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    "title": "Health Care Legislation - S. 522 (2)",
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    "ocrText": "The original documents are located in Box 2, folder \"Health Care Legislation - S. 522 (2)\"\nof the Bradley H. Patterson Files at the Gerald R. Ford Presidential Library.\nCopyright Notice\nThe copyright law of the United States (Title 17, United States Code) governs the making of\nphotocopies or other reproductions of copyrighted material. Gerald Ford donated to the United\nStates of America his copyrights in all of his unpublished writings in National Archives collections.\nWorks prepared by U.S. Government employees as part of their official duties are in the public\ndomain. The copyrights to materials written by other individuals or organizations are presumed to\nremain with them. If you think any of the information displayed in the PDF is subject to a valid\ncopyright claim, please contact the Gerald R. Ford Presidential Library.\nDigitized from Box 2 of the Bradley H. Patterson Files\nat the Gerald R. Ford Presidential Library\nTHE WHITE HOUSE\nWASHINGTON\nDATE 2/5/76\nTO: Dr. marrs\nFROM: SARAH MASSENGALE\nE-5\nHEALTH, EDUCATION, AND WELFARE\nSUBJECT:\nINDIAN HEALTH CARE\nSENATE BILL: S. 522 (Jackson (D) Wash.)\nHOUSE BILL : H.R. 2525 (Meeds (D) Wash.)\nBACKGROUND: S. 522, as introduced, is identical to S. 2938\nwhich was passed by the Senate (voice vote) on 11/25/74.\nThe Administration opposed S. 2938 last year for the\nsame reasons that it opposes S. 522 (see position below).\nH.R. 2525 is similar to S. 522.\nPROVISIONS: S. 522 and H.R. 2525 would authorize new\ncategorical programs and appropriation levels for\n7-year and 5-year periods, respectively, to expand\nand upgrade the services and facilities of Federal\nIndian health programs. Specifically, the bills would:\n-- establish new scholarship programs to recruit,\nprepare and enroll Indians in health professions\nschools,\n-- provide specific authorization levels for health\nservices (including alcholism and mental health in\nS. 522) and health facilities,\n-- provide for Medicare and Medicaid reimbursements\nfor health services provided in IHS facilities, and\n-- establish outreach programs in urban areas to\nmake health services more accessible to the urban Indian\npopulation.\nADMINISTRATION OBJECTIONS: The bills would create over 20\nnew categorical programs for a specific population group.\nThis approach is contrary to the Administration's policy\nof meeting the health needs of Americans through broad-\nbased programs such as Medicare and Medicaid. All the\nprogram activities authorized by the bills can be con-\nducted under existing legislative authority. In addition,\nthe authorization levels are significantly higher than\nwarranted.\nThe Administration opposes the bills except for the\nprovisions requiring Medicare and Medicaid reimburse-\nments for services provided to eligible beneficiaries\nin Indian Health Service facilities. Federal assistance\nfor health manpower, health services and upgrading\nhealth facilities is being carried out through existing\nFederal programs (e.g., Interior's Bureau of Indian\nAffairs already conducts a scholarship program that\nmeets the objectives of the bills) and is adequately\nfunded in the 1976 budget.\nFORD\n11/26/75\nGERALD\nLIBRARY\nE-5 (Cont'd)\nSUBJECT: INDIAN HEALTH CARE (PAGE 2)\nBUDGET IMPACT: S. 522 would authorize $213 million for the\nfirst full year and would add new programs costing\n$29 million in FY 1976. Over a 7-year period it would\nauthorize a total of $1.25 25 billion. H.R. 2525 would\nauthorize $191 million for FY 76 and $1.1 billion over\na 5-year period. The 1976 budget provides outlays of\n$322 million for the Indian Health Service, a 175%\nincrease in six years.\nSTATUS: HEW reported not consistent with to Senate\nInterior Cte. disapproving all but Title IV of S. 522.\n5/16 Senate passed S. 522 (voice vote)\n12/9 H. Interior and Insular Affairs subcte approved\nH.R. 2525 amended\nLIBRARY FORD y GERALD\n12/10/75\nPRESIDENT\nJAMES B. GILLESPIE, M.D.\n9 TENNIS COURT, N.W.\nAMERICAN\nDISTRICT CHAIRMEN\nMERRITT B. LOW, M.D.\nLA LUZ\nGREENFIELD, MASSACHUSETTS\nALBUQUERQUE, NEW MEXICO 87120\nSTEWART C. WAGONER, M.D.\nSCHENECTADY, NEW YORK\nVICE-PRESIDENT\nWILLIAM A. HOWARD, M.D.\nJOHN C. MACQUEEN, M.D.\nWASHINGTON, DISTRICT OF COLUMBIA\nDEPT. OF PEDIATRICS\nEDWIN L. KENDIG, JR., M.D.\nUNIVERSITY OF IOWA HOSPITALS\nPEDIATRIC\nRICHMOND, VIRGINIA\n@\nBRUCE D. GRAHAM, M.D.\nIOWA CITY, IOWA 52242\nCOLUMBUS, OHIO\nEXECUTIVE DIRECTOR\nR. DON BLIM, M.D.\nROBERT G. FRAZIER, M.D.\nASSOCIATE DIRECTORS\nAmerican Academy of Pedialrics\nKANSAS CITY, MISSOURI\nDAVID W. VAN GELDER, M.D.\nBATON ROUGE, LOUISIANA\nSTANLEY L. HARRISON, M.D.\nTHOMAS C. cocK, M.D.\nBELLEVUE, WASHINGTON\nRICHARD W. OLMSTED, M.D.\nP.O. BOX 1034\nEVANSTON, ILLINOIS 60204\nSAUL J. ROBINSON, M.D.\nSECRETARY\nSAN FRANCISCO, CALIFORNIA\nGERALD E. HUGHES, M.D.\nEVANSTON (312) 869-4255 CHICAGO (312) 273-3646\nGUILLERMO GUILLEN-ALVAREZ, M.D.\nSAN SALVADOR, EL SALVADOR\nTREASURER\nCOMMITTEE ON INDIAN HEALTH\nHELIO SABASTIAO DE MARTINO, M.D.\nDANIEL A. DAMON\nRIO DE JANEIRO, BRASIL\n1601 N. TUCSON BLVD., #35\nULADISLAO LOZANO ZEGARRA, M.D.\nLIMA, PERU\nTUCSON, AZ. 85716\nFEBRUARY 19, 1976\nTHE INDIAN HEALTH IMPROVEMENT BILL HAS BEEN PLACED ON THE\nLIST OF \"CONTROVERISAL BILLS\" ON WHICH THE INTERIOR COMMITTEE\nOF THE HOUSE IS HOLDING MONDAY. AND TUESDAY MEETINGS.\nMR. JOE SKUBITZ, LEADING MINORITY MEMBER OF THE COMMITTE,\nHAS BEEN LEADING THE OPPOSITION TO THE BILL. I BELIEVE THAT\nHE HAS BEEN MISINFORMED BY THE ADMINISTRATION AS REGARDS THE\nNEEDS OF THE INDIAN PEOPLE. THE ADMINISTRATION'S POSITION\nHAS ALWAYS BEEN THAT NEW LEGISLATION IS NOT NEEDED. THE CRISES\nIN INDIAN HEALTH HAS DEVELOPED UNDER THE SAME GUIDELINES THAT\nTHE ADMINISTRATION SAYS IT CAN SOLVE. THIS ARGUMENT IS NOT\nONLY INCONSISTENT BUT UNREALISTIC. THE PROBLEM IN THE PAST\nHAS BEEN THAT ONLY THE POLITICALLY POTENT TRIBES HAVE RECEIVED\nMOST OF THE ATTENTION. THE INDIAN HEALTH BILL HAS ALREADY\nBEEN COMPROMISED.\nWE NATIONAL MEDICAL ORGANIZATIONS (A.A.P., A.C.O.G., A.A.F.P.\nAND A.M.A.) HAVE BEEN ADVOCATING PASSAGE OF THIS BILL BECAUSE\nFOR OVER TEN YEARS WE HAVE SEEN THE PROBLEMS DEVELOP AFTER\nMANY PERSONAL VISITATIONS TO THE AREA INDIAN RESERVATIONS\nAND ALASKA NATIVE VILLAGES.\nAS CHAIRMAN OF THE A.A.P. COMMITTEE ON INDIAN HEALTH, I ASK\nTHAT YOU PLEASE HEED OUR ADVISE, WE ARE POLITICALLY BIPARTISAN\nAND FEEL THAT THE BILL SHOULD HAVE REMAINED BIPARTISAN.\nOBVIOUSLY, THE ONLY REAL OPPOSITION TO ADEQUATE INDIAN HEALTH\nIMPROVEMENT ARE THE BUREAUCRATIC DIE-HARDS IN THE O.M.B. AND\nW.E.W. WHO EITHER ARE BRUTALLY INDIFFERENT OR ACTIVELY RACIST\nAGAINST THE AMERICAN INDIAN PEOPLE.\nCINDIAN HEALTH CARE IMPROVEMENT ACT - A VERSION REPORTEDLY\nCLOSE TO HR 7852)\nFORD will LIBRARY GERALD\nPRESIDENT\nDISTRICT CHAIRMEN\nJAMES B. GILLESPIE, M.D.\nMERRITT B. LOW, M.D.\n9 TENNIS COURT, N.W.\nGREENFIELD, MASSACHUSETTS\nLA LUZ\nSTEWART C. WAGONER, M.D.\nALBUQUERQUE, NEW MEXICO 87120\nSCHENECTADY, NEW YORK\nWILLIAM A. HOWARD, M.D.\nVICE-PRESIDENT\nWASHINGTON, DISTRICT OF COLUMBIA\nJOHN C. MACQUEEN, M.D.\nEDWIN L. KENDIG, JR., M.D.\nDEPT. OF PEDIATRICS\nUNIVERSITY OF IOWA HOSPITALS\n. PEDIATRIC\nRICHMOND, VIRGINIA\nBRUCE D. GRAHAM, M.D.\nIOWA CITY, IOWA 52242\nCOLUMBUS, OHIO\nR. DON BLIM, M.D.\nEXECUTIVE DIRECTOR\nAmerican Academy of Pediatrics\nKANSAS CITY, MISSOURI\nROBERT G. FRAZIER, M.D.\nDAVID W. VAN GELDER, M.D.\nBATON ROUGE, LOUISIANA\nASSOCIATE DIRECTORS\nTHOMAS C. cocK, M.D.\nSTANLEY L. HARRISON, M.D.\nBELLEVUE, WASHINGTON\nRICHARD W. OLMSTED, M.D.\nSAUL J. ROBINSON, M.D.\nP.O. BOX 1034\nEVANSTON, ILLINOIS 60204\nSAN FRANCISCO, CALIFORNIA\nSECRETARY\nGERALD E. HUGHES, M.D.\nEVANSTON (312) 869-4255 CHICAGO (312) 273-3646\nGUILLERMO GUILLEN-ALVAREZ, M.D.\nSAN SALVADOR, EL SALVADOR\nTREASURER\nHELIO SABASTIAO DE MARTINO, M.D.\nCOMMITTEE ON INDIAN HEALTH\nDANIEL A. DAMON\nRIO DE JANEIRO, BRASIL\n1601 N. TUCSON BLVD. #35\nULADISLAO LOZANO ZEGARRA, M.D.\nLIMA, PERU\nTUCSON, AZ. 85716\nMAY 12, 1976\nDR. THEODORE MARRS\nSPECIAL ASSISTANT TO THE PRESIDENT\nTHE WHITE HOUSE\nWASHINGTON, D.C.\nDEAR TED:\nAS REQUESTED, HERE ARE THE ENCLOSURES ON THE INDIAN\nHEALTH IMPROVEMENT BILL. I HOPE THE PRESIDENT CAN\nBE PERSUADED NOT TO VETO THIS LEGISLATION.\nSINCERELY,\nAid\nSIDNEY R. KEMBERLING, M.D.\nCHAIRMAN\nFORD\nSRK/MK\nENCLOSURES\n10/14/75\nOctober 9, 1975\nRepresentative James P. Johnson\n129 Cannon House Office Building\nU.S. House of Representatives\nWashington, D.C. 20515\nDear Mr. Johnson:\nI'm writing to ask your support of HR 7852, the\nIndian Improvement Bill, in the Sub-committee on\nIndian Health. The bill has the endorsement of\nthe American Academy of Pediatrics. Ine scademy\nbelieves that the passage of this legislation\nwould greatly enhance the health resources and\nservices available to Indian children.\nAs you know S 522 has passed the Senate by a sub-\nstantial margin. I hope you will support committee\naction to bring HR 7852 to the floor of the House\nof Representatives.\nSincerely,\nJames E. Strain,\nChairman, District 8\nAcademy of Pediatrics\nJES/rs\ncopy to Sidney kemberlin, N.D.\nGERALD\nFORD LIBRARY &\n11/5/95\nJAMES P. JOHNSON\nOFFICE ADDRESS:\nAve DISTRICT, COLORADO\n129 CANNON BUILDING\nWASHINGTON, D.C. 20515\nCOMMITTEES\n(202) 225-4676\nAGRICUL TURE\nCongress of the United States\nDISTRICT OFFICES:\n203 FEDERAL BUILDING\nForm COLLINS, COLORADO 80521\nINTERIOR AND INSULAR AFFAIRS\nHouse of Representatives\n(303) 493-9132\nFEDERAL BUILDING\nSELECT COMMITTEE ON\nMashington, D.C. 20515\nGRAND JUNCTION, COLORADO 81501\nINTELLIGENCE\n(303) 243-1736\nROOM 9, 230 MAIN STREET\nOctober 24, 1975\nFORT MORGAN, COLORADO 80701\n(303) 867-8909\n719 GRAND AVENUE\nGLENWOOD SPRINGS, COLORADO 81601\n(303) 945-6491\nP.O. Box 21203\nDENVER, COLORADO 80221\nJames E. Strain, M.D., P.C.\n(303) 427-6439\n556 South Jersey Street\nDenver, Colorado 80222\nDear Dr. Strain:\nThank you for your recent comments regarding the Indian Health Measure,\nH.R. 7852. I appreciate your interest and concern.\nAs you may be aware, H.R. 7852 is substantively the same measure as the\noriginal Indian Health legislation of this Congress, H.R. 2525, reflect-\ning the amendments added in the Senate. The Indians Subcommittee, of\nwhich I am a member, is scheduled to \"mark-up\" the bill next week.\nSeveral amendments are expected before the Subcommittee, including an\nauthorization for an American Indian School of Medicine and increased\nfunding for Indian mental health and alcoholism programs.\nStaff counsel for the Subcommittee expects a bill to be reported to the\nfull House Interior Committee early in November. There is also a good\nchance that the full committee will draft a \"clean bill,\" or new piece of\nlegislation, encompassing all of the amendments from the House and Senate.\nIt should be ready for reporting to the floor before 1975 adjournment.\nGiven the strong bi-partisan support for this bill, in both chambers of\nthe Congress, and the seventy Members who have already co-sponsored one or\nanother of the versions, prospects for approval are very good.\nSincerely yours,\nMember dames P. of Johnson Congress\nJPJ/e\nSid - This. is Rep Jcknsons\n24ply to my Letter\nOctober 10, 1975\nThe Honorable Carl Albert\nSpeaker of the House\nU.S. House of Representatives\nThe Speakers Rooms\nWashington DC 20515\nDear Speaker Albert:\nThe American Academy of Pediatrics\nIndian Health Committee, is very interested in the\nIndian Health Improvement Bill, HR 7852.\nI am a member of that Committee, and I\nfeel that we in Oklahoma, with our strong Indian\nheritage, should give this bill strong support.\nI respectfully seek and encourage your\nsupport of this legislation.\nSincerely yours,\nEMIL F. STRATTON, M. D.\nEFS/lw\nabove letter sent to:\nTed Riwenhoover - Congress of the United States,\nTom Steed\nHouse of Representatives\nFORD LIBRA Givh\nJames R. Jones\nWashington DC 20515\nJohn Jarman\nGlen English\nTED RISENHOOVER\nCOMMITTEE ON PUBLIC WORKS\n2D DISTRICT, OKLAHOMA\nAND TRANSPORTATION\nSUBCOMMITTEES:\nJOE CARTER\nECONOMIC DEVELOPMENT\nADMINISTRATIVE ASSISTANT\nWASHINGTON OFFICE:\nCongress of the United States\nINVESTIGATIONS AND REVIEW\nPUBLIC BUILDINGS AND GROUNDS\n1407 LONGWORTH BUILDING\n(202) 225-2701\nhouse of Representatives\nCOMMITTEE ON\nINTERIOR AND INSULAR AFFAIRS\nDISTRICT OFFICES:\nBlashington, D.C. 20515\nSUBCOMMITTEES:\nPATRICK O'REILLY\nPUBLIC LANDS\nFEDERAL BUILDING, ROOM 102\nINDIAN AFFAIRS\nMUSKOGEE, OKLAHOMA 74401\nWATER AND Power RESOURCES\n(918) 687-7509\nMarch 16, 1976\nSELECT COMMITTEE ON AGING\nBILL WILLIS\nSUBCOMMITTEES:\n109 EAST DELAWARE\nFEDERAL, STATE AND COMMUNITY\nTAHLEQUAH, OKLAHOMA 74464\nSERVICES\n(918) 456-0591\nEmil F. Stratton, M.D., F.A.A.P.\nMemorial Medical Building\n443 North 16th Street\nMuskogee, Oklahoma 74401\nDear Dr. Stratton:\nThank you for taking the time to write informing me of your\nconcern for the future of the Indian Health Services Bill--\nH. R. 2525.\nIt has been my opportunity to be one of the principal workers\non this bill as it was considered in both Indian Affairs Sub-\ncommittee and full Interior and Insular Affairs Committee, both\nof which I am a member. You can be assured that I have done\neverything within my Congressional powers to insure passage\nof this badly-needed legislation.\nIn full Interior Committee, we encountered little adamant\nopposition---the strongest being from Congressman Joe Skubitz\nof Kansas. We were able to avoid the inclusion of detrimental\namendments for the most part. However, I do foresee a consider-\nable floor battle when this is brought to the Floor for final\nconsideration. I am working closely with the House Leadership\nto enable us to have the greatest chance for success in passing\nthis bill.\nAgain, thanks for writing and if I may be of service or assistance\nregarding this or any matter, please do not hesitate to call on\nme. You have my kindest personal regards.\nSincerely,\nTed\nTed Risenhoover, M.C.\nTR:Cjp\nTED RISENHOOVER\nCOMMITTEE ON\n2D DISTRICT, OKLAHOMA\nEDUCATION AND LABOR\nSUBCOMMITTEES:\nJOE CARTER\nLABOR STANDARDS\nADMINISTRATIVE ASSISTANT\nWASHINGTON OFFICE:\nCongress of the United States\nCOMPENSATION, MANPOWER, HEALTH\nAND SAFETY\n1407 LONGWORTH BUILDING\nELEMENTARY, SECONDARY AND\n(202) 225-2701\nVOCATIONAL EDUCATION\nhouse of Representatives\nBILL WILLIS\nCOMMITTEE ON\nDISTRICT OFFICE DIRECTOR\nROOM 102, FEDERAL BUILDING\nMashington, D.C. 20515\nINTERIOR AND INSULAR AFFAIRS\nMUSKOGEE, OKLAHOMA 74401\nSUBCOMMITTEES:\n(918) 687-7509\nPUBLIC LANDS\nINDIAN AFFAIRS\nJOHN TENNISON\nWATER AND POWER RESOURCES\nLABOR LIAISON\nTAMLEQUAH DISTRICT OFFICE:\n109 EAST DELAWARE\nSELECT COMMITTEE ON AGING\nTAHLEQUAH, OKLAHOMA 74464\nOctober 28, 1975\nSUBCOMMITTEE,\n(918) 456-0591\nFEDERAL STATE AND COMMUNITY\nSERVICES\nDr. Emil F. Stratton, M. D.\nMemorial Medical Building\n443 North 16th Street\nMuskogee, Oklahoma 74401\nDear Dr. Stratton:\nThank you for writing to inform me of your support for the Indian\nHealth Improvements Bill, H. R. 7852. Please know that I join you in\nyour support of this legislation.\nYou may be interested to know that I have co-sponsored similar legisla-\ntion, H. R. 2525, which I have enclosed for your information. I feel\nthat Indians in general have been reluctant to enter health professions\nat the same rate as other races.\nCurrently, H. R. 7852 is with the House Interior and Insular Committee's\nsubcommittee on Indian Affairs. I am a member of this subcommittee and\nwe finished hearings on the bill on September 26th. It is now awaiting\nbeing reported out of subcommittee back to the full committee for their\nconsideration.\nYou may be assured that I will continue to do all I can to insure that\nIndians have the best health opportunities available and to encourage\nthem to enter the health-care profession.\nIf I may be of service or assistance to you in the future, please do not\nhesitate to let me know.\nSincerely,\nJed\nTed Risenhoover, M. C.\nTR:Cvm\nEnclosure\nBOB ECKHARDT\nCOMMITTEE ON\n8TH DISTRICT, TEXAS\nINTERIOR AND INSULAR AFFAIRS\nCOMMITTEE ON\nSUBCOMMITTEES:\nINTERSTATE AND FOREIGN\nNATIONAL PARKS AND RECREATION\nCOMMERCE\nENERGY AND THE ENVIRONMENT\nMINES AND MINING\nSUBCOMMITTEES:\nCONSUMER PROTECTION AND FINANCE\nENERGY AND POWER\nCONGRESS OF THE UNITED STATES\nHOUSE OF REPRESENTATIVES\nWASHINGTON, D.C. 20515\nMarch 24, 1976\nDr. Emil F. Stratton\nMemorial Medical Building\n443 North 16th Street\nMuskogee, Oklahoma\nDear Dr. Stratton:\nThank you for your letter concerning H.R. 2525, the\nIndian Health Care Improvement Act. This landmark\nlegislation was approved by the House Interior Com-\nmittee on March 2, 1976.\nSincerely,\nBob Eckhardt\nALAN STEELMAN\n5TH DISTRICT, TEXAS\nWASHINGTON OFFICE:\n437 CANNON House OFFICE BUILDING\nWASHINGTON, D.C. 20515\nCOMMITTEES:\n(202) 225-2231\nGOVERNMENT OPERATIONS\nINTERIOR AND INSULAR AFFAIRS\nCongress of the United States\nDALLAS OFFICE:\n1100 COMMERCE STREET, SUITE 9C60\nhouse of Representatibes\nDALLAS, TEXAS 75242\n(214) 749-7277\nMashington, D.C. 20515\nMarch 30, 1976\nDr. Emil F. Stratton\n443 North 16th St.\nMuskogee, Oklahoma\nDear Dr. Stratton:\nThank you for your letter regarding HR 2525.\nI regret that I cannot give you a detailed reply because I have\nneither the staff nor the facilities to answer mail received\nfrom outside of Texas. Please be assured, however, I intend to\nsupport on the floor the Indian Health Improvement Act as reported\nby the full House Interior Committee.\nThank you again for writing.\nSincerely,\nThe\nALAN STEELMAN\nMember of Congress\n5th District, Texas\nAS:wsc\nTHIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS\nThe Speaker's Rooms\nH. $. House of Representatives\nWashington, B. C. 20515\nJuly 22, 1975\nEmil F. Stratton, M.D.\nMemorial Medical Building\n443 N. 16th Street\nMuskogee, Oklahoma 74401\nDear Dr. Stratton:\nThank you for your recent letter in support of the Indian\nHealth Care Improvement Act, S.522.\nA similar bill, H.R.2525, is currently being considered by\nthe Subcommittee on Indian Affairs of the House Committee on\nInterior and Insular Affairs. This Subcommittee has been\nholding field hearings across the country which will wind up in\nWashington, D.C., in September.\nThank you for having written. I am sure Congressman\nRisenhoover will want to have your views on this important\nlegislation.\nBest wishes.\nSincerely,\nCarl albert\nThe Speaker\nCA/km\nJOHN JARMAN\nCOMMITTEE:\n5TH DISTRICT, OKLAHOMA\nSCIENCE AND TECHNOLOGY\nCongress of the United States\nhouse of Representatives\nHashington, D.C. 20515\nOctober 15, 1975\nEmil F. Stratton, M. D.\nMemorial Medical Building\n443 North 16th Street\nMuskogee, Oklahoma\nDear Dr. Stratton:\nThis will acknowledge receipt of your letter of October 10th,\nwhich I have read with care. In response, let me report to\nyou that the House Interior and Insular Affairs Committee has\ncompleted its hearings on H. R. 7852, the Indian Health Improve-\nment bill and will be meeting in mark-up sessions during the\nweek of October 20th. I intend to discuss your letter with\nMembers serving on the Committee urging that every considera-\ntion be given to your views. Rest assured that I will have\nyour position firmly in mind as and when the matter comes before\nthe House for debate and a vote.\nWith every good wish, I remain,\nSincerely,\nJJ:wg\nJohn Aarman JOHN JARYAN, M. C.\n6/16/75\nSAM STEIGER\nCOMMITTEES:\n3RD DISTRICT, ARIZONA\nINTERIOR AND INSULAR AFFAIRS\nGOVERNMENT OPERATIONS\n2432 RAYBURN BUILDING\nWASHINGTON, D.C. 20515\n202-225-4576\nCongress of the United States\nDISTRICT OFFICE:\n5015 FEDERAL BUILDING\nPHOENIX, ARIZONA 85025\nhouse of Representatives\n602-261-4041\nWashington, D.C. 20515\nJune 10, 1975\nDr. Sidney R. Kemberling, M.D.\nCommittee on Indian Health\n1601 N. Tucson Blvd., #35\nTucson, AZ 85716\nDear Dr. Kemberling\nThank you very much for your recent letter regarding legislation\nfor Indian Health Improvement.\nYou will be pleased to know that I am going to cosponsor the\nSenate version.\nMany thanks and best wishes.\nSincerely\nEan Enger\nSAM STEIGER, M.C.\nSS: jm\nTHIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS\n81/6/74\nMORRIS K. UDALL\nCOMMITTEES:\n2D DISTRICT OF ARIZONA\nINTERIOR AND INSULAR AFFAIRS\nPOST OFFICE AND CIVIL SERVICE\nCongress of the United States\nDouse of Representatives\nWashington, D.C. 20515\nAugust 13, 1974\nDr. Sidney R. Kemberling, M. D.\nChairman, American Academy of Pediatrics\nIndian Health Committee\n1601 North Tucson Boulevard, #35\nTucson, Arizona 85716\nDear Dr. Kemberling:\nI greatly appreciated your recent letter regard-\ning my Indian Health Bill. I have pressed the Indian\nAffairs Subcommittee to hold hearings on this bill as\nsoon as possible. However, as of this date, they have\nnot yet been scheduled.\nThank you for your continued support.\nSincerely,\nem\nORD\nTHIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS\n11/5/75\nJAMES P. JOHNSON\n4TH DISTRICT. COLORADO\nOFFICE ADDRESS:\n129 CANNON BUILDING\nWASHINGTON D.C. 20515\nCOMMITTEES\n(202) 225-4676\nAGRICULTURE\nCongress of the United States\nDISTRICT OFFICES:\n203 FEDERAL BUILDING\nHouse of Representatives\nFORT COLLINS. COLORADO 80521\nINTERIOR AND INSULAR AFFAIRS\n(303) 493-9132\nFEDERAL BUILDING\nSELECT COMMITTEE ON\nINTELLIGENCE\nWashington, D.C. 20515\nGRAND JUNCTION, COLORADO 81501\n(303) 243-1736\nOctober 24, 1975\nROOM 9. 230 MAIN STREET\nFORT MORGAN, COLORADO 80701\n(303) 867-8909\n719 GRAND AVENUE\nGLENWOOD SPRINGS. COLORADO 81601\n(303) 945-6491\nP.O. Box 21203\nJames E. Strain, M.D., P.C.\nDENVER, COLORADO 80221\n(303) 427-6439\n556 South Jersey Street\nDenver, Colorado 80222\nDear Dr. Strain:\nThank you for your recent comments regarding the Indian Health Measure,\nH.R. 7852. I appreciate your interest and concern.\nAs you may be aware, H.R. 7852 is substantively the same measure as the\noriginal Indian Health legislation of this Congress, H.R. 2525, reflect-\ning the amendments added in the Senate. The Indians Subcommittee, of\nwhich I am a member, is scheduled to \"mark-up\" the bill next week.\nSeveral amendments are expected before the Subcommittee, including an\nauthorization for an American Indian School of Medicine and increased\nfunding for Indian mental health and alcoholism programs.\nStaff counsel for the Subcommittee expects a bill to be reported to the\nfull House Interior Committee early in November. There is also a good\nchance that the full committee will draft a \"clean bill,\" or new piece of\nlegislation, encompassing all of the amendments from the House and Senate.\nIt should be ready for reporting to the floor before 1975 adjournment.\nGiven the strong bi-partisan support for this bill, in both chambers of\nthe Congress, and the seventy Members who have already co-sponsored one or\nanother of the versions, prospects for approval are very good.\nSincerely yours,\nJim James P, Johnson Johnson\nMember of Congress\nJPJ/e\nSid - This. is Rep Jekusons\nreply to my Letter\n9/15/75\nNINETY-FOURTH CONGRESS\nCHARLES CONKLIN\nSTAFF DIRECTOR\nJAMES A. HALEY, FLA., CHAIRMAN\nROY A. TAYLOR, N.C.\nJOE SKUBITZ, KANS.\nLEE MC ELVAIN\nMADOLD T. JOHNSON, CALIF.\nSAM STEIGER, ARIZ.\nGENERAL COUNSEL\nMORRIS K. UDALL, ARIZ.\nDON H. CLAUSEN, CALIF.\nCOMMITTEE ON INTERIOR AND INSULAR AFFAIRS\nPHILLIP BURTON. CALIF.\nPHILIP E. RUPPE, MICH.\nMICHAEL C. MARDEN\nROBERT W. KASTENMEIER, WIS.\nMANUEL LUJAN, JR., N. MEX.\nKEITH G. SEBELIUS, KANS.\nU.S. HOUSE OF REPRESENTATIVES\nPATSY T. MINK, HAWAII\nMINORITY COUNSEL\nLLOYD MEEDS. WASH.