II 

117TH CONGRESS 

2D SESSION S. 4915 

To amend the Indian Health Care Improvement Act to improve the recruitment and retention of employees in the Indian Health Service, restore 

accountability in the Indian Health Service, improve health services, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 21, 2022 

Mr. BARRASSO (for himself, Mr. THUNE, Ms. LUMMIS, Mr. ROUNDS, Mr. 

DAINES, and Mr. HOEVEN) introduced the following bill; which was read 

twice and referred to the Committee on Indian Affairs 

A BILL 

To amend the Indian Health Care Improvement Act to improve the recruitment and retention of employees in the 

Indian Health Service, restore accountability in the Indian Health Service, improve health services, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Restoring Account5 ability in the Indian Health Service Act of 2022’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents for this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—INDIAN HEALTH SERVICE IMPROVEMENTS 

Sec. 101. Incentives for recruitment and retention. 

Sec. 102. Medical credentialing system. 

Sec. 103. Liability protections for health professional volunteers at Indian 

Health Service. 

Sec. 104. Clarification regarding eligibility for Indian Health Service loan repayment program. 

Sec. 105. Improvements in hiring practices. 

Sec. 106. Improved authorities of secretary to improve accountability of senior 

executives and employees of the Indian Health Service. 

Sec. 107. Tribal culture and history. 

Sec. 108. Staffing demonstration program. 

Sec. 109. Rule establishing Tribal consultation policy. 

Sec. 110. Treatment of certain hospitals. 

Sec. 111. Enhancing quality of care in the Indian Health Service. 

Sec. 112. Notification of investigation regarding professional conduct; submission of records. 

Sec. 113. Medical chaperones; Office of Patient Advocacy. 

Sec. 114. Fitness of health care providers. 

Sec. 115. Standards to improve timeliness of care. 

TITLE II—EMPLOYEE PROTECTIONS 

Sec. 201. Employee protections against retaliation. 

Sec. 202. Right of Federal employees to petition Congress. 

Sec. 203. Fiscal accountability. 

TITLE III—REPORTS 

Sec. 301. Definitions. 

Sec. 302. Reports by the Secretary of Health and Human Services. 

Sec. 303. Reports by the Comptroller General. 

Sec. 304. Inspector General reports. 

Sec. 305. Transparency in CMS surveys. 

TITLE IV—TECHNICAL AMENDMENTS 

Sec. 401. Technical amendments. 

1 TITLE I—INDIAN HEALTH 

2 SERVICE IMPROVEMENTS 

3 SEC. 101. INCENTIVES FOR RECRUITMENT AND RETEN4 TION. 

5 Title I of the Indian Health Care Improvement Act 

6 (25 U.S.C. 1611 et seq.) is amended by adding at the end 

7 the following: 


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1 ‘‘SEC. 125. INCENTIVES FOR RECRUITMENT AND RETEN2 TION. 

3 ‘‘(a) PARITY IN IHS HEALTH CARE WORKFORCE

4 PERSONNEL AND PAY SYSTEM.—The Secretary shall es5 tablish a personnel and pay system for physicians, den6 tists, nurses, and other health care professionals employed 

7 by the Service that provides a personnel and pay system 

8 that, to the maximum extent practicable, is comparable 

9 to the pay provided to physicians, dentists, nurses, and 

10 other health care professionals, respectively, under sub11 chapters III and IV of chapter 74 of title 38, United 

12 States Code. 

13 ‘‘(b) HOUSING VOUCHERS.— 

14 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

15 not later than 1 year after the date of enactment of 

16 the Restoring Accountability in the Indian Health 

17 Service Act of 2022, the Secretary may establish a 

18 program to provide tenant-based rental assistance to 

19 an employee of the Service who— 

20 ‘‘(A) agrees to serve for not less than 1 

21 year at a Service unit designated by the Admin22 istrator of the Health Resources and Services 

23 Administration as a health professional short24 age area (as defined in section 332(a) of the 

25 Public Health Service Act (42 U.S.C. 254e(a))) 

26 with the greatest staffing need; and 


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1 ‘‘(B) is a critical employee, as determined 

2 by the Secretary. 

3 ‘‘(2) SUNSET.—Any program established by the 

4 Secretary under paragraph (1) shall terminate on 

5 the date that is 3 years after the date on which the 

6 program is established. 

7 ‘‘(3) REPORTS.—Not later than 1 year after the 

8 date on which a program established under para9 graph (1) is terminated in accordance with para10 graph (2), the Secretary shall submit to Congress a 

11 report describing, with respect to that program— 

12 ‘‘(A) the costs of the program; 

13 ‘‘(B) employee uptake of the program; and 

14 ‘‘(C) the effects of the program on local fa15 cility staffing needs. 

16 ‘‘(c) ADMINISTRATION.—The Secretary may only 

17 provide a benefit under subsection (b) to— 

18 ‘‘(1) a full-time employee who agrees to serve 

19 for not less than 1 year in the Service beginning on 

20 the date of the agreement; or 

21 ‘‘(2) a part-time employee who agrees to serve 

22 for not less than 2 years in the service beginning on 

23 the date of the agreement.’’. 


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1 SEC. 102. MEDICAL CREDENTIALING SYSTEM. 

2 Title I of the Indian Health Care Improvement Act 

3 (25 U.S.C. 1611 et seq.) (as amended by section 101) is 

4 amended by adding at the end the following: 

5 ‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 

6 ‘‘(a) IN GENERAL.— 

7 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION

8 TIMELINE.—Not later than 1 year after the date of 

9 enactment of the Restoring Accountability in the In10 dian Health Service Act of 2022, the Secretary, act11 ing through the Service (referred to in this section 

12 as the ‘Secretary’), in accordance with subsection 

13 (b), shall develop and implement a Service-wide cen14 tralized credentialing system (referred to in this sec15 tion as the ‘credentialing system’) to credential li16 censed health professionals who seek to provide 

17 health care services at any Service unit. 

18 ‘‘(2) IMPLEMENTATION.—In implementing the 

19 credentialing system, the Secretary— 

20 ‘‘(A) shall not require re-credentialing of 

21 licensed health professionals who were 

22 credentialed using existing Service policy prior 

23 to the date of enactment of the Restoring Ac24 countability in the Indian Health Service Act of 

25 2022; and 

26 ‘‘(B) shall— 


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1 ‘‘(i) use the credentialing system 

2 for— 

3 ‘‘(I) all applications for 

4 credentialing or re-credentialing of li5 censed health professionals submitted 

6 on or after the date of enactment of 

7 the Restoring Accountability in the 

8 Indian Health Service Act of 2022; 

9 and 

10 ‘‘(II) the migration into the 

11 credentialing system of credentials 

12 data that existed prior to implementa13 tion of the credentialing system; and 

14 ‘‘(ii) maintain the established timeline 

15 for re-credentialing of licensed health pro16 fessionals who were credentialed prior to 

17 implementation of the credentialing sys18 tem, as defined by Service policy. 

19 ‘‘(b) REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—In developing the 

21 credentialing system under subsection (a), the Sec22 retary shall ensure that— 

23 ‘‘(A) credentialing procedures shall be uni24 form throughout the Service; and 


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1 ‘‘(B) with respect to each licensed health 

2 professional who successfully completes the 

3 credentialing procedures of the credentialing 

4 system, the Secretary may authorize the li5 censed health professional to provide health 

6 care services at any Service unit. 

7 ‘‘(2) EXEMPTION.—The requirements described 

8 in paragraph (1) shall not apply to licensed health 

9 professionals who were credentialed using existing 

10 Service policy prior to the date of enactment of the 

11 Restoring Accountability in the Indian Health Serv12 ice Act of 2022 until the date on which those li13 censed health professionals are required to be re14 credentialed in accordance with the credentialing 

15 system developed and implemented under subsection 

16 (a). 

17 ‘‘(c) CONSULTATION.—In developing the 

18 credentialing system under subsection (a), the Secretary— 

19 ‘‘(1) shall consult with Indian tribes; and 

20 ‘‘(2) may consult with— 

21 ‘‘(A) any public or private association of 

22 medical providers; 

23 ‘‘(B) any government agency; or 

24 ‘‘(C) any other relevant expert, as deter25 mined by the Secretary. 


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1 ‘‘(d) APPLICATION.— 

2 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

3 licensed health care professional may not provide 

4 health care services at any Service unit, unless the 

5 licensed health care professional successfully com6 pletes the credentialing procedures of the 

7 credentialing system developed and implemented 

8 under subsection (a). 

9 ‘‘(2) EXEMPTION.—Paragraph (1) shall not 

10 apply to licensed health professionals who were 

11 credentialed using existing Service policy prior to the 

12 date of enactment of the Restoring Accountability in 

13 the Indian Health Service Act of 2022 until the date 

14 on which those licensed health professionals are re15 quired to be re-credentialed in accordance with the 

16 credentialing system developed and implemented 

17 under subsection (a). 

18 ‘‘(e) NONDUPLICATION OF EFFORTS.— 

19 ‘‘(1) IN GENERAL.—To the extent that prior to 

20 the deadline described in subsection (a)(1), the Serv21 ice has begun implementing or has completed imple22 mentation of a medical credentialing system that 

23 otherwise meets the requirements of this section, the 

24 Service shall not be required to establish a new 

25 credentialing system under this section. 


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1 ‘‘(2) AUTHORITY.—The Service may expand or 

2 enhance an existing credentialing system to meet the 

3 requirements of this section. 

4 ‘‘(3) REVIEW.— 

5 ‘‘(A) IN GENERAL.—Not less frequently 

6 than once every 5 years, the Service shall— 

7 ‘‘(i) undertake a formal review of the 

8 credentialing system in effect on the date 

9 of the review; and 

10 ‘‘(ii) if necessary, take action to bring 

11 the credentialing system into compliance 

12 with the requirements of this section. 

13 ‘‘(B) CONSULTATION.—Each formal review 

14 conducted under subparagraph (A) shall be sub15 ject to the consultation requirements under sub16 section (c). 

17 ‘‘(f) EFFECT.—Nothing in this section— 

18 ‘‘(1) negatively impacts the right of an Indian 

19 tribe to enter into a compact or contract under the 

20 Indian Self-Determination and Education Assistance 

21 Act (25 U.S.C. 5301 et seq.); or 

22 ‘‘(2) applies to such a compact or contract un23 less expressly agreed to by the Indian tribe.’’. 


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1 SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFES2 SIONAL VOLUNTEERS AT INDIAN HEALTH 

3 SERVICE. 

4 Section 224 of the Public Health Service Act (42 

5 U.S.C. 233) is amended by adding at the end the fol6 lowing: 

7 ‘‘(r) CERTAIN INDIAN HEALTH SERVICE VOLUN8 TEERS DEEMED PUBLIC HEALTH SERVICE EMPLOY9 EES.— 

10 ‘‘(1) IN GENERAL.—For purposes of this sec11 tion, a health professional volunteer at a Service 

12 unit shall, in providing a health service to an indi13 vidual, be deemed to be an employee of the Public 

14 Health Service for a calendar year that begins dur15 ing a fiscal year for which a transfer was made 

16 under paragraph (4)(C). The preceding sentence is 

17 subject to the provisions of this subsection. 

18 ‘‘(2) CONDITIONS.—In providing a health serv19 ice to an individual, a health care practitioner shall, 

20 for purposes of this subsection, be considered to be 

21 a health professional volunteer at a Service unit if 

22 all of the following conditions are met: 

23 ‘‘(A) The service is provided to the indi24 vidual at the facilities of a Service unit, or 

25 through offsite programs or events carried out 

26 by the Service unit. 


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1 ‘‘(B) The Service unit is sponsoring the 

2 health care practitioner pursuant to paragraph 

3 (3)(C). 

4 ‘‘(C) The health care practitioner does not 

5 receive any compensation for the service from 

6 the individual, the Service unit, or any third7 party payer (including reimbursement under 

8 any insurance policy or health plan, or under 

9 any Federal or State health benefits program), 

10 except that the health care practitioner may re11 ceive repayment from the Service unit for rea12 sonable expenses incurred by the health care 

13 practitioner in the provision of the service to 

14 the individual. 

15 ‘‘(D) Before the service is provided, the 

16 health care practitioner or the Service unit 

17 posts a clear and conspicuous notice at the site 

18 where the service is provided of the extent to 

19 which the legal liability of the health care prac20 titioner is limited under this subsection. 

21 ‘‘(E) At the time the service is provided, 

22 the health care practitioner is licensed, certified, 

23 credentialed, and privileged in accordance with 

24 Service policy and applicable law regarding the 

25 provision of the service. 


