§ 1621. — Indian Health Care Improvement Fund.
[Laws in effect as of January 24, 2002]
[Document not affected by Public Laws enacted between
January 24, 2002 and December 19, 2002]
[CITE: 25USC1621]
TITLE 25--INDIANS
CHAPTER 18--INDIAN HEALTH CARE
SUBCHAPTER II--HEALTH SERVICES
Sec. 1621. Indian Health Care Improvement Fund
(a) Approved expenditures
The Secretary is authorized to expend funds which are appropriated
under the authority of this section, through the Service, for the
purposes of--
(1) eliminating the deficiencies in health status and resources
of all Indian tribes,
(2) eliminating backlogs in the provision of health care
services to Indians,
(3) meeting the health needs of Indians in an efficient and
equitable manner, and
(4) augmenting the ability of the Service to meet the following
health service responsibilities, either through direct or contract
care or through contracts entered into pursuant to the Indian Self-
Determination Act [25 U.S.C. 450f et seq.], with respect to those
Indian tribes with the highest levels of health status and resource
deficiencies:
(A) clinical care (direct and indirect) including clinical
eye and vision care;
(B) preventive health, including screening mammography in
accordance with section 1621k of this title;
(C) dental care (direct and indirect);
(D) mental health, including community mental health
services, inpatient mental health services, dormitory mental
health services, therapeutic and residential treatment centers,
and training of traditional Indian practitioners;
(E) emergency medical services;
(F) treatment and control of, and rehabilitative care
related to, alcoholism and drug abuse (including fetal alcohol
syndrome) among Indians;
(G) accident prevention programs;
(H) home health care;
(I) community health representatives; and
(J) maintenance and repair.
(b) Effect on other appropriations; allocation to service units
(1) Any funds appropriated under the authority of this section shall
not be used to offset or limit any appropriations made to the Service
under section 13 of this title, or any other provision of law.
(2)(A) Funds appropriated under the authority of this section may be
allocated on a service unit basis. The funds allocated to each service
unit under this subparagraph shall be used by the service unit to reduce
the health status and resource deficiency of each tribe served by such
service unit.
(B) The apportionment of funds allocated to a service unit under
subparagraph (A) among the health service responsibilities described in
subsection (a)(4) of this section shall be determined by the Service in
consultation with, and with the active participation of, the affected
Indian tribes.
(c) Health resources deficiency levels
For purposes of this section--
(1) The term ``health status and resource deficiency'' means the
extent to which--
(A) the health status objectives set forth in section
1602(b) of this title are not being achieved; and
(B) the Indian tribe does not have available to it the
health resources it needs, taking into account the actual cost
of providing health care services given local geographic,
climatic, rural, or other circumstances.
(2) The health resources available to an Indian tribe include
health resources provided by the Service as well as health resources
used by the Indian tribe, including services and financing systems
provided by any Federal programs, private insurance, and programs of
State or local governments.
(3) The Secretary shall establish procedures which allow any
Indian tribe to petition the Secretary for a review of any
determination of the extent of the health status and resource
deficiency of such tribe.
(d) Programs administered by Indian tribe
(1) Programs administered by any Indian tribe or tribal organization
under the authority of the Indian Self-Determination Act [25 U.S.C. 450f
et seq.] shall be eligible for funds appropriated under the authority of
this section on an equal basis with programs that are administered
directly by the Service.
(2) If any funds allocated to a tribe or service unit under the
authority of this section are used for a contract entered into under the
Indian Self-Determination Act, a reasonable portion of such funds may be
used for health planning, training, technical assistance, and other
administrative support functions.
(e) Report to Congress
By no later than the date that is 3 years after October 29, 1992,
the Secretary shall submit to the Congress the current health status and
resource deficiency report of the Service for each Indian tribe or
service unit, including newly recognized or acknowledged tribes. Such
report shall set out--
(1) the methodology then in use by the Service for determining
tribal health status and resource deficiencies, as well as the most
recent application of that methodology;
(2) the extent of the health status and resource deficiency of
each Indian tribe served by the Service;
(3) the amount of funds necessary to eliminate the health status
and resource deficiencies of all Indian tribes served by the
Service; and
(4) an estimate of--
(A) the amount of health service funds appropriated under
the authority of this chapter, or any other Act, including the
amount of any funds transferred to the Service, for the
preceding fiscal year which is allocated to each service unit,
Indian tribe, or comparable entity;
(B) the number of Indians eligible for health services in
each service unit or Indian tribe; and
(C) the number of Indians using the Service resources made
available to each service unit or Indian tribe.
