IB 

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 GONZA ́LEZ-COLO ́N 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 


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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. 


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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 2018’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 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. 


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1 TITLE I—INDIAN HEALTH 

2 SERVICE IMPROVEMENTS 

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

5 Title I of the Indian Health Care Improvement Act 

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

7 the following: 

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

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

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

14 by the Service that provides a personnel and pay system 

15 that, to the maximum extent practicable, is comparable 

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

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

19 States Code. 

20 ‘‘(b) RELOCATION COSTS.—The Secretary may pro21 vide to an employee of the Service reimbursement for any 

22 relocation costs the employee incurs if— 

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

24 experiencing a high level of need for employees, as 

25 determined by the Secretary; and 


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

2 would otherwise be difficult to fill, as determined by 

3 the Secretary, in the absence of an incentive. 

4 ‘‘(c) HOUSING VOUCHERS.— 

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

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

7 the Restoring Accountability in the Indian Health 

8 Service Act of 2018, the Secretary may establish a 

9 program to provide tenant-based rental assistance to 

10 an employee of the Service who— 

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

12 year at a Service unit designated by the Admin13 istrator of the Health Resources and Services 

14 Administration as a health professional short15 age area, as defined in section 332(a) of the 

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

17 with the greatest staffing need; and 

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

19 by the Secretary. 

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

21 Secretary under paragraph (1) shall terminate on 

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

23 such program is established. 

24 ‘‘(d) ADMINISTRATION.— 


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

2 carry out subsection (b) in accordance with any 

3 guidelines of the Office of Personnel Management 

4 relating to section 572 of title 5, Code of Federal 

5 Regulations (as in effect on the date of enactment 

6 of the Restoring Accountability in the Indian Health 

7 Service Act of 2018). 

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

9 may only provide reimbursement for any relocation 

10 costs under subsection (b) or any other benefit 

11 under subsection (c) to— 

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

13 serve for not less than 1 year in the Service, be14 ginning on the date of the agreement; or 

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

16 serve for not less than 2 years in the service be17 ginning on the date of the agreement.’’. 

18 SEC. 102. MEDICAL CREDENTIALING SYSTEM. 

19 Title I of the Indian Health Care Improvement Act 

20 (25 U.S.C. 1611 et seq.), as amended by section 101, is 

21 further amended by adding at the end the following: 

22 ‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 

23 ‘‘(a) IN GENERAL.— 

24 ‘‘(1) DEVELOPMENT AND IMPLEMENTATION

25 TIMELINE.—By not later than 1 year after the date 


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1 of enactment of the Restoring Accountability in the 

2 Indian Health Service Act of 2018, the Secretary, 

3 acting through the Service and in accordance with 

4 the requirements described in subsection (b), shall 

5 develop and implement a Service-wide centralized 

6 electronic credentialing system (referred to in this 

7 section as the ‘credentialing system’) to credential li8 censed health professionals who seek to provide 

9 health care services at any Service unit, including 

10 physicians, nurses and physicians assistants. 

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

12 credentialing system, the Secretary— 

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

14 licensed health professionals who were 

15 credentialed using existing Service policy prior 

16 to the date of enactment of the Restoring Ac17 countability in the Indian Health Service Act of 

18 2018; and 

19 ‘‘(B) shall— 

20 ‘‘(i) use the credentialing system for 

21 all new applications of licensed health pro22 fessionals and the migration of credentials 

23 data that existed prior to implementation 

24 into the system; 


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1 ‘‘(ii) maintain the established timeline 

2 for re-credentialing of licensed health pro3 fessionals who were credentialed prior to 

4 implementation, as defined by Service pol5 icy; and 

6 ‘‘(iii) review credentials for all profes7 sionals in the system, based on updated 

8 policies, on a not less than yearly basis. Li9 censed health professionals whose creden10 tials would not have been approved under 

11 the updated policies shall have 90 days to 

12 meet the new requirements. 

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

14 credentialing system under subsection (a), the Secretary 

15 shall ensure the following: 

16 ‘‘(1) Credentialing procedures shall be uniform 

17 and integrated throughout the Service. 

18 ‘‘(2) With respect to each licensed health pro19 fessional who successfully completes the 

20 credentialing procedures of the credentialing system, 

21 the Secretary may authorize each such professional 

22 to provide health care services at any Service unit. 

23 ‘‘(3) Credentialing procedures shall include 

24 verification of licensure, education, employment his25 tory, and criminal background checks and history. 


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

2 credentialing system under subsection (a), the Secretary 

3 shall consult with Indian Tribes and may also consult with 

4 any public or private association of medical providers, any 

5 government agency, or other relevant expert, as deter6 mined by the Secretary. 

7 ‘‘(d) APPLICATION.—A licensed health care profes8 sional may not provide health care services at any Service 

9 unit, unless such professional successfully completes the 

10 credentialing procedures of the credentialing system devel11 oped under subsection (a). 

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

13 such regulations as may be necessary to carry out the pro14 visions of this section. 

15 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec16 tion may be construed— 

17 ‘‘(1) to negatively impact the right of an Indian 

18 Tribe to enter into a compact or contract under the 

19 Indian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 5304 et seq.); and 

21 ‘‘(2) to apply to such a compact or contract un22 less expressly agreed to by the Indian Tribe.’’. 


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

3 SERVICE. 

4 Section 224 of the Public Health Service Act (42 

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

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

10 ‘‘(1) IN GENERAL.—For purposes of this sec11 tion, an employee of an IHS urban Indian health 

12 program and a health professional volunteer at a 

13 Service unit shall, in providing a health service to an 

14 individual, be deemed to be an employee of the Pub15 lic Health Service for a calendar year that begins 

16 during a fiscal year for which a transfer was made 

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

18 subject to the provisions of this subsection. 

19 ‘‘(2) CONDITIONS.—In providing a health serv20 ice to an individual, a health care practitioner shall, 

21 for purposes of this subsection, be considered to be 

22 a health professional volunteer at a Service unit if 

23 all of the following conditions are met: 

24 ‘‘(A) The service is provided to the indi25 vidual at the facilities of a Service unit, or 


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1 through offsite programs or events carried out 

2 by the Service unit. 

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

4 health care practitioner pursuant to paragraph 

5 (3)(C). 

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

7 receive any compensation for the service from 

8 the individual, the Service unit, or any third9 party payer (including reimbursement under 

10 any insurance policy or health plan, or under 

11 any Federal or State health benefits program), 

12 except that the health care practitioner may re13 ceive repayment from the Service unit for rea14 sonable expenses incurred by the health care 

15 practitioner in the provision of the service to 

16 the individual. 

