25 U.S.C. § 1621

Current through P.L. 118-47 (published on www.congress.gov on 03/23/2024)

Section 1621 - Indian Health Care Improvement Fund

(a) Use of funds

The Secretary, acting through the Service, is authorized to expend funds, directly or under the authority of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.),¹ which are appropriated under the authority of this section, for the purposes of-

(1) eliminating the deficiencies in health status and health resources of all Indian tribes;

(2) eliminating backlogs in the provision of health care services to Indians;

(3) meeting the health needs of Indians in an efficient and equitable manner, including the use of telehealth and telemedicine when appropriate;

(4) eliminating inequities in funding for both direct care and contract health service programs; and

(5) augmenting the ability of the Service to meet the following health service responsibilities with respect to those Indian tribes with the highest levels of health status deficiencies and resource deficiencies:

(A) Clinical care, including inpatient care, outpatient care (including audiology, clinical eye, and vision care), primary care, secondary and tertiary care, and long-term care.

(B) Preventive health, including mammography and other cancer screening.

(C) Dental care.

(D) Mental health, including community mental health services, inpatient mental health services, dormitory mental health services, therapeutic and residential treatment centers, and training of traditional health care practitioners.

(E) Emergency medical services.

(F) Treatment and control of, and rehabilitative care related to, alcoholism and drug abuse (including fetal alcohol syndrome) among Indians.

(G) Injury prevention programs, including data collection and evaluation, demonstration projects, training, and capacity building.

(H) Home health care.

(I) Community health representatives.

(J) Maintenance and improvement.

(b) No offset or limitation

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

(c) Allocation; use

(1) In general

Funds appropriated under the authority of this section shall be allocated to Service units, Indian tribes, or tribal organizations. The funds allocated to each Indian tribe, tribal organization, or Service unit under this paragraph shall be used by the Indian tribe, tribal organization, or Service unit under this paragraph to improve the health status and reduce the resource deficiency of each Indian tribe served by such Service unit, Indian tribe, or tribal organization.

(2) Apportionment of allocated funds

The apportionment of funds allocated to a Service unit, Indian tribe, or tribal organization under paragraph (1) among the health service responsibilities described in subsection (a)(5) shall be determined by the Service in consultation with, and with the active participation of, the affected Indian tribes and tribal organizations.

(d) Provisions relating to health status and resource deficiencies

For the purposes of this section, the following definitions apply:

(1) Definition

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

(A) the health status objectives set forth in sections 1602(1) and 1602(2) of this title are not being achieved; and

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

(2) Available resources

The health resources available to an Indian tribe or tribal organization include health resources provided by the Service as well as health resources used by the Indian tribe or tribal organization, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments.

(3) Process for review of determinations

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

(e) Eligibility for funds

Tribal health programs shall be eligible for funds appropriated under the authority of this section on an equal basis with programs that are administered directly by the Service.

(f) Report

By no later than the date that is 3 years after March 23, 2010, the Secretary shall submit to Congress the current health status and resource deficiency report of the Service for each Service unit, including newly recognized or acknowledged Indian tribes. Such report shall set out-

(1) the methodology then in use by the Service for determining tribal health status and resource deficiencies, as well as the most recent application of that methodology;

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

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

(4) an estimate of-

(A) the amount of health service funds appropriated under the authority of this chapter, or any other Act, including the amount of any funds transferred to the Service for the preceding fiscal year which is allocated to each Service unit, Indian tribe, or tribal organization;

(B) the number of Indians eligible for health services in each Service unit or Indian tribe or tribal organization; and

(C) the number of Indians using the Service resources made available to each Service unit, Indian tribe or tribal organization, and, to the extent available, information on the waiting lists and number of Indians turned away for services due to lack of resources.

(g) Inclusion in base budget

Funds appropriated under this section for any fiscal year shall be included in the base budget of the Service for the purpose of determining appropriations under this section in subsequent fiscal years.

(h) Clarification

Nothing in this section is intended to diminish the primary responsibility of the Service to eliminate existing backlogs in unmet health care needs, nor are the provisions of this section intended to discourage the Service from undertaking additional efforts to achieve equity among Indian tribes and tribal organizations.

(i) Funding designation

Any funds appropriated under the authority of this section shall be designated as the "Indian Health Care Improvement Fund".

¹ See References in Text note below.

25 U.S.C. § 1621

Pub. L. 94-437, title II, §201, Sept. 30, 1976, 90 Stat. 1404; Pub. L. 96-537, §4, Dec. 17, 1980, 94 Stat. 3174; Pub. L. 100-713, title II, §201(a), Nov. 23, 1988, 102 Stat. 4800; Pub. L. 102-573, title II, §201(a), (c), Oct. 29, 1992, 207, Oct. 29, 1992, 106 Stat. 4544, 4546, 4551, 4559; Pub. L. 111-148, title X, §10221(a), Mar. 23, 2010, 124 Stat. 935.

