[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4915 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
2d Session
S. 4915
To amend the Indian Health Care Improvement Act to improve the
recruitment and retention of employees in the Indian Health Service,
restore accountability in the Indian Health Service, improve health
services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 21, 2022
Mr. Barrasso (for himself, Mr. Thune, Ms. Lummis, Mr. Rounds, Mr.
Daines, and Mr. Hoeven) introduced the following bill; which was read
twice and referred to the Committee on Indian Affairs
_______________________________________________________________________
A BILL
To amend the Indian Health Care Improvement Act to improve the
recruitment and retention of employees in the Indian Health Service,
restore accountability in the Indian Health Service, improve health
services, 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 ``Restoring Accountability in the
Indian Health Service Act of 2022''.
SEC. 2. TABLE OF CONTENTS.
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 program.
Sec. 109. Rule establishing Tribal consultation policy.
Sec. 110. Treatment of certain hospitals.
Sec. 111. Enhancing quality of care in the Indian Health Service.
Sec. 112. Notification of investigation regarding professional conduct;
submission of records.
Sec. 113. Medical chaperones; Office of Patient Advocacy.
Sec. 114. Fitness of health care providers.
Sec. 115. Standards to improve timeliness of care.
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.
TITLE I--INDIAN HEALTH SERVICE IMPROVEMENTS
SEC. 101. INCENTIVES FOR RECRUITMENT AND RETENTION.
Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611
et seq.) is amended by adding at the end the following:
``SEC. 125. INCENTIVES FOR RECRUITMENT AND RETENTION.
``(a) Parity in IHS Health Care Workforce Personnel and Pay
System.--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 chapter 74 of title 38,
United States Code.
``(b) Housing Vouchers.--
``(1) In general.--Subject to paragraph (2), not later than
1 year after the date of enactment of the Restoring
Accountability in the Indian Health Service Act of 2022, 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 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 (42
U.S.C. 254e(a))) with the greatest staffing need; 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.
``(3) Reports.--Not later than 1 year after the date on
which a program established under paragraph (1) is terminated
in accordance with paragraph (2), the Secretary shall submit to
Congress a report describing, with respect to that program--
``(A) the costs of the program;
``(B) employee uptake of the program; and
``(C) the effects of the program on local facility
staffing needs.
``(c) Administration.--The Secretary may only provide a benefit
under subsection (b) to--
``(1) 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
``(2) a part-time employee who agrees to serve for not less
than 2 years in the service beginning on the date of the
agreement.''.
SEC. 102. MEDICAL CREDENTIALING SYSTEM.
Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611
et seq.) (as amended by section 101) is amended by adding at the end
the following:
``SEC. 126. MEDICAL CREDENTIALING SYSTEM.
``(a) In General.--
``(1) Development and implementation timeline.--Not later
than 1 year after the date of enactment of the Restoring
Accountability in the Indian Health Service Act of 2022, the
Secretary, acting through the Service (referred to in this
section as the `Secretary'), in accordance with subsection (b),
shall develop and implement a Service-wide centralized
credentialing system (referred to in this section as the
`credentialing system') to credential licensed health
professionals who seek to provide health care services at any
Service unit.
``(2) Implementation.--In implementing the credentialing
system, the Secretary--
``(A) shall not require re-credentialing of
licensed health professionals who were credentialed
using existing Service policy prior to the date of
enactment of the Restoring Accountability in the Indian
Health Service Act of 2022; and
``(B) shall--
``(i) use the credentialing system for--
``(I) all applications for
credentialing or re-credentialing of
licensed health professionals submitted
on or after the date of enactment of
the Restoring Accountability in the
Indian Health Service Act of 2022; and
``(II) the migration into the
credentialing system of credentials
data that existed prior to
implementation of the credentialing
system; and
``(ii) maintain the established timeline
for re-credentialing of licensed health
professionals who were credentialed prior to
implementation of the credentialing system, as
defined by Service policy.
``(b) Requirements.--
``(1) In general.--In developing the credentialing system
under subsection (a), the Secretary shall ensure that--
``(A) credentialing procedures shall be uniform
throughout the Service; and
``(B) with respect to each licensed health
professional who successfully completes the
credentialing procedures of the credentialing system,
the Secretary may authorize the licensed health
professional to provide health care services at any
Service unit.
``(2) Exemption.--The requirements described in paragraph
(1) shall not apply to licensed health professionals who were
credentialed using existing Service policy prior to the date of
enactment of the Restoring Accountability in the Indian Health
Service Act of 2022 until the date on which those licensed
health professionals are required to be re-credentialed in
accordance with the credentialing system developed and
implemented under subsection (a).
``(c) Consultation.--In developing the credentialing system under
subsection (a), the Secretary--
``(1) shall consult with Indian tribes; and
``(2) may consult with--
``(A) any public or private association of medical
providers;
``(B) any government agency; or
``(C) any other relevant expert, as determined by
the Secretary.
``(d) Application.--
``(1) In general.--Subject to paragraph (2), a licensed
health care professional may not provide health care services
at any Service unit, unless the licensed health care
professional successfully completes the credentialing
procedures of the credentialing system developed and
implemented under subsection (a).
``(2) Exemption.--Paragraph (1) shall not apply to licensed
health professionals who were credentialed using existing
Service policy prior to the date of enactment of the Restoring
Accountability in the Indian Health Service Act of 2022 until
the date on which those licensed health professionals are
required to be re-credentialed in accordance with the
credentialing system developed and implemented under subsection
(a).
``(e) Nonduplication of Efforts.--
``(1) In general.--To the extent that prior to the deadline
described in subsection (a)(1), the Service has begun
implementing or has completed implementation of a medical
credentialing system that otherwise meets the requirements of
this section, the Service shall not be required to establish a
new credentialing system under this section.
``(2) Authority.--The Service may expand or enhance an
existing credentialing system to meet the requirements of this
section.
``(3) Review.--
``(A) In general.--Not less frequently than once
every 5 years, the Service shall--
``(i) undertake a formal review of the
credentialing system in effect on the date of
the review; and
``(ii) if necessary, take action to bring
the credentialing system into compliance with
the requirements of this section.
``(B) Consultation.--Each formal review conducted
under subparagraph (A) shall be subject to the
consultation requirements under subsection (c).
``(f) Effect.--Nothing in this section--
``(1) negatively impacts the right of an Indian tribe to
enter into a compact or contract under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5301 et
seq.); or
``(2) applies to such a compact or contract unless
expressly agreed to by the Indian tribe.''.
SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT
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:
``(r) Certain Indian Health Service Volunteers Deemed Public Health
Service Employees.--
``(1) In general.--For purposes of this section, 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.
``(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 Service unit if all of the following conditions
are met:
``(A) 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.
``(B) The Service unit is sponsoring the health
care practitioner pursuant to paragraph (3)(C).
``(C) 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.
``(D) 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.
``(E) 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.
``(3) Applicability.--Subsection (g) (other than paragraphs
(3) and (5)) and subsections (h), (i), and (l) apply 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:
``(A) Each reference to an entity in subsections
(g), (h), (i), and (l) shall be considered to be a
reference to a Service unit.
``(B) The first sentence of paragraph (1) applies
in lieu of the first sentence of subsection (g)(1)(A).
``(C) 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--
``(i) 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
``(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 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.
``(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 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 health professional
volunteers, will be paid pursuant to 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) Definition of service unit.--
``(A) In general.--In this subsection, the term
`Service unit' has the meaning given the term in
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603).
``(B) Inclusion.--In this subsection, the term
`Service unit' includes an urban Indian organization
with which the Indian Health Service has entered into a
contract with, or to which the Indian Health Service
has made a grant, under title V of the Indian Health
Care Improvement Act (25 U.S.C. 1651 et seq.).
