I 
117TH CONGRESS 
2D SESSION 
H. R. 8937 
To amend the Indian Health Care Improvement Act to improve the recruit-
ment 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 
SEPTEMBER 21, 2022 
Mr. JOHNSON of South Dakota introduced the following bill; which was re-
ferred to the Committee on Natural Resources, and in addition to the 
Committees on Energy and Commerce, Ways and Means, and Oversight 
and Reform, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend the Indian Health Care Improvement Act to im-
prove the recruitment and retention of employees in the 
Indian Health Service, restore accountability in the In-
dian Health Service, improve health services, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Restoring Account-
ability in the Indian Health Service Act of 2022’’. 
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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 re-
payment program. 
Sec. 105. Improvements in hiring practices. 
Sec. 106. Improved authorities of secretary to improve accountability of senior 
executives and employees of the Indian Health Service. 
Sec. 107. Tribal culture and history. 
Sec. 108. Staffing demonstration program. 
Sec. 109. Rule establishing Tribal consultation policy. 
Sec. 110. Treatment of certain hospitals. 
Sec. 111. Enhancing quality of care in the Indian Health Service. 
Sec. 112. Notification of investigation regarding professional conduct; submis-
sion of records. 
Sec. 113. Medical chaperones; Office of Patient Advocacy. 
Sec. 114. Fitness of health care providers. 
Sec. 115. Standards to improve timeliness of care. 
TITLE II—EMPLOYEE PROTECTIONS 
Sec. 201. Employee protections against retaliation. 
Sec. 202. Right of Federal employees to petition Congress. 
Sec. 203. Fiscal accountability. 
TITLE III—REPORTS 
Sec. 301. Definitions. 
Sec. 302. Reports by the Secretary of Health and Human Services. 
Sec. 303. Reports by the Comptroller General. 
Sec. 304. Inspector General reports. 
Sec. 305. Transparency in CMS surveys. 
TITLE IV—TECHNICAL AMENDMENTS 
Sec. 401. Technical amendments. 
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TITLE I—INDIAN HEALTH 
SERVICE IMPROVEMENTS 
SEC. 101. INCENTIVES FOR RECRUITMENT AND RETEN-
TION. 
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 RETEN-
TION. 
‘‘(a) PARITY IN IHS HEALTH CARE WORKFORCE 
PERSONNEL AND PAY SYSTEM.—The Secretary shall es-
tablish a personnel and pay system for physicians, den-
tists, 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 sub-
chapters III and IV of chapter 74 of title 38, United 
States Code. 
‘‘(b) 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 2022, the Secretary may establish a 
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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 Admin-
istrator of the Health Resources and Services 
Administration as a health professional short-
age 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 the 
program is established. 
‘‘(3) REPORTS.—Not later than 1 year after the 
date on which a program established under para-
graph (1) is terminated in accordance with para-
graph (2), the Secretary shall submit to Congress a 
report describing, with respect to that program— 
‘‘(A) the costs of the program; 
‘‘(B) employee uptake of the program; and 
‘‘(C) the effects of the program on local fa-
cility staffing needs. 
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‘‘(c) ADMINISTRATION.—The Secretary may only 
provide a benefit under subsection (b) to— 
‘‘(1) 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 
‘‘(2) 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 
amended by adding at the end the following: 
‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 
‘‘(a) IN GENERAL.— 
‘‘(1) DEVELOPMENT
AND
IMPLEMENTATION 
TIMELINE.—Not later than 1 year after the date of 
enactment of the Restoring Accountability in the In-
dian Health Service Act of 2022, the Secretary, act-
ing through the Service (referred to in this section 
as the ‘Secretary’), in accordance with subsection 
(b), shall develop and implement a Service-wide cen-
tralized credentialing system (referred to in this sec-
tion as the ‘credentialing system’) to credential li-
censed health professionals who seek to provide 
health care services at any Service unit. 
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‘‘(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 Ac-
countability in the Indian Health Service Act of 
2022; and 
‘‘(B) shall— 
‘‘(i) use the credentialing system 
for— 
‘‘(I) 
all 
applications 
for 
credentialing or re-credentialing of li-
censed health professionals submitted 
on or after the date of enactment of 
the Restoring Accountability in the 
Indian Health Service Act of 2022; 
and 
‘‘(II) the migration into the 
credentialing system of credentials 
data that existed prior to implementa-
tion of the credentialing system; and 
‘‘(ii) maintain the established timeline 
for re-credentialing of licensed health pro-
fessionals who were credentialed prior to 
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implementation of the credentialing sys-
tem, as defined by Service policy. 
‘‘(b) REQUIREMENTS.— 
‘‘(1) 
IN
GENERAL.—In 
developing 
the 
credentialing system under subsection (a), the Sec-
retary shall ensure that— 
‘‘(A) credentialing procedures shall be uni-
form throughout the Service; and 
‘‘(B) with respect to each licensed health 
professional who successfully completes the 
credentialing procedures of the credentialing 
system, the Secretary may authorize the li-
censed health professional to provide health 
care services at any Service unit. 
‘‘(2) EXEMPTION.—The requirements described 
in paragraph (1) shall not apply to licensed health 
professionals who were credentialed using existing 
Service policy prior to the date of enactment of the 
Restoring Accountability in the Indian Health Serv-
ice Act of 2022 until the date on which those li-
censed health professionals are required to be re- 
credentialed in accordance with the credentialing 
system developed and implemented under subsection 
(a). 
