Native Health Access Improvement Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4533 To amend the Public Health Service Act to improve behavioral health outcomes for American Indians and Alaskan Natives, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 26, 2019 Mr. PALLONE (for himself and Mr. RUIZ) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Natural Resources, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To amend the Public Health Service Act to improve behav- ioral health outcomes for American Indians and Alaskan Natives, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Native Health Access 4 Improvement Act of 2019’’. 5 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4533 IH SEC. 2. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR IN- 1 DIANS. 2 Part A of title V of the Public Health Service Act 3 (42 U.S.C. 290aa et seq.) is amended by adding at the 4 end the following new section: 5 ‘‘SEC. 506B. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR 6 INDIANS. 7 ‘‘(a) IN GENERAL.—The Director of the Indian 8 Health Service, in coordination with the Assistant Sec- 9 retary for Mental Health and Substance Use, shall award 10 grants for providing services in accordance with subsection 11 (b) for the prevention and treatment of mental health and 12 substance use disorders. 13 ‘‘(b) SERVICES THROUGH INDIAN HEALTH FACILI- 14 TIES.—For purposes of subsection (a), services are pro- 15 vided in accordance with this subsection if the services are 16 provided through any of the following entities: 17 ‘‘(1) The Indian Health Service. 18 ‘‘(2) An Indian health program operated by an 19 Indian tribe or tribal organization pursuant to a 20 contract, grant, cooperative agreement, or compact 21 with the Indian Health Service pursuant to the In- 22 dian Self-Determination and Education Assistance 23 Act (25 U.S.C. 5301 et seq.). 24 ‘‘(3) An urban Indian health program operated 25 by an urban Indian organization pursuant to a grant 26 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4533 IH or contract with the Indian Health Service pursuant 1 to title V of the Indian Health Care Improvement 2 Act (25 U.S.C. 1651 et seq.). 3 ‘‘(c) REPORTS.—Each grantee under this section 4 shall submit reports at such time, in such manner, and 5 containing such information as the Director of the Indian 6 Health Service may require. 7 ‘‘(d) TECHNICAL ASSISTANCE CENTER.— 8 ‘‘(1) ESTABLISHMENT.—The Director of the 9 Indian Health Service, in coordination with the As- 10 sistant Secretary for Mental Health and Substance 11 Use, shall establish a technical assistance center (di- 12 rectly or by contract or cooperative agreement)— 13 ‘‘(A) to provide technical assistance to 14 grantees under this section; and 15 ‘‘(B) to collect and evaluate information on 16 the program carried out under this section. 17 ‘‘(2) CONSULTATION.—The technical assistance 18 center shall consult with grantees under this section 19 for purposes of developing evaluation measures and 20 data submission requirements for purposes of the 21 collection and evaluation of information under para- 22 graph (1)(B). 23 ‘‘(3) DATA SUBMISSION.—As a condition on re- 24 ceipt of a grant under this section, an applicant 25 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4533 IH shall agree to submit data consistent with the data 1 submission requirements developed pursuant to 2 paragraph (2). 3 ‘‘(e) FUNDING.— 4 ‘‘(1) IN GENERAL.—For the purpose of making 5 grants under this section, there is authorized to be 6 appropriated, and there is appropriated, out of any 7 money in the Treasury not otherwise appropriated, 8 $150,000,000 for each of fiscal years 2020 through 9 2024. 10 ‘‘(2) TECHNICAL ASSISTANCE CENTER.—Of the 11 amount made available to carry out this section for 12 each of fiscal years 2020 through 2024, the Director 13 of the Indian Health Service shall allocate a percent- 14 age of such amount, to be determined by the Direc- 15 tor in consultation with Indian tribes, for the tech- 16 nical assistance center under subsection (d). 17 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In- 18 dian health program’, ‘Indian tribe’, ‘tribal organization’, 19 and ‘urban Indian organization’ have the meanings given 20 those terms in section 4 of the Indian Health Care Im- 21 provement Act (25 U.S.C. 1603).’’