II 

118TH CONGRESS 

1ST SESSION S. 3130 

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

accountability in the Indian Health Service, improve health services, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 25, 2023 

Mr. BARRASSO (for himself, Mr. THUNE, Ms. LUMMIS, Mr. DAINES, and Mr. 

ROUNDS) introduced the following bill; which was read twice and referred 

to the Committee on Indian Affairs 

A BILL 

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

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

other purposes. 

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 2023’’. 

6 SEC. 2. TABLE OF CONTENTS. 

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


SSpencer on DSK126QN23PROD with BILLS
2 

•S 3130 IS

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—INDIAN HEALTH SERVICE IMPROVEMENTS 

Sec. 101. Incentives for recruitment and retention. 

Sec. 102. Medical credentialing system. 

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

Health Service. 

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

Sec. 105. Improvements in hiring practices. 

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

executives and employees of the Indian Health Service. 

Sec. 107. Tribal culture and history. 

Sec. 108. Staffing demonstration program. 

Sec. 109. Rule establishing Tribal consultation policy. 

Sec. 110. Enhancing quality of care in the Indian Health Service. 

Sec. 111. Notification of investigation regarding professional conduct; submission of records. 

Sec. 112. Medical chaperones; Office of Patient Advocacy. 

Sec. 113. Fitness of health care providers. 

Sec. 114. Standards to improve timeliness of care. 

TITLE II—EMPLOYEE PROTECTIONS 

Sec. 201. Employee protections against retaliation. 

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

Sec. 203. Fiscal accountability. 

TITLE III—REPORTS 

Sec. 301. Definitions. 

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

Sec. 303. Reports by the Comptroller General. 

Sec. 304. Inspector General reports. 

Sec. 305. Transparency in CMS surveys. 

TITLE IV—TECHNICAL AMENDMENTS 

Sec. 401. Technical amendments. 

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: 


SSpencer on DSK126QN23PROD with BILLS
3 

•S 3130 IS

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

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

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

7 by the Service that provides a personnel and pay system 

8 that, to the maximum extent practicable, is comparable 

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

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

12 States Code. 

13 ‘‘(b) HOUSING VOUCHERS.— 

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

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

16 the Restoring Accountability in the Indian Health 

17 Service Act of 2023, the Secretary may establish a 

18 program to provide tenant-based rental assistance to 

19 an employee of the Service who— 

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

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

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

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

26 with the greatest staffing need; and 


SSpencer on DSK126QN23PROD with BILLS
4 

•S 3130 IS

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

2 by the Secretary. 

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

4 Secretary under paragraph (1) shall terminate on 

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

6 program is established. 

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

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

11 report describing, with respect to that program— 

12 ‘‘(A) the costs of the program; 

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

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

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

17 provide a benefit under subsection (b) to— 

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

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

20 the date of the agreement; or 

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

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

23 the date of the agreement.’’. 


SSpencer on DSK126QN23PROD with BILLS
5 

•S 3130 IS

1 SEC. 102. MEDICAL CREDENTIALING SYSTEM. 

2 Title I of the Indian Health Care Improvement Act 

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

4 amended by adding at the end the following: 

5 ‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 

6 ‘‘(a) IN GENERAL.— 

7 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION

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

9 enactment of the Restoring Accountability in the In10 dian Health Service Act of 2023, the Secretary, act11 ing through the Service (referred to in this section 

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

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

17 health care services at any Service unit. 

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

19 credentialing system, the Secretary— 

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

21 licensed health professionals who were 

22 credentialed using existing Service policy prior 

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

25 2023; and 

26 ‘‘(B) shall— 


SSpencer on DSK126QN23PROD with BILLS
6 

•S 3130 IS

1 ‘‘(i) use the credentialing system 

2 for— 

3 ‘‘(I) all applications for 

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

6 on or after the date of enactment of 

7 the Restoring Accountability in the 

8 Indian Health Service Act of 2023; 

9 and 

10 ‘‘(II) the migration into the 

11 credentialing system of credentials 

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

14 ‘‘(ii) maintain the established timeline 

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

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

19 ‘‘(b) REQUIREMENTS.— 

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

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

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


SSpencer on DSK126QN23PROD with BILLS
7 

•S 3130 IS

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

2 professional who successfully completes the 

3 credentialing procedures of the credentialing 

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

6 care services at any Service unit. 

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

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

9 professionals who were credentialed using existing 

10 Service policy prior to the date of enactment of the 

11 Restoring Accountability in the Indian Health Serv12 ice Act of 2023 until the date on which those li13 censed health professionals are required to be re14 credentialed in accordance with the credentialing 

15 system developed and implemented under subsection 

16 (a). 

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

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

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

20 ‘‘(2) may consult with— 

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

22 medical providers; 

23 ‘‘(B) any government agency; or 

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


SSpencer on DSK126QN23PROD with BILLS
8 

•S 3130 IS

1 ‘‘(d) APPLICATION.— 

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

3 licensed health care professional may not provide 

4 health care services at any Service unit, unless the 

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

7 credentialing system developed and implemented 

8 under subsection (a). 

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

10 apply to licensed health professionals who were 

11 credentialed using existing Service policy prior to the 

12 date of enactment of the Restoring Accountability in 

13 the Indian Health Service Act of 2023 until the date 

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

16 credentialing system developed and implemented 

17 under subsection (a). 

18 ‘‘(e) NONDUPLICATION OF EFFORTS.— 

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

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

23 otherwise meets the requirements of this section, the 

24 Service shall not be required to establish a new 

25 credentialing system under this section. 


SSpencer on DSK126QN23PROD with BILLS
9 

•S 3130 IS

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

2 enhance an existing credentialing system to meet the 

3 requirements of this section. 

4 ‘‘(3) REVIEW.— 

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

6 than once every 5 years, the Service shall— 

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

8 credentialing system in effect on the date 

9 of the review; and 

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

11 the credentialing system into compliance 

12 with the requirements of this section. 

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

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

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

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

19 tribe to enter into a compact or contract under the 

20 Indian Self-Determination and Education Assistance 

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

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


SSpencer on DSK126QN23PROD with BILLS
10 

•S 3130 IS

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

3 SERVICE. 

4 Section 224 of the Public Health Service Act (42 

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

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

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

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

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

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

17 subject to the provisions of this subsection. 

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

20 for purposes of this subsection, be considered to be 

21 a health professional volunteer at a Service unit if 

22 all of the following conditions are met: 

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

25 authorized by the Service unit, offsite. 


SSpencer on DSK126QN23PROD with BILLS
11 

•S 3130 IS

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

2 health care practitioner pursuant to paragraph 

3 (3)(C). 

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

5 receive any compensation for the service from 

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

8 any insurance policy or health plan, or under 

9 any Federal or State health benefits program), 

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

13 practitioner in the provision of the service to 

14 the individual. 

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

16 health care practitioner or the Service unit 

17 posts a clear and conspicuous notice at the site 

18 where the service is provided of the extent to 

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

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

22 the health care practitioner is licensed, certified, 

23 and credentialed in accordance with Service pol24 icy and applicable law regarding the provision 

25 of the service. 


SSpencer on DSK126QN23PROD with BILLS
12 

•S 3130 IS

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

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

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

4 Service unit for purposes of this subsection to the 

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

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

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

12 to be a reference to a Service unit. 

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

14 applies in lieu of the first sentence of subsection 

15 (g)(1)(A). 

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

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

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

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

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

24 practitioner, the Service unit submits to 


SSpencer on DSK126QN23PROD with BILLS
13 

•S 3130 IS

1 the Secretary an application meeting the 

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

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

5 health care practitioner is deemed to be an 

6 employee of the Public Health Service. 

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

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

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

13 behalf of the Service unit sponsoring the health 

14 care practitioner pursuant to subparagraph (C)) 

15 for any cause of action arising from an act or 

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

18 makes that determination. 

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

20 health care practitioner for purposes of this 

21 subsection only to the extent that, in providing 

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

24 ‘‘(4) FUNDING.— 


SSpencer on DSK126QN23PROD with BILLS
14 

•S 3130 IS

1 ‘‘(A) IN GENERAL.—Amounts appropriated 

2 under section 1304 of title 31, United States 

3 Code, commonly known as the ‘Judgment 

4 Fund’, shall be available for transfer under sub5 paragraph (C) for purposes of carrying out this 

6 subsection, as if claims were adjudicated by a 

7 United States District Court under section 

8 1346(b) of title 28, United States Code. 

9 ‘‘(B) ANNUAL ESTIMATES.— 

10 ‘‘(i) IN GENERAL.—Not later than 

11 May 1 of each fiscal year, the Attorney 

12 General, in consultation with the Sec13 retary, shall submit to Congress a report 

14 providing an estimate of the amount of 

15 claims (together with related fees and ex16 penses of witnesses) that, by reason of the 

17 acts or omissions of health professional 

18 volunteers, will be paid pursuant to this 

19 section during the calendar year that be20 gins in the following fiscal year. 

21 ‘‘(ii) APPLICABILITY.—Subsection 

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

23 clause (i) relating to health professional 

24 volunteers to the same extent and in the 

25 same manner as that subsection applies to 


SSpencer on DSK126QN23PROD with BILLS
15 

•S 3130 IS

1 the estimate under that subsection relating 

2 to officers, governing board members, em3 ployees, and contractors of entities de4 scribed in subsection (g)(4). 

5 ‘‘(C) TRANSFERS.—Not later than Decem6 ber 31 of each fiscal year, the Secretary shall 

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

8 to the appropriate accounts in the Treasury an 

9 amount equal to the estimate made under sub10 paragraph (B) for the calendar year beginning 

11 in that fiscal year, subject to the extent of 

12 amounts in the fund. 

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

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

15 term ‘Service unit’ has the meaning given the 

16 term in section 4 of the Indian Health Care Im17 provement Act (25 U.S.C. 1603). 

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

19 term ‘Service unit’ includes an urban Indian or20 ganization with which the Indian Health Serv21 ice has entered into a contract with, or to which 

22 the Indian Health Service has made a grant, 

23 under title V of the Indian Health Care Im24 provement Act (25 U.S.C. 1651 et seq.). 