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‘‘(c) 
CONSULTATION.—In 
developing 
the 
credentialing system under subsection (a), the Secretary— 
‘‘(1) shall consult with Indian tribes; and 
‘‘(2) may consult with— 
‘‘(A) any public or private association of 
medical providers; 
‘‘(B) any government agency; or 
‘‘(C) any other relevant expert, as deter-
mined by the Secretary. 
‘‘(d) APPLICATION.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
licensed health care professional may not provide 
health care services at any Service unit, unless the 
licensed health care professional successfully com-
pletes 
the 
credentialing 
procedures 
of 
the 
credentialing system developed and implemented 
under subsection (a). 
‘‘(2) EXEMPTION.—Paragraph (1) shall not 
apply to 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 2022 until the date 
on which those licensed health professionals are re-
quired to be re-credentialed in accordance with the 
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credentialing system developed and implemented 
under subsection (a). 
‘‘(e) NONDUPLICATION OF EFFORTS.— 
‘‘(1) IN GENERAL.—To the extent that prior to 
the deadline described in subsection (a)(1), the Serv-
ice has begun implementing or has completed imple-
mentation of a medical credentialing system that 
otherwise meets the requirements of this section, the 
Service shall not be required to establish a new 
credentialing system under this section. 
‘‘(2) AUTHORITY.—The Service may expand or 
enhance an existing credentialing system to meet the 
requirements of this section. 
‘‘(3) REVIEW.— 
‘‘(A) IN
GENERAL.—Not less frequently 
than once every 5 years, the Service shall— 
‘‘(i) undertake a formal review of the 
credentialing system in effect on the date 
of the review; and 
‘‘(ii) if necessary, take action to bring 
the credentialing system into compliance 
with the requirements of this section. 
‘‘(B) CONSULTATION.—Each formal review 
conducted under subparagraph (A) shall be sub-
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ject to the consultation requirements under sub-
section (c). 
‘‘(f) EFFECT.—Nothing in this section— 
‘‘(1) negatively impacts 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. 5301 et seq.); or 
‘‘(2) applies to such a compact or contract un-
less expressly agreed to by the Indian tribe.’’. 
SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFES-
SIONAL 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 fol-
lowing: 
‘‘(r) CERTAIN INDIAN HEALTH SERVICE VOLUN-
TEERS DEEMED PUBLIC HEALTH SERVICE EMPLOY-
EES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, a health professional volunteer at a Service 
unit shall, in providing a health service to an indi-
vidual, be deemed to be an employee of the Public 
Health Service for a calendar year that begins dur-
ing a fiscal year for which a transfer was made 
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under paragraph (4)(C). The preceding sentence is 
subject to the provisions of this subsection. 
‘‘(2) CONDITIONS.—In providing a health serv-
ice 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 indi-
vidual 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 re-
ceive repayment from the Service unit for rea-
sonable expenses incurred by the health care 
practitioner in the provision of the service to 
the individual. 
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‘‘(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 prac-
titioner 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 a health care practitioner at a 
Service unit for purposes of this subsection to the 
same extent and in the same manner as such sub-
sections apply to an officer, governing board mem-
ber, employee, or contractor of an entity described in 
subsection (g)(4), subject to paragraph (4) and sub-
ject to the following subparagraphs: 
‘‘(A) Each reference to an entity in sub-
sections (g), (h), (i), and (l) shall be considered 
to be a reference to a Service unit. 
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‘‘(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 profes-
sional volunteer at the Service unit unless the 
Service unit sponsors the health care practi-
tioner. For purposes of this subsection, the 
Service unit shall be considered to be spon-
soring 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 sub-
section (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 practi-
tioner who is determined by the Secretary pur-
suant 
to 
this 
subsection 
and 
subsection 
(g)(1)(E) to be a health professional volunteer, 
this subsection applies to the health care practi-
tioner (with respect to services performed on 
behalf of the Service unit sponsoring the health 
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care practitioner pursuant to subparagraph (C)) 
for any cause of action arising from an act or 
omission of the health care practitioner occur-
ring 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 con-
ditions 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 Sec-
retary, shall submit to Congress a report 
providing an estimate of the amount of 
claims (together with related fees and ex-
penses of witnesses) that, by reason of the 
acts or omissions of health professional 
volunteers, will be paid pursuant to this 
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section during the calendar year that be-
gins in the following fiscal year. 
‘‘(ii) 
APPLICABILITY.—Subsection 
(k)(1)(B) applies to the estimate under 
clause (i) relating to 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, em-
ployees, and contractors of entities de-
scribed in subsection (g)(4). 
‘‘(C) TRANSFERS.—Not later than Decem-
ber 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 sub-
paragraph (B) for the calendar year beginning 
in that fiscal year, subject to the extent of 
amounts in the fund. 
‘‘(5) DEFINITION OF SERVICE UNIT.— 
‘‘(A) IN GENERAL.—In this subsection, the 
term ‘Service unit’ has the meaning given the 
term in section 4 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603). 
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‘‘(B) INCLUSION.—In this subsection, the 
term ‘Service unit’ includes an urban Indian or-
ganization with which the Indian Health Serv-
ice has entered into a contract with, or to which 
the Indian Health Service has made a grant, 
under title V of the Indian Health Care Im-
provement Act (25 U.S.C. 1651 et seq.). 
‘‘(6) EFFECT.—Nothing in this subsection— 
‘‘(A) negatively impacts the right of an In-
dian tribe to enter into a compact or contract 
under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304 et seq.); 
or 
‘‘(B) applies 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 ef-
fect on October 1, 2022. 
