115 HR 5874 RH: Restoring Accountability in the Indian Health Service Act of 2018
U.S. House of Representatives
2018-05-18
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Restoring Accountability in the Indian Health Service Act of 2018
. 2.The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I—Indian Health Service improvements
Sec. 101. Incentives for recruitment and retention.
Sec. 102. Medical credentialing system.
Sec. 103. Liability protections for health professional volunteers at Indian Health Service.
Sec. 104. Clarification regarding eligibility for Indian Health Service loan repayment program.
Sec. 105. Improvements in hiring practices.
Sec. 106. Improved authorities of secretary to improve accountability of senior executives and
employees of the Indian Health Service.
Sec. 107. Tribal culture and history.
Sec. 108. Staffing demonstration project.
Sec. 109. Rule establishing tribal consultation policy.
Sec. 110. Treatment of certain hospitals.
TITLE II—Employee protections
Sec. 201. Employee protections against retaliation.
Sec. 202. Right of Federal employees to petition Congress.
Sec. 203. Fiscal accountability.
TITLE III—Reports
Sec. 301. Definitions.
Sec. 302. Reports by the Secretary of Health and Human Services.
Sec. 303. Reports by the Comptroller General.
Sec. 304. Inspector General reports.
Sec. 305. Transparency in CMS surveys.
TITLE IV—Technical amendments
Sec. 401. Technical amendments.
<enum>I</enum><header>Indian Health Service improvements</header>
<section id="H52FCE63A8F55496F8060F6273E08A3D3"><enum>101.</enum><header>Incentives for recruitment and retention</header><text display-inline="no-display-inline">Title I of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1611">25 U.S.C. 1611</external-xref> et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H0DA9294C486A446CB14D4FD02ED03723" style="OLC">
<section id="H361833E0B3E24039A4E907DA3A6E4FAD"><enum>125.</enum><header>Incentives for recruitment and retention</header>
<subsection id="H9A881CB09852473D85E847E384E1D915"><enum>(a)</enum><header>Parity in IHS health care workforce personnel and pay system</header><text>The Secretary shall establish a personnel and pay system for physicians, dentists, nurses, and other health care professionals employed by the Service that provides a personnel and pay system that, to the maximum extent practicable, is comparable to the pay provided to physicians, dentists, nurses, and other health care professionals, respectively, under subchapters III and IV of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/74">chapter 74</external-xref> of title 38, United States Code.</text>
</subsection><subsection id="H4C049F6F28CB4F52949A2AB387483959"><enum>(b)</enum><header>Relocation costs</header><text>The Secretary may provide to an employee of the Service reimbursement for any relocation costs the employee incurs if—</text>
<paragraph id="H845DC8BCBA8448B68B94FEEC0C8E15B2"><enum>(1)</enum><text>the employee relocates to a Service area experiencing a high level of need for employees, as determined by the Secretary; and</text>
</paragraph><paragraph id="H3615DDFCF83E4FC9AF8336ABA5FF8123"><enum>(2)</enum><text>the employee is filling a position that would otherwise be difficult to fill, as determined by the Secretary, in the absence of an incentive.</text>
</paragraph></subsection><subsection id="H8E58F01B69E8425CAA93A19FEB775F2B"><enum>(c)</enum><header>Housing vouchers</header>
<paragraph id="H24314462301542BEB903252DAB3ED35B"><enum>(1)</enum><header>In general</header><text>Subject to paragraph (2), not later than 1 year after the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>, the Secretary may establish a program to provide tenant-based rental assistance to an employee of the Service who—</text>
<subparagraph id="H49E5F70FB9BB4D5BAD4543132F64CBD4"><enum>(A)</enum><text>agrees to serve for not less than 1 year at a Service unit designated by the Administrator of the Health Resources and Services Administration as a health professional shortage area, as defined in section 332(a) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e(a)</external-xref>), with the greatest staffing need; and</text>
</subparagraph><subparagraph id="H0A6083BF017C44C99D7320123CDCFACC"><enum>(B)</enum><text>is a critical employee, as determined by the Secretary.</text> </subparagraph></paragraph><paragraph id="H212EAF6A556A4106BF696E69F6D85AB0"><enum>(2)</enum><header>Sunset</header><text>Any program established by the Secretary under paragraph (1) shall terminate on the date that is 3 years after the date on which any such program is established.</text>
</paragraph></subsection><subsection id="H0664DA4C42F74E57ADFC2DBF687F9FD1"><enum>(d)</enum><header>Administration</header>
<paragraph id="H78D99B6042D542C2BB7EEEAF5C292A47"><enum>(1)</enum><header>OPM guidelines</header><text>The Secretary shall carry out subsection (b) in accordance with any guidelines of the Office of Personnel Management relating to section 572 of title 5, Code of Federal Regulations (as in effect on the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>).</text>
</paragraph><paragraph id="HE445F5328D3944049DF4127B7A5035D8"><enum>(2)</enum><header>Service agreements</header><text>The Secretary may only provide reimbursement for any relocation costs under subsection (b) or any other benefit under subsection (c) to—</text>
<subparagraph id="HFD1ADD3306704B4EA3679799B4AB8E26"><enum>(A)</enum><text>a full-time employee who agrees to serve for not less than 1 year in the Service, beginning on the date of the agreement; or</text>
</subparagraph><subparagraph id="H82857D4F3EFE4585865F48482B2A8B52"><enum>(B)</enum><text>a part-time employee who agrees to serve for not less than 2 years in the service beginning on the date of the agreement.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H3928BC3067C94B37BD190533F9643AC8"><enum>102.</enum><header>Medical credentialing system</header><text display-inline="no-display-inline">Title I of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1611">25 U.S.C. 1611</external-xref> et seq.), as amended by section 101, is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H716F0B89010F4311BBEE453C158462A5" style="OLC">
<section id="H5CB3014CDD084DEA969E21273E42C5B2"><enum>126.</enum><header>Medical credentialing system</header>
<subsection id="H46631A1E523B412CB1BA17E7272432C0"><enum>(a)</enum><header>In general</header>
<paragraph id="H413E5F9A4FA1495EB7CE36B24F41C981"><enum>(1)</enum><header>Development and implementation timeline</header><text display-inline="yes-display-inline">By not later than 1 year after the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>, the Secretary, acting through the Service and in accordance with the requirements described in subsection (b), shall develop and implement a Service-wide centralized electronic credentialing system (referred to in this section as the <quote>credentialing system</quote>) to credential licensed health professionals who seek to provide health care services at any Service unit, including physicians, nurses and physicians assistants.</text>
</paragraph><paragraph id="H1BC650FB56D24AF1B9EFEEADA48CF5AF"><enum>(2)</enum><header>Implementation</header><text>In implementing the credentialing system, the Secretary—</text> <subparagraph id="H268838F5E34542378AF6E9216B4A1418"><enum>(A)</enum><text>shall not require re-credentialing of licensed health professionals who were credentialed using existing Service policy prior to the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>; and</text>
</subparagraph><subparagraph id="H97CA1BDA4ACB43D59F7DD187F4A9D6ED"><enum>(B)</enum><text>shall—</text> <clause id="H062873F20075445EA167EEACC86B7DF3"><enum>(i)</enum><text>use the credentialing system for all new applications of licensed health professionals and the migration of credentials data that existed prior to implementation into the system;</text>
</clause><clause id="HE7A652D06EC246539378D0087AEAA653"><enum>(ii)</enum><text>maintain the established timeline for re-credentialing of licensed health professionals who were credentialed prior to implementation, as defined by Service policy; and</text>
</clause><clause id="H3B53C598E76D4495A3C9671BEDBF7433"><enum>(iii)</enum><text display-inline="yes-display-inline">review credentials for all professionals in the system, based on updated policies, on a not less than yearly basis. Licensed health professionals whose credentials would not have been approved under the updated policies shall have 90 days to meet the new requirements.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H4C741F63257B4640905208C31CB39179"><enum>(b)</enum><header>Requirements</header><text>In developing the credentialing system under subsection (a), the Secretary shall ensure the following:</text>
<paragraph id="H35503C349AA9450C8F39A780BFA0E541"><enum>(1)</enum><text display-inline="yes-display-inline">Credentialing procedures shall be uniform and integrated throughout the Service.</text> </paragraph><paragraph id="H007CED35909748E1BBE693B5F07E87BB"><enum>(2)</enum><text>With respect to each licensed health professional who successfully completes the credentialing procedures of the credentialing system, the Secretary may authorize each such professional to provide health care services at any Service unit.</text>
</paragraph><paragraph id="H874112B281594DD99C375CE01188D95D"><enum>(3)</enum><text display-inline="yes-display-inline">Credentialing procedures shall include verification of licensure, education, employment history, and criminal background checks and history.</text>
</paragraph></subsection><subsection id="H0D2D021BD9C24A74AAC3D31A5253A1CC"><enum>(c)</enum><header>Consultation</header><text>In developing the credentialing system under subsection (a), the Secretary shall consult with Indian Tribes and may also consult with any public or private association of medical providers, any government agency, or other relevant expert, as determined by the Secretary.</text>
</subsection><subsection id="H18C991D3D8984075869CF34000340225"><enum>(d)</enum><header>Application</header><text>A licensed health care professional may not provide health care services at any Service unit, unless such professional successfully completes the credentialing procedures of the credentialing system developed under subsection (a).</text>
</subsection><subsection id="H8A3BB34F3A0F483CBFA647C126E98D54"><enum>(e)</enum><header>Regulations</header><text>The Secretary may prescribe such regulations as may be necessary to carry out the provisions of this section.</text>
</subsection><subsection id="HEA7F3A90AF944175B9E68BE5357D3A63"><enum>(f)</enum><header>Rule of construction</header><text>Nothing in this section may be construed—</text> <paragraph id="H28996EFF813448D8B881962B78554E15"><enum>(1)</enum><text>to negatively impact the right of an Indian Tribe to enter into a compact or contract under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/5304">25 U.S.C. 5304</external-xref> et seq.); and</text>
</paragraph><paragraph id="HFBF08465C6F349A6B107C4DE38D2C864"><enum>(2)</enum><text>to apply to such a compact or contract unless expressly agreed to by the Indian Tribe.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </section><section id="H303923533EA84E3CBDB16911C2BCFEC1"><enum>103.</enum><header>Liability protections for health professional volunteers at Indian Health Service</header><text display-inline="no-display-inline">Section 224 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/233">42 U.S.C. 233</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HC8D0C4E31F704B48BC2E164787EF3524" style="OLC">
<subsection id="H90D750ABC499494C9A9D2F4F87F4C5A1"><enum>(r)</enum><header>Certain Indian Health Service volunteers deemed Public Health Service employees</header>
<paragraph id="HE95E0335AAE544B4B34458F73B7F7A20"><enum>(1)</enum><header>In general</header><text>For purposes of this section, an employee of an IHS urban Indian health program and a health professional volunteer at a Service unit shall, in providing a health service to an individual, be deemed to be an employee of the Public Health Service for a calendar year that begins during a fiscal year for which a transfer was made under paragraph (4)(C). The preceding sentence is subject to the provisions of this subsection.</text>
