[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2953 Introduced in Senate (IS)]

<DOC>






114th CONGRESS
  2d Session
                                S. 2953

   To promote patient-centered care and accountability at the Indian 
                Health Service, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 19, 2016

Mr. Barrasso (for himself and Mr. Thune) introduced the following bill; 
  which was read twice and referred to the Committee on Indian Affairs

_______________________________________________________________________

                                 A BILL


 
   To promote patient-centered care and accountability at the Indian 
                Health Service, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Indian Health Service Accountability 
Act of 2016'' or the ``IHS Accountability Act of 2016''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) in 2010, the Committee on Indian Affairs of the Senate 
        held an oversight hearing entitled ``In Critical Condition: The 
        Urgent Need to Reform Indian Health Service's Aberdeen Area'', 
        during which members of the Committee listened to testimony 
        detailing an investigation led by a former Chairman of the 
        Committee, Byron Dorgan, including his report on the Indian 
        Health Service (referred to in this section as the ``Dorgan 
        Report'');
            (2) the Dorgan Report found evidence showing the lack of 
        quality of care at Indian Health Service facilities in the 
        Great Plains Area (previously referred to as the ``Aberdeen 
        Area''), which is comprised of South Dakota, North Dakota, 
        Nebraska, and Iowa;
            (3) in 2015--
                    (A) staff of the Committee on Indian Affairs of the 
                Senate investigated claims that conditions in the Great 
                Plains Area had not improved; and
                    (B) the Committee confirmed that many issues 
                identified in the Dorgan Report had not been resolved 
                and found that some problems had become worse and new 
                problems had developed;
            (4) a culture of cronyism in the Indian Health Service has 
        further eroded confidence in the health care system of the 
        Indian Health Service;
            (5) persistent failures by the Indian Health Service to 
        provide tribal citizens access to safe, quality health care 
        have led to multiple innocent patient deaths and the suffering 
        of patients, families, and whole communities;
            (6) those failures have been extensively documented by 
        Congress, the Indian Health Service, and the Centers for 
        Medicare & Medicaid Services, which confirmed that systemic 
        problems and substandard conditions in Indian Health Service 
        facilities pose an immediate risk to patient safety;
            (7) the United States has treaty, trust, and statutory 
        obligations to provide health care to American Indians and 
        Alaska Natives, which the Indian Health Service is mandated to 
        uphold; and
            (8) prioritizing patients and restoring faith in the health 
        care system of the Indian Health Service requires greater 
        transparency, accountability, and strong leadership.

SEC. 3. REMOVAL OF INDIAN HEALTH SERVICE EMPLOYEES BASED ON PERFORMANCE 
              OR MISCONDUCT.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.) is amended by adding at the end the following:

``SEC. 605. REMOVAL OF SERVICE EMPLOYEES BASED ON PERFORMANCE OR 
              MISCONDUCT.