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1 ‘‘(3) APPLICABILITY.—Subsection (g) (other 

2 than paragraphs (3) and (5)) and subsections (h), 

3 (i), and (l) apply to a health care practitioner at a 

4 Service unit for purposes of this subsection to the 

5 same extent and in the same manner as such sub6 sections apply to an officer, governing board mem7 ber, employee, or contractor of an entity described in 

8 subsection (g)(4), subject to paragraph (4) and sub9 ject to the following subparagraphs: 

10 ‘‘(A) Each reference to an entity in sub11 sections (g), (h), (i), and (l) shall be considered 

12 to be a reference to a Service unit. 

13 ‘‘(B) The first sentence of paragraph (1) 

14 applies in lieu of the first sentence of subsection 

15 (g)(1)(A). 

16 ‘‘(C) With respect to a Service unit, a 

17 health care practitioner is not a health profes18 sional volunteer at the Service unit unless the 

19 Service unit sponsors the health care practi20 tioner. For purposes of this subsection, the 

21 Service unit shall be considered to be spon22 soring the health care practitioner if— 

23 ‘‘(i) with respect to the health care 

24 practitioner, the Service unit submits to 


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1 the Secretary an application meeting the 

2 requirements of subsection (g)(1)(D); and 

3 ‘‘(ii) the Secretary, pursuant to sub4 section (g)(1)(E), determines that the 

5 health care practitioner is deemed to be an 

6 employee of the Public Health Service. 

7 ‘‘(D) In the case of a health care practi8 tioner who is determined by the Secretary pur9 suant to this subsection and subsection 

10 (g)(1)(E) to be a health professional volunteer, 

11 this subsection applies to the health care practi12 tioner (with respect to services performed on 

13 behalf of the Service unit sponsoring the health 

14 care practitioner pursuant to subparagraph (C)) 

15 for any cause of action arising from an act or 

16 omission of the health care practitioner occur17 ring on or after the date on which the Secretary 

18 makes that determination. 

19 ‘‘(E) Subsection (g)(1)(F) applies to a 

20 health care practitioner for purposes of this 

21 subsection only to the extent that, in providing 

22 health services to an individual, each of the con23 ditions described in paragraph (2) is met. 

24 ‘‘(4) FUNDING.— 


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1 ‘‘(A) IN GENERAL.—Amounts in the fund 

2 established under subsection (k)(2) shall be 

3 available for transfer under subparagraph (C) 

4 for purposes of carrying out this subsection. 

5 ‘‘(B) ANNUAL ESTIMATES.— 

6 ‘‘(i) IN GENERAL.—Not later than 

7 May 1 of each fiscal year, the Attorney 

8 General, in consultation with the Sec9 retary, shall submit to Congress a report 

10 providing an estimate of the amount of 

11 claims (together with related fees and ex12 penses of witnesses) that, by reason of the 

13 acts or omissions of health professional 

14 volunteers, will be paid pursuant to this 

15 section during the calendar year that be16 gins in the following fiscal year. 

17 ‘‘(ii) APPLICABILITY.—Subsection 

18 (k)(1)(B) applies to the estimate under 

19 clause (i) relating to health professional 

20 volunteers to the same extent and in the 

21 same manner as that subsection applies to 

22 the estimate under that subsection relating 

23 to officers, governing board members, em24 ployees, and contractors of entities de25 scribed in subsection (g)(4). 


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1 ‘‘(C) TRANSFERS.—Not later than Decem2 ber 31 of each fiscal year, the Secretary shall 

3 transfer from the fund under subsection (k)(2) 

4 to the appropriate accounts in the Treasury an 

5 amount equal to the estimate made under sub6 paragraph (B) for the calendar year beginning 

7 in that fiscal year, subject to the extent of 

8 amounts in the fund. 

9 ‘‘(5) DEFINITION OF SERVICE UNIT.— 

10 ‘‘(A) IN GENERAL.—In this subsection, the 

11 term ‘Service unit’ has the meaning given the 

12 term in section 4 of the Indian Health Care Im13 provement Act (25 U.S.C. 1603). 

14 ‘‘(B) INCLUSION.—In this subsection, the 

15 term ‘Service unit’ includes an urban Indian or16 ganization with which the Indian Health Serv17 ice has entered into a contract with, or to which 

18 the Indian Health Service has made a grant, 

19 under title V of the Indian Health Care Im20 provement Act (25 U.S.C. 1651 et seq.). 

21 ‘‘(6) EFFECT.—Nothing in this subsection— 

22 ‘‘(A) negatively impacts the right of an In23 dian tribe to enter into a compact or contract 

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1 cation Assistance Act (25 U.S.C. 5304 et seq.); 

2 or 

3 ‘‘(B) applies to such a compact or contract 

4 unless expressly agreed to by the Indian tribe. 

5 ‘‘(7) EFFECTIVE DATES.— 

6 ‘‘(A) IN GENERAL.—Except as provided in 

7 subparagraph (B), this subsection shall take ef8 fect on October 1, 2022. 

9 ‘‘(B) REGULATIONS, APPLICATIONS, AND

10 REPORTS.—Effective on the date of the enact11 ment of the Restoring Accountability in the In12 dian Health Service Act of 2022, the Secretary 

13 may— 

14 ‘‘(i) prescribe regulations for carrying 

15 out this subsection; and 

16 ‘‘(ii) accept and consider applications 

17 submitted under paragraph (3)(C)(i).’’. 

18 SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR IN19 DIAN HEALTH SERVICE LOAN REPAYMENT 

20 PROGRAM. 

21 Section 108 of the Indian Health Care Improvement 

22 Act (25 U.S.C. 1616a) is amended— 

23 (1) in subsection (b)(1), by striking subpara24 graph (B) and inserting the following: 

25 ‘‘(B) have— 


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1 ‘‘(i)(I) a degree in a health profession; and 

2 ‘‘(II) a license to practice a health profes3 sion in a State; or 

4 ‘‘(ii)(I) a master’s degree in business ad5 ministration with an emphasis in health care 

6 management (as defined by the Secretary), 

7 health administration, hospital administration, 

8 or public health; and 

9 ‘‘(II) a license or certification to practice 

10 in the field of business administration, health 

11 administration, hospital administration, or pub12 lic health in a State, if the Secretary deter13 mines the license or certification is necessary 

14 for the Indian health program to which the in15 dividual will be assigned;’’; 

16 (2) in subsection (f)(1)(B), by striking clause 

17 (iii) and inserting the following: 

18 ‘‘(iii) to serve for a time period (re19 ferred to in this section as the ‘period of 

20 obligated service’) equal to— 

21 ‘‘(I) 2 years or such longer pe22 riod as the individual may agree to 

23 serve in the full-time practice of the 

24 individual’s profession in an Indian 

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1 vidual may be assigned by the Sec2 retary; or 

3 ‘‘(II) 4 years or such longer pe4 riod as the individual may agree to 

5 serve in the half-time practice of the 

6 individual’s profession in an Indian 

7 health program to which the indi8 vidual may be assigned by the Sec9 retary;’’; and 

10 (3) in subsection (g)(2)— 

11 (A) in subparagraph (B), by striking ‘‘(B) 

12 Any arrangement’’ and inserting the following: 

13 ‘‘(C) DEADLINE FOR REPAYMENTS.—Any 

14 arrangement’’; 

15 (B) subparagraph (A), in the second sen16 tence of the matter preceding clause (i), by 

17 striking ‘‘In making a determination’’ and in18 serting the following: 

19 ‘‘(B) DETERMINATION OF AMOUNT OF

20 PAYMENT.—In making a determination under 

21 this paragraph’’; and 

22 (C) by striking ‘‘(2)(A) For each year’’ 

23 and all that follows through ‘‘paragraph (1).’’ 

24 and inserting the following: 

25 ‘‘(2) AUTHORIZED PAYMENTS.— 


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1 ‘‘(A) AMOUNT OF PAYMENT.— 

2 ‘‘(i) FULL-TIME PRACTICE.—In the 

3 case of an individual who contracts to 

4 serve a period of obligated service under 

5 subsection (f)(1)(B)(iii)(I), for each year of 

6 the obligated service, the Secretary may 

7 pay up to $35,000 (or an amount equal to 

8 the amount specified in section 

9 338B(g)(2)(A) of the Public Health Serv10 ice Act (42 U.S.C. 254l–1(g)(2)(A))) on 

11 behalf of the individual for loans described 

12 in paragraph (1). 

13 ‘‘(ii) HALF-TIME.—In the case of an 

14 individual who contracts to serve a period 

15 of obligated service under subsection 

16 (f)(1)(B)(iii)(II), for each year of such ob17 ligated service, the Secretary may pay up 

18 to $17,500 on behalf of the individual for 

19 loans described in paragraph (1).’’. 

20 SEC. 105. IMPROVEMENTS IN HIRING PRACTICES. 

21 (a) IN GENERAL.—Title VI of the Indian Health 

22 Care Improvement Act (25 U.S.C. 1661 et seq.) is amend23 ed by adding at the end the following: 


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1 ‘‘SEC. 605. IMPROVEMENTS IN HIRING PRACTICES. 

2 ‘‘(a) DIRECT HIRE AUTHORITY.—The Secretary may 

3 appoint, without regard to subchapter I of chapter 33 of 

4 title 5, United States Code (other than sections 3303 and 

5 3328 of that title), a candidate directly to a position with6 in the Service for which the candidate meets the qualifica7 tions standard established by the Office of Personnel Man8 agement. 

9 ‘‘(b) TRIBAL NOTIFICATION.— 

10 ‘‘(1) IN GENERAL.—Before appointing, hiring, 

11 promoting, transferring, or reassigning a candidate 

12 to a Senior Executive Service position or the position 

13 of a manager at an Area office or Service unit, the 

14 Secretary shall provide notice to each Indian tribe 

15 located within the defined geographic area of the 

16 Area office or Service unit, as applicable, of the con17 tent of an inclusion in an employment record. 

18 ‘‘(2) COMMENT PERIOD.—Each Indian tribe 

19 that receives notification under paragraph (1) may 

20 submit to the Secretary comments during the 10-day 

21 period after the date of notification.’’. 

22 (b) IHS WAIVERS.—Section 2(c) of Public Law 96– 

23 135 (25 U.S.C. 5117(c)) is amended— 

24 (1) in paragraph (2)— 

25 (A) by striking ‘‘(2) The provisions’’ and 

26 inserting the following: 


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1 ‘‘(2) APPLICATION TO CERTAIN INDIVIDUALS.— 

2 The provisions’’; 

3 (B) by inserting ‘‘or (3)’’ after ‘‘paragraph 

4 (1)’’; and 

5 (C) by striking ‘‘section 1131(f) of the 

6 Education Amendments of 1978 (25 U.S.C. 

7 2011(f); 92 Stat. 2324)’’ and inserting ‘‘section 

8 1132(f) of the Education Amendments of 1978 

9 (25 U.S.C. 2012(f))’’; 

10 (2) by striking ‘‘(c)(1) Notwithstanding’’ and 

11 inserting the following: 

12 ‘‘(c) WAIVER OF APPLICABILITY IN PERSONNEL AC13 TIONS.— 

14 ‘‘(1) IN GENERAL.—Notwithstanding’’; and 

15 (3) by adding at the end the following: 

16 ‘‘(3) IHS WAIVERS.— 

17 ‘‘(A) IN GENERAL.—At the request of a 

18 concerned Indian tribe, the Secretary of Health 

19 and Human Services may seek from each In20 dian tribe concerned a waiver of Indian pref21 erence laws for a personnel action that is with 

22 respect to— 

23 ‘‘(i) a Service unit (as defined in sec24 tion 4 of the Indian Health Care Improve25 ment Act (25 U.S.C. 1603)) in which— 


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1 ‘‘(I) 15 percent or greater of the 

2 total positions are not filled by a full3 time employee of the Indian Health 

4 Service for a period of 6 months or 

5 longer; or 

6 ‘‘(II) 15 percent or greater of a 

7 specific health professional position 

8 are not filled by a full-time employee 

9 of the Indian Health Service for a pe10 riod of 6 months or longer; or 

11 ‘‘(ii) a former employee of the Indian 

12 Health Service, or a former Tribal em13 ployee, who was removed from the employ14 ment during, or demoted for performance 

15 or misconduct that occurred during, the 5- 

16 year period following the date of the per17 sonnel action. 

18 ‘‘(B) LIMITATION.—A waiver may only be 

19 requested under subparagraph (A) for a per20 sonnel action that is with respect to an em21 ployee described in clause (ii) of that subpara22 graph if the reason for the removal or demotion 

23 of the employee did not result from an action 

24 undertaken by the employee that was reported 

25 to the National Practitioner Data Bank. 


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1 ‘‘(C) RESTRICTION.—The Secretary of 

2 Health and Human Services may only approve 

3 a waiver under subparagraph (A) if the waiver 

4 is first requested by a concerned Indian tribe.’’. 

5 SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IM6 PROVE ACCOUNTABILITY OF SENIOR EXECU7 TIVES AND EMPLOYEES OF THE INDIAN 

8 HEALTH SERVICE. 

9 (a) IN GENERAL.—Title VI of the Indian Health 

10 Care Improvement Act (25 U.S.C. 1661 et seq.) (as 

11 amended by section 105) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM14 PROVE ACCOUNTABILITY OF SENIOR EXECU15 TIVES OF THE INDIAN HEALTH SERVICE. 