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


SSpencer on DSK126QN23PROD with BILLS
16 

•S 3130 IS

1 ‘‘(A) negatively impacts the right of an In2 dian tribe or Tribal organization to enter into 

3 a compact or contract under the Indian Self4 Determination and Education Assistance Act 

5 (25 U.S.C. 5304 et seq.); or 

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

7 unless expressly agreed to by the Indian tribe 

8 and the Secretary. 

9 ‘‘(7) EFFECTIVE DATES.— 

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

11 subparagraph (B), this subsection shall take ef12 fect on October 1, 2024. 

13 ‘‘(B) REGULATIONS, APPLICATIONS, AND

14 REPORTS.—Effective on the date of the enact15 ment of the Restoring Accountability in the In16 dian Health Service Act of 2023, the Secretary 

17 may— 

18 ‘‘(i) prescribe regulations for carrying 

19 out this subsection; and 

20 ‘‘(ii) accept and consider applications 

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


SSpencer on DSK126QN23PROD with BILLS
17 

•S 3130 IS

1 SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR IN2 DIAN HEALTH SERVICE LOAN REPAYMENT 

3 PROGRAM. 

4 Section 108 of the Indian Health Care Improvement 

5 Act (25 U.S.C. 1616a) is amended— 

6 (1) in subsection (b)(1), by striking subpara7 graph (B) and inserting the following: 

8 ‘‘(B) have— 

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

10 ‘‘(II) a license to practice a health profes11 sion in a State; or 

12 ‘‘(ii)(I) a master’s degree in business ad13 ministration with an emphasis in health care 

14 management (as defined by the Secretary), 

15 health administration, hospital administration, 

16 or public health; and 

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

18 in the field of business administration, health 

19 administration, hospital administration, or pub20 lic health in a State, if the Secretary deter21 mines the license or certification is necessary 

22 for the Indian health program to which the in23 dividual will be assigned;’’; 

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

25 (iii) and inserting the following: 


SSpencer on DSK126QN23PROD with BILLS
18 

•S 3130 IS

1 ‘‘(iii) to serve for a time period (re2 ferred to in this section as the ‘period of 

3 obligated service’) equal to— 

4 ‘‘(I) 2 years or such longer pe5 riod as the individual may agree to 

6 serve in the full-time practice of the 

7 individual’s profession in an Indian 

8 health program to which the indi9 vidual may be assigned by the Sec10 retary; or 

11 ‘‘(II) 4 years or such longer pe12 riod as the individual may agree to 

13 serve in the half-time practice of the 

14 individual’s profession in an Indian 

15 health program to which the indi16 vidual may be assigned by the Sec17 retary;’’; and 

18 (3) in subsection (g)(2)— 

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

20 Any arrangement’’ and inserting the following: 

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

22 arrangement’’; 

23 (B) subparagraph (A), in the second sen24 tence of the matter preceding clause (i), by 


SSpencer on DSK126QN23PROD with BILLS
19 

•S 3130 IS

1 striking ‘‘In making a determination’’ and in2 serting the following: 

3 ‘‘(B) DETERMINATION OF AMOUNT OF

4 PAYMENT.—In making a determination under 

5 this paragraph’’; and 

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

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

8 and inserting the following: 

9 ‘‘(2) AUTHORIZED PAYMENTS.— 

10 ‘‘(A) AMOUNT OF PAYMENT.— 

11 ‘‘(i) FULL-TIME PRACTICE.—In the 

12 case of an individual who contracts to 

13 serve a period of obligated service under 

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

15 the obligated service, the Secretary may 

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

17 the amount specified in section 

18 338B(g)(2)(A) of the Public Health Serv19 ice Act (42 U.S.C. 254l–1(g)(2)(A))) on 

20 behalf of the individual for loans described 

21 in paragraph (1). 

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

23 individual who contracts to serve a period 

24 of obligated service under subsection 

25 (f)(1)(B)(iii)(II), for each year of such obVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
20 

•S 3130 IS

1 ligated service, the Secretary may pay up 

2 to $17,500 (or an amount equal to half of 

3 the amount specified in section 

4 338B(g)(2)(A) of the Public Health Serv5 ice Act (42 U.S.C. 254l–1(g)(2)(A))) on 

6 behalf of the individual for loans described 

7 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 senior level manager at an Area office or Serv25 ice unit, the Secretary shall provide notice to each 


SSpencer on DSK126QN23PROD with BILLS
21 

•S 3130 IS

1 Indian tribe located within the defined geographic 

2 area of the Area office or Service unit, as applicable, 

3 of the content of an inclusion in an employment 

4 record. 

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

6 that receives notification under paragraph (1) may 

7 submit to the Secretary comments during the 10-day 

8 period after the date of notification.’’. 

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

10 135 (25 U.S.C. 5117(c)) is amended— 

11 (1) in paragraph (2)— 

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

13 inserting the following: 

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

15 The provisions’’; 

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

17 (1)’’; and 

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

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

20 2011(f); 92 Stat. 2324)’’ and inserting ‘‘section 

21 1132(f) of the Education Amendments of 1978 

22 (25 U.S.C. 2012(f))’’; 

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

24 inserting the following: 


SSpencer on DSK126QN23PROD with BILLS
22 

•S 3130 IS

1 ‘‘(c) WAIVER OF APPLICABILITY IN PERSONNEL AC2 TIONS.— 

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

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

5 ‘‘(3) IHS WAIVERS.— 

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

7 concerned Indian tribe, the Secretary of Health 

8 and Human Services may seek from each In9 dian tribe concerned a waiver of Indian pref10 erence laws for a personnel action that is with 

11 respect to— 

12 ‘‘(i) a Service unit (as defined in sec13 tion 4 of the Indian Health Care Improve14 ment Act (25 U.S.C. 1603)) in which— 

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

16 total positions are not filled by a full17 time employee of the Indian Health 

18 Service for a period of 6 months or 

19 longer; or 

20 ‘‘(II) 15 percent or greater of a 

21 specific health professional position 

22 are not filled by a full-time employee 

23 of the Indian Health Service for a pe24 riod of 6 months or longer; or 


SSpencer on DSK126QN23PROD with BILLS
23 

•S 3130 IS

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

2 Health Service, or a former Tribal em3 ployee, who was removed from the employ4 ment during, or demoted for performance 

5 or misconduct that occurred during, the 5- 

6 year period following the date of the per7 sonnel action. 

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

9 requested under subparagraph (A) for a per10 sonnel action that is with respect to an em11 ployee described in clause (ii) of that subpara12 graph if the reason for the removal or demotion 

13 of the employee did not result from an action 

14 undertaken by the employee that was reported 

15 to the National Practitioner Data Bank. 

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

17 Health and Human Services may only approve 

18 a waiver under subparagraph (A) if the waiver 

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

20 SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IM21 PROVE ACCOUNTABILITY OF SENIOR EXECU22 TIVES AND EMPLOYEES OF THE INDIAN 

23 HEALTH SERVICE. 

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

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


SSpencer on DSK126QN23PROD with BILLS
24 

•S 3130 IS

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

2 end the following: 

3 ‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM4 PROVE ACCOUNTABILITY OF SENIOR EXECU5 TIVES OF THE INDIAN HEALTH SERVICE. 

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

7 ‘‘(1) COVERED INDIVIDUAL.—The term ‘cov8 ered individual’ means a career appointee (as de9 fined in section 3132(a) of title 5, United States 

10 Code). 

11 ‘‘(2) MISCONDUCT.—The term ‘misconduct’ in12 cludes— 

13 ‘‘(A) neglect of duty; 

14 ‘‘(B) malfeasance; 

15 ‘‘(C) failure to accept a directed reassign16 ment; and 

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

18 transfer of function. 

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

20 the Secretary, acting through the Service. 

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

22 ‘senior executive position’ means a Senior Executive 

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

24 title 5, United States Code). 

25 ‘‘(b) AUTHORITY.— 


SSpencer on DSK126QN23PROD with BILLS
25 

•S 3130 IS

1 ‘‘(1) IN GENERAL.—The Secretary may, in ac2 cordance with this section, reprimand, suspend, in3 voluntarily reassign, demote, or remove a covered in4 dividual from a senior executive position at the Serv5 ice if the Secretary determines that the misconduct 

6 or performance of the covered individual warrants 

7 such an action. 

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

9 Secretary removes a covered individual pursuant to 

10 paragraph (1), the Secretary may remove the indi11 vidual from the civil service (as defined in section 

12 2101 of title 5, United States Code). 

13 ‘‘(c) RIGHTS AND PROCEDURES.— 

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

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

16 under subsection (b) is entitled— 

17 ‘‘(A) to advance notice of the action or re18 moval; 

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

20 in support of the proposed action or removal; 

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

22 other representative of the covered individual’s 

23 choice; and 

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

25 removal under paragraph (2) in accordance 


SSpencer on DSK126QN23PROD with BILLS
26 

•S 3130 IS

1 with the internal grievance process established 

2 by the Secretary under paragraph (3). 

3 ‘‘(2) NOTICE; RESPONSE; DECISION.— 

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

5 for notice, response, and decision on an action 

6 or removal under subsection (b) may not exceed 

7 15 business days. 

8 ‘‘(B) RESPONSE.—A covered individual re9 ceiving a notice under paragraph (1)(A) of an 

10 action or removal, as applicable, under sub11 section (b) shall have not more than 7 business 

12 days to respond to the notice. 

13 ‘‘(C) DECISION.— 

14 ‘‘(i) IN GENERAL.—The Secretary 

15 shall issue a decision on an action or re16 moval, as applicable, under subsection (b) 

17 not later than 15 business days after the 

18 date on which notice of the action or re19 moval, as applicable, is received by the ap20 plicable covered individual under para21 graph (1)(A). 

22 ‘‘(ii) REQUIREMENTS.—A decision 

23 under clause (i)— 

24 ‘‘(I) shall be in writing; and 


SSpencer on DSK126QN23PROD with BILLS
27 

•S 3130 IS

1 ‘‘(II) shall include the specific 

2 reasons for the decision. 