EDITORIAL NOTES

REFERENCES IN TEXTThe Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), referred to in subsec. (a), is Pub. L. 93-638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§450 et seq.) of chapter 14 of this title prior to editorial reclassification as chapter 46 (§5301 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables.This chapter, referred to in subsecs. (b) and (f)(4)(A), was in the original "this Act", meaning Pub. L. 94-437, Sept. 30, 1976, 90 Stat. 1400, known as the Indian Health Care Improvement Act, which is classified principally to this chapter. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of this title and Tables.

CODIFICATIONAmendment by Pub. L. 111-148 is based on section 121 of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111-148.

AMENDMENTS2010- Pub. L. 111-148 amended section generally. Prior to amendment, section consisted of subsecs. (a) to (h) relating to the Indian Health Care Improvement Fund.1992- Pub. L. 102-573, §201(c), amended section catchline generally.Subsec. (a). Pub. L. 102-573, §201(a)(1)(A), substituted "this section" for "subsection (h) of this section" in introductory provisions.Subsec. (a)(1). Pub. L. 102-573, §201(a)(1)(B), amended par. (1) generally. Prior to amendment, par. (1) read as follows: "raising the health status of Indians to zero deficiency,".Subsec. (a)(4). Pub. L. 102-573, §201(a)(1)(C), in introductory provisions inserted ", either through direct or contract care or through contracts entered into pursuant to the Indian Self-Determination Act," after "responsibilities" and substituted "status and resource deficiencies" for "resources deficiency".Subsec. (a)(4)(B). Pub. L. 102-573, §207(b), substituted "preventive health, including screening mammography in accordance with section 1621k of this title" for "preventive health".Subsec. (b)(1). Pub. L. 102-573, §201(a)(2)(A), substituted "this section" for "subsection (h) of this section".Subsec. (b)(2). Pub. L. 102-573, §201(a)(2)(B), redesignated par. (3) as (2) and struck out former par. (2) which read as follows: "Funds which are appropriated under the authority of subsection (h) of this section may be allocated to, or used for the benefit of, any Indian tribe which has a health resources deficiency level at level I or II only if a sufficient amount of funds have been appropriated under the authority of subsection (h) of this section to raise all Indian tribes to health resources deficiency level II."Subsec. (b)(2)(A). Pub. L. 102-573, §201(a)(2)(C), in first sentence, substituted "this section" for "subsection (h) of this section" and struck out "but such allocation shall be made in a manner which ensures that the requirement of paragraph (2) is met" after "service unit basis" and, in second sentence, struck out "(in accordance with paragraph (2))" after "the service unit" and substituted "reduce the health status and resource deficiency" for "raise the deficiency level".Subsec. (b)(2)(B). Pub. L. 102-573, §201(a)(2)(D), inserted ", and with the active participation of," after "in consultation with".Subsec. (b)(3). Pub. L. 102-573, §201(a)(2)(B), redesignated par. (3) as (2).Subsec. (c)(1). Pub. L. 102-573, §201(a)(3)(B), amended par. (1) generally, substituting provisions defining "health status and resource deficiency" for former provisions defining "health resources deficiency". Pub. L. 102-573, §201(a)(3)(A), redesignated par. (2) as (1) and struck out former par. (1) which specified the health resource deficiency levels of an Indian tribe.Subsec. (c)(2). Pub. L. 102-573, §201(a)(3)(A), redesignated par. (3) as (2). Former par. (2) redesignated (1).Subsec. (c)(3). Pub. L. 102-573, §201(a)(3)(A), (C), redesignated par. (4) as (3) and substituted "The" for "Under regulations, the" and "extent of the health status and resource deficiency" for "health resources deficiency level". Former par. (3) redesignated (2).Subsec. (c)(4). Pub. L. 102-573, §201(a)(3)(A), redesignated par. (4) as (3).Subsec. (d)(1). Pub. L. 102-573, §201(a)(4), substituted "this section" for "subsection (h) of this section".Subsec. (e). Pub. L. 102-573, §201(a)(5)(A), in introductory provisions, substituted "3 years after October 29, 1992, the Secretary shall submit to the Congress the current health status and resource deficiency report" for "60 days after November 23, 1988, the Secretary shall submit to the Congress the current health services priority system report".Subsec. (e)(1). Pub. L. 102-573, §201(a)(5)(B), substituted "health status and resource deficiencies" for "health resources deficiencies".Subsec. (e)(2). Pub. L. 102-573, §201(a)(5)(C), substituted "the extent of the health status and resource deficiency of" for "the level of health resources deficiency for".Subsec. (e)(3). Pub. L. 102-573, §201(a)(5)(D), substituted "eliminate the health status and resource deficiencies of all Indian tribes served by the Service; and" for "raise all Indian tribes served by the Service below health resources deficiency level II to health resources deficiency level II;".Subsec. (e)(4) to (6). Pub. L. 102-573, §201(a)(5)(E), redesignated par. (6) as (4) and struck out former pars. (4) and (5) which read as follows:"(4) the amount of funds necessary to raise all tribes served by the Service below health resources deficiency level I to health resources deficiency level I;"(5) the amount of funds necessary to raise all tribes served by the Service to zero health resources deficiency; and".Subsec. (f). Pub. L. 102-573, §201(a)(6), redesignated par. (2) as entire subsec. and struck out former par. (1) which read as follows: "The President shall include with the budget submitted to the Congress under section 1105 of title 31 for each fiscal year a separate statement which specifies the amount of funds requested to carry out the provisions of this section for such fiscal year."Subsec. (h). Pub. L. 102-573, §217(b)(1), substituted "this section" for "this subsection" and struck out former first sentence which authorized appropriations for fiscal years 1990 to 1992.1988- Pub. L. 100-713 amended section generally, substituting subsecs. (a) to (h) relating to improvement of Indian health status for former subsecs. (a) to (e) relating to direct patient care program.1980-Subsec. (c)(1). Pub. L. 96-537, §4(a)(1), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(2). Pub. L. 96-537, §4(a)(2), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(3). Pub. L. 96-537, §4(a)(3), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(4)(A). Pub. L. 96-537, §4(b)(1), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(4)(B). Pub. L. 96-537, §4(b)(2), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(4)(C). Pub. L. 96-537, §4(b)(3), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(4)(D). Pub. L. 96-537, §4(b)(4), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(4)(E). Pub. L. 96-537, §4(b)(5), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984.Subsec. (c)(5). Pub. L. 96-537, §4(c)(1), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984.Subsec. (c)(6). Pub. L. 96-537, §4(c)(2), inserted provisions authorizing appropriation of specific amounts for fiscal years ending Sept. 30, 1981, Sept. 30, 1982, Sept. 30, 1983, and Sept. 30, 1984, and further authorizing additional positions as may be necessary for each such fiscal year.Subsec. (c)(7). Pub. L. 96-537, §4(c)(3), struck out par. (7) which authorized appropriation for the items referred to in subsecs. (c)(1) to (c)(6) of such sums as may be specifically authorized by an act enacted after Sept. 30, 1976, for fiscal years 1981, 1982, 1983, and 1984, and which further authorized positions for items referred to in subsecs. (c)(1) to (c)(6) other than subsecs. (c)(4)(E) and (c)(5), as may be specified in an act enacted after Sept. 30, 1976.

