithstanding any other
That, whenever an urban Indian organiza-
CONTRACT ELIGIBILITY
provision of law, for the purpose of title
tion requests retrocession of the Secretary
SEC. 503. (a) The Secretary, acting through
XIX of the Social Security Act, as amended,
for any contract entered into pursuant to
the Service, shall place such conditions as
a Service facility (including a hospital,
this title, such retrocession shall become ef-
he deems necessary to effect the purpose of
fective upon a date specified by the Secretary
S 8440
CONGRESSIONAL RECORD-SENATE
May 16, 1975
not more than one hundred and twenty
rules and regulations to implement the pro-
farmers across the country responded
days from the date of the request by the
visions of this Act.
to the heavy demand and high prices of
organization or at such later date as may be
(2) Within four months from the date of
enactment of this Act, the Secretary shall
recent times by producing a harvest:
mutually agreed to by the Secretary and
the organization.
publish proposed rules and regulations in the
large enough to bring consumer prices
(d) Contracts with urban Indian orga-
Federal Register for the purpose of receiving
down to levels not seen since the 1930's.
nizations and regulations adopted pursuant
comments from interested parties.
Thus, many growers now find them-
to this title shall include provisions to as-
(3) Within six months from the date of
selves with potatoes which can be sold
sure the fair and uniform provisions to urban
enactment of this Act, the Secretary shall
only at a loss. The consumer's benefit
Indians of services and assistance under such
promulgate rules and regulations to imple-
from this situation will be short-lived
contracts by such organizations.
ment the provisions of this Act.
unless potato prices rise, as the farmer,
(b) The Secretary is authorized to revise
REPORTS AND RECORDS
and amend any rules or regulations promul-
like any businessman, cannot for long
SEC. 505. For each fiscal year during which
gated pursuant to this Act: Provided, That,
afford to do business at a loss.
an urban Indian organization receives or ex-
prior to any revision of or amendment to such
Accordingly, this resolution, directed
pends funds pursuant to a contract under
rules or regulations, the Secretary shall, to
to the Secretary of Agriculture, seeks to
this title, such organization shall submit to
the extent practicable, consult with appro-
underscore the Senate's concern over the
the Secretary a report including informa-
priate national or regional Indian organiza-
situation I have just described, and it
tion gathered pursuant to section 503(a)
tions and shall publish any proposed revision
urges the Secretary of Agriculture to
(7) and (8), information on activities con-
or amendment in the Federal Register not
ducted by the organization pursuant to the
take immediate action to distribute po-
less than sixty days prior to the effective date
contract, an accounting of the amounts and
of such revision or amendment in order to
tato stocks pursuant to existing laws.
purposes for which Federal funds were ex-
provide adequate notice to, and receive com-
Specifically, the Secretary has long been
pended, and such other information as the
ments from, other interested. parties.
authorized to purchase agricultural
Secretary may request. The reports and rec-
LEASES WITH INDIAN TRIBES
commodities for domestic consumption,
ords of the urban Indian organization with
SEC. 603. Notwithstanding any other provi-
under section 32 of the act of August 24,
respect to such contract shall be subject to
audit by the Secretary and the Comptroller
sion of law, the Secretary is authorized, in
1935 and section 416 of the Agricultural
General of the United States.
carrying out the purposes of this Act, to enter
Act of 1949; and for foreign distribu-
into leases with Indian tribes for periods not
tion under Public Law 480-the food-for-12
AUTHORIZATIONS
in excess of twenty years.
peace program.
SEC. 506. There are authorized to be appro-
AVAILABILITY OF FUNDS
I believe that the present supply of
priated for the purpose of this title: $5,000,-
000 for fiscal year 1977, $10,000,000 for fiscal
SEC. 604. The funds appropriated pursuant
potatoes is primarily & useful blessing
year 1978, and $15,000,000 for fiscal year
to this Act shall remain available until
For there are hungry people, at home
1979.
expanded.
and abroad, who would gratefully. par-n
REVIEW OF PROGRAM
The ACTING PRESIDENT pro tem-
take of some of these agricultural riches.
SEC. 507. Within six months after the end
pore. The question is on agreeing to the
And it is clear that these potatoes will
of fiscal year 1978, the Secretary, acting
committee amendment in the nature of
do no one any good if allowed to remain
through the Service and with the assistance
a substitute.
in potato house bins across the country.
of the urban Indian organizations which
The committee amendment in the na-
As the committee has so accurately
have entered into contracts pursuant to this
ture of a substitute was agreed to.
noted in its report, potatoes are an im-
title, shall review the program established
The ACTING PRESIDENT pro tem-
portant source of protein, calcium, phos-
under this title and submit to the Congress
pore. The question is on the engrossment
phorus and vitamin C, among other min-
his or her assessment thereof and recom-
erals and vitamins.
mendations for any further legislative ef-
and third reading of the bill.
forts he or she deems necessary to meet the
The bill (S. 522) was ordered to be en-
Mr. President, what we have is a sup-
purpose of this title.
grossed for a third reading was read the
ply of potatoes which may be purchased
TITLE VI--MISCELLANEOUS
at favorable prices to benefit both the
third time, and passed.
people who will consume them and the
REPORTS
farmers who grow them. It does not re-
SEC. 601. (a) The Secretary shall report an-
nually to the President and the Congress on
THE PLIGHT OF POTATO GROWERS
quire high intelligence, nor a profound
progress made in effecting the purposes of
analysis of this situation, to conclude
The Senate proceeded to consider the
this Act. Within three months after the end
that the Secretary of Agriculture, under
of fiscal year 1979, the Secretary shall review
resolution (S. Res. 122) expressing to the
authority of long-standing statutes and
expenditures and levels of authorizations un-
Secretary of Agriculture the sense of con-
without adverse effect upon the con-
der this Act and make recommendations to"
cern felt by the Senate for the present
sumer, can in large measure remedy this
Congress concerning any increases or de-
plight of potato growers across the
temporary but troublesome situation
creases in the authorizations for fiscal years
country, which had been reported from
I am confident that appropriate
1981 through 1983 under this Act which he
the Committee on Agriculture and For-
deems appropriate. Within three months af---
tion by the Secretary of Agriculture
estry, with the preamble amended as
ter the end of fiscal year 1982, the Secretary
indeed, I applaud his recent but prom
follows:
shall review the programs established or as-
ising efforts in the use of potato granules
sisted pursuant to this Act and shall submit
On page 1, in the second "Whereas"
in the food for peace program will
to the Congress his assessment thereof and
clause, strike out "high quality protein"
favorably alter the present situation and
recommendations of additional programs or
and insert "nutritious food"
encourage the resumption of normal
additional assistance necessary to, at a min-
In the fourth "Whereas" clause, after
market forces which generally prove
imum, provide health services to Indians, and
the word "Ls" insert "the imbalance of in-
satisfactory to grower and consumer
insure a health status for Indians, which are
adequacy of vitamins, minerals, and";
alike.
at a parity with the health services available
and after the word "protein" strike out
to, and the health status of, the general
Mr. President, I urge swift passage of
the word "deficiency".
population.
this resolution.