\nALAN STEELMAN, TEX.\nDON YOUNG, ALASKA\nWASHINGTON, D.C. 20515\nABRAHAM KAZEN, JR., TEX.\nROBERT G. STEPHENS, JR., GA.\nROBERT E. BAUMAN, MD.\nJOSEPH P. VIGORITO, PA.\nSTEVEN D. SYMMS, IDAHO\nJOHN MELCHER, MONT.\nJAMES P. (JIM) JOHNSON, COLO.\nTENO RONCALIO, WYO.\nROBERT J. LAGOMARSINO, CALIF.\nJONATHAN B. BINGHAM, N.Y.\nVIRGINIA SMITH, NEBR.\nJOHN F. SEIBERLING, OHIO\nSHIRLEY N. PETTIS, CALIF.\nHAROLD RUNNELS, N. MEX.\nANTONIO BORJA WON PAT, GUAM\nRON DE LUGO, V.I.\nBOB ECKHARDT, TEX.\nGOODLOE E. BYRON, MD.\nSeptember 8, 1975\nJAIME BENITEZ. P.R.\nJIM SANTINI, NEV.\nPAUL E. TSONGAS, MASS.\nALLAN T. HOWE, UTAH\nFill\nJAMES WEAVER, OREG.\nBOB CARR, MICH.\nGEORGE MILLER, CALIF.\nTHEODORE M. (TED) RISENHOOVER,\nOKLA.\nWRIGHT PATMAN, TEX.\nAmerican Academy of Pediatrics\nSidney R. Kemberling, M.D.\n1601 N. Tucson Blvd. Suite 35\nTucson, Arizona 85716\nDear Dr. Kemberling:\nThank you for accepting my invitation to testify\non H.R. 2525, and related legislation, the Indian Health\nCare Improvement Act. I have scheduled your appearance\nbefore my Subcommittee on September 25, 1975, Thursday,\nat 10:45 A.M. in 1324 Longworth HOB (main Interior Committee\nhearing room). As requested, I am scheduling Dr. Nichols,\nof the American College of Obstetricians to follow you.\nI look forward to your testimony, Dr. Kemberling,\nand I thank you for your interest in this very important\npiece of legislation.\nSincerely yours,\nLloyd Meeds,\nChairman,\nIndian Affairs Subcommittee\nLM/jp\nCC: AAP-Va. office.\n8/12/75\nto\n8/16/75\nFile Drgn Tody\nTalbed\nACOG\npeople -\nMe Cale. +\nDISTRICT CHAIRMEN\nPRESIDENT\nMERRITT'S. LOW, M.D.\n86 HIGH STREET\nGREENFIELD, MASS. 01301\nVICE-PRESIDENT\nAMERICAN ACCORDANCE\nSPRAGUE W. HAZARD, M.D.\nWALTHAM, MASSACHUSETTS\nMILTON GORDON, M.D.\nHUNTINGTON, NEW YORK\nDAVID W. VAN GELDER, M.D.\nWILLIAM A. HOWARD, M.D.\n888 TARA BOULEVARD\nWASHINGTON, D.C.\nBATON ROUGE, LOUISIANA 70806\nPEDIATRIC\nEDWIN L. KENDIG, JR., M.D.\nEXECUTIVE DIRECTOR\nRICHMOND, VIRGINIA\nROBERT G. FRAZIER, M.D.\nBRUCE D. GRAHAM, M.D.\nAmerican Academy of Pediatrics\nCOLUMBUS, OHIO\nASSOCIATE DIRECTOR\nRICHARD W. OLMSTED, M.D.\nR. DON BLIM, M.D.\nKANSAS CITY, MISSOURI\nSECRETARY\nGERALD E. HUGHES, M.D.\nBLAIR E. BATSON, M.D.\nJACKSON, MISSISSIPPI\nTREASURER\nP.O. BOX 1034\nEVANSTON, ILLINOIS 60204\nJAMES E. STRAIN, M.D.\nGEORGE A. NAUMAN\nEVANSTON (312) 869-4255 CHICAGO (312) 273-3646\nDENVER, COLORADO\nSAUL J. ROBINSON, M.D.\nSAN FRANCISCO, CALIFORNIA\nGUILLERMO GUILLEN-ALVAREZ, M.D.\nSAN SALVADOR, EL SALVADOR\nREPLY TO:\nHELIO SEBASTIAO DE MARTINO, M.D.\nR. Don Blim, M.D.\nRIO DE JANEIRO, BRASIL\n4320 Wornall Road\nJOSE MARIA ALBORES: M.D.\nBUENOS AIRES, ARGENTINA\nKansas City, Missouri 64111\n22 March 1976\nWillis F. Stanage, M.D.\nYankton Clinic\n400 Park Avenue\nYankton, South Dakota 57078\nDear Bill:\nThank you for your letter of 5 March 1976, regarding the\nIndian Health Bill. I was sorry that I didn't get a chance\nto talk to you during our district meeting, but your message\narrived after the meeting and, when I called, I received a\nrecorded message from your clinic. I tried to get through\nthe answering service but your answering service is almost\nas effective as is ours in avoiding such attempts. Never-\ntheless, I was unable to get through - thus missing your\nmessage.\nI am aware of the activities regarding the Indian Health Bill -\nI am aware that it passed committee and is headed for the Ways\nand Means Committee, subsequently the Rules Committee and ul-\ntimately to the House. It is my understanding that it will be\nheard on the floor of the House sometime in April. To my know-\nledge there are 84 co-sponsors.\nAs you know, the AAP is becoming more involved in legislative\naffairs, having formed the Legislative Issues Committee. This\ncommittee was scheduled to meet in New Orleans a week or two\nago and, undoubtedly, this was one of the items on their agenda.\nWe are developing a mechansim whereby we can communicate with\nkey legislative leaders and indeed with all members of the legi-\nslature when appropriate. The mechanisms are being sophisticated\nby George Degnon and his office and will be coming increasingly\neffective as demonstrated in the recent override of the Presidential\nveto of 8063.\n(Continued\n22 March 1976\n-2-\nWe 11 keep on top of it and do what we can to help the Indian\nHealth Committee.\nThanks very much for your continued interest. I am sorry you\nwon't be in Nebraska on the 27th, but hopefully will see you\nin Philadelphia in April.\nSincerely,\nDon\nR. Don Blim, M.D., F.A.A.P.\nChairman, District VI\nRDB/a\nMarch 5, 1976\nThe Honorable Robert 11. Kastenmeier (D-Wisc)\nHouse of Representatives\nWashington, D.C. 20515\nDear Mr. Kastenmeier:\nAs a concerned private citizen and also as a member of the American\nAcademy of Pediatrics Committee on Indian Health, I am writing to\nyou concerning the Indian Health Improvement Bill. I would solicit\nyour support of this bill. As a personal observation, it would ap-\npear that the bill will alleviate problems that have developed over\nthe years. It is disappointing to see a measure so important in the\nhealth and welfare of our Indian people becoming entangled in the web\nof politics.\nSincerely yours,\nW. F. Stanage, M.D.\nWFS:fn\nSame letter typed and mailed to the following:\nJoe Skubitz, (R-Kan)\nKeith G. Sebelium (R-Kan)\nVirginia Smith, (R-Nebr)\nMarch 5, 1976\nR. Don Blim, M.D.\n4320 Wornall Road\nKansas City, Missouri 64111\nDear Don:\nI am writing to you concerning the Indian Health Bill that evidently is\nnow meeting some opposition in the House of Representatives. Evidently,\nearlier, a noncontroversial bill, and has now become a controversial bill.\nI did talk to you about this last October, at which time you had contact\nwith George Degnon, and he felt it was better to wait until the latter\npart of the year to do anything about. it.\nI called you last Friday, in Chicago, hoping that you could bring this to\nthe attention of all members of the district, but evidently my message did\nnot get through to you. I have written letters to Representatives Kasten-\nmeier, Skubitz, Sebelium, and Smith. I am sure if people from the states\nwhere these representatives are from would write or contact them, this\nwould be more meaningful than anyone else.\nI bring this to your attention at the request of Sid Kemberling, and trust\nyou will do what is necessary.\nI see the Nebraska Pediatric Society is meeting on the 27th of March, and\nyou are going to be there. Unfortunately, I have a conflict at that time\nso will not be able to attend.\nSincerely yours,\nW. F. Stanage, M.D.\nWFS:fn\nNovember 7, 1975\nJean D. Lockhart, M.D.\nDirector\nDepartment of Committees\nThe American Academy of Pediatrics\nExecutive Office\n1801 Hinman Avenue\nEvanston, Illinois 60204\nDear Jean:\nToby Zimmer called the other day and requested recommendations\nfrom the Rapid City meeting. I have very little comment in\naddition to what we discussed at our final meeting. It appears\nthat some of the major problems were not exactly health prob-\nlems, except the general aspect they play in recruiting health\npeople. These problems were mainly related to housing and\nschools. Certainly, these problems must be alleviated in order\nto upgrade the health care. I think the Area should be com-\nmended on using trained midwives and the pediatric nurse prac-\ntitioner. I would also recommend that the position that the\nCHR plays in the health team should be evaluated. They should\nhave a more vital role than being used as chauffeurs. I think\nMr. Hank Bouker should be commended for presenting such a well\norganized program. My only true disappointment was the pessi-\nmism in the recruiting approach of the Public Health Nurse,\nMrs. McArdle.\nSincerely yours,\nW. F. Stanage, M.D.\nWFS:fn\nLARRY PRESSLER\nWASHINGTON OFFICE:\n1ST DISTRICT. SOUTH DAKOTA\n1238 LONGWORTH HOUSE OFFICE BUILDING\nWASHINGTON, D.C. 20515\n(202) 225-2801\nRESIDENCE:\nRURAL ROUTE No. 1\nHUMBOLDT, SOUTH DAKOTA\nCongress of the United States\nDISTRICT OFFICES:\n310 FEDERAL BUILDING\nDouse of Representatives\nABEROEEN, SOUTH DAKOTA 57401\nCOMMITTEES:\n(605) 225-0250 EXT. 471\nEDUCATION AND LABOR\nSCIENCE AND TECHNOLOGY\nWashington, D.C. 20515\n317 SOUTH PHILLIPS AVENUE\nSioux FALLS. SOUTH DAKOTA 57102\n(605) 336-2980 EXT. 433\nMOBILE VAN-ON THE ROAD\nOctober 22, 1975\nW. F. Stanage, M.D.\nYankton Clinic P.A.\n400 Park Avenue\nYankton, South Dakota 57078\nDear Dr. Stanage:\nThank you for your letter expressing your support of H.R. 7852, the\nIndian Health Improvement Act.\nI share your views about the importance of improving health care to\nIndians, and I was distressed at the statistics presented at the hearings\non this legislation showing the inadequacies of Indian health care services.\nThe per capita expenditures for Indian health care are 30 to 40 per cent\nless than those in an average American community; more than half of the\nIndian Health Service hospitals do not meet accreditation requirements.\nThese statistics are just some of the glaring examples supporting the\nneed for this legislation.\nH.R. 7852 is presently pending before the Subcommittee on Indian Af-\nairs of the House Interior Committee. Hearings were completed on this\nbill September 26. It is expected that the Subcommittee will begin to\nmark-up this legislation shortly.\nI appreciate your taking the time from your busy day to let me hear\nfrom you and I look forward to further correspondence on other issues of\nmutual concern.\nSincerely,\nLarry Lany Pressler\nMember of Congress\nLP:jr\n11/12/75\nINTERNAL MEDICINE\nGENERAL SURGERY\nT. H. SATTLER. M.D.\nYANKTON CLINIC P.A.\nC. B. MCVAY, M. D.\nR. F. THOMPSON. M. D.\nL. E. SAVAGE. M.D.\n400 PARK AVENUE\nR.I. PORTER, M. D.\nK. HALVERSON. M.D.\nW.W.QUICK,M.D.\nYANKTON. SOUTH DAKOTA 57078\nOBSTETRICS AND GYNECOLOGY\nTELEPHONE 605/655-7822\nORTHOPEDIC SURGERY\nBROOKS RANNEY. M. D.\nJ. K. JACKSON. M. D.\nR. R. THORNTON. M D.\nR. c. LESHER, M. D.\nCLINIC MANAGER\nD. R. HOLZWARTH. M.D.\nS. A BRAASTAD\nLABORATORY\nJ. G. HEEMSTRA. M. S.\nPEDIATRICS\nW. F. STANAGE. M.D.\nC.ISBURG, M. D.\nNovember 8, 1975\nSydney Kemberling, M.D.\n1601 North Tucson Boulevard\nTucson, Arizona 85716\nDear Syd:\nI am enclosing a copy of a letter that I received from\nour Representative in Congress, Larry Pressler. I am\nalso enclosing a copy of a letter that I sent to Jean\nLockhart concerning recommendations at the Rapid City\nmeeting.\nIf there is anything that we can do out here to facili-\ntate the work of Dr. Weil, in relating to any of the\nreservations, I would be glad to help. I am sure this\nalso goes for Tom Aceto, who is Chairman of the Depart-\nment of Pediatrics at South Dakota.\nSill Sincerely yours,\nW. F. Stanage, M.D.\nWFS:fn\nEnclosures\nFile c glass full\nHENRY J. NOWAK\n37TH DISTRICT, NEW YORK\nROOM 1223\nLONGWORTH HOUSE OFFICE BUILDING\nCOMMITTEES:\nTELEPHONE: (202) 225-3306\nPUBLIC WORKS AND\nTRANSPORTATION\nCongress of the United States\nHOME OFFICE:\nU.S. COURTHOUSE\nDISTRICT OF COLUMBIA\nBUFFALO, N.Y. 14202\nhouse of Representatives\nTELEPHONE: (716) 853-4131\nWashington, D.C. 20515\nOctober 20, 1975\nDr. Henry P. Staub\nAssociate Professor of Pediatrics\nSUNY at Buffalo\n203 Woodbridge Avenue\nBuffalo, New York 14214\nDear Dr. Staub:\nThank you for your letter calling my attention to H.R. 2525\nand H. R. 7852.\nAs you may know, the House Subcommittee on Indian Affairs\nhas completed hearings on these and several other Indian health\nbills, and markup is scheduled October 28 and 29. Although exact\npredictions are chancey before a bill is reported out, my under-\nstanding is that the committee is leaning toward the language of\nH. R. 7852. It is likely that a clean bill, with the broader\ncoverage of H. R. 7852 and some other refinements, will be intro-\nduced when the legislation is reported to full committee.\nI do appreciate hearing from you on this matter, and your\ncomments will be most helpful when it reaches the House floor\nfor consideration.\nWith best wishes and kindest regards,\nSincerely yours,\nHENRY NOWAK\nP.S. I have agreed to co-sponsor the clean bill when it is intro-\nduced, and will send you a copy when it is printed.\nH.J.N.\n11/3/75\nEdward J. Meyer Memorial Hospital\nOwned and Operated by the County of Erie\n462 GRIDER STREET\nBUFFALO, NEW YORK 14215\nAREA CODE 716 894-1212\nADVISORY BOARD\nEDWARD V. REGAN\nFREDERIC P. NORTON, Chairman\nJEAN AUGUST MARTIN, Vice Chairman\nERIE COUNTY EXECUTIVE\nMRS. RICHARD R. ROMANOWSKI, Secretary\nGUY S. ALFANO, M.D.\nEDWARD F. MARRA, M.D.\nMARSHALL G. AUSE\nBURNICE E. BALLARD\nHOSPITAL DIRECTOR\nMRS. FRANK A. SEDITA\nHenry P. Staub, M.D., Director\nDepartment of Pediatrics\nOctober 28, 1975\nSidney Kemberling, M.D.\nCommittee on Indian Health\nAmerican Academy of Pediatrics\n1601 N. Tucson Blvd. Suite 35\nTucson, Arizona 85716\nDear Sid:\nEnclosed is a copy of the letter that I received from\nCongressman Henry J. Nowak agreeing to sponsor the Indian Health\nCare Improvement Act H.R. 2525 or H.R. 7852. I wrote to him\nin response to your telephone call. I will check with Congressman\nNowak later regarding follow up.\nSincerely,\nHenry\nHenry P. Staub, M.D.\ncan\nFORD\nEnclosure\nSEAL\n3/5/2016\nMANUEL LUJAN, JR.\nDISTRICT OFFICES:\n1ST DISTRICT, NEW MEXICO\n3006 FEDERAL BUILDING AND POST OFFICE\nSANTA FE, NEW MEXICO 87501\nCOMMITTEE:\nAREA CODE 505: 988-6521\nINTERIOR AND INSULAR AFFAIRS\nCongress of the United States\n10001 FEDERAL BUILDING\nALBUQUERQUE, NEW MEXICO 87103\nJOINT COMMITTEE\nATOMIC ENERGY\nhouse of Representatives\nAREA CODE 503:766-2538\nDOUGLAS AND GRAND AVE.\nWASHINGTON OFFICE:\n1323 LONGWORTH HOUSE OFFICE BUILDING\nWashington, D.C. 20515\nP.O. 1123\nLAS VEGAS, NEW MEXICO 87701\nAREA CODE 202:225-6316\nAREA CODE 505: 425-7838\nFebruary 25, 1976\nAlice H. Cushing, M.D.\nAssociate Professor\nDepartment of Pediatrics\nSchool of Medicine\nThe University of New Mexico\nAlbuquerque, New Mexico 87131\nDear Alice,\nThank you for your letter concerning the Indian Health\nImprovement legislation.\nI am not sure where you heard that the Interior Committee\nis holding this up, but I am sure you will be happy to know\nthat this is not the case. As a matter of fact, it was the\nsubject of hearings yesterday and today by the full Committee,\nand we will begin work on it again next Tuesday.\nI appreciate your taking the time to write, and if I can\nbe of assistance in the future, don't hesitate to call on me.\nSincerely,\nMum\nManuel Lujan, Jr.\nML/pap\nFile\nbree diass 3 Health AAP\nDISTRICT CHAIRMEN\nPRESIDENT\nMERRITT B LOW. M.D.\n86 HIGH STREET\nTHE AMERICAN\nSPRAGUE W. HAZARD, M.D.\nWALTHAM, MASSACHUSETTS\nGREENFIELD. MASS. 01301\nMILTON GORDON, M.D.\nVICE-PRESIDENT\nHUNTINGTON, NEW YORK\nDAVID W. VAN GELDER. M.D.\nWILLIAM A. HOWARD, M.D.\n888 TARA BOULEVARD\nWASHINGTON, DISTRICT OF COLUMBIA\nBATON ROUGE, LOUISIANA 70806\nOK\nPEDIATRIC\nEDWIN L. KENDIG, JR., M.D.\nEXECUTIVE DIRECTOR\nRICHMOND, VIRGINIA\nROBERT G. FRAZIER, M.D.\nBRUCE D. GRAHAM, M.D.\nASSOCIATE DIRECTOR\nAmerican Academy of Pediatrics\nCOLUMBUS. OHIO\nRICHARD W. OLMSTED. M.D.\nR DON BLIM, MD\nSECRE TARY\nKANSAS CITY, MISSOURI\nGERALD & HUGHES S. MD\nBI AIR E. BATSON. M.D\nJACKSON. MISSISSIPPI\nTHE ASURER\nGEORGE A NAUMAN\nDEPARTMENT OF GOVERNMENT LIAISON\nJAMES E. STRAIN, M.D\nDENVER, COLORADO\n1800 N. KENT ST., SUITE 1102\nSAUL J. ROBINSON, M.D.\nARLINGTON, VIRGINIA 22209\nSAN FRANCISCO, CALIFORNIA\nGUILLERMO GUILLEN-ALVAREZ M.D.\nPHONE: 703-525-9560\nSAN SALVADOR, EL SALVADOR\nHELIO SEBASTIAO DE MARTINO, M D.\nRIO DE JANEIRO, BRASIL\nFebruary 12, 1976\nJOSE MARIA ALBORES, M.D.\nBUENOS AIRES, ARGENTINA\nHenry P. Staub, M. D.\nEdward J. Meyer Memorial Hospital\n462 Grider Street\nBuffalo, NY 14215\nDear Dr. Staub:\nTo answer your letter of January 21, I wish I could send you a more\noptimistic report than I can on the Indian Health Care Improvement Act.\nThe Subcommittee on Indian Affairs presented its report - a version\nreportedly close to HR 7852 to the full Committee on Interior and\nInsular Affairs on February 3. The next step is for the full Committee\nto review it, make whatever changes, and to report to the House of\nRepresentatives. Unfortunately, there will be a period of delay with\nthis step, apparently because the Administration has some problems with\nthe amounts of money and the time frame of the bill. The full Committee\nmay not consider the bill until Spring.\nAfter the House of Representatives passes a bill, it still must go to\nHouse-Senate Conference. Right now, the Indian Affairs staffers are\nlooking toward the summer for some resolution of this.\nIf I get other information to modify this lack-of-progress report, I\nwill certainly let you know.\nSincerely,\nRebecca Dinkel\nResearch Assistant\nRD:cb\ncc: Sidney R. Kemberling, M. D.\n3/10/76\nState of California\nDepartment of Health\nMemorandum\nTo\n: Dr. Saul J. Robinson\nDate : March 2, 1976\nDr. Melvin H. Schwartz\nDr. Milton L. Arnold\nSubject: Information on the Indian\nDr. Alan E. Shumacher\nHealth Care Improvement Act\nDr. Carl A. Erickson\n(HR, 2525).\nDr. S. Freudenberger\nN\nFrom : Theodore A. Montgomery, M.D.\nRecently I received a telephone call from Dr. Sid Kemberling, Chairman of\nthe National Committee on Indian Health, AAP, regarding the Indian Health\nCare Improvement Act (HR 2525).\nAttached is some further detail about the bill that I just received from the\nAcademy's Washington office.\nThe bill is stuck in the Interior Committee and as much help as can be\nmustered is needed to get it moving again.\nThere are 5 California congressmen on the committee. Would you write to your\nrepresentative if he is on the committee. If you know him personally, so\nmuch the better.\nA copy of Sid Kemberling's letter that he plans to send to several congressmen\nis attached.\nTAM:gc\nAttachment\ncc: Dr. Kemberling\nFill\n3/20/76\nALAN STEELMAN\nWASHINGTON OFFICE:\n5TH DISTRICT, TEXAS\n437 CANNON HOUSE OFFICE BUILDING\nWASHINGTON, D.C. 20515\nCOMMITTEES:\n(202) 225-2231\nGOVERNMENT OPERATIONS\nINTERIOR AND INSULAR AFFAIRS\nCongress of the United States\nDALLAS OFFICE:\n1100 COMMERCE STREET. SUITE 9C60\nhouse of Representatives\nDALLAS, TEXAS 75202\n(214) 749-7277\nWashington, D.C. 20515\nMarch 10, 1976\nWilliam B. Brendel, M.D., F.A.A.P.\n906 Basse Road\nSan Antonio, Texas 78212\nDear Dr. Brendel:\nThank you for your letter regarding HR 2525, the Indian Health\nCare Improvement Act.\nYou will be glad to know that, even though this bill was placed\non the \"controversial\" calendar, it was approved by the full\nInterior Committee on March 6. Floor action has not yet been\nscheduled.\nI voted in favor of this bill, which passed virtually intact.\nThe committee adopted one of the amendments offered by Mr. Skubitz,\nwhich would reduce Title II (health services) authorizations by\n$5.1 million (to $390 million over 7 fiscal years). I supported\nMr. Skubitz' amendment to reduce the program from seven to three\nyears, because I felt that it would be helpful to review the program,\nand possibly increase funding, sooner than the bill provides for.\nHowever, this amendment was defeated.\nThe only other amendments to the legislation were either minor or\nof a technical nature. You may be interested to know that the\ncommittee approved the bill with a two to one majority of Republicans\npresent for the markup.\nYour views and suggestions are always welcome. Please feel free to\nlet me know if I may be of assistance in the future.\nSincerely,\nt five Bill\nALAN STEELMAN\nMember of Congress\n5th District, Texas\nAS/kb\nTHIS STATIONERY PRINTED ON PAPER MADE WITH RECYCLED FIBERS\nABRAHAM KAZEN, JR.\nFill\nCOMMITTEES:\n230 DISTRICT, TEXAS\nARMED SERVICES\nINTERIOR AND INSULAR AFFAIRS\n1514 LONGWORTH HOUSE OFFICE BUILDING\nCongress of the United States\nhouse of Representatives\nWashington, D.C. 20515\nMarch 30, 1976'\nDr. William B. Brendel\n906 Basse Road\nSan Antonio, Texas 78212\nDear Dr. Brendel:\nThank you for your letter expressing interest in\nH.R. 2525 -- Indian Health Care Improvment Act. This bill has\nbeen favorably reported out of the Committee on the Interior, on\nwhich I serve. When this measure came before the full Committee, I\ngave it my full support, and will urge my colleagues in the House\nto do likewise when it is brought to the House floor.\nWith every good wish, I am\nSincerely yours,\nj\nABRAHAM KAZEN, JR. ,M.\nAK,Jr:pm\nTED RISENHOOVER\nCOMMITTEE ON\n20 DISTRICT, OKLAHOMA\nEDUCATION AND LADOR\nSUBCOMMITTEES:\nJOE CARTER\nLABOR STANDARDS\nADMINISTRATIVE ASSISTANT\nWASHINGTON OFFICE:\nCongress of the United States\nCOMPENSATION, MANPOWER, HEALTH\nAND SAFETY\n1407 LONGWORTH BUILDING\nELEMENTARY, SECONDARY AND\n(202) 225-2701\nVOCATIONAL EDUCATION\nhouse of Representatives\nBILL WILLIS\nCOMMITTEE ON\nDISTRICT OFFICE DIRECTOR\nROOM 102, FEDERAL BUILDING\nWashington, D.C. 20515\nINTERIOR AND INSULAR AFFAIRS\nMUSKOGEE, OKLAHOMA 74401\nSUBCOMMITTEES:\n(918) 687-7509\nPUBLIC LANDS\nINDIAN AFFAIRS\nJOHN TENNISON\nWATER AND POWER RESOURCES\nLABOR LIAISON\nTAHLEQUAH DISTRICT OFFICE:\n109 EAST DELAWARE\nSELECT COMMITTEE ON AGING\nTAHLEQUAH, OKLAHOMA 74464\nSUBCOMMITTEE:\n(918) 456-0591\nMarch 29, 1976\nFEDERAL, STATE AND COMMUNITY\nSERVICES\nDr. Harris D. Riley, Jr., M.D.\nThe University of Oklahoma Health\nSciences Center\nDepartment of Pediatrics\nP. 0. Box 26901\nOklahoma City, Oklahoma 73190\nDear Dr. Riley:\nThank you for your good letter of 3 March expressing your concern for.\nH. R. 2525, the Indian Health Improvement Bill.\nYou may rest assured I share your concern in this important matter. As\nyou may know, there are several Indian Health Clinics within my own\nDistrict, and even more are projected for the future. Providing proper\nhealth care to the Indian people of Oklahoma is a matter of great im-\nportance to me.\nI am taking the liberty of forwarding to you a copy of H. R. 2525, on\nwhich I am proud to say my name appears as a co-sponsor. Please know I\nwill lend my full support to the passage of this all-important legislation.\nIf I may be of any further assistance to you in this or any other matter,\nplease do not hesitate to let me know. You have my kindest regards and\nmy warmest best wishes.\nSincerely,\nTed\nTed Risenhoover, M. C.\nTR:Vm\nEnclosure\nThe Speaker's Rooms\n11. S. Bonse of Representatives\nWashington, D.C. 20313\nMarch 26, 1976\nHarris D. Riley, Jr. M.D.\nThe University of Oklahoma Health Sciences Center\nPost Office Box 26901\nOklahoma City, Oklahoma 73190\nDear Dr. Riley:\nThank you for your letter urging me to support\nH. R. 2525, the Indian Health Care Improvement legis-\nlation.\nYou will be pleased to learn- that the House\nInterior and Insular Affairs Committee has reported\nthis bill, but the report has not been sent to the\nprinters as yet. Undoubtedly, the bill will be filed\nin the near future, and there will be a vote in the House.\nLet me say that I have always been interested in\nthe welfare of our Indians and have helped to advance\nlegislation in their behalf whenever I could. I appre-\nciate hearing from you on this important legislation\nand hope you will continue to make your views known to\nme.\nWith best wishes, I am\nSincerely,\nCarl albert\nThe Speaker\nCA/vh\n4/16/76\nThe\nUniversity of Oklahoma\nHealth Sciences Center\nPost Office Box 26901 Oklahoma City, Oklahoma 73190\nDepartment of Pediatrics\nChildren's Memorial Hospital\nApril 8, 1976\nSidney R. Kemberling, M.D.\nChairman\nCommittee on Indian Health\n1601 North Tucson Boulevard\nTucson, Arizona 85716\nDear Sid:\nI am very sorry that last minute developments prevented me from\nattending the committee meeting in Asheville. I trust that you got\nmy message at the hotel pointing out what had developed and why I\ncould not attend. I hope you had a good meeting.