    ``(a) Definitions.--In this section and sections 606 through 610:
            ``(1) Employee.--The term `employee' has the meaning given 
        the term in section 2105 of title 5, United States Code.
            ``(2) Manager.--
                    ``(A) In general.--The term `manager' has the 
                meaning given the term `management official' in section 
                7103(a) of title 5, United States Code.
                    ``(B) Inclusions.--The term `manager' includes, as 
                employed at any facility of the Service--
                            ``(i) a chief executive officer;
                            ``(ii) a chief medical officer; and
                            ``(iii) a department director.
            ``(3) Misconduct.--The term `misconduct' means neglect of 
        duty, malfeasance, or failure to accept a directed reassignment 
        or to accompany a position in a transfer of function.
            ``(4) Personnel action.--The term `personnel action' means 
        a removal, transfer, or reduction in grade under subsection 
        (b)(2).
            ``(5) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services, acting through the Director of 
        the Service.
            ``(6) Senior executive.--The term `senior executive' means 
        a career appointee (as that term is defined in section 3132(a) 
        of title 5, United States Code) that occupies a Senior 
        Executive Service position.
            ``(7) Senior executive service position.--The term `Senior 
        Executive Service position' has the meaning given the term in 
        section 3132(a) of title 5, United States Code.
            ``(8) Supervisor.--The term `supervisor' has the meaning 
        given the term in section 7103(a) of title 5, United States 
        Code.
    ``(b) Removal Based on Performance or Misconduct.--
            ``(1) In general.--Subject to paragraph (4), the Secretary 
        may remove an employee of the Service from the position the 
        employee occupies if the Secretary determines the performance 
        or misconduct of the employee warrants removal.
            ``(2) Action.--If the Secretary removes an employee under 
        paragraph (1), the Secretary may--
                    ``(A) remove the employee from the civil service 
                (as defined in section 2101 of title 5, United States 
                Code);
                    ``(B) in the case of an individual described in 
                paragraph (3), transfer the individual from the Senior 
                Executive Service position to a General Schedule 
                position at any grade of the General Schedule for which 
                the individual is qualified and that the Secretary 
                determines is appropriate; or
                    ``(C) in the case of a manager or supervisor, 
                reduce the grade of the manager or supervisor to any 
                other grade for which the individual is qualified and 
                that the Secretary determines is appropriate.
            ``(3) Individual described.--An individual referred to in 
        paragraph (2)(B) is a senior executive that--
                    ``(A) previously occupied a permanent position 
                within the competitive service (as that term is defined 
                in section 2102 of title 5, United States Code); or
                    ``(B) previously occupied a permanent position 
                within the excepted service (as that term is defined in 
                section 2103 of title 5, United States Code).
            ``(4) Due process.--Before an employee may be subject to a 
        personnel action, the Secretary shall provide to the employee--
                    ``(A) not less than 10 days before the personnel 
                action, written notice of the proposed personnel 
                action; and
                    ``(B) an opportunity and reasonable time to answer 
                orally or in writing.
    ``(c) Pay of Certain Individuals.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, including the requirements of section 3594 of title 5, 
        United States Code, any individual transferred to a General 
        Schedule position under subsection (b)(2)(B) or subject to a 
        reduction in grade under subsection (b)(2)(C) shall, beginning 
        on the date of the transfer, receive the annual rate of pay 
        applicable to the position.
            ``(2) Requirements.--
                    ``(A) In general.--An individual transferred to a 
                General Schedule position under subsection (b)(2)(B) or 
                subject to a reduction in grade under subsection 
                (b)(2)(C)--
                            ``(i) may not be placed on administrative 
                        leave or any other category of paid leave 
                        during the period during which an appeal (if 
                        any) under subsection (e)(2)(A) is ongoing; and
                            ``(ii) may only receive pay if the 
                        individual--
                                    ``(I) reports for duty; and
                                    ``(II) performs a primary duty or 
                                an alternative primary duty, as each 
                                term is described in section 551.104 of 
                                title 5, Code of Federal Regulations 
                                (or a successor regulation).
                    ``(B) Failure to report.--If an individual 
                transferred to a General Schedule position under 
                subsection (b)(2)(B) or subject to a reduction in grade 
                under subsection (b)(2)(C) does not report for duty, 
                pursuant to subsection (f)(5), the individual shall not 
                receive any increase in rate of pay or other benefit.
