II 

115TH CONGRESS 

1ST SESSION S. 1250 

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 

MAY 25, 2017 

Mr. BARRASSO (for himself, Mr. THUNE, 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 2017’’. 

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. Removal or demotion of Indian Health Service employees based on 

performance or misconduct. 

Sec. 107. Standards to improve timeliness of care. 

Sec. 108. Tribal culture and history. 

Sec. 109. Staffing demonstration project. 

Sec. 110. Rule establishing tribal consultation policy. 

TITLE II—EMPLOYEE PROTECTIONS 

Sec. 201. Right of Federal employees to petition Congress. 

Sec. 202. 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 PAY.—The Secretary shall establish 

4 a pay system for physicians, dentists, nurses, and other 

5 health care professionals employed by the Service that pro6 vides pay that, to the maximum extent practicable, is com7 parable to the pay provided to physicians, dentists, nurses, 

8 and other health care professionals, respectively, under 

9 subchapters III and IV of chapter 74 of title 38, United 

10 States Code. 

11 ‘‘(b) RELOCATION COSTS.—The Secretary may pro12 vide to an employee of the Service reimbursement for any 

13 relocation costs the employee incurs if— 

14 ‘‘(1) the employee relocates to a Service area 

15 experiencing a high level of need for employees, as 

16 determined by the Secretary; and 

17 ‘‘(2) the employee is filling a position that 

18 would otherwise be difficult to fill, as determined by 

19 the Secretary, in the absence of an incentive. 

20 ‘‘(c) HOUSING VOUCHERS.— 

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

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

23 the Restoring Accountability in the Indian Health 

24 Service Act of 2017, the Secretary may establish a 

25 program to provide tenant-based rental assistance to 

26 an employee of the Service who— 


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

2 year at a Service unit designated by the Admin3 istrator of the Health Resources and Services 

4 Administration as a health professional short5 age area, as defined in section 332(a) of the 

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

7 and 

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

9 by the Secretary. 

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

11 Secretary under paragraph (1) shall terminate on 

12 the date that is 3 years after the date on which any 

13 such program is established. 

14 ‘‘(d) ADMINISTRATION.— 

15 ‘‘(1) OPM GUIDELINES.—The Secretary shall 

16 carry out this section in accordance with any guide17 lines of the Office of Personnel Management relating 

18 to the recruitment and retention of employees, in19 cluding section 575.109 of title 5, Code of Federal 

20 Regulations (as in effect on the date of enactment 

21 of the Restoring Accountability in the Indian Health 

22 Service Act of 2017). 

23 ‘‘(2) SERVICE AGREEMENTS.—The Secretary 

24 may only provide reimbursement for any relocation 


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1 costs under subsection (b) or any other benefit 

2 under subsection (c) to— 

3 ‘‘(A) a full-time employee who agrees to 

4 serve for not less than 1 year in the Service, be5 ginning on the date of the agreement; or 

6 ‘‘(B) a part-time employee who agrees to 

7 serve for not less than 2 years in the service be8 ginning on the date of the agreement.’’. 

9 SEC. 102. MEDICAL CREDENTIALING SYSTEM. 

10 Title I of the Indian Health Care Improvement Act 

11 (25 U.S.C. 1611 et seq.), as amended by section 101, is 

12 further amended by adding at the end the following: 

13 ‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 

14 ‘‘(a) IN GENERAL.—By not later than 1 year after 

15 the date of enactment of the Restoring Accountability in 

16 the Indian Health Service Act of 2017, the Secretary, act17 ing through the Service and in accordance with the re18 quirements described in subsection (b), shall develop and 

19 implement a Service-wide centralized credentialing system 

20 (referred to in this section as the ‘credentialing system’) 

21 to credential licensed health professionals who seek to pro22 vide health care services at any Service unit. 

23 ‘‘(b) REQUIREMENTS.—In developing the 

24 credentialing system under subsection (a), the Secretary 

25 shall ensure the following: 


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1 ‘‘(1) Credentialing procedures shall be uniform 

2 throughout the Service. 

3 ‘‘(2) With respect to each licensed health pro4 fessional who successfully completes the 

5 credentialing procedures of the credentialing system, 

6 the Secretary shall authorize each such professional 

7 to provide health care services at any Service unit. 

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

9 credentialing system under subsection (a), the Secretary 

10 shall consult with Indian tribes and may also consult with 

11 any public or private association of medical providers, any 

12 government agency, or other relevant expert, as deter13 mined by the Secretary. 

14 ‘‘(d) APPLICATION.—A licensed health care profes15 sional may not provide health care services at any Service 

16 unit, unless such professional successfully completes the 

17 credentialing procedures of the credentialing system devel18 oped under subsection (a). 

19 ‘‘(e) REGULATIONS.—The Secretary may prescribe 

20 such regulations as may be necessary to carry out the pro21 visions of this section. 

22 ‘‘(f) RULE OF CONSTRUCTION.—This section may 

23 not be construed to inhibit the authority of an Indian tribe 

24 to enter into or maintain a compact or contract under the 


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1 Indian Self-Determination and Education Assistance Act 

2 (25 U.S.C. 5304 et seq.).’’. 

3 SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFES4 SIONAL VOLUNTEERS AT INDIAN HEALTH 

5 SERVICE. 

6 Section 224 of the Public Health Service Act (42 

7 U.S.C. 233) is amended by adding at the end the fol8 lowing: 

9 ‘‘(r) CERTAIN INDIAN HEALTH SERVICE VOLUN10 TEERS DEEMED PUBLIC HEALTH SERVICE EMPLOY11 EES.— 

12 ‘‘(1) IN GENERAL.—For purposes of this sec13 tion, a health professional volunteer at a Service 

14 unit shall, in providing a health service to an indi15 vidual, be deemed to be an employee of the Public 

16 Health Service for a calendar year that begins dur17 ing a fiscal year for which a transfer was made 

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

19 subject to the provisions of this subsection. 