``(6) Effect.--Nothing in this subsection--
``(A) negatively impacts the right of an Indian
tribe to enter into a compact or contract under the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 5304 et seq.); or
``(B) applies to such a compact or contract unless
expressly agreed to by the Indian tribe.
``(7) Effective dates.--
``(A) In general.--Except as provided in
subparagraph (B), this subsection shall take effect on
October 1, 2022.
``(B) Regulations, applications, and reports.--
Effective on the date of the enactment of the Restoring
Accountability in the Indian Health Service Act of
2022, the Secretary may--
``(i) prescribe regulations for carrying
out this subsection; and
``(ii) accept and consider applications
submitted under paragraph (3)(C)(i).''.
SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR INDIAN HEALTH SERVICE
LOAN REPAYMENT PROGRAM.
Section 108 of the Indian Health Care Improvement Act (25 U.S.C.
1616a) is amended--
(1) in subsection (b)(1), by striking subparagraph (B) and
inserting the following:
``(B) have--
``(i)(I) a degree in a health profession; and
``(II) a license to practice a health profession in
a State; or
``(ii)(I) 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
``(II) 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 the
license or certification is necessary for the Indian
health program to which the individual will be
assigned;'';
(2) in subsection (f)(1)(B), by striking clause (iii) and
inserting the following:
``(iii) to serve for a time period
(referred to in this section as the `period of
obligated service') equal to--
``(I) 2 years or such longer period
as the individual may agree to serve in
the full-time practice of the
individual's profession in an Indian
health program to which the individual
may be assigned by the Secretary; or
``(II) 4 years or such longer
period as the individual may agree to
serve in the half-time practice of the
individual's profession in an Indian
health program to which the individual
may be assigned by the Secretary;'';
and
(3) in subsection (g)(2)--
(A) in subparagraph (B), by striking ``(B) Any
arrangement'' and inserting the following:
``(C) Deadline for repayments.--Any arrangement'';
(B) subparagraph (A), in the second sentence of the
matter preceding clause (i), by striking ``In making a
determination'' and inserting the following:
``(B) Determination of amount of payment.--In
making a determination under this paragraph''; and
(C) by striking ``(2)(A) For each year'' and all
that follows through ``paragraph (1).'' and inserting
the following:
``(2) Authorized payments.--
``(A) Amount of payment.--
``(i) Full-time practice.--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 the
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 (42 U.S.C. 254l-
1(g)(2)(A))) on behalf of the individual for
loans described in paragraph (1).
``(ii) Half-time.--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).''.
SEC. 105. IMPROVEMENTS IN HIRING PRACTICES.
(a) In General.--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. 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 the
qualifications standard established by the Office of Personnel
Management.
``(b) Tribal Notification.--
``(1) In general.--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 the
Area office or Service unit, as applicable, of the content of
an inclusion in an employment record.
``(2) Comment period.--Each Indian tribe that receives
notification under paragraph (1) may submit to the Secretary
comments during the 10-day period after the date of
notification.''.
(b) IHS Waivers.--Section 2(c) of Public Law 96-135 (25 U.S.C.
5117(c)) is amended--
(1) in paragraph (2)--
(A) by striking ``(2) The provisions'' and
inserting the following:
``(2) Application to certain individuals.--The
provisions'';
(B) by inserting ``or (3)'' after ``paragraph
(1)''; and
(C) by striking ``section 1131(f) of the Education
Amendments of 1978 (25 U.S.C. 2011(f); 92 Stat. 2324)''
and inserting ``section 1132(f) of the Education
Amendments of 1978 (25 U.S.C. 2012(f))'';
(2) by striking ``(c)(1) Notwithstanding'' and inserting
the following:
``(c) Waiver of Applicability in Personnel Actions.--
``(1) In general.--Notwithstanding''; and
(3) by adding at the end the following:
``(3) IHS waivers.--
``(A) In general.--At the request of a concerned
Indian tribe, the Secretary of Health and Human
Services may seek from each Indian tribe concerned a
waiver of Indian preference laws for a personnel action
that is with respect to--
``(i) a Service unit (as defined in section
4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)) in which--
``(I) 15 percent or greater of the
total positions are not filled by a
full-time employee of the Indian Health
Service for a period of 6 months or
longer; or
``(II) 15 percent or greater of a
specific health professional position
are not filled by a full-time employee
of the Indian Health Service for a
period of 6 months or longer; or
``(ii) a former employee of the Indian
Health Service, or a former Tribal employee,
who was removed from the employment during, or
demoted for performance or misconduct that
occurred during, the 5-year period following
the date of the personnel action.
``(B) Limitation.--A waiver may only be requested
under subparagraph (A) for a personnel action that is
with respect to an employee described in clause (ii) of
that subparagraph if the reason for the removal or
demotion of the employee did not result from an action
undertaken by the employee that was reported to the
National Practitioner Data Bank.
``(C) Restriction.--The Secretary of Health and
Human Services may only approve a waiver under
subparagraph (A) if the waiver is first requested by a
concerned Indian tribe.''.
SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY
OF SENIOR EXECUTIVES AND EMPLOYEES OF THE INDIAN HEALTH
SERVICE.
(a) In General.--Title VI of the Indian Health Care Improvement Act
(25 U.S.C. 1661 et seq.) (as amended by section 105) is amended by
adding at the end the following:
``SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY
OF SENIOR EXECUTIVES OF THE INDIAN HEALTH SERVICE.
``(a) Definitions.--In this section:
``(1) Covered individual.--The term `covered individual'
means a career appointee (as defined in section 3132(a) of
title 5, United States Code).
``(2) Misconduct.--The term `misconduct' includes--
``(A) neglect of duty;
``(B) malfeasance;
``(C) failure to accept a directed reassignment;
and
``(D) failure to accompany a position in a transfer
of function.
``(3) Secretary.--The term `Secretary' means the Secretary,
acting through the Service.
``(4) Senior executive position.--The term `senior
executive position' means a Senior Executive Service position
(as defined in section 3132(a) of title 5, United States Code).
``(b) Authority.--
``(1) In general.--The Secretary may, in accordance with
this section, reprimand, 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 an action.
``(2) Removal from civil service.--If the Secretary removes
a covered 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).
``(c) Rights and Procedures.--
``(1) In general.--A covered individual who is the subject
of an action or removal, as applicable, under subsection (b) is
entitled--
``(A) to advance notice of the action or removal;
``(B) to access a file containing all evidence in
support of the proposed action or removal;
``(C) to be represented by an attorney or other
representative of the covered individual's choice; and
``(D) to grieve the decision on the action or
removal under paragraph (2) in accordance with the
internal grievance process established by the Secretary
under paragraph (3).
``(2) Notice; response; decision.--
``(A) In general.--The aggregate period for notice,
response, and decision on an action or removal under
subsection (b) may not exceed 15 business days.
``(B) Response.--A covered individual receiving a
notice under paragraph (1)(A) of an action or removal,
as applicable, under subsection (b) shall have not more
than 7 business days to respond to the notice.
``(C) Decision.--
``(i) In general.--The Secretary shall
issue a decision on an action or removal, as
applicable, under subsection (b) not later than
15 business days after the date on which notice
of the action or removal, as applicable, is
received by the applicable covered individual
under paragraph (1)(A).
``(ii) Requirements.--A decision under
clause (i)--
``(I) shall be in writing; and
``(II) shall include the specific
reasons for the decision.
``(D) Final and conclusive decision.--A decision
under this paragraph that is not grieved under
paragraph (3) by the deadline described in that
paragraph shall be final and conclusive.
``(3) Grievance process.--
``(A) In general.--The Secretary shall establish an
internal grievance process under which a covered
individual may grieve a decision issued under paragraph
(2) not later than the date that is 7 business days
after the date on which the decision under that
paragraph was issued.
