```

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5874 Reported in House (RH)]

<DOC>

                                                 Union Calendar No. 872
115th CONGRESS
  2d Session
                                H. R. 5874

                     [Report No. 115-1065, Part I]

    To amend the Indian Health Care Improvement Act to improve the 
 recruitment and retention of employees in the Indian Health Service, 
  restore accountability in the Indian Health Service, improve health 
                   services, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 18, 2018

 Mrs. Noem (for herself, Mr. Bishop of Utah, Mr. Mullin, Mrs. McMorris 
 Rodgers, Mr. Cole, Mr. LaMalfa, Mr. Cramer, Mrs. Radewagen, and Miss 
Gonzalez-Colon of Puerto Rico) introduced the following bill; which was 
referred to the Committee on Natural Resources, and in addition to the 
 Committees on Energy and Commerce, Ways and Means, and Oversight and 
 Government Reform, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

                            December 3, 2018

            Reported from the Committee on Natural Resources

                            December 3, 2018

Referral to the Committees on Energy and Commerce, Ways and Means, and 
Oversight and Government Reform extended for a period ending not later 
                         than December 28, 2018

                           December 28, 2018

 Committees on Energy and Commerce, Ways and Means, and Oversight and 
 Government Reform discharged; committed to the Committee of the Whole 
       House on the State of the Union and ordered to be printed

_______________________________________________________________________

                                 A BILL

 
    To amend the Indian Health Care Improvement Act to improve the 
 recruitment and retention of employees in the Indian Health Service, 
  restore accountability in the Indian Health Service, improve health 
                   services, and for other purposes.

 

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Restoring Accountability in the 
Indian Health Service Act of 2018''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
              TITLE I--INDIAN HEALTH SERVICE IMPROVEMENTS

Sec. 101. Incentives for recruitment and retention.
Sec. 102. Medical credentialing system.
Sec. 103. Liability protections for health professional volunteers at 
                            Indian Health Service.
Sec. 104. Clarification regarding eligibility for Indian Health Service 
                            loan repayment program.
Sec. 105. Improvements in hiring practices.
Sec. 106. Improved authorities of secretary to improve accountability 
                            of senior executives and employees of the 
                            Indian Health Service.
Sec. 107. Tribal culture and history.
Sec. 108. Staffing demonstration project.
Sec. 109. Rule establishing tribal consultation policy.
Sec. 110. Treatment of certain hospitals.
                     TITLE II--EMPLOYEE PROTECTIONS

Sec. 201. Employee protections against retaliation.
Sec. 202. Right of Federal employees to petition Congress.
Sec. 203. Fiscal accountability.
                           TITLE III--REPORTS

Sec. 301. Definitions.
Sec. 302. Reports by the Secretary of Health and Human Services.
Sec. 303. Reports by the Comptroller General.
Sec. 304. Inspector General reports.
Sec. 305. Transparency in CMS surveys.
                     TITLE IV--TECHNICAL AMENDMENTS

Sec. 401. Technical amendments.

              TITLE I--INDIAN HEALTH SERVICE IMPROVEMENTS

SEC. 101. INCENTIVES FOR RECRUITMENT AND RETENTION.

    Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 
et seq.) is amended by adding at the end the following:

``SEC. 125. INCENTIVES FOR RECRUITMENT AND RETENTION.

    ``(a) Parity in IHS Health Care Workforce Personnel and Pay 
System.--The Secretary shall establish a personnel and pay system for 
physicians, dentists, nurses, and other health care professionals 
employed by the Service that provides a personnel and pay system that, 
to the maximum extent practicable, is comparable to the pay provided to 
physicians, dentists, nurses, and other health care professionals, 
respectively, under subchapters III and IV of chapter 74 of title 38, 
United States Code.
    ``(b) Relocation Costs.--The Secretary may provide to an employee 
of the Service reimbursement for any relocation costs the employee 
incurs if--
            ``(1) the employee relocates to a Service area experiencing 
        a high level of need for employees, as determined by the 
        Secretary; and
            ``(2) the employee is filling a position that would 
        otherwise be difficult to fill, as determined by the Secretary, 
        in the absence of an incentive.
    ``(c) Housing Vouchers.--
            ``(1) In general.--Subject to paragraph (2), not later than 
        1 year after the date of enactment of the Restoring 
        Accountability in the Indian Health Service Act of 2018, the 
        Secretary may establish a program to provide tenant-based 
        rental assistance to an employee of the Service who--
                    ``(A) agrees to serve for not less than 1 year at a 
                Service unit designated by the Administrator of the 
                Health Resources and Services Administration as a 
                health professional shortage area, as defined in 
                section 332(a) of the Public Health Service Act (42 
                U.S.C. 254e(a)), with the greatest staffing need; and
                    ``(B) is a critical employee, as determined by the 
                Secretary.
            ``(2) Sunset.--Any program established by the Secretary 
        under paragraph (1) shall terminate on the date that is 3 years 
        after the date on which any such program is established.
    ``(d) Administration.--
            ``(1) OPM guidelines.--The Secretary shall carry out 
        subsection (b) in accordance with any guidelines of the Office 
        of Personnel Management relating to section 572 of title 5, 
        Code of Federal Regulations (as in effect on the date of 
        enactment of the Restoring Accountability in the Indian Health 
        Service Act of 2018).
            ``(2) Service agreements.--The Secretary may only provide 
        reimbursement for any relocation costs under subsection (b) or 
        any other benefit under subsection (c) to--
                    ``(A) a full-time employee who agrees to serve for 
                not less than 1 year in the Service, beginning on the 
                date of the agreement; or
                    ``(B) a part-time employee who agrees to serve for 
                not less than 2 years in the service beginning on the 
                date of the agreement.''.

SEC. 102. MEDICAL CREDENTIALING SYSTEM.

    Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 
et seq.), as amended by section 101, is further amended by adding at 
the end the following:

``SEC. 126. MEDICAL CREDENTIALING SYSTEM.

    ``(a) In General.--
            ``(1) Development and implementation timeline.--By not 
        later than 1 year after the date of enactment of the Restoring 
        Accountability in the Indian Health Service Act of 2018, the 
        Secretary, acting through the Service and in accordance with 
        the requirements described in subsection (b), shall develop and 
        implement a Service-wide centralized electronic credentialing 
        system (referred to in this section as the `credentialing 
        system') to credential licensed health professionals who seek 
        to provide health care services at any Service unit, including 
        physicians, nurses and physicians assistants.
            ``(2) Implementation.--In implementing the credentialing 
        system, the Secretary--
                    ``(A) shall not require re-credentialing of 
                licensed health professionals who were credentialed 
                using existing Service policy prior to the date of 
                enactment of the Restoring Accountability in the Indian 
                Health Service Act of 2018; and
                    ``(B) shall--
                            ``(i) use the credentialing system for all 
                        new applications of licensed health 
                        professionals and the migration of credentials 
                        data that existed prior to implementation into 
                        the system;
                            ``(ii) maintain the established timeline 
                        for re-credentialing of licensed health 
                        professionals who were credentialed prior to 
                        implementation, as defined by Service policy; 
                        and
                            ``(iii) review credentials for all 
                        professionals in the system, based on updated 
                        policies, on a not less than yearly basis. 