    ``(d) Notice to Congress.--Not later than 30 days after the date on 
which the Secretary takes a personnel action, the Secretary shall 
submit, in writing, a notice of the personnel action and the reason for 
the personnel action to--
            ``(1) the Committee on Indian Affairs of the Senate;
            ``(2) the Committee on Health, Education, Labor, and 
        Pensions of the Senate;
            ``(3) the Committee on Natural Resources of the House of 
        Representatives;
            ``(4) the Committee on Energy and Commerce of the House of 
        Representatives; and
            ``(5) the Inspector General of the Department.
    ``(e) Procedure.--
            ``(1) Inapplicability.--The procedures under chapters 43 
        and 75 of title 5, United States Code, shall not apply to a 
        personnel action.
            ``(2) Appeal.--
                    ``(A) In general.--Subject to subparagraph (B) and 
                subsection (f), an employee subject to a personnel 
                action may appeal the personnel action to the Merit 
                Systems Protection Board under section 7701 of title 5, 
                United States Code.
                    ``(B) Limitation.--An appeal under subparagraph (A) 
                may only be made if the appeal is made not later than 7 
                days after the date of the personnel action.
    ``(f) Expedited Review by Administrative Law Judge.--
            ``(1) In general.--
                    ``(A) Referral.--On receipt of an appeal under 
                subsection (e)(2)(A), the Merit Systems Protection 
                Board shall refer the appeal to an administrative law 
                judge pursuant to section 7701(b)(1) of title 5, United 
                States Code.
                    ``(B) Expedition.--The administrative law judge to 
                whom an appeal is referred under subparagraph (A) 
                shall--
                            ``(i) expedite the appeal under section 
                        7701(b)(1) of title 5, United States Code; and
                            ``(ii) issue a decision in each case not 
                        later than 21 days after the date of the 
                        appeal.
            ``(2) Finality.--Notwithstanding any other provision of 
        law, including section 7703 of title 5, United States Code, the 
        decision of an administrative law judge under paragraph (1) 
        shall be final and shall not be subject to any further 
        administrative appeal.
            ``(3) Failure to issue decision.--
                    ``(A) In general.--In any case in which an 
                administrative law judge fails to issue a decision in 
                accordance with the 21-day requirement described in 
                paragraph (1)(B)(ii), the personnel action shall be 
                treated as final.
                    ``(B) Transparency.--In any case in which a 
                personnel action is treated as final under subparagraph 
                (A), the Merit Systems Protection Board shall, not 
                later than 14 days after the date on which the 
                personnel action becomes final, submit a letter 
                explaining the reasons why a decision was not issued in 
                accordance with the 21-day requirement described in 
                paragraph (1)(B)(ii) to--
                            ``(i) the Committee on Indian Affairs of 
                        the Senate;
                            ``(ii) the Committee on Health, Education, 
                        Labor, and Pensions of the Senate;
                            ``(iii) the Committee on Natural Resources 
                        of the House of Representatives; and
                            ``(iv) the Committee on Energy and Commerce 
                        of the House of Representatives.
            ``(4) Restriction.--The Merit Systems Protection Board or 
        an administrative law judge may not stay any personnel action.
            ``(5) Cessation of pay increases and benefits.--During the 
        period beginning on the date on which an employee appeals a 
        removal from the civil service under subsection (e)(2)(A) and 
        ending on the date on which the removal becomes final, the 
        employee may not receive any--
                    ``(A) increase in rate of pay; or
                    ``(B) award, bonus, incentive, allowance, 
                differential, student loan repayment, special payment, 
                or other benefit.
            ``(6) Assistance.--To the maximum extent practicable, the 
        Secretary shall provide such information and assistance as may 
        be necessary to ensure an appeal under this subsection is 
        expedited to--
                    ``(A) the Merit Systems Protection Board; and
                    ``(B) any administrative law judge to whom an 
                appeal under this section is referred.
    ``(g) Employment Record Transparency.--The Secretary shall ensure 
that the employment records for any employee subject to a personnel 
action, regardless of whether that personnel action is final, include--
            ``(1) a notation that the employee was subject to a 
        personnel action; and
            ``(2) a description of the disposition or status of the 
        personnel action or any appeal of the personnel action under 
        this section.
    ``(h) Relation to Title 5, United States Code.--
            ``(1) Additional authority.--The personnel action 
        authorities provided to the Secretary under this section are in 
        addition to the authorities provided under chapters 43 and 75 
        of title 5, United States Code.
            ``(2) Removal of senior executives.--Section 3592(b)(1) of 
        title 5, United States Code, shall not apply to a personnel 
        action.''.

