[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3130 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  1st Session
                                S. 3130

    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

                            October 25, 2023

 Mr. Barrasso (for himself, Mr. Thune, Ms. Lummis, Mr. Daines, and Mr. 
    Rounds) 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 2023''.

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. Enhancing quality of care in the Indian Health Service.
Sec. 111. Notification of investigation regarding professional conduct; 
                            submission of records.
Sec. 112. Medical chaperones; Office of Patient Advocacy.
Sec. 113. Fitness of health care providers.
Sec. 114. 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 2023, 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 2023, 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 2023; 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 2023; 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 2023 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 2023 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, as authorized by 
                the Service unit, offsite.
                    ``(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, and 
                credentialed 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 appropriated under 
                section 1304 of title 31, United States Code, commonly 
                known as the `Judgment Fund', shall be available for 
                transfer under subparagraph (C) for purposes of 
                carrying out this subsection, as if claims were 
                adjudicated by a United States District Court under 
                section 1346(b) of title 28, United States Code.
                    ``(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 or Tribal organization 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 and the 
                Secretary.
            ``(7) Effective dates.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), this subsection shall take effect on 
                October 1, 2024.
                    ``(B) Regulations, applications, and reports.--
                Effective on the date of the enactment of the Restoring 
                Accountability in the Indian Health Service Act of 
                2023, 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 (or an amount equal to half of 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).''.

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 senior level 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(a)) 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 2023, 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 2023, 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. 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. 111. 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. 112. 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(a)) 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. 113. 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 2023, 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. 114. 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 2023, 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 2023, 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.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.) (as amended by section 112(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 2023 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.--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 years for which the amounts are made 
        available, and that remain available, and in keeping with the 
        purpose for which the funds were appropriated, only to support 
        patient care by using the funds for--
                    ``(A) the costs of--
                            ``(i) essential medical equipment;
                            ``(ii) purchased or referred care; or
                            ``(iii) staffing; or
                    ``(B) any other costs necessary to improve or 
                maintain quality of care and patient safety.
            ``(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) Purpose.--The purpose of the report described in 
        paragraph (2) is to identify the certification and 
        accreditation status of each facility operated by the Service, 
        Indian tribes, tribal organizations, and Urban Indian 
        organizations.
            ``(2) Yearly report.--Subject to paragraph (3), 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.
            ``(3) Updates.--With respect to any change of a status 
        described in paragraph (2), 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) Purchased/referred care.--The term ``purchased/referred 
        care'' has the meaning given the term in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603) (as amended 
        by section 401(a)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) Service.--The term ``Service'' means the Indian Health 
        Service.
            (4) 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).
            (5) 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) Initial report.--Not later than 3 years after the date 
        of enactment of this Act, the Inspector General of the 
        Department of Health and Human Services shall develop and 
        submit to Congress and the Service a report on deferrals and 
        denials of care of patients by a purchased/referred care 
        program in direct service hospitals of the Service.
            (2) Subsequent report.--Not later than 3 years after the 
        date on which the Inspector General of the Department of Health 
        and Human Services submits the report required by paragraph 
        (1), the Inspector General of the Department of Health and 
        Human Services shall develop and submit to Congress and the 
        Service a report on patient harm events and patient deaths 
        relating to deferrals and denials of care in the Service.
            (3) Requirements.--The reports required under paragraphs 
        (1) and (2) shall include, as applicable--
                    (A)(i) an evaluation of the number and kind of 
                events that contribute to patient deaths as a result of 
                deferrals and denials of care by a purchased/referred 
                care program; and
                    (ii) recommendations relating to how to reduce the 
                number of patient harm events described in clause (i); 
                and
                    (B)(i) an evaluation of the tracking and reporting 
                by the Service of, and response to, patient harm events 
                and patient deaths that result from deferrals and 
                denials of care; and
                    (ii) recommendations relating to how to improve 
                that tracking, reporting, and response.
    (b) Reporting Systems Evaluation.--Not later than 3 years after the 
date of enactment of this Act, the Inspector General of the Department 
of Health and Human Services shall--
            (1) conduct an evaluation of the patient safety incident 
        reporting system of the Service required by the Indian Health 
        Care Improvement Act (25 U.S.C. 1601 et seq.), as of the date 
        of enactment of this Act; and
            (2) provide to the Service recommendations and technical 
        assistance regarding implementation of improved incident 
        reporting system, 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) With respect to each hospital described in subsection (a), 
standard surveys (whether conducted by the Secretary or by an 
accreditation organization under section 1865) to determine if such 
hospital meets the conditions of participation under section 1861(e) 
shall be conducted not later than 36 months after the date of the 
previous such survey.
    ``(2) With respect to each skilled nursing facility described in 
subsection (a), standard surveys to determine if such facility meets 
the conditions of participation under this title shall be conducted not 
later than 12 months after the date of the previous such survey.
    ``(3) 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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