</paragraph><paragraph id="HA286EE23C33E49EEA348E4D9DC136A93"><enum>(2)</enum><header>Conditions</header><text>In providing a health service to an individual, a health care practitioner shall, for purposes of this subsection, be considered to be a health professional volunteer at a Service unit if all of the following conditions are met:</text>
<subparagraph id="HBFBEC548D1D546D6B94550193E45CE7E"><enum>(A)</enum><text>The service is provided to the individual at the facilities of a Service unit, or through offsite programs or events carried out by the Service unit.</text>
</subparagraph><subparagraph id="HB37359AC58314FE9A55F8F0609B70BCD"><enum>(B)</enum><text>The Service unit is sponsoring the health care practitioner pursuant to paragraph (3)(C).</text> </subparagraph><subparagraph id="H846B5D07E21D45E99A8E53DE376CDB51"><enum>(C)</enum><text>The health care practitioner does not receive any compensation for the service from the individual, the Service unit, or any third-party payer (including reimbursement under any insurance policy or health plan, or under any Federal or State health benefits program), except that the health care practitioner may receive repayment from the Service unit for reasonable expenses incurred by the health care practitioner in the provision of the service to the individual.</text>
</subparagraph><subparagraph id="H2E67146D663C4DEAB184DA9E1155A6D9"><enum>(D)</enum><text>Before the service is provided, the health care practitioner or the Service unit posts a clear and conspicuous notice at the site where the service is provided of the extent to which the legal liability of the health care practitioner is limited under this subsection.</text>
</subparagraph><subparagraph id="HCE807108DA62407290213576F8C2E548"><enum>(E)</enum><text>At the time the service is provided, the health care practitioner is licensed, certified, credentialed, and privileged in accordance with Service policy and applicable law regarding the provision of the service.</text>
</subparagraph></paragraph><paragraph id="HD50C99B355F34BC694C41AE8461D6CA4"><enum>(3)</enum><header>Applicability</header><text>Subsection (g) (other than paragraphs (3) and (5)) and subsections (h), (i), and (l) apply to an employee of an IHS urban Indian health program and to a health care practitioner at a Service unit for purposes of this subsection to the same extent and in the same manner as such subsections apply to an officer, governing board member, employee, or contractor of an entity described in subsection (g)(4), subject to paragraph (4) and subject to the following subparagraphs:</text>
<subparagraph id="H2F3BFF7FFD6B47B1A846EC862E84261C"><enum>(A)</enum><text>Each reference to an entity in subsections (g), (h), (i), and (l) shall be considered to be a reference to an IHS urban Indian health program or a Service unit, as applicable.</text>
</subparagraph><subparagraph id="HB1076C2DB95D409E80496ABFBAC5003E"><enum>(B)</enum><text>The first sentence of paragraph (1) applies in lieu of the first sentence of subsection (g)(1)(A).</text> </subparagraph><subparagraph id="H0F80929C82AB4D778C3AA32B584C8D60"><enum>(C)</enum><text>With respect to a Service unit, a health care practitioner is not a health professional volunteer at the Service unit unless the Service unit sponsors the health care practitioner. For purposes of this subsection, the Service unit shall be considered to be sponsoring the health care practitioner if—</text>
<clause id="H26594A2446184925ABAE1A9B51718E50"><enum>(i)</enum><text>with respect to the health care practitioner, the Service unit submits to the Secretary an application meeting the requirements of subsection (g)(1)(D); and</text>
</clause><clause id="H828872C7471F4ECB883D18A3D988A6E2"><enum>(ii)</enum><text>the Secretary, pursuant to subsection (g)(1)(E), determines that the health care practitioner is deemed to be an employee of the Public Health Service.</text>
</clause></subparagraph><subparagraph id="H5CE1255704C345D687ACCC2C5E94FB90"><enum>(D)</enum><text>In the case of a health care practitioner who is determined by the Secretary pursuant to this subsection and subsection (g)(1)(E) to be a health professional volunteer, this subsection applies to the health care practitioner (with respect to services performed on behalf of the Service unit sponsoring the health care practitioner pursuant to subparagraph (C)) for any cause of action arising from an act or omission of the health care practitioner occurring on or after the date on which the Secretary makes that determination.</text>
</subparagraph><subparagraph id="HD1099D79A3724C7281869A8AFA9A670B"><enum>(E)</enum><text>Subsection (g)(1)(F) applies to a health care practitioner for purposes of this subsection only to the extent that, in providing health services to an individual, each of the conditions described in paragraph (2) is met.</text>
</subparagraph></paragraph><paragraph id="H01BFC570726243AF97362AF7EF16133F"><enum>(4)</enum><header>Funding</header>
<subparagraph id="HEC4555DA5FC04CB582C486DD2187659F"><enum>(A)</enum><header>In general</header><text>Amounts in the fund established under subsection (k)(2) shall be available for transfer under subparagraph (C) for purposes of carrying out this subsection.</text>
</subparagraph><subparagraph id="HD4892BAA74F1496C87C3513B4EDE6945"><enum>(B)</enum><header>Annual estimates</header>
<clause id="HC2B9391EC2C542ABAB41F930104753B6"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than May 1 of each fiscal year, the Attorney General, in consultation with the Secretary, shall submit to Congress a report providing an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the acts or omissions of employees of an IHS urban Indian health program or health professional volunteers, will be paid pursuant to this section during the calendar year that begins in the following fiscal year.</text>
</clause><clause id="H6680D0D71B754D11B8B7F84A158EB58F"><enum>(ii)</enum><header>Applicability</header><text display-inline="yes-display-inline">Subsection (k)(1)(B) applies to the estimate under clause (i) relating to employees of an IHS urban Indian health program or health professional volunteers to the same extent and in the same manner as that subsection applies to the estimate under that subsection relating to officers, governing board members, employees, and contractors of entities described in subsection (g)(4).</text>
</clause></subparagraph><subparagraph id="H31AA2B7ADA664FAF95EFD180A48DB345"><enum>(C)</enum><header>Transfers</header><text>Not later than December 31 of each fiscal year, the Secretary shall transfer from the fund under subsection (k)(2) to the appropriate accounts in the Treasury an amount equal to the estimate made under subparagraph (B) for the calendar year beginning in that fiscal year, subject to the extent of amounts in the fund.</text>
</subparagraph></paragraph><paragraph id="H351EFBE00B854EC0A3BE41E07F9F252D"><enum>(5)</enum><header>Definitions</header>
<subparagraph id="HCA4CE30F1E2148EA9284D874F6681A91"><enum>(A)</enum><header>IHS urban Indian health program</header><text display-inline="yes-display-inline">In this subsection, the term <term>IHS urban Indian health program</term> means an urban Indian health program operated by an urban Indian organization pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1651">25 U.S.C. 1651</external-xref> et seq.).</text>
</subparagraph><subparagraph id="H8560BBCB018C4DF59EF557BE825E4F7C"><enum>(B)</enum><header>Service unit</header><text>In this subsection, the term <term>Service unit</term> has the meaning given the term in section 4 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1603">25 U.S.C. 1603</external-xref>).</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H534BCAD499844B658E6B60BC1E38003F"><enum>(6)</enum><header display-inline="yes-display-inline">Rule of construction</header><text>Nothing in this subsection may be construed—</text> <subparagraph id="HB26620EBA90A4120B0F20A50DD62B3E6"><enum>(A)</enum><text>to negatively impact the right of an Indian Tribe to enter into a compact or contract under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/5304">25 U.S.C. 5304</external-xref> et seq.); and</text>
</subparagraph><subparagraph id="H7720262114254287A5179A6F96A83918"><enum>(B)</enum><text>to apply to such a compact or contract unless expressly agreed to by the Indian Tribe.</text> </subparagraph></paragraph><paragraph id="H8B2E58E5F5074D0BB0753A7510190245"><enum>(7)</enum><header>Effective dates</header> <subparagraph id="H0D3AEFE741B444DFB805388268D16BBA"><enum>(A)</enum><header>In general</header><text>Except as provided in subparagraph (B), this subsection shall take effect on October 1, 2019.</text>
</subparagraph><subparagraph id="HE4B2A6CD2A4E42BCB99B4A98F2F4BD01"><enum>(B)</enum><header>Regulations, applications, and reports</header><text>Effective on the date of the enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>, the Secretary may—</text> <clause id="H79AC7FDB135F40D8B2C7010DB48548E4"><enum>(i)</enum><text>prescribe regulations for carrying out this subsection; and</text>
</clause><clause id="H62637924B4F949EDB4E2C8EDC6D008A6"><enum>(ii)</enum><text>accept and consider applications submitted under paragraph (3)(C)(i).</text></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </section><section id="H413B6C9B06CB43419D34BFA827E74116"><enum>104.</enum><header>Clarification regarding eligibility for Indian Health Service loan repayment program</header><text display-inline="no-display-inline">Section 108 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1616a">25 U.S.C. 1616a</external-xref>) is amended—</text>
<paragraph id="HED563A11201148E89C33AC2CF954C5BC"><enum>(1)</enum><text>by amending subparagraph (B) of subsection (b)(1) to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H896D2139318D44D88B386E4878C44102" style="OLC"> <subparagraph id="HCDB343194ED94C3E9D070CBF39A1DE4A"><enum>(B)</enum><text>have—</text>
<clause id="HBD974303A8E64961A5C2BB920A705898"><enum>(i)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="H3CD18CAF544B4856909540AB95D6D148"><enum>(I)</enum><text>a degree in a health profession; and</text> </subclause><subclause id="H87DA91B211504CAEBF190FBCB9BC5FAE" indent="up1"><enum>(II)</enum><text>a license to practice a health profession in a State; or</text>
</subclause></clause><clause id="HCF44C9D8840442D0904AE71C844CFC66"><enum>(ii)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="H2CA313A0334F48C2B242DA08B23C7C72"><enum>(I)</enum><text>a master's degree in business administration with an emphasis in health care management (as defined by the Secretary), health administration, hospital administration, or public health; and</text>
</subclause><subclause id="HE5A454897941426DAAC8182AEA8A87D5" indent="up1"><enum>(II)</enum><text>a license or certification to practice in the field of business administration, health administration, hospital administration, or public health in a State, if the Secretary determines such license or certification necessary for the Indian health program to which the individual will be assigned;</text>
</subclause></clause><clause id="H0E488EADD742481EB09001A60D1DA1D5"><enum>(iii)</enum><text>maintain credentials as determined by the system described in section 102; and</text> </clause><clause id="H9278472A7D934816B5501953AB6018B0"><enum>(iv)</enum><text>participate in the training described in section 107;</text></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</paragraph><paragraph id="H2A97EAE275CD4037AC9D6EFC6D39729F"><enum>(2)</enum><text>by amending clause (iii) of subsection (f)(1)(B) to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H599571994BD34C138DD0692CA248009D" style="OLC"> <clause id="HD6970056C34A4CF5BD4E673E40816E0F"><enum>(iii)</enum><text>to serve for a time period (referred to in this section as the <quote>period of obligated service</quote>) equal to—</text>