                        Licensed health professionals whose credentials 
                        would not have been approved under the updated 
                        policies shall have 90 days to meet the new 
                        requirements.
    ``(b) Requirements.--In developing the credentialing system under 
subsection (a), the Secretary shall ensure the following:
            ``(1) Credentialing procedures shall be uniform and 
        integrated throughout the Service.
            ``(2) With respect to each licensed health professional who 
        successfully completes the credentialing procedures of the 
        credentialing system, the Secretary may authorize each such 
        professional to provide health care services at any Service 
        unit.
            ``(3) Credentialing procedures shall include verification 
        of licensure, education, employment history, and criminal 
        background checks and history.
    ``(c) Consultation.--In developing the credentialing system under 
subsection (a), the Secretary shall consult with Indian Tribes and may 
also consult with any public or private association of medical 
providers, any government agency, or other relevant expert, as 
determined by the Secretary.
    ``(d) Application.--A licensed health care professional may not 
provide health care services at any Service unit, unless such 
professional successfully completes the credentialing procedures of the 
credentialing system developed under subsection (a).
    ``(e) Regulations.--The Secretary may prescribe such regulations as 
may be necessary to carry out the provisions of this section.
    ``(f) Rule of Construction.--Nothing in this section may be 
construed--
            ``(1) to negatively impact the right of an Indian Tribe to 
        enter into a compact or contract under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304 et 
        seq.); and
            ``(2) to apply to such a compact or contract unless 
        expressly agreed to by the Indian Tribe.''.

SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT 
              INDIAN HEALTH SERVICE.

    Section 224 of the Public Health Service Act (42 U.S.C. 233) is 
amended by adding at the end the following:
    ``(r) Certain Indian Health Service Volunteers Deemed Public Health 
Service Employees.--
            ``(1) In general.--For purposes of this section, an 
        employee of an IHS urban Indian health program and a health 
        professional volunteer at a Service unit shall, in providing a 
        health service to an individual, be deemed to be an employee of 
        the Public Health Service for a calendar year that begins 
        during a fiscal year for which a transfer was made under 
        paragraph (4)(C). The preceding sentence is subject to the 
        provisions of this subsection.
            ``(2) Conditions.--In providing a health service to an 
        individual, a health care practitioner shall, for purposes of 
        this subsection, be considered to be a health professional 
        volunteer at a Service unit if all of the following conditions 
        are met:
                    ``(A) The service is provided to the individual at 
                the facilities of a Service unit, or through offsite 
                programs or events carried out by the Service unit.
                    ``(B) The Service unit is sponsoring the health 
                care practitioner pursuant to paragraph (3)(C).
                    ``(C) The health care practitioner does not receive 
                any compensation for the service from the individual, 
                the Service unit, or any third-party payer (including 
                reimbursement under any insurance policy or health 
                plan, or under any Federal or State health benefits 
                program), except that the health care practitioner may 
                receive repayment from the Service unit for reasonable 
                expenses incurred by the health care practitioner in 
                the provision of the service to the individual.
                    ``(D) Before the service is provided, the health 
                care practitioner or the Service unit posts a clear and 
                conspicuous notice at the site where the service is 
                provided of the extent to which the legal liability of 
                the health care practitioner is limited under this 
                subsection.
                    ``(E) At the time the service is provided, the 
                health care practitioner is licensed, certified, 
                credentialed, and privileged in accordance with Service 
                policy and applicable law regarding the provision of 
                the service.
            ``(3) Applicability.--Subsection (g) (other than paragraphs 
        (3) and (5)) and subsections (h), (i), and (l) apply to an 
        employee of an IHS urban Indian health program and to a health 
        care practitioner at a Service unit for purposes of this 
        subsection to the same extent and in the same manner as such 
        subsections apply to an officer, governing board member, 
        employee, or contractor of an entity described in subsection 
        (g)(4), subject to paragraph (4) and subject to the following 
        subparagraphs:
                    ``(A) Each reference to an entity in subsections 
                (g), (h), (i), and (l) shall be considered to be a 
                reference to an IHS urban Indian health program or a 
                Service unit, as applicable.
                    ``(B) The first sentence of paragraph (1) applies 
                in lieu of the first sentence of subsection (g)(1)(A).
                    ``(C) With respect to a Service unit, a health care 
                practitioner is not a health professional volunteer at 
                the Service unit unless the Service unit sponsors the 
                health care practitioner. For purposes of this 
                subsection, the Service unit shall be considered to be 
                sponsoring the health care practitioner if--
                            ``(i) with respect to the health care 
                        practitioner, the Service unit submits to the 
                        Secretary an application meeting the 
                        requirements of subsection (g)(1)(D); and
                            ``(ii) the Secretary, pursuant to 
                        subsection (g)(1)(E), determines that the 
                        health care practitioner is deemed to be an 
                        employee of the Public Health Service.
                    ``(D) In the case of a health care practitioner who 
                is determined by the Secretary pursuant to this 
                subsection and subsection (g)(1)(E) to be a health 
                professional volunteer, this subsection applies to the 
                health care practitioner (with respect to services 
                performed on behalf of the Service unit sponsoring the 
                health care practitioner pursuant to subparagraph (C)) 
                for any cause of action arising from an act or omission 
                of the health care practitioner occurring on or after 
                the date on which the Secretary makes that 
                determination.
                    ``(E) Subsection (g)(1)(F) applies to a health care 
                practitioner for purposes of this subsection only to 
                the extent that, in providing health services to an 
                individual, each of the conditions described in 
                paragraph (2) is met.
            ``(4) Funding.--
                    ``(A) In general.--Amounts in the fund established 
                under subsection (k)(2) shall be available for transfer 
                under subparagraph (C) for purposes of carrying out 
                this subsection.
                    ``(B) Annual estimates.--
                            ``(i) In general.--Not later than May 1 of 
                        each fiscal year, the Attorney General, in 
                        consultation with the Secretary, shall submit 
                        to Congress a report providing an estimate of 
                        the amount of claims (together with related 
                        fees and expenses of witnesses) that, by reason 
                        of the acts or omissions of employees of an IHS 
                        urban Indian health program or health 
                        professional volunteers, will be paid pursuant 
                        to this section during the calendar year that 
                        begins in the following fiscal year.
                            ``(ii) Applicability.--Subsection (k)(1)(B) 
                        applies to the estimate under clause (i) 
                        relating to employees of an IHS urban Indian 
                        health program or health professional 
                        volunteers to the same extent and in the same 
                        manner as that subsection applies to the 
                        estimate under that subsection relating to 
                        officers, governing board members, employees, 
                        and contractors of entities described in 
                        subsection (g)(4).
                    ``(C) Transfers.--Not later than December 31 of 
                each fiscal year, the Secretary shall transfer from the 
                fund under subsection (k)(2) to the appropriate 
                accounts in the Treasury an amount equal to the 
                estimate made under subparagraph (B) for the calendar 
                year beginning in that fiscal year, subject to the 
                extent of amounts in the fund.