16 ‘‘(a) DEFINITIONS.—In this section: 

17 ‘‘(1) COVERED INDIVIDUAL.—The term ‘cov18 ered individual’ means a career appointee (as de19 fined in section 3132(a) of title 5, United States 

20 Code). 

21 ‘‘(2) MISCONDUCT.—The term ‘misconduct’ in22 cludes— 

23 ‘‘(A) neglect of duty; 

24 ‘‘(B) malfeasance; 


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1 ‘‘(C) failure to accept a directed reassign2 ment; and 

3 ‘‘(D) failure to accompany a position in a 

4 transfer of function. 

5 ‘‘(3) SECRETARY.—The term ‘Secretary’ means 

6 the Secretary, acting through the Service. 

7 ‘‘(4) SENIOR EXECUTIVE POSITION.—The term 

8 ‘senior executive position’ means a Senior Executive 

9 Service position (as defined in section 3132(a) of 

10 title 5, United States Code). 

11 ‘‘(b) AUTHORITY.— 

12 ‘‘(1) IN GENERAL.—The Secretary may, in ac13 cordance with this section, reprimand, suspend, in14 voluntarily reassign, demote, or remove a covered in15 dividual from a senior executive position at the Serv16 ice if the Secretary determines that the misconduct 

17 or performance of the covered individual warrants 

18 such an action. 

19 ‘‘(2) REMOVAL FROM CIVIL SERVICE.—If the 

20 Secretary removes a covered individual pursuant to 

21 paragraph (1), the Secretary may remove the indi22 vidual from the civil service (as defined in section 

23 2101 of title 5, United States Code). 

24 ‘‘(c) RIGHTS AND PROCEDURES.— 


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1 ‘‘(1) IN GENERAL.—A covered individual who is 

2 the subject of an action or removal, as applicable, 

3 under subsection (b) is entitled— 

4 ‘‘(A) to advance notice of the action or re5 moval; 

6 ‘‘(B) to access a file containing all evidence 

7 in support of the proposed action or removal; 

8 ‘‘(C) to be represented by an attorney or 

9 other representative of the covered individual’s 

10 choice; and 

11 ‘‘(D) to grieve the decision on the action or 

12 removal under paragraph (2) in accordance 

13 with the internal grievance process established 

14 by the Secretary under paragraph (3). 

15 ‘‘(2) NOTICE; RESPONSE; DECISION.— 

16 ‘‘(A) IN GENERAL.—The aggregate period 

17 for notice, response, and decision on an action 

18 or removal under subsection (b) may not exceed 

19 15 business days. 

20 ‘‘(B) RESPONSE.—A covered individual re21 ceiving a notice under paragraph (1)(A) of an 

22 action or removal, as applicable, under sub23 section (b) shall have not more than 7 business 

24 days to respond to the notice. 

25 ‘‘(C) DECISION.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall issue a decision on an action or re3 moval, as applicable, under subsection (b) 

4 not later than 15 business days after the 

5 date on which notice of the action or re6 moval, as applicable, is received by the ap7 plicable covered individual under para8 graph (1)(A). 

9 ‘‘(ii) REQUIREMENTS.—A decision 

10 under clause (i)— 

11 ‘‘(I) shall be in writing; and 

12 ‘‘(II) shall include the specific 

13 reasons for the decision. 

14 ‘‘(D) FINAL AND CONCLUSIVE DECISION.— 

15 A decision under this paragraph that is not 

16 grieved under paragraph (3) by the deadline de17 scribed in that paragraph shall be final and 

18 conclusive. 

19 ‘‘(3) GRIEVANCE PROCESS.— 

20 ‘‘(A) IN GENERAL.—The Secretary shall 

21 establish an internal grievance process under 

22 which a covered individual may grieve a deci23 sion issued under paragraph (2) not later than 

24 the date that is 7 business days after the date 


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1 on which the decision under that paragraph was 

2 issued. 

3 ‘‘(B) TOTAL PERIOD.—The Secretary shall 

4 issue a decision for which an internal grievance 

5 process is initiated under subparagraph (A) not 

6 later than 21 business days after the date on 

7 which the grievance process is initiated by the 

8 covered individual. 

9 ‘‘(C) FINAL AND CONCLUSIVE DECISION.— 

10 A grievance decision under this paragraph shall 

11 be final and conclusive. 

12 ‘‘(4) JUDICIAL REVIEW.—A covered individual 

13 adversely affected by a decision under paragraph (2) 

14 that is not grieved, or by a grievance decision under 

15 paragraph (3), may obtain judicial review of the de16 cision. 

17 ‘‘(5) COURT REVIEW.—In any case in which ju18 dicial review is sought under paragraph (4), the 

19 court shall review the record and may set aside any 

20 action of the Department or the Service found to 

21 be— 

22 ‘‘(A) arbitrary, capricious, an abuse of dis23 cretion, or otherwise not in accordance with a 

24 provision of law; 


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1 ‘‘(B) obtained without procedures required 

2 by a provision of law having been followed; or 

3 ‘‘(C) unsupported by substantial evidence. 

4 ‘‘(d) RELATION TO OTHER PROVISIONS OF LAW.— 

5 Section 3592(b)(1) of title 5, United States Code, shall 

6 not apply to an action under subsection (b). 

7 ‘‘SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IM8 PROVE ACCOUNTABILITY OF EMPLOYEES OF 

9 THE INDIAN HEALTH SERVICE. 

10 ‘‘(a) DEFINITIONS.—In this section: 

11 ‘‘(1) COVERED INDIVIDUAL.— 

12 ‘‘(A) IN GENERAL.—The term ‘covered in13 dividual’ means an individual occupying a posi14 tion at the Service. 

15 ‘‘(B) EXCLUSIONS.—The term ‘covered in16 dividual’ does not include— 

17 ‘‘(i) an individual occupying a senior 

18 executive position (as defined in section 

19 606(a)); 

20 ‘‘(ii) an individual who has not com21 pleted a probationary or trial period; or 

22 ‘‘(iii) a political appointee. 

23 ‘‘(2) GRADE.—The term ‘grade’ has the mean24 ing given the term in section 7511(a) of title 5, 

25 United States Code. 


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1 ‘‘(3) MISCONDUCT.—The term ‘misconduct’ in2 cludes— 

3 ‘‘(A) neglect of duty; 

4 ‘‘(B) malfeasance; 

5 ‘‘(C) failure to accept a directed reassign6 ment; and 

7 ‘‘(D) failure to accompany a position in a 

8 transfer of function. 

9 ‘‘(4) POLITICAL APPOINTEE.—The term ‘polit10 ical appointee’ means an individual who is— 

11 ‘‘(A) employed in a position described in 

12 any of sections 5312 through 5316 of title 5, 

13 United States Code (relating to the Executive 

14 Schedule); 

15 ‘‘(B) a limited term appointee, limited 

16 emergency appointee, or noncareer appointee 

17 (as those terms are defined in section 3132(a) 

18 of title 5, United States Code); or 

19 ‘‘(C) employed in a position of a confiden20 tial or policy-determining character under 

21 schedule C of subpart C of part 213 of title 5, 

22 Code of Federal Regulations (or a successor 

23 regulation). 

24 ‘‘(5) SECRETARY.—The term ‘Secretary’ means 

25 the Secretary, acting through the Service. 


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1 ‘‘(6) SUSPEND.—The term ‘suspend’ means the 

2 placing of an employee, for disciplinary reasons, in 

3 a temporary status without duties and pay for a pe4 riod in excess of 14 days. 

5 ‘‘(b) AUTHORITY.— 

6 ‘‘(1) IN GENERAL.—The Secretary may, in ac7 cordance with this section, remove, demote, or sus8 pend a covered individual from employment at the 

9 Service if the Secretary determines that the perform10 ance or misconduct of the covered individual war11 rants such an action. 

12 ‘‘(2) ACTIONS.—If the Secretary removes, de13 motes, or suspends a covered individual pursuant to 

14 paragraph (1), the Secretary may— 

15 ‘‘(A) remove the covered individual from 

16 the civil service (as defined in section 2101 of 

17 title 5, United States Code); 

18 ‘‘(B) demote the covered individual by 

19 means of— 

20 ‘‘(i) a reduction in grade for which the 

21 covered individual is qualified, as the Sec22 retary determines appropriate; and 

23 ‘‘(ii) a reduction of the annual rate of 

24 pay of the covered individual; or 


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1 ‘‘(C) suspend the covered individual from 

2 the civil service (as defined in section 2101 of 

3 title 5, United States Code). 

4 ‘‘(c) PAY OF CERTAIN DEMOTED INDIVIDUALS.— 

5 ‘‘(1) IN GENERAL.—Notwithstanding any other 

6 provision of law, any covered individual subject to a 

7 demotion by means of a reduction in grade under 

8 subsection (b)(2)(B) shall, beginning on the date of 

9 the demotion, receive the annual rate of pay applica10 ble to the reduced grade. 

11 ‘‘(2) RESTRICTIONS.— 

12 ‘‘(A) PROHIBITION ON ADMINISTRATIVE

13 LEAVE.—A covered individual subject to a de14 motion under subsection (b)(2)(B)— 

15 ‘‘(i) may not be placed on administra16 tive leave during the period during which 

17 an appeal (if any) under this section is on18 going; and 

19 ‘‘(ii) may only receive pay if the cov20 ered individual reports for duty or is ap21 proved to use accrued unused annual, sick, 

22 family medical, military, or court leave. 

23 ‘‘(B) RESTRICTION ON PAY AND BENE24 FITS.—If a covered individual subject to a de25 motion under subsection (b)(2)(B) does not reVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 port for duty (and has not received approval to 

2 use accrued unused leave under subparagraph 

3 (A)(ii)), the covered individual shall not receive 

4 pay or other benefits pursuant to subsection 

5 (e)(7). 

6 ‘‘(d) RIGHTS AND PROCEDURES.— 

7 ‘‘(1) IN GENERAL.—A covered individual who is 

8 the subject of an action or removal, as applicable, 

9 under subsection (b) is entitled— 

10 ‘‘(A) to advance notice of the action or re11 moval; 

12 ‘‘(B) to access a file containing all evidence 

13 in support of the proposed action or removal; 

14 ‘‘(C) to be represented by an attorney or 

15 other representative of the covered individual’s 

16 choice; and 

17 ‘‘(D) to grieve the decision on the action or 

18 removal under paragraph (2) in accordance 

19 with the internal grievance process established 

20 by the Secretary under paragraph (3). 

21 ‘‘(2) NOTICE; RESPONSE; DECISION.— 

22 ‘‘(A) AGGREGATE PERIOD.—The aggregate 

23 period for notice, response, and a final decision 

24 on an action under subsection (b) may not ex25 ceed 15 business days. 


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1 ‘‘(B) RESPONSE.—A covered individual re2 ceiving a notice under paragraph (1)(A) of an 

3 action or removal under subsection (b) shall 

4 have not more than 7 business days to respond 

5 to the notice. 

6 ‘‘(C) FINAL AND CONCLUSIVE DECISION.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall issue a final and conclusive decision 

9 on an action or removal under subsection 

10 (b) not later than 15 business days after 

11 the date on which the notice of the action 

12 is received by the applicable covered indi13 vidual under paragraph (1)(A). 

14 ‘‘(ii) REQUIREMENTS.—A decision 

15 under clause (i)— 

16 ‘‘(I) shall be in writing; and 

17 ‘‘(II) shall include the specific 

18 reasons for the decision. 

19 ‘‘(3) GRIEVANCE PROCESS.— 

20 ‘‘(A) IN GENERAL.—The Secretary shall 

21 establish an internal grievance process under 

22 which a covered individual may grieve a deci23 sion issued under paragraph (2) not later than 

24 the date that is 7 business days after the date 


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1 on which the decision under that paragraph was 

2 issued. 

3 ‘‘(B) TOTAL PERIOD.—The Secretary shall 

4 issue a decision for which an internal grievance 

5 process is initiated under subparagraph (A) not 

6 later than 21 business days after the date on 

7 which the grievance process is initiated by the 

8 covered individual. 

9 ‘‘(C) FINAL AND CONCLUSIVE DECISION.— 

10 A grievance decision under this paragraph shall 

11 be final and conclusive. 

12 ‘‘(4) PROCEDURES SUPERSEDING CBAS.—The 

13 procedures under this subsection shall supersede any 

14 collective bargaining agreement to the extent that 

15 such an agreement is inconsistent with the proce16 dures. 

17 ‘‘(5) PERFORMANCE APPRAISAL.—The proce18 dures under chapter 43 of title 5, United States 

19 Code, shall not apply to an action under subsection 

20 (b). 