\nEnclosed is a copy of the letters of March 26, 1976 and March 29,\n1976 from Speaker Albert and Congressman Risenhoover, respectively,\nin response to my letters. I had these in the file to give to you in\nAsheville.\nBest regards.\nSincerely,\nPets\nHarris D. Riley, Jr., M.D.\nHDR:lmc\nEnclosures (2)\nHENRY J. NOWAK\n37TH DISTRICT, NEW YORK\nROOM 1223\nLONGWORTH HOUSE OFFICE BUILDING\nTELEPHONE: (202) 225-3306\n, COMMITTEES:\nPUBLIC WORKS AND\nTRANSPORTATION\nCongress of the United States\nHOME OFFICE:\nU.S. COURTHOUSE\nDISTRICT OF COLUMBIA\nBUFFALO, N.Y. 14202\nhouse of Representatives\nTELEPHONE: (716) 853-4131\nWashington, D.C. 20515\nOctober 20, 1975\nDr. Henry P. Staub\nAssociate Professor of Pediatrics\nSUNY at Buffalo\n203 Woodbridge Avenue\nBuffalo, New York 14214\nDear Dr. Staub:\nThank you for your letter calling my attention to H.R. 2525\nand H. R. 7852.\nAs you may know, the House Subcommittee on Indian Affairs\nhas completed hearings on these and several other Indian health\nbills, and markup is scheduled October 28 and 29. Although exact\npredictions are chancey before a bill is reported out, my under-\nstanding is that the committee is leaning toward the language of\nH. R. 7852. It is likely that a clean bill, with the broader\ncoverage of H. R. 7852 and some other refinements, will be intro-\nduced when the legislation is reported to full committee.\nI do appreciate hearing from you on this matter, and your\ncomments will be most helpful when it reaches the House floor\nfor consideration.\nWith best wishes and kindest regards,\nSincerely yours,\nHENRY NOWAK\nP.S. I have agreed to co-sponsor the clean bill when it is intro-\nduced, and will send you a copy when it is printed.\nH.J.N.\n3/22/76\nBOB ECKHARDT\nCOMMITTEE ON\n8TH DISTRICT, TEXAS\nINTERIOR AND INSULAR AFFAIRS\nCOMMITTEE ON\nSUBCOMMITTEES:\nINTERSTATE AND FOREIGN\nNATIONAL PARKS AND RECREATION\nCOMMERCE\nENERGY AND THE ENVIRONMENT\nSUBCOMMITTEES:\nUNITED\nMINES AND MINING\nCONSUMER PROTECTION AND FINANCE\nENERGY AND POWER\nCONGRESS OF THE UNITED STATES\nHOUSE OF REPRESENTATIVES\nWASHINGTON, D.C. 20515\nMarch 15, 1976\nDr. William B. Brendel\n906 Basse Road\nSan Antonio, Texas 78212\nDear Dr. Brendel:\nThank you for your letter concerning H.R. 2525, the\nIndian Health Care Improvement Act. This landmark\nlegislation was approved by the House Interior Com-\nmittee on March 2, 1976.\nSincerely,\nBob Eckhardt\n3/19/76\nWASHINGTON OFFICE:\nHAROLD RUNNELS\n1535 LONGWCH\nLDING\n20 DISTRICT, NEW MEXICO\nAREA CODE 20.\n5-2365\nCOMMITTEE ON THE BUDGET\nDISTRICT OFFICES:\nCOMMITTEE ON\nINTERIOR AND INSULAR AFFAIRS\nCongress of the United States\nSUITE A, MCCRORY BUILDING\nLOVINGTON, NEW MEXICO 88260\nSUBCOMMITTER\nPUBLIC LANDS\nDouse of Representatives\nAREA CODE 605: 396-2252\nWATER AND POWER RESOURCES\nFEDERAL BUILDING, ROOM B201\nMINES AND MINING\nWashington, D.C. 20515\nLAB CRUCES, NEW MEXICO 88001\nAREA CODE non. \"11 0022\nMarch 15, 1976\nFEDERAL Budding, HooM 100\nGALLUP, NEW MEXICO 87301\nAREA CODE 505: 063-3400\nDavid B. Post, M.D., F.A.A.P.\nLa Mesa Medical Center\n7000 Cutler, N.E., Suite E-3\nFill\npost\nAlbuquerque, New Mexico 87110\nDear Dr. Post:\n&\nThank you for your letter expressing your views on the\nIndian Health Care Improvement Act.\nH. R. 2525 was ordered from the Interior and Insular\nAffairs Committee on March 2. It is now pending consider-\nation on the floor of the House of Representatives.\nThe bill would authorize $1.19 billion over seven fiscal years\nto bring Indian Health Service to parity with other health\nservices. Programs would include scholarships for health\ncareers, hiring of patient care personnel for IHS facilities,\nmodernization and construction of facilities and construction\nof a school of medicine for the training of Indian doctors.\nI have supported this legislation, participated in both field\nhearings in New Mexico and formal hearings in Washington, and\ncertainly recognize the importance of this legislation to the\nIndian community.\nAs you know, similar legislation has already passed the Senate.\nand 1 am confident that the House of Representatives will pass\na strong bill.\nI appreciate your taking the time to make me aware of your\nthoughts on this legislation.\nSincerely,\nHeard\nFORD\nHAROLD RUNNELS, M.C.\nlma\nDISTRICT OFFICES:\nMANUEL LUJAN. JR.\n3006 FEDERAL BUILDING AND POST OFFICE\n1ST DISTRICT, NEW MEXICO\nSANTA FE, NEW MEXICO 87501\nAREA CODE 505: 988-6521\nCOMMITTEE\nINTERIOR AND INSUI AR AFFAIRS\nCongress of the United States\n10001 FEDERAL BUILDING\nALBUQUERQUE. New MEXICO 87103\nJOINT COMMITTEE\nAREA CODE 505: 766-2538\nATOMIC ENERGY\nDouse of Representatives\nDougl AS AND GRAND AVE.\nWASHINGTON world #.\nWashington, D.C. 20515\nPO 11211\n1323 LONGWOR HOUSE OFFICE BUILDING\nLAS VEGAS, NEW MEXICO 07701\nAREA Code 202: 225-6316\nAREA CODE E05: 425-7838\nMarch 8, 1976\nDavid B. Post, M. D.\nLa Mesa Medical Center\n7000 Cutler, NE, Suite E-3\nAlbuquerque, New Mexico 87110\nDear Doctor Post:\nThank you for your letter urging my support for\nH.R. 7852, the Indian Health Care Improvement bill.\nI am sure you will be happy to know that I have\nco-sponsored this bill, and I hope it is enacted.\nThanks for taking the time to contact me, and if I\ncan be of assistance in the future, don't hesitate to call\non me.\nSincerely,\nManuel Lujan, Jr.\nML/pck\n3/26/96\nThe\nDEPARTMENT OF PEDIATRICS\nUniversityof Oklahoma Health Sciences Center\nChildren's Memorial Hospital\nPost Office Box 26901 Oklahoma City, Oklahoma 73190\nMarch 8, 1976\nSidney R. Kemberling, M.D.\nChairman, Committee on Indian Health\n1601 N. Tucsin Blvd.\nTucson, Arizona\nDear Sid:\nJust a note to tell you that I have send ent off a letter to the\ncongressman as well as a letter to Speaker Albert regarding the\nIndian Health Care Improvement legislation. Best regards.\nSincerely,\nPete\nHarris D. Riley, Jr., M.D.\nHDR:s1c\nTale\nDAVID B. POST, M. D.\nLA MESA MEDICAL CENTER\n7000 CUTLER, N. E., SUITE E.3\nALBUQUERQUE, NEW MEXICO 87110\nTELEPHONE 505 208-1928\nMarch 3, 1976\nFonorable Manuel I'. Lujan\n1323 Loneworth Building\nWashington, D.C. 20515\nDear Mr. Lujan,\nT AM writing to you to urge your complete and immediate support of the\nIndian Health inprovement MIL Recent information which T. have oh-\ntained Indicates the this bill has been placed on the list of contro-\nversial bills, and T am urging tha this bill be brought before the full\nbody of the Interior Committee of the House of Representatives, SO that\nfull consideration can be given to this important legislation as soon\nas possible.\nFor the unst twelve years I have been A member of the American Academy\nof Pediatrics Indian Health Committee, and during this time I have been\nhonored and priveleced to support many of the programs that improve the\nhealth and welfare conditions of the American Indian and Alaskan Native.\nNot only our committee, but many other national medical organizations\nhave been supporting and advocating Indian Health And Welfare programs\n80 that the Indian citizen standard of living may be brought up to that\nof our other Americans. Here in New Mexico I have been supporting\nprograms and legislations during this period 80 that our Indians in this\nState can achieve a high standard of living and realize the complete\nextstence of a full and productive life. The American Academy of\nPadiatrics Committee has been priveleged to visit and meet with various\nIndian Tenders on vartous reservations through out the country, and\nduring this time we have seen many of the grave and profound archlems\nwhich affect the overall welfare of the Average Indian. The Indians\nneeds are extremely great, and now for this reason I urge you to support\n10 the fullest the passage of this important measure. Our committee\nis a nolitically bi-partisan group and us feel that support should\nregin -martisan basis and therefore the bill should receive\nproport of all members of Congress who are interested in the\nvolfare of Indian people.\nThe Indian Health Improvement bill implements the responsibility of the\nfederal government for the care and the education of the Indian neonle\nhe to improve the services and the facilities of the\nIndl mchealth brograms and also encouraging the conticipation\nof the Indians themselves in such programs an 14- ... T \"In 0'11\neventually inditive complete control and responsit flit\" for bis nun\nhealth and velfare. The bill embodies basic considerations such as\ntraining education. construction of health facilities, etc., and T am\nDAVID B. POST, M.D., F.A.A.P.\nLA MESA MEDICAL CENTER\n7000 CUTLER, N. E. - SUITE E-3\nALBUQUERQUE, NEW MEXICO 87110\nTelephone 298-1928\nsure that you are completely familiar with this bill. SO that T will\nnot go into detail. The only reason for my reiterating these important\nnyovisions is that T feel these measures are completely basic and\nresponsible things that should be provided to the Indian people. T\nfeel that you. as a representative of the people of the State of New\n\"exteo. should have as one of your foremost responsibilities the mandate\nto support legislation for this very important seement of our people\nnot only here in New Mexico. but all over the country. The crisis in\nIndian health care and facilities for this basic right 18 here and now.\nand T feel that the Congress and the Administration cannot side step\nthis responsibility any longer.\nMay T count on your support for this very important measure. If\ntestimony in support of this legislation is necessar: we have members\nof our committee who are villing to testify in this behalf as we have\nin the past. T. would appreciate not only your support but a response\nto this letter.\nUntil I have the privelege of secing you again,\nMy kindest personal regards,\nDavid B. Post, M.D.\nMember of the Indian Health Committee\nAmerican Academy of Pediatrics\nDAVID B. POST, M.D., F.A.A.P.\nLA MESA MEDICAL CENTER\n3/5/76\n7000 CUTLER, N. E. SUITE E-3\nALBUQUERQUE, NEW MEXICO 87110\nTelephone 298-1928\nFrent\nMarch 3. 1976\nHonorable Harold Bunnels\n1535 Lonevorth Building\nWashingtong. D.C. 20515\nDear Mr. Runnels.\nT am writing to you to urge your complete and immediate support of the\nIndian Health improvement bill. Recent information which I have ob-\ntained indicates that this bill has been placed on the list of contro-\nversial bills. and i am orgins that this bill be brought before the full\nbody of the Interior Committee of the House of Representatives, 80 that\nfull consideration can be given to this important lesislation as soon\nas possible.\nFor the past twelve years I have been a member of the American Academy\nof Pediatrics Indian Health Committee, and during this time I have been\nhonored and priveleged to support many of the programs that improve the\nhealth and welfare conditions of the American Indian and Alaskan Native.\nNot only our committee. but many other national medical organizations\nhave been supporting and advocating Indian Health and Welfare programs\nso that the Indian citizen standard of living may be brought up to that\nof our other Americans. Here in New Mexico T have been supporting\nprograms and legislations during this period so that our Indians\nState can achieve a high standard of living and realize the complete.\nexistence of a full and productive life. The American Academy of\nPediatrics Committee has been priveleged to visit and meet with various\nIndian leaders on various reservations through out the country, and\nduring this time we have seen many of the grave and profound problems\nwhich affect the overall welfare of the average Indian. The Indians\nneeds are extremely great, and now for this reason I urge you to support\nto the fullent the passage of this important measure. Our committee\n18 a politically bi-nartisan group and we feel that support should\nremain on a h1 partisan basis and therefore, the bill should receive\ncomplete support of all members of Congress who are interested in the\nwelfare of Indian people.\nThe Indian Health Improvement bill implements the responsibility of the\nfederal covernment for the care and the education of the Indian people\nby quaranteeing to improve the services and the facilities of the\nIndian health programs and also encouraging the maximum participation\nof the Indians themselves in such programs 80 that the Indian will\neventually achieve complete control and responsibility for his own\nhealth and welfare. The bill embodies basic considerations such ns\ntraining. education, construction of health facilities. etc,, and T am\nFORD\nDAVID B. POST, M.D., F.A.A.P.\nLA MESA MEDICAL CENTER\n7000 CUTLER, N.E. - SUITE E-3\nALBUQUERQUE, NEW MEXICO 87110\nTelephone 298-1928\nsure that you are completely familiar with this bill, 80 that T will\nnot go into detail. The only reason for my reiterating these important\nprovisions 1A that I feel these measures are completely basic and\nresponsible things that should be provided to the Indian people. I\nfeel that you. as a representative of the people of the State of New\nMexico. should have AR one of your foremost responsibilities the mandate\nto support legislation for this very important segment of our people\nnot only here in New Mexico, but all over the country. The crisis in\nIndian health care and facilities for this basic right is here and now.\nand I feel that the Congress and the Administration cannot side sten\nthis responsibility any longer.\nMay T count on your support for this very important measure. If\ntestimony in support of this legislation is necessary we have members\nof our committee who are villing to testify in this behalf as we have\nin the nast. I would appreciate not only your support but a response\nto this letter.\nUntil T have the privelege of seeing you again,\nMv kindest personal regards.\nDavid B. Post. M.D.\nMember of the Indian Health Committee\nAmerican Academy of Pediatrics\nS.R. KEMBERLING, M.D.\n1601 N. TUCSON BLVD., #35\nP\nGATE 10 0\nTUCSON, AZ. 85716\n111 90 :\n401%\n28\nDR. THEODORE MARRS\nWHITE HOUSE MAIL\nSPECIAL ASSISTANT TO THE PRESIDENT\nRECEPTION & SECURITY\nTHE WHITE HOUSE\nMAY 14 1976\nProcessed by:\n5\nWASHINGTON, D.C.\nSTATE\nOF\nUnited States Department of the Interior\nBUREAU OF INDIAN AFFAIRS\nWASHINGTON, D. C. 20245\nMarch\n1849\nIN REPLY REFER TO:\nAPR 21 1975\nDear Dr. Marrs:\nThis is in response to your request for the views of this Department\non S. 522, a bill \"To implement the Federal responsibility for\nthe care and education of the Indian people by improving the services\nand facilities of Federal Indian health programs and encouraging\nmaximum participation of Indians in such programs, and for other\npurposes.\n\"\nWhile the administration of the Indian health care program is not\nunder the jurisdiction of the Bureau of Indian Affairs, we recognize\nthe urgent need to upgrade the quantity and quality of health services\nsufficiently to insure adequate health care for Indians and Alaska\nNatives. While we would support enactment of S. 522, we realize\nthat the President's announced moratorium on new Federal spending\ninitiatives in non-energy areas must be taken into consideration\n/\nin the formulation of an Administration position.\nThe unmet health needs of the American Indian and Alaska Native\npeople are severe and their health status is far below that of the\ngeneral population of the United States. In many cases, the poor\nhealth status of these people affects their ability to fully partici-\npate in and derive the benefits that accrue to them from programs\nadministered by the Federal Government. Because the low health\nstatus of the American Indian and Alaska Native people is one of\nthe most critical problems they confront, efforts to ameliorate\nthis condition are vitally necessary.\nIt is our understanding that the purpose of S. 522 is to insure a\nsignificant improvement in the health status of the American Indian\nand Alaska Native people. The bill would provide the direction\nand financial resources needed to overcome the inadequacies in the\nexisting Indian health care program. Further, S. 522 would invite\nthe greatest possible participation of Indians and Alaska Natives\nin the direction and management of that program. In view of the\nlegislative authorities handed down by the 93rd Congress in the Act\nof January 4, 1975 (P.L. 93-638; 88 Stat. 2203), the \"Indian Self-\nDetermination and Education Assistance Act\", programs and authorities\nCONSERVE\nAMERICA'S\nFORD\nENERGY\n&\nSave Energy and You Serve America!\nsuch as those contained in S. 522 could not be more timely. We see\npotential in Titles II and III of the bill whereby some of the\nhealth services and health facility improvements proposed might\nbe performed under grant or contract with tribal governments instead\nof directly by the Indian Health Service.\nWith regard to the specific provisions of the bill, we defer to the\nIndian Health Service for their recommendations. However, we note\nthat sections 201(c)(4)(c); 201(c)(6) and 301(a)(4) include provisions\nthat involve the Bureau of Indian Affairs. We do have comments\nregarding these three sections.\nSection 201(c)(4)(c) provides for model dormitory mental health\nservices and authorizes $625,000 and 50 positions for the IHS for\neach of the next five fiscal years following enactment of the Act\nfor this activity.\nSection 201 (c) (6) provides for IHS health care personnel in primary\nand secondary Bureau of Indian Affairs schools, and authorizes funds\nin the amount of $1,000,000 for the first fiscal year after enactment\nof the Act, and $1,200,000 for each of the four succeeding fiscal\nyears thereafter.\nSection 301 (a) (4) of Title III authorizes the expenditure by the IHS\nof $1,500,000 for each of the five fiscal years after enactment of\nthe Act for the construction and renovation of health facilities\nfor primary and secondary Bureau of Indian Affairs schools.\nThe Department supports all of the above provisions and the activities\nthey would provide. We look forward to working with IHS personnel\nand tribes in implementation of the legislation should it be\nenacted.\nIn addition, section 302 (a) authorizes the Secretary of Health,\nEducation and Welfare to expend, within a five-fiscal year period\nfollowing enactment of the Act, $378,000,000 to supply unmet needs\nfor safe water and sanitary waste disposal facilities in existing\nand new Indian homes and communities. Subsection (c) of that section\ndirects the Secretary of Health, Education and Welfare, in cooperation\nwith the Secretaries of the Interior and of Housing & Urban Development,\nand after consultation with Indian tribes, to develop a plan to meet\nthe schedule provided for in the bill for the construction of safe\n2\nFORD & LIBRARY GERALD\nwater and sanitary waste disposal facilities. The coordination\ndescribed has been, and will continue to be, necessary for the develop-\nment of adequate health standards in Indian housing. We are ready to\ncooperate in any way possible to assist in making quality health\ncare for Indian and Alaska Native people a reality.\nIt is our understanding that S. 522 has received the overwhelming\nsupport of the Indian people for whose benefit it is intended.\nSincerely yours,\nMorris Chompson\nCommissioner of Indian Affairs\nDr. Theodore C. Marrs\nSpecial Assistant to the President\nThe White House\nWashington, D. C. 20500\nTHE INTERIOR THE\nUnited States Department of the Interior\nBUREAU OF INDIAN AFFAIRS\nMarch\n3,\n1849\nWASHINGTON, D.C. 20242\nIN REPLY REFER TO:\nAPR 2 1 1975\nDear Dr. Marrs:\nThis is in response to your request for the views of this Department\non S. 522, a bill \"To implement the Federal responsibility for\nthe care and education of the Indian people by improving the services\nand facilities of Federal Indian health programs and encouraging\nmaximum participation of Indians in such programs, and for other\npurposes.\"\nWhile the administration of the Indian health care program is not\nunder the jurisdiction of the Bureau of Indian Affairs, we recognize\nthe urgent need to upgrade the quantity and quality of health services\nsufficiently to insure adequate health care for Indians and Alaska\nNatives. While we would support enactment of S. 522, we realize\nthat the President's announced moratorium on new Federal spending\ninitiatives in non-energy areas must be taken into consideration\nin the formulation of an Administration position.\nThe unmet health needs of the American Indian and Alaska Native\npeople are severe and their health status is far below that of the\ngeneral population of the United States. In many cases, the poor\nhealth status of these people affects their ability to fully partici-\npate in and derive the benefits that accrue to them from programs\nadministered by the Federal Government. Because the low health\nstatus of the American Indian and Alaska Native people is one of\nthe most critical problems they confront, efforts to ameliorate\nthis condition are vitally necessary.\nIt is our understanding that the purpose of S. 522 is to insure a\nsignificant improvement in the health status of the American Indian\nand Alaska Native people. The bill would provide the direction\nand financial resources needed to overcome the inadequacies in the\nexisting Indian health care program. Further, S. 522 would invite\nthe greatest possible participation of Indians and Alaska Natives\nin the direction and management of that program. In view of the\nlegislative authorities handed down by the 93rd Congress in the Act\nof January 4, 1975 (P.L. 93-638; 88 Stat. 2203), the \"Indian Self-\nDetermination and Education Assistance Act\", programs and authorities\nsuch as those contained in S. 522 could not be more timely. We see\npotential in Titles II and III of the bill whereby some of the\nhealth services and health facility improvements proposed might\nbe performed under grant or contract with tribal governments instead\nof directly by the Indian Health Service.\nWith regard to the specific provisions of the bill, we defer to the\nIndian Health Service for their recommendations. However, we note\nthat sections 201(c)(4)(c); 201(c)(6) and 301(a)(4) include provisions\nthat involve the Bureau of Indian Affairs. We do have comments\nregarding these three sections.\nSection 201(e)(4)(c) provides for model dormitory mental health\nservices and authorizes $625,000 and 50 positions for the IHS for\neach of the next five fiscal years following enactment of the Act\nfor this activity.\nSection 201(c)(6) provides for IHS health care personnel in primary\nand secondary Bureau of Indian Affairs schools, and authorizes funds\nin the amount of $1,000,000 for the first fiscal year after enactment\nof the Act, and $1,200,000 for each of the four succeeding fiscal\nyears thereafter.\nSection 301(a)(4) of Title III authorizes the expenditure by the IHS\nof $1,500,000 for each of the five fiscal years after enactment of\nthe Act for the construction and renovation of health facilities\nfor primary and secondary Bureau of Indian Affairs schools.\nThe Department supports all of the above provisions and the activities\nthey would provide. We look forward to working with IHS personnel\nand tribes in implementation of the legislation should it be\nenacted.