            ``(5) Definitions.--
                    ``(A) IHS urban indian health program.--In this 
                subsection, the term `IHS urban Indian health program' 
                means an urban Indian health program operated by an 
                urban Indian organization pursuant to a grant or 
                contract with the Indian Health Service under title V 
                of the Indian Health Care Improvement Act (25 U.S.C. 
                1651 et seq.).
                    ``(B) Service unit.--In this subsection, the term 
                `Service unit' has the meaning given the term in 
                section 4 of the Indian Health Care Improvement Act (25 
                U.S.C. 1603).
            ``(6) Rule of construction.--Nothing in this subsection may 
        be construed--
                    ``(A) to negatively impact the right of an Indian 
                Tribe to enter into a compact or contract under the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 5304 et seq.); and
                    ``(B) to apply to such a compact or contract unless 
                expressly agreed to by the Indian Tribe.
            ``(7) Effective dates.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), this subsection shall take effect on 
                October 1, 2019.
                    ``(B) Regulations, applications, and reports.--
                Effective on the date of the enactment of the Restoring 
                Accountability in the Indian Health Service Act of 
                2018, the Secretary may--
                            ``(i) prescribe regulations for carrying 
                        out this subsection; and
                            ``(ii) accept and consider applications 
                        submitted under paragraph (3)(C)(i).''.

SEC. 104. CLARIFICATION REGARDING ELIGIBILITY FOR INDIAN HEALTH SERVICE 
              LOAN REPAYMENT PROGRAM.

    Section 108 of the Indian Health Care Improvement Act (25 U.S.C. 
1616a) is amended--
            (1) by amending subparagraph (B) of subsection (b)(1) to 
        read as follows:
                    ``(B) have--
                            ``(i)(I) a degree in a health profession; 
                        and
                            ``(II) a license to practice a health 
                        profession in a State; or
                            ``(ii)(I) a master's degree in business 
                        administration with an emphasis in health care 
                        management (as defined by the Secretary), 
                        health administration, hospital administration, 
                        or public health; and
                            ``(II) a license or certification to 
                        practice in the field of business 
                        administration, health administration, hospital 
                        administration, or public health in a State, if 
                        the Secretary determines such license or 
                        certification necessary for the Indian health 
                        program to which the individual will be 
                        assigned;
                            ``(iii) maintain credentials as determined 
                        by the system described in section 102; and
                            ``(iv) participate in the training 
                        described in section 107;'';
            (2) by amending clause (iii) of subsection (f)(1)(B) to 
        read as follows:
                            ``(iii) to serve for a time period 
                        (referred to in this section as the `period of 
                        obligated service') equal to--
                                    ``(I) 2 years or such longer period 
                                as the individual may agree to serve in 
                                the full-time practice of such 
                                individual's profession in an Indian 
                                health program to which the individual 
                                may be assigned by the Secretary; or
                                    ``(II) 4 years or such longer 
                                period as the individual may agree to 
                                serve in the half-time practice of such 
                                individual's profession in an Indian 
                                health program to which the individual 
                                may be assigned by the Secretary;''; 
                                and
            (3) in subsection (g)(2)--
                    (A) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (B) in subparagraph (A)--
                            (i) by striking the first sentence of the 
                        matter preceding clause (i) and inserting the 
                        following: ``In the case of an individual who 
                        contracts to serve a period of obligated 
                        service under subsection (f)(1)(B)(iii)(I), for 
                        each year of such obligated service, the 
                        Secretary may pay up to $35,000 (or an amount 
                        equal to the amount specified in section 
                        338B(g)(2)(A) of the Public Health Service Act 
                        (42 U.S.C. 254l-1(g)(2)(A))) on behalf of the 
                        individual for loans described in paragraph 
                        (1). In the case of an individual who contracts 
                        to serve a period of obligated service under 
                        subsection (f)(1)(B)(iii)(II), for each year of 
                        such obligated service, the Secretary may pay 
                        up to $17,500 on behalf of the individual for 
                        loans described in paragraph (1)''; and
                            (ii) by striking ``In making a 
                        determination'' and inserting the following:
                    ``(B) In making a determination under this 
                paragraph''.

SEC. 105. IMPROVEMENTS IN HIRING PRACTICES.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) is amended by adding at the end the following:

``SEC. 605. IMPROVEMENTS IN HIRING PRACTICES.

    ``(a) Direct Hire Authority.--The Secretary may appoint, without 
regard to subchapter I of chapter 33 of title 5, United States Code 
(other than sections 3303 and 3328 of such title), a candidate directly 
to a position within the Service for which the candidate meets the 
qualifications standard established by the Office of Personnel 
Management.
    ``(b) Tribal Notification.--Before appointing, hiring, promoting, 
transferring, or reassigning a candidate to a Senior Executive Service 
position or the position of a manager at an Area office or Service 
unit, the Secretary shall provide notice to each Indian Tribe located 
within the defined geographic area of such Area office or Service unit, 
as the case may be, of the content of an inclusion in an employment 
record. Each such Indian Tribe may submit comment to the Secretary 
during the 10-day period after the date of such notification regarding 
such content.''.
    (b) In General.--Subsection (c) of section 2 of the Act of December 
15, 1979 (25 U.S.C. 5117), is amended by adding the following:
            ``(3) IHS waivers.--The Secretary of Health and Human 
        Services may, at the request of an Indian Tribe, seek from each 
        Indian Tribe concerned, a waiver of Indian preference laws for 
        a personnel action that is with respect to--
                    ``(A) an Indian Health Service unit in which 15 
                percent or more of the total positions or specific 
                health professionals in the Service unit are not filled 
                by a full-time employee of the Indian Health Service 
                for a period of 6 months or longer; or
                    ``(B) a former employee of the Indian Health 
                Service or a former tribal employee who was removed 
                from such former employment within, or demoted for 
                performance or misconduct that occurred during, the 5-
                year period following the date of such personnel 
                action.''.

SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY 
              OF SENIOR EXECUTIVES AND EMPLOYEES OF THE INDIAN HEALTH 
              SERVICE.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.), as amended by section 105, is further amended 
by adding at the end the following:

``SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY 
              OF SENIOR EXECUTIVES OF THE INDIAN HEALTH SERVICE.

    ``(a) Authority.--
            ``(1) In general.--The Secretary may, as provided in this 
        section, reprimand or suspend, involuntarily reassign, demote, 
        or remove a covered individual from a senior executive position 
        at the Service if the Secretary determines that the misconduct 
        or performance of the covered individual warrants such action.
            ``(2) Removal from civil service.--If the Secretary removes 
        an individual pursuant to paragraph (1), the Secretary may 
        remove the individual from the civil service (as defined in 
        section 2101 of title 5, United States Code).
    ``(b) Rights and Procedures.--
            ``(1) In general.--A covered individual who is the subject 
        of an action under subsection (a) is entitled to--
                    ``(A) advance notice of the action and a file 
                containing all evidence in support of the proposed 
                action;
                    ``(B) be represented by an attorney or other 
                representative of the covered individual's choice; and
                    ``(C) grieve the action in accordance with an 
                internal grievance process that the Secretary shall 
                establish for purposes of this subsection.