``(B) Total period.--The Secretary shall issue a
decision for which an internal grievance process is
initiated under subparagraph (A) not later than 21
business days after the date on which the grievance
process is initiated by the covered individual.
``(C) Final and conclusive decision.--A grievance
decision under this paragraph shall be final and
conclusive.
``(4) Judicial review.--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 the decision.
``(5) Court review.--In any case in which judicial review
is sought under paragraph (4), the court shall review the
record and may set aside any action of the Department or the
Service found to be--
``(A) arbitrary, capricious, an abuse of
discretion, or otherwise not in accordance with a
provision of law;
``(B) obtained without procedures required by a
provision of law having been followed; or
``(C) unsupported by substantial evidence.
``(d) Relation to Other Provisions of Law.--Section 3592(b)(1) of
title 5, United States Code, shall not apply to an action under
subsection (b).
``SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY
OF EMPLOYEES OF THE INDIAN HEALTH SERVICE.
``(a) Definitions.--In this section:
``(1) Covered individual.--
``(A) In general.--The term `covered individual'
means an individual occupying a position at the
Service.
``(B) Exclusions.--The term `covered individual'
does not include--
``(i) an individual occupying a senior
executive position (as defined in section
606(a));
``(ii) an individual who has not completed
a probationary or trial period; or
``(iii) a political appointee.
``(2) Grade.--The term `grade' has the meaning given the
term in section 7511(a) of title 5, United States Code.
``(3) Misconduct.--The term `misconduct' includes--
``(A) neglect of duty;
``(B) malfeasance;
``(C) failure to accept a directed reassignment;
and
``(D) failure to accompany a position in a transfer
of function.
``(4) Political appointee.--The term `political appointee'
means an individual who is--
``(A) employed in a position described in any of
sections 5312 through 5316 of title 5, United States
Code (relating to the Executive Schedule);
``(B) a limited term appointee, limited emergency
appointee, or noncareer appointee (as those terms are
defined in section 3132(a) of title 5, United States
Code); or
``(C) 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 a successor regulation).
``(5) Secretary.--The term `Secretary' means the Secretary,
acting through the Service.
``(6) Suspend.--The term `suspend' 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.
``(b) Authority.--
``(1) In general.--The Secretary may, in accordance with
this section, remove, demote, or suspend a covered individual
from employment at the Service if the Secretary determines that
the performance or misconduct of the covered individual
warrants such an action.
``(2) Actions.--If the Secretary removes, demotes, or
suspends a covered individual pursuant to paragraph (1), the
Secretary may--
``(A) remove the covered individual from the civil
service (as defined in section 2101 of title 5, United
States Code);
``(B) demote the covered individual by means of--
``(i) a reduction in grade for which the
covered individual is qualified, as the
Secretary determines appropriate; and
``(ii) a reduction of the annual rate of
pay of the covered individual; or
``(C) suspend the covered individual from the civil
service (as defined in section 2101 of title 5, United
States Code).
``(c) Pay of Certain Demoted Individuals.--
``(1) In general.--Notwithstanding any other provision of
law, any covered individual subject to a demotion by means of a
reduction in grade under subsection (b)(2)(B) shall, beginning
on the date of the demotion, receive the annual rate of pay
applicable to the reduced grade.
``(2) Restrictions.--
``(A) Prohibition on administrative leave.--A
covered individual subject to a demotion under
subsection (b)(2)(B)--
``(i) may not be placed on administrative
leave during the period during which an appeal
(if any) under this section is ongoing; and
``(ii) 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.
``(B) Restriction on pay and benefits.--If a
covered individual subject to a demotion under
subsection (b)(2)(B) does not report for duty (and has
not received approval to use accrued unused leave under
subparagraph (A)(ii)), the covered individual shall not
receive pay or other benefits pursuant to subsection
(e)(7).
``(d) Rights and Procedures.--
``(1) In general.--A covered individual who is the subject
of an action or removal, as applicable, under subsection (b) is
entitled--
``(A) to advance notice of the action or removal;
``(B) to access a file containing all evidence in
support of the proposed action or removal;
``(C) to be represented by an attorney or other
representative of the covered individual's choice; and
``(D) to grieve the decision on the action or
removal under paragraph (2) in accordance with the
internal grievance process established by the Secretary
under paragraph (3).
``(2) Notice; response; decision.--
``(A) Aggregate period.--The aggregate period for
notice, response, and a final decision on an action
under subsection (b) may not exceed 15 business days.
``(B) Response.--A covered individual receiving a
notice under paragraph (1)(A) of an action or removal
under subsection (b) shall have not more than 7
business days to respond to the notice.
``(C) Final and conclusive decision.--
``(i) In general.--The Secretary shall
issue a final and conclusive decision on an
action or removal under subsection (b) not
later than 15 business days after the date on
which the notice of the action is received by
the applicable covered individual under
paragraph (1)(A).
``(ii) Requirements.--A decision under
clause (i)--
``(I) shall be in writing; and
``(II) shall include the specific
reasons for the decision.
``(3) Grievance process.--
``(A) In general.--The Secretary shall establish an
internal grievance process under which a covered
individual may grieve a decision issued under paragraph
(2) not later than the date that is 7 business days
after the date on which the decision under that
paragraph was issued.
``(B) Total period.--The Secretary shall issue a
decision for which an internal grievance process is
initiated under subparagraph (A) not later than 21
business days after the date on which the grievance
process is initiated by the covered individual.
``(C) Final and conclusive decision.--A grievance
decision under this paragraph shall be final and
conclusive.
``(4) Procedures superseding cbas.--The procedures under
this subsection shall supersede any collective bargaining
agreement to the extent that such an agreement is inconsistent
with the procedures.
``(5) Performance appraisal.--The procedures under chapter
43 of title 5, United States Code, shall not apply to an action
under subsection (b).
``(6) Appeal to merit systems protection board.--
``(A) In general.--Subject to subparagraph (B) and
subsection (e), any removal, demotion, or suspension of
more than 14 days under subsection (b) may be appealed
to the Merit Systems Protection Board, which shall
refer such appeal to an administrative law judge
pursuant to section 7701(b)(1) of title 5, United
States Code.
``(B) Time period.--An appeal under subparagraph
(A) of a removal, demotion, or suspension may only be
made if the appeal is made not later than 10 business
days after the date of the removal, demotion, or
suspension.
``(e) Expedited Review.--
``(1) In general.--On receipt of an appeal under subsection
(d)(6)(A), the applicable administrative law judge shall--
``(A) expedite the appeal under section 7701(b)(1)
of title 5, United States Code; and
``(B) issue a final and complete decision on the
appeal not later than 180 days after the date of the
appeal.
``(2) Upholding decision.--
``(A) In general.--Notwithstanding section
7701(c)(1)(B) of title 5, United States Code, the
administrative law judge shall uphold the decision of
the Secretary to remove, demote, or suspend an employee
under subsection (b) if the decision is supported by
substantial evidence.
``(B) Prohibition of mitigation.--Notwithstanding
title 5, United States Code, or any other provision of
law, if the decision of the Secretary to remove,
demote, or suspend an employee under subsection (b) is
supported by substantial evidence, the administrative
law judge shall not mitigate the penalty prescribed by
the Secretary.
``(3) Appeal to merit systems protection board.--
``(A) In general.--The decision of the
administrative law judge under paragraph (1) may be
appealed to the Merit Systems Protection Board.
``(B) Upholding decision.--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 (b) if the decision is supported by
substantial evidence.
``(C) Prohibition of mitigation.--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.
``(4) Report.--In any case in which an administrative law
judge cannot issue a final and complete decision by the
deadline described in paragraph (1)(B), the Merit Systems
Protection Board shall, not later than 14 business days after
the deadline expires, submit to the appropriate committees of
Congress a report that explains the reasons why a decision was
not issued by the deadline.
``(5) Appeal.--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
that section.