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

4 A decision under this paragraph that is not 

5 grieved under paragraph (3) by the deadline de6 scribed in that paragraph shall be final and 

7 conclusive. 

8 ‘‘(3) GRIEVANCE PROCESS.— 

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

10 establish an internal grievance process under 

11 which a covered individual may grieve a deci12 sion issued under paragraph (2) not later than 

13 the date that is 7 business days after the date 

14 on which the decision under that paragraph was 

15 issued. 

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

17 issue a decision for which an internal grievance 

18 process is initiated under subparagraph (A) not 

19 later than 21 business days after the date on 

20 which the grievance process is initiated by the 

21 covered individual. 

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

23 A grievance decision under this paragraph shall 

24 be final and conclusive. 


SSpencer on DSK126QN23PROD with BILLS
28 

•S 3130 IS

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

2 adversely affected by a decision under paragraph (2) 

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

4 paragraph (3), may obtain judicial review of the de5 cision. 

6 ‘‘(5) COURT REVIEW.—In any case in which ju7 dicial review is sought under paragraph (4), the 

8 court shall review the record and may set aside any 

9 action of the Department or the Service found to 

10 be— 

11 ‘‘(A) arbitrary, capricious, an abuse of dis12 cretion, or otherwise not in accordance with a 

13 provision of law; 

14 ‘‘(B) obtained without procedures required 

15 by a provision of law having been followed; or 

16 ‘‘(C) unsupported by substantial evidence. 

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

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

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

20 ‘‘SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IM21 PROVE ACCOUNTABILITY OF EMPLOYEES OF 

22 THE INDIAN HEALTH SERVICE. 

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

24 ‘‘(1) COVERED INDIVIDUAL.— 


SSpencer on DSK126QN23PROD with BILLS
29 

•S 3130 IS

1 ‘‘(A) IN GENERAL.—The term ‘covered in2 dividual’ means an individual occupying a posi3 tion at the Service. 

4 ‘‘(B) EXCLUSIONS.—The term ‘covered in5 dividual’ does not include— 

6 ‘‘(i) an individual occupying a senior 

7 executive position (as defined in section 

8 606(a)); 

9 ‘‘(ii) an individual who has not com10 pleted a probationary or trial period; or 

11 ‘‘(iii) a political appointee. 

12 ‘‘(2) GRADE.—The term ‘grade’ has the mean13 ing given the term in section 7511(a) of title 5, 

14 United States Code. 

15 ‘‘(3) MISCONDUCT.—The term ‘misconduct’ in16 cludes— 

17 ‘‘(A) neglect of duty; 

18 ‘‘(B) malfeasance; 

19 ‘‘(C) failure to accept a directed reassign20 ment; and 

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

22 transfer of function. 

23 ‘‘(4) POLITICAL APPOINTEE.—The term ‘polit24 ical appointee’ means an individual who is— 


SSpencer on DSK126QN23PROD with BILLS
30 

•S 3130 IS

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

2 any of sections 5312 through 5316 of title 5, 

3 United States Code (relating to the Executive 

4 Schedule); 

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

6 emergency appointee, or noncareer appointee 

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

8 of title 5, United States Code); or 

9 ‘‘(C) employed in a position of a confiden10 tial or policy-determining character under 

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

12 Code of Federal Regulations (or a successor 

13 regulation). 

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

15 the Secretary, acting through the Service. 

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

17 placing of an employee, for disciplinary reasons, in 

18 a temporary status without duties and pay for a pe19 riod in excess of 14 days. 

20 ‘‘(b) AUTHORITY.— 

21 ‘‘(1) IN GENERAL.—The Secretary may, in ac22 cordance with this section, remove, demote, or sus23 pend a covered individual from employment at the 

24 Service if the Secretary determines that the performVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
31 

•S 3130 IS

1 ance or misconduct of the covered individual war2 rants such an action. 

3 ‘‘(2) ACTIONS.—If the Secretary removes, de4 motes, or suspends a covered individual pursuant to 

5 paragraph (1), the Secretary may— 

6 ‘‘(A) remove the covered individual from 

7 the civil service (as defined in section 2101 of 

8 title 5, United States Code); 

9 ‘‘(B) demote the covered individual by 

10 means of— 

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

12 covered individual is qualified, as the Sec13 retary determines appropriate; and 

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

15 pay of the covered individual; or 

16 ‘‘(C) suspend the covered individual from 

17 the civil service (as defined in section 2101 of 

18 title 5, United States Code). 

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

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

21 provision of law, any covered individual subject to a 

22 demotion by means of a reduction in grade under 

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

24 the demotion, receive the annual rate of pay applica25 ble to the reduced grade. 


SSpencer on DSK126QN23PROD with BILLS
32 

•S 3130 IS

1 ‘‘(2) RESTRICTIONS.— 

2 ‘‘(A) PROHIBITION ON ADMINISTRATIVE

3 LEAVE.—A covered individual subject to a de4 motion under subsection (b)(2)(B)— 

5 ‘‘(i) may not be placed on administra6 tive leave during the period during which 

7 an appeal (if any) under this section is on8 going; and 

9 ‘‘(ii) may only receive pay if the cov10 ered individual reports for duty or is ap11 proved to use accrued unused annual, sick, 

12 family medical, military, or court leave. 

13 ‘‘(B) RESTRICTION ON PAY AND BENE14 FITS.—If a covered individual subject to a de15 motion under subsection (b)(2)(B) does not re16 port for duty (and has not received approval to 

17 use accrued unused leave under subparagraph 

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

19 pay or other benefits pursuant to subsection 

20 (e)(7). 

21 ‘‘(d) RIGHTS AND PROCEDURES.— 

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

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

24 under subsection (b) is entitled— 


SSpencer on DSK126QN23PROD with BILLS
33 

•S 3130 IS

1 ‘‘(A) to advance notice of the action or re2 moval; 

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

4 in support of the proposed action or removal; 

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

6 other representative of the covered individual’s 

7 choice; and 

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

9 removal under paragraph (2) in accordance 

10 with the internal grievance process established 

11 by the Secretary under paragraph (3). 

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

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

14 period for notice, response, and a final decision 

15 on an action under subsection (b) may not ex16 ceed 15 business days. 

17 ‘‘(B) RESPONSE.—A covered individual re18 ceiving a notice under paragraph (1)(A) of an 

19 action or removal under subsection (b) shall 

20 have not more than 7 business days to respond 

21 to the notice. 

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

23 ‘‘(i) IN GENERAL.—The Secretary 

24 shall issue a final and conclusive decision 

25 on an action or removal under subsection 


SSpencer on DSK126QN23PROD with BILLS
34 

•S 3130 IS

1 (b) not later than 15 business days after 

2 the date on which the notice of the action 

3 is received by the applicable covered indi4 vidual under paragraph (1)(A). 

5 ‘‘(ii) REQUIREMENTS.—A decision 

6 under clause (i)— 

7 ‘‘(I) shall be in writing; and 

8 ‘‘(II) shall include the specific 

9 reasons for the decision. 

10 ‘‘(3) GRIEVANCE PROCESS.— 

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

12 establish an internal grievance process under 

13 which a covered individual may grieve a deci14 sion issued under paragraph (2) not later than 

15 the date that is 7 business days after the date 

16 on which the decision under that paragraph was 

17 issued. 

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

19 issue a decision for which an internal grievance 

20 process is initiated under subparagraph (A) not 

21 later than 21 business days after the date on 

22 which the grievance process is initiated by the 

23 covered individual. 


SSpencer on DSK126QN23PROD with BILLS
35 

•S 3130 IS

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

2 A grievance decision under this paragraph shall 

3 be final and conclusive. 

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

5 procedures under this subsection shall supersede any 

6 collective bargaining agreement to the extent that 

7 such an agreement is inconsistent with the proce8 dures. 

9 ‘‘(5) PERFORMANCE APPRAISAL.—The proce10 dures under chapter 43 of title 5, United States 

11 Code, shall not apply to an action under subsection 

12 (b). 

13 ‘‘(6) APPEAL TO MERIT SYSTEMS PROTECTION

14 BOARD.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B) and subsection (e), any removal, de17 motion, or suspension of more than 14 days 

18 under subsection (b) may be appealed to the 

19 Merit Systems Protection Board, which shall 

20 refer such appeal to an administrative law 

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

22 United States Code. 

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

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

25 suspension may only be made if the appeal is 


SSpencer on DSK126QN23PROD with BILLS
36 

•S 3130 IS

1 made not later than 10 business days after the 

2 date of the removal, demotion, or suspension. 

3 ‘‘(e) EXPEDITED REVIEW.— 

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

5 under subsection (d)(6)(A), the applicable adminis6 trative law judge shall— 

7 ‘‘(A) expedite the appeal under section 

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

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

10 the appeal not later than 180 days after the 

11 date of the appeal. 

12 ‘‘(2) UPHOLDING DECISION.— 

13 ‘‘(A) IN GENERAL.—Notwithstanding sec14 tion 7701(c)(1)(B) of title 5, United States 

15 Code, the administrative law judge shall uphold 

16 the decision of the Secretary to remove, demote, 

17 or suspend an employee under subsection (b) if 

18 the decision is supported by substantial evi19 dence. 

20 ‘‘(B) PROHIBITION OF MITIGATION.—Not21 withstanding title 5, United States Code, or any 

22 other provision of law, if the decision of the 

23 Secretary to remove, demote, or suspend an em24 ployee under subsection (b) is supported by 

25 substantial evidence, the administrative law 


SSpencer on DSK126QN23PROD with BILLS
37 

•S 3130 IS

1 judge shall not mitigate the penalty prescribed 

2 by the Secretary. 

3 ‘‘(3) APPEAL TO MERIT SYSTEMS PROTECTION

4 BOARD.— 

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

6 administrative law judge under paragraph (1) 

7 may be appealed to the Merit Systems Protec8 tion Board. 