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

18 health care practitioner or the Service unit 

19 posts a clear and conspicuous notice at the site 

20 where the service is provided of the extent to 

21 which the legal liability of the health care prac22 titioner is limited under this subsection. 

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

24 the health care practitioner is licensed, certified, 

25 credentialed, and privileged in accordance with 


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1 Service policy and applicable law regarding the 

2 provision of the service. 

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

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

5 (i), and (l) apply to an employee of an IHS urban 

6 Indian health program and to a health care practi7 tioner at a Service unit for purposes of this sub8 section to the same extent and in the same manner 

9 as such subsections apply to an officer, governing 

10 board member, employee, or contractor of an entity 

11 described in subsection (g)(4), subject to paragraph 

12 (4) and subject to the following subparagraphs: 

13 ‘‘(A) Each reference to an entity in sub14 sections (g), (h), (i), and (l) shall be considered 

15 to be a reference to an IHS urban Indian 

16 health program or a Service unit, as applicable. 

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

18 applies in lieu of the first sentence of subsection 

19 (g)(1)(A). 

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

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

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


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

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

4 practitioner, the Service unit submits to 

5 the Secretary an application meeting the 

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

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

9 health care practitioner is deemed to be an 

10 employee of the Public Health Service. 

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

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

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

17 behalf of the Service unit sponsoring the health 

18 care practitioner pursuant to subparagraph (C)) 

19 for any cause of action arising from an act or 

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

22 makes that determination. 

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

24 health care practitioner for purposes of this 

25 subsection only to the extent that, in providing 


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

3 ‘‘(4) FUNDING.— 

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

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

6 available for transfer under subparagraph (C) 

7 for purposes of carrying out this subsection. 

8 ‘‘(B) ANNUAL ESTIMATES.— 

9 ‘‘(i) IN GENERAL.—Not later than 

10 May 1 of each fiscal year, the Attorney 

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

13 providing an estimate of the amount of 

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

16 acts or omissions of employees of an IHS 

17 urban Indian health program or health 

18 professional volunteers, will be paid pursu19 ant to this section during the calendar year 

20 that begins in the following fiscal year. 

21 ‘‘(ii) APPLICABILITY.—Subsection 

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

23 clause (i) relating to employees of an IHS 

24 urban Indian health program or health 

25 professional volunteers to the same extent 


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1 and in the same manner as that subsection 

2 applies to the estimate under that sub3 section relating to officers, governing board 

4 members, employees, and contractors of 

5 entities described in subsection (g)(4). 

6 ‘‘(C) TRANSFERS.—Not later than Decem7 ber 31 of each fiscal year, the Secretary shall 

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

9 to the appropriate accounts in the Treasury an 

10 amount equal to the estimate made under sub11 paragraph (B) for the calendar year beginning 

12 in that fiscal year, subject to the extent of 

13 amounts in the fund. 

14 ‘‘(5) DEFINITIONS.— 

15 ‘‘(A) IHS URBAN INDIAN HEALTH PRO16 GRAM.—In this subsection, the term ‘IHS 

17 urban Indian health program’ means an urban 

18 Indian health program operated by an urban 

19 Indian organization pursuant to a grant or con20 tract with the Indian Health Service under title 

21 V of the Indian Health Care Improvement Act 

22 (25 U.S.C. 1651 et seq.). 

23 ‘‘(B) SERVICE UNIT.—In this subsection, 

24 the term ‘Service unit’ has the meaning given 


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1 the term in section 4 of the Indian Health Care 

2 Improvement Act (25 U.S.C. 1603). 

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

4 this subsection may be construed— 

5 ‘‘(A) to negatively impact the right of an 

6 Indian Tribe to enter into a compact or con7 tract under the Indian Self-Determination and 

8 Education Assistance Act (25 U.S.C. 5304 et 

9 seq.); and 

10 ‘‘(B) to apply to such a compact or con11 tract unless expressly agreed to by the Indian 

12 Tribe. 

13 ‘‘(7) EFFECTIVE DATES.— 

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

15 subparagraph (B), this subsection shall take ef16 fect on October 1, 2019. 

17 ‘‘(B) REGULATIONS, APPLICATIONS, AND

18 REPORTS.—Effective on the date of the enact19 ment of the Restoring Accountability in the In20 dian Health Service Act of 2018, the Secretary 

21 may— 

22 ‘‘(i) prescribe regulations for carrying 

23 out this subsection; and 

24 ‘‘(ii) accept and consider applications 

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


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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) by amending subparagraph (B) of sub7 section (b)(1) to read as follows: 

8 ‘‘(B) have— 

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

10 and 

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

12 profession in a State; or 

13 ‘‘(ii)(I) a master’s degree in business 

14 administration with an emphasis in health 

15 care management (as defined by the Sec16 retary), health administration, hospital ad17 ministration, or public health; and 

18 ‘‘(II) a license or certification to prac19 tice in the field of business administration, 

20 health administration, hospital administra21 tion, or public health in a State, if the Sec22 retary determines such license or certifi23 cation necessary for the Indian health pro24 gram to which the individual will be as25 signed; 


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1 ‘‘(iii) maintain credentials as deter2 mined by the system described in section 

3 102; and 

4 ‘‘(iv) participate in the training de5 scribed in section 107;’’; 

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

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

8 ‘‘(iii) to serve for a time period (re9 ferred to in this section as the ‘period of 

10 obligated service’) equal to— 

11 ‘‘(I) 2 years or such longer pe12 riod as the individual may agree to 

13 serve in the full-time practice of such 

14 individual’s profession in an Indian 

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

18 ‘‘(II) 4 years or such longer pe19 riod as the individual may agree to 

20 serve in the half-time practice of such 

21 individual’s profession in an Indian 

22 health program to which the indi23 vidual may be assigned by the Sec24 retary;’’; and 

25 (3) in subsection (g)(2)— 


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1 (A) by redesignating subparagraph (B) as 

2 subparagraph (C); and 

3 (B) in subparagraph (A)— 

4 (i) by striking the first sentence of the 

5 matter preceding clause (i) and inserting 

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

7 who contracts to serve a period of obli8 gated service under subsection 

9 (f)(1)(B)(iii)(I), for each year of such obli10 gated service, the Secretary may pay up to 

11 $35,000 (or an amount equal to the 

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

13 of the Public Health Service Act (42 

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

15 individual for loans described in paragraph 

16 (1). In the case of an individual who con17 tracts to serve a period of obligated service 

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

19 year of such obligated service, the Sec20 retary may pay up to $17,500 on behalf of 

21 the individual for loans described in para22 graph (1)’’; and 

23 (ii) by striking ‘‘In making a deter24 mination’’ and inserting the following: 


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

2 paragraph’’. 

