I 

118TH CONGRESS 

2D SESSION H. R. 8966 

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 HOUSE OF REPRESENTATIVES 

JULY 9, 2024 

Mr. JOHNSON of South Dakota introduced the following bill; which was referred to the Committee on Natural Resources, and in addition to the 

Committees on Energy and Commerce, Ways and Means, and Oversight 

and Accountability, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

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 2024’’. 


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1 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—INDIAN HEALTH SERVICE IMPROVEMENTS 

Sec. 101. Incentives for recruitment and retention. 

Sec. 102. Medical credentialing system. 

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

Health Service. 

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

Sec. 105. Improvements in hiring practices. 

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

executives and employees of the Indian Health Service. 

Sec. 107. Tribal culture and history. 

Sec. 108. Staffing demonstration program. 

Sec. 109. Rule establishing Tribal consultation policy. 

Sec. 110. Treatment of certain hospitals. 

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

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

Sec. 113. Fitness of health care providers. 

Sec. 114. Standards to improve timeliness of care. 

TITLE II—EMPLOYEE PROTECTIONS 

Sec. 201. Employee protections against retaliation. 

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

Sec. 203. Fiscal accountability. 

TITLE III—REPORTS 

Sec. 301. Definitions. 

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

Sec. 303. Reports by the Comptroller General. 

Sec. 304. Inspector General reports. 

Sec. 305. Transparency in CMS surveys. 

TITLE IV—TECHNICAL AMENDMENTS 

Sec. 401. Technical amendments. 


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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: 

8 ‘‘SEC. 125. INCENTIVES FOR RECRUITMENT AND RETEN9 TION. 

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

11 PERSONNEL AND PAY SYSTEM.—The Secretary shall es12 tablish a personnel and pay system for physicians, den13 tists, nurses, and other health care professionals employed 

14 by the Service that provides a personnel and pay system 

15 that, to the maximum extent practicable, is comparable 

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

17 other health care professionals, respectively, under sub18 chapters III and IV of chapter 74 of title 38, United 

19 States Code. 

20 ‘‘(b) 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 2024, the Secretary may establish a 


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1 program to provide tenant-based rental assistance to 

2 an employee of the Service who— 

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

4 year at a Service unit designated by the Admin5 istrator of the Health Resources and Services 

6 Administration as a health professional short7 age area (as defined in section 332(a) of the 

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

9 with the greatest staffing need; and 

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

11 by the Secretary. 

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

13 Secretary under paragraph (1) shall terminate on 

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

15 program is established. 

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

17 date on which a program established under para18 graph (1) is terminated in accordance with para19 graph (2), the Secretary shall submit to Congress a 

20 report describing, with respect to that program— 

21 ‘‘(A) the costs of the program; 

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

23 ‘‘(C) the effects of the program on local fa24 cility staffing needs. 


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

2 provide a benefit under subsection (b) to— 

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

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

5 the date of the agreement; or 

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

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

8 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 amended by adding at the end the following: 

13 ‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 

14 ‘‘(a) IN GENERAL.— 

15 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION

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

17 enactment of the Restoring Accountability in the In18 dian Health Service Act of 2024, the Secretary, act19 ing through the Service (referred to in this section 

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

21 (b), shall develop and implement a Service-wide cen22 tralized credentialing system (referred to in this sec23 tion as the ‘credentialing system’) to credential li24 censed health professionals who seek to provide 

25 health care services at any Service unit. 


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

2 credentialing system, the Secretary— 

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

4 licensed health professionals who were 

5 credentialed using existing Service policy prior 

6 to the date of enactment of the Restoring Ac7 countability in the Indian Health Service Act of 

8 2024; and 

9 ‘‘(B) shall— 

10 ‘‘(i) use the credentialing system 

11 for— 

12 ‘‘(I) all applications for 

13 credentialing or re-credentialing of li14 censed health professionals submitted 

15 on or after the date of enactment of 

16 the Restoring Accountability in the 

17 Indian Health Service Act of 2024; 

18 and 

19 ‘‘(II) the migration into the 

20 credentialing system of credentials 

21 data that existed prior to implementa22 tion of the credentialing system; and 

23 ‘‘(ii) maintain the established timeline 

24 for re-credentialing of licensed health pro25 fessionals who were credentialed prior to 


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1 implementation of the credentialing sys2 tem, as defined by Service policy. 

3 ‘‘(b) REQUIREMENTS.— 

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

5 credentialing system under subsection (a), the Sec6 retary shall ensure that— 

7 ‘‘(A) credentialing procedures shall be uni8 form throughout the Service; and 

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

10 professional who successfully completes the 

11 credentialing procedures of the credentialing 

12 system, the Secretary may authorize the li13 censed health professional to provide health 

14 care services at any Service unit. 

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

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

17 professionals who were credentialed using existing 

18 Service policy prior to the date of enactment of the 

19 Restoring Accountability in the Indian Health Serv20 ice Act of 2024 until the date on which those li21 censed health professionals are required to be re22 credentialed in accordance with the credentialing 

23 system developed and implemented under subsection 

24 (a). 


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

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

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

4 ‘‘(2) may consult with— 

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

6 medical providers; 

7 ‘‘(B) any government agency; or 

8 ‘‘(C) any other relevant expert, as deter9 mined by the Secretary. 

10 ‘‘(d) APPLICATION.— 

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

12 licensed health care professional may not provide 

13 health care services at any Service unit, unless the 

14 licensed health care professional successfully com15 pletes the credentialing procedures of the 

16 credentialing system developed and implemented 

17 under subsection (a). 

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

19 apply to licensed health professionals who were 

20 credentialed using existing Service policy prior to the 

21 date of enactment of the Restoring Accountability in 

22 the Indian Health Service Act of 2024 until the date 

23 on which those licensed health professionals are re24 quired to be re-credentialed in accordance with the 


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1 credentialing system developed and implemented 

2 under subsection (a). 

3 ‘‘(e) NONDUPLICATION OF EFFORTS.— 

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

5 the deadline described in subsection (a)(1), the Serv6 ice has begun implementing or has completed imple7 mentation of a medical credentialing system that 

8 otherwise meets the requirements of this section, the 

9 Service shall not be required to establish a new 

10 credentialing system under this section. 

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

12 enhance an existing credentialing system to meet the 

13 requirements of this section. 

14 ‘‘(3) REVIEW.— 

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

16 than once every 5 years, the Service shall— 

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

18 credentialing system in effect on the date 

19 of the review; and 

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

21 the credentialing system into compliance 

22 with the requirements of this section. 

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

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1 ject to the consultation requirements under sub2 section (c). 

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

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

5 tribe to enter into a compact or contract under the 

6 Indian Self-Determination and Education Assistance 

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

8 ‘‘(2) applies to such a compact or contract un9 less expressly agreed to by the Indian tribe.’’. 

10 SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFES11 SIONAL VOLUNTEERS AT INDIAN HEALTH 

12 SERVICE. 

13 Section 224 of the Public Health Service Act (42 

14 U.S.C. 233) is amended by adding at the end the fol15 lowing: 

16 ‘‘(r) CERTAIN INDIAN HEALTH SERVICE VOLUN17 TEERS DEEMED PUBLIC HEALTH SERVICE EMPLOY18 EES.— 

19 ‘‘(1) IN GENERAL.—For purposes of this sec20 tion, a health professional volunteer at a Service 

21 unit shall, in providing a health service to an indi22 vidual, be deemed to be an employee of the Public 

23 Health Service for a calendar year that begins dur24 ing a fiscal year for which a transfer was made 


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

2 subject to the provisions of this subsection. 

3 ‘‘(2) CONDITIONS.—In providing a health serv4 ice to an individual, a health care practitioner shall, 

5 for purposes of this subsection, be considered to be 

6 a health professional volunteer at a Service unit if 

7 all of the following conditions are met: 

8 ‘‘(A) The service is provided to the indi9 vidual at the facilities of a Service unit, or 

10 through offsite programs or events carried out 

11 by the Service unit. 

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

13 health care practitioner pursuant to paragraph 

14 (3)(C). 

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

16 receive any compensation for the service from 

17 the individual, the Service unit, or any third18 party payer (including reimbursement under 

19 any insurance policy or health plan, or under 

20 any Federal or State health benefits program), 

21 except that the health care practitioner may re22 ceive repayment from the Service unit for rea23 sonable expenses incurred by the health care 

24 practitioner in the provision of the service to 

25 the individual. 


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

2 health care practitioner or the Service unit 

3 posts a clear and conspicuous notice at the site 

4 where the service is provided of the extent to 

5 which the legal liability of the health care prac6 titioner is limited under this subsection. 

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

8 the health care practitioner is licensed, certified, 

9 credentialed, and privileged in accordance with 

10 Service policy and applicable law regarding the 

11 provision of the service. 

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

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

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

15 Service unit for purposes of this subsection to the 

16 same extent and in the same manner as such sub17 sections apply to an officer, governing board mem18 ber, employee, or contractor of an entity described in 

19 subsection (g)(4), subject to paragraph (4) and sub20 ject to the following subparagraphs: 

21 ‘‘(A) Each reference to an entity in sub22 sections (g), (h), (i), and (l) shall be considered 

23 to be a reference to a Service unit. 


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

2 applies in lieu of the first sentence of subsection 

3 (g)(1)(A). 