\nIn addition, section 302(a) authorises the Secretary of Health,\nEducation and Welfare to expend, within a five-fiscal year period\nfollowing enactment of the Act, $378,000,000 to supply unmet needs\nfor safe water and sanitary waste disposal facilities in existing\nand new Indian homes and communities. Subsection (c) of that section\ndirects the Secretary of Health, Education and Welfare, in cooperation\nwith the Secretaries of the Interior and of Housing & Urban Development,\nand after consultation with Indian tribes, to develop a plan to meet\nthe schedule provided for in the bill for the construction of safe\n2\nwater and sanitary waste disposal facilities. The coordination\ndescribed has been, and will continue to be, necessary for the develop-\nment of adequate health standards in Indian housing. We are ready to\ncooperate in any way possible to assist in making quality health\ncare for Indian and Alaska Native people a reality.\nIt is our understanding that S. 522 has received the overwhelming\nsupport of the Indian people for whose benefit it is intended.\nSincerely yours,\n/s/ Morris Thompson\nCommissioner of Indian Affairs\nDr. Theodore C. Marrs\nSpecial Assistant to the President\nThe White House\nWashington, D. C. 20500\n$ 1.10 FORD\nTHE WHITE HOUSE\nWASHINGTON\nMarch 12, 1975\n634\nMEMORANDUM FOR\nTHE SECRETARY OF THE INTERIOR\nI would appreciate the views of Interior in regard to S-522 - the\nIndian Health Care Improvement Act. This is currently being reviewed\nin OMB and other offices and is needed as soon as reasonably possible.\nThanks.\nJed Mann\nTheodore C. Marrs\nSpecial Assistant to the President\n634\nFORD MOTOR LIBRARY\nINTERIOR DEPT.\nMAR 1 3 1975,237\nLEGISLATIVE COUNSEL\n13701\nSUBJECT:\nINDIAN HEALTH LEGISLATION\nAs a precis, the following points need to be\nconsidered:\no Life is one of the guarantees provided by\nthe Declaration of Independence which can,\nin this instance, be measured.\n0 In 1974 the average age at death of Indians\nand Alaskan natives was 48.3.\nFor white US citizens the average age at\ndeath was 72.3. For others, the average age\nWES 62.7.\nO In addition to the Declaration of Independence\nthe IS is committed by treaty, trust responsi-\nbility, stated policy, custom and expectation\nto provide adequacy and equity in health care\nfor the Indian people.\nFORD\nD The quality of care in Indian Health Service\nhospitals will be reduced in 1977 by other\nfactors. Two recent failures by IHS Hospitals\nto meet accreditation standards have reduced to\n23 out of 51 the number of such hospitals ap-\nproved by the Joint Commission on Accreditation\nof Hospitals. To a physician this is shocking.\n2\nO Predicted IHS hospital admissions (by HEW\nfigures) will be increased by 1000 in 1977.\nBased on austere standards (i.e. the structure\ndetermined by appropriation levels) 8500\nemployee positions were funded for FY '76\nin IHS. Recission is reducing this level by\n639 and the resultant level of 7861 positions\nwill be further stretched to man three new\nhospitals in FY '77.\nD Meanwhile, for contract medical care, a 14%\nincrease was allowed for hospital cost versus\nan actual 18.6% increase in those areas. For\nphysician fees, a 9% increase has been allowed\nin the face of an actual 19% increase. The\npreceeding three factors mean lowered workload\nand increased backlog or increased workload with\ndecreased quality of Indian health service in\n1977. In either case higher morbidity and\nmortality rates will result.\n0 Outpatient care limits imposed for FY '77 by\nbudget restriction is about 35,000 less visits\nthan the actual number in FY '75. (The National\n3\nTribal Chairmen's Association and the National\nIndian Health Board place such ambulatory case\nas their top priority.) This too contributes\nto increased morbidity and mortality rates.\nD While there has been improvement in health\nstatus of Indians during the past fifteen\nyears, a loss of momentum can further slow\nthe already sluggish rate of approach to parity.\nIncreased momentum in health delivery and sani-\ntation as insured by this bill speed the rate\nof closing the existing gap in age at death.\nO Our stated policy allows budgeting for expan-\nsion of existing humane programs. Further,\nexisting humane programs over a seven year\nperiod will decrease outyear costs of continuing\npayments for care of: Neglected tuberculosis\nwith catastrophic dependency; neglected\nalcoholism with resultant accidents and chronic\nillnesses; neglected ear infections with re-\nsultant deafness, school failure and limited\neconomic attainment, etc. These savings factors\nhave been variously estimated by some analysts\nand ignored by others.\n4\n0 The \"bottom Line\" is that there are unavoidable\naspects of equity and morality when there is\na more than twenty year differential in age\nat death between Indians and non-Indians.\nApril 26, 1976\nMEMORANDUM FOR:\nJIM LYNN\nFROM:\nTED MARRS\nSUBJECT:\nMANAGEMENT - INDIAN AFFAIRS\nThank you for maintaining our shared interest in im-\nproved management of Indian matters with Jim Mitchell.\nHe and I have discussed the uniqueness of the treaty\nand trust responsibilities of the United States gov-\nernment for Indian matters. Related to this, we share\nrecognition of the need to have a better overview and\ncoordination of the widely dispersed Indian activities\nof the federal government.\nAs a first step I will appreciate your giving as much\npriority as possible to an option paper on in-nouse\naspects of management of Indian matters. The options\ntouched on in meeting with Jim were the following:\n1. The Zarb proposal of a Domestic Council Cabinet\nCommittee.\n2. Assigning a federal overview responsibility\nto Interior.\n3. The Senate Policy Review Committee approach\n(a full time White House management operation\nwith about 40 people.)\n4. A small (3 to 5 person) White House Office:\nBIA and \"Indian Desk\" people as resource; the\ntribal chairmen and Governors as tribal oriented\nadvisors; representatives of various Indian or-\nganizations as consultants where relevant (in-\ncluding non-reservation matters as appropriate.)\n- 2 -\nIt would be appreciated if you will ask your staff\nto shake these down and come up with any other ap-\npropriate alternatives in the form of a draft option\npaper or a staff decision paper by the tenth of May.\nJanet Brown, Bobbie Kilberg and Brad Patterson and I\nshall be glad to be available for discussion and as-\nsistance during development. Jack Marsh, Phil Buchen\nand Public Liaison would like to coordinate on a final\ndraft.\nCC: J. Marsh\nJ. Mitchell\nJ. Brown\nB. Kilberg\nB. Patterson\nTCM:mcp\nFORD is LIBRAR\nApril 26, 1976\nMEMORANDUM FOR:\nTHE SECRETARY OF THE INTERIOR\nFROM:\nTED MARRS\nSUBJECT:\nTRIBAL JURISDICTION WITHIN\nRESERVATION BOUNDARIES\nI am aware that Indian Tribes across the nation are\nincreasingly asserting their tribal governmental au-\nthority within their external reservation boundaries\nto all persons regardless of their membership in the\ntribe which asserts the authority. I am also aware\nthat such assertion of governmental authority has not\nincluded the extension of political rights to resident\nnon-members who live within those external boundaries.\nThe result of such extensions of tribal authority with-\nout concurrently extending political rights to resident\nnon-members appears to deny resident non-members of the\nequal protections and due process rights of the United\nStates Constitution and the Indian Bill of Rights.\nCan you tell me what consideration we are giving to as-\nsure that all persona who reside within the external\nconfines of an Indian reservation are accorded the\npolitical rights preserved to them by law?\nIn view of the frequency with which this has recently\nbeen called to my attention, I would appreciate your\ncoordinating the relevant Departments and services in\nan effort to resolve this dilemma at an early date. It\nwill be appropriate if a proposed Administration posi-\ntion be formulated within six weeks if that is practicable.\nCC: The Attorney General\nBCC: J. Mitchell\nB. Kilberg\nB. Patterson\nJ. Brown\nTCM:mcp\nTHE WHITE HOUSE\nWASHINGTON\nApril 26, 1976\nMEMORANDUM FOR:\nPAUL O'NEILL\nFROM:\nTED MARRS\nSUBJECT:\nINDIAN HEALTH LEGISLATION\nThe attached summary warrants your attention before\nTed Cooper's testimony on Wednesday. Based on these\nfacts I have to strongly non-concur in the OMB posi-\ntion which has been imposed on HEW. After discussion\nwith Marge Lynch and Ted Cooper, it is my impression\nthat they would also like to see this changed.\nHow to change it? Let Ted Cooper testify on Wednesday\nat the close of his testimony that we are (or will)\nconsider adjusting our \"adamant\" position if there\nare certain changes: the stretch to a seven year per-\niod; limitation of first year expenditures to 50.0M;\nelimination of the Indian Medical School.\nI am confident that the involved committees would ac-\ncept these adjustments while the House looks at the\nBill and that the Senate would \"reluctantly\" agree.\nFORD LIBRARY &\nPragmatically, there will be a veto override. Polit-\nically, we can be made to look bad by not applying\nthe President's humane option in expanding funding for\nwhat is basically an \"existing program\" -- i.e. Indian\nHealth Service. Politically too, we should not cver-\nlook John Rhodes' support (Colleague letters, etc.)\nand the efforts of Fannin and others.\n- 2 -\nAdmittedly, I am biased as a physician in favor of\nequity in length of life so you will have to excuse\nmy considering the humanitarian aspect along with the\nbudgetary, pragmatic and political. Failure to adjust\nthe present course is in my opinion a flagrant depriva-\ntion of human rights in a measurable as well as dramat-\nic way.\nThanks for agreeing to take another look after our\ntalk on Friday.\nEnclosure\nCC: J. Marsh\nB. Barrody\nBCC: J. Brown\nJ. Mitchell\nB. Kilberg\nFORD LIBRAR &\nSUBJECT:\nINDIAN HEALTH LEGISLATION\nAs a precis, the following points need to be\nconsidered:\nO Life is one of the guarantees provided by\nthe Declaration of Independence which can,\nin this instance, be measured.\nO In 1974 the average age at death of Indians\nand Alaskan natives was 48.3.\nFor white US citizens the average age at\ndeath was 72.3. For others, the average age\nwas 62.7.\nI- addition to the Declaration of Independence\nthe IS is committed by treaty, trust responsi-\nbility, stated policy, custom and expectation\nto provide adequacy and equity in health care\nfor the Indian people.\nThe quality of care in Indian Health Service\nhospitals will be reduced in 1977 by other\nfactors. Two recent. failures by IHS Hospitals\nto meet accreditation standards have reduced to\n23 out of 51 the number of such hospitals ap-\nproved by the Joint Commission on Accreditation\nof Hospitals. To a physician this is shocking.\n2\nO Predicted IHS hospital admissions (by HEW\nfigures) will be increased by 1000 in 1977.\nBased on austere standards (i.e. the structure\ndetermined by appropriation levels) 8500\nemployee positions were funded for FY '76\nin IHS. Recission is reducing this level by\n639 and the resultant level of 7861 positions\nwill be further stretched to man three new\nhospitals in FY '77.\nO Meanwhile, for contract medical care, a 14%\nincrease was allowed for hospital cost versus\nan actual 18.6% increase in those areas. For\nphysician fees, a 9% increase has been allowed\nin the face of an actual 19% increase. The\npreceeding three factors mean lowered workload\nand increased backlog or increased workload with\ndecreased quality of Indian health service in\nFORD\n1977. In either case higher morbidity and\n&\nJULY\nALD\nmortality rates will result.\nO\nOutpatient care limits imposed for FY '77 by\nbudget restriction is about 35,000 less visits\nthan the actual number in FY '75. (The National\n3\nTribal Chairmen's Association and the National\nIndian Health Board place such ambulatory case\nas their top priority.) This too contributes\nto increased morbidity and mortality rates.\nO While there has been improvement in health\nstatus of Indians during the past fifteen\nyears, a loss of momentum can further slow\nthe already sluggish rate of approach to parity.\nIncreased momentum in health delivery and sani-\ntation as insured by this bill speed the rate\nof closing the existing gap in age at death.\no Our stated policy allows budgeting for expan-\nsion of existing humane programs. Further,\nexisting humane programs over a seven year\nperiod will decrease outyear costs of continuing\npayments for care of: Neglected tuberculosis\nwith catastrophic dependency; neglected\nalcoholism with resultant accidents and chronic\nillnesses; neglected ear infections with re-\nsultant deafness, school failure and limited\neconomic attainment, etc. These savings factors\nhave been variously estimated by some analysts\nand ignored by others.\n4\nO The \"bottom Line\" is that there are unavoidable\naspects of equity and morality when there is\na more than twenty year differential in age\nat death between Indians and non-Indians.\nFORD LIBRARY & 028470\n4/27/76\nH.R. 2525, the \"Indian Health Care Improvement Act\"\nEven after limiting first year expenditures to $50 million\nand eliminating the Indian Medical School, H.R. 2525 is\nstill objectionable because:\n/\n-- it is unnecessary. HEW already has the authority\nto accomplish the objectives of this bill through\nthe \"Snyder Act\" and other authorities;\n1\n-- it would add over 20 narrow categorical programs\nfor one population group at a time when the Admin-\nistration is attempting to consolidate health\nservices programs. These categories and the\nassignment of Federal positions to certain\nprogram areas is undesirably restrictive;\n3\n-- the manpower and scholarship programs in Title\nI can be accomplished through existing Federal\nprograms, e.g., the National Health Service Corps\nand BIA scholarship programs for which $35 million\nand $26 million, respectively, has been requested\nin 1977;\n4\n-- the mental health and alcoholism programs authorized\nin Title II duplicate existing HEW authorities\nwhich provide services to Indians and Alaska\nNatives;\n-- it would expand Federal programs for categorical\noutreach and health services to urban Indians\nwho are already entitled to Medicaid and other\nprograms on the same basis as any other citizen;\n6\n-- it would require the submission of unnecessary\nreports by the Secretary of HEW; and\n7\n--- the authorizations--over $1 billion in 7 years--\nare excessive as add-ons to the budget request of\n$355 million in 1977.\nFORD :- LIBEAR\n4/27/76\nH.R. 2525, the \"Indian Health Care Improvement Act\"\n1977\n1978\n1979\n1980\n1981\n1982\n1983\nI. Health Manpower\n8\n10\n12\n15\n22\n26\n32\nII. Health Services\n5\n24\n41\n55\n73\n88\n105\n(515)\n(593)\n(560)\n(560)\n(535)\n(615)\nIII. Health Facilities\n175\n113\n63\n110\n78\n38\n43\nIV. Access to Health Services\n--\n--\n--\n--\n--\n--\n--\nV. Urban Indians\n5\n10\n15\n--\n--\n--\n--\nVI. Indian School of Medicine\n--\n1\n2\n3\n3\n3\n3\nVII. Reports\n--\n--\n--\n--\n--\n--\n--\nTotal\n193\n158\n133\n183\n176\n155\n183\nNew Positions\n(515) (593) (560) (560) (535) (615)\n8436\nCONGRESSIONAL RECORD-SENATE\nMay 16, 1975\nNOMINATIONS PLACED ON THE\nTITLE IV-ACCESS TO HEALTH\n(4) related support factors. For example,\nSECRETARY'S DESK-AIR FORCE,\nSERVICES\nover seven hundred housing units are needed\nNAVY, AND MARINE CORPS\nSec. 401. Services provided to medicare\nfor staff at remote Service facilities;\neligible Indians.\n(5) lack of access of Indians to health\nThe second assistant legislative clerk\nSec. 402. Services provided. to medicaid\nservices due to remote residences, undevel-\nproceeded to read sundry nominations in\neligible Indians.\noped or underdeveloped communication and\nthe Air Force, Navy, and Marine Corps\nSec. 403. Report.\ntransportation systems, and difficult, some-\nwhich had been placed on the Secretary's\nTITLE V-HEALTH SERVICES FOR\ntimes severe, climatic conditions; and\ndesk.\nURBAN INDIANS\n(6) lack of safe water and sanitary waste\nThe ACTING PRESIDENT pro tem-\nSec. 501. Purpose.\ndisposal services. For example, over thirty-\npore. Without objection, the nominations\nSec. 502. Contracts with urban Indian or-\nseven thousand four hundred existing and\nare considered and confirmed.\nganizations.\nforty-eight thousand nine hundred and sixty\nplanned replacement and renovated Indian\nMr. MANSFIELD. Mr. President, I ask\nSec. 503. Contract eligibility.\nunanimous consent that the President\nSec. 504. Other contract requirements.\nhousing units need new or upgraded water\nand sanitation facilities.\nbe notified.\nSec. 505. Reports and records.\nSec. 506. Authorizations.\n(g) The Indian people's growth of confi-\nThe ACTING PRESIDENT pro tem-\ndence in Federal Indian health services is re-\nSec. 507. Review of program.\npore. Without objection, it is so ordered.\nvealed by their increasingly heavy use of\nTITLE VI-MISCELLANEOUS\nsuch services. Progress toward the goal of\nSec. 601. Reports:\nbetter Indian health is dependent on this\nLEGISLATIVE SESSION\nSec. 602. Regulations.\ncontinued growth of confidence. Both such\nSec. 603. Leases with Indian tribes.\nprogress and such confidence are dependent\nMr. MANSFIELD. Mr. President, I\nSec. 604. Availability of funds.\non improved Federal Indian health services.\nmove that the Senate resume the con-\nFINDINGS\nDECLARATION OF POLICY\nsideration of legislative business.\nSEC. 2. The Congress finds that-\nSEC. 3. The Congress hereby declares that\nThe motion was agreed to, and the\n(a) Federal health services to maintain\nit is the policy of this Nation, in fulfillment\nSenate resumed the consideration of leg-\nand improve the health of the Indians are\nof its special responsibilities and legal obli-\nislative business.\nconsonant with and required by the Fed-\ngation to the American Indian people, to\neral Government's historical and unique\nmeet the national goal of providing the high-\nlegal relationship with, and resulting re-\nest possible health status to Indians and to\nCONSIDERATION OF CERTAIN\nsponsibility to, the American Indian people.\nprovide existing Indian health services with\nMEASURES ON THE CALENDAR\n(b) A major national goal of the United\nall resources necessary to effect that policy.\nStates is to provide the quantity and qual-\nDEFINITIONS\nMr. MANSFIELD. Mr. President, I ask\nIty of health services which will permit the\nSEC. 4. For purposes of this Act-\nunanimous consent that the Senate turn\nhealth status of Indians to be raised to\n(a) \"Secretary\", unless otherwise desig-\nto the consideration of Calendar Nos.\nthe highest possible level and to encourage\n128, 130, and 131.\nthe maximum participation of Indians in\nnated. means the Secretary of Health, Edu-\ncation, and Welfare.\nthe planning and management of those\nThe ACTING PRESIDENT pro tem-\nservices.\n(b) \"Service\" means the Indian Health\nService.\npore. Without objection, it is so ordered.\n(c) Federal health services to Indians\nhave resulted in a reduction in the prev-\n(c) \"Indians\" or \"Indian\", unless other-\nalence and incidence of preventable ill-\nwise designated, means any person who is a\nINDIAN HEALTH CARE IM-\nnesses among, and unnecessary and prema-\nmember of an Indian tribe, as defined in\nPROVEMENT ACT\nture deaths of, Indians.\nsubsection (d) hereof, except that, for the\n(d) Despite such services, the unmet\npurpose of sections 102, 103, 104(b) (1) (1),\nThe Senate proceeded to consider the\nhealth needs of the American Indian peo-\nand 201 (c) (5), such terms shall mean any\nbill (S. 522) to implement the Federal\nple are severe and the health status of the\nindividual who (1), irrespecitve of wheher\nresponsibility for the care and educa-\nIndians is far below that of the general\nhe or she lives on or near a reservation, is a\ntion of the Indian people by improving\npopulation of the United States. For ex-\nmember of a tribe, band, or other organized\nample, for Indians compared to all Ameri-\ngroup of Indians, including those tribes,\nthe services and facilities of Federal In-\ncans in 1971, the tuberculosis death rate\nbands, or groups terminated since 1940 and\ndian health programs and encouraging\nwas over four and one-half times greater,\nthose recognized now or in the future by the\nmaximum participation of Indians in\nthe influenza and pneumonia death rate\nState in which they reside, or who is & de-\nsuch programs, and for other purposes,\nover one and one-half times greater, and\nscendant, in the first or second degree, of\nwhich had been reported from the Com-\nthe infant death rate approximately 20 per\nany such member, or (2) is an Eskimo or\nmittee on Interior and Insular Affairs\ncentum greater.\nAleut or other Alaska Native, or (3) is con-\n(e) All other Federal services and pro-\nsidered by the Secretary of the Interior to be\nwith an amendment to strike all after\ngrams in fulfillment of the Federal respon-\nan Indian for any purpose, or (4) is deter-\nthe enacting clause and insert:\nThat this Act may be cited as the \"Indian\nsibility to Indians are jeopardized by the\nmined to be an Indian under regulations\nlow health status of the American Indian\npromulgated by the Secretary.\nHealth Care Improvement Act\"\npeople.\n(d) \"Indian tribe\" means any Indian tribe,\nTABLE OF CONTENTS\n(f) Further improvement in Indian health\nband, nation, or other organized group or\nSec. 1. Short title.\nis imperiled by-\ncommunity, including any Alaska Native\nSec. 2. Findings.\n(1) inadequate, outdated, inefficient, and\nvillage or group as defined in the Alaska\nSec. 3. Declaration of policy.\nunder-manned facilities. For example, only\nNative Claims Settlement Act (85 Stat. 688),\nSec. 4. Definitions.\ntwenty-four of fifty-one Indian Health Serv-\nwhich is recognized as eligible for the special\nTITLE I-INDIAN HEALTH MANPOWER\nice hospitals are accredited by the Joint\nprograms and services provided by the\nCommission on Accreditation of Hospitals:\nUnited States to Indians because of their\nSec. 101. Purpose.\nonly thirty-one meet national fire and safety\nstatus as Indians.\nSec. 102. Health professions recruitment\ncodes; and fifty-two locations with Indian\n(e) \"Tribal organization\" means the\nprogram for Indians.\npopulations have been identified as requiring\nelected governing body of any Indian tribe\nSec. 103. Health professions preparatory\neither new or replacement health centers\nor any legally established organization of\nscholarship program for Indians.\nand stations, or clinics remodeled for im-\nIndians which is controlled by one or more\nSec. 104. Health professions scholarship\nproved or additional service;\nsuch bodies or by a board of directors elected\nprogram.\n(2) shortage of personnel. For example,\nor selected by one or more such bodies (or\nSec. 105. Indian Health Service extern pro-\nabout one-half of the Service hospitals, four-\nelected by the Indian population to be served\ngrams.\nfifths of the Service hospital outpatient\nby such organization) and which includes\nSec. 106. Educational and training programs\nclinics, and one-half of the Service health\nthe maximum participation of Indians in all\nin environmental health, health\nclinics meet only 80 per centum of staffing\nphases of its activities.\neducation, and nutrition.\nstandards for their respective services;\n(f) \"Urban Indian\" means any individual\nSec. 107. Continuing education allowances.\n(3) insufficient services in such areas as\nwho resides in an urban center, as defined\nTITLE II-HEALTH SERVICES\nlaboratory, hospital inpatient and outpa-\nin subsection (g) hereof, and who meets one\nSec. 201. Health services.\ntient, eye care and mental health services,\nor more of the four criteria in subsection\nand services available through contracts with\n(c) (1) through (4) of this section.