(f) Appropriated funds included in base budget of Service
Funds appropriated under authority of this section for any fiscal
year shall be included in the base budget of the Service for the purpose
of determining appropriations under this section in subsequent fiscal
years.
(g) Continuation of Service responsibilities for backlogs and parity
Nothing in this section is intended to diminish the primary
responsibility of the Service to eliminate existing backlogs in unmet
health care needs, nor are the provisions of this section intended to
discourage the Service from undertaking additional efforts to achieve
parity among Indian tribes.
(h) Authorization of appropriations
Any funds appropriated under the authority of this section shall be
designated as the ``Indian Health Care Improvement Fund''.
(Pub. L. 94-437, title II, Sec. 201, Sept. 30, 1976, 90 Stat. 1404; Pub.
L. 96-537, Sec. 4, Dec. 17, 1980, 94 Stat. 3174; Pub. L. 100-713, title
II, Sec. 201(a), Nov. 23, 1988, 102 Stat. 4800; Pub. L. 102-573, title
II, Sec. 201(a), (c), 207(b), 217(b)(1), Oct. 29, 1992, 106 Stat. 4544,
4546, 4551, 4559.)
References in Text
The Indian Self-Determination Act, referred to in subsecs. (a)(4)
and (d), is title I of Pub. L. 93-638, Jan. 4, 1975, 88 Stat. 2206, as
amended, which is classified principally to part A (Sec. 450f et seq.)
of subchapter II of chapter 14 of this title. For complete
classification of this Act to the Code, see Short Title note set out
under section 450 of this title and Tables.
Amendments
1992--Pub. L. 102-573, Sec. 201(c), amended section catchline
generally.
Subsec. (a). Pub. L. 102-573, Sec. 201(a)(1)(A), substituted ``this
section'' for ``subsection (h) of this section'' in introductory
provisions.
Subsec. (a)(1). Pub. L. 102-573, Sec. 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, Sec. 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, Sec. 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, Sec. 201(a)(2)(A), substituted
``this section'' for ``subsection (h) of this section''.
Subsec. (b)(2). Pub. L. 102-573, Sec. 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, Sec. 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, Sec. 201(a)(2)(D), inserted ``,
and with the active participation of,'' after ``in consultation with''.
Subsec. (b)(3). Pub. L. 102-573, Sec. 201(a)(2)(B), redesignated
par. (3) as (2).
Subsec. (c)(1). Pub. L. 102-573, Sec. 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, Sec. 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, Sec. 201(a)(3)(A), redesignated
par. (3) as (2). Former par. (2) redesignated (1).
Subsec. (c)(3). Pub. L. 102-573, Sec. 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, Sec. 201(a)(3)(A), redesignated
par. (4) as (3).
Subsec. (d)(1). Pub. L. 102-573, Sec. 201(a)(4), substituted ``this
section'' for ``subsection (h) of this section''.
Subsec. (e). Pub. L. 102-573, Sec. 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, Sec. 201(a)(5)(B), substituted
``health status and resource deficiencies'' for ``health resources
deficiencies''.
Subsec. (e)(2). Pub. L. 102-573, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 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, Sec. 4(c)(3), struck out par. (7)
which authorized appropriation for the items referred to in subsecs.
(c)(1) to (c)(6) of such sums as may be specifically authorized by an
act enacted after Sept. 30, 1976, for fiscal years 1981, 1982, 1983, and
1984, and which further authorized positions for items referred to in
subsecs. (c)(1) to (c)(6) other than subsecs. (c)(4)(E) and (c)(5), as
may be specified in an act enacted after Sept. 30, 1976.
Effective Date of 1992 Amendments
Section 201(b) of Pub. L. 102-573 provided that: ``Except with
respect to the amendments made by subsection (a)(5) [amending this
section], the amendments made by subsection (a) [amending this section]
shall take effect three years after the date of the enactment of this
Act [Oct. 29, 1992]. The amendments made by subsection (a)(5) shall take
effect upon the date of the enactment of this Act.''
Section Referred to in Other Sections
This section is referred to in sections 1660a, 1671 of this title.