20 ‘‘(2) CONDITIONS.—In providing a health serv21 ice to an individual, a health care practitioner shall, 

22 for purposes of this subsection, be considered to be 

23 a health professional volunteer at a Service unit if 

24 all of the following conditions are met: 


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1 ‘‘(A) The service is provided to the indi2 vidual at the facilities of a Service unit, or 

3 through offsite programs or events carried out 

4 by the Service unit. 

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

6 health care practitioner pursuant to paragraph 

7 (3)(C). 

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

9 receive any compensation for the service from 

10 the individual, the Service unit, or any third11 party payer (including reimbursement under 

12 any insurance policy or health plan, or under 

13 any Federal or State health benefits program), 

14 except that the health care practitioner may re15 ceive repayment from the Service unit for rea16 sonable expenses incurred by the health care 

17 practitioner in the provision of the service to 

18 the individual. 

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

20 health care practitioner or the Service unit 

21 posts a clear and conspicuous notice at the site 

22 where the service is provided of the extent to 

23 which the legal liability of the health care prac24 titioner is limited under this subsection. 


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

2 the health care practitioner is licensed or cer3 tified in accordance with applicable law regard4 ing the provision of the service. 

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

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

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

8 Service unit for purposes of this subsection to the 

9 same extent and in the same manner as such sub10 sections apply to an officer, governing board mem11 ber, employee, or contractor of an entity described in 

12 subsection (g)(4), subject to paragraph (4) and sub13 ject to the following subparagraphs: 

14 ‘‘(A) Each reference to an entity in sub15 sections (g), (h), (i), and (l) shall be considered 

16 to be a reference to a Service unit. 

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

18 applies in lieu of the first sentence of subsection 

19 (g)(1)(A). 

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

21 health care practitioner is not a health profes22 sional volunteer at the Service unit unless the 

23 Service unit sponsors the health care practi24 tioner. For purposes of this subsection, the 


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1 Service unit shall be considered to be spon2 soring the health care practitioner if— 

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

4 practitioner, the Service unit submits to 

5 the Secretary an application meeting the 

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

7 ‘‘(ii) the Secretary, pursuant to sub8 section (g)(1)(E), determines that the 

9 health care practitioner is deemed to be an 

10 employee of the Public Health Service. 

11 ‘‘(D) In the case of a health care practi12 tioner who is determined by the Secretary pur13 suant to this subsection and subsection 

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

15 this subsection applies to the health care practi16 tioner (with respect to services performed on 

17 behalf of the Service unit sponsoring the health 

18 care practitioner pursuant to subparagraph (C)) 

19 for any cause of action arising from an act or 

20 omission of the health care practitioner occur21 ring on or after the date on which the Secretary 

22 makes that determination. 

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

24 health care practitioner for purposes of this 

25 subsection only to the extent that, in providing 


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1 health services to an individual, each of the con2 ditions described in paragraph (2) is met. 

3 ‘‘(4) FUNDING.— 

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

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

6 available for transfer under subparagraph (C) 

7 for purposes of carrying out this subsection. 

8 ‘‘(B) ANNUAL ESTIMATES.— 

9 ‘‘(i) IN GENERAL.—Not later than 

10 May 1 of each fiscal year, the Attorney 

11 General, in consultation with the Sec12 retary, shall submit to Congress a report 

13 providing an estimate of the amount of 

14 claims (together with related fees and ex15 penses of witnesses) that, by reason of the 

16 acts or omissions of health professional 

17 volunteers, will be paid pursuant to this 

18 section during the calendar year that be19 gins in the following fiscal year. 

20 ‘‘(ii) APPLICABILITY.—Subsection 

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

22 clause (i) relating to health professional 

23 volunteers to the same extent and in the 

24 same manner as that subsection applies to 

25 the estimate under that subsection relating 


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1 to officers, governing board members, em2 ployees, and contractors of entities de3 scribed in subsection (g)(4). 

4 ‘‘(C) TRANSFERS.—Not later than Decem5 ber 31 of each fiscal year, the Secretary shall 

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

7 to the appropriate accounts in the Treasury an 

8 amount equal to the estimate made under sub9 paragraph (B) for the calendar year beginning 

10 in that fiscal year, subject to the extent of 

11 amounts in the fund. 

12 ‘‘(5) DEFINITION OF SERVICE UNIT.—In this 

13 subsection, the term ‘Service unit’ has the meaning 

14 given the term in section 4 of the Indian Health 

15 Care Improvement Act (25 U.S.C. 1603). 

16 ‘‘(6) RULE OF CONSTRUCTION.—Nothing in 

17 this subsection shall be construed to inhibit the au18 thority of an Indian tribe to enter into or maintain 

19 a compact or contract under the Indian Self-Deter20 mination and Education Assistance Act (25 U.S.C. 

21 5304 et seq.). 

22 ‘‘(7) EFFECTIVE DATES.— 

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

24 subparagraph (B), this subsection shall take ef25 fect on October 1, 2019. 