            ``(2) Notice.--
                    ``(A) Aggregate period for notice.--The aggregate 
                period for notice, response, and decision on an action 
                under subsection (a) may not exceed 15 business days.
                    ``(B) Response.--The period for the response of a 
                covered individual to a notice under paragraph (1)(A) 
                of an action under subsection (a) shall be 7 business 
                days.
                    ``(C) Decision.--A decision under this paragraph on 
                an action under subsection (a) shall be issued not 
                later than 15 business days after notice of the action 
                is provided to the covered individual under paragraph 
                (1)(A). The decision shall be in writing, and shall 
                include the specific reasons for the decision.
            ``(3) Grievance process.--The Secretary shall ensure that 
        the grievance process established under paragraph (1)(C) takes 
        fewer than 21 days.
            ``(4) Final and conclusive decision.--A decision under 
        paragraph (2) that is not grieved, and a grievance decision 
        under paragraph (3), shall be final and conclusive.
            ``(5) Judicial review.--A covered individual adversely 
        affected by a decision under paragraph (2) that is not grieved, 
        or by a grievance decision under paragraph (3), may obtain 
        judicial review of such decision.
            ``(6) Court review.--In any case in which judicial review 
        is sought under paragraph (5), the court shall review the 
        record and may set aside any Department action found to be--
                    ``(A) arbitrary, capricious, an abuse of 
                discretion, or otherwise not in accordance with a 
                provision of law;
                    ``(B) obtained without procedures required by a 
                provision of law having been followed; or
                    ``(C) unsupported by substantial evidence.
    ``(c) Relation to Other Provisions of Law.--Section 3592(b)(1) of 
title 5, United States Code, does not apply to an action under 
subsection (a).
    ``(d) Definitions.--In this section:
            ``(1) Covered individual.--The term `covered individual' 
        means a career appointee (as that term is defined in section 
        3132(a) of title 5, United States Code).
            ``(2) Misconduct.--The term `misconduct' includes neglect 
        of duty, malfeasance, or failure to accept a directed 
        reassignment or to accompany a position in a transfer of 
        function.
            ``(3) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services, acting through the Director of 
        the Service.
            ``(4) Senior executive position.--The term `senior 
        executive position' means a Senior Executive Service position 
        (as that term is defined in section 3132(a) of title 5, United 
        States Code).

``SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IMPROVE ACCOUNTABILITY 
              OF EMPLOYEES OF THE INDIAN HEALTH SERVICE.

    ``(a) In General.--
            ``(1) Authority.--The Secretary may remove, demote, or 
        suspend a covered individual who is an employee of the Service 
        if the Secretary determines the performance or misconduct of 
        the covered individual warrants such removal, demotion, or 
        suspension.
            ``(2) Actions.--If the Secretary removes, demotes, or 
        suspends a covered individual pursuant to paragraph (1), the 
        Secretary may--
                    ``(A) remove the covered individual from the civil 
                service (as defined in section 2101 of title 5, United 
                States Code);
                    ``(B) demote the covered individual by means of a 
                reduction in grade for which the covered individual is 
                qualified, that the Secretary determines is 
                appropriate, and that reduces the annual rate of pay of 
                the covered individual; or
                    ``(C) suspend the covered individual.
    ``(b) Pay of Certain Demoted Individuals.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, any covered individual subject to a demotion under 
        subsection (a)(2) shall, beginning on the date of such 
        demotion, receive the annual rate of pay applicable to such 
        grade.
            ``(2) Restrictions.--
                    ``(A) Prohibition on administrative leave.--A 
                covered individual subject to a demotion under 
                subsection (a)(2) may not be placed on administrative 
                leave during the period during which an appeal (if any) 
                under this section is ongoing, and may only receive pay 
                if the covered individual reports for duty or is 
                approved to use accrued unused annual, sick, family 
                medical, military, or court leave.
                    ``(B) Restriction on pay and benefits.--If a 
                covered individual subject to a demotion under 
                subsection (a)(2) does not report for duty or receive 
                approval to use accrued unused leave, such covered 
                individual shall not receive pay or other benefits 
                pursuant to subsection (d)(5).
    ``(c) Procedures.--
            ``(1) In general.--
                    ``(A) Aggregate period.--The aggregate period for 
                notice, response, and final decision in a removal, 
                demotion, or suspension under this section may not 
                exceed 15 business days.
                    ``(B) Period for response.--The period for the 
                response of a covered individual to a notice of a 
                proposed removal, demotion, or suspension under this 
                section shall be 7 business days.
                    ``(C) Representation by attorney or other 
                representative.--Paragraph (3) of subsection (b) of 
                section 7513 of title 5, United States Code, shall 
                apply with respect to a removal, demotion, or 
                suspension under this section.
                    ``(D) Procedures superseding cbas.--The procedures 
                in this subsection shall supersede any collective 
                bargaining agreement to the extent that such agreement 
                is inconsistent with such procedures.
            ``(2) Final decision.--The Secretary shall issue a final 
        decision with respect to a removal, demotion, or suspension 
        under this section not later than 15 business days after the 
        Secretary provides notice, including a file containing all the 
        evidence in support of the proposed action, to the covered 
        individual of the removal, demotion, or suspension. The 
        decision shall be in writing and shall include the specific 
        reasons for the decision.
            ``(3) Performance appraisal.--The procedures under chapter 
        43 of title 5, United States Code, shall not apply to a 
        removal, demotion, or suspension under this section.
            ``(4) Appeal to merit systems protection board.--
                    ``(A) In general.--Subject to subparagraph (B) and 
                subsection (d), any removal or demotion under this 
                section, and any suspension of more than 14 days under 
                this section, may be appealed to the Merit Systems 
                Protection Board, which shall refer such appeal to an 
                administrative judge pursuant to section 7701(b)(1) of 
                title 5, United States Code.
                    ``(B) Time period.--An appeal under subparagraph 
                (A) of a removal, demotion, or suspension may only be 
                made if such appeal is made not later than 10 business 
                days after the date of such removal, demotion, or 
                suspension.
    ``(d) Expedited Review.--
            ``(1) In general.--Upon receipt of an appeal under 
        subsection (c)(4)(A), the administrative judge shall expedite 
        any such appeal under section 7701(b)(1) of title 5, United 
        States Code, and, in any such case, shall issue a final and 
        complete decision not later than 180 days after the date of the 
        appeal.
            ``(2) Upholding decision.--
                    ``(A) In general.--Notwithstanding section 
                7701(c)(1)(B) of title 5, United States Code, the 
                administrative judge shall uphold the decision of the 
                Secretary to remove, demote, or suspend an employee 
                under subsection (a) if the decision is supported by 
                substantial evidence.
                    ``(B) Prohibition of mitigation.--Notwithstanding 
                title 5, United States Code, or any other provision of 
                law, if the decision of the Secretary is supported by 
                substantial evidence, the administrative judge shall 
                not mitigate the penalty prescribed by the Secretary.