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

5 health care practitioner is not a health profes6 sional volunteer at the Service unit unless the 

7 Service unit sponsors the health care practi8 tioner. For purposes of this subsection, the 

9 Service unit shall be considered to be spon10 soring the health care practitioner if— 

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

12 practitioner, the Service unit submits to 

13 the Secretary an application meeting the 

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

15 ‘‘(ii) the Secretary, pursuant to sub16 section (g)(1)(E), determines that the 

17 health care practitioner is deemed to be an 

18 employee of the Public Health Service. 

19 ‘‘(D) In the case of a health care practi20 tioner who is determined by the Secretary pur21 suant to this subsection and subsection 

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

23 this subsection applies to the health care practi24 tioner (with respect to services performed on 

25 behalf of the Service unit sponsoring the health 


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1 care practitioner pursuant to subparagraph (C)) 

2 for any cause of action arising from an act or 

3 omission of the health care practitioner occur4 ring on or after the date on which the Secretary 

5 makes that determination. 

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

7 health care practitioner for purposes of this 

8 subsection only to the extent that, in providing 

9 health services to an individual, each of the con10 ditions described in paragraph (2) is met. 

11 ‘‘(4) FUNDING.— 

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

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

14 available for transfer under subparagraph (C) 

15 for purposes of carrying out this subsection. 

16 ‘‘(B) ANNUAL ESTIMATES.— 

17 ‘‘(i) IN GENERAL.—Not later than 

18 May 1 of each fiscal year, the Attorney 

19 General, in consultation with the Sec20 retary, shall submit to Congress a report 

21 providing an estimate of the amount of 

22 claims (together with related fees and ex23 penses of witnesses) that, by reason of the 

24 acts or omissions of health professional 

25 volunteers, will be paid pursuant to this 


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1 section during the calendar year that be2 gins in the following fiscal year. 

3 ‘‘(ii) APPLICABILITY.—Subsection 

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

5 clause (i) relating to health professional 

6 volunteers to the same extent and in the 

7 same manner as that subsection applies to 

8 the estimate under that subsection relating 

9 to officers, governing board members, em10 ployees, and contractors of entities de11 scribed in subsection (g)(4). 

12 ‘‘(C) TRANSFERS.—Not later than Decem13 ber 31 of each fiscal year, the Secretary shall 

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

15 to the appropriate accounts in the Treasury an 

16 amount equal to the estimate made under sub17 paragraph (B) for the calendar year beginning 

18 in that fiscal year, subject to the extent of 

19 amounts in the fund. 

20 ‘‘(5) DEFINITION OF SERVICE UNIT.— 

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

22 term ‘Service unit’ has the meaning given the 

23 term in section 4 of the Indian Health Care Im24 provement Act (25 U.S.C. 1603). 


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

2 term ‘Service unit’ includes an urban Indian or3 ganization with which the Indian Health Serv4 ice has entered into a contract with, or to which 

5 the Indian Health Service has made a grant, 

6 under title V of the Indian Health Care Im7 provement Act (25 U.S.C. 1651 et seq.). 

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

9 ‘‘(A) negatively impacts the right of an In10 dian tribe to enter into a compact or contract 

11 under the Indian Self-Determination and Edu12 cation Assistance Act (25 U.S.C. 5304 et seq.); 

13 or 

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

15 unless expressly agreed to by the Indian tribe. 

16 ‘‘(7) EFFECTIVE DATES.— 

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

18 subparagraph (B), this subsection shall take ef19 fect on October 1, 2024. 

20 ‘‘(B) REGULATIONS, APPLICATIONS, AND

21 REPORTS.—Effective on the date of the enact22 ment of the Restoring Accountability in the In23 dian Health Service Act of 2024, the Secretary 

24 may— 


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1 ‘‘(i) prescribe regulations for carrying 

2 out this subsection; and 

3 ‘‘(ii) accept and consider applications 

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

5 SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR IN6 DIAN HEALTH SERVICE LOAN REPAYMENT 

7 PROGRAM. 

8 Section 108 of the Indian Health Care Improvement 

9 Act (25 U.S.C. 1616a) is amended— 

10 (1) in subsection (b)(1), by striking subpara11 graph (B) and inserting the following: 

12 ‘‘(B) have— 

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

14 ‘‘(II) a license to practice a health profes15 sion in a State; or 

16 ‘‘(ii)(I) a master’s degree in business ad17 ministration with an emphasis in health care 

18 management (as defined by the Secretary), 

19 health administration, hospital administration, 

20 or public health; and 

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

22 in the field of business administration, health 

23 administration, hospital administration, or pub24 lic health in a State, if the Secretary deter25 mines the license or certification is necessary 


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1 for the Indian health program to which the in2 dividual will be assigned;’’; 

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

4 (iii) and inserting the following: 

5 ‘‘(iii) to serve for a time period (re6 ferred to in this section as the ‘period of 

7 obligated service’) equal to— 

8 ‘‘(I) 2 years or such longer pe9 riod as the individual may agree to 

10 serve in the full-time practice of the 

11 individual’s profession in an Indian 

12 health program to which the indi13 vidual may be assigned by the Sec14 retary; or 

15 ‘‘(II) 4 years or such longer pe16 riod as the individual may agree to 

17 serve in the half-time practice of the 

18 individual’s profession in an Indian 

19 health program to which the indi20 vidual may be assigned by the Sec21 retary;’’; and 

22 (3) in subsection (g)(2)— 

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

24 Any arrangement’’ and inserting the following: 


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1 ‘‘(C) DEADLINE FOR REPAYMENTS.—Any 

2 arrangement’’; 

3 (B) subparagraph (A), in the second sen4 tence of the matter preceding clause (i), by 

5 striking ‘‘In making a determination’’ and in6 serting the following: 

7 ‘‘(B) DETERMINATION OF AMOUNT OF

8 PAYMENT.—In making a determination under 

9 this paragraph’’; and 

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

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

12 and inserting the following: 

13 ‘‘(2) AUTHORIZED PAYMENTS.— 

14 ‘‘(A) AMOUNT OF PAYMENT.— 

15 ‘‘(i) FULL-TIME PRACTICE.—In the 

16 case of an individual who contracts to 

17 serve a period of obligated service under 

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

19 the obligated service, the Secretary may 

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

21 the amount specified in section 

22 338B(g)(2)(A) of the Public Health Serv23 ice Act (42 U.S.C. 254l–1(g)(2)(A))) on 

24 behalf of the individual for loans described 

25 in paragraph (1). 


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

2 individual who contracts to serve a period 

3 of obligated service under subsection 

4 (f)(1)(B)(iii)(II), for each year of such ob5 ligated service, the Secretary may pay up 

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

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

8 SEC. 105. IMPROVEMENTS IN HIRING PRACTICES. 

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

10 Care Improvement Act (25 U.S.C. 1661 et seq.) is amend11 ed by adding at the end the following: 

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

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

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

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

16 3328 of that title), a candidate directly to a position with17 in the Service for which the candidate meets the qualifica18 tions standard established by the Office of Personnel Man19 agement. 

20 ‘‘(b) TRIBAL NOTIFICATION.— 

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

22 promoting, transferring, or reassigning a candidate 

23 to a Senior Executive Service position or the position 

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

25 Secretary shall provide notice to each Indian tribe 


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1 located within the defined geographic area of the 

2 Area office or Service unit, as applicable, of the con3 tent of an inclusion in an employment record. 

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

5 that receives notification under paragraph (1) may 

6 submit to the Secretary comments during the 10-day 

7 period after the date of notification.’’. 

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

9 135 (25 U.S.C. 5117(c)) is amended— 

10 (1) in paragraph (2)— 

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

12 inserting the following: 

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

14 The provisions’’; 

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

16 (1)’’; and 

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

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

19 2011(f); 92 Stat. 2324)’’ and inserting ‘‘section 

20 1132(f) of the Education Amendments of 1978 

21 (25 U.S.C. 2012(f))’’; 

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

23 inserting the following: 

24 ‘‘(c) WAIVER OF APPLICABILITY IN PERSONNEL AC25 TIONS.— 


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

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

3 ‘‘(3) IHS WAIVERS.— 

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

5 concerned Indian tribe, the Secretary of Health 

6 and Human Services may seek from each In7 dian tribe concerned a waiver of Indian pref8 erence laws for a personnel action that is with 

9 respect to— 

10 ‘‘(i) a Service unit (as defined in sec11 tion 4 of the Indian Health Care Improve12 ment Act (25 U.S.C. 1603)) in which— 

13 ‘‘(I) 15 percent or greater of the 

14 total positions are not filled by a full15 time employee of the Indian Health 

16 Service for a period of 6 months or 

17 longer; or 

18 ‘‘(II) 15 percent or greater of a 

19 specific health professional position 

20 are not filled by a full-time employee 

21 of the Indian Health Service for a pe22 riod of 6 months or longer; or 

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

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1 ment during, or demoted for performance 

2 or misconduct that occurred during, the 5- 

3 year period following the date of the per4 sonnel action. 

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

6 requested under subparagraph (A) for a per7 sonnel action that is with respect to an em8 ployee described in clause (ii) of that subpara9 graph if the reason for the removal or demotion 

10 of the employee did not result from an action 

11 undertaken by the employee that was reported 

12 to the National Practitioner Data Bank. 