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1 ‘‘(B) REGULATIONS, APPLICATIONS, AND

2 REPORTS.—Effective on the date of the enact3 ment of the Restoring Accountability in the In4 dian Health Service Act of 2017, the Secretary 

5 may— 

6 ‘‘(i) prescribe regulations for carrying 

7 out this subsection; and 

8 ‘‘(ii) accept and consider applications 

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

10 SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR IN11 DIAN HEALTH SERVICE LOAN REPAYMENT 

12 PROGRAM. 

13 Section 108 of the Indian Health Care Improvement 

14 Act (25 U.S.C. 1616a) is amended— 

15 (1) by amending subparagraph (B) of sub16 section (b)(1) to read as follows: 

17 ‘‘(B) have— 

18 ‘‘(i)(I) a degree in a health profession; 

19 and 

20 ‘‘(II) a license to practice a health 

21 profession in a State; or 

22 ‘‘(ii)(I) a degree in business adminis23 tration with an emphasis in health care 

24 management (as defined by the Secretary), 


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1 health administration, hospital administra2 tion, or public health; and 

3 ‘‘(II) a license or certification to prac4 tice in the field of business administration, 

5 health administration, hospital administra6 tion, or public health in a State, if the Sec7 retary determines such license or certifi8 cation necessary for the Indian health pro9 gram to which the individual will be as10 signed;’’; 

11 (2) by amending clause (iii) of subsection 

12 (f)(1)(B) to read as follows: 

13 ‘‘(iii) to serve for a time period (re14 ferred to in this section as the ‘period of 

15 obligated service’) equal to— 

16 ‘‘(I) 2 years or such longer pe17 riod as the individual may agree to 

18 serve in the full-time practice of such 

19 individual’s profession in an Indian 

20 health program to which the indi21 vidual may be assigned by the Sec22 retary; or 

23 ‘‘(II) 4 years or such longer pe24 riod as the individual may agree to 

25 serve in the half-time practice of such 


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1 individual’s profession in an Indian 

2 health program to which the indi3 vidual may be assigned by the Sec4 retary;’’; and 

5 (3) in subsection (g)(2)— 

6 (A) by redesignating subparagraph (B) as 

7 subparagraph (C); and 

8 (B) in subparagraph (A)— 

9 (i) by striking the first sentence of the 

10 matter preceding clause (i) and inserting 

11 the following: ‘‘In the case of an individual 

12 who contracts to serve a period of obli13 gated service under subsection 

14 (f)(1)(B)(iii)(I), for each year of such obli15 gated service, the Secretary may pay up to 

16 $35,000 (or an amount equal to the 

17 amount specified in section 338B(g)(2)(A) 

18 of the Public Health Service Act (42 

19 U.S.C. 254l–1(g)(2)(A))) on behalf of the 

20 individual for loans described in paragraph 

21 (1). In the case of an individual who con22 tracts to serve a period of obligated service 

23 under subsection (f)(1)(B)(iii)(II), for each 

24 year of such obligated service, the Sec25 retary may pay up to $17,500 on behalf of 


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1 the individual for loans described in para2 graph (1)’’; and 

3 (ii) by striking ‘‘In making a deter4 mination’’ and inserting the following: 

5 ‘‘(B) In making a determination under this 

6 paragraph’’. 

7 SEC. 105. IMPROVEMENTS IN HIRING PRACTICES. 

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

9 Care Improvement Act (25 U.S.C. 1661 et seq.) is amend10 ed by adding at the end the following: 

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

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

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

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

15 3328 of such title), a candidate directly to a position with16 in the Service for which the candidate meets the job de17 scription of the Office of Personnel Management. 

18 ‘‘(b) TRIBAL NOTIFICATION.—Before appointing, 

19 hiring, promoting, transferring, or reassigning a candidate 

20 to a Senior Executive Service position or the position of 

21 a manager at an Area office or Service unit, the Secretary 

22 shall provide notice to each Indian tribe located within the 

23 defined geographic area of such Area office or Service 

24 unit, as the case may be, of the content of an inclusion 

25 in an employment record under section 606(j).’’. 


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1 (b) IN GENERAL.—Subsection (c) of section 2 of the 

2 Act of December 15, 1979 (25 U.S.C. 5117), is amended 

3 by adding the following: 

4 ‘‘(3) IHS WAIVERS.—The Secretary of Health 

5 and Human Services shall seek from each Indian 

6 tribe concerned, a waiver of Indian preference laws 

7 for a personnel action that is with respect to— 

8 ‘‘(A) an Indian Health Service unit in 

9 which 20 percent or more of the positions in the 

10 Service unit are not filled by a full-time em11 ployee of the Indian Health Service for a period 

12 of 6 months or longer; or 

13 ‘‘(B) a former employee of the Indian 

14 Health Service or a formal tribal employee who 

15 was removed from such former employment 

16 within, or demoted for performance or mis17 conduct that occurred during, the 5-year period 

18 the date of such personnel action.’’. 

19 SEC. 106. REMOVAL OR DEMOTION OF INDIAN HEALTH 

20 SERVICE EMPLOYEES BASED ON PERFORM21 ANCE OR MISCONDUCT. 

22 Title VI of the Indian Health Care Improvement Act 

23 (25 U.S.C. 1661 et seq.), as amended by section 105, is 

24 further amended by adding at the end the following: 


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1 ‘‘SEC. 606. REMOVAL OR DEMOTION OF SERVICE EMPLOY2 EES BASED ON PERFORMANCE OR MIS3 CONDUCT. 

4 ‘‘(a) DEFINITIONS.—In this section and section 607: 

5 ‘‘(1) EMPLOYEE.—The term ‘employee’ has the 

6 meaning given the term in section 2105 of title 5, 

7 United States Code. 

8 ‘‘(2) MANAGER.— 

9 ‘‘(A) IN GENERAL.—The term ‘manager’ 

10 has the meaning given the term ‘management 

11 official’ in section 7103(a) of title 5, United 

12 States Code. 

13 ‘‘(B) INCLUSIONS.—The term ‘manager’ 

14 includes, as employed at any facility of the 

15 Service— 

16 ‘‘(i) a chief executive officer; 

17 ‘‘(ii) a chief medical officer; and 

18 ‘‘(iii) a department director. 

19 ‘‘(3) MISCONDUCT.—The term ‘misconduct’ 

20 means neglect of duty, malfeasance, or failure to ac21 cept a directed reassignment or to accompany a po22 sition in a transfer of function. 

23 ‘‘(4) PERSONNEL ACTION.—The term ‘per24 sonnel action’ means a removal, transfer, or reduc25 tion in grade under subsection (b)(2). 