            ``(3) Appeal to merit systems protection board.--
                    ``(A) In general.--The decision of the 
                administrative judge under paragraph (1) may be 
                appealed to the Merit Systems Protection Board.
                    ``(B) Upholding decision.--Notwithstanding section 
                7701(c)(1)(B) of title 5, United States Code, the Merit 
                Systems Protection Board shall uphold the decision of 
                the Secretary to remove, demote, or suspend an employee 
                under subsection (a) if the decision is supported by 
                substantial evidence.
                    ``(C) Prohibition of mitigation.--Notwithstanding 
                title 5, United States Code, or any other provision of 
                law, if the decision of the Secretary is supported by 
                substantial evidence, the Merit Systems Protection 
                Board shall not mitigate the penalty prescribed by the 
                Secretary.
            ``(4) Report.--In any case in which the administrative 
        judge cannot issue a decision in accordance with the 180-day 
        requirement under paragraph (1), the Merit Systems Protection 
        Board shall, not later than 14 business days after the 
        expiration of the 180-day period, submit to the appropriate 
        committees of Congress a report that explains the reasons why a 
        decision was not issued in accordance with such requirement.
            ``(5) Appeal.--A decision of the Merit Systems Protection 
        Board under paragraph (3) may be appealed to the United States 
        Court of Appeals for the Federal Circuit pursuant to section 
        7703 of title 5, United States Code, or to any court of appeals 
        of competent jurisdiction pursuant to subsection (b)(1)(B) of 
        such section.
            ``(6) Prohibition against stays.--The Merit Systems 
        Protection Board may not stay any removal or demotion under 
        this section, except as provided in section 1214(b) of title 5, 
        United States Code.
            ``(7) Restriction on pay and benefits during appeal.--
        During the period beginning on the date on which a covered 
        individual appeals a removal from the civil service under 
        subsection (c) and ending on the date that the United States 
        Court of Appeals for the Federal Circuit issues a final 
        decision on such appeal, such covered individual may not 
        receive any pay, awards, bonuses, incentives, allowances, 
        differentials, student loan repayments, special payments, or 
        benefits related to the employment of the individual by the 
        Service.
            ``(8) Information to expedite appeal.--To the maximum 
        extent practicable, the Secretary shall provide to the Merit 
        Systems Protection Board such information and assistance as may 
        be necessary to ensure an appeal under this subsection is 
        expedited.
            ``(9) Backpay.--If an employee prevails on appeal under 
        this section, the employee shall be entitled to backpay (as 
        provided in section 5596 of title 5, United States Code).
            ``(10) Applicable timelines and procedures.--If an employee 
        who is subject to a collective bargaining agreement chooses to 
        grieve an action taken under this section through a grievance 
        procedure provided under the collective bargaining agreement, 
        the timelines and procedures set forth in subsection (c) and 
        this subsection shall apply.
    ``(e) Alleged Prohibited Personnel Practice.--In the case of a 
covered individual seeking corrective action (or on behalf of whom 
corrective action is sought) from the Office of Special Counsel based 
on an alleged prohibited personnel practice described in section 
2302(b) of title 5, United States Code, the Secretary may not remove, 
demote, or suspend such covered individual under subsection (a) without 
the approval of the Special Counsel under section 1214(f) of title 5, 
United States Code.
    ``(f) Termination of Investigations by Office of Special Counsel.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Special Counsel (established by section 1211 of title 
        5, United States Code) may terminate an investigation of a 
        prohibited personnel practice alleged by an employee or former 
        employee of the Service after the Special Counsel provides to 
        the employee or former employee a written statement of the 
        reasons for the termination of the investigation.
            ``(2) Admissibility.--The statement described in paragraph 
        (1) may not be admissible as evidence in any judicial or 
        administrative proceeding without the consent of the employee 
        or former employee described in paragraph (1).
    ``(g) Vacancies.--In the case of a covered individual who is 
removed or demoted under subsection (a), to the maximum extent 
feasible, the Secretary shall fill the vacancy arising as a result of 
such removal or demotion.
    ``(h) Definitions.--In this section:
            ``(1) Covered individual.--The term `covered individual' 
        means an individual occupying a position at the Service, but 
        does not include--
                    ``(A) an individual occupying a senior executive 
                position (as defined in section 606(d));
                    ``(B) an individual who has not completed a 
                probationary or trial period; or
                    ``(C) a political appointee.
            ``(2) Grade.--The term `grade' has the meaning given such 
        term in section 7511(a) of title 5, United States Code.
            ``(3) Misconduct.--The term `misconduct' includes neglect 
        of duty, malfeasance, or failure to accept a directed 
        reassignment or to accompany a position in a transfer of 
        function.
            ``(4) Political appointee.--The term `political appointee' 
        means an individual who is--
                    ``(A) employed in a position described under 
                sections 5312 through 5316 of title 5, United States 
                Code (relating to the Executive Schedule);
                    ``(B) a limited term appointee, limited emergency 
                appointee, or noncareer appointee in the Senior 
                Executive Service, as defined under paragraphs (5), 
                (6), and (7), respectively, of section 3132(a) of title 
                5, United States Code; or
                    ``(C) employed in a position of a confidential or 
                policy-determining character under schedule C of 
                subpart C of part 213 of title 5, Code of Federal 
                Regulations, or successor regulation.
            ``(5) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services, acting through the Director of 
        the Service.
            ``(6) Suspend.--The term `suspend' means the placing of an 
        employee, for disciplinary reasons, in a temporary status 
        without duties and pay for a period in excess of 14 days.''.
    (b) Conforming Amendments.--Section 4303(f) of title 5, United 
States Code, is amended--
            (1) in paragraph (3), by striking ``or'' at the end;
            (2) in paragraph (4), by striking the period at the end and 
        inserting ``, or''; and
            (3) by adding at the end the following:
            ``(5) any removal or demotion under section 607 of the 
        Indian Health Care Improvement Act.''.
    (c) Report.--Not later than 18 months after the date of enactment 
of this Act, the Secretary of Health and Human Services or the 
Inspector General of the Department of Health and Human Services shall 
submit a report to Congress that includes the following:
            (1) The number of employees of the Indian Health Service 
        who were removed, demoted, or suspended in the 1-year period 
        before the date of enactment of this Act.
            (2) The number of employees of the Indian Health Service 
        who were removed, demoted, or suspended in the 1-year period 
        after the date of enactment of this Act using the updated 
        authorities provided in the amendments made by this Act.
            (3) The appropriate details of removals, demotions, and 
        suspensions that lend necessary context.

SEC. 107. TRIBAL CULTURE AND HISTORY.

    Section 113 of the Indian Health Care Improvement Act (25 U.S.C. 