SEC. 4. IMPROVEMENTS IN HIRING PRACTICES.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 3) is amended by adding 
at the end the following:

``SEC. 606. IMPROVEMENTS IN HIRING PRACTICES.

    ``(a) Direct Hire Authority.--The Secretary may appoint, without 
regard to subchapter I of chapter 33 of title 5, United States Code 
(other than sections 3303 and 3328 of that title), a candidate directly 
to a position within the Service for which the candidate meets Office 
of Personnel Management qualification standards.
    ``(b) Preference.--To enhance recruitment and retention of 
employees of the Service, the Secretary may waive the requirements of 
the Indian preference laws (as defined in section 2(e) of Public Law 
96-135 (25 U.S.C. 472a(e))) with respect to hiring a candidate to a 
position in a Service unit on written request or resolution of an 
Indian tribe located within the applicable Service unit.
    ``(c) Tribal Consultation.--
            ``(1) In general.--Subject to paragraph (2), before 
        appointing, hiring, promoting, or transferring a candidate to a 
        Senior Executive Service position or the position of a manager 
        at an Area office or Service unit, the Secretary shall 
        meaningfully and expeditiously consult with Indian tribes 
        located within the applicable Service area or Service unit.
            ``(2) Exception.--
                    ``(A) In general.--If the Secretary determines that 
                emergency circumstances exist that may negatively 
                impact patient health or safety if the position is not 
                filled, the Secretary may appoint a candidate to a 
                Senior Executive Service or manager position at an Area 
                office or Service unit for a temporary time period 
                only, not to exceed 180 days.
                    ``(B) Notice.--The Secretary shall notify, in 
                writing, each Indian tribe located within the 
                applicable Service area or Service unit of the 
                appointment not fewer than 7 days prior to exercising 
                the authority described in subparagraph (A).
    ``(d) Notice of Removal Based on Performance or Misconduct.--Before 
appointing, hiring, promoting, or transferring a candidate to a Senior 
Executive Service position or the position of a manager or supervisor 
at an Area office or Service unit, the Secretary shall provide to 
Indian tribes located within the applicable Service area the content of 
an inclusion in an employment record under section 605(g).''.
    (b) GAO Report on IHS Staffing Needs.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report assessing staffing 
        needs in the Indian Health Service.
            (2) Contents.--The report described in paragraph (1) shall 
        include--
                    (A) a description of the number and type of full-
                time equivalent employees needed at each facility of 
                the Indian Health Service and amounts required for 
                those employees;
                    (B) an assessment of the use of independent 
                contractors instead of full-time equivalent employees; 
                and
                    (C) recommendations to address staffing needs in 
                the Indian Health Service.
    (c) Staffing Plan.--Not later than 1 year after the date on which 
the Comptroller General of the United States submits the report under 
subsection (b), the Secretary shall submit to Congress a written plan 
to address staffing needs in the Indian Health Service based on the 
recommendations described in paragraph (2)(C) of that subsection.

SEC. 5. INCENTIVES FOR RECRUITMENT AND RETENTION.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 4(a)) is amended by 
adding at the end the following:

``SEC. 607. INCENTIVES FOR RECRUITMENT AND RETENTION.