On page 2, in the third "Whereas"
(b) There is hereby authorized to be ap-
Mr. President, I ask unanimous con-
clause, strike out high quality" and in-
propriated to the Secretary $150,000 to sup-
sent to have printed in the RECORD a
port a one-year study by the National Indian
sert vitamins, minerals, and plant".
statement by the senior Senator from
Health Board of mental health problems, in-
In the fifth "Whereas". clause, strike
Maine (Mr. MUSKIE)
cluding alcoholism and related problems,
out the word "protein" and insert the
The PRESIDING OFFICER. Without
among Indians. The study, together with any
word "food.".
objection, it is SQ ordered.
recommendations the Board may have for
The PRESIDING OFFICER. Theques-
STATEMENT BY SENATOR MUSKIE
legislative or administrative actions to rem-
tion is on agreeing to the resolution.
edy such problems, shall be submitted to
I join my colleague Senator Hathaway in
the Congress by the Secretary no later than
Mr. HATHAWAY. Mr. President, Drise
urging Senate approval for S. Res. 122. which
thirty days after the study's completion.
in support of Senate Resolution 122 and
is designed to encourage use of potato stocks
I would like briefly to recount the prob-
in our domestic and foreign food distribu-
REGULATIONS
lem which it addresses, and the reason-
tion programs. This resolution calls on the
SEC. 602. (a) (1) Within three months from
the date of enactment of this Act, the Sec-
able solution to which I believe it pro-
Secretary of Agriculture to take advantage
of the existing abundance of potatoes by
retary shall, to the extent practicable, consult
poses.
purchasing and distributing them at very
with national and regional Indian organiza-
The problem, Mr. President, is simply
favorable terms, in order to feed the needy
tions to consider and formulate appropriate
an abundance of potatoes. Potato
at home and hungry people around the world
94TH CONGRESS
1st SESSION
S. 522
IN THE HOUSE OF REPRESENTATIVES
MAY 22, 1975
Referred to the Committee on Interior and Insular Affairs
AN ACT
To implement the Federal responsibility for the care and edu-
cation of the Indian people by improving the services and
facilities of Federal Indian health programs and encouraging
maximum participation of Indians in such programs, and
for other purposes.
1
Be it enacted by the Senate and House of Representa-
2 tives of the United States of America in Congress assembled,
3 That this Act may be cited as the "Indian Health Care
4 Improvement Act".
TABLE OF CONTENTS
Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Declaration of policy.
Sec. 4. Definitions.
I
2
3
TABLE OF CONTENTS-Continued
1 relationship with, and resulting responsibility to, the Ameri-
TITLE I-INDIAN HEALTH MANPOWER
2 can Indian people.
Sec. 101. Purpose.
Sec. 102. Health professions recruitment program for Indians.
3
(b) A major national goal of the United States is to
Sec. 103. Health professions preparatory scholarship program for In-
dians.
Sec. 104. Health professions scholarship program.
4 provide the quantity and quality of health services which
Sec. 105. Indian Health Service extern programs.
Sec. 106. Educational and training programs in environmental health,
5 will permit the health status of Indians to be raised to the
health education, and nutrition.
Sec. 107. Continuing education allowances.
6 highest possible level and to encourage the maximum par-
TITLE II-HEALTH SERVICES
7 ticipation of Indians in the planning and management of
Sec. 201. Health services.
8 those services.
TITLE III-HEALTH FACILITIES
Sec. 301. Construction and renovation of Service facilities.
9
(c) Federal health services to Indians have resulted in
Sec. 302. Construction of safe water and sanitary waste disposal facilities.
Sec. 303. Preference to Indians and Indian firms.
10 a reduction in the prevalence and incidence of preventable
TITLE IV-ACCESS TO HEALTH SERVICES
11 illnesses among, and unnecessary and premature deaths of,
Sec. 401. Services provided to medicare eligible Indians.
Sec. 402. Services provided to medicaid eligible Indians.
12 Indians.
Sec. 403. Report.
TITLE V-HEALTH SERVICES FOR URBAN INDIANS
13
(d) Despite such services, the unmet health needs of
Sec. 501. Purpose.
14 the American Indian people are severe and the health status
Sec. 502. Contracts with urban Indian organizations.
Sec. 503. Contract eligibility.
Sec. 504. Other contract requirements.
15 of the Indians is far below that of the general population of
Sec. 505. Reports and records.
Sec. 506. Authorizations.
16 the United States. For example, for Indians compared to
Sec. 507. Review of program.
17 all Americans in 1971, the tuberculosis death rate was over
TITLE VI-MISCELLANEOUS
Sec. 601. Reports.
18 four and one-half times greater, the influenza and pneumonia
Sec. 602. Regulations.
Sec. 603. Leases with Indian tribes.
19 death rate over one and one-half times greater, and the
Sec. 604. Availability of funds.
20 infant death rate approximately 20 per centum greater.
1
FINDINGS
21
(e) All other Federal services and programs in fulfill-
2
SEC. 2. The Congress finds that-
22 ment of the Federal responsibility to Indians are jeopardized
3
(a) Federal health services to maintain and improve
23 by the low health status of the American Indian people.
4 the health of the Indians are consonant with and required
24
(f) Further improvement in Indian health is imperiled
5 by the Federal Government's historical and unique legal
25 by-
4
5
1
(1) inadequate, outdated, inefficient, and under-
1
seven hundred housing units are needed for staff at re-
2
manned facilities. For example, only twenty-four of fifty-
2
mote Service facilities;
3
one Indian Health Service hospitals are accredited by
3
(5) lack of access of Indians to health services due
4
the Joint Commission on Accreditation of Hospitals;
4
to remote residences, undeveloped or underdeveloped
5
only thirty-one meet national fire and safety codes;
5
communication and transportation systems, and difficult,
6
and fifty-two locations with Indian populations have
6
sometimes severe, climatic conditions; and
7
been identified as requiring either new or replacement
7
(6) lack of safe water and sanitary waste disposal
8
health centers and stations, or clinics remodeled for im-
8
services. For example, over thirty-seven thousand four
9
proved or additional service;
9
hundred existing and forty-eight thousand nine hun-
10
(2) shortage of personnel. For example, about one-
10
dred and sixty planned replacement and renovated In-
11
half of the Service hospitals, four-fifths of the Service
11
dian housing units need new or upgraded water and
12
hospital outpatient clinics, and one-half of the Service
12
sanitation facilities.