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

14 Health and Human Services may only approve 

15 a waiver under subparagraph (A) if the waiver 

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

17 SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IM18 PROVE ACCOUNTABILITY OF SENIOR EXECU19 TIVES AND EMPLOYEES OF THE INDIAN 

20 HEALTH SERVICE. 

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

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

23 amended by section 105(a)) is amended by adding at the 

24 end the following: 


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1 ‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM2 PROVE ACCOUNTABILITY OF SENIOR EXECU3 TIVES OF THE INDIAN HEALTH SERVICE. 

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

5 ‘‘(1) COVERED INDIVIDUAL.—The term ‘cov6 ered individual’ means a career appointee (as de7 fined in section 3132(a) of title 5, United States 

8 Code). 

9 ‘‘(2) MISCONDUCT.—The term ‘misconduct’ in10 cludes— 

11 ‘‘(A) neglect of duty; 

12 ‘‘(B) malfeasance; 

13 ‘‘(C) failure to accept a directed reassign14 ment; and 

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

16 transfer of function. 

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

18 the Secretary, acting through the Service. 

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

20 ‘senior executive position’ means a Senior Executive 

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

22 title 5, United States Code). 

23 ‘‘(b) AUTHORITY.— 

24 ‘‘(1) IN GENERAL.—The Secretary may, in ac25 cordance with this section, reprimand, suspend, in26 voluntarily reassign, demote, or remove a covered inVerDate Sep 11 2014 01:36 Aug 03, 2024 Jkt 049200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H8966.IH H8966

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1 dividual from a senior executive position at the Serv2 ice if the Secretary determines that the misconduct 

3 or performance of the covered individual warrants 

4 such an action. 

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

6 Secretary removes a covered individual pursuant to 

7 paragraph (1), the Secretary may remove the indi8 vidual from the civil service (as defined in section 

9 2101 of title 5, United States Code). 

10 ‘‘(c) RIGHTS AND PROCEDURES.— 

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

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

13 under subsection (b) is entitled— 

14 ‘‘(A) to advance notice of the action or re15 moval; 

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

17 in support of the proposed action or removal; 

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

19 other representative of the covered individual’s 

20 choice; and 

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

22 removal under paragraph (2) in accordance 

23 with the internal grievance process established 

24 by the Secretary under paragraph (3). 

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


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

2 for notice, response, and decision on an action 

3 or removal under subsection (b) may not exceed 

4 15 business days. 

5 ‘‘(B) RESPONSE.—A covered individual re6 ceiving a notice under paragraph (1)(A) of an 

7 action or removal, as applicable, under sub8 section (b) shall have not more than 7 business 

9 days to respond to the notice. 

10 ‘‘(C) DECISION.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall issue a decision on an action or re13 moval, as applicable, under subsection (b) 

14 not later than 15 business days after the 

15 date on which notice of the action or re16 moval, as applicable, is received by the ap17 plicable covered individual under para18 graph (1)(A). 

19 ‘‘(ii) REQUIREMENTS.—A decision 

20 under clause (i)— 

21 ‘‘(I) shall be in writing; and 

22 ‘‘(II) shall include the specific 

23 reasons for the decision. 

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

25 A decision under this paragraph that is not 


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1 grieved under paragraph (3) by the deadline de2 scribed in that paragraph shall be final and 

3 conclusive. 

4 ‘‘(3) GRIEVANCE PROCESS.— 

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

6 establish an internal grievance process under 

7 which a covered individual may grieve a deci8 sion issued under paragraph (2) not later than 

9 the date that is 7 business days after the date 

10 on which the decision under that paragraph was 

11 issued. 

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

13 issue a decision for which an internal grievance 

14 process is initiated under subparagraph (A) not 

15 later than 21 business days after the date on 

16 which the grievance process is initiated by the 

17 covered individual. 

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

19 A grievance decision under this paragraph shall 

20 be final and conclusive. 

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

22 adversely affected by a decision under paragraph (2) 

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

24 paragraph (3), may obtain judicial review of the de25 cision. 


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1 ‘‘(5) COURT REVIEW.—In any case in which ju2 dicial review is sought under paragraph (4), the 

3 court shall review the record and may set aside any 

4 action of the Department or the Service found to 

5 be— 

6 ‘‘(A) arbitrary, capricious, an abuse of dis7 cretion, or otherwise not in accordance with a 

8 provision of law; 

9 ‘‘(B) obtained without procedures required 

10 by a provision of law having been followed; or 

11 ‘‘(C) unsupported by substantial evidence. 

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

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

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

15 ‘‘SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IM16 PROVE ACCOUNTABILITY OF EMPLOYEES OF 

17 THE INDIAN HEALTH SERVICE. 

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

19 ‘‘(1) COVERED INDIVIDUAL.— 

20 ‘‘(A) IN GENERAL.—The term ‘covered in21 dividual’ means an individual occupying a posi22 tion at the Service. 

23 ‘‘(B) EXCLUSIONS.—The term ‘covered in24 dividual’ does not include— 


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1 ‘‘(i) an individual occupying a senior 

2 executive position (as defined in section 

3 606(a)); 

4 ‘‘(ii) an individual who has not com5 pleted a probationary or trial period; or 

6 ‘‘(iii) a political appointee. 

7 ‘‘(2) GRADE.—The term ‘grade’ has the mean8 ing given the term in section 7511(a) of title 5, 

9 United States Code. 

10 ‘‘(3) MISCONDUCT.—The term ‘misconduct’ in11 cludes— 

12 ‘‘(A) neglect of duty; 

13 ‘‘(B) malfeasance; 

14 ‘‘(C) failure to accept a directed reassign15 ment; and 

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

17 transfer of function. 

18 ‘‘(4) POLITICAL APPOINTEE.—The term ‘polit19 ical appointee’ means an individual who is— 

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

21 any of sections 5312 through 5316 of title 5, 

22 United States Code (relating to the Executive 

23 Schedule); 

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

25 emergency appointee, or noncareer appointee 


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

2 of title 5, United States Code); or 

3 ‘‘(C) employed in a position of a confiden4 tial or policy-determining character under 

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

6 Code of Federal Regulations (or a successor 

7 regulation). 

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

9 the Secretary, acting through the Service. 

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

11 placing of an employee, for disciplinary reasons, in 

12 a temporary status without duties and pay for a pe13 riod in excess of 14 days. 

14 ‘‘(b) AUTHORITY.— 

15 ‘‘(1) IN GENERAL.—The Secretary may, in ac16 cordance with this section, remove, demote, or sus17 pend a covered individual from employment at the 

18 Service if the Secretary determines that the perform19 ance or misconduct of the covered individual war20 rants such an action. 

21 ‘‘(2) ACTIONS.—If the Secretary removes, de22 motes, or suspends a covered individual pursuant to 

23 paragraph (1), the Secretary may— 


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1 ‘‘(A) remove the covered individual from 

2 the civil service (as defined in section 2101 of 

3 title 5, United States Code); 

4 ‘‘(B) demote the covered individual by 

5 means of— 

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

7 covered individual is qualified, as the Sec8 retary determines appropriate; and 

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

10 pay of the covered individual; or 

11 ‘‘(C) suspend the covered individual from 

12 the civil service (as defined in section 2101 of 

13 title 5, United States Code). 

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

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

16 provision of law, any covered individual subject to a 

17 demotion by means of a reduction in grade under 

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

19 the demotion, receive the annual rate of pay applica20 ble to the reduced grade. 

21 ‘‘(2) RESTRICTIONS.— 

22 ‘‘(A) PROHIBITION ON ADMINISTRATIVE

23 LEAVE.—A covered individual subject to a de24 motion under subsection (b)(2)(B)— 


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1 ‘‘(i) may not be placed on administra2 tive leave during the period during which 

3 an appeal (if any) under this section is on4 going; and 

5 ‘‘(ii) may only receive pay if the cov6 ered individual reports for duty or is ap7 proved to use accrued unused annual, sick, 

8 family medical, military, or court leave. 

9 ‘‘(B) RESTRICTION ON PAY AND BENE10 FITS.—If a covered individual subject to a de11 motion under subsection (b)(2)(B) does not re12 port for duty (and has not received approval to 

13 use accrued unused leave under subparagraph 

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

15 pay or other benefits pursuant to subsection 

16 (e)(7). 

17 ‘‘(d) RIGHTS AND PROCEDURES.— 

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

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

20 under subsection (b) is entitled— 

21 ‘‘(A) to advance notice of the action or re22 moval; 

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

24 in support of the proposed action or removal; 


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

2 other representative of the covered individual’s 

3 choice; and 

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

5 removal under paragraph (2) in accordance 

6 with the internal grievance process established 

7 by the Secretary under paragraph (3). 

8 ‘‘(2) NOTICE; RESPONSE; DECISION.— 

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

10 period for notice, response, and a final decision 

11 on an action under subsection (b) may not ex12 ceed 15 business days. 

13 ‘‘(B) RESPONSE.—A covered individual re14 ceiving a notice under paragraph (1)(A) of an 

15 action or removal under subsection (b) shall 

16 have not more than 7 business days to respond 

17 to the notice. 

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

19 ‘‘(i) IN GENERAL.—The Secretary 

20 shall issue a final and conclusive decision 

21 on an action or removal under subsection 

22 (b) not later than 15 business days after 

23 the date on which the notice of the action 

24 is received by the applicable covered indi25 vidual under paragraph (1)(A). 


