The 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.

Amendment 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.

2010—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.

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.”

Pub. L. 108–7, div. F, title II, Feb. 20, 2003, 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”.