1616f) is amended--
            (1) in subsection (a)--
                    (A) by striking ``a program'' and inserting ``an 
                annual mandatory training program''; and
                    (B) by striking ``appropriate employees of the 
                Service'' and inserting ``employees of the Service, 
                locum tenens medical providers, healthcare volunteers, 
                and other contracted employees who work at Service 
                hospitals or other Service units and whose employment 
                requires regular direct patient access''; and
            (2) by adding at the end the following:
    ``(c) Notwithstanding any other provision of law, beginning with 
the year of the date of enactment of the Restoring Accountability in 
the Indian Health Service Act of 2018, each employee or provider 
described in subsection (a) who enters into a contract with the Service 
on or after the date of such implementation shall, as a condition of 
employment, annually participate in and complete such training program. 
For purposes of the preceding sentence, participation in such training 
program may not be considered complete for the year involved until the 
individual satisfies each requirement, including testing, if 
applicable, of the training program for such year, as specified by the 
Secretary.''.

SEC. 108. STAFFING DEMONSTRATION PROJECT.

    Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 
1671 et seq.) is amended by adding at the end the following:

``SEC. 833. STAFFING DEMONSTRATION PROJECT.

    ``(a) In General.--The Secretary, acting through the Service, shall 
establish a demonstration project that authorizes the Service to 
provide federally managed Service units with additional staffing 
resources with the goal that the resources become self-sustaining.
    ``(b) Selection.--In selecting Service units for participation, the 
Secretary shall consider whether a Service unit services an Indian 
Tribe that--
            ``(1) has utilized or contributed substantial tribal funds 
        to construct a health facility used by the Service or 
        identified in the master plan for the Service unit;
            ``(2) is located in a State or States with Medicaid 
        reimbursements plans or policies that will increase the 
        likelihood that the staffing resources provided will be self-
        sustaining; and
            ``(3) is operating a health facility described in paragraph 
        (1) under historical staffing ratios that have not been 
        equalized or updated by the Service or any other Service 
        program to reflect current staffing needs.
    ``(c) Duration.--Staffing resources provided to a Service unit 
under this section shall be for a duration that the Secretary, in 
consultation with the applicable Indian Tribe, determines appropriate, 
except that each staffing position provided shall be for a period of 
not less than 3 fiscal years.
    ``(d) Effect of Staffing Awards.--No staffing resources provided 
under this section shall reduce the recurring base funding for staffing 
for any Indian Tribe or federally managed Service unit.
    ``(e) Report.--Not later than 5 years after the Secretary ends the 
demonstration project under this section, the Secretary shall prepare 
and submit a report to the Committee on Indian Affairs and the 
Committee on Health, Education, Labor, and Pensions of the Senate, and 
the Committee on Natural Resources and the Committee on Energy and 
Commerce of the House of Representatives, regarding the project, 
including--
            ``(1) whether the staffing resources resulted in additional 
        revenue for the Service unit sufficient to maintain the staff 
        on a permanent basis;
            ``(2) the levels to which the staffing resources reduced 
        the unmet staffing need for the Service unit; and
            ``(3) whether the demonstration project could be deployed 
        to reduce unmet staffing needs throughout the Service.''.

SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION POLICY.

    Title VIII of the Indian Health Care Improvement Act (25 U.S.C. 
1671 et seq.), as amended by section 108, is further amended by adding 
at the end the following:

``SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION POLICY.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of the Restoring Accountability in the Indian Health Service 
Act of 2018, the Secretary shall establish, after meaningful 
consultation with representatives of affected Indian Tribes, a rule 
establishing a tribal consultation policy for the Service.
    ``(b) Contents of Tribal Consultation Policy.--The policy 
established under the rule described in subsection (a) shall--
            ``(1) update, and replace, the tribal consultation policy 
        established under Circular No. 2006-01 of the Service, or any 
        successor policy; and
            ``(2) include the following:
                    ``(A) A process for determining when the Service 
                will notify Indian Tribes, and a description of how the 
                Indian Tribes should be notified.
                    ``(B) A determination of what actions or agency 
                decisions by the Service will trigger a requirement for 
                meaningful consultation with Indian Tribes.
                    ``(C) A determination of what actions constitute 
                meaningful consultation with Indian Tribes.''.

SEC. 110. TREATMENT OF CERTAIN HOSPITALS.

    The ``Parallel Low-Volume Hospital Payment Adjustment Regarding 
Hospitals Operated by the Indian Health Services (IHS) or a Tribe'' 
provisions described in the final rule published by the Centers for 
Medicare & Medicaid Services in the Federal Register on August 14, 
2017, and entitled ``Medicare Program; Hospital Inpatient Prospective 
Payment Systems for Acute Care Hospitals and the Long-Term Care 
Hospital Prospective Payment System and Policy Changes and Fiscal Year 
2018 Rates; Quality Reporting Requirements for Specific Providers; 
Medicare and Medicaid Electronic Health Record (EHR) Incentive Program 
Requirements for Eligible Hospitals, Critical Access Hospitals, and 
Eligible Professionals; Provider-Based Status of Indian Health Service 
and Tribal Facilities and Organizations; Costs Reporting and Provider 
Requirements; Agreement Termination Notices'' (82 Fed Reg. 37990; 
38188-38189), shall apply with respect to discharges occurring in 
fiscal year 2011 and subsequent fiscal years.

                     TITLE II--EMPLOYEE PROTECTIONS

SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIATION.

    (a) In General.--Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.), as amended by sections 105 and 106, is 
further amended by adding at the end the following:

``SEC. 608. EMPLOYEE PROTECTIONS AGAINST RETALIATION.

    ``(a) Employee Accountability.--
            ``(1) Agency reporting process requirement.--The Secretary 
        shall designate an official in the Department who is not an 
        employee of the Service to--
                    ``(A) receive reports from an employee of the 
                Service who witnesses retaliation against a 
                whistleblower, a violation of a patient safety 
                requirement, or other similar conduct; and
                    ``(B) conduct active and ongoing outreach to all 
                employees of the Service about--
                            ``(i) Federal and Department systems for 
                        reporting retaliation against whistleblowers; 
                        and
                            ``(ii) the duty of individual employees of 
                        the Service to report violations of patient 
                        safety requirements and other similar conduct.
            ``(2) Oversight.--Not later than 3 days after the date on 
        which the official designated by the Secretary under paragraph 
        (1) receives a report under paragraph (1)(A), the Secretary 
        shall--
                    ``(A) formally review the report; and
                    ``(B) provide a copy of such report and any other 
                relevant information to the Inspector General of the 
                Department.
            ``(3) Removal for whistleblower retaliation.--The Secretary 
        may remove for misconduct from the civil service (as defined in 
        section 2101 of title 5, United States Code), in accordance 
        with sections 606 and 607, an employee of the Service if the 
        Secretary determines, after completing a report review 
        described in paragraph (2), that the employee has retaliated 
        against a whistleblower and warrants removal.
            ``(4) Enhancing protections for whistleblowers.--The 
        Secretary shall carry out any actions determined necessary by 
        the Secretary to enhance protection for whistleblowers, 
        including identifying appropriate Service employees and 
        requiring the employees to complete the Office of Special 
        Counsel's Whistleblower Certification Program.