‘‘(B) REGULATIONS, APPLICATIONS, AND 
REPORTS.—Effective on the date of the enact-
ment of the Restoring Accountability in the In-
dian Health Service Act of 2022, the Secretary 
may— 
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‘‘(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 IN-
DIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
Section 108 of the Indian Health Care Improvement 
Act (25 U.S.C. 1616a) is amended— 
(1) in subsection (b)(1), by striking subpara-
graph (B) and inserting the following: 
‘‘(B) have— 
‘‘(i)(I) a degree in a health profession; and 
‘‘(II) a license to practice a health profes-
sion in a State; or 
‘‘(ii)(I) a master’s degree in business ad-
ministration 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 pub-
lic health in a State, if the Secretary deter-
mines the license or certification is necessary 
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for the Indian health program to which the in-
dividual will be assigned;’’; 
(2) in subsection (f)(1)(B), by striking clause 
(iii) and inserting the following: 
‘‘(iii) to serve for a time period (re-
ferred to in this section as the ‘period of 
obligated service’) equal to— 
‘‘(I) 2 years or such longer pe-
riod as the individual may agree to 
serve in the full-time practice of the 
individual’s profession in an Indian 
health program to which the indi-
vidual may be assigned by the Sec-
retary; or 
‘‘(II) 4 years or such longer pe-
riod as the individual may agree to 
serve in the half-time practice of the 
individual’s profession in an Indian 
health program to which the indi-
vidual may be assigned by the Sec-
retary;’’; and 
(3) in subsection (g)(2)— 
(A) in subparagraph (B), by striking ‘‘(B) 
Any arrangement’’ and inserting the following: 
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‘‘(C) DEADLINE FOR REPAYMENTS.—Any 
arrangement’’; 
(B) subparagraph (A), in the second sen-
tence of the matter preceding clause (i), by 
striking ‘‘In making a determination’’ and in-
serting the following: 
‘‘(B) DETERMINATION
OF
AMOUNT
OF 
PAYMENT.—In making a determination under 
this paragraph’’; and 
(C) by striking ‘‘(2)(A) For each year’’ 
and all that follows through ‘‘paragraph (1).’’ 
and inserting the following: 
‘‘(2) AUTHORIZED PAYMENTS.— 
‘‘(A) AMOUNT OF PAYMENT.— 
‘‘(i) FULL-TIME
PRACTICE.—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 
the 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 Serv-
ice Act (42 U.S.C. 254l–1(g)(2)(A))) on 
behalf of the individual for loans described 
in paragraph (1). 
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‘‘(ii) HALF-TIME.—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 ob-
ligated service, the Secretary may pay up 
to $17,500 on behalf of the individual for 
loans described in paragraph (1).’’. 
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 amend-
ed 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 that title), a candidate directly to a position with-
in the Service for which the candidate meets the qualifica-
tions standard established by the Office of Personnel Man-
agement. 
‘‘(b) TRIBAL NOTIFICATION.— 
‘‘(1) IN GENERAL.—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 
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located within the defined geographic area of the 
Area office or Service unit, as applicable, of the con-
tent of an inclusion in an employment record. 
‘‘(2) COMMENT
PERIOD.—Each Indian tribe 
that receives notification under paragraph (1) may 
submit to the Secretary comments during the 10-day 
period after the date of notification.’’. 
(b) IHS WAIVERS.—Section 2(c) of Public Law 96– 
135 (25 U.S.C. 5117(c)) is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘(2) The provisions’’ and 
inserting the following: 
‘‘(2) APPLICATION TO CERTAIN INDIVIDUALS.— 
The provisions’’; 
(B) by inserting ‘‘or (3)’’ after ‘‘paragraph 
(1)’’; and 
(C) by striking ‘‘section 1131(f) of the 
Education Amendments of 1978 (25 U.S.C. 
2011(f); 92 Stat. 2324)’’ and inserting ‘‘section 
1132(f) of the Education Amendments of 1978 
(25 U.S.C. 2012(f))’’; 
(2) by striking ‘‘(c)(1) Notwithstanding’’ and 
inserting the following: 
‘‘(c) WAIVER OF APPLICABILITY IN PERSONNEL AC-
TIONS.— 
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‘‘(1) IN GENERAL.—Notwithstanding’’; and 
(3) by adding at the end the following: 
‘‘(3) IHS WAIVERS.— 
‘‘(A) IN GENERAL.—At the request of a 
concerned Indian tribe, the Secretary of Health 
and Human Services may seek from each In-
dian tribe concerned a waiver of Indian pref-
erence laws for a personnel action that is with 
respect to— 
‘‘(i) a Service unit (as defined in sec-
tion 4 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1603)) in which— 
‘‘(I) 15 percent or greater of the 
total positions are not filled by a full- 
time employee of the Indian Health 
Service for a period of 6 months or 
longer; or 
‘‘(II) 15 percent or greater of a 
specific health professional position 
are not filled by a full-time employee 
of the Indian Health Service for a pe-
riod of 6 months or longer; or 
‘‘(ii) a former employee of the Indian 
Health Service, or a former Tribal em-
ployee, who was removed from the employ-
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ment during, or demoted for performance 
or misconduct that occurred during, the 5- 
year period following the date of the per-
sonnel action. 
‘‘(B) LIMITATION.—A waiver may only be 
requested under subparagraph (A) for a per-
sonnel action that is with respect to an em-
ployee described in clause (ii) of that subpara-
graph if the reason for the removal or demotion 
of the employee did not result from an action 
undertaken by the employee that was reported 
to the National Practitioner Data Bank. 