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1 ‘‘(ii) REQUIREMENTS.—A decision 

2 under clause (i)— 

3 ‘‘(I) shall be in writing; and 

4 ‘‘(II) shall include the specific 

5 reasons for the decision. 

6 ‘‘(3) GRIEVANCE PROCESS.— 

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

8 establish an internal grievance process under 

9 which a covered individual may grieve a deci10 sion issued under paragraph (2) not later than 

11 the date that is 7 business days after the date 

12 on which the decision under that paragraph was 

13 issued. 

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

15 issue a decision for which an internal grievance 

16 process is initiated under subparagraph (A) not 

17 later than 21 business days after the date on 

18 which the grievance process is initiated by the 

19 covered individual. 

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

21 A grievance decision under this paragraph shall 

22 be final and conclusive. 

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

24 procedures under this subsection shall supersede any 

25 collective bargaining agreement to the extent that 


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1 such an agreement is inconsistent with the proce2 dures. 

3 ‘‘(5) PERFORMANCE APPRAISAL.—The proce4 dures under chapter 43 of title 5, United States 

5 Code, shall not apply to an action under subsection 

6 (b). 

7 ‘‘(6) APPEAL TO MERIT SYSTEMS PROTECTION

8 BOARD.— 

9 ‘‘(A) IN GENERAL.—Subject to subpara10 graph (B) and subsection (e), any removal, de11 motion, or suspension of more than 14 days 

12 under subsection (b) may be appealed to the 

13 Merit Systems Protection Board, which shall 

14 refer such appeal to an administrative law 

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

16 United States Code. 

17 ‘‘(B) TIME PERIOD.—An appeal under 

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

19 suspension may only be made if the appeal is 

20 made not later than 10 business days after the 

21 date of the removal, demotion, or suspension. 

22 ‘‘(e) EXPEDITED REVIEW.— 

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

24 under subsection (d)(6)(A), the applicable adminis25 trative law judge shall— 


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1 ‘‘(A) expedite the appeal under section 

2 7701(b)(1) of title 5, United States Code; and 

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

4 the appeal not later than 180 days after the 

5 date of the appeal. 

6 ‘‘(2) UPHOLDING DECISION.— 

7 ‘‘(A) IN GENERAL.—Notwithstanding sec8 tion 7701(c)(1)(B) of title 5, United States 

9 Code, the administrative law judge shall uphold 

10 the decision of the Secretary to remove, demote, 

11 or suspend an employee under subsection (b) if 

12 the decision is supported by substantial evi13 dence. 

14 ‘‘(B) PROHIBITION OF MITIGATION.—Not15 withstanding title 5, United States Code, or any 

16 other provision of law, if the decision of the 

17 Secretary to remove, demote, or suspend an em18 ployee under subsection (b) is supported by 

19 substantial evidence, the administrative law 

20 judge shall not mitigate the penalty prescribed 

21 by the Secretary. 

22 ‘‘(3) APPEAL TO MERIT SYSTEMS PROTECTION

23 BOARD.— 

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

25 administrative law judge under paragraph (1) 


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1 may be appealed to the Merit Systems Protec2 tion Board. 

3 ‘‘(B) UPHOLDING DECISION.—Notwith4 standing section 7701(c)(1)(B) of title 5, 

5 United States Code, the Merit Systems Protec6 tion Board shall uphold the decision of the Sec7 retary to remove, demote, or suspend an em8 ployee under subsection (b) if the decision is 

9 supported by substantial evidence. 

10 ‘‘(C) PROHIBITION OF MITIGATION.—Not11 withstanding title 5, United States Code, or any 

12 other provision of law, if the decision of the 

13 Secretary is supported by substantial evidence, 

14 the Merit Systems Protection Board shall not 

15 mitigate the penalty prescribed by the Sec16 retary. 

17 ‘‘(4) REPORT.—In any case in which an admin18 istrative law judge cannot issue a final and complete 

19 decision by the deadline described in paragraph 

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

21 not later than 14 business days after the deadline 

22 expires, submit to the appropriate committees of 

23 Congress a report that explains the reasons why a 

24 decision was not issued by the deadline. 


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

2 Protection Board under paragraph (3) may be ap3 pealed to the United States Court of Appeals for the 

4 Federal Circuit pursuant to section 7703 of title 5, 

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

6 competent jurisdiction pursuant to subsection 

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

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

9 Systems Protection Board may not stay any removal 

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

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

12 ‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR13 ING APPEAL.— 

14 ‘‘(A) IN GENERAL.— 

15 ‘‘(i) RESTRICTION ON PAY AND BENE16 FITS.—During the period described in 

17 clause (ii), a covered individual may not re18 ceive any pay and benefits described in 

19 subparagraph (B). 

20 ‘‘(ii) PERIOD DESCRIBED.—The pe21 riod referred to in clause (i) is the pe22 riod— 

23 ‘‘(I) beginning on the date on 

24 which a covered individual appeals 

25 under this section a removal from the 


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1 civil service under subsection 

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

3 ‘‘(II) ending on the later of— 

4 ‘‘(aa) the date on which the 

5 Merit Systems Protection Board 

6 issues a final decision on the ap7 peal under paragraph (3); and 

8 ‘‘(bb) the date on which the 

9 United States Court of Appeals 

10 for the Federal Circuit issues a 

11 final decision on the appeal 

12 under paragraph (5). 

13 ‘‘(B) PAY AND BENEFITS DESCRIBED.— 

14 The pay and benefits referred to in subpara15 graph (A)(i) are any pay, awards, bonuses, in16 centives, allowances, differentials, student loan 

17 repayments, special payments, or benefits re18 lated to the employment of the individual by the 

19 Service. 

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

21 the maximum extent practicable, the Secretary shall 

22 provide to the Merit Systems Protection Board such 

23 information and assistance as may be necessary to 

24 ensure an appeal under this subsection is expedited. 


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1 ‘‘(9) BACKPAY.—If an employee prevails on ap2 peal under this section, the employee shall be enti3 tled to backpay (as provided in section 5596 of title 

4 5, United States Code). 

5 ‘‘(10) APPLICABLE TIMELINES AND PROCE6 DURES.—If an employee who is subject to a collec7 tive bargaining agreement chooses to grieve an ac8 tion taken under this section through a grievance 

9 procedure provided under the collective bargaining 

10 agreement, the timelines and procedures described in 

11 subsection (d) and this subsection shall apply. 

12 ‘‘(f) ALLEGED PROHIBITED PERSONNEL PRAC13 TICE.—In the case of a covered individual seeking correc14 tive action (or on behalf of whom corrective action is 

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

16 alleged prohibited personnel practice described in section 

17 2302(b) of title 5, United States Code, the Secretary may 

18 not remove, demote, or suspend the covered individual 

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

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

21 Code. 

22 ‘‘(g) TERMINATION OF INVESTIGATIONS BY OFFICE

23 OF SPECIAL COUNSEL.— 

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

25 provision of law, the Special Counsel established by 


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1 section 1211 of title 5, United States Code, may ter2 minate an investigation of a prohibited personnel 

3 practice alleged by an employee or former employee 

4 of the Service after the Special Counsel provides to 

5 the employee or former employee a written state6 ment of the reasons for the termination of the inves7 tigation. 

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

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

10 in any judicial or administrative proceeding without 

11 the consent of the employee or former employee de12 scribed in paragraph (1). 

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

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

15 maximum extent practicable, the Secretary shall fill the 

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

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

18 title 5, United States Code, is amended— 

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

20 end; 

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

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

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

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

25 607 of the Indian Health Care Improvement Act.’’. 


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

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

3 Human Services or the Inspector General of the Depart4 ment of Health and Human Services, as appropriate, shall 

5 submit to Congress a report that includes information 

6 on— 

7 (1) the number of employees of the Indian 

8 Health Service who were removed, demoted, or sus9 pended during the 1-year period preceding the date 

10 of enactment of this Act; 

11 (2) the number of employees of the Indian 

12 Health Service who were removed, demoted, or sus13 pended during the 1-year period beginning on the 

14 date of enactment of this Act pursuant to the 

15 amendments made by this section; and 

16 (3) the appropriate details of any such remov17 als, demotions, and suspensions that lend necessary 

18 context. 

19 SEC. 107. TRIBAL CULTURE AND HISTORY. 

20 Section 113 of the Indian Health Care Improvement 

21 Act (25 U.S.C. 1616f) is amended— 

22 (1) in subsection (a)— 

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

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


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1 (B) by striking ‘‘appropriate employees of 

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

3 Service, locum tenens medical providers, 

4 healthcare volunteers, and other contracted em5 ployees who work at Service hospitals or other 

6 Service units and whose employment requires 

7 regular direct patient access’’; and 

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

9 ‘‘(c) REQUIREMENT TO COMPLETE TRAINING PRO10 GRAM.—Notwithstanding any other provision of law, be11 ginning on the date of enactment of the Restoring Ac12 countability in the Indian Health Service Act of 2024, 

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

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

15 of employment, annually participate in and complete the 

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

17 SEC. 108. STAFFING DEMONSTRATION PROGRAM. 

18 Title VIII of the Indian Health Care Improvement 

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

20 the end the following: 

21 ‘‘SEC. 833. STAFFING DEMONSTRATION PROGRAM. 