<subclause id="HE2615634225340B4BB082E91AEE65580"><enum>(I)</enum><text>2 years or such longer period as the individual may agree to serve in the full-time practice of such individual’s profession in an Indian health program to which the individual may be assigned by the Secretary; or</text>
</subclause><subclause id="H0D1350EB46694CE8BC2762D97F8C6F9F"><enum>(II)</enum><text>4 years or such longer period as the individual may agree to serve in the half-time practice of such individual’s profession in an Indian health program to which the individual may be assigned by the Secretary;</text></subclause></clause><after-quoted-block>; and</after-quoted-block></quoted-block>
</paragraph><paragraph id="H07F3D83D07414DA59A97DB4D206DFD1E"><enum>(3)</enum><text>in subsection (g)(2)—</text> <subparagraph id="HC852EF96441D481AA021C6026532DFE6"><enum>(A)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text>
</subparagraph><subparagraph id="H48DC85B60B54418FBAF2C4BF25308A01"><enum>(B)</enum><text>in subparagraph (A)—</text> <clause id="HBE545F0CE576427DAA60470EAD9DD210"><enum>(i)</enum><text>by striking the first sentence of the matter preceding clause (i) and inserting the following: <quote>In the case of an individual who contracts to serve a period of obligated service under subsection (f)(1)(B)(iii)(I), for each year of such obligated service, the Secretary may pay up to $35,000 (or an amount equal to the amount specified in section 338B(g)(2)(A) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254l-1">42 U.S.C. 254l–1(g)(2)(A)</external-xref>)) on behalf of the individual for loans described in paragraph (1). In the case of an individual who contracts to serve a period of obligated service under subsection (f)(1)(B)(iii)(II), for each year of such obligated service, the Secretary may pay up to $17,500 on behalf of the individual for loans described in paragraph (1)</quote>; and</text>
</clause><clause id="HD4F647637F024690B101995E424BA5B4"><enum>(ii)</enum><text>by striking <quote>In making a determination</quote> and inserting the following:</text> <quoted-block display-inline="no-display-inline" id="HF026DFB9DF8E4FDEA1BA55E4ACA418C7" style="OLC"> <subparagraph id="H1E1794A9DD6B4AECA89F33B73B793F88"><enum>(B)</enum><text>In making a determination under this paragraph</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</clause></subparagraph></paragraph></section><section id="H724B3EFA5BEA44D79192286915C3A3D3"><enum>105.</enum><header>Improvements in hiring practices</header>
<subsection id="H2722DBDD40FE46FE87CADB8964F3A653"><enum>(a)</enum><header>In general</header><text>Title VI of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1661">25 U.S.C. 1661</external-xref> et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H210BD5E5410A4B40ABF87BB5DC73708E" style="OLC">
<section id="H412DF9DBBBE84999968B64A2DB6DB056"><enum>605.</enum><header>Improvements in hiring practices</header>
<subsection id="H2521A5F5CEC84AA4860364DC92D5C9EA"><enum>(a)</enum><header>Direct hire authority</header><text>The Secretary may appoint, without regard to subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/33">chapter 33</external-xref> of title 5, United States Code (other than sections 3303 and 3328 of such title), a candidate directly to a position within the Service for which the candidate meets the qualifications standard established by the Office of Personnel Management.</text>
</subsection><subsection id="H900742573C0241CC8FC1CFC211DC15FD"><enum>(b)</enum><header>Tribal notification</header><text>Before appointing, hiring, promoting, transferring, or reassigning a candidate to a Senior Executive Service position or the position of a manager at an Area office or Service unit, the Secretary shall provide notice to each Indian Tribe located within the defined geographic area of such Area office or Service unit, as the case may be, of the content of an inclusion in an employment record. Each such Indian Tribe may submit comment to the Secretary during the 10-day period after the date of such notification regarding such content.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H2A7B24FF025F45ADA1555FE70EA5431B"><enum>(b)</enum><header>In general</header><text>Subsection (c) of section 2 of the Act of December 15, 1979 (<external-xref legal-doc="usc" parsable-cite="usc/25/5117">25 U.S.C. 5117</external-xref>), is amended by adding the following:</text>
<quoted-block display-inline="no-display-inline" id="HFEF466E3248D4209AD126EFC52E5F410" style="OLC">
<paragraph id="H5D953D229BF74536B97D5638B7F709FC"><enum>(3)</enum><header>IHS waivers</header><text>The Secretary of Health and Human Services may, at the request of an Indian Tribe, seek from each Indian Tribe concerned, a waiver of Indian preference laws for a personnel action that is with respect to—</text>
<subparagraph id="H14DD4AE888A64436B5727BEF84D4CEBA"><enum>(A)</enum><text>an Indian Health Service unit in which 15 percent or more of the total positions or specific health professionals in the Service unit are not filled by a full-time employee of the Indian Health Service for a period of 6 months or longer; or</text>
</subparagraph><subparagraph id="HDC495EA127BC411AAFD5B29A008E69FD"><enum>(B)</enum><text>a former employee of the Indian Health Service or a former tribal employee who was removed from such former employment within, or demoted for performance or misconduct that occurred during, the 5-year period following the date of such personnel action.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H51E32A8832FD4664A5A541670E402156"><enum>106.</enum><header>Improved authorities of secretary to improve accountability of senior executives and employees of
the Indian Health Service</header>
<subsection id="H3E1ECC8A50664C6D8C8587D13CCA7F70"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Title VI of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1661">25 U.S.C. 1661</external-xref> et seq.), as amended by section 105, is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H4385E1CF7C434E058C534120849B5814" style="OLC">
<section id="H062EFBA765DC41B3963650ECFD478835"><enum>606.</enum><header>Improved authorities of secretary to improve accountability of senior executives of the Indian
Health Service</header>
<subsection commented="no" display-inline="no-display-inline" id="HEABFB134A8494F95B07FA0E7256B54AF"><enum>(a)</enum><header display-inline="yes-display-inline">Authority</header>
<paragraph commented="no" display-inline="no-display-inline" id="H03E32C7E079E4353B63D011F5B2DEA2B"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary may, as provided in this section, reprimand or suspend, involuntarily reassign, demote, or remove a covered individual from a senior executive position at the Service if the Secretary determines that the misconduct or performance of the covered individual warrants such action.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1C74B3750695418E95EA8E33537C13D4"><enum>(2)</enum><header>Removal from civil service</header><text>If the Secretary removes an individual pursuant to paragraph (1), the Secretary may remove the individual from the civil service (as defined in section 2101 of title 5, United States Code).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H1F286839E2AE4F62B114BF7BBB3E78A5"><enum>(b)</enum><header display-inline="yes-display-inline">Rights and procedures</header>
<paragraph commented="no" display-inline="no-display-inline" id="H9D0C522AE8784BCEBCA25654E278D9CB"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">A covered individual who is the subject of an action under subsection (a) is entitled to—</text> <subparagraph commented="no" display-inline="no-display-inline" id="H3DC870D91DB3426892F9EE26F736173D"><enum>(A)</enum><text display-inline="yes-display-inline">advance notice of the action and a file containing all evidence in support of the proposed action;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H45F69E563EB74957A5E872BFC1A080F8"><enum>(B)</enum><text display-inline="yes-display-inline">be represented by an attorney or other representative of the covered individual’s choice; and</text> </subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H8B0F8CB80EA742BFBE032A082ACE3F4D"><enum>(C)</enum><text display-inline="yes-display-inline">grieve the action in accordance with an internal grievance process that the Secretary shall establish for purposes of this subsection.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HDF7639109A9E49CE8FB706DA86503201"><enum>(2)</enum><header>Notice</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H0CDEAF021474429D80F7A07B7A4B7EE0"><enum>(A)</enum><header>Aggregate period for notice</header><text>The aggregate period for notice, response, and decision on an action under subsection (a) may not exceed 15 business days.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9D18E219F5BE4D92A2AB53F51B5E6281"><enum>(B)</enum><header>Response</header><text>The period for the response of a covered individual to a notice under paragraph (1)(A) of an action under subsection (a) shall be 7 business days.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H62DDB9BC86A44FFB8BC8B6B411562861"><enum>(C)</enum><header>Decision</header><text>A decision under this paragraph on an action under subsection (a) shall be issued not later than 15 business days after notice of the action is provided to the covered individual under paragraph (1)(A). The decision shall be in writing, and shall include the specific reasons for the decision.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBC824A61624D4B6B92A8F5D20CA9BCEB"><enum>(3)</enum><header>Grievance process</header><text>The Secretary shall ensure that the grievance process established under paragraph (1)(C) takes fewer than 21 days.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H5047FB044C9E4EC3A63693F0E9E441D1"><enum>(4)</enum><header>Final and conclusive decision</header><text>A decision under paragraph (2) that is not grieved, and a grievance decision under paragraph (3), shall be final and conclusive.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H454854E358B24F3B86CB24CF90CC9F64"><enum>(5)</enum><header>Judicial review</header><text>A covered individual adversely affected by a decision under paragraph (2) that is not grieved, or by a grievance decision under paragraph (3), may obtain judicial review of such decision.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA8BFE54B7236473BA8D3CDAE2A6482F9"><enum>(6)</enum><header>Court review</header><text>In any case in which judicial review is sought under paragraph (5), the court shall review the record and may set aside any Department action found to be—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HCA1798FEDFF145B6A74169015381D757"><enum>(A)</enum><text display-inline="yes-display-inline">arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with a provision of law;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H8B60BBFCCA03447598C2B560F1EFD8F9"><enum>(B)</enum><text display-inline="yes-display-inline">obtained without procedures required by a provision of law having been followed; or</text> </subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2AF1EE7CBD0745969046CECDCF3BCE35"><enum>(C)</enum><text display-inline="yes-display-inline">unsupported by substantial evidence.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HB1D559E03D994EEAADB24170CA82836A"><enum>(c)</enum><header display-inline="yes-display-inline">Relation to other provisions of law</header><text display-inline="yes-display-inline">Section 3592(b)(1) of title 5, United States Code, does not apply to an action under subsection (a).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H3B843532AEE04BE7AD0779563818ADB1"><enum>(d)</enum><header display-inline="yes-display-inline">Definitions</header><text display-inline="yes-display-inline">In this section:</text> <paragraph commented="no" display-inline="no-display-inline" id="H30B924B4404847868D9B76E6BC78DADB"><enum>(1)</enum><header>Covered individual</header><text display-inline="yes-display-inline">The term <term>covered individual</term> means a career appointee (as that term is defined in section 3132(a) of title 5, United States Code).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H31A3D9D335A14D829638DE3D40519CFD"><enum>(2)</enum><header>Misconduct</header><text display-inline="yes-display-inline">The term <term>misconduct</term> includes neglect of duty, malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function.</text>