``(6) Prohibition against stays.--The Merit Systems
Protection Board may not stay any removal or demotion under
subsection (b), except as provided in section 1214(b) of title
5, United States Code.
``(7) Restriction on pay and benefits during appeal.--
``(A) In general.--
``(i) Restriction on pay and benefits.--
During the period described in clause (ii), a
covered individual may not receive any pay and
benefits described in subparagraph (B).
``(ii) Period described.--The period
referred to in clause (i) is the period--
``(I) beginning on the date on
which a covered individual appeals
under this section a removal from the
civil service under subsection
(b)(2)(A); and
``(II) ending on the later of--
``(aa) the date on which
the Merit Systems Protection
Board issues a final decision
on the appeal under paragraph
(3); and
``(bb) the date on which
the United States Court of
Appeals for the Federal Circuit
issues a final decision on the
appeal under paragraph (5).
``(B) Pay and benefits described.--The pay and
benefits referred to in subparagraph (A)(i) are any
pay, awards, bonuses, incentives, allowances,
differentials, student loan repayments, special
payments, or benefits related to the employment of the
individual by the Service.
``(8) Information to expedite appeal.--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.
``(9) Backpay.--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).
``(10) Applicable timelines and procedures.--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 described in subsection (d) and
this subsection shall apply.
``(f) Alleged Prohibited Personnel Practice.--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 the covered individual under subsection (b) without
the approval of the Special Counsel under section 1214(f) of title 5,
United States Code.
``(g) Termination of Investigations by Office of Special Counsel.--
``(1) In general.--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.
``(2) Admissibility.--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).
``(h) Vacancies.--In the case of a covered individual who is
removed or demoted under subsection (b), to the maximum extent
practicable, the Secretary shall fill the vacancy arising as a result
of the removal or demotion.''.
(b) Conforming Amendments.--Section 4303(f) of title 5, United
States Code, is amended--
(1) in paragraph (3), by striking ``or'' at the end;
(2) in paragraph (4), by striking the period at the end and
inserting ``, or''; and
(3) by adding at the end the following:
``(5) any removal or demotion under section 607 of the
Indian Health Care Improvement Act.''.
(c) Report.--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, as
appropriate, shall submit to Congress a report that includes
information on--
(1) the number of employees of the Indian Health Service
who were removed, demoted, or suspended during the 1-year
period preceding the date of enactment of this Act;
(2) the number of employees of the Indian Health Service
who were removed, demoted, or suspended during the 1-year
period beginning on the date of enactment of this Act pursuant
to the amendments made by this section; and
(3) the appropriate details of any such removals,
demotions, and suspensions that lend necessary context.
SEC. 107. TRIBAL CULTURE AND HISTORY.
Section 113 of the Indian Health Care Improvement Act (25 U.S.C.
1616f) is amended--
(1) in subsection (a)--
(A) by striking ``a program'' and inserting ``an
annual mandatory training program''; and
(B) by striking ``appropriate employees of the
Service'' and inserting ``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''; and
(2) by adding at the end the following:
``(c) Requirement To Complete Training Program.--Notwithstanding
any other provision of law, beginning on the date of enactment of the
Restoring Accountability in the Indian Health Service Act of 2022, each
employee or provider described in subsection (a) who enters into a
contract with the Service shall, as a condition of employment, annually
participate in and complete the program established under subsection
(a).''.
SEC. 108. STAFFING DEMONSTRATION PROGRAM.
Title VIII of the Indian Health Care Improvement Act (25 U.S.C.
1671 et seq.) is amended by adding at the end the following:
``SEC. 833. STAFFING DEMONSTRATION PROGRAM.
``(a) In General.--Not later than 1 year after the date of
enactment of the Restoring Accountability in the Indian Health Service
Act of 2022, the Secretary, acting through the Service (referred to in
this section as the `Secretary'), shall establish a demonstration
program (referred to in this section as the `demonstration program')
under which the Service may provide Service units with additional
staffing resources, with the goal that the resources become self-
sustaining.
``(b) Selection.--In selecting Service units for participation in
the demonstration program, the Secretary shall consider whether a
Service unit services an Indian tribe that--
``(1) 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;
``(2) is located in 1 or more States with Medicaid
reimbursements plans or policies that will increase the
likelihood that the staffing resources provided will be self-
sustaining; and
``(3) is operating a health facility described in paragraph
(1) under historical staffing ratios, as determined by the
Secretary, that have not been equalized or updated by the
Service or any other Service program to reflect current
staffing needs.
``(c) Duration.--Staffing resources provided to a Service unit
under the demonstration program shall be provided for a duration that
the Secretary, in consultation with the applicable Indian tribe,
determines appropriate, on the condition that each staffing position
provided shall be for a period of not less than 3 fiscal years.
``(d) Effect of Staffing Awards.--No staffing resources provided
under the demonstration program shall reduce the recurring base funding
for staffing for any Indian tribe or Service unit.
``(e) Sunset.--The demonstration program established under
subsection (a) shall terminate on the date that is 4 years after the
date on which the demonstration program is established.
``(f) Report.--Not later than 1 year after the date on which the
demonstration program terminates under subsection (e), the Secretary
shall submit 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 a report describing the demonstration program,
including information on--
``(1) whether the staffing resources provided under the
demonstration program resulted in additional revenue for the
applicable Service unit sufficient to maintain the staff on a
permanent basis;
``(2) the levels to which the staffing resources provided
under the demonstration program reduced the unmet staffing need
for the applicable Service unit; and
``(3) whether the demonstration program could be deployed
permanently to reduce unmet staffing needs throughout the
Service.''.
SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION POLICY.
Title VIII of the Indian Health Care Improvement Act (25 U.S.C.
1671 et seq.) (as amended by section 108) is amended by adding at the
end the following:
``SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION POLICY.
``(a) In General.--Not later than December 31, 2023, the Secretary
shall establish, and once every 5 years thereafter, the Secretary shall
update, after meaningful consultation with representatives of affected
Indian tribes, a rule establishing a Tribal consultation policy for the
Service.
``(b) Contents of Tribal Consultation Policy.--The policy
established under the rule under subsection (a) shall--
``(1) update, and replace, the Tribal consultation policy
established under Circular No. 2006-01 of the Service (or any
successor policy); and
``(2) include--
``(A) a process for determining when and how the
Service will notify Indian tribes of the availability
of meaningful consultation;
``(B) a determination of which actions or agency
decisions by the Service will trigger a requirement for
meaningful consultation with Indian tribes; and
``(C) a determination of which actions constitute
meaningful consultation with Indian tribes.''.
SEC. 110. TREATMENT OF CERTAIN HOSPITALS.
The ``Parallel Low-Volume Hospital Payment Adjustment Regarding
Hospitals Operated by the Indian Health Services (IHS) or a Tribe''
provisions described in the final rule of the Centers for Medicare &
Medicaid Services entitled ``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'' (82 Fed Reg. 37990;
38188-38189 (August 14, 2017)), shall apply with respect to discharges
occurring in fiscal year 2011 and each fiscal year thereafter.
SEC. 111. ENHANCING QUALITY OF CARE IN THE INDIAN HEALTH SERVICE.
(a) IHCIA Definitions.--In this section, the terms ``Area office'',
``Indian tribe'', ``Secretary'', ``Service'', ``Service unit'',
``tribal organization'', and ``Urban Indian organization'' have the
meanings given those terms in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603).
(b) Best Practices for Governing Board and Area Office Meetings.--
(1) Definition of governing board.--In this subsection, the
term ``governing board'' means the governing board of the
facility of a Service unit.
(2) In general.--Not later than 1 year after the date of
enactment of this Act, the Secretary, in consultation with
Indian tribes, governing boards, Area offices, Service units,
and other stakeholders, as determined appropriate by the
Secretary, shall establish--
(A) in accordance with paragraph (3)(A), best
practices for governing boards; and
(B) in accordance with paragraph (3)(B), best
practices for Area offices.