21 ‘‘(6) APPEAL TO MERIT SYSTEMS PROTECTION

22 BOARD.— 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graph (B) and subsection (e), any removal, de25 motion, or suspension of more than 14 days 


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1 under subsection (b) may be appealed to the 

2 Merit Systems Protection Board, which shall 

3 refer such appeal to an administrative law 

4 judge pursuant to section 7701(b)(1) of title 5, 

5 United States Code. 

6 ‘‘(B) TIME PERIOD.—An appeal under 

7 subparagraph (A) of a removal, demotion, or 

8 suspension may only be made if the appeal is 

9 made not later than 10 business days after the 

10 date of the removal, demotion, or suspension. 

11 ‘‘(e) EXPEDITED REVIEW.— 

12 ‘‘(1) IN GENERAL.—On receipt of an appeal 

13 under subsection (d)(6)(A), the applicable adminis14 trative law judge shall— 

15 ‘‘(A) expedite the appeal under section 

16 7701(b)(1) of title 5, United States Code; and 

17 ‘‘(B) issue a final and complete decision on 

18 the appeal not later than 180 days after the 

19 date of the appeal. 

20 ‘‘(2) UPHOLDING DECISION.— 

21 ‘‘(A) IN GENERAL.—Notwithstanding sec22 tion 7701(c)(1)(B) of title 5, United States 

23 Code, the administrative law judge shall uphold 

24 the decision of the Secretary to remove, demote, 

25 or suspend an employee under subsection (b) if 


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1 the decision is supported by substantial evi2 dence. 

3 ‘‘(B) PROHIBITION OF MITIGATION.—Not4 withstanding title 5, United States Code, or any 

5 other provision of law, if the decision of the 

6 Secretary to remove, demote, or suspend an em7 ployee under subsection (b) is supported by 

8 substantial evidence, the administrative law 

9 judge shall not mitigate the penalty prescribed 

10 by the Secretary. 

11 ‘‘(3) APPEAL TO MERIT SYSTEMS PROTECTION

12 BOARD.— 

13 ‘‘(A) IN GENERAL.—The decision of the 

14 administrative law judge under paragraph (1) 

15 may be appealed to the Merit Systems Protec16 tion Board. 

17 ‘‘(B) UPHOLDING DECISION.—Notwith18 standing section 7701(c)(1)(B) of title 5, 

19 United States Code, the Merit Systems Protec20 tion Board shall uphold the decision of the Sec21 retary to remove, demote, or suspend an em22 ployee under subsection (b) if the decision is 

23 supported by substantial evidence. 

24 ‘‘(C) PROHIBITION OF MITIGATION.—Not25 withstanding title 5, United States Code, or any 


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1 other provision of law, if the decision of the 

2 Secretary is supported by substantial evidence, 

3 the Merit Systems Protection Board shall not 

4 mitigate the penalty prescribed by the Sec5 retary. 

6 ‘‘(4) REPORT.—In any case in which an admin7 istrative law judge cannot issue a final and complete 

8 decision by the deadline described in paragraph 

9 (1)(B), the Merit Systems Protection Board shall, 

10 not later than 14 business days after the deadline 

11 expires, submit to the appropriate committees of 

12 Congress a report that explains the reasons why a 

13 decision was not issued by the deadline. 

14 ‘‘(5) APPEAL.—A decision of the Merit Systems 

15 Protection Board under paragraph (3) may be ap16 pealed to the United States Court of Appeals for the 

17 Federal Circuit pursuant to section 7703 of title 5, 

18 United States Code, or to any court of appeals of 

19 competent jurisdiction pursuant to subsection 

20 (b)(1)(B) of that section. 

21 ‘‘(6) PROHIBITION AGAINST STAYS.—The Merit 

22 Systems Protection Board may not stay any removal 

23 or demotion under subsection (b), except as provided 

24 in section 1214(b) of title 5, United States Code. 


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1 ‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR2 ING APPEAL.— 

3 ‘‘(A) IN GENERAL.— 

4 ‘‘(i) RESTRICTION ON PAY AND BENE5 FITS.—During the period described in 

6 clause (ii), a covered individual may not re7 ceive any pay and benefits described in 

8 subparagraph (B). 

9 ‘‘(ii) PERIOD DESCRIBED.—The pe10 riod referred to in clause (i) is the pe11 riod— 

12 ‘‘(I) beginning on the date on 

13 which a covered individual appeals 

14 under this section a removal from the 

15 civil service under subsection 

16 (b)(2)(A); and 

17 ‘‘(II) ending on the later of— 

18 ‘‘(aa) the date on which the 

19 Merit Systems Protection Board 

20 issues a final decision on the ap21 peal under paragraph (3); and 

22 ‘‘(bb) the date on which the 

23 United States Court of Appeals 

24 for the Federal Circuit issues a 


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1 final decision on the appeal 

2 under paragraph (5). 

3 ‘‘(B) PAY AND BENEFITS DESCRIBED.— 

4 The pay and benefits referred to in subpara5 graph (A)(i) are any pay, awards, bonuses, in6 centives, allowances, differentials, student loan 

7 repayments, special payments, or benefits re8 lated to the employment of the individual by the 

9 Service. 

10 ‘‘(8) INFORMATION TO EXPEDITE APPEAL.—To 

11 the maximum extent practicable, the Secretary shall 

12 provide to the Merit Systems Protection Board such 

13 information and assistance as may be necessary to 

14 ensure an appeal under this subsection is expedited. 

15 ‘‘(9) BACKPAY.—If an employee prevails on ap16 peal under this section, the employee shall be enti17 tled to backpay (as provided in section 5596 of title 

18 5, United States Code). 

19 ‘‘(10) APPLICABLE TIMELINES AND PROCE20 DURES.—If an employee who is subject to a collec21 tive bargaining agreement chooses to grieve an ac22 tion taken under this section through a grievance 

23 procedure provided under the collective bargaining 

24 agreement, the timelines and procedures described in 

25 subsection (d) and this subsection shall apply. 


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1 ‘‘(f) ALLEGED PROHIBITED PERSONNEL PRAC2 TICE.—In the case of a covered individual seeking correc3 tive action (or on behalf of whom corrective action is 

4 sought) from the Office of Special Counsel based on an 

5 alleged prohibited personnel practice described in section 

6 2302(b) of title 5, United States Code, the Secretary may 

7 not remove, demote, or suspend the covered individual 

8 under subsection (b) without the approval of the Special 

9 Counsel under section 1214(f) of title 5, United States 

10 Code. 

11 ‘‘(g) TERMINATION OF INVESTIGATIONS BY OFFICE

12 OF SPECIAL COUNSEL.— 

13 ‘‘(1) IN GENERAL.—Notwithstanding any other 

14 provision of law, the Special Counsel established by 

15 section 1211 of title 5, United States Code, may ter16 minate an investigation of a prohibited personnel 

17 practice alleged by an employee or former employee 

18 of the Service after the Special Counsel provides to 

19 the employee or former employee a written state20 ment of the reasons for the termination of the inves21 tigation. 

22 ‘‘(2) ADMISSIBILITY.—The statement described 

23 in paragraph (1) may not be admissible as evidence 

24 in any judicial or administrative proceeding without 


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1 the consent of the employee or former employee de2 scribed in paragraph (1). 

3 ‘‘(h) VACANCIES.—In the case of a covered individual 

4 who is removed or demoted under subsection (b), to the 

5 maximum extent practicable, the Secretary shall fill the 

6 vacancy arising as a result of the removal or demotion.’’. 

7 (b) CONFORMING AMENDMENTS.—Section 4303(f) of 

8 title 5, United States Code, is amended— 

9 (1) in paragraph (3), by striking ‘‘or’’ at the 

10 end; 

11 (2) in paragraph (4), by striking the period at 

12 the end and inserting ‘‘, or’’; and 

13 (3) by adding at the end the following: 

14 ‘‘(5) any removal or demotion under section 

15 607 of the Indian Health Care Improvement Act.’’. 

16 (c) REPORT.—Not later than 18 months after the 

17 date of enactment of this Act, the Secretary of Health and 

18 Human Services or the Inspector General of the Depart19 ment of Health and Human Services, as appropriate, shall 

20 submit to Congress a report that includes information 

21 on— 

22 (1) the number of employees of the Indian 

23 Health Service who were removed, demoted, or sus24 pended during the 1-year period preceding the date 

25 of enactment of this Act; 


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1 (2) the number of employees of the Indian 

2 Health Service who were removed, demoted, or sus3 pended during the 1-year period beginning on the 

4 date of enactment of this Act pursuant to the 

5 amendments made by this section; and 

6 (3) the appropriate details of any such remov7 als, demotions, and suspensions that lend necessary 

8 context. 

9 SEC. 107. TRIBAL CULTURE AND HISTORY. 

10 Section 113 of the Indian Health Care Improvement 

11 Act (25 U.S.C. 1616f) is amended— 

12 (1) in subsection (a)— 

13 (A) by striking ‘‘a program’’ and inserting 

14 ‘‘an annual mandatory training program’’; and 

15 (B) by striking ‘‘appropriate employees of 

16 the Service’’ and inserting ‘‘employees of the 

17 Service, locum tenens medical providers, 

18 healthcare volunteers, and other contracted em19 ployees who work at Service hospitals or other 

20 Service units and whose employment requires 

21 regular direct patient access’’; and 

22 (2) by adding at the end the following: 

23 ‘‘(c) REQUIREMENT TO COMPLETE TRAINING PRO24 GRAM.—Notwithstanding any other provision of law, be25 ginning on the date of enactment of the Restoring AcVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 countability in the Indian Health Service Act of 2022, 

2 each employee or provider described in subsection (a) who 

3 enters into a contract with the Service shall, as a condition 

4 of employment, annually participate in and complete the 

5 program established under subsection (a).’’. 

6 SEC. 108. STAFFING DEMONSTRATION PROGRAM. 

7 Title VIII of the Indian Health Care Improvement 

8 Act (25 U.S.C. 1671 et seq.) is amended by adding at 

9 the end the following: 

10 ‘‘SEC. 833. STAFFING DEMONSTRATION PROGRAM. 

11 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

12 date of enactment of the Restoring Accountability in the 

13 Indian Health Service Act of 2022, the Secretary, acting 

14 through the Service (referred to in this section as the ‘Sec15 retary’), shall establish a demonstration program (referred 

16 to in this section as the ‘demonstration program’) under 

17 which the Service may provide Service units with addi18 tional staffing resources, with the goal that the resources 

19 become self-sustaining. 

20 ‘‘(b) SELECTION.—In selecting Service units for par21 ticipation in the demonstration program, the Secretary 

22 shall consider whether a Service unit services an Indian 

23 tribe that— 

24 ‘‘(1) has utilized or contributed substantial 

25 Tribal funds to construct a health facility used by 


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1 the Service or identified in the master plan for the 

2 Service unit; 

3 ‘‘(2) is located in 1 or more States with Med4 icaid reimbursements plans or policies that will in5 crease the likelihood that the staffing resources pro6 vided will be self-sustaining; and 

7 ‘‘(3) is operating a health facility described in 

8 paragraph (1) under historical staffing ratios, as de9 termined by the Secretary, that have not been equal10 ized or updated by the Service or any other Service 

11 program to reflect current staffing needs. 

12 ‘‘(c) DURATION.—Staffing resources provided to a 

13 Service unit under the demonstration program shall be 

14 provided for a duration that the Secretary, in consultation 

15 with the applicable Indian tribe, determines appropriate, 

16 on the condition that each staffing position provided shall 

17 be for a period of not less than 3 fiscal years. 

18 ‘‘(d) EFFECT OF STAFFING AWARDS.—No staffing 

19 resources provided under the demonstration program shall 

20 reduce the recurring base funding for staffing for any In21 dian tribe or Service unit. 

22 ‘‘(e) SUNSET.—The demonstration program estab23 lished under subsection (a) shall terminate on the date 

24 that is 4 years after the date on which the demonstration 

25 program is established. 


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1 ‘‘(f) REPORT.—Not later than 1 year after the date 

2 on which the demonstration program terminates under 

3 subsection (e), the Secretary shall submit to the Com4 mittee on Indian Affairs and the Committee on Health, 

5 Education, Labor, and Pensions of the Senate and the 

6 Committee on Natural Resources and the Committee on 

7 Energy and Commerce of the House of Representatives 

8 a report describing the demonstration program, including 

9 information on— 

10 ‘‘(1) whether the staffing resources provided 

11 under the demonstration program resulted in addi12 tional revenue for the applicable Service unit suffi13 cient to maintain the staff on a permanent basis; 

14 ‘‘(2) the levels to which the staffing resources 

15 provided under the demonstration program reduced 

16 the unmet staffing need for the applicable Service 

17 unit; and 

18 ‘‘(3) whether the demonstration program could 

19 be deployed permanently to reduce unmet staffing 

20 needs throughout the Service.’’. 