</paragraph><paragraph id="H2E13D1318E5E4F3F9AF527B25DBF04BA"><enum>(3)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services, acting through the Director of the Service.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF08599CCEF504CA788D67FC6FFBC4C48"><enum>(4)</enum><header>Senior executive position</header><text display-inline="yes-display-inline">The term <term>senior executive position</term> means a Senior Executive Service position (as that term is defined in section 3132(a) of title 5, United States Code).</text>
</paragraph></subsection></section><section id="HA5273C6100F74489828642EE9350F150"><enum>607.</enum><header>Improved authorities of secretary to improve accountability of employees of the Indian Health
Service</header>
<subsection commented="no" display-inline="no-display-inline" id="HDA40987ABA974775AEF1EDED47468EDD"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header>
<paragraph commented="no" display-inline="no-display-inline" id="HC672EDFE5104408A805E727832FEE487"><enum>(1)</enum><header>Authority</header><text display-inline="yes-display-inline">The Secretary may remove, demote, or suspend a covered individual who is an employee of the Service if the Secretary determines the performance or misconduct of the covered individual warrants such removal, demotion, or suspension.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HB54628A588924F5EB7311139D08E1265"><enum>(2)</enum><header>Actions</header><text>If the Secretary removes, demotes, or suspends a covered individual pursuant to paragraph (1), the Secretary may—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HDE087FDE79DF4BF58813B4584870E96D"><enum>(A)</enum><text display-inline="yes-display-inline">remove the covered individual from the civil service (as defined in section 2101 of title 5, United States Code);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H2A4F743B3C104375A72FF330E10376BC"><enum>(B)</enum><text display-inline="yes-display-inline">demote the covered individual by means of a reduction in grade for which the covered individual is qualified, that the Secretary determines is appropriate, and that reduces the annual rate of pay of the covered individual; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H6DEEFBFB4864499F9CB642B365DDD682"><enum>(C)</enum><text display-inline="yes-display-inline">suspend the covered individual.</text> </subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HF43827A791E54649A152916F533FF06E"><enum>(b)</enum><header display-inline="yes-display-inline">Pay of certain demoted individuals</header> <paragraph commented="no" display-inline="no-display-inline" id="H583D65EA8BFF4DC09AC61958B996B91A"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, any covered individual subject to a demotion under subsection (a)(2) shall, beginning on the date of such demotion, receive the annual rate of pay applicable to such grade.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H5DE1C0E2AA9146079318A65DBA5F8684"><enum>(2)</enum><header>Restrictions</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H5C62E2FD375A44BC8F219EBD85975094"><enum>(A)</enum><header>Prohibition on administrative leave</header><text>A covered individual subject to a demotion under subsection (a)(2) may not be placed on administrative leave during the period during which an appeal (if any) under this section is ongoing, and may only receive pay if the covered individual reports for duty or is approved to use accrued unused annual, sick, family medical, military, or court leave.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HE8BBB6D07A274D4EAF1F5FD5393C36B7"><enum>(B)</enum><header>Restriction on pay and benefits</header><text>If a covered individual subject to a demotion under subsection (a)(2) does not report for duty or receive approval to use accrued unused leave, such covered individual shall not receive pay or other benefits pursuant to subsection (d)(5).</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HB7EF3150530F4C46B606BD254A784C7A"><enum>(c)</enum><header display-inline="yes-display-inline">Procedures</header>
<paragraph commented="no" display-inline="no-display-inline" id="H5487E5B80E44474F86525E1AB94F5DFC"><enum>(1)</enum><header>In general</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H1D601F4DD96D4AA3B2B644933AE34F8E"><enum>(A)</enum><header>Aggregate period</header><text display-inline="yes-display-inline">The aggregate period for notice, response, and final decision in a removal, demotion, or suspension under this section may not exceed 15 business days.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HD4A4586B84B1450B9ACAD99A11A968FC"><enum>(B)</enum><header>Period for response</header><text display-inline="yes-display-inline">The period for the response of a covered individual to a notice of a proposed removal, demotion, or suspension under this section shall be 7 business days.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HFC80BF3E95DC4A9288AAEF8603CFB3A5"><enum>(C)</enum><header>Representation by attorney or other representative</header><text display-inline="yes-display-inline">Paragraph (3) of subsection (b) of section 7513 of title 5, United States Code, shall apply with respect to a removal, demotion, or suspension under this section.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF88533AE7A074193903C19420D4BE6A8"><enum>(D)</enum><header>Procedures superseding CBAs</header><text>The procedures in this subsection shall supersede any collective bargaining agreement to the extent that such agreement is inconsistent with such procedures.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HFC0B956884BF4B1FB36CCD700A532FB2"><enum>(2)</enum><header>Final decision</header><text>The Secretary shall issue a final decision with respect to a removal, demotion, or suspension under this section not later than 15 business days after the Secretary provides notice, including a file containing all the evidence in support of the proposed action, to the covered individual of the removal, demotion, or suspension. The decision shall be in writing and shall include the specific reasons for the decision.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H4CF249B818794ABAB9F5BF7145438705"><enum>(3)</enum><header>Performance appraisal</header><text>The procedures under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/43">chapter 43</external-xref> of title 5, United States Code, shall not apply to a removal, demotion, or suspension under this section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF44E8238332C46048C84A6127A67D4DA"><enum>(4)</enum><header>Appeal to merit systems protection board</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H35310500169A4DED96BE9BE95B4D636B"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to subparagraph (B) and subsection (d), any removal or demotion under this section, and any suspension of more than 14 days under this section, may be appealed to the Merit Systems Protection Board, which shall refer such appeal to an administrative judge pursuant to section 7701(b)(1) of title 5, United States Code.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF688034DCD4B4DDC97A149477753D8DB"><enum>(B)</enum><header>Time period</header><text display-inline="yes-display-inline">An appeal under subparagraph (A) of a removal, demotion, or suspension may only be made if such appeal is made not later than 10 business days after the date of such removal, demotion, or suspension.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H9F0ECBE3073F4081A9A1E3D199EBAF5E"><enum>(d)</enum><header display-inline="yes-display-inline">Expedited review</header>
<paragraph commented="no" display-inline="no-display-inline" id="H05F1EE545A4B4F6AB653CE913078C8A8"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Upon receipt of an appeal under subsection (c)(4)(A), the administrative judge shall expedite any such appeal under section 7701(b)(1) of title 5, United States Code, and, in any such case, shall issue a final and complete decision not later than 180 days after the date of the appeal.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H3FDAA38DB15040B98AA76980504D5894"><enum>(2)</enum><header>Upholding decision</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H3BBC85406EC2409584EDEE6F0DD73C01"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding section 7701(c)(1)(B) of title 5, United States Code, the administrative judge shall uphold the decision of the Secretary to remove, demote, or suspend an employee under subsection (a) if the decision is supported by substantial evidence.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H7B51804203814AA2A6B72D3675DB6E88"><enum>(B)</enum><header>Prohibition of mitigation</header><text display-inline="yes-display-inline">Notwithstanding title 5, United States Code, or any other provision of law, if the decision of the Secretary is supported by substantial evidence, the administrative judge shall not mitigate the penalty prescribed by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H395847A609E540C48E1A00A8D2CF1C1D"><enum>(3)</enum><header>Appeal to merit systems protection board</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H531B0145A8444085957C1B91F672C9B9"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The decision of the administrative judge under paragraph (1) may be appealed to the Merit Systems Protection Board.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H6227BF824F2348C2B456345FB02BB9DB"><enum>(B)</enum><header>Upholding decision</header><text display-inline="yes-display-inline">Notwithstanding section 7701(c)(1)(B) of title 5, United States Code, the Merit Systems Protection Board shall uphold the decision of the Secretary to remove, demote, or suspend an employee under subsection (a) if the decision is supported by substantial evidence.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HBC67EA259B1A4C6384FEF31E51040106"><enum>(C)</enum><header>Prohibition of mitigation</header><text display-inline="yes-display-inline">Notwithstanding title 5, United States Code, or any other provision of law, if the decision of the Secretary is supported by substantial evidence, the Merit Systems Protection Board shall not mitigate the penalty prescribed by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA013FFB795034111803094D675F6ABD8"><enum>(4)</enum><header>Report</header><text display-inline="yes-display-inline">In any case in which the administrative judge cannot issue a decision in accordance with the 180-day requirement under paragraph (1), the Merit Systems Protection Board shall, not later than 14 business days after the expiration of the 180-day period, submit to the appropriate committees of Congress a report that explains the reasons why a decision was not issued in accordance with such requirement.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H998A8BB8EFE549AF96013B26E1FFCF9C"><enum>(5)</enum><header>Appeal</header><text>A decision of the Merit Systems Protection Board under paragraph (3) may be appealed to the United States Court of Appeals for the Federal Circuit pursuant to section 7703 of title 5, United States Code, or to any court of appeals of competent jurisdiction pursuant to subsection (b)(1)(B) of such section.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H1AEF2478D9D84A439F663C25773A64EE"><enum>(6)</enum><header>Prohibition against stays</header><text display-inline="yes-display-inline">The Merit Systems Protection Board may not stay any removal or demotion under this section, except as provided in section 1214(b) of title 5, United States Code.