. 22 SEC. 3. INDIAN DEFINED IN PPACA. 23 (a) INDIAN DEFINED IN PPACA.— 24 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4533 IH (1) IN GENERAL.—Section 1304 of the Patient 1 Protection and Affordable Care Act (42 U.S.C. 2 18024) is amended by adding at the end the fol- 3 lowing new subsection: 4 ‘‘(f) INDIAN.— 5 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 6 dian’ means any individual— 7 ‘‘(A) described in paragraph (13) or (28) 8 of section 4 of the Indian Health Care Improve- 9 ment Act (25 U.S.C. 1603); 10 ‘‘(B) who is eligible for health services pro- 11 vided by the Indian Health Service under sec- 12 tion 809 of the Indian Health Care Improve- 13 ment Act (25 U.S.C. 1679); 14 ‘‘(C) who is of Indian descent and belongs 15 to the Indian community served by the local fa- 16 cilities and program of the Indian Health Serv- 17 ice; or 18 ‘‘(D) who is described in paragraph (2). 19 ‘‘(2) INCLUDED INDIVIDUALS.—For purposes of 20 this title, the following individuals shall be consid- 21 ered to be an ‘Indian’: 22 ‘‘(A) A member of a Federally recognized 23 Indian tribe. 24 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4533 IH ‘‘(B) A resident of an urban center who 1 meets one or more of the following four criteria: 2 ‘‘(i) Membership in a Tribe, band, or 3 other organized group of Indians, including 4 those Tribes, bands, or groups terminated 5 since 1940 and those recognized by the 6 State in which they reside, or being a de- 7 scendant, in the first or second degree, of 8 any such member. 9 ‘‘(ii) Is an Eskimo or Aleut or other 10 Alaska Native. 11 ‘‘(iii) Is considered by the Secretary of 12 the Interior to be an Indian for any pur- 13 pose. 14 ‘‘(iv) Is determined to be an Indian 15 under regulations promulgated by the Sec- 16 retary. 17 ‘‘(C) An individual who is considered by 18 the Secretary of the Interior to be an Indian for 19 any purpose. 20 ‘‘(D) An individual who is considered by 21 the Secretary to be an Indian for purposes of 22 eligibility for Indian health care services, includ- 23 ing as a California Indian, Eskimo, Aleut, or 24 other Alaska Native.’’. 25 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4533 IH (2) CONFORMING AMENDMENTS.— 1 (A) AFFORDABLE CHOICES HEALTH BEN- 2 EFIT PLANS.—Section 1311(c)(6)(D) of the Pa- 3 tient Protection and Affordable Care Act (42 4 U.S.C. 18031(c)(6)(D)) is amended by striking 5 ‘‘section 4 of the Indian Health Care Improve- 6 ment Act’’ and inserting ‘‘section 1304(f)’’. 7 (B) REDUCED COST-SHARING FOR INDI- 8 VIDUALS ENROLLING IN QUALIFIED HEALTH 9 PLANS.—Section 1402(d) of the Patient Protec- 10 tion and Affordable Care Act (42 U.S.C. 11 18071(d)) is amended— 12 (i) in paragraph (1), in the matter 13 preceding subparagraph (A), by striking 14 ‘‘section 4(d) of the Indian Self-Deter- 15 mination and Education Assistance Act 16 (25 U.S.C. 450b(d))’’ and inserting ‘‘sec- 17 tion 1304(f)’’; and 18 (ii) in paragraph (2), in the matter 19 preceding subparagraph (A), by striking 20 ‘‘(as so defined)’’ and inserting ‘‘(as de- 21 fined in section 1304(f))’’. 22 (C) EXEMPTION FROM PENALTY FOR NOT 23 MAINTAINING MINIMUM ESSENTIAL COV- 24 ERAGE.—Section 5000A(e) of the Internal Rev- 25 VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4533 IH enue Code of 1986 is amended by striking para- 1 graph (3) and inserting the following new para- 2 graph: 3 ‘‘(3) INDIANS.—Any applicable individual who 4 is an Indian (as defined in section 1304(f) of the 5 Patient Protection and Affordable Care Act).’’. 6 (3) EFFECTIVE DATE.—The amendments made 7 by this subsection shall apply with respect to plan 8 years beginning on or after January 1, 2021. 9 (b) TECHNICAL AMENDMENTS.—Section 4 of the In- 10 dian Health Care Improvement Act (25 U.S.C. 1603) is 11 amended— 12 (1) in paragraph (13), by striking ‘‘as defined 13 in subsection (d) hereof’’ and inserting ‘‘as defined 14 in paragraph (14)’’; and 15 (2) in paragraph (28)— 16 (A) by striking ‘‘as defined in subsection 17 (g) hereof’’ and inserting ‘‘as defined in para- 18 graph (27)’’; and 19 (B) by striking ‘‘subsection (c)(1) through 20 (4)’’ and inserting ‘‘subparagraphs (A) through 21 (D) of paragraph (13)’’. 22 Æ VerDate Sep 11 2014 21:50 Oct 03, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H4533.IH H4533 pamtmann on DSKBC07HB2PROD with BILLS