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

23 date of enactment of the Restoring Accountability in the 

24 Indian Health Service Act of 2024, the Secretary, acting 

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1 retary’), shall establish a demonstration program (referred 

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

3 which the Service may provide Service units with addi4 tional staffing resources, with the goal that the resources 

5 become self-sustaining. 

6 ‘‘(b) SELECTION.—In selecting Service units for par7 ticipation in the demonstration program, the Secretary 

8 shall consider whether a Service unit services an Indian 

9 tribe that— 

10 ‘‘(1) has utilized or contributed substantial 

11 Tribal funds to construct a health facility used by 

12 the Service or identified in the master plan for the 

13 Service unit; 

14 ‘‘(2) is located in 1 or more States with Med15 icaid reimbursements plans or policies that will in16 crease the likelihood that the staffing resources pro17 vided will be self-sustaining; and 

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

19 paragraph (1) under historical staffing ratios, as de20 termined by the Secretary, that have not been equal21 ized or updated by the Service or any other Service 

22 program to reflect current staffing needs. 

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

24 Service unit under the demonstration program shall be 

25 provided for a duration that the Secretary, in consultation 


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1 with the applicable Indian tribe, determines appropriate, 

2 on the condition that each staffing position provided shall 

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

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

5 resources provided under the demonstration program shall 

6 reduce the recurring base funding for staffing for any In7 dian tribe or Service unit. 

8 ‘‘(e) SUNSET.—The demonstration program estab9 lished under subsection (a) shall terminate on the date 

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

11 program is established. 

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

13 on which the demonstration program terminates under 

14 subsection (e), the Secretary shall submit to the Com15 mittee on Indian Affairs and the Committee on Health, 

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

17 Committee on Natural Resources and the Committee on 

18 Energy and Commerce of the House of Representatives 

19 a report describing the demonstration program, including 

20 information on— 

21 ‘‘(1) whether the staffing resources provided 

22 under the demonstration program resulted in addi23 tional revenue for the applicable Service unit suffi24 cient to maintain the staff on a permanent basis; 


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

2 provided under the demonstration program reduced 

3 the unmet staffing need for the applicable Service 

4 unit; and 

5 ‘‘(3) whether the demonstration program could 

6 be deployed permanently to reduce unmet staffing 

7 needs throughout the Service.’’. 

8 SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION 

9 POLICY. 

10 Title VIII of the Indian Health Care Improvement 

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

12 is amended by adding at the end the following: 

13 ‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 

14 POLICY. 

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

16 2023, the Secretary shall establish, and once every 5 years 

17 thereafter, the Secretary shall update, after meaningful 

18 consultation with representatives of affected Indian tribes, 

19 a rule establishing a Tribal consultation policy for the 

20 Service. 

21 ‘‘(b) CONTENTS OF TRIBAL CONSULTATION POL22 ICY.—The policy established under the rule under sub23 section (a) shall— 


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1 ‘‘(1) update, and replace, the Tribal consulta2 tion policy established under Circular No. 2006–01 

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

4 ‘‘(2) include— 

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

6 how the Service will notify Indian tribes of the 

7 availability of meaningful consultation; 

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

9 agency decisions by the Service will trigger a re10 quirement for meaningful consultation with In11 dian tribes; and 

12 ‘‘(C) a determination of which actions con13 stitute meaningful consultation with Indian 

14 tribes.’’. 

15 SEC. 110. TREATMENT OF CERTAIN HOSPITALS. 

16 The ‘‘Parallel Low-Volume Hospital Payment Adjust17 ment Regarding Hospitals Operated by the Indian Health 

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

19 final rule of the Centers for Medicare & Medicaid Services 

20 entitled ‘‘Medicare Program; Hospital Inpatient Prospec21 tive Payment Systems for Acute Care Hospitals and the 

22 Long-Term Care Hospital Prospective Payment System 

23 and Policy Changes and Fiscal Year 2018 Rates; Quality 

24 Reporting Requirements for Specific Providers; Medicare 

25 and Medicaid Electronic Health Record (EHR) Incentive 


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1 Program Requirements for Eligible Hospitals, Critical Ac2 cess Hospitals, and Eligible Professionals; Provider-Based 

3 Status of Indian Health Service and Tribal Facilities and 

4 Organizations; Costs Reporting and Provider Require5 ments; Agreement Termination Notices’’ (82 Fed Reg. 

6 37990; 38188–38189 (August 14, 2017)), shall apply with 

7 respect to discharges occurring in fiscal year 2011 and 

8 each fiscal year thereafter. 

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

10 HEALTH SERVICE. 

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

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

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

14 organization’’ have the meanings given those terms in sec15 tion 4 of the Indian Health Care Improvement Act (25 

16 U.S.C. 1603). 

17 (b) BEST PRACTICES FOR GOVERNING BOARD AND

18 AREA OFFICE MEETINGS.— 

19 (1) DEFINITION OF GOVERNING BOARD.—In 

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

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

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

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

24 consultation with Indian tribes, governing boards, 

25 Area offices, Service units, and other stakeholders, 


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1 as determined appropriate by the Secretary, shall es2 tablish— 

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

4 best practices for governing boards; and 

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

6 best practices for Area offices. 

7 (3) REQUIREMENTS.— 

8 (A) GOVERNING BOARD BEST PRAC9 TICES.—The best practices for governing 

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

11 include provisions relating to— 

12 (i) adequately monitoring the delivery 

13 of care at the applicable facility managed 

14 by the governing board; 

15 (ii) ensuring ongoing facility compli16 ance with Federal health care program re17 quirements, including requirements of the 

18 Service and the Centers for Medicare & 

19 Medicaid Services; 

20 (iii) handling, documenting, and re21 sponding to patient complaints; 

22 (iv) documenting, addressing, and, if 

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1 cordance with applicable Federal and State 

2 law; 

3 (v) improving facility performance and 

4 operations with respect to mandatory and 

5 voluntary quality initiatives carried out by 

6 the Service and the Centers for Medicare & 

7 Medicaid Services; and 

8 (vi) reporting requirements under 

9 Federal law, including with respect to— 

10 (I) the Government Performance 

11 and Results Act of 1993 (Public Law 

12 103–62; 107 Stat. 285), the GPRA 

13 Modernization Act of 2010 (Public 

14 Law 111–352; 124 Stat. 3866), and 

15 the amendments made by those Acts; 

16 and 

17 (II) the applicable provisions of 

18 titles XVIII and XIX of the Social Se19 curity Act (42 U.S.C. 1395 et seq., 

20 1396 et seq.). 

21 (B) AREA OFFICE BEST PRACTICES.—The 

22 best practices for Area offices established under 

23 paragraph (2)(B) shall include provisions relat24 ing to— 


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1 (i) strategies for how to best monitor 

2 governing board activities relating to the 

3 oversight of— 

4 (I) delivery and quality of patient 

5 care; 

6 (II) documenting and responding 

7 to patient complaints and instances of 

8 professional misconduct; and 

9 (III) facility compliance with 

10 Federal health care program require11 ments, including requirements of the 

12 Service and the Centers for Medicare 

13 & Medicaid Services; and 

14 (ii) connecting governing boards, in15 cluding the applicable facilities of those 

16 governing boards, to resources necessary 

17 for enhancing patient outcomes and im18 proving facility performance, including 

19 through the use of technical assistance. 

20 (4) PUBLICATION.—The best practices estab21 lished under paragraph (2) shall be— 

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

23 all governing boards and Area offices; and 

24 (B) incorporated into the Indian Health 

25 Manual of the Service. 


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1 (c) REVIEW OF QUALITY AND PERFORMANCE MEAS2 URES.— 

3 (1) REVIEW.— 

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

5 after the date of enactment of this Act, the Sec6 retary, in coordination with the Agency for 

7 Healthcare Research and Quality, the National 

8 Quality Forum, Indian tribes, practitioners and 

9 administrators of the Service, and other quali10 fied experts, as determined appropriate by the 

11 Secretary, shall undertake a review of the re12 ported quality and performance measures of 

13 Service facilities conducted by the Secretary in 

14 accordance with— 

15 (i) section 306 of title 5, United 

16 States Code; 

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

18 States Code; and 

19 (iii) any law (including regulations) 

20 used in any mandatory or voluntary pro21 gram of the Centers for Medicare & Med22 icaid Services. 

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

24 after the date on which the review required 

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1 retary shall submit to Congress a report on the 

2 details and findings of that review, which shall 

3 include an assessment of— 

4 (i) the suitability of measures used as 

5 of the date of enactment of this Act for the 

6 applicable Service facility, taking into con7 sideration the patient volume of the facil8 ity, the mix of patient cases at the facility, 

9 the geographic location of the facility, and 

10 medical professional shortage designations 

11 at the facility, as determined by the Sec12 retary; and 

13 (ii) the extent to which the perform14 ance and quality measures are outcome15 based or process-based measures. 

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

17 date on which the report required under paragraph 

18 (1)(B) is submitted to Congress, the Service, in co19 ordination with the Centers for Medicare & Medicaid 

20 Services, shall adopt, and assist Service facilities to 

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

22 compared to those quality and performance meas23 ures adopted prior to the submission of that report, 

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1 based, in accordance with the factors described in 

2 paragraph (1)(B)(i). 