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA976E930691140DE99C67E8A595ED3B4"><enum>(7)</enum><header>Restriction on pay and benefits during appeal</header><text display-inline="yes-display-inline">During the period beginning on the date on which a covered individual appeals a removal from the civil service under subsection (c) and ending on the date that the United States Court of Appeals for the Federal Circuit issues a final decision on such appeal, such covered individual may not receive any pay, awards, bonuses, incentives, allowances, differentials, student loan repayments, special payments, or benefits related to the employment of the individual by the Service.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H37198B1503F94615860F1881BBB9A16D"><enum>(8)</enum><header>Information to expedite appeal</header><text display-inline="yes-display-inline">To the maximum extent practicable, the Secretary shall provide to the Merit Systems Protection Board such information and assistance as may be necessary to ensure an appeal under this subsection is expedited.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H017F8153237E4BEBA4992BC690AEFA82"><enum>(9)</enum><header>Backpay</header><text display-inline="yes-display-inline">If an employee prevails on appeal under this section, the employee shall be entitled to backpay (as provided in section 5596 of title 5, United States Code).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF93BE6FABCAE4DC6B220D65C9B13DBC4"><enum>(10)</enum><header>Applicable timelines and procedures</header><text display-inline="yes-display-inline">If an employee who is subject to a collective bargaining agreement chooses to grieve an action taken under this section through a grievance procedure provided under the collective bargaining agreement, the timelines and procedures set forth in subsection (c) and this subsection shall apply.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H5834E731BE9D4AA0AB453D58600298CA"><enum>(e)</enum><header display-inline="yes-display-inline">Alleged prohibited personnel practice</header><text display-inline="yes-display-inline">In the case of a covered individual seeking corrective action (or on behalf of whom corrective action is sought) from the Office of Special Counsel based on an alleged prohibited personnel practice described in section 2302(b) of title 5, United States Code, the Secretary may not remove, demote, or suspend such covered individual under subsection (a) without the approval of the Special Counsel under section 1214(f) of title 5, United States Code.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H74976020C51B40698F462AD5BA7EAC25"><enum>(f)</enum><header display-inline="yes-display-inline">Termination of investigations by Office of Special Counsel</header>
<paragraph commented="no" display-inline="no-display-inline" id="H3C32851044BD436CAA76034B83A040AE"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law, the Special Counsel (established by section 1211 of title 5, United States Code) may terminate an investigation of a prohibited personnel practice alleged by an employee or former employee of the Service after the Special Counsel provides to the employee or former employee a written statement of the reasons for the termination of the investigation.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBB6B5F1E40EE418A91242BA7B94D4478"><enum>(2)</enum><header>Admissibility</header><text>The statement described in paragraph (1) may not be admissible as evidence in any judicial or administrative proceeding without the consent of the employee or former employee described in paragraph (1).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H05BBAFB845F742259B93A88F735461A3"><enum>(g)</enum><header display-inline="yes-display-inline">Vacancies</header><text display-inline="yes-display-inline">In the case of a covered individual who is removed or demoted under subsection (a), to the maximum extent feasible, the Secretary shall fill the vacancy arising as a result of such removal or demotion.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="HCF8DEACF4E7E494CB6E32F6ECF79B795"><enum>(h)</enum><header display-inline="yes-display-inline">Definitions</header><text display-inline="yes-display-inline">In this section:</text> <paragraph commented="no" display-inline="no-display-inline" id="HA377D41BA65649EB80209381A781CFB5"><enum>(1)</enum><header>Covered individual</header><text display-inline="yes-display-inline">The term <term>covered individual</term> means an individual occupying a position at the Service, but does not include—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HB871D8F0C7124AEDADDAB1F5481D796E"><enum>(A)</enum><text display-inline="yes-display-inline">an individual occupying a senior executive position (as defined in section 606(d));</text> </subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H81B1254897C0446E9283C522F753AAB3"><enum>(B)</enum><text display-inline="yes-display-inline">an individual who has not completed a probationary or trial period; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H96757785782445AEAB02DFDC1DAFE13D"><enum>(C)</enum><text display-inline="yes-display-inline">a political appointee.</text> </subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H247E885943694E919C7A17E5C06093AC"><enum>(2)</enum><header>Grade</header><text display-inline="yes-display-inline">The term <term>grade</term> has the meaning given such term in section 7511(a) of title 5, United States Code.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC2BBDA37524C4BC1AF514D604FB39FDC"><enum>(3)</enum><header>Misconduct</header><text display-inline="yes-display-inline">The term <term>misconduct</term> includes neglect of duty, malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC205E0E1FBA341E4B4ED73729F30BF4A"><enum>(4)</enum><header>Political appointee</header><text display-inline="yes-display-inline">The term <term>political appointee</term> means an individual who is—</text> <subparagraph commented="no" display-inline="no-display-inline" id="H96D59FA24A00473EA35BDED8275023CF"><enum>(A)</enum><text display-inline="yes-display-inline">employed in a position described under sections 5312 through 5316 of title 5, United States Code (relating to the Executive Schedule);</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H349486C09B5F425EB27BDB3EA91C6DE5"><enum>(B)</enum><text display-inline="yes-display-inline">a limited term appointee, limited emergency appointee, or noncareer appointee in the Senior Executive Service, as defined under paragraphs (5), (6), and (7), respectively, of section 3132(a) of title 5, United States Code; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HF436F0164706481BBB8F3FDED73BCE27"><enum>(C)</enum><text display-inline="yes-display-inline">employed in a position of a confidential or policy-determining character under schedule C of subpart C of part 213 of title 5, Code of Federal Regulations, or successor regulation.</text>
</subparagraph></paragraph><paragraph id="HF10FB47F7F5C4F77953A8E9455F9EEF4"><enum>(5)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services, acting through the Director of the Service.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF58B97543A2844C4B10F889308E76282"><enum>(6)</enum><header>Suspend</header><text display-inline="yes-display-inline">The term <term>suspend</term> means the placing of an employee, for disciplinary reasons, in a temporary status without duties and pay for a period in excess of 14 days.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="H386A0B2A708441659AC674BA544BA85F"><enum>(b)</enum><header>Conforming amendments</header><text>Section 4303(f) of title 5, United States Code, is amended—</text> <paragraph commented="no" display-inline="no-display-inline" id="H23B911E9DA0248ACAACC6A0B270AEB91"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (3), by striking <quote>or</quote> at the end;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H15BD87CD1ED244919FA7CE5423CBEA1C"><enum>(2)</enum><text display-inline="yes-display-inline">in paragraph (4), by striking the period at the end and inserting <quote>, or</quote>; and</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="H50A2610651A141C2A237B83AFC222673"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H95DDF6BCE10649F895A5E2811A760D81" style="USC">
<paragraph commented="no" display-inline="no-display-inline" id="HAD6CA02E706B42A485A3E1FD2C4F71F8"><enum>(5)</enum><text display-inline="yes-display-inline">any removal or demotion under section 607 of the Indian Health Care Improvement Act.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HCFCA4BE7F1694812859B20F4D6B94D11"><enum>(c)</enum><header>Report</header><text>Not later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services or the Inspector General of the Department of Health and Human Services shall submit a report to Congress that includes the following:</text>
<paragraph id="H180208F97C8244FFB9E3E44B06E4F40F"><enum>(1)</enum><text>The number of employees of the Indian Health Service who were removed, demoted, or suspended in the 1-year period before the date of enactment of this Act.</text>
</paragraph><paragraph id="HAF1E6279AACF4109BF2AC3DDD019FD75"><enum>(2)</enum><text>The number of employees of the Indian Health Service who were removed, demoted, or suspended in the 1-year period after the date of enactment of this Act using the updated authorities provided in the amendments made by this Act.</text>
</paragraph><paragraph id="H3BBE29387E8746D4A0B9D30169AEC88E"><enum>(3)</enum><text>The appropriate details of removals, demotions, and suspensions that lend necessary context.</text> </paragraph></subsection></section><section id="HDA4732116BAE41CEA00EF4C4D13FF80C"><enum>107.</enum><header>Tribal culture and history</header><text display-inline="no-display-inline">Section 113 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1616f">25 U.S.C. 1616f</external-xref>) is amended—</text>
<paragraph id="H335F94285B374FCEBF176E6670B0E761"><enum>(1)</enum><text>in subsection (a)—</text> <subparagraph id="HC61C31EB1F38410AB04E4F02A44A79C8"><enum>(A)</enum><text>by striking <quote>a program</quote> and inserting <quote>an annual mandatory training program</quote>; and</text>
</subparagraph><subparagraph id="HAC94B1CD204949AC85836F0482220C01"><enum>(B)</enum><text>by striking <quote>appropriate employees of the Service</quote> and inserting <quote>employees of the Service, locum tenens medical providers, healthcare volunteers, and other contracted employees who work at Service hospitals or other Service units and whose employment requires regular direct patient access</quote>; and</text>
</subparagraph></paragraph><paragraph id="H0BB0449CBC504A548215686465B89C6F"><enum>(2)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H9753C1C7F29148CAAB0797B5052F60BF" style="OLC"> <subsection id="HDFA19E7030E44FA2AE3A82D5B454B5B7"><enum>(c)</enum><text>Notwithstanding any other provision of law, beginning with the year of the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>, each employee or provider described in subsection (a) who enters into a contract with the Service on or after the date of such implementation shall, as a condition of employment, annually participate in and complete such training program. For purposes of the preceding sentence, participation in such training program may not be considered complete for the year involved until the individual satisfies each requirement, including testing, if applicable, of the training program for such year, as specified by the Secretary.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="HE2B937AEE6644A039E75152F194AD72C"><enum>108.</enum><header>Staffing demonstration project</header><text display-inline="no-display-inline">Title VIII of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1671">25 U.S.C. 1671</external-xref> et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HCD12A579E97546FEBF7B04430978D7B9" style="OLC">