\nTITLE III-HEALTH FACILITIES\nprivate physicians, clinics, and agencies. For\n(g) \"Urban center\" means any community\nSec. 301. Construction and renovation of\nexample, about 90 per centum of the surgical\nwhich has a sufficient urban Indian popula-\nService facilities.\noperations needed for otitis media have not\ntion with unmet health needs to warrant\nSec. 302. Construction of safe water and\nbeen performed, over 57 per centum of re-\nassistance under title V, as determined by\nsanitary waste disposal facilities.\nquired dental services remain to be provided,\nthe Secretary.\nSec. 303. Preference to Indians and Indian\nand about 98 per centum of hearing aid\n(h) \"Urban Indian organization\" means a\nfirms.\nrequirements are unmet;\nnonprofit corporate body situated in an\nMay 16, 1975\nCONGRESSIONAL RECORD-SENATE\nS 8437\nurban center, composed of urban Indians,\ntransportation, board, and other necessary\n1978, $9,000,000 for fiscal year 1979, $12,500,-\nand providing for the maximum participa-\nrelated expenses.\n000 for fiscal year 1980, $19,000,000 for fiscal\ntion of all interested Indian groups and\n(d) There are authorized to be appro-\nyear 1981, $26,000,000 for fiscal year 1982,\nindividuals, which body is capable of legally\npriated for the purpose of this section: $2,-\n$30,000,000 for fiscal year 1983, and, for each\ncooperating with other public and private\n000,000 for fiscal year 1977, $2,500,000 for\nsucceeding fiscal year, such sums as may be\nentities for the purpose of performing the\nfiscal year 1978, $3,000,000 for fiscal year\nnecessary to continue to make scholarship\nactivities described in section 503 (a).\n1979, $3,500,000 for fiscal year 1980, $4,000,000\ngrants under this section to individuals who\nTITLE I-INDIAN HEALTH MANPOWER\nfor fiscal year 1981, $4,500,000 for fiscal year\nhave received such grants prior to the end\n1982, and $4,500,000 for fiscal year 1983.\nPURPOSE\nof fiscal year 1983 and who are eligible for\nHEALTH PROFESSIONS SCHOLARSHIP PROGRAM\nsuch grants during each such succeeding\nSEC. 101. The purpose of this title is to\nfiscal year.\naugment the inadequate number of health\nSEC. 104. (a) The Secretary, acting through\nprofessionals serving Indians and remove the\nthe Sedvice, shall make scholarship grants\nINDIAN HEALTH SERVICE EXTERN PROGRAMS\nmultiple barriers to the entrance of health\nto individuals (1) who are enrolled in schools\nSEC. 195. (a) Any individual who receives\nprofessionals into the Service and private\nof medicine, osteopathy, dentistry, veterinary\na scholarship grant pursuant to section 104\npractice among Indians.\nmedicine, optometry, podiatry, pharmacy,\nshall be entitled to employment in the Serv-\npublic health, nursing, or allied health pro-\nHEALTH PROFESSIONS RECRUITMENT PROGRAM\nice during any nonacademic period of the\nfessions (including schools certified by the\nFOR INDIANS\nyear. Periods of employment pursuant to\nSecretary as capable of training individuals\nthis subsection shall not be counted in de-\nSEC. 102. (a) The Secretary, acting through.\nin Indian traditional medicine), and (ii)\ntermining the fulfillment of the service ob-\nthe Service, shall make grants to public or\nwho agree to provide their professional serv-\nligation incurred as-a condition of the schor-\nnonprofit private health or educational en-\nices to Indians after the completion of their\ntities or Indian tribes or tribal organizations\narship grant.\nprofessional training.\nto assist such entities in meeting the costs\n(b) Any individual enrolled In a school of\n(b) (1) The Secretary, acting through the\nof-\nmedicine, osteopathy, dentistry, veterinary\nService, (1) shall accord priority for scholar-\n(1) identifying Indians with a potential\nmedicine, optometry, podiatry, pharmacy,\nship grants under this section to applicants\nfor education or training in the health pro-\npublic health, nursing, or allied health pro-\nwho are Indians, and (ii) may determine dis-\nfessions and encouraging and assisting them\nfessions (including schools certified by the\ntribution of scholarship grants on the basis\n(A) to enroll in schools of medicine, osteop-\nSecretary as capable of training individuals\nof the relative needs of Indians for additional\nathy, dentistry, veterinary medicine, optom-\nin Indian traditional medicine) may be em-\nservice in specifice health profesions.\netry, podiatry, pharmacy, public health,\nployed by the Service during any nonaca-\n(2) Each scholarship grant under this\nnursing, or allied health professions; or (B),\ndemic period of the year. Any such employ-\nsection shall (i) fully cover the costs of tui-\nif they are not qualified to enroll in any such\nment shall not exceed one hundred and\ntion, and (ii), when taken together with the\nschool, to undertake such postsecondary\ntwenty days during any calendar year.\nfinancial resources of the grantee, fully cover\neducation or training as may be required to\n(c) Any employment pursuant to this\nthe costs of books, transportation, board, and\nqualify them for enrollment;\nsection shall be made without regard to any\nother necessary related expenses:- Provided,\n(2) publicizing existing sources of finan-\ncompetitive personnel system or agency per-\nThat the amount of grant funds available\ncial aid available to Indians enrolled in any\nsonnel limitation and to a position which\nannually to each grantee under clause (II)\nschool referred to in clause (1) (A) of this\nwill enable the individual so employed to\nshall not exceed $8,000, except where the\nsubsection or who are undertaking training\nreceive practical experience in the health\nnecessary to qualify them to enroll in any\nscholarship grant is extended to cover the\nprofession in which he or she is engaged in\nsuch school; or\nperiod between academic years pursuant to\nstudy. Any individual so employed shall re-\n(3) establishing other programs which the\nparagraph (3) of this subsection.\nceive payment for his or her services com-\nSecretary determines will enhance and fa-\n(3) Scholarship grants under this section\nparable to the salary he or she would receive\ncilitate the enrollment of Indians, and the\nshall be made with respect to academic years,\nif he or she were employed in the competi-\nsubsequent pursuit and completion by them\nexcept that any such grant may be extended\ntive system. Any individual so employed shall\nof courses of study, in any school referred\nand increased for the period. between aca-\ndemic years if the grantee is engaged in\nnot be counted against any employment\nto in clause (1) (A) of this subsection.\nclinical or other practical experience related\ncelling affecting the Service or the Depart-\n(b) (1) No grant may be made under this\nment of Health, Education, and Welfare.\nsection unless an application therefor has\nto his or her course of study and if further\ngrant assistance during such period is re-\n(d) There are authorized to be appropri-\nbeen submitted to, and approved by, the\nated for the purpose of this section: $800,000\nSecretary. Such application shall be in such\nquired by the grantee because of his or her\nform, submitted in such manner, and con-\nfinancial need.\nfor fiscal year 1977, $1,200,000 for fiscal year\n1978, $1,600,000 for fiscal year 1979, $2,200,000\ntain such information, as the Secretary shall\n(c) (1) As a condition for any scholarship\nfor fiscal year 1980, $2,800,000 for fiscal year\nby regulation prescribe.\ngrants under this section, each grantee shall\n1981, $3,200,000 for fiscal year 1982, and\n(2) The amount of any grant under this\nbe obligated to provide professional service\n$3,550,000 for fiscal year 1983.\nsection shall be determined by the Secre-\nto Indians for a period of years equal to the\ntary. Payments pursuant to grants under\nnumber of years during which he or she re-\nEDUCATIONAL AND TRAINING PROGRAMS IN EN-\nthis section may be made in advance or by\ncelves such grants.\nVIRONMENTAL HEALTH, HEALTH EDUCATION,\n(2) For the purpose of clause (1) of this\nAND NUTRITION\nway of reimbursement, and at such inter-\nvals and on such conditions, as the Secretary\nsubsection, \"professional service to Indians\"\nSEC. 106. (a) The Secretary, acting through\nfinds necessary.\nshall mean employment in the Service or in\nthe Service, shall make grants to individuals,\n(c) For the purpose of making payments\nprivate practice where, in the judgment of\nnonprofit entitles, appropriate public or pri-\npursuant to grants under this section, there\nthe Secretary in accordance with guidelines\nvate agencies, educational institutions, or In-\nare authorized to be appropriated $1,500,000\npromulgated by him, such practice is situated\ndian tribes and tribal organizations to en-\nfor fiscal year 1977, $2,500,000 for fiscal year\nin B physician or other health professional\nable the recipients of such grants to estab-\n1978, $3,000,000 for fiscal year 1979, $4,000,000\nshortage area and addresses the health care\nlish and carry out programs to train individ-\nfor fiscal year 1980, $4,500,000 for fiscal year\nneeds of a substantial number of Indians. Pe-\nuals so as to enable them to provide their\n1981, $5,000,000 for fiscal year 1982, and\nriods of internship or residency, except resi-\nservices to Indians in the following areas:\n$4,500,000 for fiscal year 1983.\ndency served in a facility of the Service, shall\n(1) environmental health, including proper\nHEALTH PROFESSIONS PREPARATORY SCHOLAR-\nnot constitute fulfillment of this service\nwaste disposal, reduced pesticide inhalation,\nSHIP PROGRAM FOR INDIANS\nobligation.\nproper sanitation, and vector control;\nSEC. 103. (a) The Secretary, acting through\n(3) (A) A service obligation of any indi-\n(2) health education, including advising\nthe Service, shall make scholarship grants to\nvidual pursuant to this section shall be\nand training Indians with respect to personal\nIndians who-\ncanceled upon the death of such individual.\nhygiene, the essentials of first aid, the care\n(1) have successfully completed their\n(B) The Secretary shall by regulation pro-\nof critically ill in the home and entitlements\nhigh school education or high school equiv-\nvide for the waiver or suspension of a service\nof Indians to, and the availability of, health\nalency; and\nobligation of any individual whenever com-\ncare services and assistance; providing ade-\n(2) have demonstrated the capability to\npliance by such individual is impossible or\nquate health information to schools; and es-\nsuccessfully complete courses of study in\nwould involve extreme hardship to such in-\ntablishing health courses in secondary\nschools of medicine, osteopathy, dentistry,\ndividual and if enforcement of such obliga--\nschools encouraging entry by Indians into\nveterinary medicine, optometry, podiatry,\ntion with respect to any individual would\nhealth-related professions; and\npharmacy, public health, nursing, or allied\nbe against equity and good conscience.\n(3) nutrition, including advising and train-\nhealth professions.\ning Indians with respect to child nutrition,\n(d) Individuals receiving scholarship\n(b) Each scholarship grant, made under\navailability of nutrition programs (such as\ngrants under this section shall not be\nthis section shall be for a period not to ex-\nhot school lunch programs), nutrition in\ncounted against any employment ceiling af-\nceed two academic years, which years shall\nprenatal care, and nutrition education for the\nfecting the Service or the Department of\nbe the final two years of the preprofessional\ntotal population, particularly for those found\nHealth, Education, and Welfare.\neducation of any grantee.\nto have or to be susceptible to, diabetes, hy-\n(e) There are authorized to be appropriated\n(c) Scholarship grants made under this\npertension, and heart disease.\nfor the purpose of this section: $6,000,000\nsection may cover costs of tuition, books,\n(b) Grants pursuant to this section shall\nfor fiscal year 1977, $7,500,000 for fiscal year\nbe made in such manner and in such amounts\n8438\nCONGRESSIONAL RECORD-SENATE\nMay 16, 1975\nand subject to such conditions as the Secre-\nyear 1981, $23,000,000 and one hnudred and\neach of the clauses (1) through (5) of sub-\ntary shall by regulation prescribe.\nfifty positions for fiscal year 1982, and\nsection (c) for research in each of the areas\n(c) There are authorized to be appropri-\n$28,500,000 and one hundred and sixty-five\nof Indian health care for which such funds\nated to carry out the provisions of this sec-\npositions for fiscal year 1983.\nare authorized to be appropriated.\ntion: $500,000 for fiscal year 1977, $600,000\n(3) Dental care (direct and indirect)\nTITLE II-HEALTH FACILITIES\nfor fiscal year 1978, $700,000 for fiscal year\n$800,000 and eighty positions for fiscal year\n1979, $800,000 for fiscal year 1980, $900,000 for\n1977, $1,500,000 and seventy positions for\nCONSTRUCTION AND RENOVATION OF SERVICE\nfiscal year 1978, $2,000,000 and fifty positions\nFACILITIES\nfiscal year 1981, $900,000 for fiscal year 1982,\nand $600,000 for fiscal year 1983.\nfor fiscal year 1979, $2,500,000 and fifty posi-\nSEC. 301. (a) For the purpose of eliminat-\nCONTINUING EDUCATION ALLOWANCES\ntions for fiscal year 1980, $2,900,000 and forty\ning inadequate, outdated, and otherwise un-\npositions for fiscal year 1981, $3,200,000 and\nsatisfactory Service hospitals, health cen-\nSEC. 107. (a) In order to encourage physl-\nthirty positions for fiscal year 1982, and\nters, health stations, and other Service fa-\ncians and other health professionals. to join\n$3,500,000 and twenty-five positions for fiscal\ncilities, the Secretary, acting through the\nthe Service and to provide their services in\nyear 1983.\nService, is authorized to expend $528,637,000\nthe rural and remote areas where a signif-\n(4) Mental health: (A) Community men-\nover a seven-fiscal-year period in accord-\nicant portion of the Indian people resides,\ntal health services: $900,000 and forty posi-\nance with the following schedule:\nthe Secretary, acting through the Service,\ntions for fiscal year 1977, $1,700,000 and\n(1) Hospitals: $123,880,000 for fiscal year\nmay provide allowances to health profes-\nthirty positions for fiscal year 1978, $2,400,000\n1977, $55,171,000 for fiscal year 1978, $24,703,-\nsionals employed in the Service to enable\nand thirty positions for fiscal year 1979,\n000 for fiscal year 1979, $70,810,000 for fiscal\nthem for a period of time each year pre-\n$3,000,000 and twenty-five positions for fiscal\nyear 1980, $45,652,000 for fiscal year 1981,\nscribed by regulation of the Secretary to\nyear 1980, $3,500,000 and twenty positions\n$29,675,000 for fiscal year 1982, and $33,779,-\ntake leave of their duty stations for profes-\nfor fiscal year 1981, $3,800,000 and ten posi-\n000 for fiscal year 1983.\nsional consultation and refresher training\ntions for fiscal year 1982, and $4,100,000 and\n(2) Health centers and health stations:\ncourses.\nfifteen positions for fiscal year 1983.\n$6,960,000 for fiscal year 1977, $6,226,000 for\n(b) There are authorized to be appro-\n(B) Inpatient mental health services:\nfiscal year 1978, $3,720,000 for fiscal year\npriated for the purpose of this section:\n$200,000 and fifteen positions for fiscal year\n1979, $4,440,000 for fiscal year 1980, $2,335,000\n$100,000 for fiscal year 1977, $200,000 for\n1977, $400,000 and fifteen positions for fiscal\nfor fiscal year 1981, $1,760,000 for fiscal year\nfiscal year 1978, $250,000 for fiscal year 1979,\nyear 1978, $600,000 and fifteen positions for\n1982 and $2,360,000 for fiscal year 1983.\n$300,000 for fiscal year 1980, $350,000 for\nfiscal year 1979, $800,000 and fifteen posi-\n(3) Staff housing: $2, 484,000 for fiscal year\nfiscal year 1981, $350,000 for fiscal year 1982,\ntions for fiscal year 1980, $1,000,000 and fif-\n1977, $43,450,000 for fiscal year 1978, $8,231,-\nand $325,000 for fiscal year 1983.\nteen positions for fiscal year 1981, $1,300,000\n000 for fiscal year 1979, $9,390,000 for fiscal\nTITLE II-HEALTH SERVICES\nand twenty positions for fiscal year 1982,\nyear 1980, $20,140,000 for fiscal year 1981,\nSEC. 201. (a) For the purpose of eliminat-\nand $1,600,000 and twenty-five positions for\n$12,267,000 for fiscal year 1982, and $13,704,-\ning backlogs in Indian health care services\nfiscal year 1983.\n000 for fiscal year 1983.\nand to supply known, unmet medical, surgi-\n(C) Model dormitory mental health serv-\n(4) Health facilities for primary and sec-\ncal, dental. and other Indian health needs,\nices: $625,000 and fifty positions for fiscal\nondary Bureau of Indian Affairs schools:\nthe Secretary is authorized to expend $491,-\nyear 1977, $1,250,000 and fifty positions for\n$1,500,000 for fiscal year 1977, $1,000,000 for\n975,000 through the Service, over a seven-\nfiscal year 1978, $1,875,000 and fifty positions\nfiscal year 1978, $1,000,000 for fiscal year 1979,\nfiscal-year period in accordance with the\nfor fiscal year 1979, and $2,500,000 and fifty\n$1,000,000 for fiscal year 1980, $1,000,000 for\nschedule provided in subsection (c). Funds\npositions for fiscal year 1980.\nfiscal year 1981, $1,000,000 for fiscal year 1982,\nappropriated pursuant to-this section each\n(D) Therapeutic and residential treat-\nand $1,000,000 for fiscal year 1983.\nfiscal year shall not be used to offset or limit\nment centers: $150,000 and ten positions for\n(b) The Secretary acting through the Serv-\nthe appropriations required by the Service\nfiscal year 1977, $300,000 and ten positions\nice, is authorized to equip and staff such\nto continue to serve the health needs of\nfor fiscal year 1978, $400,000 and five posi-\nService facilities at levels commensurate with\nIndians during and subsequent to such\ntions for fiscal year 1979, $500,000 and five\ntheir operation at optimum levels of effec-\nseven-fiscal-year period, but shall be in ad-\npositions for fiscal year 1980, $600,000 and\ntiveness.\ndition to the level of appropriations pro-\nten positions for fiscal year 1981, $700,000\n(c) Prior to the expenditure of, or the\nvided to the Service in fiscal year 1976 re-\nand five positions for fiscal year 1982, and\nmaking of any firm commitment to expend,\nquired to continue the programs of the Serv-\n$800,000 and five positions for fiscal year\nany funds authorized in subsection (a), the\nice thereafter.\n1983.\nSecretary. acting through the Service, shall-\n(b) The Secretary, acting through the\n(E) Training of traditional Indian prac-\n(1) consult with any Indian tribe to be\nService, is authorized to employ persons to\ntitioners in mental health: $75,000 for fis-\nsignificantly affected by any such expendi-\nimplement the provisions of this section dur-\ncal year 1977, $150,000 for fiscal year 1978,\nture for the purpose of determining and,\ning the seven-fiscal-year period in accord-\n$200,000 for fiscal year 1979, $250,000 for fis-\nwherever practicable, honoring tribal prefer-\nance with the schedule provided in subsec-\ncal year 1980, $300,000 for fiscal year 1981,\nences concerning the size, location, type, and\ntion (c). Such positions authorized each\n$300,000 for fiscal year 1982, and $300,000 for\nother characteristics of any facility on which\nfiscal year pursuant to this section shall not\nfiscal year 1983.\nsuch expenditure is to be made; and\nbe considered as offsetting or limiting the\n(5) Treatment and control of alcoholism\n(2) be assured that, wherever practicable,\npersonnel required by the Service to serve\namong Indians: $8,000,000 for fiscal year 1977,\nthe health needs of Indians during and sub-\nsuch facility, not later than five years after\n$10,500,000 for fiscal year 1978, $13,000,000\nsequent to such seven-fiscal-year period but\nits construction or renovation, shall meet the\nfor fiscal year 1979, $15,000,000 for fiscal year\nstandards of the Joint Commission on Ac-\nshall be in addition to the positions au-\n1980, $17,000,000 for fiscal year 1981, $18,-\ncreditation of Hospitals:\nthorized in the previous fiscal year and to\n500,000 for fiscal year 1982, and $20,000,000\nthe annual personnel levels required to con-\nfor fiscal year 1983.\nCONSTRUCTION OF SAFE WATER AND SANITARY\ntinue the programs of the Service.\n(6) Provision of health care personnel in\nWASTE DISPOSAL FACILITIES\n(c) The following amounts and positions\nprimary-and secondary Bureau of Indian Af-\nSEC. 302. (a) The Secretary is authorized\nare authorized, in accordance with the pro-\nfairs schools: $600,000 and thirty-three posi-\nto expend, pursuant to the Act of July 31,\nvisions of subsections (a) and (b), for the\ntions for fiscal year 1977, $1,000,000 and twen-\n1959 (73 Stat. 267); $378,000,000 within a\nspecific purposes noted:\nty-two-positions for fiscal year 1978, $1,300,-\nseven-fiscal-year petriod following the enact-\n(1) Patient care (direct and indirect)\n000 and sixteen positions for fiscal year 1979,\nment of this Act, in accordance with the\n$4,000,000 and one hundred and fifty posi-\n$1,700,000 and twenty-two positions for fis-\nschedule provided in subsection (b), to sup-\ntions for fiscal year 1977, $10,000,000 and two\ncal year 1980, $2,500,000 and forty-four posi-\nply unmet needs for safe water and sanitary\nhundred and twenty-five positions for fiscal\ntions for fiscal year 1981, $3,900,000 and\nwaste disposal facilities in existing and new\nyear 1978, $18,000,000 and three hundred\nseventy-six positions for fiscal year 1982, and\nIndian homes and communities.\npositions for fiscal year 1979, $26,500,000 and\n$6,000,000 and one hundred and fifteen po-\n(b) To effect the purpose of subsection (a),\nthree hundred and twenty positions for fiscal\nsitions for fiscal year 1983.\nthere are authorized to be appropriated:\nyear 1980, $36,000,000 and three hundred and\n(7) Maintenance and repair (direct and\n$60,000,000 for fiscal year 1977, $60,000,000\nsixty positions for fiscal year 1981, $46,000.-\nindirect) $3,000,000 and twenty positions for\nfor fiscal year 1978, $60,000,000 for fiscal year\n000, and three hundred and seventy-five po-\nfiscal year 1977, $3,000,000 and twenty posi-\n1979, $60,000,000 for fiscal year 1980, $60,000-\nsitions for fiscal year 1982, and $58,000,000\ntions for fiscal year 1978, $4,000,000 and thirty\n000 for fiscal year 1981, $52,000,000 for fiscal\nand four hundred and fifty positions for\npositions for fiscal year 1979, $4,000,000 and\nyear 1982, and $26,000,000 for fiscal year 1983.\nfiscal year 1983.\nthirty positions for fiscal year 1980, $4,000,-\n(c) The Secretary is authorized and dl-\n(2) Field health, excluding dental care\n000 and thirty positions for fiscal year 1981,\nrected to develop a plan, together with the\n(direct and indirect) $3,000,000 and ninety\n$2,000,000 and fifteen positions for fiscal\nSecretaries of the Interior and of Housing\npositions for fiscal year 1977, $6,000,000 and\nyear 1982, and $1,000,000 and five positions\nand Urban Development and upon consulta-\nninety positions for fiscal year 1978, $9,000,-\nfor fiscal year 1983.\ntion with Indian tribes, to assure that the\n000 and ninety positions for fiscal year 1979,\n(d) The Secretary, acting through the\nschedule provided for in subsection (b) will\n$13,000,000 and one hundred and twenty\nService, shall expend directly or by contract\nbe met. Such plan shall be submitted to the\npositions for fiscal year 1980, $18,000,000 and\nnot less than 1 per centum of the funds\nCongress no later than ninety days from the\none hundred and fifty positions for fiscal\nappropriated under the authorizations in\ndate of enactment of this Act.