    ``(a) Rewarding Quality Performance.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary may grant or rescind bonuses or other 
        benefits to employees of the Service--
                    ``(A) to promote patient safety;
                    ``(B) to promote quality of performance of the 
                employees; or
                    ``(C) to improve recruitment and retention of 
                employees in the Service.
            ``(2) Quality incentives.--The Secretary may grant a bonus 
        under paragraph (1) to a manager or supervisor in the Service 
        who identifies one or more ways--
                    ``(A) to improve patient care; or
                    ``(B) to reduce waste, fraud, or abuse.
    ``(b) Pay System.--The Secretary shall establish a pay system for 
physicians, dentists, nurses, and other health care professionals 
employed by the Service that provides pay that, to the maximum extent 
practicable, is comparable to the pay provided to physicians, dentists, 
nurses, and other health care professionals under chapter 74 of title 
38, United States Code.
    ``(c) Relocation Costs.--The Secretary may provide to an employee 
of the Service the costs the employee incurs in the relocation of the 
employee if, as determined by the Secretary--
            ``(1) the employee relocates to a Service area experiencing 
        a high level of need for employees; and
            ``(2) the employee will accept a position that is likely to 
        be difficult to fill in the absence of an incentive.
    ``(d) Performance-Based Retention Bonuses.--To improve retention of 
employees in the Service, the Secretary may provide to an employee of 
the Service a bonus based on the performance of the employee.
    ``(e) Administration.--
            ``(1) OPM guidelines.--The Secretary shall carry out 
        subsections (a) through (d) in accordance with guidelines of 
        the Office of Personnel Management for recruitment and 
        retention, including section 575.109 of title 5, Code of 
        Federal Regulations (as in effect on the date of enactment of 
        this Act).
            ``(2) Service agreements.--The Secretary may only provide a 
        bonus, pay increase, relocation cost, or other benefit under 
        subsections (a) through (d) to an employee who agrees to serve 
        for not less than 1 year in the Service.
    ``(f) Housing Vouchers.--
            ``(1) In general.--Subject to paragraph (2), not later than 
        1 year after the date of enactment of this section, the 
        Secretary may establish a program to provide tenant-based 
        rental assistance to an employee of the Service who--
                    ``(A) agrees to serve for not less than 1 year at a 
                Service facility designated by the Administrator of the 
                Health Resources and Services Administration as a 
                health professional shortage area; and
                    ``(B) is a critical employee, as determined by the 
                Secretary.
            ``(2) Sunset.--Any program established by the Secretary 
        under paragraph (1) shall terminate on the date that is 3 years 
        after the date on which the program is established.''.
    (b) GAO Report on IHS Professional Housing.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report identifying 
        professional housing needs for employees of the Indian Health 
        Service.
            (2) Contents.--The report described in paragraph (1) shall 
        include--
                    (A) an evaluation of any existing assessments and 
                projections for the professional housing needs of 
                employees of the Indian Health Service;
                    (B) an accurate and independent assessment of the 
                professional housing needs of employees of the Indian 
                Health Service for each Service area (as defined in 
                section 4 of the Indian Health Care Improvement Act (25 
                U.S.C. 1603));
                    (C) a discussion and conclusion on whether the 
                assessments and projections described in subparagraph 
                (A) accurately reflect the professional housing needs 
                of employees of the Indian Health Service described in 
                subparagraph (B); and
                    (D) recommendations for establishing appropriate 
                means for the Indian Health Service to accurately 
                assess professional housing needs in the future.
    (c) Housing Plan.--Not later than 1 year after the date on which 
the Comptroller General of the United States submits the report under 
subsection (b), the Secretary shall submit to Congress a written plan 
to address the professional housing needs of the Indian Health Service 
based on the recommendations described in paragraph (2)(D) of that 
subsection.

SEC. 6. EMPLOYEE PROTECTIONS AGAINST RETALIATION.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 5(a)) is amended by 
adding at the end the following:

``SEC. 608. EMPLOYEE PROTECTIONS AGAINST RETALIATION.

    ``(a) Employee Accountability.--
            ``(1) Mandatory reporting.--An employee of the Service who 
        witnesses retaliation against a whistleblower, a violation of 
        patient safety requirements, or other similar conduct shall 
        make a report of the conduct to an official in the Department 
        who--
                    ``(A) is designated by the Secretary of Health and 
                Human Services to receive those reports; and
                    ``(B) is not an employee of the Service.
            ``(2) Oversight.--The Secretary of Health and Human 
        Services shall provide a copy of each report described in 
        paragraph (1) and any other relevant information to the 
        Inspector General of the Department of Health and Human 
        Services by not later than 3 days after receipt of the report 
        by the designated official described in that paragraph.
            ``(3) Removal.--The Secretary may remove for misconduct 
        from the civil service (as defined in section 2101 of title 5, 
        United States Code), in accordance with section 605, an 
        employee of the Service who retaliates against a whistleblower.
    ``(b) Agency Accountability.--
            ``(1) In general.--The Secretary shall formally review each 
        claim of--
                    ``(A) discrimination against an employee of the 
                Service; or
                    ``(B) retaliation against a whistleblower in the 
                Service.
            ``(2) Annual reports to congress.--The Secretary shall 
        submit to Congress each year a report describing the status or 
        disposition of each claim described in paragraph (1).''.
    (b) GAO Report.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report examining protections 
        for whistleblowers in the Indian Health Service (referred to in 
        this subsection as the ``Service'').
            (2) Contents.--The report described in paragraph (1) shall 
        include--
                    (A) a follow-up investigation on the investigation 
                of the Committee on Indian Affairs of the Senate 
                entitled ``In Critical Condition: The Urgent Need to 
                Reform the Indian Health Service's Aberdeen Area'';
                    (B) a discussion and conclusion on whether the 
                Service has taken proper steps to ensure that 
                whistleblowers are not retaliated against;
                    (C) recommendations for changes in Service policy 
                relating to whistleblowers; and
                    (D) a discussion and conclusion on whether the 
                official email accounts of employees of the Service are 
                being monitored.