‘‘(C) RESTRICTION.—The Secretary of 
Health and Human Services may only approve 
a waiver under subparagraph (A) if the waiver 
is first requested by a concerned Indian tribe.’’. 
SEC. 106. IMPROVED AUTHORITIES OF SECRETARY TO IM-
PROVE ACCOUNTABILITY OF SENIOR EXECU-
TIVES 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 amended by adding at the end 
the following: 
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‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM-
PROVE ACCOUNTABILITY OF SENIOR EXECU-
TIVES OF THE INDIAN HEALTH SERVICE. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) COVERED
INDIVIDUAL.—The term ‘cov-
ered individual’ means a career appointee (as de-
fined in section 3132(a) of title 5, United States 
Code). 
‘‘(2) MISCONDUCT.—The term ‘misconduct’ in-
cludes— 
‘‘(A) neglect of duty; 
‘‘(B) malfeasance; 
‘‘(C) failure to accept a directed reassign-
ment; and 
‘‘(D) failure to accompany a position in a 
transfer of function. 
‘‘(3) SECRETARY.—The term ‘Secretary’ means 
the Secretary, acting through the Service. 
‘‘(4) SENIOR EXECUTIVE POSITION.—The term 
‘senior executive position’ means a Senior Executive 
Service position (as defined in section 3132(a) of 
title 5, United States Code). 
‘‘(b) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may, in ac-
cordance with this section, reprimand, suspend, in-
voluntarily reassign, demote, or remove a covered in-
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dividual from a senior executive position at the Serv-
ice if the Secretary determines that the misconduct 
or performance of the covered individual warrants 
such an action. 
‘‘(2) REMOVAL FROM CIVIL SERVICE.—If the 
Secretary removes a covered individual pursuant to 
paragraph (1), the Secretary may remove the indi-
vidual from the civil service (as defined in section 
2101 of title 5, United States Code). 
‘‘(c) RIGHTS AND PROCEDURES.— 
‘‘(1) IN GENERAL.—A covered individual who is 
the subject of an action or removal, as applicable, 
under subsection (b) is entitled— 
‘‘(A) to advance notice of the action or re-
moval; 
‘‘(B) to access a file containing all evidence 
in support of the proposed action or removal; 
‘‘(C) to be represented by an attorney or 
other representative of the covered individual’s 
choice; and 
‘‘(D) to grieve the decision on the action or 
removal under paragraph (2) in accordance 
with the internal grievance process established 
by the Secretary under paragraph (3). 
‘‘(2) NOTICE; RESPONSE; DECISION.— 
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‘‘(A) IN GENERAL.—The aggregate period 
for notice, response, and decision on an action 
or removal under subsection (b) may not exceed 
15 business days. 
‘‘(B) RESPONSE.—A covered individual re-
ceiving a notice under paragraph (1)(A) of an 
action or removal, as applicable, under sub-
section (b) shall have not more than 7 business 
days to respond to the notice. 
‘‘(C) DECISION.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall issue a decision on an action or re-
moval, as applicable, under subsection (b) 
not later than 15 business days after the 
date on which notice of the action or re-
moval, as applicable, is received by the ap-
plicable covered individual under para-
graph (1)(A). 
‘‘(ii) 
REQUIREMENTS.—A 
decision 
under clause (i)— 
‘‘(I) shall be in writing; and 
‘‘(II) shall include the specific 
reasons for the decision. 
‘‘(D) FINAL AND CONCLUSIVE DECISION.— 
A decision under this paragraph that is not 
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grieved under paragraph (3) by the deadline de-
scribed in that paragraph shall be final and 
conclusive. 
‘‘(3) GRIEVANCE PROCESS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish an internal grievance process under 
which a covered individual may grieve a deci-
sion issued under paragraph (2) not later than 
the date that is 7 business days after the date 
on which the decision under that paragraph was 
issued. 
‘‘(B) TOTAL PERIOD.—The Secretary shall 
issue a decision for which an internal grievance 
process is initiated under subparagraph (A) not 
later than 21 business days after the date on 
which the grievance process is initiated by the 
covered individual. 
‘‘(C) FINAL AND CONCLUSIVE DECISION.— 
A grievance decision under this paragraph shall 
be final and conclusive. 
‘‘(4) 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 the de-
cision. 
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‘‘(5) COURT REVIEW.—In any case in which ju-
dicial review is sought under paragraph (4), the 
court shall review the record and may set aside any 
action of the Department or the Service found to 
be— 
‘‘(A) arbitrary, capricious, an abuse of dis-
cretion, 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. 
‘‘(d) RELATION TO OTHER PROVISIONS OF LAW.— 
Section 3592(b)(1) of title 5, United States Code, shall 
not apply to an action under subsection (b). 
‘‘SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IM-
PROVE ACCOUNTABILITY OF EMPLOYEES OF 
THE INDIAN HEALTH SERVICE. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) COVERED INDIVIDUAL.— 
‘‘(A) IN GENERAL.—The term ‘covered in-
dividual’ means an individual occupying a posi-
tion at the Service. 
‘‘(B) EXCLUSIONS.—The term ‘covered in-
dividual’ does not include— 
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‘‘(i) an individual occupying a senior 
executive position (as defined in section 
606(a)); 
‘‘(ii) an individual who has not com-
pleted a probationary or trial period; or 
‘‘(iii) a political appointee. 