\nMay 16, 1975\nCONGRESSIONAL RECORD-SENATE\n8439\nPREFERENCE TO INDIANS AND INDIAN FIRMS\nskilled nursing facility, or intermediate care\nthis title in any contract which he makes\nSEC. 303. (a) The Secretary, acting through\nfacility). whether operated by the Service\nwith any urban Indian organization pursuant\nthe Service, may utilize the negotiating au-\nor by an Indian tribe or tribal organization,\nto this title. Such conditions shall include,\nthority of the Act of June 25, 1910 (36 Stat.\nshall hereby be deemed to be a facility eli-\nbut are not limited to, requirements that the\n861), to give preference to any Indian or any\ngible for reimbursement under said title\norganization successfully undertake the fol-\nenterprise, partnership, corporation, or other\nXIX: Provided, That the requirements of\nlowing activities:\ntype of business organization owned and\nsubsection (c) are met.\n(1) determine the population of urban In-\ncontrolled by an Indian or Indians (herein-\n(b) The Secretary is authorized to enter\ndians which are or could be recipients of\nafter referred to as an \"Indian firm\") in\ninto agreements with the appropriate State\nhealth referral or care services;\nthe construction and renovation of Service\nagency for the purpose of reimbursing such\n(2) identify all public and private health\nfacilities pursuant to section 301 and in\nagency for health care and services pro-\nservice resources within the urban center in\nthe construction of safe water and sanitary\nvided in Service facilities to Indians who\nwhich the organization is situated which are\nwaste disposal facilities pursuant to section\nare beneficiaries under title XIX of the So-\nor may be available to urban Indians;\n302. Such preference may be accorded by\ncial Security Act, as amended.\n(3) assist such resources in providing serv-\nthe Secretary unless he finds, pursuant to\n(c) Prior to the provision of any care or\nice to such urban Indians:\nrules and regulations promulgated by him,\nservice for which reimbursement may be\n(4) assist such urban Indians in becoming\nthat the project or function to be contracted\nmade, the Secretary shall certify that the\nfamiliar with and utilizing such resources;\nfor will not be satisfactory or such project\nfacility meets the standards applicable to\n(5) provide basic health education to such\nor function cannot be properly completed\nother hospitals eligible for reimbursement\nurban Indians;\nor maintained under the proposed contract.\nunder title XIX of the Social Security Act,\n(6) establish and implement manpower\nThe Secretary, in arriving at his finding,\nas amended, or, in the case of any facility\ntraining programs to accomplish the referral\nshall consider whether the Indian or Indian\nexisting at the time of enactment of this\nand education tasks set forth in-clauses (3)\nfirm will be deficient with respect to (1)\nAct, that the Service has provided an ac-\nthrough (5) of this subsection;\nownership and control by Indians, (2) equip-\nceptable written plan for bringing the fa-\n(7). identify gaps between unmet health\nment. (3) bookkeeping and accounting pro-\ncility into full compliance with such stand-\nneeds of urban Indians and the resources\ncedures, (4) substantive knowledge of the\nards within two years from the date of ac-\navailable to meet such needs;\nproject or function to be contracted for, (5)\nceptance of the plan by the Secretary. The\n(8) make recommendations to the Sec-\nadequately trained personnel, or (8) other\nService facilities shall not be required to\nretary and Federal, State, local, and other\nnecessary components of contract perform-\nbe licensed by any State or locality in which\nresource agencies on methods of improving\nance.\nthey are located: Provided, however, That\nhealth service programs to meet the needs\n(b) For the purpose of implementing the\nthe Secretary shall include in his certifica-\nof urban Indians; and\nprovisions of this title, the Secretary shall\ntions appropriate assurances that such facil-\n(9) where necessary, provide or contract\nassure that the rates of pay for personnel\nities will meet standards equivalent to licen-\nfor health care services to urban Indians.\nengaged in the construction or renovation\nsure requireemnts.\n(b) The Secretary, acting through the\nof facilities constructed or renovated in\n(d) Any payments received for services\nService, shall by regulation prescribe the cri-\nwhole or in part by funds made available\nprovided recipients hereunder shall not be\nteria for selecting urban Indian organiza-\npursuant to this title are not less than the\nconsidered in determining appropriations\ntions with which to contract pursuant to\nprevailing local wage rates for similar work\nfor the provision of health care and serv-\nthis title. Such criteria shall; among other\nas determined in accordance with the Act\nices to Indians.\nfactors, take into consideration:\nof March 3, 1921 (46 Stat. 1491), as amended.\n(1) the extent of the unmet health care\n(e) Notwithstanding any other provision of\nTITLE IV-ACCESS TO HEALTH SERVICES\nlaw, with respect to amounts expended dur-\nneeds of urban Indians in the urban center\ninvolved;\nSERVICES PROVIDED TO MEDICARE ELIGIBLE\ning any quarter as medical assistance under\nINDIANS\ntitle XIX of the Social Security Act, as\n(2) the size of the urban Indian popula-\namended, for services which are included in\ntion which is to receive assistance;\nSEC. 401. (a) Notwithstanding any other\n(3) the relative accessibility which such\nprovision of law, for purpose of title XVIII\nthe State plan and are received through a\nof the Social Security Act, as amended, 8\nService facility, whether operated by the\npopulation has to health care services in\nsuch urban center;\nService facility (including a hospital or\nService or by an Indian tribe or tribal orga-\nskilled nursing facility), whether operated\nnization, to individuals who are (1) eligible\n(4) the extent, if any, to which the project\nby the Service or by any Indian tribe or\nunder the plan of the State under said title\nwould duplicate any previous or current pub-\nXIX and (ii) eligible for comprehensive\nlic or private health services project funded\ntribal organization, shall hereby be deemed\nhealth services under the Service program,\nby another source in such urban center;\nto be a facility eligible for reimbursement\nunder said title XVIII: Provided, That the\nthe Federal medical assistance percentage\n(5) the appropriateness and likely effec--\nrequirements of subsection (b) are met.\nunder said title XIX shall be increased to 100\ntiveness of a project assisted pursuant to this\ntitle in such urban center;\n(b) Prior to the provision of any care or\nper centum.\n(6) the existence of an urban Indian or-\nservice for which reimbursement may be\n(f) Nothing in this section shall authorize\nganization capable of performing the activi-\nmade, the Secretary shall certify that the\nthe Secretary to provide services to an Indian\nties set forth in subsection (a) and of enter-\nfacility meets the standards applicable to\nbeneficiary with coverage under title XIX of\ning into a contract with the Secretary pur-\nother hospitals and skilled nursing facilities\nthe Social Security Act, as amended, in\nsuant to this title; and\neligible for reimbursement under title XVIII\npreference to an Indian beneficiary without\nsuch coverage.\n(7) the extent of existing or likely future\nof the Social Security Act, as amended, or, in\nthe case of any facility existing at the time\nREPORT\nparticipation in such activities by appro-\npriate health and health-related Federal,\nof enactment of this Act, that the Service\nSEC. 403. The Secretary shall include in his\nState, local, and other resource agencies.\nhas provided an acceptable written plan for\nannual report required by subsection (a) of\nbringing the facility into full compliance\nsection 601 an accounting on the amount\nOTHER CONTRACT REQUIREMENTS\nwith such standards within two years from\nand use. of funds made available to the\nSEC. 504. (a) Contracts with urban Indian\nthe date of acceptance of the plan by the\nService pursuant to this title as a result of\norganizations pursuant to this title shall be\nSecretary. The Service facilities shall not be\nreimbursements through titles XVIII and\nin accordance with all Federal contracting\nrequired to be licensed by any State or lo-\nXIX of the Social Security Act, as amended.\nlaws and regulations except that, in the dis-\ncality in which they are located: Provided,\nTITLE V-HEALTH SERVICES FOR URBAN\ncretion of the Secretary, such contracts may\nhowever, That the Secretary shall include\nbe negotiated without advertising and need\nINDIANS\nin his certifications appropriate assurances\nnot conform to the provisions of the Act of\nthat such facilities will meet standards\nPURPOSE\nAugust 24, 1935 (48 Stat. 793), as amended.\nequivalent to licensure requirements.\nSEC. 501. The purpose of this title is to\n(b) Payments under any contracts pursu-\n(c) Any payments received for services\nencourage establishment of programs in\nant to this title may be made in advance or\nprovided to beneficiaries hereunder shall not\nurban Indian areas to make health services\nby way of reimbursement and in such install-\nbe considered in determining appropriations\nmore accessible to the urban Indian popula-\nments and on such conditions as the Secre-\nfor health care and services to Indians.\ntion.\ntary deems necessary to carry out the pur-\n(d) Nothing herein authorizes the Secre-\nCONTRACTS WITH URBAN INDIAN ORGANIZATIONS\nposes of this title.\ntary to provide services to an Indian bene-\nSEC. 502. The Secretary, acting through the\n(c) Notwithstanding any provision of law\nficiary with coverage under title XVIII of\nService, shall enter into contraets with urban\nto the contrary, the Secretary may, at the re-\nthe Social Security Act, as amended, in pref-\nIndian organizations to assist such organiza-\nquest or consent of an urban Indian orga-\nerence to an Indian beneficiary without such\ntions to establish and administer, in the ur-\nnization, revise or amend any contract\ncoverage.\nban centers in which such organizations are\nmade by him with such organization pursu-\nSERVICES PROVIDED TO MEDICAID ELIGIBLE\nsituated, programs which meet the require-\nant to this title as necessary to carry out the\nINDIANS\nments set forth in sections 503 and 504.\npurposes of this title: Provided, however,\nSEC. 402. (a) Notwithstanding any other\nThat, whenever an urban Indian organiza-\nCONTRACT ELIGIBILITY\nprovision of law, for the purpose of title\ntion requests retrocession of the Secretary\nSEC. 503. (a) The Secretary, acting through\nXIX of the Social Security Act, as amended,\nfor any contract entered into pursuant to\nthe Service, shall place such conditions as\na Service facility (including a hospital,\nthis title, such retrocession shall become ef-\nhe deems necessary to effect the purpose of\nfective upon a date specified by the Secretary\nS 8440\nCONGRESSIONAL RECORD-SENATE\nMay 16, 1975\nnot more than one hundred and twenty\nrules and regulations to implement the pro-\nfarmers across the country responded\ndays from the date of the request by the\nvisions of this Act.\nto the heavy demand and high prices of\norganization or at such later date as may be\n(2) Within four months from the date of\nenactment of this Act, the Secretary shall\nrecent times by producing a harvest:\nmutually agreed to by the Secretary and\nthe organization.\npublish proposed rules and regulations in the\nlarge enough to bring consumer prices\n(d) Contracts with urban Indian orga-\nFederal Register for the purpose of receiving\ndown to levels not seen since the 1930's.\nnizations and regulations adopted pursuant\ncomments from interested parties.\nThus, many growers now find them-\nto this title shall include provisions to as-\n(3) Within six months from the date of\nselves with potatoes which can be sold\nsure the fair and uniform provisions to urban\nenactment of this Act, the Secretary shall\nonly at a loss. The consumer's benefit\nIndians of services and assistance under such\npromulgate rules and regulations to imple-\nfrom this situation will be short-lived\ncontracts by such organizations.\nment the provisions of this Act.\nunless potato prices rise, as the farmer,\n(b) The Secretary is authorized to revise\nREPORTS AND RECORDS\nand amend any rules or regulations promul-\nlike any businessman, cannot for long\nSEC. 505. For each fiscal year during which\ngated pursuant to this Act: Provided, That,\nafford to do business at a loss.\nan urban Indian organization receives or ex-\nprior to any revision of or amendment to such\nAccordingly, this resolution, directed\npends funds pursuant to a contract under\nrules or regulations, the Secretary shall, to\nto the Secretary of Agriculture, seeks to\nthis title, such organization shall submit to\nthe extent practicable, consult with appro-\nunderscore the Senate's concern over the\nthe Secretary a report including informa-\npriate national or regional Indian organiza-\nsituation I have just described, and it\ntion gathered pursuant to section 503(a)\ntions and shall publish any proposed revision\nurges the Secretary of Agriculture to\n(7) and (8), information on activities con-\nor amendment in the Federal Register not\nducted by the organization pursuant to the\ntake immediate action to distribute po-\nless than sixty days prior to the effective date\ncontract, an accounting of the amounts and\nof such revision or amendment in order to\ntato stocks pursuant to existing laws.\npurposes for which Federal funds were ex-\nprovide adequate notice to, and receive com-\nSpecifically, the Secretary has long been\npended, and such other information as the\nments from, other interested. parties.\nauthorized to purchase agricultural\nSecretary may request. The reports and rec-\nLEASES WITH INDIAN TRIBES\ncommodities for domestic consumption,\nords of the urban Indian organization with\nSEC. 603. Notwithstanding any other provi-\nunder section 32 of the act of August 24,\nrespect to such contract shall be subject to\naudit by the Secretary and the Comptroller\nsion of law, the Secretary is authorized, in\n1935 and section 416 of the Agricultural\nGeneral of the United States.\ncarrying out the purposes of this Act, to enter\nAct of 1949; and for foreign distribu-\ninto leases with Indian tribes for periods not\ntion under Public Law 480-the food-for-12\nAUTHORIZATIONS\nin excess of twenty years.\npeace program.\nSEC. 506. There are authorized to be appro-\nAVAILABILITY OF FUNDS\nI believe that the present supply of\npriated for the purpose of this title: $5,000,-\n000 for fiscal year 1977, $10,000,000 for fiscal\nSEC. 604. The funds appropriated pursuant\npotatoes is primarily & useful blessing\nyear 1978, and $15,000,000 for fiscal year\nto this Act shall remain available until\nFor there are hungry people, at home\n1979.\nexpanded.\nand abroad, who would gratefully. par-n\nREVIEW OF PROGRAM\nThe ACTING PRESIDENT pro tem-\ntake of some of these agricultural riches.\nSEC. 507. Within six months after the end\npore. The question is on agreeing to the\nAnd it is clear that these potatoes will\nof fiscal year 1978, the Secretary, acting\ncommittee amendment in the nature of\ndo no one any good if allowed to remain\nthrough the Service and with the assistance\na substitute.\nin potato house bins across the country.\nof the urban Indian organizations which\nThe committee amendment in the na-\nAs the committee has so accurately\nhave entered into contracts pursuant to this\nture of a substitute was agreed to.\nnoted in its report, potatoes are an im-\ntitle, shall review the program established\nThe ACTING PRESIDENT pro tem-\nportant source of protein, calcium, phos-\nunder this title and submit to the Congress\npore. The question is on the engrossment\nphorus and vitamin C, among other min-\nhis or her assessment thereof and recom-\nerals and vitamins.\nmendations for any further legislative ef-\nand third reading of the bill.\nforts he or she deems necessary to meet the\nThe bill (S. 522) was ordered to be en-\nMr. President, what we have is a sup-\npurpose of this title.\ngrossed for a third reading was read the\nply of potatoes which may be purchased\nTITLE VI--MISCELLANEOUS\nat favorable prices to benefit both the\nthird time, and passed.\npeople who will consume them and the\nREPORTS\nfarmers who grow them. It does not re-\nSEC. 601. (a) The Secretary shall report an-\nnually to the President and the Congress on\nTHE PLIGHT OF POTATO GROWERS\nquire high intelligence, nor a profound\nprogress made in effecting the purposes of\nanalysis of this situation, to conclude\nThe Senate proceeded to consider the\nthis Act. Within three months after the end\nthat the Secretary of Agriculture, under\nof fiscal year 1979, the Secretary shall review\nresolution (S. Res. 122) expressing to the\nauthority of long-standing statutes and\nexpenditures and levels of authorizations un-\nSecretary of Agriculture the sense of con-\nwithout adverse effect upon the con-\nder this Act and make recommendations to\"\ncern felt by the Senate for the present\nsumer, can in large measure remedy this\nCongress concerning any increases or de-\nplight of potato growers across the\ntemporary but troublesome situation\ncreases in the authorizations for fiscal years\ncountry, which had been reported from\nI am confident that appropriate\n1981 through 1983 under this Act which he\nthe Committee on Agriculture and For-\ndeems appropriate. Within three months af---\ntion by the Secretary of Agriculture\nestry, with the preamble amended as\nter the end of fiscal year 1982, the Secretary\nindeed, I applaud his recent but prom\nfollows:\nshall review the programs established or as-\nising efforts in the use of potato granules\nsisted pursuant to this Act and shall submit\nOn page 1, in the second \"Whereas\"\nin the food for peace program will\nto the Congress his assessment thereof and\nclause, strike out \"high quality protein\"\nfavorably alter the present situation and\nrecommendations of additional programs or\nand insert \"nutritious food\"\nencourage the resumption of normal\nadditional assistance necessary to, at a min-\nIn the fourth \"Whereas\" clause, after\nmarket forces which generally prove\nimum, provide health services to Indians, and\nthe word \"Ls\" insert \"the imbalance of in-\nsatisfactory to grower and consumer\ninsure a health status for Indians, which are\nadequacy of vitamins, minerals, and\";\nalike.\nat a parity with the health services available\nand after the word \"protein\" strike out\nto, and the health status of, the general\nMr. President, I urge swift passage of\nthe word \"deficiency\".\npopulation.\nthis resolution.\nOn page 2, in the third \"Whereas\"\n(b) There is hereby authorized to be ap-\nMr. President, I ask unanimous con-\nclause, strike out high quality\" and in-\npropriated to the Secretary $150,000 to sup-\nsent to have printed in the RECORD a\nport a one-year study by the National Indian\nsert vitamins, minerals, and plant\".\nstatement by the senior Senator from\nHealth Board of mental health problems, in-\nIn the fifth \"Whereas\". clause, strike\nMaine (Mr. MUSKIE)\ncluding alcoholism and related problems,\nout the word \"protein\" and insert the\nThe PRESIDING OFFICER. Without\namong Indians. The study, together with any\nword \"food.\".\nobjection, it is SQ ordered.\nrecommendations the Board may have for\nThe PRESIDING OFFICER. Theques-\nSTATEMENT BY SENATOR MUSKIE\nlegislative or administrative actions to rem-\ntion is on agreeing to the resolution.\nedy such problems, shall be submitted to\nI join my colleague Senator Hathaway in\nthe Congress by the Secretary no later than\nMr. HATHAWAY. Mr. President, Drise\nurging Senate approval for S. Res. 122. which\nthirty days after the study's completion.\nin support of Senate Resolution 122 and\nis designed to encourage use of potato stocks\nI would like briefly to recount the prob-\nin our domestic and foreign food distribu-\nREGULATIONS\nlem which it addresses, and the reason-\ntion programs. This resolution calls on the\nSEC. 602. (a) (1) Within three months from\nthe date of enactment of this Act, the Sec-\nable solution to which I believe it pro-\nSecretary of Agriculture to take advantage\nof the existing abundance of potatoes by\nretary shall, to the extent practicable, consult\nposes.\npurchasing and distributing them at very\nwith national and regional Indian organiza-\nThe problem, Mr. President, is simply\nfavorable terms, in order to feed the needy\ntions to consider and formulate appropriate\nan abundance of potatoes. Potato\nat home and hungry people around the world\n94TH CONGRESS\n1st SESSION\nS. 522\nIN THE HOUSE OF REPRESENTATIVES\nMAY 22, 1975\nReferred to the Committee on Interior and Insular Affairs\nAN ACT\nTo implement the Federal responsibility for the care and edu-\ncation of the Indian people by improving the services and\nfacilities of Federal Indian health programs and encouraging\nmaximum participation of Indians in such programs, and\nfor other purposes.\n1\nBe it enacted by the Senate and House of Representa-\n2 tives of the United States of America in Congress assembled,\n3 That this Act may be cited as the \"Indian Health Care\n4 Improvement Act\".\nTABLE OF CONTENTS\nSec. 1. Short title.\nSec. 2. Findings.\nSec. 3. Declaration of policy.\nSec. 4. Definitions.\nI\n2\n3\nTABLE OF CONTENTS-Continued\n1 relationship with, and resulting responsibility to, the Ameri-\nTITLE I-INDIAN HEALTH MANPOWER\n2 can Indian people.\nSec. 101. Purpose.\nSec. 102. Health professions recruitment program for Indians.\n3\n(b) A major national goal of the United States is to\nSec. 103. Health professions preparatory scholarship program for In-\ndians.\nSec. 104. Health professions scholarship program.\n4 provide the quantity and quality of health services which\nSec. 105. Indian Health Service extern programs.\nSec. 106. Educational and training programs in environmental health,\n5 will permit the health status of Indians to be raised to the\nhealth education, and nutrition.\nSec. 107. Continuing education allowances.\n6 highest possible level and to encourage the maximum par-\nTITLE II-HEALTH SERVICES\n7 ticipation of Indians in the planning and management of\nSec. 201. Health services.\n8 those services.\nTITLE III-HEALTH FACILITIES\nSec. 301. Construction and renovation of Service facilities.\n9\n(c) Federal health services to Indians have resulted in\nSec. 302. Construction of safe water and sanitary waste disposal facilities.\nSec. 303. Preference to Indians and Indian firms.\n10 a reduction in the prevalence and incidence of preventable\nTITLE IV-ACCESS TO HEALTH SERVICES\n11 illnesses among, and unnecessary and premature deaths of,\nSec. 401. Services provided to medicare eligible Indians.\nSec. 402. Services provided to medicaid eligible Indians.\n12 Indians.\nSec. 403. Report.\nTITLE V-HEALTH SERVICES FOR URBAN INDIANS\n13\n(d) Despite such services, the unmet health needs of\nSec. 501. Purpose.\n14 the American Indian people are severe and the health status\nSec. 502. Contracts with urban Indian organizations.\nSec. 503. Contract eligibility.\nSec. 504. Other contract requirements.\n15 of the Indians is far below that of the general population of\nSec. 505. Reports and records.\nSec. 506. Authorizations.\n16 the United States. For example, for Indians compared to\nSec. 507. Review of program.