SEC. 7. RIGHT OF EMPLOYEES TO PETITION CONGRESS.

    (a) Action for Violation of Right of Federal Employees.--Section 
7211 of title 5, United States Code, is amended--
            (1) by striking ``The right of'' and inserting ``(a) In 
        General.--The right of''; and
            (2) by adding at the end the following:
    ``(b) Adverse Action.--An employee who interferes with or denies a 
right protected under this section shall, in accordance with subchapter 
II of chapter 75, or other applicable procedures, be subject to an 
adverse action described in paragraphs (1) through (5) of section 
7512.''.
    (b) Electronic Notification of Right of Indian Health Service 
Employees.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Director of the Indian Health 
        Service (referred to in this subsection as the ``Secretary'') 
        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 
        of employees under section 7211 of title 5, United States Code 
        (relating to employees' right to petition Congress).
            (2) Contents.--The memorandum described in paragraph (1) 
        shall include the following statement: ``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 may be subject to an adverse 
        action described in paragraphs (1) through (5) of section 7512 
        of title 5, United States Code, including suspension without 
        pay for a period of more than 14 days.''.
            (3) Submission.--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 section as the ``Inspector General'') for approval.
            (4) Approval or disapproval.--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 the revised 
        memorandum.
            (5) Notice.--Not later than 30 days after approval of the 
        memorandum or the revised memorandum under paragraph (4), the 
        Secretary shall--
                    (A) provide to each employee of the Indian Health 
                Service an electronic copy of the memorandum; and
                    (B) post the memorandum in a clear and conspicuous 
                place on the website of the Indian Health Service for a 
                period of not fewer than 120 days.
            (6) Revised memorandum.--If the Inspector General 
        disapproves the memorandum or a revised memorandum under 
        paragraph (4), not later than 15 days after the disapproval, 
        the Secretary shall submit a revised memorandum to the 
        Inspector General for approval under paragraph (4).

SEC. 8. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS IN THE 
              INDIAN HEALTH SERVICE.