3 SEC. 105. IMPROVEMENTS IN HIRING PRACTICES. 

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

5 Care Improvement Act (25 U.S.C. 1661 et seq.) is amend6 ed by adding at the end the following: 

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

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

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

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

11 3328 of such title), a candidate directly to a position with12 in the Service for which the candidate meets the qualifica13 tions standard established by the Office of Personnel Man14 agement. 

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

16 hiring, promoting, transferring, or reassigning a candidate 

17 to a Senior Executive Service position or the position of 

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

19 shall provide notice to each Indian Tribe located within 

20 the defined geographic area of such Area office or Service 

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

22 in an employment record. Each such Indian Tribe may 

23 submit comment to the Secretary during the 10-day period 

24 after the date of such notification regarding such con25 tent.’’. 


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

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

3 by adding the following: 

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

5 and Human Services may, at the request of an In6 dian Tribe, seek from each Indian Tribe concerned, 

7 a waiver of Indian preference laws for a personnel 

8 action that is with respect to— 

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

10 which 15 percent or more of the total positions 

11 or specific health professionals in the Service 

12 unit are not filled by a full-time employee of the 

13 Indian Health Service for a period of 6 months 

14 or longer; or 

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

16 Health Service or a former tribal employee who 

17 was removed from such former employment 

18 within, or demoted for performance or mis19 conduct that occurred during, the 5-year period 

20 following the date of such personnel action.’’. 


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1 SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IM2 PROVE ACCOUNTABILITY OF SENIOR EXECU3 TIVES AND EMPLOYEES OF THE INDIAN 

4 HEALTH SERVICE. 

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

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

7 amended by section 105, is further amended by adding 

8 at the end the following: 

9 ‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM10 PROVE ACCOUNTABILITY OF SENIOR EXECU11 TIVES OF THE INDIAN HEALTH SERVICE. 

12 ‘‘(a) AUTHORITY.— 

13 ‘‘(1) IN GENERAL.—The Secretary may, as pro14 vided in this section, reprimand or suspend, involun15 tarily reassign, demote, or remove a covered indi16 vidual from a senior executive position at the Service 

17 if the Secretary determines that the misconduct or 

18 performance of the covered individual warrants such 

19 action. 

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

21 Secretary removes an individual pursuant to para22 graph (1), the Secretary may remove the individual 

23 from the civil service (as defined in section 2101 of 

24 title 5, United States Code). 

25 ‘‘(b) RIGHTS AND PROCEDURES.— 


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

2 the subject of an action under subsection (a) is enti3 tled to— 

4 ‘‘(A) advance notice of the action and a file 

5 containing all evidence in support of the pro6 posed action; 

7 ‘‘(B) be represented by an attorney or 

8 other representative of the covered individual’s 

9 choice; and 

10 ‘‘(C) grieve the action in accordance with 

11 an internal grievance process that the Secretary 

12 shall establish for purposes of this subsection. 

13 ‘‘(2) NOTICE.— 

14 ‘‘(A) AGGREGATE PERIOD FOR NOTICE.— 

15 The aggregate period for notice, response, and 

16 decision on an action under subsection (a) may 

17 not exceed 15 business days. 

18 ‘‘(B) RESPONSE.—The period for the re19 sponse of a covered individual to a notice under 

20 paragraph (1)(A) of an action under subsection 

21 (a) shall be 7 business days. 

22 ‘‘(C) DECISION.—A decision under this 

23 paragraph on an action under subsection (a) 

24 shall be issued not later than 15 business days 

25 after notice of the action is provided to the covVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 ered individual under paragraph (1)(A). The 

2 decision shall be in writing, and shall include 

3 the specific reasons for the decision. 

4 ‘‘(3) GRIEVANCE PROCESS.—The Secretary 

5 shall ensure that the grievance process established 

6 under paragraph (1)(C) takes fewer than 21 days. 

7 ‘‘(4) FINAL AND CONCLUSIVE DECISION.—A de8 cision under paragraph (2) that is not grieved, and 

9 a grievance decision under paragraph (3), shall be 

10 final and conclusive. 

11 ‘‘(5) JUDICIAL REVIEW.—A covered individual 

12 adversely affected by a decision under paragraph (2) 

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

14 paragraph (3), may obtain judicial review of such 

15 decision. 

16 ‘‘(6) COURT REVIEW.—In any case in which ju17 dicial review is sought under paragraph (5), the 

18 court shall review the record and may set aside any 

19 Department action found to be— 

20 ‘‘(A) arbitrary, capricious, an abuse of dis21 cretion, or otherwise not in accordance with a 

22 provision of law; 

23 ‘‘(B) obtained without procedures required 

24 by a provision of law having been followed; or 

25 ‘‘(C) unsupported by substantial evidence. 


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1 ‘‘(c) RELATION TO OTHER PROVISIONS OF LAW.— 

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

3 not apply to an action under subsection (a). 

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

5 ‘‘(1) COVERED INDIVIDUAL.—The term ‘cov6 ered individual’ means a career appointee (as that 

7 term is defined in section 3132(a) of title 5, United 

8 States Code). 

9 ‘‘(2) MISCONDUCT.—The term ‘misconduct’ in10 cludes neglect of duty, malfeasance, or failure to ac11 cept a directed reassignment or to accompany a po12 sition in a transfer of function. 

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

14 the Secretary of Health and Human Services, acting 

15 through the Director of the Service. 

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

17 ‘senior executive position’ means a Senior Executive 

18 Service position (as that term is defined in section 

19 3132(a) of title 5, United States Code). 

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

22 THE INDIAN HEALTH SERVICE. 

23 ‘‘(a) IN GENERAL.— 

24 ‘‘(1) AUTHORITY.—The Secretary may remove, 

25 demote, or suspend a covered individual who is an 


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1 employee of the Service if the Secretary determines 

2 the performance or misconduct of the covered indi3 vidual warrants such removal, demotion, or suspen4 sion. 

