[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 498 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 498

   To provide for an independent outside audit of the Indian Health 
                                Service.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 14, 2019

  Mr. Rounds introduced the following bill; which was read twice and 
              referred to the Committee on Indian Affairs

_______________________________________________________________________

                                 A BILL


 
   To provide for an independent outside audit of the Indian Health 
                                Service.

    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 ``Assessment of the Indian Health 
Service Act of 2019''.

SEC. 2. ASSESSMENT OF THE INDIAN HEALTH SERVICE.

    (a) Definitions.--In this section:
            (1) Reputable private entity.--The term ``reputable private 
        entity'' means a private entity that--
                    (A) has experience with, and proven outcomes in 
                optimizing the performance of, Federal health care 
                delivery systems, the private sector, and health care 
                management; and
                    (B) specializes in implementing large-scale 
                organizational and cultural transformations, especially 
                with respect to health care delivery systems.
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) Service.--The term ``Service'' means the Indian Health 
        Service.
    (b) Assessment.--Not later than 180 days after the date of 
enactment of this Act, the Secretary shall enter into one or more 
contracts with a reputable private entity to conduct an independent 
assessment of the health care delivery systems and financial management 
processes of the Service. The Secretary shall not be required to 
provide a full and open competition in entering into such contracts. 
Such independent assessment shall be made only of Service-operated 
facilities.
    (c) Program Integrator.--
            (1) In general.--If the Secretary enters into contracts 
        under this section with more than 1 reputable private sector 
        entity, the Secretary shall designate one such entity that is 
        predominantly a health care organization as the program 
        integrator.
            (2) Responsibilities.--The program integrator designated 
        under paragraph (1) shall be responsible for coordinating the 
        outcomes of the assessments conducted by the reputable private 
        entities under this section.
    (d) Coordination With GAO and OIG.--As part of planning or 
designing the assessment described in subsection (b), the Secretary (or 
the program integrator designated under subsection (c)(1) acting on 
behalf of the Secretary) shall consult with the Comptroller General of 
the United States and the Inspector General of the Department of Health 
and Human Services to minimize duplications in the areas of study 
required under subsection (e) and to incorporate the Government 
Accountability Office's and Office of Inspector General's prior, 
publicly released, and relevant report findings dated January 1, 2013, 
or later, as appropriate.
    (e) Areas of Study.--Each assessment conducted under subsection (b) 
shall address each of the following:
            (1) Current and projected demographics and unique health 
        care needs of the patient population served by the Service.
            (2) Current and projected health care capabilities and 
        resources of the Service, including hospital care, medical 
        services, and other health care furnished by non-Service 
        facilities under contract with the Service, to provide timely 
        and accessible care to eligible patients.
            (3) The authorities and mechanisms under which the 
        Secretary may furnish hospital care, medical services, and 
        other health care at non-Service facilities.
            (4) The appropriate systemwide access standard applicable 
        to hospital care, medical services, and other health care 
        furnished by and through the Service, including an 
        identification of appropriate access standards for each 
        individual specialty and post-care rehabilitation.
            (5) The workflow process at each medical facility of the 
        Service for providing hospital care, medical services, or other 
        health care from the Service.
            (6) The organization, workflow processes, and tools used by 
        the Service to support clinical staffing, access to care, 
        effective length-of-stay management and care transitions, 
        positive patient experience, accurate documentation, and 
        subsequent coding of inpatient services.
            (7) The staffing level at each medical facility of the 
        Service and the productivity of each health care provider at 
        such medical facility, compared with health care industry 
        performance metrics, which may include an assessment of any of 
        the following:
                    (A) The case load of, and number of patients 
                treated by, each health care provider at such medical 
                facility during an average week.
                    (B) The time spent by such health care provider on 
                matters other than the case load of such health care 
                provider.
                    (C) The percentage of Service personnel carrying 
                out administrative duties compared to direct health 
                care duties, as compared to the percentage of private 
                health care institution personnel carrying out 
                administrative duties compared to direct health care 
                duties.
                    (D) The allocation of the budget of the Service 
                used for administration compared with the allocation of 
                the budget used for direct health care at Service-
                operated facilities.
                    (E) Any vacancies in positions of full-time 
                equivalent employees that the Service has not filled 
                during the 12-month period beginning on the date on 
                which the position became vacant.
                    (F) The disposition of amounts budgeted for full-
                time equivalent employees that is not used for those 
                employees because the positions of the employees are 
                vacant, including--
                            (i) whether the amounts are redeployed; and
                            (ii) if the amounts are redeployed, how the 
                        redeployment is determined.
                    (G) With respect to the approximately 3,700 
                Medicaid-reimbursable full-time equivalent employees of 
                the Service--
                            (i) the number of those employees who are 
                        certified coders;
                            (ii) how that number of employees compares 
                        with health care industry standards for 
                        staffing of certified coders; and
                            (iii) how much time is spent on training 
                        and participating in continuing education 
                        courses once employed by the Service.
            (8) The information technology strategies of the Service 
        with respect to furnishing and managing health care, including 
        an identification of any weaknesses and opportunities with 
        respect to the technology used by the Service, especially those 
        strategies with respect to clinical documentation of episodes 
        of hospital care, medical services, and other health care, 
        including any clinical images and associated textual reports, 
        furnished by the Service in Service or non-Service facilities.