(3) Requirements.--
(A) Governing board best practices.--The best
practices for governing boards established under
paragraph (2)(A) shall include provisions relating to--
(i) adequately monitoring the delivery of
care at the applicable facility managed by the
governing board;
(ii) ensuring ongoing facility compliance
with Federal health care program requirements,
including requirements of the Service and the
Centers for Medicare & Medicaid Services;
(iii) handling, documenting, and responding
to patient complaints;
(iv) documenting, addressing, and, if
applicable, reporting instances of professional
misconduct by facility staff in accordance with
applicable Federal and State law;
(v) improving facility performance and
operations with respect to mandatory and
voluntary quality initiatives carried out by
the Service and the Centers for Medicare &
Medicaid Services; and
(vi) reporting requirements under Federal
law, including with respect to--
(I) the Government Performance and
Results Act of 1993 (Public Law 103-62;
107 Stat. 285), the GPRA Modernization
Act of 2010 (Public Law 111-352; 124
Stat. 3866), and the amendments made by
those Acts; and
(II) the applicable provisions of
titles XVIII and XIX of the Social
Security Act (42 U.S.C. 1395 et seq.,
1396 et seq.).
(B) Area office best practices.--The best practices
for Area offices established under paragraph (2)(B)
shall include provisions relating to--
(i) strategies for how to best monitor
governing board activities relating to the
oversight of--
(I) delivery and quality of patient
care;
(II) documenting and responding to
patient complaints and instances of
professional misconduct; and
(III) facility compliance with
Federal health care program
requirements, including requirements of
the Service and the Centers for
Medicare & Medicaid Services; and
(ii) connecting governing boards, including
the applicable facilities of those governing
boards, to resources necessary for enhancing
patient outcomes and improving facility
performance, including through the use of
technical assistance.
(4) Publication.--The best practices established under
paragraph (2) shall be--
(A) reported to, in writing, as applicable, all
governing boards and Area offices; and
(B) incorporated into the Indian Health Manual of
the Service.
(c) Review of Quality and Performance Measures.--
(1) Review.--
(A) In general.--Not later than 1 year after the
date of enactment of this Act, the Secretary, in
coordination with the Agency for Healthcare Research
and Quality, the National Quality Forum, Indian tribes,
practitioners and administrators of the Service, and
other qualified experts, as determined appropriate by
the Secretary, shall undertake a review of the reported
quality and performance measures of Service facilities
conducted by the Secretary in accordance with--
(i) section 306 of title 5, United States
Code;
(ii) section 1115(b) of title 31, United
States Code; and
(iii) any law (including regulations) used
in any mandatory or voluntary program of the
Centers for Medicare & Medicaid Services.
(B) Report.--Not later than 6 months after the date
on which the review required under subparagraph (A) is
completed, the Secretary shall submit to Congress a
report on the details and findings of that review,
which shall include an assessment of--
(i) the suitability of measures used as of
the date of enactment of this Act for the
applicable Service facility, taking into
consideration the patient volume of the
facility, the mix of patient cases at the
facility, the geographic location of the
facility, and medical professional shortage
designations at the facility, as determined by
the Secretary; and
(ii) the extent to which the performance
and quality measures are outcome-based or
process-based measures.
(2) Adoption.--Not later than 1 year after the date on
which the report required under paragraph (1)(B) is submitted
to Congress, the Service, in coordination with the Centers for
Medicare & Medicaid Services, shall adopt, and assist Service
facilities to adopt, to the extent practicable, more suitable,
as compared to those quality and performance measures adopted
prior to the submission of that report, quality and performance
measures, including measures that are more outcome-based and
process-based, in accordance with the factors described in
paragraph (1)(B)(i).
(3) GAO report.--Not later than 1 year after the date on
which the report required under paragraph (1)(B) is submitted
to Congress, the Comptroller General of the United States shall
submit to Congress a report on challenges relating to quality
measure and data collection in Service facilities, which shall
include--
(A) barriers to the adoption of relevant
performance and quality measures in Service facilities;
and
(B) recommendations for how the Service, other
Federal agencies, and stakeholders can assist Service
facilities in adopting suitable quality and performance
measures.
(d) Compliance Assistance Program.--
(1) Definitions.--In this subsection:
(A) Administrator.--The term ``Administrator''
means the Administrator of the Centers for Medicare &
Medicaid Services.
(B) Eligible facility.--
(i) In general.--The term ``eligible
facility'' means a facility operated by the
Service that--
(I) is an underperforming hospital
or outpatient facility; and
(II) is eligible for payments under
title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(ii) Inclusion.--The term ``eligible
facility'' includes a tribally operated
facility, if that facility consents to
participating in the program.
(C) Program.--The term ``program'' means the
compliance assistance program established under
paragraph (2).
(D) Tribally operated facility.--The term
``tribally operated facility'' means a facility
operated by an Indian tribe, a tribal organization, or
an Urban Indian organization that--
(i) is an underperforming hospital or
outpatient facility; and
(ii) is eligible for payments under title
XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(2) Establishment of program.--Not later than 1 year after
the date of enactment of this Act, the Secretary, in
coordination with the Administrator and quality improvement
organizations having a contract with the Secretary under part B
of title XI of the Social Security Act (42 U.S.C. 1320c et
seq.), shall establish a compliance assistance program for
eligible facilities.
(3) Methodology.--The Secretary shall establish a
methodology for determining which eligible facilities shall
participate in the program, which shall take into account the
following factors:
(A) The number and severity of facility
deficiencies with respect to applicable requirements
under title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.).
(B) The history of provider misconduct or patient
harm at the facility.
(C) Whether there is high staff turnover at the
facility.
(D) Whether the facility has low performance on
program quality measures, relative to other facilities
of the Service, in accordance with reported quality and
performance measures conducted by the Secretary in
accordance with--
(i) section 306 of title 5, United States
Code;
(ii) section 1115(b) of title 31, United
States Code; and
(iii) any law (including regulations) used
in any mandatory or voluntary program of the
Centers for Medicare & Medicaid Services.
(4) Selection of facilities.--
(A) In general.--The Secretary, in coordination
with the Administrator, shall select not less than 25
percent of the eligible facilities to participate in
the program using the methodology established under
paragraph (3).
(B) Participation.--
(i) In general.--An eligible facility
selected to participate in the program under
subparagraph (A) shall be required to
participate in the program.
(ii) Requirement.--The Secretary shall
ensure that, at all times during the period
beginning on the date of establishment of the
program and the date on which the program
terminates under paragraph (8), not less than
25 percent of eligible facilities are
participating in the program.
(C) Term of participation.--
(i) In general.--Subject to clause (ii), an
eligible facility selected to participate in
the program under subparagraph (A) shall
participate in the program for a period of 2
years.
(ii) Waiver.--If the Secretary, in
coordination with the Administrator, certifies
that an eligible facility participating in the
program has improved on its performance to a
satisfactory level, as determined by the
Secretary, then the eligible facility does not
have to participate in the program for the full
2-year period.
(D) Participation limit.--An eligible facility may
participate in the program for more than 1 2-year
period.
(5) Program components.--The program shall provide on-site
consultation and educational programming for eligible
facilities to ensure those eligible facilities are--
(A) meeting Federal requirements of the Service and
any conditions of participation applicable under title
XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.); and
(B) satisfactorily implementing any quality
initiatives and programs established by the Service or
the Centers for Medicare & Medicaid Services.
(6) Enforcement or noncompliance actions.--
(A) In general.--The program shall be conducted
independently of any enforcement actions under the
Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.) or noncompliance actions taken by the
Administrator with respect to noncompliance with
conditions of participation applicable under title
XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.), unless, while carrying out the program, the
Secretary or the Administrator, as applicable,
encounters a triggering event, as determined by the
Secretary or the Administrator, as applicable, that
would necessitate an enforcement action or
noncompliance action.