21 SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION 

22 POLICY. 

23 Title VIII of the Indian Health Care Improvement 

24 Act (25 U.S.C. 1671 et seq.) (as amended by section 108) 

25 is amended by adding at the end the following: 


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1 ‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 

2 POLICY. 

3 ‘‘(a) IN GENERAL.—Not later than December 31, 

4 2023, the Secretary shall establish, and once every 5 years 

5 thereafter, the Secretary shall update, after meaningful 

6 consultation with representatives of affected Indian tribes, 

7 a rule establishing a Tribal consultation policy for the 

8 Service. 

9 ‘‘(b) CONTENTS OF TRIBAL CONSULTATION POL10 ICY.—The policy established under the rule under sub11 section (a) shall— 

12 ‘‘(1) update, and replace, the Tribal consulta13 tion policy established under Circular No. 2006–01 

14 of the Service (or any successor policy); and 

15 ‘‘(2) include— 

16 ‘‘(A) a process for determining when and 

17 how the Service will notify Indian tribes of the 

18 availability of meaningful consultation; 

19 ‘‘(B) a determination of which actions or 

20 agency decisions by the Service will trigger a re21 quirement for meaningful consultation with In22 dian tribes; and 

23 ‘‘(C) a determination of which actions con24 stitute meaningful consultation with Indian 

25 tribes.’’. 


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1 SEC. 110. TREATMENT OF CERTAIN HOSPITALS. 

2 The ‘‘Parallel Low-Volume Hospital Payment Adjust3 ment Regarding Hospitals Operated by the Indian Health 

4 Services (IHS) or a Tribe’’ provisions described in the 

5 final rule of the Centers for Medicare & Medicaid Services 

6 entitled ‘‘Medicare Program; Hospital Inpatient Prospec7 tive Payment Systems for Acute Care Hospitals and the 

8 Long-Term Care Hospital Prospective Payment System 

9 and Policy Changes and Fiscal Year 2018 Rates; Quality 

10 Reporting Requirements for Specific Providers; Medicare 

11 and Medicaid Electronic Health Record (EHR) Incentive 

12 Program Requirements for Eligible Hospitals, Critical Ac13 cess Hospitals, and Eligible Professionals; Provider-Based 

14 Status of Indian Health Service and Tribal Facilities and 

15 Organizations; Costs Reporting and Provider Require16 ments; Agreement Termination Notices’’ (82 Fed Reg. 

17 37990; 38188–38189 (August 14, 2017)), shall apply with 

18 respect to discharges occurring in fiscal year 2011 and 

19 each fiscal year thereafter. 

20 SEC. 111. ENHANCING QUALITY OF CARE IN THE INDIAN 

21 HEALTH SERVICE. 

22 (a) IHCIA DEFINITIONS.—In this section, the terms 

23 ‘‘Area office’’, ‘‘Indian tribe’’, ‘‘Secretary’’, ‘‘Service’’, 

24 ‘‘Service unit’’, ‘‘tribal organization’’, and ‘‘Urban Indian 

25 organization’’ have the meanings given those terms in secVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 tion 4 of the Indian Health Care Improvement Act (25 

2 U.S.C. 1603). 

3 (b) BEST PRACTICES FOR GOVERNING BOARD AND

4 AREA OFFICE MEETINGS.— 

5 (1) DEFINITION OF GOVERNING BOARD.—In 

6 this subsection, the term ‘‘governing board’’ means 

7 the governing board of the facility of a Service unit. 

8 (2) IN GENERAL.—Not later than 1 year after 

9 the date of enactment of this Act, the Secretary, in 

10 consultation with Indian tribes, governing boards, 

11 Area offices, Service units, and other stakeholders, 

12 as determined appropriate by the Secretary, shall es13 tablish— 

14 (A) in accordance with paragraph (3)(A), 

15 best practices for governing boards; and 

16 (B) in accordance with paragraph (3)(B), 

17 best practices for Area offices. 

18 (3) REQUIREMENTS.— 

19 (A) GOVERNING BOARD BEST PRAC20 TICES.—The best practices for governing 

21 boards established under paragraph (2)(A) shall 

22 include provisions relating to— 

23 (i) adequately monitoring the delivery 

24 of care at the applicable facility managed 

25 by the governing board; 


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1 (ii) ensuring ongoing facility compli2 ance with Federal health care program re3 quirements, including requirements of the 

4 Service and the Centers for Medicare & 

5 Medicaid Services; 

6 (iii) handling, documenting, and re7 sponding to patient complaints; 

8 (iv) documenting, addressing, and, if 

9 applicable, reporting instances of profes10 sional misconduct by facility staff in ac11 cordance with applicable Federal and State 

12 law; 

13 (v) improving facility performance and 

14 operations with respect to mandatory and 

15 voluntary quality initiatives carried out by 

16 the Service and the Centers for Medicare & 

17 Medicaid Services; and 

18 (vi) reporting requirements under 

19 Federal law, including with respect to— 

20 (I) the Government Performance 

21 and Results Act of 1993 (Public Law 

22 103–62; 107 Stat. 285), the GPRA 

23 Modernization Act of 2010 (Public 

24 Law 111–352; 124 Stat. 3866), and 


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1 the amendments made by those Acts; 

2 and 

3 (II) the applicable provisions of 

4 titles XVIII and XIX of the Social Se5 curity Act (42 U.S.C. 1395 et seq., 

6 1396 et seq.). 

7 (B) AREA OFFICE BEST PRACTICES.—The 

8 best practices for Area offices established under 

9 paragraph (2)(B) shall include provisions relat10 ing to— 

11 (i) strategies for how to best monitor 

12 governing board activities relating to the 

13 oversight of— 

14 (I) delivery and quality of patient 

15 care; 

16 (II) documenting and responding 

17 to patient complaints and instances of 

18 professional misconduct; and 

19 (III) facility compliance with 

20 Federal health care program require21 ments, including requirements of the 

22 Service and the Centers for Medicare 

23 & Medicaid Services; and 

24 (ii) connecting governing boards, in25 cluding the applicable facilities of those 


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1 governing boards, to resources necessary 

2 for enhancing patient outcomes and im3 proving facility performance, including 

4 through the use of technical assistance. 

5 (4) PUBLICATION.—The best practices estab6 lished under paragraph (2) shall be— 

7 (A) reported to, in writing, as applicable, 

8 all governing boards and Area offices; and 

9 (B) incorporated into the Indian Health 

10 Manual of the Service. 

11 (c) REVIEW OF QUALITY AND PERFORMANCE MEAS12 URES.— 

13 (1) REVIEW.— 

14 (A) IN GENERAL.—Not later than 1 year 

15 after the date of enactment of this Act, the Sec16 retary, in coordination with the Agency for 

17 Healthcare Research and Quality, the National 

18 Quality Forum, Indian tribes, practitioners and 

19 administrators of the Service, and other quali20 fied experts, as determined appropriate by the 

21 Secretary, shall undertake a review of the re22 ported quality and performance measures of 

23 Service facilities conducted by the Secretary in 

24 accordance with— 


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1 (i) section 306 of title 5, United 

2 States Code; 

3 (ii) section 1115(b) of title 31, United 

4 States Code; and 

5 (iii) any law (including regulations) 

6 used in any mandatory or voluntary pro7 gram of the Centers for Medicare & Med8 icaid Services. 

9 (B) REPORT.—Not later than 6 months 

10 after the date on which the review required 

11 under subparagraph (A) is completed, the Sec12 retary shall submit to Congress a report on the 

13 details and findings of that review, which shall 

14 include an assessment of— 

15 (i) the suitability of measures used as 

16 of the date of enactment of this Act for the 

17 applicable Service facility, taking into con18 sideration the patient volume of the facil19 ity, the mix of patient cases at the facility, 

20 the geographic location of the facility, and 

21 medical professional shortage designations 

22 at the facility, as determined by the Sec23 retary; and 


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1 (ii) the extent to which the perform2 ance and quality measures are outcome3 based or process-based measures. 

4 (2) ADOPTION.—Not later than 1 year after the 

5 date on which the report required under paragraph 

6 (1)(B) is submitted to Congress, the Service, in co7 ordination with the Centers for Medicare & Medicaid 

8 Services, shall adopt, and assist Service facilities to 

9 adopt, to the extent practicable, more suitable, as 

10 compared to those quality and performance meas11 ures adopted prior to the submission of that report, 

12 quality and performance measures, including meas13 ures that are more outcome-based and process14 based, in accordance with the factors described in 

15 paragraph (1)(B)(i). 

16 (3) GAO REPORT.—Not later than 1 year after 

17 the date on which the report required under para18 graph (1)(B) is submitted to Congress, the Comp19 troller General of the United States shall submit to 

20 Congress a report on challenges relating to quality 

21 measure and data collection in Service facilities, 

22 which shall include— 

23 (A) barriers to the adoption of relevant 

24 performance and quality measures in Service 

25 facilities; and 


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1 (B) recommendations for how the Service, 

2 other Federal agencies, and stakeholders can 

3 assist Service facilities in adopting suitable 

4 quality and performance measures. 

5 (d) COMPLIANCE ASSISTANCE PROGRAM.— 

6 (1) DEFINITIONS.—In this subsection: 

7 (A) ADMINISTRATOR.—The term ‘‘Admin8 istrator’’ means the Administrator of the Cen9 ters for Medicare & Medicaid Services. 

10 (B) ELIGIBLE FACILITY.— 

11 (i) IN GENERAL.—The term ‘‘eligible 

12 facility’’ means a facility operated by the 

13 Service that— 

14 (I) is an underperforming hos15 pital or outpatient facility; and 

16 (II) is eligible for payments 

17 under title XVIII of the Social Secu18 rity Act (42 U.S.C. 1395 et seq.). 

19 (ii) INCLUSION.—The term ‘‘eligible 

20 facility’’ includes a tribally operated facil21 ity, if that facility consents to participating 

22 in the program. 

23 (C) PROGRAM.—The term ‘‘program’’ 

24 means the compliance assistance program es25 tablished under paragraph (2). 


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1 (D) TRIBALLY OPERATED FACILITY.—The 

2 term ‘‘tribally operated facility’’ means a facil3 ity operated by an Indian tribe, a tribal organi4 zation, or an Urban Indian organization that— 

5 (i) is an underperforming hospital or 

6 outpatient facility; and 

7 (ii) is eligible for payments under title 

8 XVIII of the Social Security Act (42 

9 U.S.C. 1395 et seq.). 

10 (2) ESTABLISHMENT OF PROGRAM.—Not later 

11 than 1 year after the date of enactment of this Act, 

12 the Secretary, in coordination with the Adminis13 trator and quality improvement organizations having 

14 a contract with the Secretary under part B of title 

15 XI of the Social Security Act (42 U.S.C. 1320c et 

16 seq.), shall establish a compliance assistance pro17 gram for eligible facilities. 

18 (3) METHODOLOGY.—The Secretary shall es19 tablish a methodology for determining which eligible 

20 facilities shall participate in the program, which 

21 shall take into account the following factors: 

22 (A) The number and severity of facility de23 ficiencies with respect to applicable require24 ments under title XVIII of the Social Security 

25 Act (42 U.S.C. 1395 et seq.). 


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1 (B) The history of provider misconduct or 

2 patient harm at the facility. 

3 (C) Whether there is high staff turnover at 

4 the facility. 

5 (D) Whether the facility has low perform6 ance on program quality measures, relative to 

7 other facilities of the Service, in accordance 

8 with reported quality and performance meas9 ures conducted by the Secretary in accordance 

10 with— 

11 (i) section 306 of title 5, United 

12 States Code; 

13 (ii) section 1115(b) of title 31, United 

14 States Code; and 

15 (iii) any law (including regulations) 

16 used in any mandatory or voluntary pro17 gram of the Centers for Medicare & Med18 icaid Services. 

19 (4) SELECTION OF FACILITIES.— 

20 (A) IN GENERAL.—The Secretary, in co21 ordination with the Administrator, shall select 

22 not less than 25 percent of the eligible facilities 

23 to participate in the program using the method24 ology established under paragraph (3). 

25 (B) PARTICIPATION.— 


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1 (i) IN GENERAL.—An eligible facility 

2 selected to participate in the program 

3 under subparagraph (A) shall be required 

4 to participate in the program. 

5 (ii) REQUIREMENT.—The Secretary 

6 shall ensure that, at all times during the 

7 period beginning on the date of establish8 ment of the program and the date on 

9 which the program terminates under para10 graph (8), not less than 25 percent of eli11 gible facilities are participating in the pro12 gram. 

13 (C) TERM OF PARTICIPATION.— 

14 (i) IN GENERAL.—Subject to clause 

15 (ii), an eligible facility selected to partici16 pate in the program under subparagraph 

17 (A) shall participate in the program for a 

18 period of 2 years. 