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

2 the Secretary of Health and Human Services, acting 

3 through the Director of the Service. 

4 ‘‘(6) SENIOR EXECUTIVE.—The term ‘senior ex5 ecutive’ means a career appointee (as that term is 

6 defined in section 3132(a) of title 5, United States 

7 Code). 

8 ‘‘(7) SENIOR EXECUTIVE SERVICE POSITION.— 

9 The term ‘Senior Executive Service position’ has the 

10 meaning given the term in section 3132(a) of title 

11 5, United States Code. 

12 ‘‘(8) SUPERVISOR.—The term ‘supervisor’ has 

13 the meaning given the term in section 7103(a) of 

14 title 5, United States Code. 

15 ‘‘(b) REMOVAL BASED ON PERFORMANCE OR MIS16 CONDUCT.— 

17 ‘‘(1) IN GENERAL.—Subject to paragraph (4), 

18 the Secretary may remove an employee of the Serv19 ice from the position the employee occupies if the 

20 Secretary determines the performance or misconduct 

21 of the employee warrants removal. 

22 ‘‘(2) ACTION.—If the Secretary removes an em23 ployee under paragraph (1), the Secretary may— 


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1 ‘‘(A) remove the employee from the civil 

2 service (as defined in section 2101 of title 5, 

3 United States Code); 

4 ‘‘(B) in the case of an individual described 

5 in paragraph (3), transfer the individual from 

6 the Senior Executive Service position to a Gen7 eral Schedule position at any grade of the Gen8 eral Schedule for which the individual is quali9 fied and that the Secretary determines is appro10 priate; or 

11 ‘‘(C) in the case of a manager or super12 visor, reduce the grade of the manager or su13 pervisor to any other grade for which the indi14 vidual is qualified and that the Secretary deter15 mines is appropriate. 

16 ‘‘(3) INDIVIDUAL DESCRIBED.—An individual 

17 referred to in paragraph (2)(B) is a senior executive 

18 that— 

19 ‘‘(A) previously occupied a permanent posi20 tion within the competitive service (as that term 

21 is defined in section 2102 of title 5, United 

22 States Code); or 

23 ‘‘(B) previously occupied a permanent posi24 tion within the excepted service (as that term is 


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1 defined in section 2103 of title 5, United States 

2 Code). 

3 ‘‘(4) DUE PROCESS.—Before an employee may 

4 be subject to a personnel action, the Secretary shall 

5 provide to the employee— 

6 ‘‘(A) not less than 10 days before the per7 sonnel action, written notice of the proposed 

8 personnel action; and 

9 ‘‘(B) an opportunity and reasonable time 

10 to answer orally or in writing. 

11 ‘‘(c) PAY OF CERTAIN INDIVIDUALS.— 

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

13 provision of law, including the requirements of sec14 tion 3594 of title 5, United States Code, any indi15 vidual transferred to a General Schedule position 

16 under subsection (b)(2)(B) or subject to a reduction 

17 in grade under subsection (b)(2)(C) shall, beginning 

18 on the date of the transfer, receive the annual rate 

19 of pay applicable to the position. 

20 ‘‘(2) REQUIREMENTS.— 

21 ‘‘(A) IN GENERAL.—An individual trans22 ferred to a General Schedule position under 

23 subsection (b)(2)(B) or subject to a reduction 

24 in grade under subsection (b)(2)(C)— 


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1 ‘‘(i) may not be placed on administra2 tive leave or any other category of paid 

3 leave during the period during which an 

4 appeal (if any) under subsection (e)(2)(A) 

5 is ongoing; and 

6 ‘‘(ii) may only receive pay if the indi7 vidual— 

8 ‘‘(I) reports for duty; and 

9 ‘‘(II) performs a primary duty or 

10 an alternative primary duty, as each 

11 term is described in section 551.104 

12 of title 5, Code of Federal Regulations 

13 (or a successor regulation). 

14 ‘‘(B) FAILURE TO REPORT.—If an indi15 vidual transferred to a General Schedule posi16 tion under subsection (b)(2)(B) or subject to a 

17 reduction in grade under subsection (b)(2)(C) 

18 does not report for duty, pursuant to subsection 

19 (f)(3)(B), the individual shall not receive any 

20 increase in rate of pay or other benefit. 

21 ‘‘(d) NOTICE TO CONGRESS.—Not later than 30 days 

22 after the date on which the Secretary takes a personnel 

23 action, the Secretary shall submit, in writing, a notice of 

24 the personnel action and the reason for the personnel ac25 tion to— 


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1 ‘‘(1) the Committee on Indian Affairs of the 

2 Senate; 

3 ‘‘(2) the Committee on Health, Education, 

4 Labor, and Pensions of the Senate; 

5 ‘‘(3) the Committee on Natural Resources of 

6 the House of Representatives; 

7 ‘‘(4) the Committee on Energy and Commerce 

8 of the House of Representatives; and 

9 ‘‘(5) the Inspector General of the Department. 

10 ‘‘(e) PROCEDURE.— 

11 ‘‘(1) INAPPLICABILITY.—The procedures under 

12 chapters 43 and 75 of title 5, United States Code, 

13 shall not apply to a personnel action. 

14 ‘‘(2) APPEAL.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B) and subsection (f), an employee sub17 ject to a personnel action may appeal the per18 sonnel action to the Merit Systems Protection 

19 Board under section 7701 of title 5, United 

20 States Code. 

21 ‘‘(B) LIMITATION.—An appeal under sub22 paragraph (A) may only be made if the appeal 

23 is made not later than 7 days after the date of 

24 the personnel action. 