(B) Triggering event encountered.--If a triggering
event is encountered by the Secretary or Administrator
under subparagraph (A), the eligible facility shall
continue to participate in the program so long as the
facility--
(i) remains eligible for payments under
title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.); and
(ii) continues to meet all of the
conditions and requirements for such payments
which are applicable under such title.
(7) Implementation.--The Secretary shall carry out the
program in coordination with quality improvement organizations
having a contract with the Secretary under part B of title XI
of the Social Security Act (42 U.S.C. 1320c et seq.).
(8) Sunset.--The program shall terminate 6 years after the
date on which the program is established.
(9) Report.--Not later than 1 year after the date on which
the program terminates under paragraph (8), the Comptroller
General of the United States shall submit to Congress a report
evaluating the effectiveness of the program, which shall
include, to the extent practicable--
(A) detailed data on changes in the patient
experience at eligible facilities that participated in
the program;
(B) a description of the compliance status of
eligible facilities that participated in the program
with requirements of the Service and any conditions of
participation applicable under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.); and
(C) a description of the progress by eligible
facilities that participated in the program in meeting
the goals of quality improvement activities of the
Department of Health and Human Services.
SEC. 112. NOTIFICATION OF INVESTIGATION REGARDING PROFESSIONAL CONDUCT;
SUBMISSION OF RECORDS.
Title VIII of the Indian Health Care Improvement Act (25 U.S.C.
1671 et seq.) (as amended by section 109) is amended by adding at the
end the following:
``SEC. 835. NOTIFICATION OF INVESTIGATION REGARDING PROFESSIONAL
CONDUCT; SUBMISSION OF RECORDS.
``(a) Report.--Not later than 14 calendar days after the date on
which the Service undertakes an investigation into the professional
conduct of a licensee of a State, the Secretary, acting through the
Service, shall notify the relevant State medical board of the
investigation.
``(b) Submission of Records.--Not later than 14 calendar days after
the date on which the Service generates records relating to an
investigation conducted by the Service into the professional conduct of
a licensee of a State, the Secretary, acting through the Service, shall
provide the records to the relevant State medical board.''.
SEC. 113. MEDICAL CHAPERONES; OFFICE OF PATIENT ADVOCACY.
(a) Medical Chaperones.--Title II of the Indian Health Care
Improvement Act is amended by inserting after section 223 (25 U.S.C.
1621v) the following:
``SEC. 224. MEDICAL CHAPERONES.
``(a) Indian Health Service.--
``(1) In general.--The Secretary, acting through the
Service, shall, at the request of a patient of the Service,
provide to the patient a medical chaperone, to be present
during any medical examination of the patient provided by or
through the Service.
``(2) Requirements.--The Secretary, acting through the
Service, shall--
``(A) notify patients of the Service of the right
to have a medical chaperone present during a medical
examination provided by or through the Service; and
``(B) ensure that the right described in
subparagraph (A) is provided to each patient in each
Service unit.
``(b) Other Providers of Services.--An Indian tribe, tribal
organization, or any other Indian health program may use amounts made
available under this Act to provide, at the request of a patient to
whom the Indian tribe, tribal organization, or Indian health program is
providing health care services, a medical chaperone to the patient, to
be present during any medical examination of the patient provided by
the Indian tribe or tribal organization.''.
(b) Indian Health Service Office of Patient Advocacy.--Title VI of
the Indian Health Care Improvement Act (25 U.S.C. 1661 et seq.) (as
amended by section 106) is amended by adding at the end the following:
``SEC. 608. OFFICE OF PATIENT ADVOCACY.
``(a) Definitions.--In this section:
``(1) Director.--The term `Director' means the Director of
the Office.
``(2) Office.--The term `Office' means the Office of
Patient Advocacy established by subsection (b).
``(b) Establishment.--There is established within the Department an
office, to be known as the `Office of Patient Advocacy'.
``(c) Director.--The Office shall be headed by a Director, who
shall--
``(1) be appointed by the Secretary from among individuals
qualified to perform the duties of the position; and
``(2) report directly to the Secretary.
``(d) Duties.--
``(1) In general.--The Office shall carry out a patient
advocacy program of the Service, under which the Office shall--
``(A) employ patient advocates to advocate on
behalf of Indians with respect to health care services
sought or received through the Service;
``(B) provide to those patient advocates training
to ensure the advocates carry out the responsibilities
described in paragraph (2); and
``(C) in as many prominent locations as the
Director determines to be appropriate to be seen by the
largest percentage of patients and family members of
patients at each Service unit, display--
``(i) the purposes of the patient advocacy
program;
``(ii) the contact information for a
patient advocate employed at the Service unit;
and
``(iii) a description of the rights and
responsibilities of patients and family members
of patients at the Service unit.
``(2) Patient advocate responsibilities.--The
responsibilities of a patient advocate employed by the Office
shall include the following:
``(A) Resolving any complaints by Indian patients
with respect to health care services provided by or
through the Service that cannot be resolved at--
``(i) the point of service; or
``(ii) a higher level easily accessible to
the patient.
``(B) Expressing to Indians their rights and
responsibilities as patients in receiving health care
services through the Service.
``(C) Presenting at various meetings, and to
various committees, a description of any issues
experienced by Indians in receiving health care
services through the Service.
``(D) Managing a patient advocate tracking system,
if applicable.
``(E) Compiling data relating to any complaints
made to the advocate by Indians with respect to the
receipt of health care services through the Service,
and the satisfaction of Indians with those services, to
determine whether there exist any trends in those data.
``(F) Ensuring that a process exists for the
distribution of data compiled under subparagraph (E) to
Indian health programs, appropriate leaders,
committees, and service providers, and staff of the
Service.
``(G) Identifying, not less frequently than
quarterly, opportunities for improvement in the
provision of health care services to Indians by or
through the Service, including based on complaints by
Indian patients or immediate family members.
``(H) Ensuring that any significant complaint by an
Indian patient or family member with respect to health
care provided by or through the Service is brought to
the attention of appropriate staff of the Service or
Indian health program for the purpose of assessing
whether further analysis of the problem is required at
the Service, Service area, Service unit, or Indian
health program level.
``(I) Supporting any other patient advocacy
programs carried out by the Department.
``(J) Ensuring that all appeals and final decisions
with respect to the receipt of health care services
through the Service are entered into a patient advocate
tracking system of the Office, if applicable.
``(K) Understanding all laws, directives, and other
rules relating to the rights and responsibilities of
Indians in receiving health care services through the
Service, including the appeals processes available to
Indian patients and immediate family members.
``(L) Ensuring that Indians receiving behavioral
health services under title VII (and any surrogate
decisionmakers for such Indians) are aware of the right
of Indians--
``(i) to seek representation from systems
established under section 103 of the Protection
and Advocacy for Mentally Ill Individuals Act
of 1986 (42 U.S.C. 10803);
``(ii) to protect and advocate for the
rights of Indians experiencing behavioral
health issues; and
``(iii) to investigate incidents of abuse
and neglect of Indians experiencing behavioral
health issues.
``(M) Achieving compliance with any applicable
requirements established by the Secretary with respect
to the inspection of controlled substances (as defined
in section 102 of the Controlled Substances Act (21
U.S.C. 802)).
``(N) Documenting potentially threatening behavior
and reporting that behavior to the appropriate
authorities.
``(3) Training.--The Director shall ensure that the
training provided to patient advocates under paragraph (1)(B)
is consistent throughout the Office, including with respect to
any mandatory training or certification standards approved by
the Director.''.
SEC. 114. FITNESS OF HEALTH CARE PROVIDERS.