<section id="H261641B729EC49BB813EFCC888FB3A3E"><enum>833.</enum><header>Staffing demonstration project</header>
<subsection id="HEBDD1BFC5D57416AA072136A3B08D066"><enum>(a)</enum><header>In general</header><text>The Secretary, acting through the Service, shall establish a demonstration project that authorizes the Service to provide federally managed Service units with additional staffing resources with the goal that the resources become self-sustaining.</text>
</subsection><subsection id="H242332E7622D41ECBE22CB4DFEE22F2C"><enum>(b)</enum><header>Selection</header><text>In selecting Service units for participation, the Secretary shall consider whether a Service unit services an Indian Tribe that—</text>
<paragraph commented="no" id="HD46D565E166D4602BF34DDF2FA7547FD"><enum>(1)</enum><text>has utilized or contributed substantial tribal funds to construct a health facility used by the Service or identified in the master plan for the Service unit;</text>
</paragraph><paragraph commented="no" id="HDDC5D207735D4F3CA94A3D1DCCE89338"><enum>(2)</enum><text>is located in a State or States with Medicaid reimbursements plans or policies that will increase the likelihood that the staffing resources provided will be self-sustaining; and</text>
</paragraph><paragraph commented="no" id="H4AB5C28C0DA9421D9174AC928C951472"><enum>(3)</enum><text>is operating a health facility described in paragraph (1) under historical staffing ratios that have not been equalized or updated by the Service or any other Service program to reflect current staffing needs.</text>
</paragraph></subsection><subsection id="HC8F5574E973B499BA7B5AFAB0E3134FA"><enum>(c)</enum><header>Duration</header><text>Staffing resources provided to a Service unit under this section shall be for a duration that the Secretary, in consultation with the applicable Indian Tribe, determines appropriate, except that each staffing position provided shall be for a period of not less than 3 fiscal years.</text>
</subsection><subsection id="HD5213D1372654B55A0F7172A6C9633CF"><enum>(d)</enum><header>Effect of staffing awards</header><text>No staffing resources provided under this section shall reduce the recurring base funding for staffing for any Indian Tribe or federally managed Service unit.</text>
</subsection><subsection id="H7E7F2ACAE70044A7802FE80D93382CC0"><enum>(e)</enum><header>Report</header><text>Not later than 5 years after the Secretary ends the demonstration project under this section, the Secretary shall prepare and submit a report to the Committee on Indian Affairs and the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Natural Resources and the Committee on Energy and Commerce of the House of Representatives, regarding the project, including—</text>
<paragraph id="H69B5DF567159479E847F63B0D6A10336"><enum>(1)</enum><text>whether the staffing resources resulted in additional revenue for the Service unit sufficient to maintain the staff on a permanent basis;</text>
</paragraph><paragraph id="H8166354C2D284E168C8C74A875FFAC65"><enum>(2)</enum><text>the levels to which the staffing resources reduced the unmet staffing need for the Service unit; and</text>
</paragraph><paragraph id="H1E9561F711F046C6B83CA768D343D06A"><enum>(3)</enum><text>whether the demonstration project could be deployed to reduce unmet staffing needs throughout the Service.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section commented="no" id="H36E98293510C4D289C63FBD170C7CDFD"><enum>109.</enum><header>Rule establishing tribal consultation policy</header><text display-inline="no-display-inline">Title VIII of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1671">25 U.S.C. 1671</external-xref> et seq.), as amended by section 108, is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H8AB4EE5569794AC38DC2A89B34C03D93" style="OLC">
<section commented="no" id="H511C0A67B38741159712B43910FC8490"><enum>834.</enum><header>Rule establishing tribal consultation policy</header>
<subsection commented="no" id="H0C5576BC061A4272A632636F368C4334"><enum>(a)</enum><header>In General</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title>, the Secretary shall establish, after meaningful consultation with representatives of affected Indian Tribes, a rule establishing a tribal consultation policy for the Service.</text>
</subsection><subsection commented="no" id="H21EADEA0D30F463B8E7C94EB736F1B43"><enum>(b)</enum><header>Contents of tribal consultation policy</header><text display-inline="yes-display-inline">The policy established under the rule described in subsection (a) shall—</text> <paragraph commented="no" id="H269AF3377F194602A00898A78CE36FBE"><enum>(1)</enum><text>update, and replace, the tribal consultation policy established under Circular No. 2006–01 of the Service, or any successor policy; and</text>
</paragraph><paragraph commented="no" id="H5EE7BF7E83CE46D8A87246959772E1AF"><enum>(2)</enum><text display-inline="yes-display-inline">include the following:</text> <subparagraph commented="no" id="H2B8645FCFA304CD096E01DDC62DC26AD"><enum>(A)</enum><text>A process for determining when the Service will notify Indian Tribes, and a description of how the Indian Tribes should be notified.</text>
</subparagraph><subparagraph commented="no" id="H513FB50888434AFD9E505C06E651026C"><enum>(B)</enum><text>A determination of what actions or agency decisions by the Service will trigger a requirement for meaningful consultation with Indian Tribes.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H000019634E264FDA96C0224FDB81BDEF"><enum>(C)</enum><text>A determination of what actions constitute meaningful consultation with Indian Tribes.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </section><section commented="no" id="H5F0B6EE4DADD4CDCA0B1A9E9697C3465"><enum>110.</enum><header>Treatment of certain hospitals</header><text display-inline="no-display-inline">The <quote>Parallel Low-Volume Hospital Payment Adjustment Regarding Hospitals Operated by the Indian Health Services (IHS) or a Tribe</quote> provisions described in the final rule published by the Centers for Medicare & Medicaid Services in the Federal Register on August 14, 2017, and entitled <quote>Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices</quote> (82 Fed Reg. 37990; 38188–38189), shall apply with respect to discharges occurring in fiscal year 2011 and subsequent fiscal years.</text>
</section><enum>II</enum><header>Employee protections</header>
<section id="HE55EDE4B5F8C4EE4B4EB739508E59B94"><enum>201.</enum><header>Employee protections against retaliation</header>
<subsection id="H00E07B66D9A045069B3C8D61674C495F"><enum>(a)</enum><header>In general</header><text>Title VI of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1661">25 U.S.C. 1661</external-xref> et seq.), as amended by sections 105 and 106, is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H6BC45D1CAE0744789DECB70DFF490ED4" style="OLC">
<section id="HB4599A3BA11E45DDB922EC164B22D022"><enum>608.</enum><header>Employee protections against retaliation</header>
<subsection id="HF0C9B4A1AFAB4BA2BD533D3756F182A9"><enum>(a)</enum><header>Employee accountability</header>
<paragraph id="HE53FA2A9B84149EBAEE094D3CD575DEF"><enum>(1)</enum><header>Agency reporting process requirement</header><text>The Secretary shall designate an official in the Department who is not an employee of the Service to—</text>
<subparagraph id="HF8607F5F767A4B67BA7F0C373DE3EBD0"><enum>(A)</enum><text>receive reports from an employee of the Service who witnesses retaliation against a whistleblower, a violation of a patient safety requirement, or other similar conduct; and</text>
</subparagraph><subparagraph id="H336D76C9A8CE4BAA9A14B796B3716BDD"><enum>(B)</enum><text>conduct active and ongoing outreach to all employees of the Service about—</text> <clause id="HAB821070438C4833B0769E04FD0DF0B8"><enum>(i)</enum><text>Federal and Department systems for reporting retaliation against whistleblowers; and</text>
</clause><clause id="HB86D24E6B2D74E6FAA637369680D05EB"><enum>(ii)</enum><text>the duty of individual employees of the Service to report violations of patient safety requirements and other similar conduct.</text>
</clause></subparagraph></paragraph><paragraph id="H3EF99BCB7AEF400AB9357E1E4D8A270D"><enum>(2)</enum><header>Oversight</header><text>Not later than 3 days after the date on which the official designated by the Secretary under paragraph (1) receives a report under paragraph (1)(A), the Secretary shall—</text>
<subparagraph id="H2746D4A9FEDF4E34AA88823CF0F3BF09"><enum>(A)</enum><text>formally review the report; and</text> </subparagraph><subparagraph id="H53AD1F34D71048D3A97739B06A1A1676"><enum>(B)</enum><text>provide a copy of such report and any other relevant information to the Inspector General of the Department.</text>
</subparagraph></paragraph><paragraph id="H255F89C828374DBA9BB849BCB27D9D03"><enum>(3)</enum><header>Removal for whistleblower retaliation</header><text>The Secretary may remove for misconduct from the civil service (as defined in section 2101 of title 5, United States Code), in accordance with sections 606 and 607, an employee of the Service if the Secretary determines, after completing a report review described in paragraph (2), that the employee has retaliated against a whistleblower and warrants removal.</text>
</paragraph><paragraph id="H94DB26AEF3CB4B1FAD2AEA1B8015E5B9"><enum>(4)</enum><header>Enhancing protections for whistleblowers</header><text>The Secretary shall carry out any actions determined necessary by the Secretary to enhance protection for whistleblowers, including identifying appropriate Service employees and requiring the employees to complete the Office of Special Counsel's Whistleblower Certification Program.</text>
</paragraph></subsection><subsection id="H4A0F39F0D83F44A193049DD9617FC4A8"><enum>(b)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="HF185F85E564247D4BBFA079358435722"><enum>(1)</enum><header>Retaliation</header><text>The term <term>retaliation</term>—</text>
<subparagraph id="HA3FD2845E7264C9EB02CC2245F438833"><enum>(A)</enum><text>means an adverse employment action or any significantly adverse action against a whistleblower, such as the refusal or delay of care provided through the Service; and</text>
</subparagraph><subparagraph id="HCCD551B0496B4C6995E32D4EA39A411B"><enum>(B)</enum><text>includes instances where the adverse action described in subparagraph (A) is perpetrated against a family member or friend of the whistleblower because of the whistleblower’s disclosure of information.</text>
</subparagraph></paragraph><paragraph id="H7970B34FF6D4462E8A632FBC84E3F8E0"><enum>(2)</enum><header>Whistleblower</header><text>The term <term>whistleblower</term> means an employee of Service who discloses information—</text> <subparagraph id="H9ED74C86AE804383A1A0823978596FF7"><enum>(A)</enum><text>that the employee reasonably believes evidences—</text>
<clause id="H0CDA0DC2D78C48BEA342F6804FD55831"><enum>(i)</enum><text>a violation of any law, rule, or regulation; or</text> </clause><clause id="H71844603C3A34D57972178084559EFD0"><enum>(ii)</enum><text>gross mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety; and</text>
</clause></subparagraph><subparagraph id="H94B10999F1154D81993875658EB9C414"><enum>(B)</enum><text>if such disclosure is not specifically prohibited by law and if such information is not specifically required by Executive Order to be kept secret in the interest of national defense or the conduct of foreign affairs.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="H9528FA5E6DC44A129FA678A2A3520854"><enum>202.</enum><header>Right of Federal employees to petition Congress</header>
<subsection id="H910BC0C6C2144F8EAC5EB243F59B05E9"><enum>(a)</enum><header>Adverse action for violation of right To petition Congress</header><text>Section 7211 of title 5, United States Code, is amended—</text> <paragraph id="H28CE7AEE34604B9695BB9856A8B003CD"><enum>(1)</enum><text>by striking <quote>The right of</quote> and inserting <quote>(a) <header-in-text level="subsection" style="OLC">In general</header-in-text>.—The right of</quote>; and</text>