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1 ‘‘(f) EXPEDITED REVIEW BY ADMINISTRATIVE LAW

2 JUDGE.— 

3 ‘‘(1) IN GENERAL.— 

4 ‘‘(A) REFERRAL.—On receipt of an appeal 

5 under subsection (e)(2)(A), the Merit Systems 

6 Protection Board shall refer the appeal to an 

7 administrative law judge pursuant to section 

8 7701(b)(1) of title 5, United States Code. 

9 ‘‘(B) EXPEDITION.—The administrative 

10 law judge to whom an appeal is referred under 

11 subparagraph (A) shall— 

12 ‘‘(i) expedite the appeal under section 

13 7701(b)(1) of title 5, United States Code; 

14 and 

15 ‘‘(ii) issue a decision in each case not 

16 later than 21 days after the date of the ap17 peal. 

18 ‘‘(2) FINALITY.—Notwithstanding any other 

19 provision of law, including section 7703 of title 5, 

20 United States Code, the decision of an administra21 tive law judge under paragraph (1) shall be final 

22 and shall not be subject to any further administra23 tive appeal. 

24 ‘‘(3) FAILURE TO ISSUE DECISION.— 


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1 ‘‘(A) IN GENERAL.—In any case in which 

2 an administrative law judge fails to issue a de3 cision in accordance with the 21-day require4 ment described in paragraph (1)(B)(ii), the per5 sonnel action shall be treated as final. 

6 ‘‘(B) TRANSPARENCY.—In any case in 

7 which a personnel action is treated as final 

8 under subparagraph (A), the Merit Systems 

9 Protection Board shall, not later than 14 days 

10 after the date on which the personnel action be11 comes final, submit a letter explaining the rea12 sons why a decision was not issued in accord13 ance with the 21-day requirement described in 

14 paragraph (1)(B)(ii) to— 

15 ‘‘(i) the Committee on Indian Affairs 

16 of the Senate; 

17 ‘‘(ii) the Committee on Health, Edu18 cation, Labor, and Pensions of the Senate; 

19 ‘‘(iii) the Committee on Natural Re20 sources of the House of Representatives; 

21 and 

22 ‘‘(iv) the Committee on Energy and 

23 Commerce of the House of Representa24 tives. 


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1 ‘‘(4) RESTRICTION.—The Merit Systems Pro2 tection Board or an administrative law judge may 

3 not stay any personnel action. 

4 ‘‘(5) CESSATION OF PAY INCREASES AND BENE5 FITS.—During the period beginning on the date on 

6 which an employee appeals a removal from the civil 

7 service under subsection (e)(2)(A) and ending on the 

8 date on which the removal becomes final, the em9 ployee may not receive any— 

10 ‘‘(A) increase in rate of pay; or 

11 ‘‘(B) award, bonus, incentive, allowance, 

12 differential, student loan repayment, special 

13 payment, or other benefit. 

14 ‘‘(6) ASSISTANCE.—To the maximum extent 

15 practicable, the Secretary shall provide such infor16 mation and assistance as may be necessary to ensure 

17 an appeal under this subsection is expedited to— 

18 ‘‘(A) the Merit Systems Protection Board; 

19 and 

20 ‘‘(B) any administrative law judge to 

21 whom an appeal under this section is referred. 

22 ‘‘(g) EMPLOYMENT RECORD TRANSPARENCY.—The 

23 Secretary shall ensure that the employment records for 

24 any employee subject to a personnel action, regardless of 

25 whether that personnel action is final, include— 


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1 ‘‘(1) a notation that the employee was subject 

2 to a personnel action; and 

3 ‘‘(2) a description of the disposition or status of 

4 the personnel action or any appeal of the personnel 

5 action under this section. 

6 ‘‘(h) RELATION TO TITLE 5, UNITED STATES

7 CODE.— 

8 ‘‘(1) ADDITIONAL AUTHORITY.—The personnel 

9 action authorities provided to the Secretary under 

10 this section are in addition to the authorities pro11 vided under chapters 43 and 75 of title 5, United 

12 States Code. 

13 ‘‘(2) REMOVAL OF SENIOR EXECUTIVES.—Sec14 tion 3592(b)(1) of title 5, United States Code, shall 

15 not apply to a personnel action.’’. 

16 SEC. 107. STANDARDS TO IMPROVE TIMELINESS OF CARE. 

17 Title IV of the Indian Health Care Improvement Act 

18 (25 U.S.C. 1641 et seq.) is amended by adding at the end 

19 the following: 

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

21 ‘‘(a) IN GENERAL.—Not later than 180 days after 

22 the date of enactment of the Restoring Accountability in 

23 the Indian Health Service Act of 2017, the Secretary, act24 ing through the Service, shall— 


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

2 measure the timeliness of the provision of health 

3 care services in Service facilities; and 

4 ‘‘(2) provide such standards to each Service 

5 unit. 

6 ‘‘(b) DATA COLLECTION.—The Secretary, acting 

7 through the Service, shall develop a process for each Serv8 ice unit to submit to the Secretary data with respect to 

9 the standards established under subsection (a)(1).’’. 

10 SEC. 108. TRIBAL CULTURE AND HISTORY. 

11 Section 113 of the Indian Health Care Improvement 

12 Act (25 U.S.C. 1616f ) is amended— 

13 (1) in subsection (a)— 

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

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

16 (B) by striking ‘‘appropriate employees of 

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

18 Service, locum tenens medical providers, and 

19 other contracted employees who work at Service 

20 hospitals or other Service units and whose em21 ployment requires regular direct patient ac22 cess’’; and 

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

24 ‘‘(c) Notwithstanding any other provision of law, be25 ginning with the year of the date of enactment of the ReVerDate Sep 11 2014 23:28 Jun 01, 2017 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\S1250.IS S1250

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1 storing Accountability in the Indian Health Service Act 

2 of 2017, each employee or provider described in subsection 

3 (a) who enters into a contract with the Service on or after 

4 the date of such implementation shall, as a condition of 

5 employment, annually participate in and complete such 

6 training program. For purposes of the preceding sentence, 

7 participation in such training program may not be consid8 ered complete for the year involved until the individual 

9 satisfies each requirement, including testing, if applicable, 

10 of the training program for such year, as specified by the 

11 Secretary.’’. 

12 SEC. 109. STAFFING DEMONSTRATION PROJECT. 

13 Title VIII of the Indian Health Care Improvement 

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

15 the end the following: 

16 ‘‘SEC. 833. STAFFING DEMONSTRATION PROJECT. 