9 ‘‘(B) UPHOLDING DECISION.—Notwith10 standing section 7701(c)(1)(B) of title 5, 

11 United States Code, the Merit Systems Protec12 tion Board shall uphold the decision of the Sec13 retary to remove, demote, or suspend an em14 ployee under subsection (b) if the decision is 

15 supported by substantial evidence. 

16 ‘‘(C) PROHIBITION OF MITIGATION.—Not17 withstanding title 5, United States Code, or any 

18 other provision of law, if the decision of the 

19 Secretary is supported by substantial evidence, 

20 the Merit Systems Protection Board shall not 

21 mitigate the penalty prescribed by the Sec22 retary. 

23 ‘‘(4) REPORT.—In any case in which an admin24 istrative law judge cannot issue a final and complete 

25 decision by the deadline described in paragraph 


SSpencer on DSK126QN23PROD with BILLS
38 

•S 3130 IS

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

2 not later than 14 business days after the deadline 

3 expires, submit to the appropriate committees of 

4 Congress a report that explains the reasons why a 

5 decision was not issued by the deadline. 

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

7 Protection Board under paragraph (3) may be ap8 pealed to the United States Court of Appeals for the 

9 Federal Circuit pursuant to section 7703 of title 5, 

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

11 competent jurisdiction pursuant to subsection 

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

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

14 Systems Protection Board may not stay any removal 

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

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

17 ‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR18 ING APPEAL.— 

19 ‘‘(A) IN GENERAL.— 

20 ‘‘(i) RESTRICTION ON PAY AND BENE21 FITS.—During the period described in 

22 clause (ii), a covered individual may not re23 ceive any pay and benefits described in 

24 subparagraph (B). 


SSpencer on DSK126QN23PROD with BILLS
39 

•S 3130 IS

1 ‘‘(ii) PERIOD DESCRIBED.—The pe2 riod referred to in clause (i) is the pe3 riod— 

4 ‘‘(I) beginning on the date on 

5 which a covered individual appeals 

6 under this section a removal from the 

7 civil service under subsection 

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

9 ‘‘(II) ending on the later of— 

10 ‘‘(aa) the date on which the 

11 Merit Systems Protection Board 

12 issues a final decision on the ap13 peal under paragraph (3); and 

14 ‘‘(bb) the date on which the 

15 United States Court of Appeals 

16 for the Federal Circuit issues a 

17 final decision on the appeal 

18 under paragraph (5). 

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

20 The pay and benefits referred to in subpara21 graph (A)(i) are any pay, awards, bonuses, in22 centives, allowances, differentials, student loan 

23 repayments, special payments, or benefits re24 lated to the employment of the individual by the 

25 Service. 


SSpencer on DSK126QN23PROD with BILLS
40 

•S 3130 IS

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

2 the maximum extent practicable, the Secretary shall 

3 provide to the Merit Systems Protection Board such 

4 information and assistance as may be necessary to 

5 ensure an appeal under this subsection is expedited. 

6 ‘‘(9) BACKPAY.—If an employee prevails on ap7 peal under this section, the employee shall be enti8 tled to backpay (as provided in section 5596 of title 

9 5, United States Code). 

10 ‘‘(10) APPLICABLE TIMELINES AND PROCE11 DURES.—If an employee who is subject to a collec12 tive bargaining agreement chooses to grieve an ac13 tion taken under this section through a grievance 

14 procedure provided under the collective bargaining 

15 agreement, the timelines and procedures described in 

16 subsection (d) and this subsection shall apply. 

17 ‘‘(f) ALLEGED PROHIBITED PERSONNEL PRAC18 TICE.—In the case of a covered individual seeking correc19 tive action (or on behalf of whom corrective action is 

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

21 alleged prohibited personnel practice described in section 

22 2302(b) of title 5, United States Code, the Secretary may 

23 not remove, demote, or suspend the covered individual 

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


SSpencer on DSK126QN23PROD with BILLS
41 

•S 3130 IS

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

2 Code. 

3 ‘‘(g) TERMINATION OF INVESTIGATIONS BY OFFICE

4 OF SPECIAL COUNSEL.— 

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

6 provision of law, the Special Counsel established by 

7 section 1211 of title 5, United States Code, may ter8 minate an investigation of a prohibited personnel 

9 practice alleged by an employee or former employee 

10 of the Service after the Special Counsel provides to 

11 the employee or former employee a written state12 ment of the reasons for the termination of the inves13 tigation. 

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

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

16 in any judicial or administrative proceeding without 

17 the consent of the employee or former employee de18 scribed in paragraph (1). 

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

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

21 maximum extent practicable, the Secretary shall fill the 

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

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

24 title 5, United States Code, is amended— 


SSpencer on DSK126QN23PROD with BILLS
42 

•S 3130 IS

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

2 end; 

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

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

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

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

7 607 of the Indian Health Care Improvement Act.’’. 

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

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

10 Human Services or the Inspector General of the Depart11 ment of Health and Human Services, as appropriate, shall 

12 submit to Congress a report that includes information 

13 on— 

14 (1) the number of employees of the Indian 

15 Health Service who were removed, demoted, or sus16 pended during the 1-year period preceding the date 

17 of enactment of this Act; 

18 (2) the number of employees of the Indian 

19 Health Service who were removed, demoted, or sus20 pended during the 1-year period beginning on the 

21 date of enactment of this Act pursuant to the 

22 amendments made by this section; and 

23 (3) the appropriate details of any such remov24 als, demotions, and suspensions that lend necessary 

25 context. 


SSpencer on DSK126QN23PROD with BILLS
43 

•S 3130 IS

1 SEC. 107. TRIBAL CULTURE AND HISTORY. 

2 Section 113 of the Indian Health Care Improvement 

3 Act (25 U.S.C. 1616f) is amended— 

4 (1) in subsection (a)— 

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

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

7 (B) by striking ‘‘appropriate employees of 

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

9 Service, locum tenens medical providers, 

10 healthcare volunteers, and other contracted em11 ployees who work at Service hospitals or other 

12 Service units and whose employment requires 

13 regular direct patient access’’; and 

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

15 ‘‘(c) REQUIREMENT TO COMPLETE TRAINING PRO16 GRAM.—Notwithstanding any other provision of law, be17 ginning on the date of enactment of the Restoring Ac18 countability in the Indian Health Service Act of 2023, 

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

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

21 of employment, annually participate in and complete the 

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

23 SEC. 108. STAFFING DEMONSTRATION PROGRAM. 

24 Title VIII of the Indian Health Care Improvement 

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

26 the end the following: 


SSpencer on DSK126QN23PROD with BILLS
44 

•S 3130 IS

1 ‘‘SEC. 833. STAFFING DEMONSTRATION PROGRAM. 

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

3 date of enactment of the Restoring Accountability in the 

4 Indian Health Service Act of 2023, the Secretary, acting 

5 through the Service (referred to in this section as the ‘Sec6 retary’), shall establish a demonstration program (referred 

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

8 which the Service may provide Service units with addi9 tional staffing resources, with the goal that the resources 

10 become self-sustaining. 

11 ‘‘(b) SELECTION.—In selecting Service units for par12 ticipation in the demonstration program, the Secretary 

13 shall consider whether a Service unit services an Indian 

14 tribe that— 

15 ‘‘(1) has utilized or contributed substantial 

16 Tribal funds to construct a health facility used by 

17 the Service or identified in the master plan for the 

18 Service unit; 

19 ‘‘(2) is located in 1 or more States with Med20 icaid reimbursements plans or policies that will in21 crease the likelihood that the staffing resources pro22 vided will be self-sustaining; and 

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

24 paragraph (1) under historical staffing ratios, as de25 termined by the Secretary, that have not been equalVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
45 

•S 3130 IS

1 ized or updated by the Service or any other Service 

2 program to reflect current staffing needs. 

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

4 Service unit under the demonstration program shall be 

5 provided for a duration that the Secretary, in consultation 

6 with the applicable Indian tribe, determines appropriate, 

7 on the condition that each staffing position provided shall 

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

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

10 resources provided under the demonstration program shall 

11 reduce the recurring base funding for staffing for any In12 dian tribe or Service unit. 

13 ‘‘(e) SUNSET.—The demonstration program estab14 lished under subsection (a) shall terminate on the date 

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

16 program is established. 

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

18 on which the demonstration program terminates under 

19 subsection (e), the Secretary shall submit to the Com20 mittee on Indian Affairs and the Committee on Health, 

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

22 Committee on Natural Resources and the Committee on 

23 Energy and Commerce of the House of Representatives 

24 a report describing the demonstration program, including 

25 information on— 


SSpencer on DSK126QN23PROD with BILLS
46 

•S 3130 IS

1 ‘‘(1) whether the staffing resources provided 

2 under the demonstration program resulted in addi3 tional revenue for the applicable Service unit suffi4 cient to maintain the staff on a permanent basis; 

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

6 provided under the demonstration program reduced 

7 the unmet staffing need for the applicable Service 

8 unit; and 

9 ‘‘(3) whether the demonstration program could 

10 be deployed permanently to reduce unmet staffing 

11 needs throughout the Service.’’. 

12 SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION 

13 POLICY. 

14 Title VIII of the Indian Health Care Improvement 

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

16 is amended by adding at the end the following: 

17 ‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 

18 POLICY. 

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

20 2023, the Secretary shall establish, and once every 5 years 

21 thereafter, the Secretary shall update, after meaningful 

22 consultation with representatives of affected Indian tribes, 

23 a rule establishing a Tribal consultation policy for the 

24 Service. 


SSpencer on DSK126QN23PROD with BILLS
47 

•S 3130 IS

1 ‘‘(b) CONTENTS OF TRIBAL CONSULTATION POL2 ICY.—The policy established under the rule under sub3 section (a) shall— 

4 ‘‘(1) update, and replace, the Tribal consulta5 tion policy established under Circular No. 2006–01 

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

7 ‘‘(2) include— 

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

9 how the Service will notify Indian tribes of the 

10 availability of meaningful consultation; 

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

12 agency decisions by the Service will trigger a re13 quirement for meaningful consultation with In14 dian tribes; and 

15 ‘‘(C) a determination of which actions con16 stitute meaningful consultation with Indian 

17 tribes.’’. 