‘‘(2) GRADE.—The term ‘grade’ has the mean-
ing given the term in section 7511(a) of title 5, 
United States Code. 
‘‘(3) MISCONDUCT.—The term ‘misconduct’ in-
cludes— 
‘‘(A) neglect of duty; 
‘‘(B) malfeasance; 
‘‘(C) failure to accept a directed reassign-
ment; and 
‘‘(D) failure to accompany a position in a 
transfer of function. 
‘‘(4) POLITICAL APPOINTEE.—The term ‘polit-
ical appointee’ means an individual who is— 
‘‘(A) employed in a position described in 
any of 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 
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(as those terms are defined in section 3132(a) 
of title 5, United States Code); or 
‘‘(C) employed in a position of a confiden-
tial or policy-determining character under 
schedule C of subpart C of part 213 of title 5, 
Code of Federal Regulations (or a successor 
regulation). 
‘‘(5) SECRETARY.—The term ‘Secretary’ means 
the Secretary, acting through 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 pe-
riod in excess of 14 days. 
‘‘(b) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may, in ac-
cordance with this section, remove, demote, or sus-
pend a covered individual from employment at the 
Service if the Secretary determines that the perform-
ance or misconduct of the covered individual war-
rants such an action. 
‘‘(2) ACTIONS.—If the Secretary removes, de-
motes, or suspends a covered individual pursuant to 
paragraph (1), the Secretary may— 
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‘‘(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— 
‘‘(i) a reduction in grade for which the 
covered individual is qualified, as the Sec-
retary determines appropriate; and 
‘‘(ii) a reduction of the annual rate of 
pay of the covered individual; or 
‘‘(C) suspend the covered individual from 
the civil service (as defined in section 2101 of 
title 5, United States Code). 
‘‘(c) PAY OF CERTAIN DEMOTED INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, any covered individual subject to a 
demotion by means of a reduction in grade under 
subsection (b)(2)(B) shall, beginning on the date of 
the demotion, receive the annual rate of pay applica-
ble to the reduced grade. 
‘‘(2) RESTRICTIONS.— 
‘‘(A) PROHIBITION
ON
ADMINISTRATIVE 
LEAVE.—A covered individual subject to a de-
motion under subsection (b)(2)(B)— 
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‘‘(i) may not be placed on administra-
tive leave during the period during which 
an appeal (if any) under this section is on-
going; and 
‘‘(ii) may only receive pay if the cov-
ered individual reports for duty or is ap-
proved to use accrued unused annual, sick, 
family medical, military, or court leave. 
‘‘(B) RESTRICTION
ON
PAY
AND
BENE-
FITS.—If a covered individual subject to a de-
motion under subsection (b)(2)(B) does not re-
port for duty (and has not received approval to 
use accrued unused leave under subparagraph 
(A)(ii)), the covered individual shall not receive 
pay or other benefits pursuant to subsection 
(e)(7). 
‘‘(d) RIGHTS AND PROCEDURES.— 
‘‘(1) IN GENERAL.—A covered individual who is 
the subject of an action or removal, as applicable, 
under subsection (b) is entitled— 
‘‘(A) to advance notice of the action or re-
moval; 
‘‘(B) to access a file containing all evidence 
in support of the proposed action or removal; 
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‘‘(C) to be represented by an attorney or 
other representative of the covered individual’s 
choice; and 
‘‘(D) to grieve the decision on the action or 
removal under paragraph (2) in accordance 
with the internal grievance process established 
by the Secretary under paragraph (3). 
‘‘(2) NOTICE; RESPONSE; DECISION.— 
‘‘(A) AGGREGATE PERIOD.—The aggregate 
period for notice, response, and a final decision 
on an action under subsection (b) may not ex-
ceed 15 business days. 
‘‘(B) RESPONSE.—A covered individual re-
ceiving a notice under paragraph (1)(A) of an 
action or removal under subsection (b) shall 
have not more than 7 business days to respond 
to the notice. 
‘‘(C) FINAL AND CONCLUSIVE DECISION.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall issue a final and conclusive decision 
on an action or removal under subsection 
(b) not later than 15 business days after 
the date on which the notice of the action 
is received by the applicable covered indi-
vidual under paragraph (1)(A). 
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‘‘(ii) 
REQUIREMENTS.—A 
decision 
under clause (i)— 
‘‘(I) shall be in writing; and 
‘‘(II) shall include the specific 
reasons for the decision. 
‘‘(3) GRIEVANCE PROCESS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish an internal grievance process under 
which a covered individual may grieve a deci-
sion issued under paragraph (2) not later than 
the date that is 7 business days after the date 
on which the decision under that paragraph was 
issued. 
‘‘(B) TOTAL PERIOD.—The Secretary shall 
issue a decision for which an internal grievance 
process is initiated under subparagraph (A) not 
later than 21 business days after the date on 
which the grievance process is initiated by the 
covered individual. 
‘‘(C) FINAL AND CONCLUSIVE DECISION.— 
A grievance decision under this paragraph shall 
be final and conclusive. 
‘‘(4) PROCEDURES
SUPERSEDING
CBAS.—The 
procedures under this subsection shall supersede any 
collective bargaining agreement to the extent that 
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such an agreement is inconsistent with the proce-
dures. 
‘‘(5) PERFORMANCE
APPRAISAL.—The proce-
dures under chapter 43 of title 5, United States 
Code, shall not apply to an action under subsection 
(b). 