</paragraph><paragraph id="HA723EF543EFF4F4DB5BCA84ACBAF9AC7"><enum>(2)</enum><text>by adding at the end the following new subsection:</text> <quoted-block display-inline="no-display-inline" id="HED413514E6A540879678065DC8783472" style="OLC"> <subsection id="H9957E5D1381843A3AD80E6B810FCD6F4"><enum>(b)</enum><header>Adverse action</header><text>An employee who interferes with or denies a right protected under subsection (a) shall be subject to any adverse action described in paragraphs (1) through (5) of section 7512, in accordance with the procedure described in section 7513 and any other applicable procedure.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H5BACC6576EEE43F2946DE6DB8F2089A6"><enum>(b)</enum><header>Electronic notification of right of employees of Indian Health Service</header>
<paragraph id="H92DF41616D7E4E42A4477C0C9BC155E3"><enum>(1)</enum><header>In general</header><text>The Secretary of Health and Human Services (referred to in this subsection as the <quote>Secretary</quote>), acting through the Director of the Indian Health Service, shall, in accordance with paragraphs (2) through (6), provide to each employee of the Indian Health Service, and electronically post, a memorandum providing notice of the right to petition Congress under section 7211 of title 5, United States Code.</text>
</paragraph><paragraph id="HAAF527FE6EF04A6190803D130CB38AAE"><enum>(2)</enum><header>Contents</header><text>The memorandum described in paragraph (1) shall include the following statement: <quote>It is a violation of section 7211 of title 5, United States Code, for any Federal agency or employee to require a Federal employee to seek approval, guidance, or any other form of input prior to contacting Congress with information, even if that information is in relation to the job responsibilities of the employee. A Federal employee found to have interfered with or denied the right of another Federal employee under such section shall be subject to an adverse action described in paragraphs (1) through (5) of section 7512 of title 5, United States Code, including a suspension for more than 14 days without pay.</quote>.</text>
</paragraph><paragraph id="HD87012A8D336460986053BA599F1B935"><enum>(3)</enum><header>Submission</header><text>Not later than 30 days after the date of enactment of this Act, the Secretary shall submit the memorandum described in paragraph (1) to the Inspector General of the Department of Health and Human Services (referred to in this subsection as the <quote>Inspector General</quote>) for approval.</text>
</paragraph><paragraph id="H0351C0DD388A40E791D86444A0EE79A4"><enum>(4)</enum><header>Approval or disapproval</header><text>Not later than 30 days after the submission of the memorandum under paragraph (3), or a revised memorandum under paragraph (6), the Inspector General shall approve or disapprove the memorandum or revised memorandum, as the case may be.</text>
</paragraph><paragraph id="H1D8E348EBAB74E63A5369AD36BCA8662"><enum>(5)</enum><header>Notice</header><text>In the case of an approval under paragraph (4), not later than 30 days after such approval, the Secretary shall—</text>
<subparagraph id="H2F2AF076DF3D4715B4B1044FD9A72287"><enum>(A)</enum><text>provide to each employee of the Indian Health Service an electronic copy of the approved memorandum; and</text>
</subparagraph><subparagraph id="HD685641A2C6A48FAB5B9A4AF4C219257"><enum>(B)</enum><text>post such memorandum in a clear and conspicuous place on the website of the Indian Health Service for a period not less than 120 days.</text>
</subparagraph></paragraph><paragraph id="HD236F6B71D124E918186CC021636EA30"><enum>(6)</enum><header>Revised memorandum</header><text>In the case of a disapproval under paragraph (4), not later than 15 days after such disapproval, the Secretary shall submit a revised memorandum to the Inspector General for approval under paragraph (4).</text>
</paragraph></subsection></section><section id="HAEDC5DD25B7C4A1A8E7A385219A2EC5A"><enum>203.</enum><header>Fiscal accountability</header><text display-inline="no-display-inline">Title VI of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1661">25 U.S.C. 1661</external-xref> et seq.), as amended by sections 105, 106, and 201, is further amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H7EF080A7865D43119BC757A34FFEBA84" style="OLC">
<section id="H8720D1BEF70C46AE96A4509872C0E87A"><enum>609.</enum><header>Fiscal accountability</header>
<subsection id="H78528737894B46AEA3BC079B5473091A"><enum>(a)</enum><header>Management of funds</header>
<paragraph id="H5379F589DB9941698A5D7531FAE88CAE"><enum>(1)</enum><header>In general</header><text>If the Secretary fails to submit the professional housing plan under section 301(a) of the <short-title>Restoring Accountability in the Indian Health Service Act of 2018</short-title> or the staffing plan under section 301(b) of that Act, the Secretary may not receive, obligate, transfer, or expend any amounts for a salary increase or bonus of an individual described in paragraph (2) until the professional housing plan or staffing plan, as the case may be, is submitted.</text>
</paragraph><paragraph id="H2D04425B5DC3432D86E47B6EDCCC1499"><enum>(2)</enum><header>Individual described</header><text>An individual described in this paragraph is an individual employed in a position in the Service that is a position—</text>
<subparagraph id="H08B097D34C4F47FE8C41E85E8D4A2B16"><enum>(A)</enum><text>described under sections 5312 through 5316 of title 5, United States Code;</text> </subparagraph><subparagraph id="HDEB9150AF2B7454B936749F655FF8494"><enum>(B)</enum><text>placed in level IV or V of the Executive Schedule under section 5317 of title 5, United States Code;</text>
</subparagraph><subparagraph id="HC73C99BE46A04BFDB8247064C2A40EC4"><enum>(C)</enum><text>as a limited term appointee, limited emergency appointee, or noncareer appointee in the Senior Executive Service, as defined under paragraphs (5), (6), and (7), respectively, of section 3132(a) of title 5, United States Code; or</text>
</subparagraph><subparagraph id="H4F254F46389740F0AE2A2C54910C6405"><enum>(D)</enum><text>under section 213.3301 or 213.3302 of title 5, Code of Federal Regulations.</text> </subparagraph></paragraph></subsection><subsection id="HB6BC39FC27C943A28CFE15E242D27360"><enum>(b)</enum><header>Prioritization of patient care</header> <paragraph id="H3C04DF60A1804C3BBBEE33C27388DDB2"><enum>(1)</enum><header>In general</header><text>Notwithstanding any other provision of law, the Secretary shall use amounts available to the Indian Health Service that are not obligated or expended, including base budget funding and third party collections, during the fiscal year for which the amounts are made available, and that remain available, only to support patient care by using such funds for the costs of—</text>
<subparagraph id="H038501BDDAC6438FB12B6813FDAB0F6F"><enum>(A)</enum><text>essential medical equipment;</text> </subparagraph><subparagraph id="HE49DA3FCB8B64B71A851026B22CC15C2"><enum>(B)</enum><text>purchased or referred care; or</text>
</subparagraph><subparagraph id="H557C4915B1D7437BB3CBAB44B7FEE639"><enum>(C)</enum><text>staffing.</text> </subparagraph></paragraph><paragraph id="H09B6B12B313E4D5B919A0A32352ABFBE"><enum>(2)</enum><header>Special rule</header><text>In using amounts under paragraph (1), the Secretary shall ensure that, in any case where the amounts were originally made available for a particular Service unit, such amounts are used to benefit Indians served by that Service unit.</text>
</paragraph><paragraph id="H155E76FD47B845799E3452EC6754F3E8"><enum>(3)</enum><header>Restrictions</header><text>The Secretary may not use amounts described in paragraph (1)—</text> <subparagraph id="HB41955A2AEB84B279255F49BC6EF9C86"><enum>(A)</enum><text>to remodel or interior decorate any Area office; or</text>
</subparagraph><subparagraph id="H6C5CF5AC8ED8486199D6392246661E28"><enum>(B)</enum><text>to increase the rate of pay of any employee of an Area office.</text> </subparagraph></paragraph></subsection><subsection id="HB22ADF6D61094A0FB8C7D81D08C780AA"><enum>(c)</enum><header>Spending reports</header><text>Not later than 90 days after the end of each quarter of a fiscal year, the Secretary shall submit a report describing the authorizations, expenditures, outlays, transfers, reprogramming, and obligations of each level of the Service, including the headquarters, each Area office, each Service unit, and each health clinic or facility, to—</text>
<paragraph id="HF53E82AD7D454125BFD858705F7A51D9"><enum>(1)</enum><text>each Indian Tribe;</text> </paragraph><paragraph id="H61073E636BBE439CAA55CF59B50CC8D5"><enum>(2)</enum><text>in the Senate—</text>
<subparagraph id="H6FA5339FD1FE4DFF8DBA0A6D9B2C203F"><enum>(A)</enum><text>the Committee on Indian Affairs;</text> </subparagraph><subparagraph id="H1766787F0333446194280014D6BC6592"><enum>(B)</enum><text>the Committee on Health, Education, Labor, and Pensions;</text>
</subparagraph><subparagraph id="H1DD1615DAC534BD49F331179C739A251"><enum>(C)</enum><text>the Committee on Appropriations; and</text> </subparagraph><subparagraph id="H379A95BB2DA44193BCC6B9F6FF25026A"><enum>(D)</enum><text>the Committee on the Budget; and</text>
</subparagraph></paragraph><paragraph id="H0FD8EA5CB8D04D9B84D503E9F1766D94"><enum>(3)</enum><text>in the House of Representatives—</text> <subparagraph id="H3C7D0C50987B49428537C5F1F5E478CD"><enum>(A)</enum><text>the Committee on Natural Resources;</text>
</subparagraph><subparagraph id="HFAB6ED08297C4FCA836EC9C49FF7C009"><enum>(B)</enum><text>the Committee on Energy and Commerce;</text> </subparagraph><subparagraph id="H4042E653012E4317BD67CAE3E18A6445"><enum>(C)</enum><text>the Committee on Appropriations; and</text>
</subparagraph><subparagraph id="H42EDDD094C714F44B6CF1122CB93D741"><enum>(D)</enum><text>the Committee on the Budget.</text> </subparagraph></paragraph></subsection><subsection id="HC65F96274C3E4CBCA616826E9CEC8723"><enum>(d)</enum><header>Status reports</header> <paragraph id="HE7AA1F76BEC742D1A4798DBE958A0450"><enum>(1)</enum><header>In general</header><text>Subject to paragraph (2), not later than 180 days after the end of each fiscal year, the Secretary shall provide to each entity described in paragraphs (1) through (3) of subsection (c) a report describing the safety, billing, certification, credential, and compliance statuses of each facility managed, operated, or otherwise supported by the Service.</text>
</paragraph><paragraph id="HF0F2E27EAFF54A5288948578656E22D7"><enum>(2)</enum><header>Updates</header><text>With respect to any change of a status described in paragraph (1), the Secretary shall immediately provide to each entity described in paragraphs (1) through (3) of subsection (c) an update describing such change.</text>
</paragraph></subsection><subsection id="HBE08EEB5A1E74587BC219246A0751D52"><enum>(e)</enum><header>Rule of construction</header><text>Nothing in this section may be construed—</text> <paragraph id="H3E1232FB0FF84D20942619BAEA621757"><enum>(1)</enum><text>to negatively impact the right of an Indian Tribe to enter into a compact or contract under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/5304">25 U.S.C. 5304</external-xref> et seq.); and</text>
</paragraph><paragraph id="H2197979B6B5D4E6F9226D6DA305C8B22"><enum>(2)</enum><text>to apply to such a compact or contract unless expressly agreed to by the Indian Tribe.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </section><enum>III</enum><header>Reports</header> <section id="HE1A089E55DE14D028AD197F3F3DE1AA3"><enum>301.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph id="H1DCBB9AF4D824A8A92A74468FD1F8766"><enum>(1)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text> </paragraph><paragraph id="HFCED6E5B2B364708B2C4781D949D439E"><enum>(2)</enum><header>Service</header><text>The term <term>Service</term> means the Indian Health Service.</text>