13
health clinics meet only 80 per centum of staffing stand-
13
(g) The Indian people's growth of confidence in Federal
14
ards for their respective services;
14 Indian health services is revealed by their increasingly heavy
15
(3) insufficient services in such areas as laboratory,
15
use of such services. Progress toward the goal of better
16
hospital inpatient and outpatient, eye care and mental
16 Indian health is dependent on this continued growth of con-
17
health services, and services available through contracts
17 fidence. Both such progress and such confidence are depend-
18
with private physicians, clinics, and agencies. For ex-
18 ent on improved Federal Indian health services.
19
ample, about 90 per centum of the surgical operations
19
DECLARATION OF POLICY
20
needed for otitis media have not been performed, over 57
20
SEC. 3. The Congress hereby declares that it is the
21
per centum of required dental services remain to be pro-
21 policy of this Nation, in fulfillment of its special responsi-
22
vided, and about 98 per centum of hearing aid require-
22 bilities and legal obligation to the American Indian people,
23
ments are unmet;
23 to meet the national goal of providing the highest possible
24
(4) related support factors. For example, over
24 health status to Indians and to provide existing Indian
6
7
1 health services with all resources necessary to effect that
1 Alaska Native village or group as defined in the Alaska Na-
2 policy.
2 tive Claims Settlement Act (85 Stat. 688), which is recog-
3
DEFINITIONS
3 nized as eligible for the special programs and services pro-
4
SEC. 4. For purposes of this Act-
4 vided by the United States to Indians because of their status
5
(a) "Secretary", unless otherwise designated, means
5 as Indians.
6 the Secretary of Health, Education, and Welfare.
6
(e) "Tribal organization" means the elected governing
7
(b) "Service" means the Indian Health Service.
7 body of any Indian tribe or any legally established organiza-
8
(c) "Indians" or "Indian", unless otherwise designated,
8 tion of Indians which is controlled by one or more such
9 means any person who is a member of an Indian tribe, as
9 bodies or by a board of directors elected or selected by one
10 defined in subsection (d) hereof, except that, for the purpose
10 or more such bodies (or elected by the Indian population to
11 of sections 102, 103, 104 (b) (1) (i), and 201 (c) (5), such
11 be served by such organization) and which includes the max-
12 terms shall mean any individual who (1), irrespective of
12 imum participation of Indians in all phases of its activities.
13 whether he or she lives on or near a reservation, is a mem-
13
(f) "Urban Indian" means any individual who resides
14 ber of a tribe, band, or other organized group of Indians,
14 in an urban center, as defined in subsection (g) hereof, and
15 including those tribes, bands, or groups terminated since
15 who meets one or more of the four critèria in subsection (c)
16 1940 and those recognized now or in the future by the State
16 (1) through (4) of this section.
17 in which they reside, or who is a descendant, in the first or
17
(g) "Urban center" means any community which has
18 second degree, of any such member, or (2) is an Eskimo or
18 a sufficient urban Indian population with unmet health needs
19 Aleut or other Alaska Native, or (3) is considered by the
19 to warrant assistance under title V, as determined by the
20 Secretary of the Interior to be an Indian for any purpose,
20
Secretary.
21 or (4) is determined to be an Indian under regulations
21
(h) "Urban Indian organization" means a nonprofit
22 promulgated by the Secretary.
22 corporate body situated in an urban center, composed of
23
(d) "Indian tribe" means any Indian tribe, band, na-
23 urban Indians, and providing for the maximum participation
24 tion, or other organized group or community, including any
24 of all interested Indian groups and individuals, which body is
8
9
1 capable of legally cooperating with other public and private
1
(2) publicizing existing sources of financial aid
2 entities for the purpose of performing the activities described
2
available to Indians enrolled in any school referred to
3 in section 503 (a)
3
in clause (1) (A) of this subsection or who are under-
4
TITLE I-INDIAN HEALTH MANPOWER
4
taking training necessary to qualify them to enroll in
5
PURPOSE
5
any such school; or
6
SEC. 101. The purpose of this title is to augment the
6
(3) establishing other programs which the Secre-
7 inadequate number of health professionals serving Indians
7
tary determines will enhance and facilitate the enroll-
8 and remove the multiple barriers to the entrance of health
8
ment of Indians, and the subsequent pursuit and comple-
9 professionals into the Service and private practice among
9
tion by them of courses of study, in any school referred
10 Indians.
10
to in clause (1) (A) of this subsection.
11
HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR
11
(b) (1) No grant may be made under this section unless
12
INDIANS
12 an application therefor has been submitted to, and approved
13
SEC. 102. (a) The Secretary, acting through the Serv-
13 by, the Secretary. Such application shall be in such form,
14 ice, shall make grants to public or nonprofit private health or
14 submitted in such manner, and contain such information, as
15 educational entities or Indian tribes or tribal organizations
15 the Secretary shall by regulation prescribe.
16 to assist such entities in meeting the costs of-
16
(2) The amount of any grant under this section shall be
17
(1) identifying Indians with a potential for educa-
17 determined by the Secretary. Payments pursuant to grants
18
tion or training in the health professions and encouraging
18 under this section may be made in advance or by way of
19
and assisting them (A) to enroll in schools of medicine,
19 reimbursement, and at such intervals and on such conditions,
20
osteopathy, dentistry, veterinary medicine, optometry,
20 as the Secretary finds necessary.
21
podiatry, pharmacy, public health, nursing, or allied
21
(c) For the purpose of making payments pursuant
22
health professions; or (B), if they are not qualified to
FORD LIBRAFE
22
grants under this section, there are authorized to be appro-
23
enroll in any such school, to undertake such postsecond-
23 priated $1,500,000 for fiscal year 1977, $2,500,000 for
24
ary education or training as may be required to qualify
24 fiscal year 1978, $3,000,000 for fiscal year 1979, $4,000-
25
them for enrollment;
25 000 for fiscal year 1980, $4,500,000 for fiscal year 1981,
S. 522-2
10
11
$5,000,000 for fiscal year 1982, and $4,500,000 for fiscal
1 year 1981, $4,500,000 for fiscal year 1982, and $4,500,000
2
year,
1983
2
for
fiscal
year
1983.
8
3
HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP
3
HEALTH PROFESSIONS SCHOLARSHIP PROGRAM
4
PROGRAM
FOR
INDIANS
4
SEC. 104. (a) The Secretary acting through the Serv-
5
SEC. 103. (a) The Secretary, acting through the Serv-
5 ice, shall make scholarship grants to individuals (i) who are
6 ice, shall make scholarship grants to Indians who-
6 enrolled in schools of medicine, osteopathy, dentistry, veteri-
7.
(1) have successfully completed their high school
7 nary medicine, optometry, podiatry, pharmacy, public health,
8
education or high school equivalency; and
8 nursing, or allied health professions (including schools cêr-
9
(2) have demonstrated the capability to success-
9 tified by the Secretary as capable of training individuals In
10
fully complete courses of study in schools of medicine,
10 Indian traditional medicine), and (ii) who agree to provide
11
osteopathy, dentistry, veterinary medicine, optometry,
11 their professional services to Indians after the completion of
12
podiatry, pharmacy public health, nursing, or allied
12 their professional training.