‘‘(6) APPEAL TO MERIT SYSTEMS PROTECTION 
BOARD.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and subsection (e), any removal, de-
motion, or suspension of more than 14 days 
under subsection (b) may be appealed to the 
Merit Systems Protection Board, which shall 
refer such appeal to an administrative law 
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 the appeal is 
made not later than 10 business days after the 
date of the removal, demotion, or suspension. 
‘‘(e) EXPEDITED REVIEW.— 
‘‘(1) IN
GENERAL.—On receipt of an appeal 
under subsection (d)(6)(A), the applicable adminis-
trative law judge shall— 
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‘‘(A) expedite the appeal under section 
7701(b)(1) of title 5, United States Code; and 
‘‘(B) issue a final and complete decision on 
the appeal not later than 180 days after the 
date of the appeal. 
‘‘(2) UPHOLDING DECISION.— 
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 7701(c)(1)(B) of title 5, United States 
Code, the administrative law judge shall uphold 
the decision of the Secretary to remove, demote, 
or suspend an employee under subsection (b) if 
the decision is supported by substantial evi-
dence. 
‘‘(B) PROHIBITION OF MITIGATION.—Not-
withstanding title 5, United States Code, or any 
other provision of law, if the decision of the 
Secretary to remove, demote, or suspend an em-
ployee under subsection (b) is supported by 
substantial evidence, the administrative law 
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 law judge under paragraph (1) 
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may be appealed to the Merit Systems Protec-
tion Board. 
‘‘(B) 
UPHOLDING
DECISION.—Notwith-
standing section 7701(c)(1)(B) of title 5, 
United States Code, the Merit Systems Protec-
tion Board shall uphold the decision of the Sec-
retary to remove, demote, or suspend an em-
ployee under subsection (b) if the decision is 
supported by substantial evidence. 
‘‘(C) PROHIBITION OF MITIGATION.—Not-
withstanding 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 Sec-
retary. 
‘‘(4) REPORT.—In any case in which an admin-
istrative law judge cannot issue a final and complete 
decision by the deadline described in paragraph 
(1)(B), the Merit Systems Protection Board shall, 
not later than 14 business days after the deadline 
expires, submit to the appropriate committees of 
Congress a report that explains the reasons why a 
decision was not issued by the deadline. 
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‘‘(5) APPEAL.—A decision of the Merit Systems 
Protection Board under paragraph (3) may be ap-
pealed 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 that section. 
‘‘(6) PROHIBITION AGAINST STAYS.—The Merit 
Systems Protection Board may not stay any removal 
or demotion under subsection (b), except as provided 
in section 1214(b) of title 5, United States Code. 
‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR-
ING APPEAL.— 
‘‘(A) IN GENERAL.— 
‘‘(i) RESTRICTION ON PAY AND BENE-
FITS.—During the period described in 
clause (ii), a covered individual may not re-
ceive any pay and benefits described in 
subparagraph (B). 
‘‘(ii) PERIOD
DESCRIBED.—The pe-
riod referred to in clause (i) is the pe-
riod— 
‘‘(I) beginning on the date on 
which a covered individual appeals 
under this section a removal from the 
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civil 
service 
under 
subsection 
(b)(2)(A); and 
‘‘(II) ending on the later of— 
‘‘(aa) the date on which the 
Merit Systems Protection Board 
issues a final decision on the ap-
peal under paragraph (3); and 
‘‘(bb) the date on which the 
United States Court of Appeals 
for the Federal Circuit issues a 
final decision on the appeal 
under paragraph (5). 
‘‘(B) PAY
AND
BENEFITS
DESCRIBED.— 
The pay and benefits referred to in subpara-
graph (A)(i) are any pay, awards, bonuses, in-
centives, allowances, differentials, student loan 
repayments, special payments, or benefits re-
lated 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. 
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‘‘(9) BACKPAY.—If an employee prevails on ap-
peal under this section, the employee shall be enti-
tled to backpay (as provided in section 5596 of title 
5, United States Code). 
‘‘(10) APPLICABLE
TIMELINES
AND
PROCE-
DURES.—If an employee who is subject to a collec-
tive bargaining agreement chooses to grieve an ac-
tion taken under this section through a grievance 
procedure provided under the collective bargaining 
agreement, the timelines and procedures described in 
subsection (d) and this subsection shall apply. 
‘‘(f) ALLEGED
PROHIBITED
PERSONNEL
PRAC-
TICE.—In the case of a covered individual seeking correc-
tive 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 the covered individual 
under subsection (b) without the approval of the Special 
Counsel under section 1214(f) of title 5, United States 
Code. 
‘‘(g) TERMINATION OF INVESTIGATIONS BY OFFICE 
OF SPECIAL COUNSEL.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Special Counsel established by 
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section 1211 of title 5, United States Code, may ter-
minate 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 state-
ment of the reasons for the termination of the inves-
tigation. 
‘‘(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 de-
scribed in paragraph (1). 
‘‘(h) VACANCIES.—In the case of a covered individual 
who is removed or demoted under subsection (b), to the 
maximum extent practicable, the Secretary shall fill the 
vacancy arising as a result of the removal or demotion.’’. 
(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.’’. 