    ``(b) Definitions.--In this section:
            ``(1) Retaliation.--The term `retaliation'--
                    ``(A) means an adverse employment action or any 
                significantly adverse action against a whistleblower, 
                such as the refusal or delay of care provided through 
                the Service; and
                    ``(B) includes instances where the adverse action 
                described in subparagraph (A) is perpetrated against a 
                family member or friend of the whistleblower because of 
                the whistleblower's disclosure of information.
            ``(2) Whistleblower.--The term `whistleblower' means an 
        employee of Service who discloses information--
                    ``(A) that the employee reasonably believes 
                evidences--
                            ``(i) a violation of any law, rule, or 
                        regulation; or
                            ``(ii) gross mismanagement, a gross waste 
                        of funds, an abuse of authority, or a 
                        substantial and specific danger to public 
                        health or safety; and
                    ``(B) if such disclosure is not specifically 
                prohibited by law and if such information is not 
                specifically required by Executive Order to be kept 
                secret in the interest of national defense or the 
                conduct of foreign affairs.''.

SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION CONGRESS.

    (a) Adverse Action for Violation of Right To Petition Congress.--
Section 7211 of title 5, United States Code, is amended--
            (1) by striking ``The right of'' and inserting ``(a) In 
        General.--The right of''; and
            (2) by adding at the end the following new subsection:
    ``(b) Adverse Action.--An employee who interferes with or denies a 
right protected under subsection (a) shall be subject to any adverse 
action described in paragraphs (1) through (5) of section 7512, in 
accordance with the procedure described in section 7513 and any other 
applicable procedure.''.
    (b) Electronic Notification of Right of Employees of Indian Health 
Service.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary''), acting 
        through the Director of the Indian Health Service, shall, in 
        accordance with paragraphs (2) through (6), provide to each 
        employee of the Indian Health Service, and electronically post, 
        a memorandum providing notice of the right to petition Congress 
        under section 7211 of title 5, United States Code.
            (2) Contents.--The memorandum described in paragraph (1) 
        shall include the following statement: ``It is a violation of 
        section 7211 of title 5, United States Code, for any Federal 
        agency or employee to require a Federal employee to seek 
        approval, guidance, or any other form of input prior to 
        contacting Congress with information, even if that information 
        is in relation to the job responsibilities of the employee. A 
        Federal employee found to have interfered with or denied the 
        right of another Federal employee under such section shall be 
        subject to an adverse action described in paragraphs (1) 
        through (5) of section 7512 of title 5, United States Code, 
        including a suspension for more than 14 days without pay.''.
            (3) Submission.--Not later than 30 days after the date of 
        enactment of this Act, the Secretary shall submit the 
        memorandum described in paragraph (1) to the Inspector General 
        of the Department of Health and Human Services (referred to in 
        this subsection as the ``Inspector General'') for approval.
            (4) Approval or disapproval.--Not later than 30 days after 
        the submission of the memorandum under paragraph (3), or a 
        revised memorandum under paragraph (6), the Inspector General 
        shall approve or disapprove the memorandum or revised 
        memorandum, as the case may be.
            (5) Notice.--In the case of an approval under paragraph 
        (4), not later than 30 days after such approval, the Secretary 
        shall--
                    (A) provide to each employee of the Indian Health 
                Service an electronic copy of the approved memorandum; 
                and
                    (B) post such memorandum in a clear and conspicuous 
                place on the website of the Indian Health Service for a 
                period not less than 120 days.
            (6) Revised memorandum.--In the case of a disapproval under 
        paragraph (4), not later than 15 days after such disapproval, 
        the Secretary shall submit a revised memorandum to the 
        Inspector General for approval under paragraph (4).

SEC. 203. FISCAL ACCOUNTABILITY.

    Title VI of the Indian Health Care Improvement Act (25 U.S.C. 1661 
et seq.), as amended by sections 105, 106, and 201, is further amended 
by adding at the end the following:

``SEC. 609. FISCAL ACCOUNTABILITY.

    ``(a) Management of Funds.--
            ``(1) In general.--If the Secretary fails to submit the 
        professional housing plan under section 301(a) of the Restoring 
        Accountability in the Indian Health Service Act of 2018 or the 
        staffing plan under section 301(b) of that Act, the Secretary 
        may not receive, obligate, transfer, or expend any amounts for 
        a salary increase or bonus of an individual described in 
        paragraph (2) until the professional housing plan or staffing 
        plan, as the case may be, is submitted.
            ``(2) Individual described.--An individual described in 
        this paragraph is an individual employed in a position in the 
        Service that is a position--
                    ``(A) described under sections 5312 through 5316 of 
                title 5, United States Code;
                    ``(B) placed in level IV or V of the Executive 
                Schedule under section 5317 of title 5, United States 
                Code;
                    ``(C) as a limited term appointee, limited 
                emergency appointee, or noncareer appointee in the 
                Senior Executive Service, as defined under paragraphs 
                (5), (6), and (7), respectively, of section 3132(a) of 
                title 5, United States Code; or
                    ``(D) under section 213.3301 or 213.3302 of title 
                5, Code of Federal Regulations.
    ``(b) Prioritization of Patient Care.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary shall use amounts available to the Indian 
        Health Service that are not obligated or expended, including 
        base budget funding and third party collections, during the 
        fiscal year for which the amounts are made available, and that 
        remain available, only to support patient care by using such 
        funds for the costs of--
                    ``(A) essential medical equipment;
                    ``(B) purchased or referred care; or
                    ``(C) staffing.
            ``(2) Special rule.--In using amounts under paragraph (1), 
        the Secretary shall ensure that, in any case where the amounts 
        were originally made available for a particular Service unit, 
        such amounts are used to benefit Indians served by that Service 
        unit.
            ``(3) Restrictions.--The Secretary may not use amounts 
        described in paragraph (1)--
                    ``(A) to remodel or interior decorate any Area 
                office; or
                    ``(B) to increase the rate of pay of any employee 
                of an Area office.
    ``(c) Spending Reports.--Not later than 90 days after the end of 
each quarter of a fiscal year, the Secretary shall submit a report 
describing the authorizations, expenditures, outlays, transfers, 
reprogramming, and obligations of each level of the Service, including 
the headquarters, each Area office, each Service unit, and each health 
clinic or facility, to--
            ``(1) each Indian Tribe;
            ``(2) in the Senate--
                    ``(A) the Committee on Indian Affairs;
                    ``(B) the Committee on Health, Education, Labor, 
                and Pensions;
                    ``(C) the Committee on Appropriations; and
                    ``(D) the Committee on the Budget; and
            ``(3) in the House of Representatives--
                    ``(A) the Committee on Natural Resources;
                    ``(B) the Committee on Energy and Commerce;
                    ``(C) the Committee on Appropriations; and
                    ``(D) the Committee on the Budget.
    ``(d) Status Reports.--
            ``(1) In general.--Subject to paragraph (2), not later than 
        180 days after the end of each fiscal year, the Secretary shall 
        provide to each entity described in paragraphs (1) through (3) 
        of subsection (c) a report describing the safety, billing, 
        certification, credential, and compliance statuses of each 
        facility managed, operated, or otherwise supported by the 
        Service.