ST
13
health professions:
13
(b) (1) The Secretary, acting through the Service, (i)
14
(b) Each scholarship grant, made under this section
14 shall accord priority for scholarship grants under this section
15 shall be for a period not to exceed two academic years, which
15 to applicants who are Indians, and (ii) may determine dis-
16 years shall be the final two years of the preprofessional
16 tribution of scholarship grants on the basis of the relative
17 education of any grantee,
17 needs of Indians for additional service in specific health
18
(c) Scholarship grants made under this section may
18
professions.
19 cover costs of tuition, books, transportation, board, and other
19
(2) Each scholarship grant under this section shall (i)
20 necessary related expenses.
20 fully cover the costs of tuition, and (ii) when taken together
21
(d) There are authorized to be appropriated for the
21 with the financial resourcés of the grantee, fully cover the
22 purpose of this section: $2,000,000 for fiscal year 1977,
22 costs of books, transportation, board, and other neqessary
23 $2,500,000 for fiscal year 1978, $3,000,000 for fiscal year
23 related expenses: Provided, That the amount of grant funds
24 1979, $3,500,000 for fiscal year 1980, $4,000,000 for fiscal
24 available annually to each grantee under clause (ii) shall
13
12
1
1 not exceed $8,000, except where the scholarship grant is
(3) (A) A service obligation of any individual pursuant
2 extended to cover the period between academic years pur-
2 to this section shall be canceled upon the death of such
3 individual.
3 suant to paragraph (3) of this subsection.
4
4
(3) Scholarship grants under this section shall be made
(B) The Secretary shall by regulation provide for the
5 with respect to academic years, except that any such grant
5 waiver or suspension of a service obligation of any individual
6 may be extended and increased for the period between aca-
6 whenever compliance by such individual is impossible or
7 demic years if the grantee is engaged in clinical or other
7 would involve extreme hardship to such individual and if
8 practical experience related to his or her course of study and
8 enforcement of such obligation with respect to any individual
9 if further grant assistance during such period is required by
9 would be against equity and good conscience.
10
10 the grantee because of his or her financial need.
(d) Individuals receiving scholarship grants under this
11
(c) (1) As a condition for any scholarship grants under
11 section shall not be counted against any employment ceiling
12 this section, each grantee shall be obligated to provide pro-
12 affecting the Service or the Department of Health, Educa-
13 fessional service to Indians for a period of years equal to
13 tion, and Welfare.
14
14
the number of years during which he or she receives such
(e) There are authorized to be appropriated for the
15
15 purpose of this section: $6,000,000 for fiscal year 1977,
grants.
16
(2) For the purpose of clause (1) of this subsection,
16 $7,500,000 for fiscal year 1978, $9,000,000 for fiscal year
17
17 1979, $12,500,000 for fiscal year 1980, $19,000,000 for
"professional service to Indians" shall mean employment in
18
the Service or in private practice where, in the judgment of
18 fiscal year 1981, $26,000,000 for fiscal year 1982, $30,-
19 the Secretary in accordance with guidelines promulgated by
19 000,000 for fiscal year 1983, and, for each succeeding fiscal
20
him, such practice is situated in a physician or other health
20 year, such sums as may be necessary to continue to make
21
21 scholarship grants under this section to individuals who have
professional shortage area and addresses the health care needs
22
of a substantial number of Indians. Periods of internship or
22 received such grants prior to the end of fiscal year 1983 and
23
residency, except residency served in a facility of the Serv-
23 who are eligible for such grants during each such succeeding
24
24 fiscal year.
ice, shall not constitute fulfillment of this service obligation.
14
15
1 INDIAN HEALTH SERVICE EXTERN PROGRAMS
1 against any employment ceiling affecting the Service or the
2
SEC. 105. (a) Any individual who receives a scholar-
2
Department of Health, Education, and Welfare. 0700
3 ship grant pursuant to section 104 shall be entitled to employs
3
(d) There are authorized to be appropriated for the pur-
4 ment in the Service during any nonacademic period of the
4 pose of this section: $800,000 for fiscal year 1977, $1,200,-
5 year. Periods of employment pursuant to this subsection shall
5 000 for fiscal year 1978, $1,600,000 for fiscal year 1979,
6 not be counted in determining the fulfillment of the service
6 $2,200,000 for fiscal year 1980, $2,800,000 for fiscal year
7 obligation incurred as a condition of the scholarship grant.
7
1981, $3,200,000 for fiscal year 1982, and $3,550,000 for
8
(b) Any individual enrolled in a school of medicine, os-
8
fiscal
year
1983
9 teopathy, dentistry, veterinary medicine, optometry, podia-
9 EDUCATIONAL AND TRAINING PROGRAMS IN ENVI-
10 try, pharmacy, public health, nursing, or allied health
10
RONMENTAL HEALTH, HEALTH EDUCATION, AND
11 professions (including schools certified by the Secretary as ca-
11
NUTRITION
12 pable of training individuals in Indian traditional medicine)
12
SEC. 106. (a) The Secretary, acting through the Serv
13 may be employed by the Service during, any nonacademic
13 ice, shall make grants to individuals, nonprofit édtities, ap
14 period of the year. Any such employment shall not exceed
14 propriate public or private agencies, educational institutions
15 one hundred and twenty days during any calendar year.
15 or Indian tribes and tribal organizations to enable the re-
16
(e) Any employment pursuant to this section shall be
16 cipients of such grants to establish and carry lout, programs
17 made without regard to any competitive personnel system
17 to train individuals SO as to enable them to provided their
18 or agency personnel limitation and to a position which will
18 services to Indians in the following areas: 000,0008
80
19 enable the individual SO employed to receive practical expe-
19
(1) environmental Health, including proper waste
20 rience in the health profession in which he or she is engaged
20
disposal, reduced pesticide inhalation, proper. sanitation.
21 in study. Any, individual so employed shall receive payment
21
and vector control;
22 for his or her services comparable to the salary he or she
22
(2) health education, including advising and train
23 would receive if he or she were employed in the competitive
23
ing Indians with respect to personal hygiene, the essens
24 system. Any individual SO employed shall not be counted
24
tials of first aid, the care of critically ill in the home and
US
16
17
1
entitlements of Indians to, and the availability of, health
1 icant portion of the Indian people resides, the Secretary, act-
2
care services and assistance; providing adequate health
2 ing through the Service, may provide allowances to health
3
information to schools; and establishing health courses in
3 professionals employed in the Service to enable them for a
4
secondary schools encouraging entry by Indians into
4 period of time each year prescribed by regulation of the Sec-
5
health-related professions; and
5 retary to take leave of their duty stations for professional
6
(3) nutrition, including advising and training In-
6 consultation and refresher training courses.