</paragraph><paragraph id="H24316AECB39F435E83AA80C747468D81"><enum>(3)</enum><header>Service unit</header><text>The term <term>Service unit</term> has the meaning given the term in section 4 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1603">25 U.S.C. 1603</external-xref>).</text>
</paragraph></section><section id="H65CE2A9C2AF448419FE5F52F7A3782BD"><enum>302.</enum><header>Reports by the Secretary of Health and Human Services</header>
<subsection id="HB77BD57B0766437C97DB26B6A8450F85"><enum>(a)</enum><header>IHS Professional housing plan</header><text>Not later than 1 year after the date the Government Accountability Office releases their ongoing report about Indian Health Service housing needs, the Secretary shall develop, make publicly available, and submit to Congress and the Comptroller General of the United States a written plan to address the professional housing needs of employees of the Service that comports with the practices and recommendations of the Government Accountability Office relating to professional housing.</text>
</subsection><subsection id="H074F9AF5A6D14C99A61C929D3FFBA841"><enum>(b)</enum><header>Plan relating to IHS staffing needs</header><text>Not later than 1 year after the date the Government Accountability Office releases their ongoing report about Indian Health Service housing needs, the Secretary shall develop, make publicly available, and submit to Congress and the Comptroller General of the United States a written plan to address staffing needs in the Service that comports with the practices of the Government Accountability Office relating to workforce planning.</text>
</subsection><subsection id="H2BF419AC6D9D48E897B4D45857B2BC4F"><enum>(c)</enum><header>Indian Health Care Improvement Act report</header><text>Not later than 1 year after the date of enactment of this Act, and each year thereafter for a period of 5 years, the Secretary shall develop, make publicly available, and submit to Congress a report on the data submitted under section 412(b) of the Indian Health Care Improvement Act, as amended by section 107.</text>
</subsection><subsection id="H6A53DE2A085148A79CA77D445013F52F"><enum>(d)</enum><header>Quality of Care and Staffing report</header><text>Not later than 1 year after the date of enactment of this Act, and each year thereafter, the Secretary shall develop and submit to Congress a report on the data obtained under section 108, with an emphasis on quality of care and access to care.</text>
</subsection></section><section id="HAE4AFB0FBCB94CA684B708035CD35C90"><enum>303.</enum><header>Reports by the Comptroller General</header>
<subsection id="H28873C4857F949D48343101C16105EFD"><enum>(a)</enum><header>IHS Housing needs report</header>
<paragraph id="H42534C1DFFEE4E2DB969AD4D6CFDF443"><enum>(1)</enum><header>In general</header><text>Not later than 5 years after the date on which the Comptroller General of the United States receives the professional housing plan under section 302(a), the Comptroller General shall develop and submit to Congress a report.</text>
</paragraph><paragraph id="HB4D508B445554D9E806843953AB9F0C7"><enum>(2)</enum><header>Contents</header><text>The report required under paragraph (1) shall include the following:</text> <subparagraph id="HBBA324D75293416B8E3EC0B4512C6152"><enum>(A)</enum><text>An evaluation of any existing, as of the date of the report, assessments and projections for the professional housing needs of employees of the Service, including discussion and conclusion as to whether existing assessments and projections accurately reflect the professional housing needs of employees of the Service.</text>
</subparagraph><subparagraph id="H69E085C3608D4007B433A913B9A074AF"><enum>(B)</enum><text>An assessment of the professional housing needs of employees of the Service for each Service area (as defined in section 4 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1603">25 U.S.C. 1603</external-xref>)).</text>
</subparagraph><subparagraph id="HB5513D24D27E4DE2A184A1C3AB1905C8"><enum>(C)</enum><text>An assessment of the professional housing plan developed by the Secretary under section 302(a).</text> </subparagraph></paragraph></subsection><subsection id="H6152AA3B04744F28BCAF777A48561A82"><enum>(b)</enum><header>IHS staffing needs report</header> <paragraph id="HAB90445BD3C94839BB3FA283AFD40845"><enum>(1)</enum><header>In general</header><text>Not later than 5 years after the date on which the Comptroller General receives the report under section 302(b), the Comptroller General shall prepare and submit to Congress a report on the staffing needs of the Service.</text>
</paragraph><paragraph id="H2EBF179516AC4897ADFD09F5E344FDC3"><enum>(2)</enum><header>Contents</header><text>The report required under paragraph (1) shall include the following:</text> <subparagraph id="HA793A33B5E15492180EA0CDFFBC90F0B"><enum>(A)</enum><text>A description of the number and type of full-time positions needed at each facility of the Service and the amount of funds necessary to maintain such positions.</text>
</subparagraph><subparagraph id="H074BA51A68E54071A9D87CF61D4E5AA3"><enum>(B)</enum><text>An explanation of the various methodologies that the Service utilizes and has previously utilized to determine the number and type of full-time positions needed at federally managed Service units.</text>
</subparagraph><subparagraph id="HE8A0D5A4185949BA9C8736FFCE30F169"><enum>(C)</enum><text>An assessment of the use of independent contractors, including the number of independent contractors hired to fill vacant full-time positions and amounts spent on independent contractors who provide health care services.</text>
</subparagraph><subparagraph id="H3D057B9ED8A047F9AA3FB11F867A2D8B"><enum>(D)</enum><text>An assessment of the staffing plan developed by the Secretary under section 302(b).</text> </subparagraph></paragraph></subsection><subsection id="HBCBDF649A5B24C6B83EDEAB16BF6D340"><enum>(c)</enum><header>Whistleblower protections report</header> <paragraph id="HE814ADE157D7416597679E67A529D75E"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of enactment of this Act, the Comptroller General shall develop and submit to Congress a report on the efficacy of existing protections for whistleblowers in the Service.</text>
</paragraph><paragraph id="HE8579B1D4CFC46D6A059FECF7B6C6CB4"><enum>(2)</enum><header>Contents</header><text>The report required under paragraph (1) shall include the following:</text> <subparagraph id="HCF8B5020994845E88EA203DCD2D4C0B4"><enum>(A)</enum><text>A discussion and conclusion as to whether the Service has taken proper steps to prevent retaliation against whistleblowers.</text>
</subparagraph><subparagraph id="H976536B0007447D69CDD9B96B89B9C2B"><enum>(B)</enum><text>If applicable, any recommendations for changes to the policy of the Service with respect to whistleblowers.</text>
</subparagraph><subparagraph id="HD82E9F85724F4EFAA72E53BA2F06AF30"><enum>(C)</enum><text>A discussion and conclusion as to whether the official email accounts of employees of the Service are appropriately monitored.</text>
</subparagraph></paragraph></subsection></section><section id="HFB9405B031F64923AC287526C579ABE1"><enum>304.</enum><header>Inspector General reports</header>
<subsection id="H56C0BE4989C3465DBC0E8C5D663748C0"><enum>(a)</enum><header>Patient care reports</header>
<paragraph id="H9D936E312AAE4E1EA462A49A52E271D3"><enum>(1)</enum><header>In general</header><text>Not later than 2 years after the date of enactment of this Act, and not less than every 3 years thereafter, the Inspector General of the Department of Health and Human Services shall develop and submit to Congress and the Service a report on patient harm events occurring in Service units and deferrals and denials of care of patients of the Service.</text>
</paragraph><paragraph id="HAAF77A50F5504CAFA4FDCB4DF6340B54"><enum>(2)</enum><header>Contents</header><text>The report required under paragraph (1) shall include the following:</text> <subparagraph id="HDA49A44942884FB4B9010ED8559CE734"><enum>(A)</enum><text>An evaluation of the number and kind of events that contribute to patient deaths in a Service unit and recommendations regarding reducing the number of patient deaths.</text>
</subparagraph><subparagraph id="H5554A743461349F79052D0FDAA5F2DCA"><enum>(B)</enum><text>An evaluation of the Service’s tracking and reporting of, and response to, patient harm events and recommendations regarding how to improve such tracking, reporting, and response.</text>
</subparagraph><subparagraph id="H930628FBD6E048ECA860CC4B4FFA66AC"><enum>(C)</enum><text>The effects of deferrals and denials of care on patients of the Service, including patient outcomes, and recommendations regarding how to reduce deferrals and denials of care.</text>
</subparagraph></paragraph></subsection><subsection id="H6656103758554C08949F63C534606062"><enum>(b)</enum><header>Reporting systems audit</header><text>Not later than 2 years after the date of enactment of this Act, the Inspector General shall—</text> <paragraph id="H1631188AB01A4E87826E138E4F2EEE59"><enum>(1)</enum><text>conduct an audit of reporting systems of the Service, as of the date of enactment of this Act; and</text>
</paragraph><paragraph id="H238A875DB31C45728D5F7409EC0EC599"><enum>(2)</enum><text>provide to the Service recommendations and technical assistance regarding implementation of improved reporting systems, procedures, standards, and protocols.</text>
</paragraph></subsection></section><section id="HD5A88CD089B3442A82628C27F4102356"><enum>305.</enum><header>Transparency in CMS surveys</header><text display-inline="no-display-inline">Section 1880 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395qq">42 U.S.C. 1395qq</external-xref>) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H36CFE0C9C010498F9B5C505048216D4E" style="OLC">
<subsection id="H2E94408536DF45FA971296FFFFE69B3D"><enum>(g)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H54D231E264B44468B4EBBC2131B4BFAF"><enum>(1)</enum><text>Not less frequently than once every 2 years, the Administrator of the Centers for Medicare & Medicaid Services shall conduct surveys of participating Indian Health Service facilities to assess the compliance of each hospital or skilled nursing facility of the Indian Health Service with—</text>
<subparagraph id="H12601FF18DB44723B7A9671A30CF7BBE" indent="up1"><enum>(A)</enum><text>section 1867; and</text> </subparagraph><subparagraph id="HE6388428EF9D419C98558673AA4E5F83" indent="up1"><enum>(B)</enum><text>conditions of participation in the program under this title.</text>
</subparagraph></paragraph><paragraph id="HF56ADEFDA2E447E5B3478195E8C4B322" indent="up1"><enum>(2)</enum><text>Each survey completed under this subsection shall be posted on the Internet website of the Centers for Medicare & Medicaid Services. Such posting shall comply with the Federal regulations concerning the privacy of individually identifiable health information promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>IV</enum><header>Technical amendments</header>
<section id="HEEEACC3C239B4AC989B68BF111D3FE18"><enum>401.</enum><header>Technical amendments</header><text display-inline="no-display-inline">The Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1601">25 U.S.C. 1601</external-xref> et seq.) is amended—</text> <paragraph id="HC76FAA002F3549ED9C5ECD04AD415C85"><enum>(1)</enum><text>by striking <quote>contract health service</quote> each place such term appears (regardless of casing and typeface and including in the headings) and inserting <quote>purchased/referred care</quote> (with appropriate casing and typeface); and</text>
</paragraph><paragraph id="H5EF4596445374F3FA17F605F3073713E"><enum>(2)</enum><text>by striking <quote>contract health services</quote> each place such term appears (regardless of casing and typeface and including in the headings) and inserting <quote>purchased/referred care</quote> (with appropriate casing and typeface).</text>
</paragraph></section>
December 28, 2018
Committees on Energy and Commerce, Ways and Means, and Oversight and Government Reform discharged; committed to the Committee of the Whole House on the State of the Union and ordered to
be printed