5 ‘‘(2) ACTIONS.—If the Secretary removes, de6 motes, or suspends a covered individual pursuant to 

7 paragraph (1), the Secretary may— 

8 ‘‘(A) remove the covered individual from 

9 the civil service (as defined in section 2101 of 

10 title 5, United States Code); 

11 ‘‘(B) demote the covered individual by 

12 means of a reduction in grade for which the 

13 covered individual is qualified, that the Sec14 retary determines is appropriate, and that re15 duces the annual rate of pay of the covered in16 dividual; or 

17 ‘‘(C) suspend the covered individual. 

18 ‘‘(b) PAY OF CERTAIN DEMOTED INDIVIDUALS.— 

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

20 provision of law, any covered individual subject to a 

21 demotion under subsection (a)(2) shall, beginning on 

22 the date of such demotion, receive the annual rate 

23 of pay applicable to such grade. 

24 ‘‘(2) RESTRICTIONS.— 


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1 ‘‘(A) PROHIBITION ON ADMINISTRATIVE

2 LEAVE.—A covered individual subject to a de3 motion under subsection (a)(2) may not be 

4 placed on administrative leave during the period 

5 during which an appeal (if any) under this sec6 tion is ongoing, and may only receive pay if the 

7 covered individual reports for duty or is ap8 proved to use accrued unused annual, sick, fam9 ily medical, military, or court leave. 

10 ‘‘(B) RESTRICTION ON PAY AND BENE11 FITS.—If a covered individual subject to a de12 motion under subsection (a)(2) does not report 

13 for duty or receive approval to use accrued un14 used leave, such covered individual shall not re15 ceive pay or other benefits pursuant to sub16 section (d)(5). 

17 ‘‘(c) PROCEDURES.— 

18 ‘‘(1) IN GENERAL.— 

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

20 period for notice, response, and final decision in 

21 a removal, demotion, or suspension under this 

22 section may not exceed 15 business days. 

23 ‘‘(B) PERIOD FOR RESPONSE.—The period 

24 for the response of a covered individual to a no25 tice of a proposed removal, demotion, or susVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 pension under this section shall be 7 business 

2 days. 

3 ‘‘(C) REPRESENTATION BY ATTORNEY OR

4 OTHER REPRESENTATIVE.—Paragraph (3) of 

5 subsection (b) of section 7513 of title 5, United 

6 States Code, shall apply with respect to a re7 moval, demotion, or suspension under this sec8 tion. 

9 ‘‘(D) PROCEDURES SUPERSEDING CBAS.— 

10 The procedures in this subsection shall super11 sede any collective bargaining agreement to the 

12 extent that such agreement is inconsistent with 

13 such procedures. 

14 ‘‘(2) FINAL DECISION.—The Secretary shall 

15 issue a final decision with respect to a removal, de16 motion, or suspension under this section not later 

17 than 15 business days after the Secretary provides 

18 notice, including a file containing all the evidence in 

19 support of the proposed action, to the covered indi20 vidual of the removal, demotion, or suspension. The 

21 decision shall be in writing and shall include the spe22 cific reasons for the decision. 

23 ‘‘(3) PERFORMANCE APPRAISAL.—The proce24 dures under chapter 43 of title 5, United States 


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1 Code, shall not apply to a removal, demotion, or sus2 pension under this section. 

3 ‘‘(4) APPEAL TO MERIT SYSTEMS PROTECTION

4 BOARD.— 

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B) and subsection (d), any removal or 

7 demotion under this section, and any suspen8 sion of more than 14 days under this section, 

9 may be appealed to the Merit Systems Protec10 tion Board, which shall refer such appeal to an 

11 administrative judge pursuant to section 

12 7701(b)(1) of title 5, United States Code. 

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

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

15 suspension may only be made if such appeal is 

16 made not later than 10 business days after the 

17 date of such removal, demotion, or suspension. 

18 ‘‘(d) EXPEDITED REVIEW.— 

19 ‘‘(1) IN GENERAL.—Upon receipt of an appeal 

20 under subsection (c)(4)(A), the administrative judge 

21 shall expedite any such appeal under section 

22 7701(b)(1) of title 5, United States Code, and, in 

23 any such case, shall issue a final and complete deci24 sion not later than 180 days after the date of the 

25 appeal. 


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1 ‘‘(2) UPHOLDING DECISION.— 

2 ‘‘(A) IN GENERAL.—Notwithstanding sec3 tion 7701(c)(1)(B) of title 5, United States 

4 Code, the administrative judge shall uphold the 

5 decision of the Secretary to remove, demote, or 

6 suspend an employee under subsection (a) if the 

7 decision is supported by substantial evidence. 

8 ‘‘(B) PROHIBITION OF MITIGATION.—Not9 withstanding title 5, United States Code, or any 

10 other provision of law, if the decision of the 

11 Secretary is supported by substantial evidence, 

12 the administrative judge shall not mitigate the 

13 penalty prescribed by the Secretary. 

14 ‘‘(3) APPEAL TO MERIT SYSTEMS PROTECTION

15 BOARD.— 

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

17 administrative judge under paragraph (1) may 

18 be appealed to the Merit Systems Protection 

19 Board. 

20 ‘‘(B) UPHOLDING DECISION.—Notwith21 standing section 7701(c)(1)(B) of title 5, 

22 United States Code, the Merit Systems Protec23 tion Board shall uphold the decision of the Sec24 retary to remove, demote, or suspend an emVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 ployee under subsection (a) if the decision is 

2 supported by substantial evidence. 

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

5 other provision of law, if the decision of the 

6 Secretary is supported by substantial evidence, 

7 the Merit Systems Protection Board shall not 

8 mitigate the penalty prescribed by the Sec9 retary. 

10 ‘‘(4) REPORT.—In any case in which the ad11 ministrative judge cannot issue a decision in accord12 ance with the 180-day requirement under paragraph 

13 (1), the Merit Systems Protection Board shall, not 

14 later than 14 business days after the expiration of 

15 the 180-day period, submit to the appropriate com16 mittees of Congress a report that explains the rea17 sons why a decision was not issued in accordance 

18 with such requirement. 

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

20 Protection Board under paragraph (3) may be ap21 pealed to the United States Court of Appeals for the 

22 Federal Circuit pursuant to section 7703 of title 5, 

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

24 competent jurisdiction pursuant to subsection 

25 (b)(1)(B) of such section. 


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

2 Systems Protection Board may not stay any removal 

3 or demotion under this section, except as provided in 

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

5 ‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR6 ING APPEAL.—During the period beginning on the 

7 date on which a covered individual appeals a removal 

8 from the civil service under subsection (c) and end9 ing on the date that the United States Court of Ap10 peals for the Federal Circuit issues a final decision 

11 on such appeal, such covered individual may not re12 ceive any pay, awards, bonuses, incentives, allow13 ances, differentials, student loan repayments, special 

14 payments, or benefits related to the employment of 

15 the individual by the Service. 