            ``(2) Updates.--With respect to any change of a status 
        described in paragraph (1), the Secretary shall immediately 
        provide to each entity described in paragraphs (1) through (3) 
        of subsection (c) an update describing such change.
    ``(e) Rule of Construction.--Nothing in this section may be 
construed--
            ``(1) to negatively impact the right of an Indian Tribe to 
        enter into a compact or contract under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5304 et 
        seq.); and
            ``(2) to apply to such a compact or contract unless 
        expressly agreed to by the Indian Tribe.''.

                           TITLE III--REPORTS

SEC. 301. DEFINITIONS.

    In this title:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) Service.--The term ``Service'' means the Indian Health 
        Service.
            (3) Service unit.--The term ``Service unit'' has the 
        meaning given the term in section 4 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1603).

SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND HUMAN SERVICES.

    (a) IHS Professional Housing Plan.--Not later than 1 year after the 
date the Government Accountability Office releases their ongoing report 
about Indian Health Service housing needs, the Secretary shall develop, 
make publicly available, and submit to Congress and the Comptroller 
General of the United States a written plan to address the professional 
housing needs of employees of the Service that comports with the 
practices and recommendations of the Government Accountability Office 
relating to professional housing.
    (b) Plan Relating to IHS Staffing Needs.--Not later than 1 year 
after the date the Government Accountability Office releases their 
ongoing report about Indian Health Service housing needs, the Secretary 
shall develop, make publicly available, and submit to Congress and the 
Comptroller General of the United States a written plan to address 
staffing needs in the Service that comports with the practices of the 
Government Accountability Office relating to workforce planning.
    (c) Indian Health Care Improvement Act Report.--Not later than 1 
year after the date of enactment of this Act, and each year thereafter 
for a period of 5 years, the Secretary shall develop, make publicly 
available, and submit to Congress a report on the data submitted under 
section 412(b) of the Indian Health Care Improvement Act, as amended by 
section 107.
    (d) Quality of Care and Staffing Report.--Not later than 1 year 
after the date of enactment of this Act, and each year thereafter, the 
Secretary shall develop and submit to Congress a report on the data 
obtained under section 108, with an emphasis on quality of care and 
access to care.

SEC. 303. REPORTS BY THE COMPTROLLER GENERAL.

    (a) IHS Housing Needs Report.--
            (1) In general.--Not later than 5 years after the date on 
        which the Comptroller General of the United States receives the 
        professional housing plan under section 302(a), the Comptroller 
        General shall develop and submit to Congress a report.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) An evaluation of any existing, as of the date 
                of the report, assessments and projections for the 
                professional housing needs of employees of the Service, 
                including discussion and conclusion as to whether 
                existing assessments and projections accurately reflect 
                the professional housing needs of employees of the 
                Service.
                    (B) An assessment of the professional housing needs 
                of employees of the Service for each Service area (as 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
                    (C) An assessment of the professional housing plan 
                developed by the Secretary under section 302(a).
    (b) IHS Staffing Needs Report.--
            (1) In general.--Not later than 5 years after the date on 
        which the Comptroller General receives the report under section 
        302(b), the Comptroller General shall prepare and submit to 
        Congress a report on the staffing needs of the Service.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) A description of the number and type of full-
                time positions needed at each facility of the Service 
                and the amount of funds necessary to maintain such 
                positions.
                    (B) An explanation of the various methodologies 
                that the Service utilizes and has previously utilized 
                to determine the number and type of full-time positions 
                needed at federally managed Service units.
                    (C) An assessment of the use of independent 
                contractors, including the number of independent 
                contractors hired to fill vacant full-time positions 
                and amounts spent on independent contractors who 
                provide health care services.
                    (D) An assessment of the staffing plan developed by 
                the Secretary under section 302(b).
    (c) Whistleblower Protections Report.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Comptroller General shall develop 
        and submit to Congress a report on the efficacy of existing 
        protections for whistleblowers in the Service.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) A discussion and conclusion as to whether the 
                Service has taken proper steps to prevent retaliation 
                against whistleblowers.
                    (B) If applicable, any recommendations for changes 
                to the policy of the Service with respect to 
                whistleblowers.
                    (C) A discussion and conclusion as to whether the 
                official email accounts of employees of the Service are 
                appropriately monitored.

SEC. 304. INSPECTOR GENERAL REPORTS.

    (a) Patient Care Reports.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act, and not less than every 3 years 
        thereafter, the Inspector General of the Department of Health 
        and Human Services shall develop and submit to Congress and the 
        Service a report on patient harm events occurring in Service 
        units and deferrals and denials of care of patients of the 
        Service.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) An evaluation of the number and kind of events 
                that contribute to patient deaths in a Service unit and 
                recommendations regarding reducing the number of 
                patient deaths.
                    (B) An evaluation of the Service's tracking and 
                reporting of, and response to, patient harm events and 
                recommendations regarding how to improve such tracking, 
                reporting, and response.
                    (C) The effects of deferrals and denials of care on 
                patients of the Service, including patient outcomes, 
                and recommendations regarding how to reduce deferrals 
                and denials of care.
    (b) Reporting Systems Audit.--Not later than 2 years after the date 
of enactment of this Act, the Inspector General shall--
            (1) conduct an audit of reporting systems of the Service, 
        as of the date of enactment of this Act; and
            (2) provide to the Service recommendations and technical 
        assistance regarding implementation of improved reporting 
        systems, procedures, standards, and protocols.

SEC. 305. TRANSPARENCY IN CMS SURVEYS.

    Section 1880 of the Social Security Act (42 U.S.C. 1395qq) is 
amended by adding at the end the following:
    ``(g)(1) Not less frequently than once every 2 years, the 
Administrator of the Centers for Medicare & Medicaid Services shall 
conduct surveys of participating Indian Health Service facilities to 
assess the compliance of each hospital or skilled nursing facility of 
the Indian Health Service with--
            ``(A) section 1867; and
            ``(B) conditions of participation in the program under this 
        title.
    ``(2) Each survey completed under this subsection shall be posted 
on the Internet website of the Centers for Medicare & Medicaid 
Services. Such posting shall comply with the Federal regulations 
concerning the privacy of individually identifiable health information 
promulgated under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996.''.

                     TITLE IV--TECHNICAL AMENDMENTS

SEC. 401. TECHNICAL AMENDMENTS.

    The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is 
amended--
            (1) by striking ``contract health service'' each place such 
        term appears (regardless of casing and typeface and including 
        in the headings) and inserting ``purchased/referred care'' 
        (with appropriate casing and typeface); and
            (2) by striking ``contract health services'' each place 
        such term appears (regardless of casing and typeface and 
        including in the headings) and inserting ``purchased/referred 
        care'' (with appropriate casing and typeface).
                                                 Union Calendar No. 872

115th CONGRESS

  2d Session

                               H. R. 5874

                     [Report No. 115-1065, Part I]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                           December 28, 2018

 Committees on Energy and Commerce, Ways and Means, and Oversight and 
 Government Reform discharged; committed to the Committee of the Whole 
       House on the State of the Union and ordered to be printed
```