7
dians with respect to child nutrition, availability of nutri-
7
(b) There are authorized to be appropriated for the
8
tion programs (such as hot school lunch programs),
8 purpose of this section: $100,000 for fiscal year 1977,
9
nutrition in prenatal care, and nutrition education for
9 $200,000 for fiscal year 1978, $250,000 for fiscal year 1979,
10
the total population, particularly for those found to have
10 $300,000 for fiscal year 1980, $350,000 for fiscal year
11
or to be susceptible to, diabetes, hypertension, and heart
11 1981, $350,000 for fiscal year 1982, and $325,000 for fiscal
12
disease.
12 year 1983.
13
(b) Grants pursuant to this section shall be made in
13
TITLE II-HEALTH SERVICES
14 such manner and in such amounts and subject to such condi-
14
HEALTH SERVICES
15 tions as the Secretary shall by regulation prescribe.
15
SEC. 201. (a) For the purpose of eliminating backlogs
16
(c) There are authorized to be appropriated to carry out
16 in Indian health care services and to supply known, unmet
17 the provisions of this section: $500,000 for fiscal year 1977,
17 medical, surgical, dental, and other Indian health needs, the
18 $600,000 for fiscal year 1978, $700,000 for fiscal year
18 Secretary is authorized to expend $491,975,000 through the
19 1979, $800,000 for fiscal year 1980, $900,000 for fiscal
19 Service, over a seven-fiscal-year period in accordance with
20 year 1981, $900,000 for fiscal year 1982, and $600,000 for
20 the schedule provided in subsection (c) Funds appropriated
21 fiscal year 1983.
21 pursuant to this section each fiscal year shall not be used to
22
22 offset or limit the appropriations required by the Service to
FORD LIBRARD
CONTINUING EDUCATION ALLOWANCES
23
SEC. 107. (a) In order to encourage physicians and
23 continue to serve the health needs of Indians during and
24
other health professionals to join the Service and to provide
24 subsequent to such seven-fiscal-year period, but shall be in
25
their services in the rural and remote areas where a signif-
25 addition to the level of appropriations provided to the Service
S. 522-3
18
19
1 in fiscal year 1976 required to continue the programs of the
1
five positions for fiscal year 1982, and $58,000,000 and
2 Service thereafter.
2
four hundred and fifty positions for fiscal year 1983.
3
(b) The Secretary, acting through the Service, is au-
3
(2) Field health, excluding dental care (direct and
4 thorized to employ persons to implement the provisions of
4
indirect) : $3,000,000 and ninety positions for fiscal year
5 this section during the seven-fiscal-year period in accordance
5
1977, $6,000,000 and ninety positions for fiscal year
6 with the schedule provided in subsection (c). Such positions
6
1978, $9,000,000 and ninety positions for fiscal year
7 authorized each fiscal year pursuant to this section shall not
7
1979, $13,000,000 and one hundred and twenty posi-
8 be considered as offsetting or limiting the personnel required
8
tions for fiscal year 1980, $18,000,000 and one hundred
9 by the Service to serve the health needs of Indians during
9
and fifty positions for fiscal year 1981, $23,000,000 and
10 and subsequent to such seven-fiscal-year period but shall be
10
one hundred and fifty positions for fiscal year 1982,
11 in addition to the positions authorized in the previous fiscal
11
and $28,500,000 and one hundred and sixty-five posi-
12 year and to the annual personnel levels required to continue
12
tions for fiscal year 1983.
13 the programs of the Service.
13
(3) Dental care (direct and indirect) : $800,000
14
(c) The following amounts and positions are authorized,
14
and eighty positions for fiscal year 1977, $1,500,000
15
in accordance with the provisions of subsections (a) and
15
and seventy positions for fiscal year 1978, $2,000,000
16
(b), for the specific purposes noted:
16
and fifty positions for fiscal year 1979, $2,500,000 and
17
(1) Patient care (direct and indirect) : $4,000,000
17
fifty positions for fiscal year 1980, $2,900,000 and forty
18
and one hundred and fifty positions for fiscal year 1977,
18
positions for fiscal year 1981, $3,200,000 and thirty
19
$10,000,000 and two hundred and twenty-five positions
19
positions for fiscal year 1982, and $3,500,000 and
20
for fiscal year 1978, $18,000,000 and three hundred
20
twenty-five positions for fiscal year 1983.
21
positions for fiscal year 1979, $26,500,000 and three
21
(4) Mental health: (A) Community mental health
22
hundred and twenty positions for fiscal year 1980, $36,-
22
services: $900,000 and forty positions for fiscal year
23
000,000 and three hundred and sixty positions for fiscal
23
1977, $1,700,000 and thirty positions for fiscal year
24
year 1981, $46,000,000, and three hundred and seventy-
24
1978, $2,400,000 and thirty positions for fiscal year
20
21
1
1979, $3,000,000 and twenty-five positions for fiscal
1
for fiscal year 1982, and $800,000 and five positions for
2
year 1980, $3,500,000 and twenty positions for fiscal
2
fiscal year 1983.
3
year 1981, $3,800,000 and ten positions for fiscal year
3
(E) Training of traditional Indian practitioners in
4
1982, and $4,100,000 and fifteen positions for fiscal
4
mental health: $75,000 for fiscal year 1977, $150,000
5
year 1983.
5
for fiscal year 1978, $200,000 for fiscal year 1979,
6
(B) Inpatient mental health services: $200,000
6
$250,000 for fiscal year 1980, $300,000 for fiscal year
7
and fifteen positions for fiscal year 1977, $400,000
7
1981, $300,000 for fiscal year 1982, and $300,000 for
8
and fifteen positions for fiscal year 1978, $600,000 and
8
fiscal year 1983.
9
fifteen positions for fiscal year 1979, $800,000 and
9
(5) Treatment and control of alcoholism among
10
fifteen positions for fiscal year 1980, $1,000,000 and
10
Indians: $8,000,000 for fiscal year 1977, $10,500,000
11
fifteen positions for fiscal year 1981, $1,300,000 and
11
for fiscal year 1978, $13,000,000 for fiscal year 1979,
12
twenty positions for fiscal year 1982, and $1,600,000
12
$15,000,000 for fiscal year 1980, $17,000,000 for fiscal
13
and twenty-five positions for fiscal year 1983.
13
year 1981, $18,500,000 for fiscal year 1982, and
14
(C) Model dormitory mental health services: $625,-
14
$20,000,000 for fiscal year 1983.
15
000 and fifty positions for fiscal year 1977, $1,250,000
15
(6) Provision of health care personnel in primary
16
and fifty positions for fiscal year 1978, $1,875,000 and
16
and secondary Bureau of Indian Affairs schools:
17
fifty positions for fiscal year 1979, and $2,500,000 and
17
$600,000 and thirty-three positions for fiscal year 1977,
18
fifty positions for fiscal year 1980.