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

17 the maximum extent practicable, the Secretary shall 

18 provide to the Merit Systems Protection Board such 

19 information and assistance as may be necessary to 

20 ensure an appeal under this subsection is expedited. 

21 ‘‘(9) BACKPAY.—If an employee prevails on ap22 peal under this section, the employee shall be enti23 tled to backpay (as provided in section 5596 of title 

24 5, United States Code). 


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1 ‘‘(10) APPLICABLE TIMELINES AND PROCE2 DURES.—If an employee who is subject to a collec3 tive bargaining agreement chooses to grieve an ac4 tion taken under this section through a grievance 

5 procedure provided under the collective bargaining 

6 agreement, the timelines and procedures set forth in 

7 subsection (c) and this subsection shall apply. 

8 ‘‘(e) ALLEGED PROHIBITED PERSONNEL PRAC9 TICE.—In the case of a covered individual seeking correc10 tive action (or on behalf of whom corrective action is 

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

12 alleged prohibited personnel practice described in section 

13 2302(b) of title 5, United States Code, the Secretary may 

14 not remove, demote, or suspend such covered individual 

15 under subsection (a) without the approval of the Special 

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

17 Code. 

18 ‘‘(f) TERMINATION OF INVESTIGATIONS BY OFFICE

19 OF SPECIAL COUNSEL.— 

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

21 provision of law, the Special Counsel (established by 

22 section 1211 of title 5, United States Code) may ter23 minate an investigation of a prohibited personnel 

24 practice alleged by an employee or former employee 

25 of the Service after the Special Counsel provides to 


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1 the employee or former employee a written state2 ment of the reasons for the termination of the inves3 tigation. 

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

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

6 in any judicial or administrative proceeding without 

7 the consent of the employee or former employee de8 scribed in paragraph (1). 

9 ‘‘(g) VACANCIES.—In the case of a covered individual 

10 who is removed or demoted under subsection (a), to the 

11 maximum extent feasible, the Secretary shall fill the va12 cancy arising as a result of such removal or demotion. 

13 ‘‘(h) DEFINITIONS.—In this section: 

14 ‘‘(1) COVERED INDIVIDUAL.—The term ‘cov15 ered individual’ means an individual occupying a po16 sition at the Service, but does not include— 

17 ‘‘(A) an individual occupying a senior exec18 utive position (as defined in section 606(d)); 

19 ‘‘(B) an individual who has not completed 

20 a probationary or trial period; or 

21 ‘‘(C) a political appointee. 

22 ‘‘(2) GRADE.—The term ‘grade’ has the mean23 ing given such term in section 7511(a) of title 5, 

24 United States Code. 


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1 ‘‘(3) MISCONDUCT.—The term ‘misconduct’ in2 cludes neglect of duty, malfeasance, or failure to ac3 cept a directed reassignment or to accompany a po4 sition in a transfer of function. 

5 ‘‘(4) POLITICAL APPOINTEE.—The term ‘polit6 ical appointee’ means an individual who is— 

7 ‘‘(A) employed in a position described 

8 under sections 5312 through 5316 of title 5, 

9 United States Code (relating to the Executive 

10 Schedule); 

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

12 emergency appointee, or noncareer appointee in 

13 the Senior Executive Service, as defined under 

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

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

16 or 

17 ‘‘(C) employed in a position of a confiden18 tial or policy-determining character under 

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

20 Code of Federal Regulations, or successor regu21 lation. 

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

23 the Secretary of Health and Human Services, acting 

24 through the Director of the Service. 


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

2 placing of an employee, for disciplinary reasons, in 

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

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

6 title 5, United States Code, is amended— 

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

8 end; 

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

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

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

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

13 607 of the Indian Health Care Improvement Act.’’. 

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

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

16 Human Services or the Inspector General of the Depart17 ment of Health and Human Services shall submit a report 

18 to Congress that includes the following: 

19 (1) The number of employees of the Indian 

20 Health Service who were removed, demoted, or sus21 pended in the 1-year period before the date of enact22 ment of this Act. 

23 (2) The number of employees of the Indian 

24 Health Service who were removed, demoted, or sus25 pended in the 1-year period after the date of enactVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 ment of this Act using the updated authorities pro2 vided in the amendments made by this Act. 

3 (3) The appropriate details of removals, demo4 tions, and suspensions that lend necessary context. 

5 SEC. 107. TRIBAL CULTURE AND HISTORY. 

6 Section 113 of the Indian Health Care Improvement 

7 Act (25 U.S.C. 1616f) is amended— 

8 (1) in subsection (a)— 

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

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

11 (B) by striking ‘‘appropriate employees of 

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

13 Service, locum tenens medical providers, 

14 healthcare volunteers, and other contracted em15 ployees who work at Service hospitals or other 

16 Service units and whose employment requires 

17 regular direct patient access’’; and 

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

19 ‘‘(c) Notwithstanding any other provision of law, be20 ginning with the year of the date of enactment of the Re21 storing Accountability in the Indian Health Service Act 

22 of 2018, each employee or provider described in subsection 

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

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

25 employment, annually participate in and complete such 


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1 training program. For purposes of the preceding sentence, 

2 participation in such training program may not be consid3 ered complete for the year involved until the individual 

4 satisfies each requirement, including testing, if applicable, 

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

6 Secretary.’’. 

7 SEC. 108. STAFFING DEMONSTRATION PROJECT. 

8 Title VIII of the Indian Health Care Improvement 

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

10 the end the following: 

11 ‘‘SEC. 833. STAFFING DEMONSTRATION PROJECT. 

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

13 the Service, shall establish a demonstration project that 

14 authorizes the Service to provide federally managed Serv15 ice units with additional staffing resources with the goal 

16 that the resources become self-sustaining. 

17 ‘‘(b) SELECTION.—In selecting Service units for par18 ticipation, the Secretary shall consider whether a Service 

19 unit services an Indian Tribe that— 

20 ‘‘(1) has utilized or contributed substantial trib21 al funds to construct a health facility used by the 

22 Service or identified in the master plan for the Serv23 ice unit; 

24 ‘‘(2) is located in a State or States with Med25 icaid reimbursements plans or policies that will inVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 crease the likelihood that the staffing resources pro2 vided will be self-sustaining; and 

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

4 paragraph (1) under historical staffing ratios that 

5 have not been equalized or updated by the Service 

6 or any other Service program to reflect current 

7 staffing needs. 