19 (ii) WAIVER.—If the Secretary, in co20 ordination with the Administrator, certifies 

21 that an eligible facility participating in the 

22 program has improved on its performance 

23 to a satisfactory level, as determined by 

24 the Secretary, then the eligible facility does 


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1 not have to participate in the program for 

2 the full 2-year period. 

3 (D) PARTICIPATION LIMIT.—An eligible fa4 cility may participate in the program for more 

5 than 1 2-year period. 

6 (5) PROGRAM COMPONENTS.—The program 

7 shall provide on-site consultation and educational 

8 programming for eligible facilities to ensure those el9 igible facilities are— 

10 (A) meeting Federal requirements of the 

11 Service and any conditions of participation ap12 plicable under title XVIII of the Social Security 

13 Act (42 U.S.C. 1395 et seq.); and 

14 (B) satisfactorily implementing any quality 

15 initiatives and programs established by the 

16 Service or the Centers for Medicare & Medicaid 

17 Services. 

18 (6) ENFORCEMENT OR NONCOMPLIANCE AC19 TIONS.— 

20 (A) IN GENERAL.—The program shall be 

21 conducted independently of any enforcement ac22 tions under the Indian Health Care Improve23 ment Act (25 U.S.C. 1601 et seq.) or non24 compliance actions taken by the Administrator 

25 with respect to noncompliance with conditions 


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1 of participation applicable under title XVIII of 

2 the Social Security Act (42 U.S.C. 1395 et 

3 seq.), unless, while carrying out the program, 

4 the Secretary or the Administrator, as applica5 ble, encounters a triggering event, as deter6 mined by the Secretary or the Administrator, as 

7 applicable, that would necessitate an enforce8 ment action or noncompliance action. 

9 (B) TRIGGERING EVENT ENCOUNTERED.— 

10 If a triggering event is encountered by the Sec11 retary or Administrator under subparagraph 

12 (A), the eligible facility shall continue to partici13 pate in the program so long as the facility— 

14 (i) remains eligible for payments 

15 under title XVIII of the Social Security 

16 Act (42 U.S.C. 1395 et seq.); and 

17 (ii) continues to meet all of the condi18 tions and requirements for such payments 

19 which are applicable under such title. 

20 (7) IMPLEMENTATION.—The Secretary shall 

21 carry out the program in coordination with quality 

22 improvement organizations having a contract with 

23 the Secretary under part B of title XI of the Social 

24 Security Act (42 U.S.C. 1320c et seq.). 


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1 (8) SUNSET.—The program shall terminate 6 

2 years after the date on which the program is estab3 lished. 

4 (9) REPORT.—Not later than 1 year after the 

5 date on which the program terminates under para6 graph (8), the Comptroller General of the United 

7 States shall submit to Congress a report evaluating 

8 the effectiveness of the program, which shall include, 

9 to the extent practicable— 

10 (A) detailed data on changes in the patient 

11 experience at eligible facilities that participated 

12 in the program; 

13 (B) a description of the compliance status 

14 of eligible facilities that participated in the pro15 gram with requirements of the Service and any 

16 conditions of participation applicable under title 

17 XVIII of the Social Security Act (42 U.S.C. 

18 1395 et seq.); and 

19 (C) a description of the progress by eligible 

20 facilities that participated in the program in 

21 meeting the goals of quality improvement activi22 ties of the Department of Health and Human 

23 Services. 


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1 SEC. 112. NOTIFICATION OF INVESTIGATION REGARDING 

2 PROFESSIONAL CONDUCT; SUBMISSION OF 

3 RECORDS. 

4 Title VIII of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1671 et seq.) (as amended by section 109) 

6 is amended by adding at the end the following: 

7 ‘‘SEC. 835. NOTIFICATION OF INVESTIGATION REGARDING 

8 PROFESSIONAL CONDUCT; SUBMISSION OF 

9 RECORDS. 

10 ‘‘(a) REPORT.—Not later than 14 calendar days after 

11 the date on which the Service undertakes an investigation 

12 into the professional conduct of a licensee of a State, the 

13 Secretary, acting through the Service, shall notify the rel14 evant State medical board of the investigation. 

15 ‘‘(b) SUBMISSION OF RECORDS.—Not later than 14 

16 calendar days after the date on which the Service gen17 erates records relating to an investigation conducted by 

18 the Service into the professional conduct of a licensee of 

19 a State, the Secretary, acting through the Service, shall 

20 provide the records to the relevant State medical board.’’. 

21 SEC. 113. MEDICAL CHAPERONES; OFFICE OF PATIENT AD22 VOCACY. 

23 (a) MEDICAL CHAPERONES.—Title II of the Indian 

24 Health Care Improvement Act is amended by inserting 

25 after section 223 (25 U.S.C. 1621v) the following: 


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1 ‘‘SEC. 224. MEDICAL CHAPERONES. 

2 ‘‘(a) INDIAN HEALTH SERVICE.— 

3 ‘‘(1) IN GENERAL.—The Secretary, acting 

4 through the Service, shall, at the request of a pa5 tient of the Service, provide to the patient a medical 

6 chaperone, to be present during any medical exam7 ination of the patient provided by or through the 

8 Service. 

9 ‘‘(2) REQUIREMENTS.—The Secretary, acting 

10 through the Service, shall— 

11 ‘‘(A) notify patients of the Service of the 

12 right to have a medical chaperone present dur13 ing a medical examination provided by or 

14 through the Service; and 

15 ‘‘(B) ensure that the right described in 

16 subparagraph (A) is provided to each patient in 

17 each Service unit. 

18 ‘‘(b) OTHER PROVIDERS OF SERVICES.—An Indian 

19 tribe, tribal organization, or any other Indian health pro20 gram may use amounts made available under this Act to 

21 provide, at the request of a patient to whom the Indian 

22 tribe, tribal organization, or Indian health program is pro23 viding health care services, a medical chaperone to the pa24 tient, to be present during any medical examination of the 

25 patient provided by the Indian tribe or tribal organiza26 tion.’’. 


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1 (b) INDIAN HEALTH SERVICE OFFICE OF PATIENT

2 ADVOCACY.—Title VI of the Indian Health Care Improve3 ment Act (25 U.S.C. 1661 et seq.) (as amended by section 

4 106) is amended by adding at the end the following: 

5 ‘‘SEC. 608. OFFICE OF PATIENT ADVOCACY. 

6 ‘‘(a) DEFINITIONS.—In this section: 

7 ‘‘(1) DIRECTOR.—The term ‘Director’ means 

8 the Director of the Office. 

9 ‘‘(2) OFFICE.—The term ‘Office’ means the Of10 fice of Patient Advocacy established by subsection 

11 (b). 

12 ‘‘(b) ESTABLISHMENT.—There is established within 

13 the Department an office, to be known as the ‘Office of 

14 Patient Advocacy’. 

15 ‘‘(c) DIRECTOR.—The Office shall be headed by a Di16 rector, who shall— 

17 ‘‘(1) be appointed by the Secretary from among 

18 individuals qualified to perform the duties of the po19 sition; and 

20 ‘‘(2) report directly to the Secretary. 

21 ‘‘(d) DUTIES.— 

22 ‘‘(1) IN GENERAL.—The Office shall carry out 

23 a patient advocacy program of the Service, under 

24 which the Office shall— 


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1 ‘‘(A) employ patient advocates to advocate 

2 on behalf of Indians with respect to health care 

3 services sought or received through the Service; 

4 ‘‘(B) provide to those patient advocates 

5 training to ensure the advocates carry out the 

6 responsibilities described in paragraph (2); and 

7 ‘‘(C) in as many prominent locations as 

8 the Director determines to be appropriate to be 

9 seen by the largest percentage of patients and 

10 family members of patients at each Service 

11 unit, display— 

12 ‘‘(i) the purposes of the patient advo13 cacy program; 

14 ‘‘(ii) the contact information for a pa15 tient advocate employed at the Service 

16 unit; and 

17 ‘‘(iii) a description of the rights and 

18 responsibilities of patients and family 

19 members of patients at the Service unit. 

20 ‘‘(2) PATIENT ADVOCATE RESPONSIBILITIES.— 

21 The responsibilities of a patient advocate employed 

22 by the Office shall include the following: 

23 ‘‘(A) Resolving any complaints by Indian 

24 patients with respect to health care services 


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1 provided by or through the Service that cannot 

2 be resolved at— 

3 ‘‘(i) the point of service; or 

4 ‘‘(ii) a higher level easily accessible to 

5 the patient. 

6 ‘‘(B) Expressing to Indians their rights 

7 and responsibilities as patients in receiving 

8 health care services through the Service. 

9 ‘‘(C) Presenting at various meetings, and 

10 to various committees, a description of any 

11 issues experienced by Indians in receiving 

12 health care services through the Service. 

13 ‘‘(D) Managing a patient advocate track14 ing system, if applicable. 

15 ‘‘(E) Compiling data relating to any com16 plaints made to the advocate by Indians with 

17 respect to the receipt of health care services 

18 through the Service, and the satisfaction of In19 dians with those services, to determine whether 

20 there exist any trends in those data. 

21 ‘‘(F) Ensuring that a process exists for the 

22 distribution of data compiled under subpara23 graph (E) to Indian health programs, appro24 priate leaders, committees, and service pro25 viders, and staff of the Service. 


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1 ‘‘(G) Identifying, not less frequently than 

2 quarterly, opportunities for improvement in the 

3 provision of health care services to Indians by 

4 or through the Service, including based on com5 plaints by Indian patients or immediate family 

6 members. 

7 ‘‘(H) Ensuring that any significant com8 plaint by an Indian patient or family member 

9 with respect to health care provided by or 

10 through the Service is brought to the attention 

11 of appropriate staff of the Service or Indian 

12 health program for the purpose of assessing 

13 whether further analysis of the problem is re14 quired at the Service, Service area, Service unit, 

15 or Indian health program level. 

16 ‘‘(I) Supporting any other patient advocacy 

17 programs carried out by the Department. 

18 ‘‘(J) Ensuring that all appeals and final 

19 decisions with respect to the receipt of health 

20 care services through the Service are entered 

21 into a patient advocate tracking system of the 

22 Office, if applicable. 

23 ‘‘(K) Understanding all laws, directives, 

24 and other rules relating to the rights and re25 sponsibilities of Indians in receiving health care 


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1 services through the Service, including the ap2 peals processes available to Indian patients and 

3 immediate family members. 

4 ‘‘(L) Ensuring that Indians receiving be5 havioral health services under title VII (and any 

6 surrogate decisionmakers for such Indians) are 

7 aware of the right of Indians— 

8 ‘‘(i) to seek representation from sys9 tems established under section 103 of the 

10 Protection and Advocacy for Mentally Ill 

11 Individuals Act of 1986 (42 U.S.C. 

12 10803); 

13 ‘‘(ii) to protect and advocate for the 

14 rights of Indians experiencing behavioral 

15 health issues; and 

16 ‘‘(iii) to investigate incidents of abuse 

17 and neglect of Indians experiencing behav18 ioral health issues. 

19 ‘‘(M) Achieving compliance with any appli20 cable requirements established by the Secretary 

21 with respect to the inspection of controlled sub22 stances (as defined in section 102 of the Con23 trolled Substances Act (21 U.S.C. 802)). 


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1 ‘‘(N) Documenting potentially threatening 

2 behavior and reporting that behavior to the ap3 propriate authorities. 

4 ‘‘(3) TRAINING.—The Director shall ensure 

5 that the training provided to patient advocates 

6 under paragraph (1)(B) is consistent throughout the 

7 Office, including with respect to any mandatory 

8 training or certification standards approved by the 

9 Director.’’. 

10 SEC. 114. FITNESS OF HEALTH CARE PROVIDERS. 

11 (a) IN GENERAL.—Title VIII of the Indian Health 

12 Care Improvement Act is amended by inserting after sec13 tion 802 (25 U.S.C. 1672) the following: 

14 ‘‘SEC. 803. FITNESS OF HEALTH CARE PROVIDERS. 

15 ‘‘(a) ADDITIONAL REQUIREMENTS FOR HIRING OF

16 HEALTH CARE PROVIDERS BY SERVICE.—As part of the 

17 hiring process for each health care provider position at 

18 the Service after the date of enactment of the Restoring 

19 Accountability in the Indian Health Service Act of 2022, 

20 the Director shall require from the medical board of each 

21 State in which the health care provider has or had a med22 ical license— 

23 ‘‘(1) information on any violation of the re24 quirements of the medical license of the health care 

25 provider during the 20-year period ending on the 


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1 date on which the health care provider is being con2 sidered for a position at the Service; and 

3 ‘‘(2) information on whether the health care 

4 provider has entered into any settlement agreement 

5 for a disciplinary charge relating to the practice of 

6 medicine by the health care provider. 