18 SEC. 110. ENHANCING QUALITY OF CARE IN THE INDIAN 

19 HEALTH SERVICE. 

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

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

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

23 organization’’ have the meanings given those terms in sec24 tion 4 of the Indian Health Care Improvement Act (25 

25 U.S.C. 1603). 


SSpencer on DSK126QN23PROD with BILLS
48 

•S 3130 IS

1 (b) BEST PRACTICES FOR GOVERNING BOARD AND

2 AREA OFFICE MEETINGS.— 

3 (1) DEFINITION OF GOVERNING BOARD.—In 

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

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

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

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

8 consultation with Indian tribes, governing boards, 

9 Area offices, Service units, and other stakeholders, 

10 as determined appropriate by the Secretary, shall es11 tablish— 

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

13 best practices for governing boards; and 

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

15 best practices for Area offices. 

16 (3) REQUIREMENTS.— 

17 (A) GOVERNING BOARD BEST PRAC18 TICES.—The best practices for governing 

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

20 include provisions relating to— 

21 (i) adequately monitoring the delivery 

22 of care at the applicable facility managed 

23 by the governing board; 

24 (ii) ensuring ongoing facility compli25 ance with Federal health care program reVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
49 

•S 3130 IS

1 quirements, including requirements of the 

2 Service and the Centers for Medicare & 

3 Medicaid Services; 

4 (iii) handling, documenting, and re5 sponding to patient complaints; 

6 (iv) documenting, addressing, and, if 

7 applicable, reporting instances of profes8 sional misconduct by facility staff in ac9 cordance with applicable Federal and State 

10 law; 

11 (v) improving facility performance and 

12 operations with respect to mandatory and 

13 voluntary quality initiatives carried out by 

14 the Service and the Centers for Medicare & 

15 Medicaid Services; and 

16 (vi) reporting requirements under 

17 Federal law, including with respect to— 

18 (I) the Government Performance 

19 and Results Act of 1993 (Public Law 

20 103–62; 107 Stat. 285), the GPRA 

21 Modernization Act of 2010 (Public 

22 Law 111–352; 124 Stat. 3866), and 

23 the amendments made by those Acts; 

24 and 


SSpencer on DSK126QN23PROD with BILLS
50 

•S 3130 IS

1 (II) the applicable provisions of 

2 titles XVIII and XIX of the Social Se3 curity Act (42 U.S.C. 1395 et seq., 

4 1396 et seq.). 

5 (B) AREA OFFICE BEST PRACTICES.—The 

6 best practices for Area offices established under 

7 paragraph (2)(B) shall include provisions relat8 ing to— 

9 (i) strategies for how to best monitor 

10 governing board activities relating to the 

11 oversight of— 

12 (I) delivery and quality of patient 

13 care; 

14 (II) documenting and responding 

15 to patient complaints and instances of 

16 professional misconduct; and 

17 (III) facility compliance with 

18 Federal health care program require19 ments, including requirements of the 

20 Service and the Centers for Medicare 

21 & Medicaid Services; and 

22 (ii) connecting governing boards, in23 cluding the applicable facilities of those 

24 governing boards, to resources necessary 

25 for enhancing patient outcomes and imVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
51 

•S 3130 IS

1 proving facility performance, including 

2 through the use of technical assistance. 

3 (4) PUBLICATION.—The best practices estab4 lished under paragraph (2) shall be— 

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

6 all governing boards and Area offices; and 

7 (B) incorporated into the Indian Health 

8 Manual of the Service. 

9 (c) REVIEW OF QUALITY AND PERFORMANCE MEAS10 URES.— 

11 (1) REVIEW.— 

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

13 after the date of enactment of this Act, the Sec14 retary, in coordination with the Agency for 

15 Healthcare Research and Quality, the National 

16 Quality Forum, Indian tribes, practitioners and 

17 administrators of the Service, and other quali18 fied experts, as determined appropriate by the 

19 Secretary, shall undertake a review of the re20 ported quality and performance measures of 

21 Service facilities conducted by the Secretary in 

22 accordance with— 

23 (i) section 306 of title 5, United 

24 States Code; 


SSpencer on DSK126QN23PROD with BILLS
52 

•S 3130 IS

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 (B) REPORT.—Not later than 6 months 

8 after the date on which the review required 

9 under subparagraph (A) is completed, the Sec10 retary shall submit to Congress a report on the 

11 details and findings of that review, which shall 

12 include an assessment of— 

13 (i) the suitability of measures used as 

14 of the date of enactment of this Act for the 

15 applicable Service facility, taking into con16 sideration the patient volume of the facil17 ity, the mix of patient cases at the facility, 

18 the geographic location of the facility, and 

19 medical professional shortage designations 

20 at the facility, as determined by the Sec21 retary; and 

22 (ii) the extent to which the perform23 ance and quality measures are outcome24 based or process-based measures. 


SSpencer on DSK126QN23PROD with BILLS
53 

•S 3130 IS

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

2 date on which the report required under paragraph 

3 (1)(B) is submitted to Congress, the Service, in co4 ordination with the Centers for Medicare & Medicaid 

5 Services, shall adopt, and assist Service facilities to 

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

7 compared to those quality and performance meas8 ures adopted prior to the submission of that report, 

9 quality and performance measures, including meas10 ures that are more outcome-based and process11 based, in accordance with the factors described in 

12 paragraph (1)(B)(i). 

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

14 the date on which the report required under para15 graph (1)(B) is submitted to Congress, the Comp16 troller General of the United States shall submit to 

17 Congress a report on challenges relating to quality 

18 measure and data collection in Service facilities, 

19 which shall include— 

20 (A) barriers to the adoption of relevant 

21 performance and quality measures in Service 

22 facilities; and 

23 (B) recommendations for how the Service, 

24 other Federal agencies, and stakeholders can 


SSpencer on DSK126QN23PROD with BILLS
54 

•S 3130 IS

1 assist Service facilities in adopting suitable 

2 quality and performance measures. 

3 (d) COMPLIANCE ASSISTANCE PROGRAM.— 

4 (1) DEFINITIONS.—In this subsection: 

5 (A) ADMINISTRATOR.—The term ‘‘Admin6 istrator’’ means the Administrator of the Cen7 ters for Medicare & Medicaid Services. 

8 (B) ELIGIBLE FACILITY.— 

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

10 facility’’ means a facility operated by the 

11 Service that— 

12 (I) is an underperforming hos13 pital or outpatient facility; and 

14 (II) is eligible for payments 

15 under title XVIII of the Social Secu16 rity Act (42 U.S.C. 1395 et seq.). 

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

18 facility’’ includes a tribally operated facil19 ity, if that facility consents to participating 

20 in the program. 

21 (C) PROGRAM.—The term ‘‘program’’ 

22 means the compliance assistance program es23 tablished under paragraph (2). 

24 (D) TRIBALLY OPERATED FACILITY.—The 

25 term ‘‘tribally operated facility’’ means a facilVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
55 

•S 3130 IS

1 ity operated by an Indian tribe, a tribal organi2 zation, or an Urban Indian organization that— 

3 (i) is an underperforming hospital or 

4 outpatient facility; and 

5 (ii) is eligible for payments under title 

6 XVIII of the Social Security Act (42 

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

8 (2) ESTABLISHMENT OF PROGRAM.—Not later 

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

10 the Secretary, in coordination with the Adminis11 trator and quality improvement organizations having 

12 a contract with the Secretary under part B of title 

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

14 seq.), shall establish a compliance assistance pro15 gram for eligible facilities. 

16 (3) METHODOLOGY.—The Secretary shall es17 tablish a methodology for determining which eligible 

18 facilities shall participate in the program, which 

19 shall take into account the following factors: 

20 (A) The number and severity of facility de21 ficiencies with respect to applicable require22 ments under title XVIII of the Social Security 

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

24 (B) The history of provider misconduct or 

25 patient harm at the facility. 


SSpencer on DSK126QN23PROD with BILLS
56 

•S 3130 IS

1 (C) Whether there is high staff turnover at 

2 the facility. 

3 (D) Whether the facility has low perform4 ance on program quality measures, relative to 

5 other facilities of the Service, in accordance 

6 with reported quality and performance meas7 ures conducted by the Secretary in accordance 

8 with— 

9 (i) section 306 of title 5, United 

10 States Code; 

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

12 States Code; and 

13 (iii) any law (including regulations) 

14 used in any mandatory or voluntary pro15 gram of the Centers for Medicare & Med16 icaid Services. 

17 (4) SELECTION OF FACILITIES.— 

18 (A) IN GENERAL.—The Secretary, in co19 ordination with the Administrator, shall select 

20 not less than 25 percent of the eligible facilities 

21 to participate in the program using the method22 ology established under paragraph (3). 

23 (B) PARTICIPATION.— 

24 (i) IN GENERAL.—An eligible facility 

25 selected to participate in the program 


SSpencer on DSK126QN23PROD with BILLS
57 

•S 3130 IS

1 under subparagraph (A) shall be required 

2 to participate in the program. 

3 (ii) REQUIREMENT.—The Secretary 

4 shall ensure that, at all times during the 

5 period beginning on the date of establish6 ment of the program and the date on 

7 which the program terminates under para8 graph (8), not less than 25 percent of eli9 gible facilities are participating in the pro10 gram. 

11 (C) TERM OF PARTICIPATION.— 

12 (i) IN GENERAL.—Subject to clause 

13 (ii), an eligible facility selected to partici14 pate in the program under subparagraph 

15 (A) shall participate in the program for a 

16 period of 2 years. 

17 (ii) WAIVER.—If the Secretary, in co18 ordination with the Administrator, certifies 

19 that an eligible facility participating in the 

20 program has improved on its performance 

21 to a satisfactory level, as determined by 

22 the Secretary, then the eligible facility does 

23 not have to participate in the program for 

24 the full 2-year period. 