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

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

10 the Secretary, in consultation with the applicable Indian 

11 Tribe, determines appropriate, except that each staffing 

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

13 3 fiscal years. 

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

15 resources provided under this section shall reduce the re16 curring base funding for staffing for any Indian Tribe or 

17 federally managed Service unit. 

18 ‘‘(e) REPORT.—Not later than 5 years after the Sec19 retary ends the demonstration project under this section, 

20 the Secretary shall prepare and submit a report to the 

21 Committee on Indian Affairs and the Committee on 

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

23 and the Committee on Natural Resources and the Com24 mittee on Energy and Commerce of the House of Rep25 resentatives, regarding the project, including— 


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

2 additional revenue for the Service unit sufficient to 

3 maintain the staff on a permanent basis; 

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

5 reduced the unmet staffing need for the Service unit; 

6 and 

7 ‘‘(3) whether the demonstration project could 

8 be deployed to reduce unmet staffing needs through9 out the Service.’’. 

10 SEC. 109. RULE ESTABLISHING TRIBAL CONSULTATION 

11 POLICY. 

12 Title VIII of the Indian Health Care Improvement 

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

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

15 ‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 

16 POLICY. 

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

18 date of enactment of the Restoring Accountability in the 

19 Indian Health Service Act of 2018, the Secretary shall es20 tablish, after meaningful consultation with representatives 

21 of affected Indian Tribes, a rule establishing a tribal con22 sultation policy for the Service. 

23 ‘‘(b) CONTENTS OF TRIBAL CONSULTATION POL24 ICY.—The policy established under the rule described in 

25 subsection (a) shall— 


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

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

3 Service, or any successor policy; and 

4 ‘‘(2) include the following: 

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

6 Service will notify Indian Tribes, and a descrip7 tion of how the Indian Tribes should be noti8 fied. 

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

10 agency decisions by the Service will trigger a re11 quirement for meaningful consultation with In12 dian Tribes. 

13 ‘‘(C) A determination of what actions con14 stitute meaningful consultation with Indian 

15 Tribes.’’. 

16 SEC. 110. TREATMENT OF CERTAIN HOSPITALS. 

17 The ‘‘Parallel Low-Volume Hospital Payment Adjust18 ment Regarding Hospitals Operated by the Indian Health 

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

20 final rule published by the Centers for Medicare & Med21 icaid Services in the Federal Register on August 14, 2017, 

22 and entitled ‘‘Medicare Program; Hospital Inpatient Pro23 spective Payment Systems for Acute Care Hospitals and 

24 the Long-Term Care Hospital Prospective Payment Sys25 tem and Policy Changes and Fiscal Year 2018 Rates; 


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1 Quality Reporting Requirements for Specific Providers; 

2 Medicare and Medicaid Electronic Health Record (EHR) 

3 Incentive Program Requirements for Eligible Hospitals, 

4 Critical Access Hospitals, and Eligible Professionals; Pro5 vider-Based Status of Indian Health Service and Tribal 

6 Facilities and Organizations; Costs Reporting and Pro7 vider Requirements; Agreement Termination Notices’’ (82 

8 Fed Reg. 37990; 38188–38189), shall apply with respect 

9 to discharges occurring in fiscal year 2011 and subsequent 

10 fiscal years. 

11 TITLE II—EMPLOYEE 

12 PROTECTIONS 

13 SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIA14 TION. 

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

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

17 amended by sections 105 and 106, is further amended by 

18 adding at the end the following: 

19 ‘‘SEC. 608. EMPLOYEE PROTECTIONS AGAINST RETALIA20 TION. 

21 ‘‘(a) EMPLOYEE ACCOUNTABILITY.— 

22 ‘‘(1) AGENCY REPORTING PROCESS REQUIRE23 MENT.—The Secretary shall designate an official in 

24 the Department who is not an employee of the Serv25 ice to— 


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1 ‘‘(A) receive reports from an employee of 

2 the Service who witnesses retaliation against a 

3 whistleblower, a violation of a patient safety re4 quirement, or other similar conduct; and 

5 ‘‘(B) conduct active and ongoing outreach 

6 to all employees of the Service about— 

7 ‘‘(i) Federal and Department systems 

8 for reporting retaliation against whistle9 blowers; and 

10 ‘‘(ii) the duty of individual employees 

11 of the Service to report violations of pa12 tient safety requirements and other similar 

13 conduct. 

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

15 the date on which the official designated by the Sec16 retary under paragraph (1) receives a report under 

17 paragraph (1)(A), the Secretary shall— 

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

19 ‘‘(B) provide a copy of such report and any 

20 other relevant information to the Inspector 

21 General of the Department. 

22 ‘‘(3) REMOVAL FOR WHISTLEBLOWER RETALIA23 TION.—The Secretary may remove for misconduct 

24 from the civil service (as defined in section 2101 of 

25 title 5, United States Code), in accordance with secVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 tions 606 and 607, an employee of the Service if the 

2 Secretary determines, after completing a report re3 view described in paragraph (2), that the employee 

4 has retaliated against a whistleblower and warrants 

5 removal. 

6 ‘‘(4) ENHANCING PROTECTIONS FOR WHISTLE7 BLOWERS.—The Secretary shall carry out any ac8 tions determined necessary by the Secretary to en9 hance protection for whistleblowers, including identi10 fying appropriate Service employees and requiring 

11 the employees to complete the Office of Special 

12 Counsel’s Whistleblower Certification Program. 

13 ‘‘(b) DEFINITIONS.—In this section: 

14 ‘‘(1) RETALIATION.—The term ‘retaliation’— 

15 ‘‘(A) means an adverse employment action 

16 or any significantly adverse action against a 

17 whistleblower, such as the refusal or delay of 

18 care provided through the Service; and 

19 ‘‘(B) includes instances where the adverse 

20 action described in subparagraph (A) is per21 petrated against a family member or friend of 

22 the whistleblower because of the whistleblower’s 

23 disclosure of information. 


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1 ‘‘(2) WHISTLEBLOWER.—The term ‘whistle2 blower’ means an employee of Service who discloses 

3 information— 

4 ‘‘(A) that the employee reasonably believes 

5 evidences— 

6 ‘‘(i) a violation of any law, rule, or 

7 regulation; or 

8 ‘‘(ii) gross mismanagement, a gross 

9 waste of funds, an abuse of authority, or 

10 a substantial and specific danger to public 

11 health or safety; and 

12 ‘‘(B) if such disclosure is not specifically 

13 prohibited by law and if such information is not 

14 specifically required by Executive Order to be 

15 kept secret in the interest of national defense or 

16 the conduct of foreign affairs.’’. 