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(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 Depart-
ment of Health and Human Services, as appropriate, shall 
submit to Congress a report that includes information 
on— 
(1) the number of employees of the Indian 
Health Service who were removed, demoted, or sus-
pended during the 1-year period preceding the date 
of enactment of this Act; 
(2) the number of employees of the Indian 
Health Service who were removed, demoted, or sus-
pended during the 1-year period beginning on the 
date of enactment of this Act pursuant to the 
amendments made by this section; and 
(3) the appropriate details of any such remov-
als, 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 
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(B) by striking ‘‘appropriate employees of 
the Service’’ and inserting ‘‘employees of the 
Service, 
locum 
tenens 
medical 
providers, 
healthcare volunteers, and other contracted em-
ployees 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) REQUIREMENT TO COMPLETE TRAINING PRO-
GRAM.—Notwithstanding any other provision of law, be-
ginning on the date of enactment of the Restoring Ac-
countability in the Indian Health Service Act of 2022, 
each employee or provider described in subsection (a) who 
enters into a contract with the Service shall, as a condition 
of employment, annually participate in and complete the 
program established under subsection (a).’’. 
SEC. 108. STAFFING DEMONSTRATION PROGRAM. 
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 PROGRAM. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of the Restoring Accountability in the 
Indian Health Service Act of 2022, the Secretary, acting 
through the Service (referred to in this section as the ‘Sec-
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retary’), shall establish a demonstration program (referred 
to in this section as the ‘demonstration program’) under 
which the Service may provide Service units with addi-
tional staffing resources, with the goal that the resources 
become self-sustaining. 
‘‘(b) SELECTION.—In selecting Service units for par-
ticipation in the demonstration program, 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 1 or more States with Med-
icaid reimbursements plans or policies that will in-
crease the likelihood that the staffing resources pro-
vided will be self-sustaining; and 
‘‘(3) is operating a health facility described in 
paragraph (1) under historical staffing ratios, as de-
termined by the Secretary, that have not been equal-
ized 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 the demonstration program shall be 
provided for a duration that the Secretary, in consultation 
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with the applicable Indian tribe, determines appropriate, 
on the condition 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 the demonstration program shall 
reduce the recurring base funding for staffing for any In-
dian tribe or Service unit. 
‘‘(e) SUNSET.—The demonstration program estab-
lished under subsection (a) shall terminate on the date 
that is 4 years after the date on which the demonstration 
program is established. 
‘‘(f) REPORT.—Not later than 1 year after the date 
on which the demonstration program terminates under 
subsection (e), the Secretary shall submit to the Com-
mittee 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 
a report describing the demonstration program, including 
information on— 
‘‘(1) whether the staffing resources provided 
under the demonstration program resulted in addi-
tional revenue for the applicable Service unit suffi-
cient to maintain the staff on a permanent basis; 
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‘‘(2) the levels to which the staffing resources 
provided under the demonstration program reduced 
the unmet staffing need for the applicable Service 
unit; and 
‘‘(3) whether the demonstration program could 
be deployed permanently 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 amended by adding at the end the following: 
‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 
POLICY. 
‘‘(a) IN GENERAL.—Not later than December 31, 
2023, the Secretary shall establish, and once every 5 years 
thereafter, the Secretary shall update, after meaningful 
consultation with representatives of affected Indian tribes, 
a rule establishing a Tribal consultation policy for the 
Service. 
‘‘(b) CONTENTS
OF TRIBAL CONSULTATION POL-
ICY.—The policy established under the rule under sub-
section (a) shall— 
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‘‘(1) update, and replace, the Tribal consulta-
tion policy established under Circular No. 2006–01 
of the Service (or any successor policy); and 
‘‘(2) include— 
‘‘(A) a process for determining when and 
how the Service will notify Indian tribes of the 
availability of meaningful consultation; 
‘‘(B) a determination of which actions or 
agency decisions by the Service will trigger a re-
quirement for meaningful consultation with In-
dian tribes; and 
‘‘(C) a determination of which actions con-
stitute meaningful consultation with Indian 
tribes.’’. 
SEC. 110. TREATMENT OF CERTAIN HOSPITALS. 
The ‘‘Parallel Low-Volume Hospital Payment Adjust-
ment Regarding Hospitals Operated by the Indian Health 
Services (IHS) or a Tribe’’ provisions described in the 
final rule of the Centers for Medicare & Medicaid Services 
entitled ‘‘Medicare Program; Hospital Inpatient Prospec-
tive 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 
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Program Requirements for Eligible Hospitals, Critical Ac-
cess Hospitals, and Eligible Professionals; Provider-Based 
Status of Indian Health Service and Tribal Facilities and 
Organizations; Costs Reporting and Provider Require-
ments; Agreement Termination Notices’’ (82 Fed Reg. 
37990; 38188–38189 (August 14, 2017)), shall apply with 
respect to discharges occurring in fiscal year 2011 and 
each fiscal year thereafter. 
SEC. 111. ENHANCING QUALITY OF CARE IN THE INDIAN 
HEALTH SERVICE. 
(a) IHCIA DEFINITIONS.—In this section, the terms 
‘‘Area office’’, ‘‘Indian tribe’’, ‘‘Secretary’’, ‘‘Service’’, 
‘‘Service unit’’, ‘‘tribal organization’’, and ‘‘Urban Indian 
organization’’ have the meanings given those terms in sec-
tion 4 of the Indian Health Care Improvement Act (25 
U.S.C. 1603). 
(b) BEST PRACTICES FOR GOVERNING BOARD AND 
AREA OFFICE MEETINGS.— 
(1) DEFINITION
OF
GOVERNING
BOARD.—In 
this subsection, the term ‘‘governing board’’ means 
the governing board of the facility of a Service unit. 