            (9) Business processes of the Service, including processes 
        relating to furnishing non-Service health care, insurance 
        identification, third-party revenue collection, and vendor 
        reimbursement, including an identification of mechanisms as 
        follows:
                    (A) To avoid the payment of penalties to vendors.
                    (B) To increase the collection of amounts owed to 
                the Service for hospital care, medical services, or 
                other health care provided by the Service for which 
                reimbursement from a third party is authorized and to 
                ensure that such amounts collected are accurate.
                    (C) To increase the collection of any other amounts 
                owed to the Service with respect to hospital care, 
                medical services, and other health care and to ensure 
                that such amounts collected are accurate.
                    (D) To increase the accuracy and timeliness of 
                Service payments to vendors and providers.
            (10) The purchasing, distribution, and use of 
        pharmaceuticals, medical and surgical supplies, medical 
        devices, and health care related services by the Service, 
        including the following:
                    (A) The prices paid for, standardization of, and 
                use by the Service of, the following:
                            (i) Pharmaceuticals.
                            (ii) Medical and surgical supplies.
                            (iii) Medical devices.
                    (B) The use by the Service of group purchasing 
                arrangements to purchase pharmaceuticals, medical and 
                surgical supplies, medical devices, and health care 
                related services.
                    (C) The strategy and systems used by the Service to 
                distribute pharmaceuticals, medical and surgical 
                supplies, medical devices, and health care related 
                services to medical facilities of the Service.
            (11) The process of the Service for carrying out 
        construction and maintenance projects at medical facilities of 
        the Service and the medical facility leasing program of the 
        Service, including--
                    (A) whether the maintenance budget is updated or 
                increased to reflect increases in maintenance costs 
                with the addition of new facilities and whether any 
                increase is sufficient to support the growth of the 
                facilities; and
                    (B) what the process is for facilities that reach 
                the end of their proposed life cycle.
            (12) The competency of leadership with respect to culture, 
        accountability, reform readiness, leadership development, 
        physician alignment, employee engagement, succession planning, 
        and performance management, including--
                    (A) the reasons leading tribal leadership to 
                request increased transparency and more open 
                communication between the Service and the people served 
                by the Service; and
                    (B) whether any checks and balances exist to assess 
                potential fraud or misuse of amounts within the 
                Service.
            (13) The lack of a funding formula to distribute base 
        funding to the 12 Service areas, including the following:
                    (A) The establishment of the current process of 
                funding being distributed based on historical 
                allocations and not on need such as population growth, 
                number of facilities, etc.
                    (B) The communication to area office directors on 
                distribution decisionmaking.
                    (C) How the tribal and residual shares are 
                determined for each Indian tribe and the amounts of 
                those shares.
                    (D) The auditing or evaluation process used by the 
                Service to determine whether amounts are distributed 
                and expended appropriately, including--
                            (i) whether periodic or end-of-year records 
                        document the actual distributions; and
                            (ii) whether any auditing or evaluation is 
                        conducted in accordance with generally accepted 
                        accounting principles or other appropriate 
                        practices.
            (14) Whether the Service tracks patients eligible for two 
        or more of either the Medicaid program under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.), health care 
        received through the Service, or any other Federal health care 
        program (referred to in this section as ``dual eligible 
        patients''). If so, how dual eligible patients are managed.
            (15) The number of procurement contracts entered into and 
        awards made by the Service under section 23 of the Act of June 
        25, 1910 (commonly known as the ``Buy Indian Act'') (25 U.S.C. 
        47), and a comparison of that number, with--
                    (A) the total number of procurement contracts 
                entered into and awards made by the Service during 
                2015, 2016, 2017, and 2018; and
                    (B) the process used by the Service facilities to 
                ensure compliance with section 23 of the Act of June 
                25, 1910 (commonly known as the ``Buy Indian Act'') (25 
                U.S.C. 47).
            (16) An assessment of the availability of cancer services 
        for populations living on large, rural Indian reservations, 
        individual billing information, and reimbursement claims of 
        patients.
            (17) Any other items determined to be addressed during the 
        course of the assessment.
    (f) Report on Assessment.--
            (1) Submission to secretary.--Not later than 240 days after 
        the date that a contract is entered into under subsection (b), 
        the entity carrying out the assessment under the contract 
        shall--
                    (A) complete the assessment; and
                    (B) submit to the Secretary a report describing the 
                findings and recommendations of the entity with respect 
                to the assessment.
            (2) Submission to congress.--Immediately on receipt of the 
        report under paragraph (1)(B), the Secretary shall submit the 
        report to--
                    (A) the appropriate committees of Congress, 
                including--
                            (i) the Committee on Appropriations of the 
                        Senate; and
                            (ii) the Committee on Appropriations of the 
                        House of Representatives;
                    (B) the Majority Leader of the Senate;
                    (C) the Minority Leader of the Senate;
                    (D) the Speaker of the House of Representatives; 
                and
                    (E) the Minority Leader of the House of 
                Representatives.
            (3) Publication.--Not later than 30 days after receiving 
        the report under paragraph (1)(B), the Secretary shall publish 
        such report in the Federal Register and on an Internet website 
        of the Service that is accessible to the public.
    (g) Funding for Independent Outside Assessment.--The Secretary 
shall use such amounts as are necessary from other amounts available to 
the Secretary that are not otherwise obligated to fund the contract 
under subsection (b). Such amounts shall not come from funds available 
to the Indian Health Service.
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