SSpencer on DSK126QN23PROD with BILLS
58 

•S 3130 IS

1 (D) PARTICIPATION LIMIT.—An eligible fa2 cility may participate in the program for more 

3 than 1 2-year period. 

4 (5) PROGRAM COMPONENTS.—The program 

5 shall provide on-site consultation and educational 

6 programming for eligible facilities to ensure those el7 igible facilities are— 

8 (A) meeting Federal requirements of the 

9 Service and any conditions of participation ap10 plicable under title XVIII of the Social Security 

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

12 (B) satisfactorily implementing any quality 

13 initiatives and programs established by the 

14 Service or the Centers for Medicare & Medicaid 

15 Services. 

16 (6) ENFORCEMENT OR NONCOMPLIANCE AC17 TIONS.— 

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

19 conducted independently of any enforcement ac20 tions under the Indian Health Care Improve21 ment Act (25 U.S.C. 1601 et seq.) or non22 compliance actions taken by the Administrator 

23 with respect to noncompliance with conditions 

24 of participation applicable under title XVIII of 

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


SSpencer on DSK126QN23PROD with BILLS
59 

•S 3130 IS

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

2 the Secretary or the Administrator, as applica3 ble, encounters a triggering event, as deter4 mined by the Secretary or the Administrator, as 

5 applicable, that would necessitate an enforce6 ment action or noncompliance action. 

7 (B) TRIGGERING EVENT ENCOUNTERED.— 

8 If a triggering event is encountered by the Sec9 retary or Administrator under subparagraph 

10 (A), the eligible facility shall continue to partici11 pate in the program so long as the facility— 

12 (i) remains eligible for payments 

13 under title XVIII of the Social Security 

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

15 (ii) continues to meet all of the condi16 tions and requirements for such payments 

17 which are applicable under such title. 

18 (7) IMPLEMENTATION.—The Secretary shall 

19 carry out the program in coordination with quality 

20 improvement organizations having a contract with 

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

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

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

24 years after the date on which the program is estab25 lished. 


SSpencer on DSK126QN23PROD with BILLS
60 

•S 3130 IS

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

2 date on which the program terminates under para3 graph (8), the Comptroller General of the United 

4 States shall submit to Congress a report evaluating 

5 the effectiveness of the program, which shall include, 

6 to the extent practicable— 

7 (A) detailed data on changes in the patient 

8 experience at eligible facilities that participated 

9 in the program; 

10 (B) a description of the compliance status 

11 of eligible facilities that participated in the pro12 gram with requirements of the Service and any 

13 conditions of participation applicable under title 

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

15 1395 et seq.); and 

16 (C) a description of the progress by eligible 

17 facilities that participated in the program in 

18 meeting the goals of quality improvement activi19 ties of the Department of Health and Human 

20 Services. 


SSpencer on DSK126QN23PROD with BILLS
61 

•S 3130 IS

1 SEC. 111. NOTIFICATION OF INVESTIGATION REGARDING 

2 PROFESSIONAL CONDUCT; SUBMISSION OF 

3 RECORDS. 

4 Title VIII of the Indian Health Care Improvement 

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

6 is amended by adding at the end the following: 

7 ‘‘SEC. 835. NOTIFICATION OF INVESTIGATION REGARDING 

8 PROFESSIONAL CONDUCT; SUBMISSION OF 

9 RECORDS. 

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

11 the date on which the Service undertakes an investigation 

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

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

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

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

18 the Service into the professional conduct of a licensee of 

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

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

21 SEC. 112. MEDICAL CHAPERONES; OFFICE OF PATIENT AD22 VOCACY. 

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

24 Health Care Improvement Act is amended by inserting 

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


SSpencer on DSK126QN23PROD with BILLS
62 

•S 3130 IS

1 ‘‘SEC. 224. MEDICAL CHAPERONES. 

2 ‘‘(a) INDIAN HEALTH SERVICE.— 

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

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

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

8 Service. 

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

10 through the Service, shall— 

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

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

14 through the Service; and 

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

16 subparagraph (A) is provided to each patient in 

17 each Service unit. 

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

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

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

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

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


SSpencer on DSK126QN23PROD with BILLS
63 

•S 3130 IS

1 (b) INDIAN HEALTH SERVICE OFFICE OF PATIENT

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

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

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

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

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

8 the Director of the Office. 

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

11 (b). 

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

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

14 Patient Advocacy’. 

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

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

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

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

21 ‘‘(d) DUTIES.— 

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

23 a patient advocacy program of the Service, under 

24 which the Office shall— 


SSpencer on DSK126QN23PROD with BILLS
64 

•S 3130 IS

1 ‘‘(A) employ patient advocates to advocate 

2 on behalf of Indians with respect to health care 

3 services sought or received through the Service; 

4 ‘‘(B) provide to those patient advocates 

5 training to ensure the advocates carry out the 

6 responsibilities described in paragraph (2); and 

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

8 the Director determines to be appropriate to be 

9 seen by the largest percentage of patients and 

10 family members of patients at each Service 

11 unit, display— 

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

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

16 unit; and 

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

18 responsibilities of patients and family 

19 members of patients at the Service unit. 

20 ‘‘(2) PATIENT ADVOCATE RESPONSIBILITIES.— 

21 The responsibilities of a patient advocate employed 

22 by the Office shall include the following: 

23 ‘‘(A) Resolving any complaints by Indian 

24 patients with respect to health care services 


SSpencer on DSK126QN23PROD with BILLS
65 

•S 3130 IS

1 provided by or through the Service that cannot 

2 be resolved at— 

3 ‘‘(i) the point of service; or 

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

5 the patient. 

6 ‘‘(B) Expressing to Indians their rights 

7 and responsibilities as patients in receiving 

8 health care services through the Service. 

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

10 to various committees, a description of any 

11 issues experienced by Indians in receiving 

12 health care services through the Service. 

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

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

17 respect to the receipt of health care services 

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

20 there exist any trends in those data. 

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

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


SSpencer on DSK126QN23PROD with BILLS
66 

•S 3130 IS

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

2 quarterly, opportunities for improvement in the 

3 provision of health care services to Indians by 

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

6 members. 

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

9 with respect to health care provided by or 

10 through the Service is brought to the attention 

11 of appropriate staff of the Service or Indian 

12 health program for the purpose of assessing 

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

15 or Indian health program level. 

16 ‘‘(I) Supporting any other patient advocacy 

17 programs carried out by the Department. 

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

19 decisions with respect to the receipt of health 

20 care services through the Service are entered 

21 into a patient advocate tracking system of the 

22 Office, if applicable. 

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

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


SSpencer on DSK126QN23PROD with BILLS
67 

•S 3130 IS

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

3 immediate family members. 

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

6 surrogate decisionmakers for such Indians) are 

7 aware of the right of Indians— 

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

10 Protection and Advocacy for Mentally Ill 

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

12 10803); 

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

14 rights of Indians experiencing behavioral 

15 health issues; and 

16 ‘‘(iii) to investigate incidents of abuse 

17 and neglect of Indians experiencing behav18 ioral health issues. 

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

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


SSpencer on DSK126QN23PROD with BILLS
68 

•S 3130 IS

1 ‘‘(N) Documenting potentially threatening 

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

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

5 that the training provided to patient advocates 

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

7 Office, including with respect to any mandatory 

8 training or certification standards approved by the 

9 Director.’’. 

10 SEC. 113. FITNESS OF HEALTH CARE PROVIDERS. 

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

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

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

15 ‘‘(a) ADDITIONAL REQUIREMENTS FOR HIRING OF

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

17 hiring process for each health care provider position at 

18 the Service after the date of enactment of the Restoring 

19 Accountability in the Indian Health Service Act of 2023, 

20 the Director shall require from the medical board of each 

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

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

25 provider during the 20-year period ending on the 


SSpencer on DSK126QN23PROD with BILLS
69 

•S 3130 IS

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

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

4 provider has entered into any settlement agreement 

5 for a disciplinary charge relating to the practice of 

6 medicine by the health care provider. 

7 ‘‘(b) PROVISION OF INFORMATION ON SERVICE

8 HEALTH CARE PROVIDERS TO STATE MEDICAL

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

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

11 the Service who has violated a requirement of the medical 

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

14 care provider is licensed detailed information with respect 

15 to the violation, regardless of whether the medical board 

16 has formally requested that information.’’. 

17 (b) REPORT ON COMPLIANCE BY INDIAN HEALTH

18 SERVICE WITH REVIEWS OF HEALTH CARE PROVIDERS

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

22 shall submit to the Committee on Indian Affairs of the 

23 Senate and the Committee on Natural Resources of the 

24 House of Representatives a report on the compliance by 


SSpencer on DSK126QN23PROD with BILLS
70 

•S 3130 IS

1 the Indian Health Service with the policy of the Indian 

2 Health Service— 

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

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

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

9 of the health care provider; and 

10 (2) to take appropriate action with respect to 

11 any concern, complaint, or allegation described in 

12 paragraph (1). 

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

14 Title IV of the Indian Health Care Improvement Act 

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

16 the following: 

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

18 ‘‘(a) REGULATIONS.— 

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

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

22 2023, the Secretary, acting through the Service, 

23 shall— 


SSpencer on DSK126QN23PROD with BILLS
71 

•S 3130 IS

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

2 measure the timeliness of the provision of 

3 health care services in Service facilities; and 

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

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

8 each Service unit to submit to the Secretary data 

9 with respect to the standards established under 

10 paragraph (1)(A). 

11 ‘‘(b) ANNUAL REPORTS.— 

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

13 the date of enactment of the Restoring Account14 ability in the Indian Health Service Act of 2023, 

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

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

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

21 each report received under paragraph (1) publicly 

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


SSpencer on DSK126QN23PROD with BILLS
72 

•S 3130 IS

1 TITLE II—EMPLOYEE 

2 PROTECTIONS 

3 SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIA4 TION. 

5 Title VI of the Indian Health Care Improvement Act 

6 (25 U.S.C. 1661 et seq.) (as amended by section 112(b)) 

7 is amended by adding at the end the following: 

8 ‘‘SEC. 609. EMPLOYEE PROTECTIONS AGAINST RETALIA9 TION. 