\n17 all Americans in 1971, the tuberculosis death rate was over\nTITLE VI-MISCELLANEOUS\nSec. 601. Reports.\n18 four and one-half times greater, the influenza and pneumonia\nSec. 602. Regulations.\nSec. 603. Leases with Indian tribes.\n19 death rate over one and one-half times greater, and the\nSec. 604. Availability of funds.\n20 infant death rate approximately 20 per centum greater.\n1\nFINDINGS\n21\n(e) All other Federal services and programs in fulfill-\n2\nSEC. 2. The Congress finds that-\n22 ment of the Federal responsibility to Indians are jeopardized\n3\n(a) Federal health services to maintain and improve\n23 by the low health status of the American Indian people.\n4 the health of the Indians are consonant with and required\n24\n(f) Further improvement in Indian health is imperiled\n5 by the Federal Government's historical and unique legal\n25 by-\n4\n5\n1\n(1) inadequate, outdated, inefficient, and under-\n1\nseven hundred housing units are needed for staff at re-\n2\nmanned facilities. For example, only twenty-four of fifty-\n2\nmote Service facilities;\n3\none Indian Health Service hospitals are accredited by\n3\n(5) lack of access of Indians to health services due\n4\nthe Joint Commission on Accreditation of Hospitals;\n4\nto remote residences, undeveloped or underdeveloped\n5\nonly thirty-one meet national fire and safety codes;\n5\ncommunication and transportation systems, and difficult,\n6\nand fifty-two locations with Indian populations have\n6\nsometimes severe, climatic conditions; and\n7\nbeen identified as requiring either new or replacement\n7\n(6) lack of safe water and sanitary waste disposal\n8\nhealth centers and stations, or clinics remodeled for im-\n8\nservices. For example, over thirty-seven thousand four\n9\nproved or additional service;\n9\nhundred existing and forty-eight thousand nine hun-\n10\n(2) shortage of personnel. For example, about one-\n10\ndred and sixty planned replacement and renovated In-\n11\nhalf of the Service hospitals, four-fifths of the Service\n11\ndian housing units need new or upgraded water and\n12\nhospital outpatient clinics, and one-half of the Service\n12\nsanitation facilities.\n13\nhealth clinics meet only 80 per centum of staffing stand-\n13\n(g) The Indian people's growth of confidence in Federal\n14\nards for their respective services;\n14 Indian health services is revealed by their increasingly heavy\n15\n(3) insufficient services in such areas as laboratory,\n15\nuse of such services. Progress toward the goal of better\n16\nhospital inpatient and outpatient, eye care and mental\n16 Indian health is dependent on this continued growth of con-\n17\nhealth services, and services available through contracts\n17 fidence. Both such progress and such confidence are depend-\n18\nwith private physicians, clinics, and agencies. For ex-\n18 ent on improved Federal Indian health services.\n19\nample, about 90 per centum of the surgical operations\n19\nDECLARATION OF POLICY\n20\nneeded for otitis media have not been performed, over 57\n20\nSEC. 3. The Congress hereby declares that it is the\n21\nper centum of required dental services remain to be pro-\n21 policy of this Nation, in fulfillment of its special responsi-\n22\nvided, and about 98 per centum of hearing aid require-\n22 bilities and legal obligation to the American Indian people,\n23\nments are unmet;\n23 to meet the national goal of providing the highest possible\n24\n(4) related support factors. For example, over\n24 health status to Indians and to provide existing Indian\n6\n7\n1 health services with all resources necessary to effect that\n1 Alaska Native village or group as defined in the Alaska Na-\n2 policy.\n2 tive Claims Settlement Act (85 Stat. 688), which is recog-\n3\nDEFINITIONS\n3 nized as eligible for the special programs and services pro-\n4\nSEC. 4. For purposes of this Act-\n4 vided by the United States to Indians because of their status\n5\n(a) \"Secretary\", unless otherwise designated, means\n5 as Indians.\n6 the Secretary of Health, Education, and Welfare.\n6\n(e) \"Tribal organization\" means the elected governing\n7\n(b) \"Service\" means the Indian Health Service.\n7 body of any Indian tribe or any legally established organiza-\n8\n(c) \"Indians\" or \"Indian\", unless otherwise designated,\n8 tion of Indians which is controlled by one or more such\n9 means any person who is a member of an Indian tribe, as\n9 bodies or by a board of directors elected or selected by one\n10 defined in subsection (d) hereof, except that, for the purpose\n10 or more such bodies (or elected by the Indian population to\n11 of sections 102, 103, 104 (b) (1) (i), and 201 (c) (5), such\n11 be served by such organization) and which includes the max-\n12 terms shall mean any individual who (1), irrespective of\n12 imum participation of Indians in all phases of its activities.\n13 whether he or she lives on or near a reservation, is a mem-\n13\n(f) \"Urban Indian\" means any individual who resides\n14 ber of a tribe, band, or other organized group of Indians,\n14 in an urban center, as defined in subsection (g) hereof, and\n15 including those tribes, bands, or groups terminated since\n15 who meets one or more of the four critèria in subsection (c)\n16 1940 and those recognized now or in the future by the State\n16 (1) through (4) of this section.\n17 in which they reside, or who is a descendant, in the first or\n17\n(g) \"Urban center\" means any community which has\n18 second degree, of any such member, or (2) is an Eskimo or\n18 a sufficient urban Indian population with unmet health needs\n19 Aleut or other Alaska Native, or (3) is considered by the\n19 to warrant assistance under title V, as determined by the\n20 Secretary of the Interior to be an Indian for any purpose,\n20\nSecretary.\n21 or (4) is determined to be an Indian under regulations\n21\n(h) \"Urban Indian organization\" means a nonprofit\n22 promulgated by the Secretary.\n22 corporate body situated in an urban center, composed of\n23\n(d) \"Indian tribe\" means any Indian tribe, band, na-\n23 urban Indians, and providing for the maximum participation\n24 tion, or other organized group or community, including any\n24 of all interested Indian groups and individuals, which body is\n8\n9\n1 capable of legally cooperating with other public and private\n1\n(2) publicizing existing sources of financial aid\n2 entities for the purpose of performing the activities described\n2\navailable to Indians enrolled in any school referred to\n3 in section 503 (a)\n3\nin clause (1) (A) of this subsection or who are under-\n4\nTITLE I-INDIAN HEALTH MANPOWER\n4\ntaking training necessary to qualify them to enroll in\n5\nPURPOSE\n5\nany such school; or\n6\nSEC. 101. The purpose of this title is to augment the\n6\n(3) establishing other programs which the Secre-\n7 inadequate number of health professionals serving Indians\n7\ntary determines will enhance and facilitate the enroll-\n8 and remove the multiple barriers to the entrance of health\n8\nment of Indians, and the subsequent pursuit and comple-\n9 professionals into the Service and private practice among\n9\ntion by them of courses of study, in any school referred\n10 Indians.\n10\nto in clause (1) (A) of this subsection.\n11\nHEALTH PROFESSIONS RECRUITMENT PROGRAM FOR\n11\n(b) (1) No grant may be made under this section unless\n12\nINDIANS\n12 an application therefor has been submitted to, and approved\n13\nSEC. 102. (a) The Secretary, acting through the Serv-\n13 by, the Secretary. Such application shall be in such form,\n14 ice, shall make grants to public or nonprofit private health or\n14 submitted in such manner, and contain such information, as\n15 educational entities or Indian tribes or tribal organizations\n15 the Secretary shall by regulation prescribe.\n16 to assist such entities in meeting the costs of-\n16\n(2) The amount of any grant under this section shall be\n17\n(1) identifying Indians with a potential for educa-\n17 determined by the Secretary. Payments pursuant to grants\n18\ntion or training in the health professions and encouraging\n18 under this section may be made in advance or by way of\n19\nand assisting them (A) to enroll in schools of medicine,\n19 reimbursement, and at such intervals and on such conditions,\n20\nosteopathy, dentistry, veterinary medicine, optometry,\n20 as the Secretary finds necessary.\n21\npodiatry, pharmacy, public health, nursing, or allied\n21\n(c) For the purpose of making payments pursuant\n22\nhealth professions; or (B), if they are not qualified to\nFORD LIBRAFE\n22\ngrants under this section, there are authorized to be appro-\n23\nenroll in any such school, to undertake such postsecond-\n23 priated $1,500,000 for fiscal year 1977, $2,500,000 for\n24\nary education or training as may be required to qualify\n24 fiscal year 1978, $3,000,000 for fiscal year 1979, $4,000-\n25\nthem for enrollment;\n25 000 for fiscal year 1980, $4,500,000 for fiscal year 1981,\nS. 522-2\n10\n11\n$5,000,000 for fiscal year 1982, and $4,500,000 for fiscal\n1 year 1981, $4,500,000 for fiscal year 1982, and $4,500,000\n2\nyear,\n1983\n2\nfor\nfiscal\nyear\n1983.\n8\n3\nHEALTH PROFESSIONS PREPARATORY SCHOLARSHIP\n3\nHEALTH PROFESSIONS SCHOLARSHIP PROGRAM\n4\nPROGRAM\nFOR\nINDIANS\n4\nSEC. 104. (a) The Secretary acting through the Serv-\n5\nSEC. 103. (a) The Secretary, acting through the Serv-\n5 ice, shall make scholarship grants to individuals (i) who are\n6 ice, shall make scholarship grants to Indians who-\n6 enrolled in schools of medicine, osteopathy, dentistry, veteri-\n7.\n(1) have successfully completed their high school\n7 nary medicine, optometry, podiatry, pharmacy, public health,\n8\neducation or high school equivalency; and\n8 nursing, or allied health professions (including schools cêr-\n9\n(2) have demonstrated the capability to success-\n9 tified by the Secretary as capable of training individuals In\n10\nfully complete courses of study in schools of medicine,\n10 Indian traditional medicine), and (ii) who agree to provide\n11\nosteopathy, dentistry, veterinary medicine, optometry,\n11 their professional services to Indians after the completion of\n12\npodiatry, pharmacy public health, nursing, or allied\n12 their professional training.\nST\n13\nhealth professions:\n13\n(b) (1) The Secretary, acting through the Service, (i)\n14\n(b) Each scholarship grant, made under this section\n14 shall accord priority for scholarship grants under this section\n15 shall be for a period not to exceed two academic years, which\n15 to applicants who are Indians, and (ii) may determine dis-\n16 years shall be the final two years of the preprofessional\n16 tribution of scholarship grants on the basis of the relative\n17 education of any grantee,\n17 needs of Indians for additional service in specific health\n18\n(c) Scholarship grants made under this section may\n18\nprofessions.\n19 cover costs of tuition, books, transportation, board, and other\n19\n(2) Each scholarship grant under this section shall (i)\n20 necessary related expenses.\n20 fully cover the costs of tuition, and (ii) when taken together\n21\n(d) There are authorized to be appropriated for the\n21 with the financial resourcés of the grantee, fully cover the\n22 purpose of this section: $2,000,000 for fiscal year 1977,\n22 costs of books, transportation, board, and other neqessary\n23 $2,500,000 for fiscal year 1978, $3,000,000 for fiscal year\n23 related expenses: Provided, That the amount of grant funds\n24 1979, $3,500,000 for fiscal year 1980, $4,000,000 for fiscal\n24 available annually to each grantee under clause (ii) shall\n13\n12\n1\n1 not exceed $8,000, except where the scholarship grant is\n(3) (A) A service obligation of any individual pursuant\n2 extended to cover the period between academic years pur-\n2 to this section shall be canceled upon the death of such\n3 individual.\n3 suant to paragraph (3) of this subsection.\n4\n4\n(3) Scholarship grants under this section shall be made\n(B) The Secretary shall by regulation provide for the\n5 with respect to academic years, except that any such grant\n5 waiver or suspension of a service obligation of any individual\n6 may be extended and increased for the period between aca-\n6 whenever compliance by such individual is impossible or\n7 demic years if the grantee is engaged in clinical or other\n7 would involve extreme hardship to such individual and if\n8 practical experience related to his or her course of study and\n8 enforcement of such obligation with respect to any individual\n9 if further grant assistance during such period is required by\n9 would be against equity and good conscience.\n10\n10 the grantee because of his or her financial need.\n(d) Individuals receiving scholarship grants under this\n11\n(c) (1) As a condition for any scholarship grants under\n11 section shall not be counted against any employment ceiling\n12 this section, each grantee shall be obligated to provide pro-\n12 affecting the Service or the Department of Health, Educa-\n13 fessional service to Indians for a period of years equal to\n13 tion, and Welfare.\n14\n14\nthe number of years during which he or she receives such\n(e) There are authorized to be appropriated for the\n15\n15 purpose of this section: $6,000,000 for fiscal year 1977,\ngrants.\n16\n(2) For the purpose of clause (1) of this subsection,\n16 $7,500,000 for fiscal year 1978, $9,000,000 for fiscal year\n17\n17 1979, $12,500,000 for fiscal year 1980, $19,000,000 for\n\"professional service to Indians\" shall mean employment in\n18\nthe Service or in private practice where, in the judgment of\n18 fiscal year 1981, $26,000,000 for fiscal year 1982, $30,-\n19 the Secretary in accordance with guidelines promulgated by\n19 000,000 for fiscal year 1983, and, for each succeeding fiscal\n20\nhim, such practice is situated in a physician or other health\n20 year, such sums as may be necessary to continue to make\n21\n21 scholarship grants under this section to individuals who have\nprofessional shortage area and addresses the health care needs\n22\nof a substantial number of Indians. Periods of internship or\n22 received such grants prior to the end of fiscal year 1983 and\n23\nresidency, except residency served in a facility of the Serv-\n23 who are eligible for such grants during each such succeeding\n24\n24 fiscal year.\nice, shall not constitute fulfillment of this service obligation.\n14\n15\n1 INDIAN HEALTH SERVICE EXTERN PROGRAMS\n1 against any employment ceiling affecting the Service or the\n2\nSEC. 105. (a) Any individual who receives a scholar-\n2\nDepartment of Health, Education, and Welfare. 0700\n3 ship grant pursuant to section 104 shall be entitled to employs\n3\n(d) There are authorized to be appropriated for the pur-\n4 ment in the Service during any nonacademic period of the\n4 pose of this section: $800,000 for fiscal year 1977, $1,200,-\n5 year. Periods of employment pursuant to this subsection shall\n5 000 for fiscal year 1978, $1,600,000 for fiscal year 1979,\n6 not be counted in determining the fulfillment of the service\n6 $2,200,000 for fiscal year 1980, $2,800,000 for fiscal year\n7 obligation incurred as a condition of the scholarship grant.\n7\n1981, $3,200,000 for fiscal year 1982, and $3,550,000 for\n8\n(b) Any individual enrolled in a school of medicine, os-\n8\nfiscal\nyear\n1983\n9 teopathy, dentistry, veterinary medicine, optometry, podia-\n9 EDUCATIONAL AND TRAINING PROGRAMS IN ENVI-\n10 try, pharmacy, public health, nursing, or allied health\n10\nRONMENTAL HEALTH, HEALTH EDUCATION, AND\n11 professions (including schools certified by the Secretary as ca-\n11\nNUTRITION\n12 pable of training individuals in Indian traditional medicine)\n12\nSEC. 106. (a) The Secretary, acting through the Serv\n13 may be employed by the Service during, any nonacademic\n13 ice, shall make grants to individuals, nonprofit édtities, ap\n14 period of the year. Any such employment shall not exceed\n14 propriate public or private agencies, educational institutions\n15 one hundred and twenty days during any calendar year.\n15 or Indian tribes and tribal organizations to enable the re-\n16\n(e) Any employment pursuant to this section shall be\n16 cipients of such grants to establish and carry lout, programs\n17 made without regard to any competitive personnel system\n17 to train individuals SO as to enable them to provided their\n18 or agency personnel limitation and to a position which will\n18 services to Indians in the following areas: 000,0008\n80\n19 enable the individual SO employed to receive practical expe-\n19\n(1) environmental Health, including proper waste\n20 rience in the health profession in which he or she is engaged\n20\ndisposal, reduced pesticide inhalation, proper. sanitation.\n21 in study. Any, individual so employed shall receive payment\n21\nand vector control;\n22 for his or her services comparable to the salary he or she\n22\n(2) health education, including advising and train\n23 would receive if he or she were employed in the competitive\n23\ning Indians with respect to personal hygiene, the essens\n24 system. Any individual SO employed shall not be counted\n24\ntials of first aid, the care of critically ill in the home and\nUS\n16\n17\n1\nentitlements of Indians to, and the availability of, health\n1 icant portion of the Indian people resides, the Secretary, act-\n2\ncare services and assistance; providing adequate health\n2 ing through the Service, may provide allowances to health\n3\ninformation to schools; and establishing health courses in\n3 professionals employed in the Service to enable them for a\n4\nsecondary schools encouraging entry by Indians into\n4 period of time each year prescribed by regulation of the Sec-\n5\nhealth-related professions; and\n5 retary to take leave of their duty stations for professional\n6\n(3) nutrition, including advising and training In-\n6 consultation and refresher training courses.\n7\ndians with respect to child nutrition, availability of nutri-\n7\n(b) There are authorized to be appropriated for the\n8\ntion programs (such as hot school lunch programs),\n8 purpose of this section: $100,000 for fiscal year 1977,\n9\nnutrition in prenatal care, and nutrition education for\n9 $200,000 for fiscal year 1978, $250,000 for fiscal year 1979,\n10\nthe total population, particularly for those found to have\n10 $300,000 for fiscal year 1980, $350,000 for fiscal year\n11\nor to be susceptible to, diabetes, hypertension, and heart\n11 1981, $350,000 for fiscal year 1982, and $325,000 for fiscal\n12\ndisease.\n12 year 1983.\n13\n(b) Grants pursuant to this section shall be made in\n13\nTITLE II-HEALTH SERVICES\n14 such manner and in such amounts and subject to such condi-\n14\nHEALTH SERVICES\n15 tions as the Secretary shall by regulation prescribe.\n15\nSEC. 201. (a) For the purpose of eliminating backlogs\n16\n(c) There are authorized to be appropriated to carry out\n16 in Indian health care services and to supply known, unmet\n17 the provisions of this section: $500,000 for fiscal year 1977,\n17 medical, surgical, dental, and other Indian health needs, the\n18 $600,000 for fiscal year 1978, $700,000 for fiscal year\n18 Secretary is authorized to expend $491,975,000 through the\n19 1979, $800,000 for fiscal year 1980, $900,000 for fiscal\n19 Service, over a seven-fiscal-year period in accordance with\n20 year 1981, $900,000 for fiscal year 1982, and $600,000 for\n20 the schedule provided in subsection (c) Funds appropriated\n21 fiscal year 1983.\n21 pursuant to this section each fiscal year shall not be used to\n22\n22 offset or limit the appropriations required by the Service to\nFORD LIBRARD\nCONTINUING EDUCATION ALLOWANCES\n23\nSEC. 107. (a) In order to encourage physicians and\n23 continue to serve the health needs of Indians during and\n24\nother health professionals to join the Service and to provide\n24 subsequent to such seven-fiscal-year period, but shall be in\n25\ntheir services in the rural and remote areas where a signif-\n25 addition to the level of appropriations provided to the Service\nS. 522-3\n18\n19\n1 in fiscal year 1976 required to continue the programs of the\n1\nfive positions for fiscal year 1982, and $58,000,000 and\n2 Service thereafter.\n2\nfour hundred and fifty positions for fiscal year 1983.\n3\n(b) The Secretary, acting through the Service, is au-\n3\n(2) Field health, excluding dental care (direct and\n4 thorized to employ persons to implement the provisions of\n4\nindirect) : $3,000,000 and ninety positions for fiscal year\n5 this section during the seven-fiscal-year period in accordance\n5\n1977, $6,000,000 and ninety positions for fiscal year\n6 with the schedule provided in subsection (c). Such positions\n6\n1978, $9,000,000 and ninety positions for fiscal year\n7 authorized each fiscal year pursuant to this section shall not\n7\n1979, $13,000,000 and one hundred and twenty posi-\n8 be considered as offsetting or limiting the personnel required\n8\ntions for fiscal year 1980, $18,000,000 and one hundred\n9 by the Service to serve the health needs of Indians during\n9\nand fifty positions for fiscal year 1981, $23,000,000 and\n10 and subsequent to such seven-fiscal-year period but shall be\n10\none hundred and fifty positions for fiscal year 1982,\n11 in addition to the positions authorized in the previous fiscal\n11\nand $28,500,000 and one hundred and sixty-five posi-\n12 year and to the annual personnel levels required to continue\n12\ntions for fiscal year 1983.\n13 the programs of the Service.\n13\n(3) Dental care (direct and indirect) : $800,000\n14\n(c) The following amounts and positions are authorized,\n14\nand eighty positions for fiscal year 1977, $1,500,000\n15\nin accordance with the provisions of subsections (a) and\n15\nand seventy positions for fiscal year 1978, $2,000,000\n16\n(b), for the specific purposes noted:\n16\nand fifty positions for fiscal year 1979, $2,500,000 and\n17\n(1) Patient care (direct and indirect) : $4,000,000\n17\nfifty positions for fiscal year 1980, $2,900,000 and forty\n18\nand one hundred and fifty positions for fiscal year 1977,\n18\npositions for fiscal year 1981, $3,200,000 and thirty\n19\n$10,000,000 and two hundred and twenty-five positions\n19\npositions for fiscal year 1982, and $3,500,000 and\n20\nfor fiscal year 1978, $18,000,000 and three hundred\n20\ntwenty-five positions for fiscal year 1983.\n21\npositions for fiscal year 1979, $26,500,000 and three\n21\n(4) Mental health: (A) Community mental health\n22\nhundred and twenty positions for fiscal year 1980, $36,-\n22\nservices: $900,000 and forty positions for fiscal year\n23\n000,000 and three hundred and sixty positions for fiscal\n23\n1977, $1,700,000 and thirty positions for fiscal year\n24\nyear 1981, $46,000,000, and three hundred and seventy-\n24\n1978, $2,400,000 and thirty positions for fiscal year\n20\n21\n1\n1979, $3,000,000 and twenty-five positions for fiscal\n1\nfor fiscal year 1982, and $800,000 and five positions for\n2\nyear 1980, $3,500,000 and twenty positions for fiscal\n2\nfiscal year 1983.\n3\nyear 1981, $3,800,000 and ten positions for fiscal year\n3\n(E) Training of traditional Indian practitioners in\n4\n1982, and $4,100,000 and fifteen positions for fiscal\n4\nmental health: $75,000 for fiscal year 1977, $150,000\n5\nyear 1983.\n5\nfor fiscal year 1978, $200,000 for fiscal year 1979,\n6\n(B) Inpatient mental health services: $200,000\n6\n$250,000 for fiscal year 1980, $300,000 for fiscal year\n7\nand fifteen positions for fiscal year 1977, $400,000\n7\n1981, $300,000 for fiscal year 1982, and $300,000 for\n8\nand fifteen positions for fiscal year 1978, $600,000 and\n8\nfiscal year 1983.