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

4 the date on which the report required under para5 graph (1)(B) is submitted to Congress, the Comp6 troller General of the United States shall submit to 

7 Congress a report on challenges relating to quality 

8 measure and data collection in Service facilities, 

9 which shall include— 

10 (A) barriers to the adoption of relevant 

11 performance and quality measures in Service 

12 facilities; and 

13 (B) recommendations for how the Service, 

14 other Federal agencies, and stakeholders can 

15 assist Service facilities in adopting suitable 

16 quality and performance measures. 

17 (d) COMPLIANCE ASSISTANCE PROGRAM.— 

18 (1) DEFINITIONS.—In this subsection: 

19 (A) ADMINISTRATOR.—The term ‘‘Admin20 istrator’’ means the Administrator of the Cen21 ters for Medicare & Medicaid Services. 

22 (B) ELIGIBLE FACILITY.— 

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

24 facility’’ means a facility operated by the 

25 Service that— 


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1 (I) is an underperforming hos2 pital or outpatient facility; and 

3 (II) is eligible for payments 

4 under title XVIII of the Social Secu5 rity Act (42 U.S.C. 1395 et seq.). 

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

7 facility’’ includes a tribally operated facil8 ity, if that facility consents to participating 

9 in the program. 

10 (C) PROGRAM.—The term ‘‘program’’ 

11 means the compliance assistance program es12 tablished under paragraph (2). 

13 (D) TRIBALLY OPERATED FACILITY.—The 

14 term ‘‘tribally operated facility’’ means a facil15 ity operated by an Indian tribe, a tribal organi16 zation, or an Urban Indian organization that— 

17 (i) is an underperforming hospital or 

18 outpatient facility; and 

19 (ii) is eligible for payments under title 

20 XVIII of the Social Security Act (42 

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

22 (2) ESTABLISHMENT OF PROGRAM.—Not later 

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

24 the Secretary, in coordination with the Adminis25 trator and quality improvement organizations having 


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1 a contract with the Secretary under part B of title 

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

3 seq.), shall establish a compliance assistance pro4 gram for eligible facilities. 

5 (3) METHODOLOGY.—The Secretary shall es6 tablish a methodology for determining which eligible 

7 facilities shall participate in the program, which 

8 shall take into account the following factors: 

9 (A) The number and severity of facility de10 ficiencies with respect to applicable require11 ments under title XVIII of the Social Security 

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

13 (B) The history of provider misconduct or 

14 patient harm at the facility. 

15 (C) Whether there is high staff turnover at 

16 the facility. 

17 (D) Whether the facility has low perform18 ance on program quality measures, relative to 

19 other facilities of the Service, in accordance 

20 with reported quality and performance meas21 ures conducted by the Secretary in accordance 

22 with— 

23 (i) section 306 of title 5, United 

24 States Code; 


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

2 States Code; and 

3 (iii) any law (including regulations) 

4 used in any mandatory or voluntary pro5 gram of the Centers for Medicare & Med6 icaid Services. 

7 (4) SELECTION OF FACILITIES.— 

8 (A) IN GENERAL.—The Secretary, in co9 ordination with the Administrator, shall select 

10 not less than 25 percent of the eligible facilities 

11 to participate in the program using the method12 ology established under paragraph (3). 

13 (B) PARTICIPATION.— 

14 (i) IN GENERAL.—An eligible facility 

15 selected to participate in the program 

16 under subparagraph (A) shall be required 

17 to participate in the program. 

18 (ii) REQUIREMENT.—The Secretary 

19 shall ensure that, at all times during the 

20 period beginning on the date of establish21 ment of the program and the date on 

22 which the program terminates under para23 graph (8), not less than 25 percent of eli24 gible facilities are participating in the pro25 gram. 


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1 (C) TERM OF PARTICIPATION.— 

2 (i) IN GENERAL.—Subject to clause 

3 (ii), an eligible facility selected to partici4 pate in the program under subparagraph 

5 (A) shall participate in the program for a 

6 period of 2 years. 

7 (ii) WAIVER.—If the Secretary, in co8 ordination with the Administrator, certifies 

9 that an eligible facility participating in the 

10 program has improved on its performance 

11 to a satisfactory level, as determined by 

12 the Secretary, then the eligible facility does 

13 not have to participate in the program for 

14 the full 2-year period. 

15 (D) PARTICIPATION LIMIT.—An eligible fa16 cility may participate in the program for more 

17 than 1 2-year period. 

18 (5) PROGRAM COMPONENTS.—The program 

19 shall provide on-site consultation and educational 

20 programming for eligible facilities to ensure those el21 igible facilities are— 

22 (A) meeting Federal requirements of the 

23 Service and any conditions of participation ap24 plicable under title XVIII of the Social Security 

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


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1 (B) satisfactorily implementing any quality 

2 initiatives and programs established by the 

3 Service or the Centers for Medicare & Medicaid 

4 Services. 

5 (6) ENFORCEMENT OR NONCOMPLIANCE AC6 TIONS.— 

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

8 conducted independently of any enforcement ac9 tions under the Indian Health Care Improve10 ment Act (25 U.S.C. 1601 et seq.) or non11 compliance actions taken by the Administrator 

12 with respect to noncompliance with conditions 

13 of participation applicable under title XVIII of 

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

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

16 the Secretary or the Administrator, as applica17 ble, encounters a triggering event, as deter18 mined by the Secretary or the Administrator, as 

19 applicable, that would necessitate an enforce20 ment action or noncompliance action. 

21 (B) TRIGGERING EVENT ENCOUNTERED.— 

22 If a triggering event is encountered by the Sec23 retary or Administrator under subparagraph 

24 (A), the eligible facility shall continue to partici25 pate in the program so long as the facility— 


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1 (i) remains eligible for payments 

2 under title XVIII of the Social Security 

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

4 (ii) continues to meet all of the condi5 tions and requirements for such payments 

6 which are applicable under such title. 

7 (7) IMPLEMENTATION.—The Secretary shall 

8 carry out the program in coordination with quality 

9 improvement organizations having a contract with 

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

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

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

13 years after the date on which the program is estab14 lished. 

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

16 date on which the program terminates under para17 graph (8), the Comptroller General of the United 

18 States shall submit to Congress a report evaluating 

19 the effectiveness of the program, which shall include, 

20 to the extent practicable— 

21 (A) detailed data on changes in the patient 

22 experience at eligible facilities that participated 

23 in the program; 

24 (B) a description of the compliance status 

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1 gram with requirements of the Service and any 

2 conditions of participation applicable under title 

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

4 1395 et seq.); and 

5 (C) a description of the progress by eligible 

6 facilities that participated in the program in 

7 meeting the goals of quality improvement activi8 ties of the Department of Health and Human 

9 Services. 

10 SEC. 112. NOTIFICATION OF INVESTIGATION REGARDING 

11 PROFESSIONAL CONDUCT; SUBMISSION OF 

12 RECORDS. 

13 Title VIII of the Indian Health Care Improvement 

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

15 is amended by adding at the end the following: 

16 ‘‘SEC. 835. NOTIFICATION OF INVESTIGATION REGARDING 

17 PROFESSIONAL CONDUCT; SUBMISSION OF 

18 RECORDS. 

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

20 the date on which the Service undertakes an investigation 

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

22 Secretary, acting through the Service, shall notify the rel23 evant State medical board of the investigation. 

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

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1 erates records relating to an investigation conducted by 

2 the Service into the professional conduct of a licensee of 

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

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

5 SEC. 113. FITNESS OF HEALTH CARE PROVIDERS. 

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

7 Care Improvement Act is amended by inserting after sec8 tion 802 (25 U.S.C. 1672) the following: 

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

10 ‘‘(a) ADDITIONAL REQUIREMENTS FOR HIRING OF

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

12 hiring process for each health care provider position at 

13 the Service after the date of enactment of the Restoring 

14 Accountability in the Indian Health Service Act of 2024, 

15 the Director shall require from the medical board of each 

16 State in which the health care provider has or had a med17 ical license— 

18 ‘‘(1) information on any violation of the re19 quirements of the medical license of the health care 

20 provider during the 20-year period ending on the 

21 date on which the health care provider is being con22 sidered for a position at the Service; and 

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

24 provider has entered into any settlement agreement 


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1 for a disciplinary charge relating to the practice of 

2 medicine by the health care provider. 

3 ‘‘(b) PROVISION OF INFORMATION ON SERVICE

4 HEALTH CARE PROVIDERS TO STATE MEDICAL

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

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

7 the Service who has violated a requirement of the medical 

8 license of the health care provider, the Director shall pro9 vide to the medical board of each State in which the health 

10 care provider is licensed detailed information with respect 

11 to the violation, regardless of whether the medical board 

12 has formally requested that information.’’. 

13 (b) REPORT ON COMPLIANCE BY INDIAN HEALTH

14 SERVICE WITH REVIEWS OF HEALTH CARE PROVIDERS

15 LEAVING SERVICE OR TRANSFERRING TO OTHER FACILI16 TIES.—Not later than 180 days after the date of enact17 ment of this Act, the Director of the Indian Health Service 

18 shall submit to the Committee on Indian Affairs of the 

19 Senate and the Committee on Natural Resources of the 

20 House of Representatives a report on the compliance by 

21 the Indian Health Service with the policy of the Indian 

22 Health Service— 

23 (1) to conduct a review of each health care pro24 vider of the Indian Health Service who transfers to 

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1 ice, resigns, retires, or is terminated to determine 

2 whether there are any concerns, complaints, or alle3 gations of violations relating to the medical practice 

4 of the health care provider; and 

5 (2) to take appropriate action with respect to 

6 any concern, complaint, or allegation described in 

7 paragraph (1). 