18
$1,000,000 and twenty-two positions for fiscal year
19
(D) Therapeutic and residential treatment centers:
19
1978, $1,300,000 and sixteen positions for fiscal year
20
$150,000 and ten positions for fiscal year 1977, $300,-
20
1979, $1,700,000 and twenty-two positions for fiscal
21
000 and ten positions for fiscal year 1978, $400,000 and
21
year 1980, $2,500,000 and forty-four positions for fiscal
22
five positions for fiscal year 1979, $500,000, and five
22
year 1981, $3,900,000 and seventy-six positions for
23
positions for fiscal year 1980, $600,000 and ten posi-
23
fiscal year 1982, and $6,000,0000 and one hundred and
24
tions for fiscal year 1981, $700,000 and five positions
24
fifteen positions for fiscal year 1983.
22
23
1
(7) Maintenance and repair (direct and indirect) :
1
652,000 for fiscal year 1981, $29,675,000 for fiscal
2
$3,000,000 and twenty positions for fiscal year 1977,
2
year 1982, and $33,779,000 for fiscal year 1983.
3
$3,000,000 and twenty positions for fiscal year 1978,
3
(2) Health centers and health stations: $6,960,000
4
$4,000,000 and thirty positions for fiscal year 1979,
4
for fiscal year 1977, $6,226,000 for fiscal year 1978,
5
$4,000,000 and thirty positions for fiscal year 1980,
5
$3,720,000 for fiscal year 1979, $4,440,000 for fiscal
6
$4,000,000 and thirty positions for fiscal year 1981,
6
year 1980, $2,335,000 for fiscal year 1981, $1,760,000
7
$2,000,000 and fifteen positions for fiscal year 1982,
7
for fiscal year 1982, and $2,360,000 for fiscal year 1983.
8
and $1,000,000 and five positions for fiscal year 1983.
8
(3) Staff housing: $2,484,000 for fiscal year 1977,
9
(d) The Secretary, acting through the Service, shall
9
$43,450,000 for fiscal year 1978, $8,231,000 for fiscal
10 expend directly or by contract not less than 1 per centum of
10
year 1979, $9,390,000 for fiscal year 1980, $20,140-
11 the funds appropriated under the authorizations in each of
11
000 for fiscal year 1981, $12,267,000 for fiscal year
12 the clauses (1) through (5) of subsection (c) for research
12
1982, and $13,704,000 for fiscal year 1983.
13 in each of the areas of Indian health care for which such
13
(4) Health facilities for primary and secondary
14 funds are authorized to be appropriated.
14
Bureau of Indian Affairs schools: $1,500,000 for fiscal
15
TITLE III-HEALTH FACILITIES
15
year 1977, $1,000,000 for fiscal year 1978, $1,000,000
16 CONSTRUCTION AND RENOVATION OF SERVICE FACILITIES
16
for fiscal year 1979, $1,000,000 for fiscal year 1980,
17
17
SEC. 301. (a) For the purpose of eliminating inade-
$1,000,000 for fiscal year 1981, $1,000,000 for fiscal
18 quate, outdated, and otherwise unsatisfactory Service hos-
18
year 1982, and $1,000,000 for fiscal year 1983.
19 pitals, health centers, health stations, and other Service
19
(b) The Secretary, acting through the Service, is au-
20 facilities, the Secretary, acting through the Service, is au-
20 thorized to equip and staff such Service facilities at levels
21 thorized to expend $528,637,000 over a seven-fiscal-year
21 commensurate with their operation at optimum levels of
22 period in accordance with the following schedule:
22
effectiveness.
23
(1) Hospitals: $123,880,000 for fiscal year 1977,
23
(c) Prior to the expenditure of, or the making of any
24
$55,171,000 for fiscal year 1978, $24,703,000 for fiscal
24 firm commitment to expend, any funds authorized in subsec-
25
year 1979, $70,810,000 for fiscal year 1980, $45,-
25 tion (a), the Secretary, acting through the Service, shall-
24
25
1
(1) consult with any Indian tribe to be significantly
1
(c) The Secretary is authorized and directed to develop
2
affected by any such expenditure for the purpose of deter-
2 a plan, together with the Secretaries of the Interior and of
3
mining and, wherever practicable, honoring tribal prefer-
3 Housing and Urban Development and upon consultation
4
ences concerning the size, location, type, and other char-
4 with Indian tribes, to assure that the schedule provided for
5
acteristics of any facility on which such expenditure is to
5 in subsection (b) will be met. Such plan shall be submitted
6
be made; and
6 to the Congress no later than ninety days from the date of
7
(2) be assured that, wherever practicable, such
7 enactment of this Act.
8
facility, not later than five years after its construction or
8
PREFERENCE TO INDIANS AND INDIAN FIRMS
9
renovation, shall meet the standards of the Joint Com-
9
SEC. 303. (a) The Secretary, acting through the Serv-
10
mission on Accreditation of Hospitals.
10 ice, may utilize the negotiating authority of the Act of June
11 CONSTRUCTION OF SAFE WATER AND SANITARY WASTE
11 25, 1910 (36 Stat. 861), to give preference to any Indian
12
DISPOSAL FACILITIES
12 or any enterprise, partnership, corporation, or other type
13
SEC. 302. (a) The Secretary is authorized to expend,
13 of business organization owned and controlled by an Indian
14 pursuant to the Act of July 31, 1959 (73 Stat. 267), $378,-
14 or Indians (hereinafter referred to as an "Indian firm")
15 000,000 within a seven-fiscal-year period following the en-
15 in the construction and renovation of Service facilities pur-
16 actment of this Act, in accordance with the schedule provided
16 suant to section 301 and in the construction of safe water
17 in subsection (b), to supply unmet needs for safe water and
17 and sanitary waste disposal facilities pursuant to section 302.
18 sanitary waste disposal facilities in existing and new Indian
18 Such preference may be accorded by the Secretary unless he
19 homes and communities.
19 finds, pursuant to rules and regulations promulgated by him,
20
(b) To effect the purpose of subsection (a), there are
20 that the project or function to be contracted for will not be
21 authorized to be appropriated: $60,000,000 for fiscal year
21 satisfactory or such project or function cannot be properly
22 1977, $60,000,000 for fiscal year 1978, $60,000,000 for
22 completed or maintained under the proposed contract. The
23 fiscal year 1979, $60,000,000 for fiscal year 1980, $60,-
23 Secretary, in arriving at his finding, shall consider whether
24 000,000 for fiscal year 1981, $52,000,000 for fiscal year
24 the Indian or Indian firm will be deficient with respect to
25 1982, and $26,000,000 for fiscal year 1983.
25 (1) ownership and control by Indians, (2) equipment, (3)
26
27
1 bookkeeping and accounting procedures, (4) substantive
1 hospitals and skilled nursing facilities eligible for reimburse-
2 knowledge of the project or function to be contracted for,
2 ment under title XVIII of the Social Security Act, as
3 (5) adequately trained personnel, or (6) other necessary
3 amended, or, in the case of any facility existing at the time
4 components of contract performance.