\n9\nfifteen positions for fiscal year 1979, $800,000 and\n9\n(5) Treatment and control of alcoholism among\n10\nfifteen positions for fiscal year 1980, $1,000,000 and\n10\nIndians: $8,000,000 for fiscal year 1977, $10,500,000\n11\nfifteen positions for fiscal year 1981, $1,300,000 and\n11\nfor fiscal year 1978, $13,000,000 for fiscal year 1979,\n12\ntwenty positions for fiscal year 1982, and $1,600,000\n12\n$15,000,000 for fiscal year 1980, $17,000,000 for fiscal\n13\nand twenty-five positions for fiscal year 1983.\n13\nyear 1981, $18,500,000 for fiscal year 1982, and\n14\n(C) Model dormitory mental health services: $625,-\n14\n$20,000,000 for fiscal year 1983.\n15\n000 and fifty positions for fiscal year 1977, $1,250,000\n15\n(6) Provision of health care personnel in primary\n16\nand fifty positions for fiscal year 1978, $1,875,000 and\n16\nand secondary Bureau of Indian Affairs schools:\n17\nfifty positions for fiscal year 1979, and $2,500,000 and\n17\n$600,000 and thirty-three positions for fiscal year 1977,\n18\nfifty positions for fiscal year 1980.\n18\n$1,000,000 and twenty-two positions for fiscal year\n19\n(D) Therapeutic and residential treatment centers:\n19\n1978, $1,300,000 and sixteen positions for fiscal year\n20\n$150,000 and ten positions for fiscal year 1977, $300,-\n20\n1979, $1,700,000 and twenty-two positions for fiscal\n21\n000 and ten positions for fiscal year 1978, $400,000 and\n21\nyear 1980, $2,500,000 and forty-four positions for fiscal\n22\nfive positions for fiscal year 1979, $500,000, and five\n22\nyear 1981, $3,900,000 and seventy-six positions for\n23\npositions for fiscal year 1980, $600,000 and ten posi-\n23\nfiscal year 1982, and $6,000,0000 and one hundred and\n24\ntions for fiscal year 1981, $700,000 and five positions\n24\nfifteen positions for fiscal year 1983.\n22\n23\n1\n(7) Maintenance and repair (direct and indirect) :\n1\n652,000 for fiscal year 1981, $29,675,000 for fiscal\n2\n$3,000,000 and twenty positions for fiscal year 1977,\n2\nyear 1982, and $33,779,000 for fiscal year 1983.\n3\n$3,000,000 and twenty positions for fiscal year 1978,\n3\n(2) Health centers and health stations: $6,960,000\n4\n$4,000,000 and thirty positions for fiscal year 1979,\n4\nfor fiscal year 1977, $6,226,000 for fiscal year 1978,\n5\n$4,000,000 and thirty positions for fiscal year 1980,\n5\n$3,720,000 for fiscal year 1979, $4,440,000 for fiscal\n6\n$4,000,000 and thirty positions for fiscal year 1981,\n6\nyear 1980, $2,335,000 for fiscal year 1981, $1,760,000\n7\n$2,000,000 and fifteen positions for fiscal year 1982,\n7\nfor fiscal year 1982, and $2,360,000 for fiscal year 1983.\n8\nand $1,000,000 and five positions for fiscal year 1983.\n8\n(3) Staff housing: $2,484,000 for fiscal year 1977,\n9\n(d) The Secretary, acting through the Service, shall\n9\n$43,450,000 for fiscal year 1978, $8,231,000 for fiscal\n10 expend directly or by contract not less than 1 per centum of\n10\nyear 1979, $9,390,000 for fiscal year 1980, $20,140-\n11 the funds appropriated under the authorizations in each of\n11\n000 for fiscal year 1981, $12,267,000 for fiscal year\n12 the clauses (1) through (5) of subsection (c) for research\n12\n1982, and $13,704,000 for fiscal year 1983.\n13 in each of the areas of Indian health care for which such\n13\n(4) Health facilities for primary and secondary\n14 funds are authorized to be appropriated.\n14\nBureau of Indian Affairs schools: $1,500,000 for fiscal\n15\nTITLE III-HEALTH FACILITIES\n15\nyear 1977, $1,000,000 for fiscal year 1978, $1,000,000\n16 CONSTRUCTION AND RENOVATION OF SERVICE FACILITIES\n16\nfor fiscal year 1979, $1,000,000 for fiscal year 1980,\n17\n17\nSEC. 301. (a) For the purpose of eliminating inade-\n$1,000,000 for fiscal year 1981, $1,000,000 for fiscal\n18 quate, outdated, and otherwise unsatisfactory Service hos-\n18\nyear 1982, and $1,000,000 for fiscal year 1983.\n19 pitals, health centers, health stations, and other Service\n19\n(b) The Secretary, acting through the Service, is au-\n20 facilities, the Secretary, acting through the Service, is au-\n20 thorized to equip and staff such Service facilities at levels\n21 thorized to expend $528,637,000 over a seven-fiscal-year\n21 commensurate with their operation at optimum levels of\n22 period in accordance with the following schedule:\n22\neffectiveness.\n23\n(1) Hospitals: $123,880,000 for fiscal year 1977,\n23\n(c) Prior to the expenditure of, or the making of any\n24\n$55,171,000 for fiscal year 1978, $24,703,000 for fiscal\n24 firm commitment to expend, any funds authorized in subsec-\n25\nyear 1979, $70,810,000 for fiscal year 1980, $45,-\n25 tion (a), the Secretary, acting through the Service, shall-\n24\n25\n1\n(1) consult with any Indian tribe to be significantly\n1\n(c) The Secretary is authorized and directed to develop\n2\naffected by any such expenditure for the purpose of deter-\n2 a plan, together with the Secretaries of the Interior and of\n3\nmining and, wherever practicable, honoring tribal prefer-\n3 Housing and Urban Development and upon consultation\n4\nences concerning the size, location, type, and other char-\n4 with Indian tribes, to assure that the schedule provided for\n5\nacteristics of any facility on which such expenditure is to\n5 in subsection (b) will be met. Such plan shall be submitted\n6\nbe made; and\n6 to the Congress no later than ninety days from the date of\n7\n(2) be assured that, wherever practicable, such\n7 enactment of this Act.\n8\nfacility, not later than five years after its construction or\n8\nPREFERENCE TO INDIANS AND INDIAN FIRMS\n9\nrenovation, shall meet the standards of the Joint Com-\n9\nSEC. 303. (a) The Secretary, acting through the Serv-\n10\nmission on Accreditation of Hospitals.\n10 ice, may utilize the negotiating authority of the Act of June\n11 CONSTRUCTION OF SAFE WATER AND SANITARY WASTE\n11 25, 1910 (36 Stat. 861), to give preference to any Indian\n12\nDISPOSAL FACILITIES\n12 or any enterprise, partnership, corporation, or other type\n13\nSEC. 302. (a) The Secretary is authorized to expend,\n13 of business organization owned and controlled by an Indian\n14 pursuant to the Act of July 31, 1959 (73 Stat. 267), $378,-\n14 or Indians (hereinafter referred to as an \"Indian firm\")\n15 000,000 within a seven-fiscal-year period following the en-\n15 in the construction and renovation of Service facilities pur-\n16 actment of this Act, in accordance with the schedule provided\n16 suant to section 301 and in the construction of safe water\n17 in subsection (b), to supply unmet needs for safe water and\n17 and sanitary waste disposal facilities pursuant to section 302.\n18 sanitary waste disposal facilities in existing and new Indian\n18 Such preference may be accorded by the Secretary unless he\n19 homes and communities.\n19 finds, pursuant to rules and regulations promulgated by him,\n20\n(b) To effect the purpose of subsection (a), there are\n20 that the project or function to be contracted for will not be\n21 authorized to be appropriated: $60,000,000 for fiscal year\n21 satisfactory or such project or function cannot be properly\n22 1977, $60,000,000 for fiscal year 1978, $60,000,000 for\n22 completed or maintained under the proposed contract. The\n23 fiscal year 1979, $60,000,000 for fiscal year 1980, $60,-\n23 Secretary, in arriving at his finding, shall consider whether\n24 000,000 for fiscal year 1981, $52,000,000 for fiscal year\n24 the Indian or Indian firm will be deficient with respect to\n25 1982, and $26,000,000 for fiscal year 1983.\n25 (1) ownership and control by Indians, (2) equipment, (3)\n26\n27\n1 bookkeeping and accounting procedures, (4) substantive\n1 hospitals and skilled nursing facilities eligible for reimburse-\n2 knowledge of the project or function to be contracted for,\n2 ment under title XVIII of the Social Security Act, as\n3 (5) adequately trained personnel, or (6) other necessary\n3 amended, or, in the case of any facility existing at the time\n4 components of contract performance.\n4 of enactment of this Act, that the Service has provided an\n5\n(b) For the purpose of implementing the provisions\n5 acceptable written plan for bringing the facility into full\n6 of this title, the Secretary shall assure that the rates of\n6\ncompliance with such standards within two years from the\n7 pay for personnel engaged in the construction or renovation\n7 date of acceptance of the plan by the Secretary. The Service\n8 of facilities constructed or renovated in whole or in part\n8 facilities shall not be required to be licensed by any State or\n9 by funds made available pursuant to this title are not less\n9 locality in which they are located: Provided, however, That\n10 than the prevailing local wage rates for similar work as\n10 the Secretary shall include in his certifications appropriate\n11 determined in accordance with the Act of March 3, 1921\n11 assurances that such facilities will meet standards equivalent\n12 (46 Stat. 1491), as amended.\n12 to licensure requirements.\n13\nTITLE IV-ACCESS TO HEALTH SERVICES\n13\n(c) Any payments received for services provided to\n14\nSERVICES PROVIDED TO MEDICARE ELIGIBLE INDIANS\nbeneficiaries hereunder shall not be considered in deter-\n14\n15\nSEC. 401. (a) Notwithstanding any other provision of\n15\nmining appropriations for health care and services to Indians.\n16 law, for purpose of title XVIII of the Social Sécurity Act,\n16\n(d) Nothing herein authorizes the Secretary to provide\n17 as amended, a Service facility (including a hospital or skilled\nservices to an Indian beneficiary with coverage under title\n17\n18 nursing facility), whether operated by the Service or by\nXVIII of the Social Security Act, as amended, in preference\n18\n19 any Indian tribe or tribal organization, shall hereby be\nto an Indian beneficiary without such coverage.\n19\n20 deemed to be a facility eligible for reimbursement under said\nSERVICES PROVIDED TO MEDICAID ELIGIBLE INDIANS\n20\n21 title XVIII: Provided, That the requirements of subsection\nSEC. 402. (a) Notwithstanding any other provision of\n21\n22 (b) are met.\nlaw, for the purpose of title XIX of the Social Security Act,\n22\n23\n(b) Prior to the provision of any care or service for\nas amended, a Service facility (including a hospital, skilled\n23\n24 which reimbursement may be made, the Secretary shall cer-\n24\nnursing facility, or intermediate care facility), whether\n25 tify that the facility meets the standards applicable to other\n25\noperated by the Service or by an Indian tribe or tribal\n28\n29\n1 organization, shall hereby be deemed to be a facility eligible\n1 appropriations for the provision of health care and services\n2 for reimbursement under said title XIX Provided, That the\n2 to Indians.\n3 requirements of subsection (c) are met.\n3\n(e) Notwithstanding any other provision of law, with\n4\n(b) The Secretary is authorized to enter into agree-\n4 respect to amounts expended during any quarter as medical\n5 ments with the appropriate State agency for the purpose of\n5 assistance under title XIX of the Social Security Act, as\n6 reimbursing such agency for health care and services pro-\n6 amended, for services which are included in the State plan\n7 vided in Service facilities to Indians who are beneficiaries\n7 and are received through a Service facility, whether operated\n8 under title XIX of the Social Security Act, as amended.\n8 by the Service or by an Indian tribe or tribal organization,\n9\n(c) Prior to the provision of any care or service for\n9 to individuals who are (i) eligible under the plan of the\n10 which reimbursement may be made, the Secretary shall cer-\n10 State under said title XIX and (ii) eligible for comprehen-\n11 tify that the facility meets the standards applicable to other\n11 sive health services under the Service program, the Federal\n12 hospitals, skilled nursing facilities, and intermediate care\n12 medical assistance percentage under said title XIX shall be\n13 facilities eligible for reimbursement under title XIX of the\n13 increased to 100 per centum.\n14 Social Security Act, as amended, or, in the case of any\n14\n(f) Nothing in this section shall authorize the Secretary\n15 facility existing at the time of enactment of this Act, that the\n15 to provide services to an Indian beneficiary with coverage\n16 Service has provided an acceptable written plan for bring-\n16 under title XIX of the Social Security Act, as amended, in\n17 ing the facility into full compliance with such standards\n17\npreference to an Indian beneficiary without such coverage.\n18 within two years from the date of acceptance of the plan by\n18\nREPORT\n19 the Secretary. The Service facilities shall not be required\n19\nSEC. 403. The Secretary shall include in his annual\n20 to be licensed by any State or locality in which they are\n20 report required by subsection (a) of section 601 an account-\n21 located: Provided, however, That the Secretary shall include\n21 ing on the amount and use of funds made available to the\n22 in his certifications appropriate assurances that such facil-\n22 Service pursuant to this title as a result of reimbursements\n23 ities will meet standards equivalent to licensure requirements.\n23 through title XVIII and XIX of the Social Security Act,\n24\n(d) Any payments received for services provided re-\n24 as amended.\n25 cipients hereunder shall not be considered in determining\n30\n31\n1\nTITLE V-HEALTH SERVICES FOR URBAN\n1\n(2) identify all public and private health service\n2\nINDIANS\n2\nresources within the urban center in which the organiza-\n3\nPURPOSE\n3\ntion is situated which are or may be available to urban\n4\nSEC. 501. The purpose of this title is to encourage the\n4\nIndians;\n5 establishment of programs in urban areas to make health\n5\n(3) assist such resources in providing service to\n6 services more accessible to the urban Indian population.\n6\nsuch urban Indians;\n7\nCONTRACTS WITH URBAN INDIAN ORGANIZATIONS\n7\n(4) assist such urban Indians in becoming familiar\n8\nSEC. 502. The Secretary, acting through the Service,\n8\nwith and utilizing such resources;\n9 shall enter into contracts with urban Indian organizations\n9\n(5) provide basic health education to such urban\n10 to assist such organizations to establish and administer, in\n10\nIndians;\n11 the urban centers in which such organizations are situated,\n11\n(6) establish and implement manpower training\n12 programs which meet the requirements set forth in sections\n12\nprograms to accomplish the referral and education tasks\n13 503 and 504.\n13\nset forth in clauses (3) through (5) of this subsection;\n14\nCONTRACT ELIGIBILITY\n14\n(7) identify gaps between unmet health needs of\n15\nSEC. 503. (a) The Secretary, acting through the Serv-\n15\nurban Indians and the resources available to meet such\n16 ice, shall place such conditions as he deems necessary to effect\n16\nneeds;\n17 the purpose of this title in any contract which he makes with\n17\n(8) make recommendations to the Secretary and\n18 any urban Indian organization pursuant to this title. Such\n18\nFederal, State, local, and other resource agencies on\n19 conditions shall include, but are not limited to, requirements\n19\nmethods of improving health service programs to meet\n20 that the organization successfully undertake the following\n20\nthe needs of urban Indians; and\n21 activities:\n21\n(9) where necessary, provide or contract for health\n22\n(1) determine the population of urban Indians\n22\ncare services to urban Indians.\n23\nwhich are or could be recipients of health referral or\n23\n(b) The Secretary, acting through the Service, shall\n24\ncare services;\n24 by regulation prescribe the criteria for selecting urban Indian\n33\n32\n1 organizations with which to contract pursuant to this title.\n1\nOTHER CONTRACT REQUIREMENTS\n2 Such criteria shall, among other factors, take into consid-\n2\nSEC. 504. (a) Contracts with urban Indian organiza-\n3 eration:\n3\ntions pursuant to this title shall be in accordance with all\n4 Federal contracting laws and regulations except that, in the\n4\n(1) the extent of the unmet health care needs of\n5 discretion of the Secretary, such contracts may be negotiated\n5\nurban Indians in the urban center involved;\n6 without advertising and need not conform to the provisions\n6\n(2) the size of the urban Indian population which\n7\n7\nof the Act of August 24, 1935 (48 Stat. 793), as amended.\nis to receive assistance;\n8\n8\n(b) Payments under any contracts pursuant to this title\n(3) the relative accessibility which such popula-\n9 may be made in advance or by way of reimbursement and in\n9\ntion has to health care services in such urban center;\n10\nsuch installments and on such conditions as the Secretary\n10\n(4) the extent, if any, to which the project would\n11\n11\ndeems necessary to carry out the purposes of this title.\nduplicate any previous or current public or private health\n12\n12\n(c) Notwithstanding any provision of law to the con-\nservices project funded by another source in such urban\n13 trary, the Secretary may, at the request or consent of an\n13\ncenter;\n14\n14 urban Indian organization, revise or amend any contract\n(5) the appropriateness and likely effectiveness of\n15\n15 made by him with such organization pursuant to this title\na project assisted pursuant to this title in such urban\n16\n16 as necessary to carry out the purposes of this title: Provided,\ncenter;\n17\n17 however, That, whenever an urban Indian organization re-\n(6) the existence of an urban Indian organization\n18\n18 quests retrocession of the Secretary for any contract entered\ncapable of performing the activities set forth in subsec-\n19\n19 into pursuant to this title, such retrocession shall become\ntion (a) and of entering into a contract with the Secre-\n20\n20 effective upon a date specified by the Secretary not more\ntary pursuant to this title; and\n21\n21 than one hundred and twenty days from the date of the\n(7) the extent of existing or likely future participa-\n22\n22 request by the organization or at such later date as may be\ntion in such activities by appropriate health and health-\n23\n23 mutually agreed to by the Secretary and the organization.\nrelated Federal, State, local, and other resource agencies.\n34\n35\n1\n(d) Contracts with urban Indian organizations and reg-\n1\nREVIEW OF PROGRAM\n2 ulations adopted pursuant to this title shall include provisions\n2\nSEC. 507. Within six months after the end of fiscal year\n3 to assure the fair and uniform provision to urban Indians\n3 1978, the Secretary, acting through the Service and with the\n4 of services and assistance under such contracts by such\n4 assistance of the urban Indian organizations which have\n5 organizations.\n5 entered into contracts pursuant to this title, shall review the\n6\nREPORTS AND RECORDS\n6 program established under this title and submit to the Con-\n7\nSEC. 505. For each fiscal year during which an urban\n7 gress his or her assessment thereof and recommendations for\n8 Indian organization receives or expends funds pursuant to\n8 any further legislative efforts he or she deems necessary to\n9 a contract under this title, such organization shall submit to\n9 meet the purpose of this title.\n10 the Secretary a report including information gathered pur-\n10\nTITLE VI-MISCELLANEOUS\n11 suant to section 503 (a) (7) and (8) information on activi-\n11\nREPORTS\n12 ties conducted by the organization pursuant to the contract,\n12\nSEC. 601. (a) The Secretary shall report annually to\n13 an accounting of the amounts and purposes for which Fed-\n13 the President and the Congress on progress made in effecting\n14 eral funds were expended, and such other information as the\n14 the purposes of this Act. Within three months after the end\n15 Secretary may request. The reports and records of the urban\n15 of fiscal year 1979, the Secretary shall review expenditures\n16 Indian organization with respect to such contract shall be\n16 and levels of authorizations under this Act and make recom-\n17 subject to audit by the Secretary and the Comptroller General\n17 mendations to Congress concerning any increases or de-\n18 of the United States.\n18 creases in the authorizations for fiscal years 1981 through\n19\nAUTHORIZATIONS\n19 1983 under this Act which he deems appropriate. Within\n20\nSEC. 506. There are authorized to be appropriated for\n20 three months after the end of fiscal year 1982, the Secretary\n21 the purpose of this title: $5,000,000 for fiscal year 1977,\n21 shall review the programs established or assisted pursuant to\n22 $10,000,000 for fiscal year 1978, and $15,000,000 for fiscal\n22 this Act and shall submit to the Congress his assessment\n23 year 1979.\n23 thereof and recommendations of additional programs or\n36\n37\n1 additional assistance necessary to, at a minimum, provide\n1\n(b) The Secretary is authorized to revise and amend\n2 health services to Indians, and insure a health status for\n2\nany rules or regulations promulgated pursuant to this Act:\n3 Indians, which are at a parity with the health services avail-\n3\nProvided, That, prior to any revision of or amendment to\n4 able to, and the health status of, the general population.\n4\nsuch rules or regulations, the Secretary shall, to the extent\n5\n(b) There is hereby authorized to be appropriated to\n5\npracticable, consult with appropriate national or regional\n6 the Secretary $150,000 to support a one-year study by the\n6\nIndian organizations and shall publish any proposed revision\n7 National Indian Health Board of mental health problems,\n7\nor amendment in the Federal Register not less than sixty days\n8 including alcoholism and related problems, among Indians.\n8 prior to the effective date of such revision or amendment in\n9 The study, together with any recommendations the Board\n9 order to provide adequate notice to, and receive comments\n10 may have for legislative or administrative actions to remedy\n10 from, other interested parties.\n11 such problems, shall be submitted to the Congress by the\n11\nLEASES WITH INDIAN TRIBES\n12 Secretary no later than thirty days after the study's com-\n12\nSEC. 603. Notwithstanding any other provision of law,\n13 pletion.\n13 the Secretary is authorized, in carrying out the purposes\n14\nREGULATIONS\n14 of this Act, to enter into leases with Indian tribes for periods\n15\nSEC. 602. (a) (1) Within three months from the date\n15 not in excess of twenty years.\n16 of enactment of this Act, the Secretary shall, to the extent\n16\nAVAILIBILITY OF FUNDS\n17 practicable, consult with national and regional Indian orga-\n17\nSEC. 604. The funds appropriated pursuant to this Act\n18 nizations to consider and formulate appropriate rules and\n18 shall remain available until expended.\n19 regulations to implement the provisions of this Act.\nPassed the Senate May 16 (legislative day, April 21),\n20\n(2) Within four months from the date of enactment of\n1975.\n21 this Act, the Secretary shall publish proposed rules and regu-\nAttest:\nFRANCIS R. VALEO,\nSecretary.\n22 lations in the Federal Register for the purpose of receiving\n23 comments from interested parties.\n24\n(3) Within six months from the date of enactment of\n25 this Act, the Secretary shall promulgate rules and regulations\n26 to implement the provisions of this Act.\n94TH CONGRESS\n1ST SESSION\nS. 522\nAN ACT\nTo implement the Federal responsibility for the\ncare and education of the Indian people by\nimproving the services and facilities of Fed-\neral Indian health programs and encourag-\ning maximum participation of Indians in\nsuch programs, and for other purposes.\nMAY 22, 1975\nReferred to the Committee on Interior and Insular\nAffairs"
}