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Replaces existing text of subsection (b)(3)(A) to specify how the active duty service obligation under contracts under section 338A of the Public Health Service Act may be met for Indian Health Scholarship recipients, adding explicit full-time and half-time practice options, authority for private practice as determined by the Secretary under guidelines, a half-time option requiring a written agreement to double the obligated period, and application of damages procedures after conversion to full-time equivalent if the obligation is not begun or completed.
Amends Section 108 by revising subsection (f)(1)(B)(iii) to define the 'period of obligated service' for loan repayment contracts with specific full-time and half-time options (2 years full-time; 4 years half-time or equivalent; 2 years half-time at 50% payment) and adding a clause (iv) that applies subsection (l)(2) damage procedures—after conversion to full-time equivalent—if an individual fails to begin or complete a half-time obligated service period. Also inserts additional text into subsection (l)(2) in the undesignated matter following subparagraph (D).
Changes how people who receive Indian Health Service (IHS) scholarships or loan repayments can meet their required service. Recipients may serve full-time in IHS, in tribal/self-determination programs, in Title V–assisted programs, or in certain qualifying private-practice settings; recipients may also serve half-time if they agree to double the service period and accept breach-conversion rules. The loan repayment program is clarified to define obligated service lengths (for example, 2 years full-time or 4 years half-time) and how breaches and half-time calculations are handled.
Amends Section 104(b)(3) of the Indian Health Care Improvement Act (25 U.S.C. 1613a(b)(3)) to replace the existing paragraph with a new provision governing how an active duty service obligation under a written contract under section 338A of the Public Health Service Act is to be met for recipients of an Indian Health Scholarship.
Scholarship recipients may meet the active duty service obligation by full-time practice (as defined in PHSA section 331(j)) in any of the following: (I) in the Service (Indian Health Service), (II) in a program conducted under a contract entered into under the Indian Self-Determination and Education Assistance Act, (III) in a program assisted under Title V, or (IV) in the private practice of the applicable profession if, as determined by the Secretary and in accordance with guidelines issued by the Secretary, the private practice qualifies.
Scholarship recipients may meet the obligation by half-time practice (as defined in PHSA section 331(j)) in any of the programs listed above if the individual agrees in writing to (I) double the period of obligated service that would otherwise be required if satisfied through full-time practice, and (II) that if the individual fails to begin or complete the doubled period, the procedures in section 108(l)(2) for determining damages for breach of contract will be used after converting the obligated period or service performed into its full-time equivalent.
Amends Section 108 of the Indian Health Care Improvement Act (25 U.S.C. 1616a) by replacing subsection (f)(1)(B)(iii) to define the 'period of obligated service' for loan repayment program participants.
Under the revised loan repayment provision, the period of obligated service may be: (I) 2 years, or longer if agreed by the individual, of full-time clinical practice in an Indian health program to which the individual may be assigned by the Secretary; (II) 4 years, or longer if agreed, of half-time clinical practice in such an Indian health program, with the condition that if the individual has agreed to serve longer than 2 years full-time, the half-time obligation equals the time required to complete the equivalent service on a half-time basis; or (III) 2 years in half-time clinical practice with a loan payment amount equal to 50 percent of the amount that would otherwise be payable for full-time service for that same period.
Who is affected and how:
IHS scholarship recipients: Gain more flexibility in where they can serve to satisfy obligations (IHS facilities, tribal/self-determination program sites, Title V–assisted programs, or certain private-practice roles). They also gain a half-time option but must accept a longer total service period and breach-conversion terms.
IHS loan repayment participants: Benefit from clearer rules about obligated service durations and how half-time service is calculated and treated for breach purposes; this provides predictability for planning and retention.
Tribal health programs and tribal self-determination contractors: May see improved ability to recruit clinicians who can meet service obligations while working for tribal-run programs, supporting local staffing and continuity of care.
Title V–assisted programs and qualifying private practitioners serving Native communities: Become explicit acceptable placement sites, which could broaden recruitment channels and allow more clinicians who receive federal support to serve in these settings.
Program administrators (IHS and implementing agencies): Must update contracts, service agreements, monitoring systems, and breach/repayment procedures. Administrative workload could increase during implementation and oversight.
Risks and trade-offs:
Overall effect:
Expand sections to see detailed analysis
Read twice and referred to the Committee on Indian Affairs.
Introduced February 19, 2025 by Catherine Marie Cortez Masto · Last progress February 19, 2025
Placed on Senate Legislative Calendar under General Orders. Calendar No. 74.
Committee on Indian Affairs. Reported by Senator Murkowski without amendment. With written report No. 119-21.
Committee on Indian Affairs. Ordered to be reported without amendment favorably.
Read twice and referred to the Committee on Indian Affairs.