17 SEC. 202. RIGHT OF FEDERAL EMPLOYEES TO PETITION 

18 CONGRESS. 

19 (a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO

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

21 States Code, is amended— 

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

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

24 (2) by adding at the end the following new sub25 section: 


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

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

3 be subject to any adverse action described in paragraphs 

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

5 procedure described in section 7513 and any other appli6 cable procedure.’’. 

7 (b) ELECTRONIC NOTIFICATION OF RIGHT OF EM8 PLOYEES OF INDIAN HEALTH SERVICE.— 

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

10 Human Services (referred to in this subsection as 

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

12 Indian Health Service, shall, in accordance with 

13 paragraphs (2) through (6), provide to each em14 ployee of the Indian Health Service, and electroni15 cally post, a memorandum providing notice of the 

16 right to petition Congress under section 7211 of title 

17 5, United States Code. 

18 (2) CONTENTS.—The memorandum described 

19 in paragraph (1) shall include the following state20 ment: ‘‘It is a violation of section 7211 of title 5, 

21 United States Code, for any Federal agency or em22 ployee to require a Federal employee to seek ap23 proval, guidance, or any other form of input prior to 

24 contacting Congress with information, even if that 

25 information is in relation to the job responsibilities 


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1 of the employee. A Federal employee found to have 

2 interfered with or denied the right of another Fed3 eral employee under such section shall be subject to 

4 an adverse action described in paragraphs (1) 

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

6 Code, including a suspension for more than 14 days 

7 without pay.’’. 

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

9 the date of enactment of this Act, the Secretary 

10 shall submit the memorandum described in para11 graph (1) to the Inspector General of the Depart12 ment of Health and Human Services (referred to in 

13 this subsection as the ‘‘Inspector General’’) for ap14 proval. 

15 (4) APPROVAL OR DISAPPROVAL.—Not later 

16 than 30 days after the submission of the memo17 randum under paragraph (3), or a revised memo18 randum under paragraph (6), the Inspector General 

19 shall approve or disapprove the memorandum or re20 vised memorandum, as the case may be. 

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

22 paragraph (4), not later than 30 days after such ap23 proval, the Secretary shall— 


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1 (A) provide to each employee of the Indian 

2 Health Service an electronic copy of the ap3 proved memorandum; and 

4 (B) post such memorandum in a clear and 

5 conspicuous place on the website of the Indian 

6 Health Service for a period not less than 120 

7 days. 

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

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

10 days after such disapproval, the Secretary shall sub11 mit a revised memorandum to the Inspector General 

12 for approval under 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 sections 105, 

16 106, and 201, is further amended by adding at the end 

17 the following: 

18 ‘‘SEC. 609. FISCAL ACCOUNTABILITY. 

19 ‘‘(a) MANAGEMENT OF FUNDS.— 

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

21 submit the professional housing plan under section 

22 301(a) of the Restoring Accountability in the Indian 

23 Health Service Act of 2018 or the staffing plan 

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

25 not receive, obligate, transfer, or expend any 


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1 amounts for a salary increase or bonus of an indi2 vidual described in paragraph (2) until the profes3 sional housing plan or staffing plan, as the case may 

4 be, is submitted. 

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

6 described in this paragraph is an individual em7 ployed in a position in the Service that is a posi8 tion— 

9 ‘‘(A) described under sections 5312 

10 through 5316 of title 5, United States Code; 

11 ‘‘(B) placed in level IV or V of the Execu12 tive Schedule under section 5317 of title 5, 

13 United States Code; 

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

15 emergency appointee, or noncareer appointee in 

16 the Senior Executive Service, as defined under 

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

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

19 or 

20 ‘‘(D) under section 213.3301 or 213.3302 

21 of title 5, Code of Federal Regulations. 

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

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

24 provision of law, the Secretary shall use amounts 

25 available to the Indian Health Service that are not 


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1 obligated or expended, including base budget fund2 ing and third party collections, during the fiscal year 

3 for which the amounts are made available, and that 

4 remain available, only to support patient care by 

5 using such funds for the costs of— 

6 ‘‘(A) essential medical equipment; 

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

8 ‘‘(C) staffing. 

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

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

11 any case where the amounts were originally made 

12 available for a particular Service unit, such amounts 

13 are used to benefit Indians served by that Service 

14 unit. 

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

16 use amounts described in paragraph (1)— 

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

18 Area office; or 

19 ‘‘(B) to increase the rate of pay of any em20 ployee of an Area office. 

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

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

23 shall submit a report describing the authorizations, ex24 penditures, outlays, transfers, reprogramming, and obliga25 tions of each level of the Service, including the headVerDate Sep 11 2014 21:35 Dec 28, 2018 Jkt 089200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H5874.RH H5874

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1 quarters, each Area office, each Service unit, and each 

2 health clinic or facility, to— 

3 ‘‘(1) each Indian Tribe; 

4 ‘‘(2) in the Senate— 

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

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

7 Labor, and Pensions; 

8 ‘‘(C) the Committee on Appropriations; 

9 and 

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

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

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

13 ‘‘(B) the Committee on Energy and Com14 merce; 

15 ‘‘(C) the Committee on Appropriations; 

16 and 

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

18 ‘‘(d) STATUS REPORTS.— 

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

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

21 year, the Secretary shall provide to each entity de22 scribed in paragraphs (1) through (3) of subsection 

23 (c) a report describing the safety, billing, certifi24 cation, credential, and compliance statuses of each 


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1 facility managed, operated, or otherwise supported 

2 by the Service. 

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

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

5 shall immediately provide to each entity described in 

6 paragraphs (1) through (3) of subsection (c) an up7 date describing such change. 

8 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec9 tion may be construed— 

10 ‘‘(1) to negatively impact the right of an Indian 

11 Tribe to enter into a compact or contract under the 

12 Indian Self-Determination and Education Assistance 

13 Act (25 U.S.C. 5304 et seq.); and 

14 ‘‘(2) to apply to such a compact or contract un15 less expressly agreed to by the Indian Tribe.’’. 

16 TITLE III—REPORTS 

17 SEC. 301. DEFINITIONS. 

18 In this title: 

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

20 the Secretary of Health and Human Services. 

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

22 Indian Health Service. 

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

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


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

2 1603). 