(a) In General.--Title VIII of the Indian Health Care Improvement
Act is amended by inserting after section 802 (25 U.S.C. 1672) the
following:
``SEC. 803. FITNESS OF HEALTH CARE PROVIDERS.
``(a) Additional Requirements for Hiring of Health Care Providers
by Service.--As part of the hiring process for each health care
provider position at the Service after the date of enactment of the
Restoring Accountability in the Indian Health Service Act of 2022, the
Director shall require from the medical board of each State in which
the health care provider has or had a medical license--
``(1) information on any violation of the requirements of
the medical license of the health care provider during the 20-
year period ending on the date on which the health care
provider is being considered for a position at the Service; and
``(2) information on whether the health care provider has
entered into any settlement agreement for a disciplinary charge
relating to the practice of medicine by the health care
provider.
``(b) Provision of Information on Service Health Care Providers to
State Medical Boards.--Notwithstanding section 552a of title 5, United
States Code, with respect to each health care provider of the Service
who has violated a requirement of the medical license of the health
care provider, the Director shall provide to the medical board of each
State in which the health care provider is licensed detailed
information with respect to the violation, regardless of whether the
medical board has formally requested that information.''.
(b) Report on Compliance by Indian Health Service With Reviews of
Health Care Providers Leaving Service or Transferring to Other
Facilities.--Not later than 180 days after the date of enactment of
this Act, the Director of the Indian Health Service shall submit to the
Committee on Indian Affairs of the Senate and the Committee on Natural
Resources of the House of Representatives a report on the compliance by
the Indian Health Service with the policy of the Indian Health
Service--
(1) to conduct a review of each health care provider of the
Indian Health Service who transfers to another medical facility
of the Indian Health Service, resigns, retires, or is
terminated to determine whether there are any concerns,
complaints, or allegations of violations relating to the
medical practice of the health care provider; and
(2) to take appropriate action with respect to any concern,
complaint, or allegation described in paragraph (1).
SEC. 115. STANDARDS TO IMPROVE TIMELINESS OF CARE.
Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641
et seq.) is amended by adding at the end the following:
``SEC. 412. STANDARDS TO IMPROVE TIMELINESS OF CARE.
``(a) Regulations.--
``(1) In general.--Not later than 180 days after the date
of enactment of the Restoring Accountability in the Indian
Health Service Act of 2022, the Secretary, acting through the
Service, shall--
``(A) establish, by regulation, standards to
measure the timeliness of the provision of health care
services in Service facilities; and
``(B) provide such standards to each Service unit.
``(2) Data collection.--The Secretary, acting through the
Service, shall develop a process for each Service unit to
submit to the Secretary data with respect to the standards
established under paragraph (1)(A).
``(b) Annual Reports.--
``(1) In general.--Not later than 1 year after the date of
enactment of the Restoring Accountability in the Indian Health
Service Act of 2022, and annually thereafter, each Area office
shall submit to the Secretary a report on the metrics reported
by Service units relating to the timeliness of the provision of
health care services in Service facilities within each Service
unit.
``(2) Publication.--The Secretary shall make each report
received under paragraph (1) publicly available on the website
of the Service.''.
TITLE II--EMPLOYEE PROTECTIONS
SEC. 201. 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 113(b)) is amended by
adding at the end the following:
``SEC. 609. EMPLOYEE PROTECTIONS AGAINST RETALIATION.
``(a) Definitions.--In this section:
``(1) Information.--The term `information' means
information--
``(A) the disclosure of which is not specifically
prohibited by law; and
``(B) that is not specifically required by
Executive order to be kept secret in the interest of
national defense or the conduct of foreign affairs.
``(2) Retaliation.--The term `retaliation', with respect to
a whistleblower, means--
``(A) an adverse employment action against the
whistleblower;
``(B) a significantly adverse action against the
whistleblower, such as the refusal or delay of care
provided through the Service; and
``(C) an adverse action described in subparagraph
(A) or (B) against a family member or friend of the
whistleblower.
``(3) Whistleblower.--The term `whistleblower' means an
employee of the Service who discloses information that the
employee reasonably believes evidences--
``(A) a violation of any law, rule, regulation, or
Service policy; or
``(B) gross mismanagement, a gross waste of funds,
an abuse of authority, or a substantial and specific
danger to public health or safety.
``(b) Employee Accountability.--
``(1) Designated official.--The Secretary shall designate
an official in the Department who is not an employee of the
Service to receive reports under paragraph (2).
``(2) Mandatory reporting.--An employee of the Service who
witnesses retaliation against a whistleblower, a violation of a
patient safety requirement, or other similar conduct shall
submit to the official designated under paragraph (1) a report
of the conduct.
``(3) Oversight.--Not later than 3 days after the date on
which the official designated under paragraph (1) receives a
report under paragraph (2), the Secretary shall--
``(A) formally review the report; and
``(B) provide a copy of the report and any other
relevant information to the Inspector General of the
Department.
``(4) Removal for whistleblower retaliation.--
``(A) In general.--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 606 or 607, as applicable, an
employee of the Service if the Secretary determines,
after completing a review described in paragraph (3),
that the employee has retaliated against a
whistleblower and warrants removal for misconduct.
``(B) Retaliation as misconduct.--Retaliation by an
employee against a whistleblower, as described in
subparagraph (A), shall be considered to be misconduct
for purposes of sections 606 and 607.
``(5) Enhancing protections for whistleblowers.--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.''.
SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION CONGRESS.
(a) Adverse Action for Violation of Right to Petition Congress.--
Section 7211 of title 5, United States Code, is amended--
(1) by striking ``The right of'' and inserting the
following:
``(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 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.''.
(b) Electronic Notification of Right of Employees of Indian Health
Service.--
(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 provide, in accordance with paragraphs (2) through (5),
to each employee of the Indian Health Service notice of the
right to petition Congress under section 7211 of title 5,
United States Code.
(2) Memorandum.--Not later than 30 days after the date of
enactment of this Act, the Secretary shall submit to the
Inspector General of the Department of Health and Human
Services (referred to in this subsection as the ``Inspector
General'') a memorandum that includes 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 under such section
shall be subject to an adverse action described in any of
paragraphs (1) through (5) of section 7512 of title 5, United
States Code, including a suspension for more than 14 days
without pay.''.
(3) Approval or disapproval.--
(A) In general.--Not later than 30 days after the
date on which the memorandum is submitted under
paragraph (2), the Inspector General shall approve or
disapprove the memorandum.
(B) Disapproval.--If the Inspector General
disapproves the memorandum, the Inspector General shall
advise the Secretary on what changes to the memorandum
are necessary for approval.
(4) Notice.--If the memorandum is approved under paragraph
(3), not later than 30 days after the date of the approval, the
Secretary shall--
(A) provide to each employee of the Indian Health
Service an electronic copy of the approved memorandum;
and
(B) post the memorandum in a clear and conspicuous
place on the website of the Indian Health Service.
(5) Revised memorandum.--
(A) In general.--If the memorandum is disapproved
under paragraph (3), not later than 15 days after the
date of disapproval, the Secretary shall submit to the
Inspector General a revised memorandum that
incorporates the changes advised under subparagraph (B)
of that paragraph.
(B) Approval or disapproval.--Not later than 30
days after the date on which the revised memorandum is
submitted under subparagraph (A), the Inspector General
shall approve the revised memorandum.
(C) Notice.--Not later than 30 days after the date
on which a revised memorandum is approved under this
paragraph, the Secretary shall provide notice of the
memorandum in accordance with paragraph (4).
SEC. 203. FISCAL ACCOUNTABILITY.
Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661
et seq.) (as amended by section 201) is amended by adding at the end
the following:
``SEC. 610. FISCAL ACCOUNTABILITY.
``(a) Management of Funds.--
``(1) In general.--If the Secretary fails to submit a
professional housing plan under section 302(a) of the Restoring
Accountability in the Indian Health Service Act of 2022 or a
staffing plan under section 302(b) of that Act by the
applicable deadline, 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 applicable, is
submitted.