7 ‘‘(b) PROVISION OF INFORMATION ON SERVICE

8 HEALTH CARE PROVIDERS TO STATE MEDICAL

9 BOARDS.—Notwithstanding section 552a of title 5, United 

10 States Code, with respect to each health care provider of 

11 the Service who has violated a requirement of the medical 

12 license of the health care provider, the Director shall pro13 vide to the medical board of each State in which the health 

14 care provider is licensed detailed information with respect 

15 to the violation, regardless of whether the medical board 

16 has formally requested that information.’’. 

17 (b) REPORT ON COMPLIANCE BY INDIAN HEALTH

18 SERVICE WITH REVIEWS OF HEALTH CARE PROVIDERS

19 LEAVING SERVICE OR TRANSFERRING TO OTHER FACILI20 TIES.—Not later than 180 days after the date of enact21 ment of this Act, the Director of the Indian Health Service 

22 shall submit to the Committee on Indian Affairs of the 

23 Senate and the Committee on Natural Resources of the 

24 House of Representatives a report on the compliance by 


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1 the Indian Health Service with the policy of the Indian 

2 Health Service— 

3 (1) to conduct a review of each health care pro4 vider of the Indian Health Service who transfers to 

5 another medical facility of the Indian Health Serv6 ice, resigns, retires, or is terminated to determine 

7 whether there are any concerns, complaints, or alle8 gations of violations relating to the medical practice 

9 of the health care provider; and 

10 (2) to take appropriate action with respect to 

11 any concern, complaint, or allegation described in 

12 paragraph (1). 

13 SEC. 115. STANDARDS TO IMPROVE TIMELINESS OF CARE. 

14 Title IV of the Indian Health Care Improvement Act 

15 (25 U.S.C. 1641 et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘SEC. 412. STANDARDS TO IMPROVE TIMELINESS OF CARE. 

18 ‘‘(a) REGULATIONS.— 

19 ‘‘(1) IN GENERAL.—Not later than 180 days 

20 after the date of enactment of the Restoring Ac21 countability in the Indian Health Service Act of 

22 2022, the Secretary, acting through the Service, 

23 shall— 


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1 ‘‘(A) establish, by regulation, standards to 

2 measure the timeliness of the provision of 

3 health care services in Service facilities; and 

4 ‘‘(B) provide such standards to each Serv5 ice unit. 

6 ‘‘(2) DATA COLLECTION.—The Secretary, act7 ing through the Service, shall develop a process for 

8 each Service unit to submit to the Secretary data 

9 with respect to the standards established under 

10 paragraph (1)(A). 

11 ‘‘(b) ANNUAL REPORTS.— 

12 ‘‘(1) IN GENERAL.—Not later than 1 year after 

13 the date of enactment of the Restoring Account14 ability in the Indian Health Service Act of 2022, 

15 and annually thereafter, each Area office shall sub16 mit to the Secretary a report on the metrics re17 ported by Service units relating to the timeliness of 

18 the provision of health care services in Service facili19 ties within each Service unit. 

20 ‘‘(2) PUBLICATION.—The Secretary shall make 

21 each report received under paragraph (1) publicly 

22 available on the website of the Service.’’. 


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1 TITLE II—EMPLOYEE 

2 PROTECTIONS 

3 SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIA4 TION. 

5 (a) IN GENERAL.—Title VI of the Indian Health 

6 Care Improvement Act (25 U.S.C. 1661 et seq.) (as 

7 amended by section 113(b)) is amended by adding at the 

8 end the following: 

9 ‘‘SEC. 609. EMPLOYEE PROTECTIONS AGAINST RETALIA10 TION. 

11 ‘‘(a) DEFINITIONS.—In this section: 

12 ‘‘(1) INFORMATION.—The term ‘information’ 

13 means information— 

14 ‘‘(A) the disclosure of which is not specifi15 cally prohibited by law; and 

16 ‘‘(B) that is not specifically required by 

17 Executive order to be kept secret in the interest 

18 of national defense or the conduct of foreign af19 fairs. 

20 ‘‘(2) RETALIATION.—The term ‘retaliation’, 

21 with respect to a whistleblower, means— 

22 ‘‘(A) an adverse employment action against 

23 the whistleblower; 


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1 ‘‘(B) a significantly adverse action against 

2 the whistleblower, such as the refusal or delay 

3 of care provided through the Service; and 

4 ‘‘(C) an adverse action described in sub5 paragraph (A) or (B) against a family member 

6 or friend of the whistleblower. 

7 ‘‘(3) WHISTLEBLOWER.—The term ‘whistle8 blower’ means an employee of the Service who dis9 closes information that the employee reasonably be10 lieves evidences— 

11 ‘‘(A) a violation of any law, rule, regula12 tion, or Service policy; or 

13 ‘‘(B) gross mismanagement, a gross waste 

14 of funds, an abuse of authority, or a substantial 

15 and specific danger to public health or safety. 

16 ‘‘(b) EMPLOYEE ACCOUNTABILITY.— 

17 ‘‘(1) DESIGNATED OFFICIAL.—The Secretary 

18 shall designate an official in the Department who is 

19 not an employee of the Service to receive reports 

20 under paragraph (2). 

21 ‘‘(2) MANDATORY REPORTING.—An employee of 

22 the Service who witnesses retaliation against a whis23 tleblower, a violation of a patient safety requirement, 

24 or other similar conduct shall submit to the official 


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1 designated under paragraph (1) a report of the con2 duct. 

3 ‘‘(3) OVERSIGHT.—Not later than 3 days after 

4 the date on which the official designated under para5 graph (1) receives a report under paragraph (2), the 

6 Secretary shall— 

7 ‘‘(A) formally review the report; and 

8 ‘‘(B) provide a copy of the report and any 

9 other relevant information to the Inspector 

10 General of the Department. 

11 ‘‘(4) REMOVAL FOR WHISTLEBLOWER RETALIA12 TION.— 

13 ‘‘(A) IN GENERAL.—The Secretary may re14 move for misconduct from the civil service (as 

15 defined in section 2101 of title 5, United States 

16 Code), in accordance with section 606 or 607, 

17 as applicable, an employee of the Service if the 

18 Secretary determines, after completing a review 

19 described in paragraph (3), that the employee 

20 has retaliated against a whistleblower and war21 rants removal for misconduct. 

22 ‘‘(B) RETALIATION AS MISCONDUCT.—Re23 taliation by an employee against a whistle24 blower, as described in subparagraph (A), shall 


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1 be considered to be misconduct for purposes of 

2 sections 606 and 607. 

3 ‘‘(5) ENHANCING PROTECTIONS FOR WHISTLE4 BLOWERS.—The Secretary shall carry out any ac5 tions determined necessary by the Secretary to en6 hance protection for whistleblowers, including identi7 fying appropriate Service employees and requiring 

8 the employees to complete the Office of Special 

9 Counsel’s Whistleblower Certification Program.’’. 

10 SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION 

11 CONGRESS. 

12 (a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO

13 PETITION CONGRESS.—Section 7211 of title 5, United 

14 States Code, is amended— 

15 (1) by striking ‘‘The right of’’ and inserting the 

16 following: 

17 ‘‘(a) IN GENERAL.—The right of’’; and 

18 (2) by adding at the end the following: 

19 ‘‘(b) ADVERSE ACTION.—An employee who interferes 

20 with or denies a right protected under subsection (a) shall 

21 be subject to any adverse action described in paragraphs 

22 (1) through (5) of section 7512, in accordance with the 

23 procedure described in section 7513 and any other appli24 cable procedure.’’. 


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1 (b) ELECTRONIC NOTIFICATION OF RIGHT OF EM2 PLOYEES OF INDIAN HEALTH SERVICE.— 

3 (1) IN GENERAL.—The Secretary of Health and 

4 Human Services, acting through the Director of the 

5 Indian Health Service (referred to in this subsection 

6 as the ‘‘Secretary’’), shall provide, in accordance 

7 with paragraphs (2) through (5), to each employee 

8 of the Indian Health Service notice of the right to 

9 petition Congress under section 7211 of title 5, 

10 United States Code. 

11 (2) MEMORANDUM.—Not later than 30 days 

12 after the date of enactment of this Act, the Sec13 retary shall submit to the Inspector General of the 

14 Department of Health and Human Services (re15 ferred to in this subsection as the ‘‘Inspector Gen16 eral’’) a memorandum that includes the following 

17 statement: ‘‘It is a violation of section 7211 of title 

18 5, United States Code, for any Federal agency or 

19 employee to require a Federal employee to seek ap20 proval, guidance, or any other form of input prior to 

21 contacting Congress with information, even if that 

22 information is in relation to the job responsibilities 

23 of the employee. A Federal employee found to have 

24 interfered with or denied the right of another Fed25 eral employee under such section shall be subject to 


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1 an adverse action described in any of paragraphs (1) 

2 through (5) of section 7512 of title 5, United States 

3 Code, including a suspension for more than 14 days 

4 without pay.’’. 

5 (3) APPROVAL OR DISAPPROVAL.— 

6 (A) IN GENERAL.—Not later than 30 days 

7 after the date on which the memorandum is 

8 submitted under paragraph (2), the Inspector 

9 General shall approve or disapprove the memo10 randum. 

11 (B) DISAPPROVAL.—If the Inspector Gen12 eral disapproves the memorandum, the Inspec13 tor General shall advise the Secretary on what 

14 changes to the memorandum are necessary for 

15 approval. 

16 (4) NOTICE.—If the memorandum is approved 

17 under paragraph (3), not later than 30 days after 

18 the date of the approval, the Secretary shall— 

19 (A) provide to each employee of the Indian 

20 Health Service an electronic copy of the ap21 proved memorandum; and 

22 (B) post the memorandum in a clear and 

23 conspicuous place on the website of the Indian 

24 Health Service. 

25 (5) REVISED MEMORANDUM.— 


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1 (A) IN GENERAL.—If the memorandum is 

2 disapproved under paragraph (3), not later 

3 than 15 days after the date of disapproval, the 

4 Secretary shall submit to the Inspector General 

5 a revised memorandum that incorporates the 

6 changes advised under subparagraph (B) of 

7 that paragraph. 

8 (B) APPROVAL OR DISAPPROVAL.—Not 

9 later than 30 days after the date on which the 

10 revised memorandum is submitted under sub11 paragraph (A), the Inspector General shall ap12 prove the revised memorandum. 

13 (C) NOTICE.—Not later than 30 days after 

14 the date on which a revised memorandum is ap15 proved under this paragraph, the Secretary 

16 shall provide notice of the memorandum in ac17 cordance with paragraph (4). 

18 SEC. 203. FISCAL ACCOUNTABILITY. 

19 Title VI of the Indian Health Care Improvement Act 

20 (25 U.S.C. 1661 et seq.) (as amended by section 201) is 

21 amended by adding at the end the following: 

22 ‘‘SEC. 610. FISCAL ACCOUNTABILITY. 

23 ‘‘(a) MANAGEMENT OF FUNDS.— 

24 ‘‘(1) IN GENERAL.—If the Secretary fails to 

25 submit a professional housing plan under section 


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1 302(a) of the Restoring Accountability in the Indian 

2 Health Service Act of 2022 or a staffing plan under 

3 section 302(b) of that Act by the applicable dead4 line, the Secretary may not receive, obligate, trans5 fer, or expend any amounts for a salary increase or 

6 bonus of an individual described in paragraph (2) 

7 until the professional housing plan or staffing plan, 

8 as applicable, is submitted. 

9 ‘‘(2) INDIVIDUAL DESCRIBED.—An individual 

10 referred to in paragraph (1) is an individual em11 ployed in the Service— 

12 ‘‘(A) in a position that is— 

13 ‘‘(i) described in any of sections 5312 

14 through 5316 of title 5, United States 

15 Code; 

16 ‘‘(ii) placed in level IV or V of the Ex17 ecutive Schedule under section 5317 of 

18 title 5, United States Code; or 

19 ‘‘(iii) described in section 213.3301 or 

20 213.3302 of title 5, Code of Federal Regu21 lations (or a successor regulation); or 

22 ‘‘(B) as a limited term appointee, limited 

23 emergency appointee, or noncareer appointee 

24 (as those terms are defined in section 3132(a) 

25 of title 5, United States Code). 


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1 ‘‘(b) PRIORITIZATION OF PATIENT CARE.— 

2 ‘‘(1) IN GENERAL.—Notwithstanding any other 

3 provision of law, the Secretary shall use amounts 

4 available to the Service that are not obligated or ex5 pended, including base budget funding and third 

6 party collections, during the fiscal year for which the 

7 amounts are made available, and that remain avail8 able, only to support patient care by using the funds 

9 for the costs of— 

10 ‘‘(A) essential medical equipment; 

11 ‘‘(B) purchased or referred care; or 

12 ‘‘(C) staffing. 

13 ‘‘(2) SPECIAL RULE.—In using amounts under 

14 paragraph (1), the Secretary shall ensure that, in 

15 any case where the amounts were originally made 

16 available for a particular Service unit, the amounts 

17 are used to benefit Indians served by that Service 

18 unit. 