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

4 HUMAN SERVICES. 

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

6 than 1 year after the date the Government Accountability 

7 Office releases their ongoing report about Indian Health 

8 Service housing needs, the Secretary shall develop, make 

9 publicly available, and submit to Congress and the Comp10 troller General of the United States a written plan to ad11 dress the professional housing needs of employees of the 

12 Service that comports with the practices and recommenda13 tions of the Government Accountability Office relating to 

14 professional housing. 

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

16 Not later than 1 year after the date the Government Ac17 countability Office releases their ongoing report about In18 dian Health Service housing needs, the Secretary shall de19 velop, make publicly available, and submit to Congress and 

20 the Comptroller General of the United States a written 

21 plan to address staffing needs in the Service that comports 

22 with the practices of the Government Accountability Office 

23 relating to workforce planning. 

24 (c) INDIAN HEALTH CARE IMPROVEMENT ACT RE25 PORT.—Not later than 1 year after the date of enactment 


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

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

3 and submit to Congress a report on the data submitted 

4 under section 412(b) of the Indian Health Care Improve5 ment Act, as amended by section 107. 

6 (d) QUALITY OF CARE AND STAFFING REPORT.— 

7 Not later than 1 year after the date of enactment of this 

8 Act, and each year thereafter, the Secretary shall develop 

9 and submit to Congress a report on the data obtained 

10 under section 108, with an emphasis on quality of care 

11 and access to care. 

12 SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 

13 (a) IHS HOUSING NEEDS REPORT.— 

14 (1) IN GENERAL.—Not later than 5 years after 

15 the date on which the Comptroller General of the 

16 United States receives the professional housing plan 

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

18 develop and submit to Congress a report. 

19 (2) CONTENTS.—The report required under 

20 paragraph (1) shall include the following: 

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

22 date of the report, assessments and projections 

23 for the professional housing needs of employees 

24 of the Service, including discussion and conclu25 sion as to whether existing assessments and 


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1 projections accurately reflect the professional 

2 housing needs of employees of the Service. 

3 (B) An assessment of the professional 

4 housing needs of employees of the Service for 

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

6 Indian Health Care Improvement Act (25 

7 U.S.C. 1603)). 

8 (C) An assessment of the professional 

9 housing plan developed by the Secretary under 

10 section 302(a). 

11 (b) IHS STAFFING NEEDS REPORT.— 

12 (1) IN GENERAL.—Not later than 5 years after 

13 the date on which the Comptroller General receives 

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

15 General shall prepare and submit to Congress a re16 port on the staffing needs of the Service. 

17 (2) CONTENTS.—The report required under 

18 paragraph (1) shall include the following: 

19 (A) A description of the number and type 

20 of full-time positions needed at each facility of 

21 the Service and the amount of funds necessary 

22 to maintain such positions. 

23 (B) An explanation of the various meth24 odologies that the Service utilizes and has pre25 viously utilized to determine the number and 


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1 type of full-time positions needed at federally 

2 managed Service units. 

3 (C) An assessment of the use of inde4 pendent contractors, including the number of 

5 independent contractors hired to fill vacant full6 time positions and amounts spent on inde7 pendent contractors who provide health care 

8 services. 

9 (D) An assessment of the staffing plan de10 veloped by the Secretary under section 302(b). 

11 (c) WHISTLEBLOWER PROTECTIONS REPORT.— 

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

13 the date of enactment of this Act, the Comptroller 

14 General shall develop and submit to Congress a re15 port on the efficacy of existing protections for whis16 tleblowers in the Service. 

17 (2) CONTENTS.—The report required under 

18 paragraph (1) shall include the following: 

19 (A) A discussion and conclusion as to 

20 whether the Service has taken proper steps to 

21 prevent retaliation against whistleblowers. 

22 (B) If applicable, any recommendations for 

23 changes to the policy of the Service with respect 

24 to whistleblowers. 


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1 (C) A discussion and conclusion as to 

2 whether the official email accounts of employees 

3 of the Service are appropriately monitored. 

4 SEC. 304. INSPECTOR GENERAL REPORTS. 

5 (a) PATIENT CARE REPORTS.— 

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

7 the date of enactment of this Act, and not less than 

8 every 3 years thereafter, the Inspector General of 

9 the Department of Health and Human Services shall 

10 develop and submit to Congress and the Service a 

11 report on patient harm events occurring in Service 

12 units and deferrals and denials of care of patients of 

13 the Service. 

14 (2) CONTENTS.—The report required under 

15 paragraph (1) shall include the following: 

16 (A) An evaluation of the number and kind 

17 of events that contribute to patient deaths in a 

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

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

21 and reporting of, and response to, patient harm 

22 events and recommendations regarding how to 

23 improve such tracking, reporting, and response. 

24 (C) The effects of deferrals and denials of 

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1 tient outcomes, and recommendations regarding 

2 how to reduce deferrals and denials of care. 

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

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

5 General shall— 

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

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

8 (2) provide to the Service recommendations and 

9 technical assistance regarding implementation of im10 proved reporting systems, procedures, standards, 

11 and protocols. 

12 SEC. 305. TRANSPARENCY IN CMS SURVEYS. 

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

14 1395qq) is amended by adding at the end the following: 

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

16 the Administrator of the Centers for Medicare & Medicaid 

17 Services shall conduct surveys of participating Indian 

18 Health Service facilities to assess the compliance of each 

19 hospital or skilled nursing facility of the Indian Health 

20 Service with— 

21 ‘‘(A) section 1867; and 

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

23 under this title. 

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

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


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1 Medicare & Medicaid Services. Such posting shall comply 

2 with the Federal regulations concerning the privacy of in3 dividually identifiable health information promulgated 

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

5 and Accountability Act of 1996.’’. 

6 TITLE IV—TECHNICAL 

7 AMENDMENTS 

8 SEC. 401. TECHNICAL AMENDMENTS. 

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

10 1601 et seq.) is amended— 

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

12 place such term appears (regardless of casing and 

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

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

17 place such term appears (regardless of casing and 

18 typeface and including in the headings) and insert19 ing ‘‘purchased/referred care’’ (with appropriate cas20 ing and typeface). 


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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 

prove health services, and for other purposes. accountability in the Indian Health Service, imemployees in the Indian Health Service, restore Act to improve the recruitment and retention of 

DECEMBER 28, 2018 

Committees on Energy and Commerce, Ways and Means, 

the State of the Union and ordered to be printed committed to the Committee of the Whole House on and Oversight and Government Reform discharged; 


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