STATUTORY NOTES AND RELATED SUBSIDIARIES

EFFECTIVE DATE OF 1992 AMENDMENTS Pub. L. 102-573, title II, §201(b), Oct. 29, 1992, 106 Stat. 4546, provided that: "Except with respect to the amendments made by subsection (a)(5) [amending this section], the amendments made by subsection (a) [amending this section] shall take effect three years after the date of the enactment of this Act [Oct. 29, 1992]. The amendments made by subsection (a)(5) shall take effect upon the date of the enactment of this Act."

CONTRACT MEDICAL CARE FUNDS Pub. L. 108-7, 117 Stat. 261, provided in part: "That contract medical care funds appropriated heretofore and hereafter for tribes recognized after January 1, 1995, may be used to provide medical services directly or through contract medical care".

Indian tribe: The term "Indian tribe" means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or group or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (85 Stat. 688) [43 U.S.C. 1601 et seq.], which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.
Service unit: The term "Service unit" means an administrative entity of the Service or a tribal health program through which services are provided, directly or by contract, to eligible Indians within a defined geographic area.
Service: The term "Service" means the Indian Health Service.
contract health service: The term "contract health service" means any health service that is-(A) delivered based on a referral by, or at the expense of, an Indian health program; and(B) provided by a public or private medical provider or hospital that is not a provider or hospital of the Indian health program.
telemedicine: The term "telemedicine" means a telecommunications link to an end user through the use of eligible equipment that electronically links health professionals or patients and health professionals at separate sites in order to exchange health care information in audio, video, graphic, or other format for the purpose of providing improved health care services.
tribal health program: The term "tribal health program" means an Indian tribe or tribal organization that operates any health program, service, function, activity, or facility funded, in whole or part, by the Service through, or provided for in, a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).1