8 SEC. 114. STANDARDS TO IMPROVE TIMELINESS OF CARE. 

9 Title IV of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1641 et seq.) is amended by adding at the end 

11 the following: 

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

13 ‘‘(a) REGULATIONS.— 

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

15 after the date of enactment of the Restoring Ac16 countability in the Indian Health Service Act of 

17 2024, the Secretary, acting through the Service, 

18 shall— 

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

20 measure the timeliness of the provision of 

21 health care services in Service facilities; and 

22 ‘‘(B) provide such standards to each Serv23 ice unit. 

24 ‘‘(2) DATA COLLECTION.—The Secretary, act25 ing through the Service, shall develop a process for 


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1 each Service unit to submit to the Secretary data 

2 with respect to the standards established under 

3 paragraph (1)(A). 

4 ‘‘(b) ANNUAL REPORTS.— 

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

6 the date of enactment of the Restoring Account7 ability in the Indian Health Service Act of 2024, 

8 and annually thereafter, each Area office shall sub9 mit to the Secretary a report on the metrics re10 ported by Service units relating to the timeliness of 

11 the provision of health care services in Service facili12 ties within each Service unit. 

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

14 each report received under paragraph (1) publicly 

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

16 TITLE II—EMPLOYEE 

17 PROTECTIONS 

18 SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIA19 TION. 

20 Title VI of the Indian Health Care Improvement Act 

21 (25 U.S.C. 1661 et seq.) is amended by adding at the end 

22 the following: 

23 ‘‘SEC. 608. EMPLOYEE PROTECTIONS AGAINST RETALIA24 TION. 

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


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

2 means information— 

3 ‘‘(A) the disclosure of which is not specifi4 cally prohibited by law; and 

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

6 Executive order to be kept secret in the interest 

7 of national defense or the conduct of foreign af8 fairs. 

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

10 with respect to a whistleblower, means— 

11 ‘‘(A) an adverse employment action against 

12 the whistleblower; 

13 ‘‘(B) a significantly adverse action against 

14 the whistleblower, such as the refusal or delay 

15 of care provided through the Service; and 

16 ‘‘(C) an adverse action described in sub17 paragraph (A) or (B) against a family member 

18 or friend of the whistleblower. 

19 ‘‘(3) WHISTLEBLOWER.—The term ‘whistle20 blower’ means an employee of the Service who dis21 closes information that the employee reasonably be22 lieves evidences— 

23 ‘‘(A) a violation of any law, rule, regula24 tion, or Service policy; or 


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

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

3 and specific danger to public health or safety. 

4 ‘‘(b) EMPLOYEE ACCOUNTABILITY.— 

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

6 shall designate an official in the Department who is 

7 not an employee of the Service to receive reports 

8 under paragraph (2). 

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

10 the Service who witnesses retaliation against a whis11 tleblower, a violation of a patient safety requirement, 

12 or other similar conduct shall submit to the official 

13 designated under paragraph (1) a report of the con14 duct. 

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

16 the date on which the official designated under para17 graph (1) receives a report under paragraph (2), the 

18 Secretary shall— 

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

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

21 other relevant information to the Inspector 

22 General of the Department. 

23 ‘‘(4) REMOVAL FOR WHISTLEBLOWER RETALIA24 TION.— 


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1 ‘‘(A) IN GENERAL.—The Secretary may re2 move for misconduct from the civil service (as 

3 defined in section 2101 of title 5, United States 

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

5 as applicable, an employee of the Service if the 

6 Secretary determines, after completing a review 

7 described in paragraph (3), that the employee 

8 has retaliated against a whistleblower and war9 rants removal for misconduct. 

10 ‘‘(B) RETALIATION AS MISCONDUCT.—Re11 taliation by an employee against a whistle12 blower, as described in subparagraph (A), shall 

13 be considered to be misconduct for purposes of 

14 sections 606 and 607. 

15 ‘‘(5) ENHANCING PROTECTIONS FOR WHISTLE16 BLOWERS.—The Secretary shall carry out any ac17 tions determined necessary by the Secretary to en18 hance protection for whistleblowers, including identi19 fying appropriate Service employees and requiring 

20 the employees to complete the Office of Special 

21 Counsel’s Whistleblower Certification Program.’’. 


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1 SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION 

2 CONGRESS. 

3 (a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO

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

5 States Code, is amended— 

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

7 following: 

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

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

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

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

12 be subject to any adverse action described in paragraphs 

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

14 procedure described in section 7513 and any other appli15 cable procedure.’’. 

16 (b) ELECTRONIC NOTIFICATION OF RIGHT OF EM17 PLOYEES OF INDIAN HEALTH SERVICE.— 

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

19 Human Services, acting through the Director of the 

20 Indian Health Service (referred to in this subsection 

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

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

23 of the Indian Health Service notice of the right to 

24 petition Congress under section 7211 of title 5, 

25 United States Code. 


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

2 after the date of enactment of this Act, the Sec3 retary shall submit to the Inspector General of the 

4 Department of Health and Human Services (re5 ferred to in this subsection as the ‘‘Inspector Gen6 eral’’) a memorandum that includes the following 

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

8 5, United States Code, for any Federal agency or 

9 employee to require a Federal employee to seek ap10 proval, guidance, or any other form of input prior to 

11 contacting Congress with information, even if that 

12 information is in relation to the job responsibilities 

13 of the employee. A Federal employee found to have 

14 interfered with or denied the right of another Fed15 eral employee under such section shall be subject to 

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

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

18 Code, including a suspension for more than 14 days 

19 without pay.’’. 

20 (3) APPROVAL OR DISAPPROVAL.— 

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

22 after the date on which the memorandum is 

23 submitted under paragraph (2), the Inspector 

24 General shall approve or disapprove the memo25 randum. 


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1 (B) DISAPPROVAL.—If the Inspector Gen2 eral disapproves the memorandum, the Inspec3 tor General shall advise the Secretary on what 

4 changes to the memorandum are necessary for 

5 approval. 

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

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

8 the date of the approval, the Secretary shall— 

9 (A) provide to each employee of the Indian 

10 Health Service an electronic copy of the ap11 proved memorandum; and 

12 (B) post the memorandum in a clear and 

13 conspicuous place on the website of the Indian 

14 Health Service. 

15 (5) REVISED MEMORANDUM.— 

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

17 disapproved under paragraph (3), not later 

18 than 15 days after the date of disapproval, the 

19 Secretary shall submit to the Inspector General 

20 a revised memorandum that incorporates the 

21 changes advised under subparagraph (B) of 

22 that paragraph. 

23 (B) APPROVAL OR DISAPPROVAL.—Not 

24 later than 30 days after the date on which the 

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1 paragraph (A), the Inspector General shall ap2 prove the revised memorandum. 

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

4 the date on which a revised memorandum is ap5 proved under this paragraph, the Secretary 

6 shall provide notice of the memorandum in ac7 cordance with paragraph (4). 

8 SEC. 203. FISCAL ACCOUNTABILITY. 

9 Title VI of the Indian Health Care Improvement Act 

10 (25 U.S.C. 1661 et seq.) (as amended by section 201) is 

11 amended by adding at the end the following: 

12 ‘‘SEC. 609. FISCAL ACCOUNTABILITY. 

13 ‘‘(a) MANAGEMENT OF FUNDS.— 

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

15 submit a professional housing plan under section 

16 302(a) of the Restoring Accountability in the Indian 

17 Health Service Act of 2024 or a staffing plan under 

18 section 302(b) of that Act by the applicable dead19 line, the Secretary may not receive, obligate, trans20 fer, or expend any amounts for a salary increase or 

21 bonus of an individual described in paragraph (2) 

22 until the professional housing plan or staffing plan, 

23 as applicable, is submitted. 


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

2 referred to in paragraph (1) is an individual em3 ployed in the Service— 

4 ‘‘(A) in a position that is— 

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

6 through 5316 of title 5, United States 

7 Code; 

8 ‘‘(ii) placed in level IV or V of the Ex9 ecutive Schedule under section 5317 of 

10 title 5, United States Code; or 

11 ‘‘(iii) described in section 213.3301 or 

12 213.3302 of title 5, Code of Federal Regu13 lations (or a successor regulation); or 

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

15 emergency appointee, or noncareer appointee 

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

17 of title 5, United States Code). 

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

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

20 provision of law, the Secretary shall use amounts 

21 available to the Service that are not obligated or ex22 pended, including base budget funding and third 

23 party collections, during the fiscal year for which the 

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1 able, only to support patient care by using the funds 

2 for the costs of— 

3 ‘‘(A) essential medical equipment; 

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

5 ‘‘(C) staffing. 

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

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

8 any case where the amounts were originally made 

9 available for a particular Service unit, the amounts 

10 are used to benefit Indians served by that Service 

11 unit. 

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

13 the Secretary, in consultation with Indian tribes, 

14 shall establish a plan for distributing the amounts 

15 described in paragraph (1) across the categories of 

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

17 that paragraph. 