17 ‘‘(a) IN GENERAL.—The Secretary, acting through 

18 the Service, shall establish a demonstration project that 

19 authorizes the Service to provide federally managed Serv20 ice units with additional staffing resources with the goal 

21 that the resources become self-sustaining. 

22 ‘‘(b) SELECTION.—In selecting Service units for par23 ticipation, the Secretary shall consider whether a Service 

24 unit services an Indian tribe that— 


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1 ‘‘(1) has utilized or contributed substantial trib2 al funds to construct a health facility used by the 

3 Service or identified in the master plan for the Serv4 ice unit; 

5 ‘‘(2) is located in a State or States with Med6 icaid reimbursements plans or policies that will in7 crease the likelihood that the staffing resources pro8 vided will be self-sustaining; and 

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

10 paragraph (1) under historical staffing ratios that 

11 have not been equalized or updated by the Service 

12 or any other Service program to reflect current 

13 staffing needs. 

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

15 Service unit under this section shall be for a duration that 

16 the Secretary, in consultation with the applicable Indian 

17 tribe, determines appropriate, except that each staffing 

18 position provided shall be for a period of not less than 

19 3 fiscal years. 

20 ‘‘(d) REPORT.—Not later than 5 years after the Sec21 retary ends the demonstration project under this section, 

22 the Secretary shall prepare and submit a report to the 

23 Committee on Indian Affairs and the Committee on 

24 Health, Education, Labor, and Pensions of the Senate, 

25 and the Committee on Natural Resources and the ComVerDate Sep 11 2014 23:28 Jun 01, 2017 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1250.IS S1250

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1 mittee on Energy and Commerce of the House of Rep2 resentatives, regarding the project, including— 

3 ‘‘(1) whether the staffing resources resulted in 

4 additional revenue for the Service unit sufficient to 

5 maintain the staff on a permanent basis; 

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

7 reduced the unmet staffing need for the Service unit; 

8 and 

9 ‘‘(3) whether the demonstration project could 

10 be deployed to reduce unmet staffing needs through11 out the Service.’’. 

12 SEC. 110. RULE ESTABLISHING TRIBAL CONSULTATION 

13 POLICY. 

14 Title VIII of the Indian Health Care Improvement 

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

16 is further amended by adding at the end the following: 

17 ‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 

18 POLICY. 

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

20 date of enactment of the Restoring Accountability in the 

21 Indian Health Service Act of 2017, the Secretary shall es22 tablish, through the negotiated rulemaking process de23 scribed in subsection (b), a rule establishing a tribal con24 sultation policy for the Service. 


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1 ‘‘(b) NEGOTIATED RULEMAKING.—Before publishing 

2 a proposed rule described in subsection (a), the Secretary 

3 shall follow the provisions of subchapter III of chapter 5 

4 of title 5, United States Code (commonly known as the 

5 ‘Negotiated Rulemaking Act of 1990’). 

6 ‘‘(c) CONTENTS OF TRIBAL CONSULTATION POL7 ICY.—The policy established under the rule described in 

8 subsection (a) shall— 

9 ‘‘(1) update, and replace, the tribal consultation 

10 policy established under Circular No. 2006–01 of the 

11 Service, or any successor policy; and 

12 ‘‘(2) include the following: 

13 ‘‘(A) A process for determining when the 

14 Service will notify Indian tribes, and a descrip15 tion of how the Indian tribes should be notified. 

16 ‘‘(B) A determination of what actions or 

17 agency decisions by the Service will trigger a re18 quirement for meaningful consultation with In19 dian tribes. 

20 ‘‘(C) A determination of what actions con21 stitute meaningful consultation with Indian 

22 tribes.’’. 


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1 TITLE II—EMPLOYEE 

2 PROTECTIONS 

3 SEC. 201. RIGHT OF FEDERAL EMPLOYEES TO PETITION 

4 CONGRESS. 

5 (a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO

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

7 States Code, is amended— 

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

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

10 (2) by adding at the end the following new sub11 section: 

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

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

14 be subject to any adverse action described in paragraphs 

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

16 procedure described in section 7513 and any other appli17 cable procedure.’’. 

18 (b) ELECTRONIC NOTIFICATION OF RIGHT OF EM19 PLOYEES OF INDIAN HEALTH SERVICE.— 

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

21 Human Services (referred to in this subsection as 

22 the ‘‘Secretary’’), acting through the Director of the 

23 Indian Health Service, shall, in accordance with 

24 paragraphs (2) through (6), provide to each em25 ployee of the Indian Health Service, and electroniVerDate Sep 11 2014 23:28 Jun 01, 2017 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S1250.IS S1250

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1 cally post, a memorandum providing notice of the 

2 right to petition Congress under section 7211 of title 

3 5, United States Code. 

4 (2) CONTENTS.—The memorandum described 

5 in paragraph (1) shall include the following state6 ment: ‘‘It is a violation of section 7211 of title 5, 

7 United States Code, for any Federal agency or em8 ployee to require a Federal employee to seek ap9 proval, guidance, or any other form of input prior to 

10 contacting Congress with information, even if that 

11 information is in relation to the job responsibilities 

12 of the employee. A Federal employee found to have 

13 interfered with or denied the right of another Fed14 eral employee under such section shall be subject to 

15 an adverse action described in paragraphs (1) 

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

17 Code, including a suspension for more than 14 days 

18 without pay.’’. 