    Section 224 of the Public Health Service Act (42 U.S.C. 233) is 
amended by adding at the end the following:
    ``(q) Certain Indian Health Service Volunteers Deemed Public Health 
Service Employees.--
            ``(1) In general.--
                    ``(A) For purposes of this section, a health 
                professional volunteer at a Service unit or Service 
                area (as those terms are defined in section 4 of the 
                Indian Health Care Improvement Act (25 U.S.C. 1603)) 
                (referred to in this subsection as a `covered entity') 
                shall, in providing a health professional 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).
                    ``(B) Subparagraph (A) is subject to this 
                subsection.
            ``(2) Conditions.--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 covered entity if all of the following 
        conditions are met:
                    ``(A) The service is provided to the individual at 
                the facilities of a covered entity, or through offsite 
                programs or events carried out by the covered entity.
                    ``(B) The covered entity is sponsoring the health 
                care practitioner pursuant to paragraph (3)(B).
                    ``(C) The health care practitioner does not receive 
                any compensation for the service from the individual or 
                from 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 covered entity for reasonable expenses incurred by 
                the health care practitioner in the provision of the 
                service to the individual.
                    ``(D) Before the service is provided, the health 
                care practitioner or the covered entity 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.
                    ``(E) At the time the service is provided, the 
                health care practitioner is licensed or certified in 
                accordance with applicable law regarding the provision 
                of the service.
            ``(3) Applicability.--Subsection (g) (other than paragraphs 
        (3) and (5) of that subsection) and subsections (h), (i), and 
        (l) apply to a health care practitioner at a covered entity 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:
                    ``(A) Each reference to an entity described in 
                subsection (g)(4) shall be considered to be a reference 
                to a covered entity.
                    ``(B) Paragraph (1)(A) applies in lieu of the first 
                sentence of subsection (g)(1)(A).
                    ``(C)(i) With respect to a covered entity, a health 
                care practitioner is not a health professional 
                volunteer at the covered entity unless the covered 
                entity sponsors the health care practitioner.
                    ``(ii) For purposes of this subsection, the covered 
                entity shall be considered to be sponsoring the health 
                care practitioner if--
                            ``(I) with respect to the health care 
                        practitioner, the covered entity submits to the 
                        Secretary an application meeting the 
                        requirements of subsection (g)(1)(D); and
                            ``(II) 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.
                    ``(D) In the case of a health care practitioner who 
                is determined by the Secretary pursuant to subsection 
                (g)(1)(E) to be a health professional volunteer at the 
                covered entity, this subsection applies to the health 
                care practitioner (with respect to services performed 
                on behalf of the covered entity 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.
                    ``(E) 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.
            ``(4) Funding.--
                    ``(A) In general.--Amounts in the fund established 
                under subsection (k)(2) shall be available for transfer 
                under subparagraph (C) for purposes of carrying out 
                this subsection.
                    ``(B) Annual estimates.--
                            ``(i) In general.--Not later 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 health professional 
                        volunteers, will be paid under this section 
                        during the calendar year that begins in the 
                        following fiscal year.
                            ``(ii) Applicability.--Subsection (k)(1)(B) 
                        applies to the estimate under clause (i) 
                        relating to 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).
                    ``(C) Transfers.--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.
            ``(5) Effective dates.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), this subsection takes effect on 
                October 1, 2017.
                    ``(B) Regulations, applications, and reports.--
                Effective on the date of the enactment of this 
                subsection--
                            ``(i) the Secretary may--
                                    ``(I) issue regulations for 
                                carrying out this subsection; and
                                    ``(II) accept and consider 
                                applications submitted under paragraph 
                                (3)(C); and
                            ``(ii) the Attorney General may submit to 
                        Congress a report under paragraph (4)(B).''.

SEC. 9. FISCAL ACCOUNTABILITY.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.) (as amended by section 6(a)) is amended by adding at the end 
the following:

``SEC. 609. FISCAL ACCOUNTABILITY.

    ``(a) Management of Funds.--
            ``(1) In general.--If the Secretary fails to submit the 
        staffing plan in accordance with section 4(c) of the Indian 
        Health Service Accountability Act of 2016 or the housing plan 
        in accordance with section 5(c) 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) before the applicable plan is submitted in 
        accordance with section 4(c) or section 5(c) of that Act, as 
        applicable.
            ``(2) Individual described.--An individual referred to in 
        paragraph (1) is--
                    ``(A) an individual who--
                            ``(i) is employed in a position described 
                        in sections 5312 through 5316 of title 5, 
                        United States Code (relating to the Executive 
                        Schedule);
                            ``(ii) is 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
                            ``(iii) is employed in a position in the 
                        executive branch of the Government of a 
                        confidential or policy-determining nature under 
                        schedule C of subpart C of part 213 of title 5, 
                        Code of Federal Regulations; or
                    ``(B) a senior executive (as defined in section 
                3132(a) of title 5, United States Code).
    ``(b) Prioritization of Patient Care.--
            ``(1) In general.--The Secretary shall use amounts that are 
        not obligated or expended during the fiscal year for which the 
        amounts are made available, and that remain available, only to 
        support patient care, specifically for--
                    ``(A) costs of essential medical equipment;
                    ``(B) the Purchased/Referred Care program; or
                    ``(C) any other purpose approved by the Secretary 
                after consultation with appropriate Indian tribes.
            ``(2) Restrictions.--The Secretary shall not use amounts 
        described in paragraph (1) for--
                    ``(A) interior decorating or remodeling of a 
                facility of the Service; or
                    ``(B) an increase in rate of pay for an employee of 
                an Area office.
    ``(c) Spending Reports.--The Secretary shall provide a report each 
quarter of a fiscal year describing the expenditures, outlays, 
transfers, reprogramming, obligations, and other spending of each level 
of the Service, including the headquarters, each Area office, each 
Service unit, and each facility, to--
            ``(1) Indian tribes;
            ``(2) in the Senate--
                    ``(A) the Committee on Indian Affairs;
                    ``(B) the Committee on Health, Education, Labor, 
                and Pensions;
                    ``(C) the Committee on Appropriations; and
                    ``(D) the Committee on the Budget; and
            ``(3) in the House of Representatives--
                    ``(A) the Committee on Natural Resources;
                    ``(B) the Committee on Energy and Commerce;
                    ``(C) the Committee on Appropriations; and
                    ``(D) the Committee on the Budget.
    ``(d) Status Reports.--
            ``(1) In general.--The Secretary shall provide to each 
        entity described in paragraphs (1) through (3) of subsection 
        (c) a report each quarter of a fiscal year, except as provided 
        in paragraph (2), describing the safety, billing, 
        certification, credential, and compliance statuses of each 
        facility managed, operated, or otherwise supported by the 
        Service.
            ``(2) Updates.--On a 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 the change.''.