4 of enactment of this Act, that the Service has provided an
5
(b) For the purpose of implementing the provisions
5 acceptable written plan for bringing the facility into full
6 of this title, the Secretary shall assure that the rates of
6
compliance with such standards within two years from the
7 pay for personnel engaged in the construction or renovation
7 date of acceptance of the plan by the Secretary. The Service
8 of facilities constructed or renovated in whole or in part
8 facilities shall not be required to be licensed by any State or
9 by funds made available pursuant to this title are not less
9 locality in which they are located: Provided, however, That
10 than the prevailing local wage rates for similar work as
10 the Secretary shall include in his certifications appropriate
11 determined in accordance with the Act of March 3, 1921
11 assurances that such facilities will meet standards equivalent
12 (46 Stat. 1491), as amended.
12 to licensure requirements.
13
TITLE IV-ACCESS TO HEALTH SERVICES
13
(c) Any payments received for services provided to
14
SERVICES PROVIDED TO MEDICARE ELIGIBLE INDIANS
beneficiaries hereunder shall not be considered in deter-
14
15
SEC. 401. (a) Notwithstanding any other provision of
15
mining appropriations for health care and services to Indians.
16 law, for purpose of title XVIII of the Social Sécurity Act,
16
(d) Nothing herein authorizes the Secretary to provide
17 as amended, a Service facility (including a hospital or skilled
services to an Indian beneficiary with coverage under title
17
18 nursing facility), whether operated by the Service or by
XVIII of the Social Security Act, as amended, in preference
18
19 any Indian tribe or tribal organization, shall hereby be
to an Indian beneficiary without such coverage.
19
20 deemed to be a facility eligible for reimbursement under said
SERVICES PROVIDED TO MEDICAID ELIGIBLE INDIANS
20
21 title XVIII: Provided, That the requirements of subsection
SEC. 402. (a) Notwithstanding any other provision of
21
22 (b) are met.
law, for the purpose of title XIX of the Social Security Act,
22
23
(b) Prior to the provision of any care or service for
as amended, a Service facility (including a hospital, skilled
23
24 which reimbursement may be made, the Secretary shall cer-
24
nursing facility, or intermediate care facility), whether
25 tify that the facility meets the standards applicable to other
25
operated by the Service or by an Indian tribe or tribal
28
29
1 organization, shall hereby be deemed to be a facility eligible
1 appropriations for the provision of health care and services
2 for reimbursement under said title XIX Provided, That the
2 to Indians.
3 requirements of subsection (c) are met.
3
(e) Notwithstanding any other provision of law, with
4
(b) The Secretary is authorized to enter into agree-
4 respect to amounts expended during any quarter as medical
5 ments with the appropriate State agency for the purpose of
5 assistance under title XIX of the Social Security Act, as
6 reimbursing such agency for health care and services pro-
6 amended, for services which are included in the State plan
7 vided in Service facilities to Indians who are beneficiaries
7 and are received through a Service facility, whether operated
8 under title XIX of the Social Security Act, as amended.
8 by the Service or by an Indian tribe or tribal organization,
9
(c) Prior to the provision of any care or service for
9 to individuals who are (i) eligible under the plan of the
10 which reimbursement may be made, the Secretary shall cer-
10 State under said title XIX and (ii) eligible for comprehen-
11 tify that the facility meets the standards applicable to other
11 sive health services under the Service program, the Federal
12 hospitals, skilled nursing facilities, and intermediate care
12 medical assistance percentage under said title XIX shall be
13 facilities eligible for reimbursement under title XIX of the
13 increased to 100 per centum.
14 Social Security Act, as amended, or, in the case of any
14
(f) Nothing in this section shall authorize the Secretary
15 facility existing at the time of enactment of this Act, that the
15 to provide services to an Indian beneficiary with coverage
16 Service has provided an acceptable written plan for bring-
16 under title XIX of the Social Security Act, as amended, in
17 ing the facility into full compliance with such standards
17
preference to an Indian beneficiary without such coverage.
18 within two years from the date of acceptance of the plan by
18
REPORT
19 the Secretary. The Service facilities shall not be required
19
SEC. 403. The Secretary shall include in his annual
20 to be licensed by any State or locality in which they are
20 report required by subsection (a) of section 601 an account-
21 located: Provided, however, That the Secretary shall include
21 ing on the amount and use of funds made available to the
22 in his certifications appropriate assurances that such facil-
22 Service pursuant to this title as a result of reimbursements
23 ities will meet standards equivalent to licensure requirements.
23 through title XVIII and XIX of the Social Security Act,
24
(d) Any payments received for services provided re-
24 as amended.
25 cipients hereunder shall not be considered in determining
30
31
1
TITLE V-HEALTH SERVICES FOR URBAN
1
(2) identify all public and private health service
2
INDIANS
2
resources within the urban center in which the organiza-
3
PURPOSE
3
tion is situated which are or may be available to urban
4
SEC. 501. The purpose of this title is to encourage the
4
Indians;
5 establishment of programs in urban areas to make health
5
(3) assist such resources in providing service to
6 services more accessible to the urban Indian population.
6
such urban Indians;
7
CONTRACTS WITH URBAN INDIAN ORGANIZATIONS
7
(4) assist such urban Indians in becoming familiar
8
SEC. 502. The Secretary, acting through the Service,
8
with and utilizing such resources;
9 shall enter into contracts with urban Indian organizations
9
(5) provide basic health education to such urban
10 to assist such organizations to establish and administer, in
10
Indians;
11 the urban centers in which such organizations are situated,
11
(6) establish and implement manpower training
12 programs which meet the requirements set forth in sections
12
programs to accomplish the referral and education tasks
13 503 and 504.
13
set forth in clauses (3) through (5) of this subsection;
14
CONTRACT ELIGIBILITY
14
(7) identify gaps between unmet health needs of
15
SEC. 503. (a) The Secretary, acting through the Serv-
15
urban Indians and the resources available to meet such
16 ice, shall place such conditions as he deems necessary to effect
16
needs;
17 the purpose of this title in any contract which he makes with
17
(8) make recommendations to the Secretary and
18 any urban Indian organization pursuant to this title. Such
18
Federal, State, local, and other resource agencies on
19 conditions shall include, but are not limited to, requirements
19
methods of improving health service programs to meet
20 that the organization successfully undertake the following
20
the needs of urban Indians; and
21 activities:
21
(9) where necessary, provide or contract for health
22
(1) determine the population of urban Indians
22
care services to urban Indians.
23
which are or could be recipients of health referral or
23
(b) The Secretary, acting through the Service, shall
24
care services;
24 by regulation prescribe the criteria for selecting urban Indian
33
32
1 organizations with which to contract pursuant to this title.