19 (3) SUBMISSION.—Not later than 30 days after 

20 the date of enactment of this Act, the Secretary 

21 shall submit the memorandum described in para22 graph (1) to the Inspector General of the Depart23 ment of Health and Human Services (referred to in 

24 this subsection as the ‘‘Inspector General’’) for ap25 proval. 


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1 (4) APPROVAL OR DISAPPROVAL.—Not later 

2 than 30 days after the submission of the memo3 randum under paragraph (3), or a revised memo4 randum under paragraph (6), the Inspector General 

5 shall approve or disapprove the memorandum or re6 vised memorandum, as the case may be. 

7 (5) NOTICE.—In the case of an approval under 

8 paragraph (4), not later than 30 days after such ap9 proval, the Secretary shall— 

10 (A) provide to each employee of the Indian 

11 Health Service an electronic copy of the ap12 proved memorandum; and 

13 (B) post such memorandum in a clear and 

14 conspicuous place on the website of the Indian 

15 Health Service for a period not less than 120 

16 days. 

17 (6) REVISED MEMORANDUM.—In the case of a 

18 disapproval under paragraph (4), not later than 15 

19 days after such disapproval, the Secretary shall sub20 mit a revised memorandum to the Inspector General 

21 for approval under paragraph (4). 

22 SEC. 202. FISCAL ACCOUNTABILITY. 

23 Title VI of the Indian Health Care Improvement Act 

24 (25 U.S.C. 1661 et seq.), as amended by sections 105 and 


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1 106, is further amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 607. FISCAL ACCOUNTABILITY. 

4 ‘‘(a) MANAGEMENT OF FUNDS.— 

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

6 submit the professional housing plan under section 

7 301(a) of the Restoring Accountability in the Indian 

8 Health Service Act of 2017 or the staffing plan 

9 under section 301(b) of that Act, the Secretary may 

10 not receive, obligate, transfer, or expend any 

11 amounts for a salary increase or bonus of an indi12 vidual described in paragraph (2) until the profes13 sional housing plan or staffing plan, as the case may 

14 be, is submitted. 

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

16 described in this paragraph is an individual em17 ployed in a position in the Service that is a posi18 tion— 

19 ‘‘(A) described under sections 5312 

20 through 5316 of title 5, United States Code; 

21 ‘‘(B) placed in level IV or V of the Execu22 tive Schedule under section 5317 of title 5, 

23 United States Code; 

24 ‘‘(C) as a limited term appointee, limited 

25 emergency appointee, or noncareer appointee in 


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1 the Senior Executive Service, as defined under 

2 paragraphs (5), (6), and (7), respectively, of 

3 section 3132(a) of title 5, United States Code; 

4 or 

5 ‘‘(D) under section 213.3301 or 213.3302 

6 of title 5, Code of Federal Regulations. 

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

8 ‘‘(1) IN GENERAL.—The Secretary shall use 

9 amounts available to the Indian Health Service that 

10 are not obligated or expended, including base budget 

11 funding and third party collections, during the fiscal 

12 year for which the amounts are made available, and 

13 that remain available, only to support patient care 

14 by using such funds for the costs of— 

15 ‘‘(A) essential medical equipment; 

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

17 ‘‘(C) staffing. 

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

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

20 any case where the amounts were originally made 

21 available for a particular Service unit, such amounts 

22 are used to benefit Indians served by that Service 

23 unit. 

24 ‘‘(3) RESTRICTIONS.—The Secretary may not 

25 use amounts described in paragraph (1)— 


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

2 Area office; or 

3 ‘‘(B) to increase the rate of pay of any em4 ployee of an Area office. 

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

6 after the end of each quarter of a fiscal year, the Secretary 

7 shall submit a report describing the authorizations, ex8 penditures, outlays, transfers, reprogramming, and obliga9 tions of each level of the Service, including the head10 quarters, each Area office, each Service unit, and each 

11 health clinic or facility, to— 

12 ‘‘(1) each Indian tribe; 

13 ‘‘(2) in the Senate— 

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

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

16 Labor, and Pensions; 

17 ‘‘(C) the Committee on Appropriations; 

18 and 

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

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

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

22 ‘‘(B) the Committee on Energy and Com23 merce; 

24 ‘‘(C) the Committee on Appropriations; 

25 and 


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1 ‘‘(D) the Committee on the Budget. 

2 ‘‘(d) STATUS REPORTS.— 

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

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

5 year, the Secretary shall provide to each entity de6 scribed in paragraphs (1) through (3) of subsection 

7 (c) a report describing the safety, billing, certifi8 cation, credential, and compliance statuses of each 

9 facility managed, operated, or otherwise supported 

10 by the Service. 

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

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

13 shall immediately provide to each entity described in 

14 paragraphs (1) through (3) of subsection (c) an up15 date describing such change. 

16 ‘‘(e) RULE OF CONSTRUCTION.—This section may 

17 not be construed to inhibit the authority of an Indian tribe 

18 to enter into or maintain a compact or contract under the 

19 Indian Self-Determination and Education Assistance Act 

20 (25 U.S.C. 5304 et seq.).’’. 

21 TITLE III—REPORTS 

22 SEC. 301. DEFINITIONS. 

23 In this title: 

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

25 the Secretary of Health and Human Services. 


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

2 Indian Health Service. 

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

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

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

6 1603). 

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

8 HUMAN SERVICES. 

9 (a) IHS PROFESSIONAL HOUSING PLAN.—Not later 

10 than 90 days after the date of enactment of this Act, the 

11 Secretary shall develop, make publicly available, and sub12 mit to Congress and the Comptroller General of the 

13 United States a written plan to address the professional 

14 housing needs of employees of the Service that comports 

15 with the practices and recommendations of the Govern16 ment Accountability Office relating to professional hous17 ing. 