``(2) Individual described.--An individual referred to in
paragraph (1) is an individual employed in the Service--
``(A) in a position that is--
``(i) described in any of sections 5312
through 5316 of title 5, United States Code;
``(ii) placed in level IV or V of the
Executive Schedule under section 5317 of title
5, United States Code; or
``(iii) described in section 213.3301 or
213.3302 of title 5, Code of Federal
Regulations (or a successor regulation); or
``(B) as a limited term appointee, limited
emergency appointee, or noncareer appointee (as those
terms are defined in section 3132(a) of title 5, United
States Code).
``(b) Prioritization of Patient Care.--
``(1) In general.--Notwithstanding any other provision of
law, the Secretary shall use amounts available to the 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 the funds for
the costs of--
``(A) essential medical equipment;
``(B) purchased or referred care; or
``(C) staffing.
``(2) Special rule.--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,
the amounts are used to benefit Indians served by that Service
unit.
``(3) HHS plan.--Each applicable fiscal year, the
Secretary, in consultation with Indian tribes, shall establish
a plan for distributing the amounts described in paragraph (1)
across the categories of uses described in subparagraphs (A)
through (C) of that paragraph.
``(4) Restrictions.--The Secretary may not use amounts
described in paragraph (1)--
``(A) to remodel or interior decorate any Area
office; or
``(B) to increase the rate of pay of any employee
of an Area office.
``(c) Spending Reports.--Not later than 90 days after the end of
each 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--
``(1) each Indian tribe;
``(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.--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.
``(2) Updates.--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 the change.
``(e) Effect.--Nothing in this section--
``(1) negatively impacts the right of an Indian tribe to
enter into a compact or contract under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5301 et
seq.); or
``(2) applies to such a compact or contract unless
expressly agreed to by the Indian tribe.''.
TITLE III--REPORTS
SEC. 301. DEFINITIONS.
In this title:
(1) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(2) Service.--The term ``Service'' means the Indian Health
Service.
(3) Service unit.--The term ``Service unit'' has the
meaning given the term in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603).
(4) Tribal health program.--The term ``tribal health
program'' has the meaning given the term in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603).
SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND HUMAN SERVICES.
(a) IHS Professional Housing Plan.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act, 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 and
employees of tribal health programs that comports with the
practices and recommendations of the Government Accountability
Office relating to professional housing included in the most
recent report of the Government Accountability Office regarding
Indian Health Service housing needs.
(2) Requirement.--The plan under paragraph (1) shall
include, at a minimum, projections for the professional housing
needs for--
(A) the 1-year period following the date of the
plan;
(B) the 5-year period following the date of the
plan; and
(C) the 10-year period following the date of the
plan.
(b) Plan Relating to IHS Staffing Needs.--
(1) In general.--Not later than 1 year after the date on
which the Government Accountability Office releases the report
described in subsection (a), 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
staffing needs of the Service and tribal health programs that
comports with the practices and recommendations of the
Government Accountability Office relating to workforce planning
included in the report.
(2) Requirement.--The plan under paragraph (1) shall
include, at a minimum, projections for the staffing needs for--
(A) the 1-year period following the date of the
plan;
(B) the 5-year period following the date of the
plan; and
(C) the 10-year period following the date of the
plan.
SEC. 303. REPORTS BY THE COMPTROLLER GENERAL.
(a) IHS Housing Needs Report.--Not later than 2 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 that includes--
(1) an assessment of the professional housing plan;
(2) 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 and employees of
tribal health programs, including a discussion and conclusions
as to whether the existing assessments and projections
accurately reflect the professional housing needs of employees
of the Service and employees of tribal health programs; and
(3) an assessment of the professional housing needs of--
(A) employees of the Service for each Service area
(as defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)); and
(B) employees of tribal health programs for each
Indian tribe, as applicable.
(b) IHS Staffing Needs Report.--
(1) In general.--Not later than 2 years after the date on
which the Comptroller General receives the plan relating to IHS
staffing needs under section 302(b), the Comptroller General
shall prepare and submit to Congress a report on the staffing
needs of the Service and tribal health programs.
(2) Contents.--The report under paragraph (1) shall
include--
(A) an assessment of the staffing plan referred to
in paragraph (1);
(B) a description of--
(i) the number and type of full-time
positions needed at each facility of the
Service and at each tribal health program; and
(ii) the amount of funds necessary to
maintain those positions;
(C) an explanation of the various methodologies
that the Service uses and has previously used to
determine the number and type of full-time positions
needed at federally managed Service units; and
(D) an assessment of the use of independent
contractors, including--
(i) the number of independent contractors
hired to fill vacant full-time positions; and
(ii) the amount of funds spent on
independent contractors who provide health care
services.
(c) Whistleblower Protections Report.--
(1) In general.--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, including the
protections implemented pursuant to sections 201 and 202 and
the amendments made by those sections.
(2) Contents.--The report under paragraph (1) shall
include--
(A) a discussion and conclusions as to whether the
Service has taken proper steps to prevent retaliation
against whistleblowers;
(B) if applicable, any recommendations for changes
to the policy of the Service with respect to
whistleblowers; and
(C) a discussion and conclusions as to whether the
official email accounts of employees of the Service are
appropriately monitored.
SEC. 304. INSPECTOR GENERAL REPORTS.
(a) Patient Care Reports.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, and not less frequently 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--
(A) patient harm events and patient deaths
occurring in Service units;
(B) deferrals and denials of care of patients of
the Service; and
(C) the standards to improve the timeliness of
care, developed in accordance with section 412 of the
Indian Health Care Improvement Act (as added by section
115), and quality of care at Service facilities,
including quality and performance measures developed by
the Secretary in accordance with--
(i) section 306 of title 5, United States
Code;
(ii) section 1115(b) of title 31, United
States Code; and
(iii) any law (including regulations) used
in any mandatory or voluntary program of the
Centers for Medicare & Medicaid Services.
(2) Contents.--The report under paragraph (1) shall
include--
(A) 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;
(B) an evaluation of how the Service tracks,
reports, and responds to patient harm events and
patient deaths and recommendations regarding how to
improve the tracking, reporting, and response; and
(C) 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.
(b) Reporting Systems Audit.--Not later than 2 years after the date
of enactment of this Act, the Inspector General of the Department of
Health and Human Services shall--
(1) conduct an audit of reporting systems of the Service,
as of the date of enactment of this Act; and
(2) provide to the Service recommendations and technical
assistance regarding implementation of improved reporting
systems, procedures, standards, and protocols.
SEC. 305. TRANSPARENCY IN CMS 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 of participating Indian Health Service facilities 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 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.''.
TITLE IV--TECHNICAL AMENDMENTS
SEC. 401. TECHNICAL AMENDMENTS.
(a) Definitions.--Section 4 of the Indian Health Care Improvement
Act (25 U.S.C. 1603) is amended--
(1) in paragraph (5), by striking the paragraph designation
and heading and all that follows through ``means'' and
inserting the following:
``(5) Purchased/referred care.--The term `purchased/
referred care' means''; and
(2) by redesignating paragraph (5) and paragraphs (6)
through (15) as paragraph (15) and paragraphs (5) through (14),
respectively, and moving the paragraphs so as to appear in
numerical order.
(b) Technical Amendments.--The Indian Health Care Improvement Act
(25 U.S.C. 1601 et seq.) is amended--
(1) by striking ``contract health service'' each place it
appears (regardless of casing and typeface and including in the
headings) and inserting ``purchased/referred care'' (with
appropriate casing and typeface); and
(2) by striking ``contract health services'' each place it
appears (regardless of casing and typeface and including in the
headings) and inserting ``purchased/referred care'' (with
appropriate casing and typeface).
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