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

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

12 means information— 

13 ‘‘(A) the disclosure of which is not specifi14 cally prohibited by law; and 

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

16 Executive order to be kept secret in the interest 

17 of national defense or the conduct of foreign af18 fairs. 

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

20 with respect to a whistleblower, means— 

21 ‘‘(A) an adverse employment action against 

22 the whistleblower; 

23 ‘‘(B) a significantly adverse action against 

24 the whistleblower, such as the refusal or delay 

25 of care provided through the Service; and 


SSpencer on DSK126QN23PROD with BILLS
73 

•S 3130 IS

1 ‘‘(C) an adverse action described in sub2 paragraph (A) or (B) against a family member 

3 or friend of the whistleblower. 

4 ‘‘(3) WHISTLEBLOWER.—The term ‘whistle5 blower’ means an employee of the Service who dis6 closes information that the employee reasonably be7 lieves evidences— 

8 ‘‘(A) a violation of any law, rule, regula9 tion, or Service policy; or 

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

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

12 and specific danger to public health or safety. 

13 ‘‘(b) EMPLOYEE ACCOUNTABILITY.— 

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

15 shall designate an official in the Department who is 

16 not an employee of the Service to receive reports 

17 under paragraph (2). 

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

19 the Service who witnesses retaliation against a whis20 tleblower, a violation of a patient safety requirement, 

21 or other similar conduct shall submit to the official 

22 designated under paragraph (1) a report of the con23 duct. 

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

25 the date on which the official designated under paraVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
74 

•S 3130 IS

1 graph (1) receives a report under paragraph (2), the 

2 Secretary shall— 

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

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

5 other relevant information to the Inspector 

6 General of the Department. 

7 ‘‘(4) REMOVAL FOR WHISTLEBLOWER RETALIA8 TION.— 

9 ‘‘(A) IN GENERAL.—The Secretary may re10 move for misconduct from the civil service (as 

11 defined in section 2101 of title 5, United States 

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

13 as applicable, an employee of the Service if the 

14 Secretary determines, after completing a review 

15 described in paragraph (3), that the employee 

16 has retaliated against a whistleblower and war17 rants removal for misconduct. 

18 ‘‘(B) RETALIATION AS MISCONDUCT.—Re19 taliation by an employee against a whistle20 blower, as described in subparagraph (A), shall 

21 be considered to be misconduct for purposes of 

22 sections 606 and 607. 

23 ‘‘(5) ENHANCING PROTECTIONS FOR WHISTLE24 BLOWERS.—The Secretary shall carry out any ac25 tions determined necessary by the Secretary to enVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
75 

•S 3130 IS

1 hance protection for whistleblowers, including identi2 fying appropriate Service employees and requiring 

3 the employees to complete the Office of Special 

4 Counsel’s Whistleblower Certification Program.’’. 

5 SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION 

6 CONGRESS. 

7 (a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO

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

9 States Code, is amended— 

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

11 following: 

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

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

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

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

16 be subject to any adverse action described in paragraphs 

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

18 procedure described in section 7513 and any other appli19 cable procedure.’’. 

20 (b) ELECTRONIC NOTIFICATION OF RIGHT OF EM21 PLOYEES OF INDIAN HEALTH SERVICE.— 

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

23 Human Services, acting through the Director of the 

24 Indian Health Service (referred to in this subsection 

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


SSpencer on DSK126QN23PROD with BILLS
76 

•S 3130 IS

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

2 of the Indian Health Service notice of the right to 

3 petition Congress under section 7211 of title 5, 

4 United States Code. 

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

6 after the date of enactment of this Act, the Sec7 retary shall submit to the Inspector General of the 

8 Department of Health and Human Services (re9 ferred to in this subsection as the ‘‘Inspector Gen10 eral’’) a memorandum that includes the following 

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

12 5, United States Code, for any Federal agency or 

13 employee to require a Federal employee to seek ap14 proval, guidance, or any other form of input prior to 

15 contacting Congress with information, even if that 

16 information is in relation to the job responsibilities 

17 of the employee. A Federal employee found to have 

18 interfered with or denied the right of another Fed19 eral employee under such section shall be subject to 

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

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

22 Code, including a suspension for more than 14 days 

23 without pay.’’. 

24 (3) APPROVAL OR DISAPPROVAL.— 


SSpencer on DSK126QN23PROD with BILLS
77 

•S 3130 IS

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

2 after the date on which the memorandum is 

3 submitted under paragraph (2), the Inspector 

4 General shall approve or disapprove the memo5 randum. 

6 (B) DISAPPROVAL.—If the Inspector Gen7 eral disapproves the memorandum, the Inspec8 tor General shall advise the Secretary on what 

9 changes to the memorandum are necessary for 

10 approval. 

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

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

13 the date of the approval, the Secretary shall— 

14 (A) provide to each employee of the Indian 

15 Health Service an electronic copy of the ap16 proved memorandum; and 

17 (B) post the memorandum in a clear and 

18 conspicuous place on the website of the Indian 

19 Health Service. 

20 (5) REVISED MEMORANDUM.— 

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

22 disapproved under paragraph (3), not later 

23 than 15 days after the date of disapproval, the 

24 Secretary shall submit to the Inspector General 

25 a revised memorandum that incorporates the 


SSpencer on DSK126QN23PROD with BILLS
78 

•S 3130 IS

1 changes advised under subparagraph (B) of 

2 that paragraph. 

3 (B) APPROVAL OR DISAPPROVAL.—Not 

4 later than 30 days after the date on which the 

5 revised memorandum is submitted under sub6 paragraph (A), the Inspector General shall ap7 prove the revised memorandum. 

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

9 the date on which a revised memorandum is ap10 proved under this paragraph, the Secretary 

11 shall provide notice of the memorandum in ac12 cordance with paragraph (4). 

13 SEC. 203. FISCAL ACCOUNTABILITY. 

14 Title VI of the Indian Health Care Improvement Act 

15 (25 U.S.C. 1661 et seq.) (as amended by section 201) is 

16 amended by adding at the end the following: 

17 ‘‘SEC. 610. FISCAL ACCOUNTABILITY. 

18 ‘‘(a) MANAGEMENT OF FUNDS.— 

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

20 submit a professional housing plan under section 

21 302(a) of the Restoring Accountability in the Indian 

22 Health Service Act of 2023 or a staffing plan under 

23 section 302(b) of that Act by the applicable dead24 line, the Secretary may not receive, obligate, trans25 fer, or expend any amounts for a salary increase or 


SSpencer on DSK126QN23PROD with BILLS
79 

•S 3130 IS

1 bonus of an individual described in paragraph (2) 

2 until the professional housing plan or staffing plan, 

3 as applicable, is submitted. 

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

5 referred to in paragraph (1) is an individual em6 ployed in the Service— 

7 ‘‘(A) in a position that is— 

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

9 through 5316 of title 5, United States 

10 Code; 

11 ‘‘(ii) placed in level IV or V of the Ex12 ecutive Schedule under section 5317 of 

13 title 5, United States Code; or 

14 ‘‘(iii) described in section 213.3301 or 

15 213.3302 of title 5, Code of Federal Regu16 lations (or a successor regulation); or 

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

18 emergency appointee, or noncareer appointee 

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

20 of title 5, United States Code). 

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

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

23 amounts available to the Service that are not obli24 gated or expended, including base budget funding 

25 and third party collections, during the fiscal years 


SSpencer on DSK126QN23PROD with BILLS
80 

•S 3130 IS

1 for which the amounts are made available, and that 

2 remain available, and in keeping with the purpose 

3 for which the funds were appropriated, only to sup4 port patient care by using the funds for— 

5 ‘‘(A) the costs of— 

6 ‘‘(i) essential medical equipment; 

7 ‘‘(ii) purchased or referred care; or 

8 ‘‘(iii) staffing; or 

9 ‘‘(B) any other costs necessary to improve 

10 or maintain quality of care and patient safety. 

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

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

13 any case where the amounts were originally made 

14 available for a particular Service unit, the amounts 

15 are used to benefit Indians served by that Service 

16 unit. 

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

18 the Secretary, in consultation with Indian tribes, 

19 shall establish a plan for distributing the amounts 

20 described in paragraph (1) across the categories of 

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

22 that paragraph. 

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

24 use amounts described in paragraph (1)— 


SSpencer on DSK126QN23PROD with BILLS
81 

•S 3130 IS

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

2 Area office; or 

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

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

6 after the end of each fiscal year, the Secretary shall sub7 mit a report describing the authorizations, expenditures, 

8 outlays, transfers, reprogramming, and obligations of each 

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

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

11 to— 

12 ‘‘(1) each Indian tribe; 

13 ‘‘(2) in the Senate— 

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

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

16 Labor, and Pensions; 

17 ‘‘(C) the Committee on Appropriations; 

18 and 

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

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

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

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

24 ‘‘(C) the Committee on Appropriations; 

25 and 


SSpencer on DSK126QN23PROD with BILLS
82 

•S 3130 IS

1 ‘‘(D) the Committee on the Budget. 

2 ‘‘(d) STATUS REPORTS.— 

3 ‘‘(1) PURPOSE.—The purpose of the report de4 scribed in paragraph (2) is to identify the certifi5 cation and accreditation status of each facility oper6 ated by the Service, Indian tribes, tribal organiza7 tions, and Urban Indian organizations. 

8 ‘‘(2) YEARLY REPORT.—Subject to paragraph 

9 (3), not later than 180 days after the end of each 

10 fiscal year, the Secretary shall provide to each entity 

11 described in paragraphs (1) through (3) of sub12 section (c) a report describing the safety, billing, 

13 certification, credential, and compliance statuses of 

14 each facility managed, operated, or otherwise sup15 ported by the Service. 

16 ‘‘(3) UPDATES.—With respect to any change of 

17 a status described in paragraph (2), the Secretary 

18 shall immediately provide to each entity described in 

19 paragraphs (1) through (3) of subsection (c) an up20 date describing the change. 