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

19 Not later than 90 days after the date of the enactment 

20 of this Act, the Secretary shall develop, make publicly 

21 available, and submit to Congress and the Comptroller 

22 General of the United States a written plan to address 

23 staffing needs in the Service that comports with the prac24 tices of the Government Accountability Office relating to 

25 workforce planning. 


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1 (c) INDIAN HEALTH CARE IMPROVEMENT ACT RE2 PORT.—Not later than 1 year after the date of enactment 

3 of this Act, and each year thereafter for a period of 5 

4 years, the Secretary shall develop, make publicly available, 

5 and submit to Congress a report on the data submitted 

6 under section 412(b) of the Indian Health Care Improve7 ment Act, as amended by section 107. 

8 SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 

9 (a) IHS HOUSING NEEDS REPORT.— 

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

11 the date on which the Comptroller General of the 

12 United States receives the professional housing plan 

13 under section 302(a), the Comptroller General shall 

14 develop and submit to Congress a report on the pro15 fessional housing needs of employees of the Service. 

16 (2) CONTENTS.—The report required under 

17 paragraph (1) shall include the following: 

18 (A) An evaluation of any existing, as of the 

19 date of the report, assessments and projections 

20 for the professional housing needs of employees 

21 of the Service, including discussion and conclu22 sion as to whether existing assessments and 

23 projections accurately reflect the professional 

24 housing needs of employees of the Service. 


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1 (B) An assessment of the professional 

2 housing needs of employees of the Service for 

3 each Service area (as defined in section 4 of the 

4 Indian Health Care Improvement Act (25 

5 U.S.C. 1603)). 

6 (C) An assessment of the professional 

7 housing plan developed by the Secretary under 

8 section 302(a). 

9 (b) IHS STAFFING NEEDS REPORT.— 

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

11 the date on which the Comptroller General receives 

12 the report under section 302(b), the Comptroller 

13 General shall prepare and submit to Congress a re14 port on the staffing needs of the Service. 

15 (2) CONTENTS.—The report required under 

16 paragraph (1) shall include the following: 

17 (A) A description of the number and type 

18 of full-time positions needed at each facility of 

19 the Service and the amount of funds necessary 

20 to maintain such positions. 

21 (B) An assessment of the use of inde22 pendent contractors, including the number of 

23 independent contractors hired to fill vacant full24 time positions and amounts spent on indeVerDate Sep 11 2014 23:28 Jun 01, 2017 Jkt 069200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1250.IS S1250

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1 pendent contractors who provide health care 

2 services. 

3 (C) An assessment of the staffing plan de4 veloped by the Secretary under section 302(b). 

5 (c) WHISTLEBLOWER PROTECTIONS REPORT.— 

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

7 the date of enactment of this Act, the Comptroller 

8 General shall develop and submit to Congress a re9 port on the efficacy of existing protections for whis10 tleblowers in the Service. 

11 (2) CONTENTS.—The report required under 

12 paragraph (1) shall include the following: 

13 (A) A discussion and conclusion as to 

14 whether the Service has taken proper steps to 

15 prevent retaliation against whistleblowers. 

16 (B) If applicable, any recommendations for 

17 changes to the policy of the Service with respect 

18 to whistleblowers. 

19 (C) A discussion and conclusion as to 

20 whether the official email accounts of employees 

21 of the Service are appropriately monitored. 

22 SEC. 304. INSPECTOR GENERAL REPORTS. 

23 (a) PATIENT CARE REPORTS.— 

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

25 the date of enactment of this Act, and every 2 years 


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1 thereafter, the Inspector General of the Department 

2 of Health and Human Services shall develop and 

3 submit to Congress and the Service a report on pa4 tient harm events occurring in Service units and de5 ferrals and denials of care of patients of the Service. 

6 (2) CONTENTS.—The report required under 

7 paragraph (1) shall include the following: 

8 (A) An evaluation of the number and kind 

9 of events that contribute to patient deaths in a 

10 Service unit and recommendations regarding re11 ducing the number of patient deaths. 

12 (B) An evaluation of the Service’s tracking 

13 and reporting of, and response to, patient harm 

14 events and recommendations regarding how to 

15 improve such tracking, reporting, and response. 

16 (C) The effects of deferrals and denials of 

17 care on patients of the Service, including pa18 tient outcomes, and recommendations regarding 

19 how to reduce deferrals and denials of care. 

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

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

22 General shall— 

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

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


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1 (2) provide to the Service recommendations and 

2 technical assistance regarding implementation of im3 proved reporting systems, procedures, standards, 

4 and protocols. 

5 SEC. 305. TRANSPARENCY IN CMS SURVEYS. 

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

7 1395qq) is amended by adding at the end the following: 

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

9 the Administrator of the Centers for Medicare & Medicaid 

10 Services shall conduct surveys to assess the compliance of 

11 each hospital or skilled nursing facility of the Indian 

12 Health Service with— 

13 ‘‘(A) section 1867; and 

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

15 under this title. 

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

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

18 Medicare & Medicaid Services. Such posting shall comply 

19 with the Federal regulations concerning the privacy of in20 dividually identifiable health information promulgated 

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

22 and Accountability Act of 1996.’’. 


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1 TITLE IV—TECHNICAL 

2 AMENDMENTS 

3 SEC. 401. TECHNICAL AMENDMENTS. 

4 The Indian Health Care Improvement Act (25 U.S.C. 

5 1601 et seq.) is amended— 

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

7 place such term appears (regardless of casing and 

8 typeface and including in the headings) and insert9 ing ‘‘purchased/referred care’’ (with appropriate cas10 ing and typeface); and 

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

12 place such term appears (regardless of casing and 

13 typeface and including in the headings) and insert14 ing ‘‘purchased/referred care’’ (with appropriate cas15 ing and typeface). 

Æ 


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