§1680h Demonstration Projects for Tribal Management of Health Care Services

Summary

The Secretary, through the Indian Health Service (IHS), must give grants to Indian tribes to run test projects where the tribe gradually takes over IHS health care for tribe members who live on or near the reservation. Grants are allowed only if the tribe proves it has the needed administrative and financial ability. While a test project runs, the Secretary must give the tribe one single grant for all health care contracts (for example, community, behavioral, and preventive care), and the rules in part A of title XIX of the Public Health Service Act (42 U.S.C. 300w et seq.) apply as needed and as the tribe and Secretary agree. The Secretary may waive federal buying rules if needed to let a tribe try new administrative systems, but only if care to patients is not harmed. Each test project ends on September 30, 1993, or, for grants made after September 30, 1990, three years after the grant date. By September 30, 1996, the Secretary must evaluate each participating tribe and report to Congress. The Secretary must also set up joint-venture projects where a tribe spends tribal, private, or other nontribal money to buy or build a health facility and gives the facility to IHS under a no-cost lease for at least 20 years. In return, IHS provides equipment, supplies, staff, and operations and maintenance. The tribe may use loans or guarantees to meet its commitment. The Secretary may only enter these agreements with tribes that show they have the needed administrative and financial ability. If a tribe breaks or ends an agreement without good cause, the tribe must repay amounts the United States paid to the tribe or to third parties, and the Secretary may recover tangible property (less depreciation) and funds spent on operations and maintenance. Funds spent on delivering health care or on personnel and staffing cannot be recovered.