19 ‘‘(3) HHS PLAN.—Each applicable fiscal year, 

20 the Secretary, in consultation with Indian tribes, 

21 shall establish a plan for distributing the amounts 

22 described in paragraph (1) across the categories of 

23 uses described in subparagraphs (A) through (C) of 

24 that paragraph. 


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1 ‘‘(4) RESTRICTIONS.—The Secretary may not 

2 use amounts described in paragraph (1)— 

3 ‘‘(A) to remodel or interior decorate any 

4 Area office; or 

5 ‘‘(B) to increase the rate of pay of any em6 ployee of an Area office. 

7 ‘‘(c) SPENDING REPORTS.—Not later than 90 days 

8 after the end of each fiscal year, the Secretary shall sub9 mit a report describing the authorizations, expenditures, 

10 outlays, transfers, reprogramming, and obligations of each 

11 level of the Service, including the headquarters, each Area 

12 office, each Service unit, and each health clinic or facility, 

13 to— 

14 ‘‘(1) each Indian tribe; 

15 ‘‘(2) in the Senate— 

16 ‘‘(A) the Committee on Indian Affairs; 

17 ‘‘(B) the Committee on Health, Education, 

18 Labor, and Pensions; 

19 ‘‘(C) the Committee on Appropriations; 

20 and 

21 ‘‘(D) the Committee on the Budget; and 

22 ‘‘(3) in the House of Representatives— 

23 ‘‘(A) the Committee on Natural Resources; 

24 ‘‘(B) the Committee on Energy and Com25 merce; 


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1 ‘‘(C) the Committee on Appropriations; 

2 and 

3 ‘‘(D) the Committee on the Budget. 

4 ‘‘(d) STATUS REPORTS.— 

5 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

6 not later than 180 days after the end of each fiscal 

7 year, the Secretary shall provide to each entity de8 scribed in paragraphs (1) through (3) of subsection 

9 (c) a report describing the safety, billing, certifi10 cation, credential, and compliance statuses of each 

11 facility managed, operated, or otherwise supported 

12 by the Service. 

13 ‘‘(2) UPDATES.—With respect to any change of 

14 a status described in paragraph (1), the Secretary 

15 shall immediately provide to each entity described in 

16 paragraphs (1) through (3) of subsection (c) an up17 date describing the change. 

18 ‘‘(e) EFFECT.—Nothing in this section— 

19 ‘‘(1) negatively impacts the right of an Indian 

20 tribe to enter into a compact or contract under the 

21 Indian Self-Determination and Education Assistance 

22 Act (25 U.S.C. 5301 et seq.); or 

23 ‘‘(2) applies to such a compact or contract un24 less expressly agreed to by the Indian tribe.’’. 


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1 TITLE III—REPORTS 

2 SEC. 301. DEFINITIONS. 

3 In this title: 

4 (1) SECRETARY.—The term ‘‘Secretary’’ means 

5 the Secretary of Health and Human Services. 

6 (2) SERVICE.—The term ‘‘Service’’ means the 

7 Indian Health Service. 

8 (3) SERVICE UNIT.—The term ‘‘Service unit’’ 

9 has the meaning given the term in section 4 of the 

10 Indian Health Care Improvement Act (25 U.S.C. 

11 1603). 

12 (4) TRIBAL HEALTH PROGRAM.—The term 

13 ‘‘tribal health program’’ has the meaning given the 

14 term in section 4 of the Indian Health Care Im15 provement Act (25 U.S.C. 1603). 

16 SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND 

17 HUMAN SERVICES. 

18 (a) IHS PROFESSIONAL HOUSING PLAN.— 

19 (1) IN GENERAL.—Not later than 1 year after 

20 the date of enactment of this Act, the Secretary 

21 shall develop, make publicly available, and submit to 

22 Congress and the Comptroller General of the United 

23 States a written plan to address the professional 

24 housing needs of employees of the Service and em25 ployees of tribal health programs that comports with 


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1 the practices and recommendations of the Govern2 ment Accountability Office relating to professional 

3 housing included in the most recent report of the 

4 Government Accountability Office regarding Indian 

5 Health Service housing needs. 

6 (2) REQUIREMENT.—The plan under paragraph 

7 (1) shall include, at a minimum, projections for the 

8 professional housing needs for— 

9 (A) the 1-year period following the date of 

10 the plan; 

11 (B) the 5-year period following the date of 

12 the plan; and 

13 (C) the 10-year period following the date 

14 of the plan. 

15 (b) PLAN RELATING TO IHS STAFFING NEEDS.— 

16 (1) IN GENERAL.—Not later than 1 year after 

17 the date on which the Government Accountability 

18 Office releases the report described in subsection (a), 

19 the Secretary shall develop, make publicly available, 

20 and submit to Congress and the Comptroller General 

21 of the United States a written plan to address the 

22 staffing needs of the Service and tribal health pro23 grams that comports with the practices and rec24 ommendations of the Government Accountability OfVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 fice relating to workforce planning included in the 

2 report. 

3 (2) REQUIREMENT.—The plan under paragraph 

4 (1) shall include, at a minimum, projections for the 

5 staffing needs for— 

6 (A) the 1-year period following the date of 

7 the plan; 

8 (B) the 5-year period following the date of 

9 the plan; and 

10 (C) the 10-year period following the date 

11 of the plan. 

12 SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 

13 (a) IHS HOUSING NEEDS REPORT.—Not later than 

14 2 years after the date on which the Comptroller General 

15 of the United States receives the professional housing plan 

16 under section 302(a), the Comptroller General shall de17 velop and submit to Congress a report that includes— 

18 (1) an assessment of the professional housing 

19 plan; 

20 (2) an evaluation of any existing, as of the date 

21 of the report, assessments and projections for the 

22 professional housing needs of employees of the Serv23 ice and employees of tribal health programs, includ24 ing a discussion and conclusions as to whether the 

25 existing assessments and projections accurately reVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 flect the professional housing needs of employees of 

2 the Service and employees of tribal health programs; 

3 and 

4 (3) an assessment of the professional housing 

5 needs of— 

6 (A) employees of the Service for each Serv7 ice area (as defined in section 4 of the Indian 

8 Health Care Improvement Act (25 U.S.C. 

9 1603)); and 

10 (B) employees of tribal health programs 

11 for each Indian tribe, as applicable. 

12 (b) IHS STAFFING NEEDS REPORT.— 

13 (1) IN GENERAL.—Not later than 2 years after 

14 the date on which the Comptroller General receives 

15 the plan relating to IHS staffing needs under sec16 tion 302(b), the Comptroller General shall prepare 

17 and submit to Congress a report on the staffing 

18 needs of the Service and tribal health programs. 

19 (2) CONTENTS.—The report under paragraph 

20 (1) shall include— 

21 (A) an assessment of the staffing plan re22 ferred to in paragraph (1); 

23 (B) a description of— 

24 (i) the number and type of full-time 

25 positions needed at each facility of the 


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1 Service and at each tribal health program; 

2 and 

3 (ii) the amount of funds necessary to 

4 maintain those positions; 

5 (C) an explanation of the various meth6 odologies that the Service uses and has pre7 viously used to determine the number and type 

8 of full-time positions needed at federally man9 aged Service units; and 

10 (D) an assessment of the use of inde11 pendent contractors, including— 

12 (i) the number of independent con13 tractors hired to fill vacant full-time posi14 tions; and 

15 (ii) the amount of funds spent on 

16 independent contractors who provide 

17 health care services. 

18 (c) WHISTLEBLOWER PROTECTIONS REPORT.— 

19 (1) IN GENERAL.—Not later than 1 year after 

20 the date of enactment of this Act, the Comptroller 

21 General shall develop and submit to Congress a re22 port on the efficacy of existing protections for whis23 tleblowers in the Service, including the protections 

24 implemented pursuant to sections 201 and 202 and 

25 the amendments made by those sections. 


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1 (2) CONTENTS.—The report under paragraph 

2 (1) shall include— 

3 (A) a discussion and conclusions as to 

4 whether the Service has taken proper steps to 

5 prevent retaliation against whistleblowers; 

6 (B) if applicable, any recommendations for 

7 changes to the policy of the Service with respect 

8 to whistleblowers; and 

9 (C) a discussion and conclusions as to 

10 whether the official email accounts of employees 

11 of the Service are appropriately monitored. 

12 SEC. 304. INSPECTOR GENERAL REPORTS. 

13 (a) PATIENT CARE REPORTS.— 

14 (1) IN GENERAL.—Not later than 2 years after 

15 the date of enactment of this Act, and not less fre16 quently than every 3 years thereafter, the Inspector 

17 General of the Department of Health and Human 

18 Services shall develop and submit to Congress and 

19 the Service a report on— 

20 (A) patient harm events and patient deaths 

21 occurring in Service units; 

22 (B) deferrals and denials of care of pa23 tients of the Service; and 

24 (C) the standards to improve the timeli25 ness of care, developed in accordance with secVerDate Sep 11 2014 22:54 Sep 28, 2022 Jkt 029200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S4915.IS S4915

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1 tion 412 of the Indian Health Care Improve2 ment Act (as added by section 115), and qual3 ity of care at Service facilities, including quality 

4 and performance measures developed by the 

5 Secretary in accordance with— 

6 (i) section 306 of title 5, United 

7 States Code; 

8 (ii) section 1115(b) of title 31, United 

9 States Code; and 

10 (iii) any law (including regulations) 

11 used in any mandatory or voluntary pro12 gram of the Centers for Medicare & Med13 icaid Services. 

14 (2) CONTENTS.—The report under paragraph 

15 (1) shall include— 

16 (A) an evaluation of the number and kind 

17 of events that contribute to patient deaths in a 

18 Service unit and recommendations regarding re19 ducing the number of patient deaths; 

20 (B) an evaluation of how the Service 

21 tracks, reports, and responds to patient harm 

22 events and patient deaths and recommendations 

23 regarding how to improve the tracking, report24 ing, and response; and 


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1 (C) the effects of deferrals and denials of 

2 care on patients of the Service, including pa3 tient outcomes, and recommendations regarding 

4 how to reduce deferrals and denials of care. 

5 (b) REPORTING SYSTEMS AUDIT.—Not later than 2 

6 years after the date of enactment of this Act, the Inspector 

7 General of the Department of Health and Human Services 

8 shall— 

9 (1) conduct an audit of reporting systems of the 

10 Service, as of the date of enactment of this Act; and 

11 (2) provide to the Service recommendations and 

12 technical assistance regarding implementation of im13 proved reporting systems, procedures, standards, 

14 and protocols. 

15 SEC. 305. TRANSPARENCY IN CMS SURVEYS. 

16 Section 1880 of the Social Security Act (42 U.S.C. 

17 1395qq) is amended by adding at the end the following: 

18 ‘‘(g)(1) Not less frequently than once every 2 years, 

19 the Administrator of the Centers for Medicare & Medicaid 

20 Services shall conduct surveys of participating Indian 

21 Health Service facilities to assess the compliance of each 

22 hospital or skilled nursing facility of the Indian Health 

23 Service with— 

24 ‘‘(A) section 1867; and 


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1 ‘‘(B) conditions of participation in the program 

2 under this title. 

3 ‘‘(2) Each survey completed under this subsection 

4 shall be posted on the Internet website of the Centers for 

5 Medicare & Medicaid Services. Such posting shall comply 

6 with the Federal regulations concerning the privacy of in7 dividually identifiable health information promulgated 

8 under section 264(c) of the Health Insurance Portability 

9 and Accountability Act of 1996.’’. 

10 TITLE IV—TECHNICAL 

11 AMENDMENTS 

12 SEC. 401. TECHNICAL AMENDMENTS. 

13 (a) DEFINITIONS.—Section 4 of the Indian Health 

14 Care Improvement Act (25 U.S.C. 1603) is amended— 

15 (1) in paragraph (5), by striking the paragraph 

16 designation and heading and all that follows through 

17 ‘‘means’’ and inserting the following: 

18 ‘‘(5) PURCHASED/REFERRED CARE.—The term 

19 ‘purchased/referred care’ means’’; and 

20 (2) by redesignating paragraph (5) and para21 graphs (6) through (15) as paragraph (15) and 

22 paragraphs (5) through (14), respectively, and mov23 ing the paragraphs so as to appear in numerical 

24 order. 


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1 (b) TECHNICAL AMENDMENTS.—The Indian Health 

2 Care Improvement Act (25 U.S.C. 1601 et seq.) is amend3 ed— 

4 (1) by striking ‘‘contract health service’’ each 

5 place it appears (regardless of casing and typeface 

6 and including in the headings) and inserting ‘‘pur7 chased/referred care’’ (with appropriate casing and 

8 typeface); and 

9 (2) by striking ‘‘contract health services’’ each 

10 place it appears (regardless of casing and typeface 

11 and including in the headings) and inserting ‘‘pur12 chased/referred care’’ (with appropriate casing and 

13 typeface). 

Æ 


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