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

19 use amounts described in paragraph (1)— 

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

21 Area office; or 

22 ‘‘(B) to increase the rate of pay of any em23 ployee of an Area office. 

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

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1 mit a report describing the authorizations, expenditures, 

2 outlays, transfers, reprogramming, and obligations of each 

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

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

5 to— 

6 ‘‘(1) each Indian tribe; 

7 ‘‘(2) in the Senate— 

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

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

10 Labor, and Pensions; 

11 ‘‘(C) the Committee on Appropriations; 

12 and 

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

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

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

16 ‘‘(B) the Committee on Energy and Com17 merce; 

18 ‘‘(C) the Committee on Appropriations; 

19 and 

20 ‘‘(D) the Committee on the Budget. 

21 ‘‘(d) STATUS REPORTS.— 

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

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

24 year, the Secretary shall provide to each entity de25 scribed in paragraphs (1) through (3) of subsection 


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1 (c) a report describing the safety, billing, certifi2 cation, credential, and compliance statuses of each 

3 facility managed, operated, or otherwise supported 

4 by the Service. 

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

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

7 shall immediately provide to each entity described in 

8 paragraphs (1) through (3) of subsection (c) an up9 date describing the change. 

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

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

12 tribe to enter into a compact or contract under the 

13 Indian Self-Determination and Education Assistance 

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

15 ‘‘(2) applies to such a compact or contract un16 less expressly agreed to by the Indian tribe.’’. 

17 TITLE III—REPORTS 

18 SEC. 301. DEFINITIONS. 

19 In this title: 

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

21 the Secretary of Health and Human Services. 

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

23 Indian Health Service. 

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

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


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

2 1603). 

3 (4) TRIBAL HEALTH PROGRAM.—The term 

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

5 term in section 4 of the Indian Health Care Im6 provement Act (25 U.S.C. 1603). 

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

8 HUMAN SERVICES. 

9 (a) IHS PROFESSIONAL HOUSING PLAN.— 

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

11 the date of enactment of this Act, the Secretary 

12 shall develop, make publicly available, and submit to 

13 Congress and the Comptroller General of the United 

14 States a written plan to address the professional 

15 housing needs of employees of the Service and em16 ployees of tribal health programs that comports with 

17 the practices and recommendations of the Govern18 ment Accountability Office relating to professional 

19 housing included in the most recent report of the 

20 Government Accountability Office regarding Indian 

21 Health Service housing needs. 

22 (2) REQUIREMENT.—The plan under paragraph 

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

24 professional housing needs for— 


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

2 the plan; 

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

4 the plan; and 

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

6 of the plan. 

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

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

9 the date on which the Government Accountability 

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

11 the Secretary shall develop, make publicly available, 

12 and submit to Congress and the Comptroller General 

13 of the United States a written plan to address the 

14 staffing needs of the Service and tribal health pro15 grams that comports with the practices and rec16 ommendations of the Government Accountability Of17 fice relating to workforce planning included in the 

18 report. 

19 (2) REQUIREMENT.—The plan under paragraph 

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

21 staffing needs for— 

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

23 the plan; 

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

25 the plan; and 


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

2 of the plan. 

3 SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 

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

5 2 years after the date on which the Comptroller General 

6 of the United States receives the professional housing plan 

7 under section 302(a), the Comptroller General shall de8 velop and submit to Congress a report that includes— 

9 (1) an assessment of the professional housing 

10 plan; 

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

12 of the report, assessments and projections for the 

13 professional housing needs of employees of the Serv14 ice and employees of tribal health programs, includ15 ing a discussion and conclusions as to whether the 

16 existing assessments and projections accurately re17 flect the professional housing needs of employees of 

18 the Service and employees of tribal health programs; 

19 and 

20 (3) an assessment of the professional housing 

21 needs of— 

22 (A) employees of the Service for each Serv23 ice area (as defined in section 4 of the Indian 

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

25 1603)); and 


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1 (B) employees of tribal health programs 

2 for each Indian tribe, as applicable. 

3 (b) IHS STAFFING NEEDS REPORT.— 

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

5 the date on which the Comptroller General receives 

6 the plan relating to IHS staffing needs under sec7 tion 302(b), the Comptroller General shall prepare 

8 and submit to Congress a report on the staffing 

9 needs of the Service and tribal health programs. 

10 (2) CONTENTS.—The report under paragraph 

11 (1) shall include— 

12 (A) an assessment of the staffing plan re13 ferred to in paragraph (1); 

14 (B) a description of— 

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

16 positions needed at each facility of the 

17 Service and at each tribal health program; 

18 and 

19 (ii) the amount of funds necessary to 

20 maintain those positions; 

21 (C) an explanation of the various meth22 odologies that the Service uses and has pre23 viously used to determine the number and type 

24 of full-time positions needed at federally man25 aged Service units; and 


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1 (D) an assessment of the use of inde2 pendent contractors, including— 

3 (i) the number of independent con4 tractors hired to fill vacant full-time posi5 tions; and 

6 (ii) the amount of funds spent on 

7 independent contractors who provide 

8 health care services. 

9 (c) WHISTLEBLOWER PROTECTIONS REPORT.— 

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

11 the date of enactment of this Act, the Comptroller 

12 General shall develop and submit to Congress a re13 port on the efficacy of existing protections for whis14 tleblowers in the Service, including the protections 

15 implemented pursuant to sections 201 and 202 and 

16 the amendments made by those sections. 

17 (2) CONTENTS.—The report under paragraph 

18 (1) shall include— 

19 (A) a discussion and conclusions as to 

20 whether the Service has taken proper steps to 

21 prevent retaliation against whistleblowers; 

22 (B) if applicable, any recommendations for 

23 changes to the policy of the Service with respect 

24 to whistleblowers; and 


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1 (C) a discussion and conclusions as to 

2 whether the official email accounts of employees 

3 of the Service are appropriately monitored. 

4 SEC. 304. INSPECTOR GENERAL REPORTS. 

5 (a) PATIENT CARE REPORTS.— 

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

7 the date of enactment of this Act, and not less fre8 quently than every 3 years thereafter, the Inspector 

9 General of the Department of Health and Human 

10 Services shall develop and submit to Congress and 

11 the Service a report on— 

12 (A) patient harm events and patient deaths 

13 occurring in Service units; 

14 (B) deferrals and denials of care of pa15 tients of the Service; and 

16 (C) the standards to improve the timeli17 ness of care, developed in accordance with sec18 tion 412 of the Indian Health Care Improve19 ment Act (as added by section 114), and qual20 ity of care at Service facilities, including quality 

21 and performance measures developed by the 

22 Secretary in accordance with— 

23 (i) section 306 of title 5, United 

24 States Code; 


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

2 States Code; and 

3 (iii) any law (including regulations) 

4 used in any mandatory or voluntary pro5 gram of the Centers for Medicare & Med6 icaid Services. 

7 (2) CONTENTS.—The report under paragraph 

8 (1) shall include— 

9 (A) an evaluation of the number and kind 

10 of events that contribute to patient deaths in a 

11 Service unit and recommendations regarding re12 ducing the number of patient deaths; 

13 (B) an evaluation of how the Service 

14 tracks, reports, and responds to patient harm 

15 events and patient deaths and recommendations 

16 regarding how to improve the tracking, report17 ing, and response; and 

18 (C) the effects of deferrals and denials of 

19 care on patients of the Service, including pa20 tient outcomes, and recommendations regarding 

21 how to reduce deferrals and denials of care. 

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

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

24 General of the Department of Health and Human Services 

25 shall— 


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

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

3 (2) provide to the Service recommendations and 

4 technical assistance regarding implementation of im5 proved reporting systems, procedures, standards, 

6 and protocols. 

7 SEC. 305. TRANSPARENCY IN CMS SURVEYS. 

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

9 1395qq) is amended by adding at the end the following: 

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

11 the Administrator of the Centers for Medicare & Medicaid 

12 Services shall conduct surveys of participating Indian 

13 Health Service facilities to assess the compliance of each 

14 hospital or skilled nursing facility of the Indian Health 

15 Service with— 

16 ‘‘(A) section 1867; and 

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

18 under this title. 

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

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

21 Medicare & Medicaid Services. Such posting shall comply 

22 with the Federal regulations concerning the privacy of in23 dividually identifiable health information promulgated 

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

25 and Accountability Act of 1996.’’. 


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1 TITLE IV—TECHNICAL 

2 AMENDMENTS 

3 SEC. 401. TECHNICAL AMENDMENTS. 

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

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

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

7 designation and heading and all that follows through 

8 ‘‘means’’ and inserting the following: 

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

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

11 (2) by redesignating paragraph (5) and para12 graphs (6) through (15) as paragraph (15) and 

13 paragraphs (5) through (14), respectively, and mov14 ing the paragraphs so as to appear in numerical 

15 order. 

16 (b) TECHNICAL AMENDMENTS.—The Indian Health 

17 Care Improvement Act (25 U.S.C. 1601 et seq.) is amend18 ed— 

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

20 place it appears (regardless of casing and typeface 

21 and including in the headings) and inserting ‘‘pur22 chased/referred care’’ (with appropriate casing and 

23 typeface); and 

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

25 place it appears (regardless of casing and typeface 


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1 and including in the headings) and inserting ‘‘pur2 chased/referred care’’ (with appropriate casing and 

3 typeface). 

Æ 


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