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

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

23 tribe to enter into a compact or contract under the 

24 Indian Self-Determination and Education Assistance 

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


SSpencer on DSK126QN23PROD with BILLS
83 

•S 3130 IS

1 ‘‘(2) applies to such a compact or contract un2 less expressly agreed to by the Indian tribe.’’. 

3 TITLE III—REPORTS 

4 SEC. 301. DEFINITIONS. 

5 In this title: 

6 (1) PURCHASED/REFERRED CARE.—The term 

7 ‘‘purchased/referred care’’ has the meaning given the 

8 term in section 4 of the Indian Health Care Im9 provement Act (25 U.S.C. 1603) (as amended by 

10 section 401(a)). 

11 (2) SECRETARY.—The term ‘‘Secretary’’ means 

12 the Secretary of Health and Human Services. 

13 (3) SERVICE.—The term ‘‘Service’’ means the 

14 Indian Health Service. 

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

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

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

18 1603). 

19 (5) TRIBAL HEALTH PROGRAM.—The term 

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

21 term in section 4 of the Indian Health Care Im22 provement Act (25 U.S.C. 1603). 

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

24 HUMAN SERVICES. 

25 (a) IHS PROFESSIONAL HOUSING PLAN.— 


SSpencer on DSK126QN23PROD with BILLS
84 

•S 3130 IS

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

2 the date of enactment of this Act, the Secretary 

3 shall develop, make publicly available, and submit to 

4 Congress and the Comptroller General of the United 

5 States a written plan to address the professional 

6 housing needs of employees of the Service and em7 ployees of tribal health programs that comports with 

8 the practices and recommendations of the Govern9 ment Accountability Office relating to professional 

10 housing included in the most recent report of the 

11 Government Accountability Office regarding Indian 

12 Health Service housing needs. 

13 (2) REQUIREMENT.—The plan under paragraph 

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

15 professional housing needs for— 

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

17 the plan; 

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

19 the plan; and 

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

21 of the plan. 

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

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

24 the date on which the Government Accountability 

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


SSpencer on DSK126QN23PROD with BILLS
85 

•S 3130 IS

1 the Secretary shall develop, make publicly available, 

2 and submit to Congress and the Comptroller General 

3 of the United States a written plan to address the 

4 staffing needs of the Service and tribal health pro5 grams that comports with the practices and rec6 ommendations of the Government Accountability Of7 fice relating to workforce planning included in the 

8 report. 

9 (2) REQUIREMENT.—The plan under paragraph 

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

11 staffing needs for— 

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

13 the plan; 

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

15 the plan; and 

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

17 of the plan. 

18 SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 

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

20 2 years after the date on which the Comptroller General 

21 of the United States receives the professional housing plan 

22 under section 302(a), the Comptroller General shall de23 velop and submit to Congress a report that includes— 

24 (1) an assessment of the professional housing 

25 plan; 


SSpencer on DSK126QN23PROD with BILLS
86 

•S 3130 IS

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

2 of the report, assessments and projections for the 

3 professional housing needs of employees of the Serv4 ice and employees of tribal health programs, includ5 ing a discussion and conclusions as to whether the 

6 existing assessments and projections accurately re7 flect the professional housing needs of employees of 

8 the Service and employees of tribal health programs; 

9 and 

10 (3) an assessment of the professional housing 

11 needs of— 

12 (A) employees of the Service for each Serv13 ice area (as defined in section 4 of the Indian 

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

15 1603)); and 

16 (B) employees of tribal health programs 

17 for each Indian tribe, as applicable. 

18 (b) IHS STAFFING NEEDS REPORT.— 

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

20 the date on which the Comptroller General receives 

21 the plan relating to IHS staffing needs under sec22 tion 302(b), the Comptroller General shall prepare 

23 and submit to Congress a report on the staffing 

24 needs of the Service and tribal health programs. 


SSpencer on DSK126QN23PROD with BILLS
87 

•S 3130 IS

1 (2) CONTENTS.—The report under paragraph 

2 (1) shall include— 

3 (A) an assessment of the staffing plan re4 ferred to in paragraph (1); 

5 (B) a description of— 

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

7 positions needed at each facility of the 

8 Service and at each tribal health program; 

9 and 

10 (ii) the amount of funds necessary to 

11 maintain those positions; 

12 (C) an explanation of the various meth13 odologies that the Service uses and has pre14 viously used to determine the number and type 

15 of full-time positions needed at federally man16 aged Service units; and 

17 (D) an assessment of the use of inde18 pendent contractors, including— 

19 (i) the number of independent con20 tractors hired to fill vacant full-time posi21 tions; and 

22 (ii) the amount of funds spent on 

23 independent contractors who provide 

24 health care services. 

25 (c) WHISTLEBLOWER PROTECTIONS REPORT.— 


SSpencer on DSK126QN23PROD with BILLS
88 

•S 3130 IS

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

2 the date of enactment of this Act, the Comptroller 

3 General shall develop and submit to Congress a re4 port on the efficacy of existing protections for whis5 tleblowers in the Service, including the protections 

6 implemented pursuant to sections 201 and 202 and 

7 the amendments made by those sections. 

8 (2) CONTENTS.—The report under paragraph 

9 (1) shall include— 

10 (A) a discussion and conclusions as to 

11 whether the Service has taken proper steps to 

12 prevent retaliation against whistleblowers; 

13 (B) if applicable, any recommendations for 

14 changes to the policy of the Service with respect 

15 to whistleblowers; and 

16 (C) a discussion and conclusions as to 

17 whether the official email accounts of employees 

18 of the Service are appropriately monitored. 

19 SEC. 304. INSPECTOR GENERAL REPORTS. 

20 (a) PATIENT CARE REPORTS.— 

21 (1) INITIAL REPORT.—Not later than 3 years 

22 after the date of enactment of this Act, the Inspec23 tor General of the Department of Health and 

24 Human Services shall develop and submit to Con25 gress and the Service a report on deferrals and deniVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
89 

•S 3130 IS

1 als of care of patients by a purchased/referred care 

2 program in direct service hospitals of the Service. 

3 (2) SUBSEQUENT REPORT.—Not later than 3 

4 years after the date on which the Inspector General 

5 of the Department of Health and Human Services 

6 submits the report required by paragraph (1), the 

7 Inspector General of the Department of Health and 

8 Human Services shall develop and submit to Con9 gress and the Service a report on patient harm 

10 events and patient deaths relating to deferrals and 

11 denials of care in the Service. 

12 (3) REQUIREMENTS.—The reports required 

13 under paragraphs (1) and (2) shall include, as appli14 cable— 

15 (A)(i) an evaluation of the number and 

16 kind of events that contribute to patient deaths 

17 as a result of deferrals and denials of care by 

18 a purchased/referred care program; and 

19 (ii) recommendations relating to how to re20 duce the number of patient harm events de21 scribed in clause (i); and 

22 (B)(i) an evaluation of the tracking and re23 porting by the Service of, and response to, pa24 tient harm events and patient deaths that result 

25 from deferrals and denials of care; and 


SSpencer on DSK126QN23PROD with BILLS
90 

•S 3130 IS

1 (ii) recommendations relating to how to 

2 improve that tracking, reporting, and response. 

3 (b) REPORTING SYSTEMS EVALUATION.—Not later 

4 than 3 years after the date of enactment of this Act, the 

5 Inspector General of the Department of Health and 

6 Human Services shall— 

7 (1) conduct an evaluation of the patient safety 

8 incident reporting system of the Service required by 

9 the Indian Health Care Improvement Act (25 U.S.C. 

10 1601 et seq.), as of the date of enactment of this 

11 Act; and 

12 (2) provide to the Service recommendations and 

13 technical assistance regarding implementation of im14 proved incident reporting system, procedures, stand15 ards, and protocols. 

16 SEC. 305. TRANSPARENCY IN CMS SURVEYS. 

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

18 1395qq) is amended by adding at the end the following: 

19 ‘‘(g)(1) With respect to each hospital described in 

20 subsection (a), standard surveys (whether conducted by 

21 the Secretary or by an accreditation organization under 

22 section 1865) to determine if such hospital meets the con23 ditions of participation under section 1861(e) shall be con24 ducted not later than 36 months after the date of the pre25 vious such survey. 


SSpencer on DSK126QN23PROD with BILLS
91 

•S 3130 IS

1 ‘‘(2) With respect to each skilled nursing facility de2 scribed in subsection (a), standard surveys to determine 

3 if such facility meets the conditions of participation under 

4 this title shall be conducted not later than 12 months after 

5 the date of the previous such survey. 

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

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

8 Medicare & Medicaid Services. Such posting shall comply 

9 with the Federal regulations concerning the privacy of in10 dividually identifiable health information promulgated 

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

12 and Accountability Act of 1996.’’. 

13 TITLE IV—TECHNICAL 

14 AMENDMENTS 

15 SEC. 401. TECHNICAL AMENDMENTS. 

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

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

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

19 designation and heading and all that follows through 

20 ‘‘means’’ and inserting the following: 

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

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

23 (2) by redesignating paragraph (5) and para24 graphs (6) through (15) as paragraph (15) and 

25 paragraphs (5) through (14), respectively, and movVerDate Sep 11 2014 03:05 Oct 27, 2023 Jkt 049200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\S3130.IS S3130

SSpencer on DSK126QN23PROD with BILLS
92 

•S 3130 IS

1 ing the paragraphs so as to appear in numerical 

2 order. 

3 (b) TECHNICAL AMENDMENTS.—The Indian Health 

4 Care Improvement Act (25 U.S.C. 1601 et seq.) is amend5 ed— 

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

7 place it appears (regardless of casing and typeface 

8 and including in the headings) and inserting ‘‘pur9 chased/referred care’’ (with appropriate casing and 

10 typeface); and 

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

12 place it appears (regardless of casing and typeface 

13 and including in the headings) and inserting ‘‘pur14 chased/referred care’’ (with appropriate casing and 

15 typeface). 

Æ 


SSpencer on DSK126QN23PROD with BILLS