1
OTHER CONTRACT REQUIREMENTS
2 Such criteria shall, among other factors, take into consid-
2
SEC. 504. (a) Contracts with urban Indian organiza-
3 eration:
3
tions pursuant to this title shall be in accordance with all
4 Federal contracting laws and regulations except that, in the
4
(1) the extent of the unmet health care needs of
5 discretion of the Secretary, such contracts may be negotiated
5
urban Indians in the urban center involved;
6 without advertising and need not conform to the provisions
6
(2) the size of the urban Indian population which
7
7
of the Act of August 24, 1935 (48 Stat. 793), as amended.
is to receive assistance;
8
8
(b) Payments under any contracts pursuant to this title
(3) the relative accessibility which such popula-
9 may be made in advance or by way of reimbursement and in
9
tion has to health care services in such urban center;
10
such installments and on such conditions as the Secretary
10
(4) the extent, if any, to which the project would
11
11
deems necessary to carry out the purposes of this title.
duplicate any previous or current public or private health
12
12
(c) Notwithstanding any provision of law to the con-
services project funded by another source in such urban
13 trary, the Secretary may, at the request or consent of an
13
center;
14
14 urban Indian organization, revise or amend any contract
(5) the appropriateness and likely effectiveness of
15
15 made by him with such organization pursuant to this title
a project assisted pursuant to this title in such urban
16
16 as necessary to carry out the purposes of this title: Provided,
center;
17
17 however, That, whenever an urban Indian organization re-
(6) the existence of an urban Indian organization
18
18 quests retrocession of the Secretary for any contract entered
capable of performing the activities set forth in subsec-
19
19 into pursuant to this title, such retrocession shall become
tion (a) and of entering into a contract with the Secre-
20
20 effective upon a date specified by the Secretary not more
tary pursuant to this title; and
21
21 than one hundred and twenty days from the date of the
(7) the extent of existing or likely future participa-
22
22 request by the organization or at such later date as may be
tion in such activities by appropriate health and health-
23
23 mutually agreed to by the Secretary and the organization.
related Federal, State, local, and other resource agencies.
34
35
1
(d) Contracts with urban Indian organizations and reg-
1
REVIEW OF PROGRAM
2 ulations adopted pursuant to this title shall include provisions
2
SEC. 507. Within six months after the end of fiscal year
3 to assure the fair and uniform provision to urban Indians
3 1978, the Secretary, acting through the Service and with the
4 of services and assistance under such contracts by such
4 assistance of the urban Indian organizations which have
5 organizations.
5 entered into contracts pursuant to this title, shall review the
6
REPORTS AND RECORDS
6 program established under this title and submit to the Con-
7
SEC. 505. For each fiscal year during which an urban
7 gress his or her assessment thereof and recommendations for
8 Indian organization receives or expends funds pursuant to
8 any further legislative efforts he or she deems necessary to
9 a contract under this title, such organization shall submit to
9 meet the purpose of this title.
10 the Secretary a report including information gathered pur-
10
TITLE VI-MISCELLANEOUS
11 suant to section 503 (a) (7) and (8) information on activi-
11
REPORTS
12 ties conducted by the organization pursuant to the contract,
12
SEC. 601. (a) The Secretary shall report annually to
13 an accounting of the amounts and purposes for which Fed-
13 the President and the Congress on progress made in effecting
14 eral funds were expended, and such other information as the
14 the purposes of this Act. Within three months after the end
15 Secretary may request. The reports and records of the urban
15 of fiscal year 1979, the Secretary shall review expenditures
16 Indian organization with respect to such contract shall be
16 and levels of authorizations under this Act and make recom-
17 subject to audit by the Secretary and the Comptroller General
17 mendations to Congress concerning any increases or de-
18 of the United States.
18 creases in the authorizations for fiscal years 1981 through
19
AUTHORIZATIONS
19 1983 under this Act which he deems appropriate. Within
20
SEC. 506. There are authorized to be appropriated for
20 three months after the end of fiscal year 1982, the Secretary
21 the purpose of this title: $5,000,000 for fiscal year 1977,
21 shall review the programs established or assisted pursuant to
22 $10,000,000 for fiscal year 1978, and $15,000,000 for fiscal
22 this Act and shall submit to the Congress his assessment
23 year 1979.
23 thereof and recommendations of additional programs or
36
37
1 additional assistance necessary to, at a minimum, provide
1
(b) The Secretary is authorized to revise and amend
2 health services to Indians, and insure a health status for
2
any rules or regulations promulgated pursuant to this Act:
3 Indians, which are at a parity with the health services avail-
3
Provided, That, prior to any revision of or amendment to
4 able to, and the health status of, the general population.
4
such rules or regulations, the Secretary shall, to the extent
5
(b) There is hereby authorized to be appropriated to
5
practicable, consult with appropriate national or regional
6 the Secretary $150,000 to support a one-year study by the
6
Indian organizations and shall publish any proposed revision
7 National Indian Health Board of mental health problems,
7
or amendment in the Federal Register not less than sixty days
8 including alcoholism and related problems, among Indians.
8 prior to the effective date of such revision or amendment in
9 The study, together with any recommendations the Board
9 order to provide adequate notice to, and receive comments
10 may have for legislative or administrative actions to remedy
10 from, other interested parties.
11 such problems, shall be submitted to the Congress by the
11
LEASES WITH INDIAN TRIBES
12 Secretary no later than thirty days after the study's com-
12
SEC. 603. Notwithstanding any other provision of law,
13 pletion.
13 the Secretary is authorized, in carrying out the purposes
14
REGULATIONS
14 of this Act, to enter into leases with Indian tribes for periods
15
SEC. 602. (a) (1) Within three months from the date
15 not in excess of twenty years.
16 of enactment of this Act, the Secretary shall, to the extent
16
AVAILIBILITY OF FUNDS
17 practicable, consult with national and regional Indian orga-
17
SEC. 604. The funds appropriated pursuant to this Act
18 nizations to consider and formulate appropriate rules and
18 shall remain available until expended.
19 regulations to implement the provisions of this Act.
Passed the Senate May 16 (legislative day, April 21),
20
(2) Within four months from the date of enactment of
1975.
21 this Act, the Secretary shall publish proposed rules and regu-
Attest:
FRANCIS R. VALEO,
Secretary.
22 lations in the Federal Register for the purpose of receiving
23 comments from interested parties.
24
(3) Within six months from the date of enactment of
25 this Act, the Secretary shall promulgate rules and regulations
26 to implement the provisions of this Act.
94TH CONGRESS
1ST SESSION
S. 522
AN ACT
To implement the Federal responsibility for the
care and education of the Indian people by
improving the services and facilities of Fed-
eral Indian health programs and encourag-
ing maximum participation of Indians in
such programs, and for other purposes.
MAY 22, 1975
Referred to the Committee on Interior and Insular
Affairs