SEC. 10. TRANSPARENCY AND ACCOUNTABILITY FOR PATIENT SAFETY.

    (a) Transparency and Accountability.--Title VI of the Indian Health 
Care Improvement Act (25 U.S.C. 1661 et seq.) (as amended by section 9) 
is amended by adding at the end the following:

``SEC. 610. TRANSPARENCY AND ACCOUNTABILITY FOR PATIENT SAFETY.

    ``(a) Transparency.--The Secretary shall ensure that all surveys, 
reports, and other materials of the Centers for Medicare & Medicaid 
Services relating to patient safety and compliance are posted on the 
websites of each hospital and clinic wholly or partially owned, 
operated, managed, or funded by the Service.
    ``(b) Accountability.--
            ``(1) In general.--The Inspector General of the Department 
        (referred to in this section as the `Inspector General') shall 
        investigate each patient death in which the Service is alleged 
        to be involved by an act or omission.
            ``(2) Notice.--The Secretary shall notify the Inspector 
        General of each patient death that occurs--
                    ``(A) in a facility of the Service; or
                    ``(B) under the care of the Service.
            ``(3) Reports.--Not less frequently than once each year, 
        the Inspector General shall provide to Indian tribes in the 
        relevant Service area and Congress a report describing the 
        investigations described in paragraph (1).
            ``(4) Disclosure.--On completion of each investigation 
        described in paragraph (1), the Inspector General shall provide 
        to the family of the deceased patient information relating to--
                    ``(A) the findings of the investigation; and
                    ``(B) any action taken by the Inspector General, 
                including any criminal referral.
    ``(c) Quality Monitoring.--The Secretary, in consultation with the 
Inspector General, shall establish within the Service a program to 
monitor the quality of patient care in the Service.
    ``(d) Reporting Systems.--The Inspector General shall--
            ``(1) conduct an audit of reporting systems of the Service 
        as of the date of enactment of this section; and
            ``(2) provide to the Service recommendations and technical 
        assistance to implement improved reporting systems, procedures, 
        standards, and protocols.''.
    (b) Compliance Surveys.--Section 1880 of the Social Security Act 
(42 U.S.C. 1395qq) is amended by adding at the end the following:
    ``(g)(1) Not less frequently than once every 2 years, the 
Administrator of the Centers for Medicare & Medicaid Services shall 
conduct surveys to assess the compliance of each hospital or skilled 
nursing facility of the Indian Health Service with--
            ``(A) section 1867; and
            ``(B) conditions of participation in the program under this 
        title.
    ``(2) Each survey completed under this subsection shall be made 
available on the public Internet website of the Centers for Medicare & 
Medicaid Services.''.
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