(2) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary, in 
consultation with Indian tribes, governing boards, 
Area offices, Service units, and other stakeholders, 
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as determined appropriate by the Secretary, shall es-
tablish— 
(A) in accordance with paragraph (3)(A), 
best practices for governing boards; and 
(B) in accordance with paragraph (3)(B), 
best practices for Area offices. 
(3) REQUIREMENTS.— 
(A) 
GOVERNING
BOARD
BEST
PRAC-
TICES.—The 
best 
practices 
for 
governing 
boards established under paragraph (2)(A) shall 
include provisions relating to— 
(i) adequately monitoring the delivery 
of care at the applicable facility managed 
by the governing board; 
(ii) ensuring ongoing facility compli-
ance with Federal health care program re-
quirements, including requirements of the 
Service and the Centers for Medicare & 
Medicaid Services; 
(iii) handling, documenting, and re-
sponding to patient complaints; 
(iv) documenting, addressing, and, if 
applicable, reporting instances of profes-
sional misconduct by facility staff in ac-
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cordance with applicable Federal and State 
law; 
(v) improving facility performance and 
operations with respect to mandatory and 
voluntary quality initiatives carried out by 
the Service and the Centers for Medicare & 
Medicaid Services; and 
(vi) reporting requirements under 
Federal law, including with respect to— 
(I) the Government Performance 
and Results Act of 1993 (Public Law 
103–62; 107 Stat. 285), the GPRA 
Modernization Act of 2010 (Public 
Law 111–352; 124 Stat. 3866), and 
the amendments made by those Acts; 
and 
(II) the applicable provisions of 
titles XVIII and XIX of the Social Se-
curity Act (42 U.S.C. 1395 et seq., 
1396 et seq.). 
(B) AREA OFFICE BEST PRACTICES.—The 
best practices for Area offices established under 
paragraph (2)(B) shall include provisions relat-
ing to— 
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(i) strategies for how to best monitor 
governing board activities relating to the 
oversight of— 
(I) delivery and quality of patient 
care; 
(II) documenting and responding 
to patient complaints and instances of 
professional misconduct; and 
(III) facility compliance with 
Federal health care program require-
ments, including requirements of the 
Service and the Centers for Medicare 
& Medicaid Services; and 
(ii) connecting governing boards, in-
cluding the applicable facilities of those 
governing boards, to resources necessary 
for enhancing patient outcomes and im-
proving facility performance, including 
through the use of technical assistance. 
(4) PUBLICATION.—The best practices estab-
lished under paragraph (2) shall be— 
(A) reported to, in writing, as applicable, 
all governing boards and Area offices; and 
(B) incorporated into the Indian Health 
Manual of the Service. 
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(c) REVIEW OF QUALITY AND PERFORMANCE MEAS-
URES.— 
(1) REVIEW.— 
(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of this Act, the Sec-
retary, in coordination with the Agency for 
Healthcare Research and Quality, the National 
Quality Forum, Indian tribes, practitioners and 
administrators of the Service, and other quali-
fied experts, as determined appropriate by the 
Secretary, shall undertake a review of the re-
ported quality and performance measures of 
Service facilities conducted by the Secretary in 
accordance with— 
(i) section 306 of title 5, United 
States Code; 
(ii) section 1115(b) of title 31, United 
States Code; and 
(iii) any law (including regulations) 
used in any mandatory or voluntary pro-
gram of the Centers for Medicare & Med-
icaid Services. 
(B) REPORT.—Not later than 6 months 
after the date on which the review required 
under subparagraph (A) is completed, the Sec-
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retary shall submit to Congress a report on the 
details and findings of that review, which shall 
include an assessment of— 
(i) the suitability of measures used as 
of the date of enactment of this Act for the 
applicable Service facility, taking into con-
sideration the patient volume of the facil-
ity, the mix of patient cases at the facility, 
the geographic location of the facility, and 
medical professional shortage designations 
at the facility, as determined by the Sec-
retary; and 
(ii) the extent to which the perform-
ance and quality measures are outcome- 
based or process-based measures. 
(2) ADOPTION.—Not later than 1 year after the 
date on which the report required under paragraph 
(1)(B) is submitted to Congress, the Service, in co-
ordination with the Centers for Medicare & Medicaid 
Services, shall adopt, and assist Service facilities to 
adopt, to the extent practicable, more suitable, as 
compared to those quality and performance meas-
ures adopted prior to the submission of that report, 
quality and performance measures, including meas-
ures that are more outcome-based and process- 
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based, in accordance with the factors described in 
paragraph (1)(B)(i). 
(3) GAO REPORT.—Not later than 1 year after 
the date on which the report required under para-
graph (1)(B) is submitted to Congress, the Comp-
troller General of the United States shall submit to 
Congress a report on challenges relating to quality 
measure and data collection in Service facilities, 
which shall include— 
(A) barriers to the adoption of relevant 
performance and quality measures in Service 
facilities; and 
(B) recommendations for how the Service, 
other Federal agencies, and stakeholders can 
assist Service facilities in adopting suitable 
quality and performance measures. 
(d) COMPLIANCE ASSISTANCE PROGRAM.— 
(1) DEFINITIONS.—In this subsection: 
(A) ADMINISTRATOR.—The term ‘‘Admin-
istrator’’ means the Administrator of the Cen-
ters for Medicare & Medicaid Services. 
(B) ELIGIBLE FACILITY.— 
(i) IN GENERAL.—The term ‘‘eligible 
facility’’ means a facility operated by the 
Service that— 
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(I) is an underperforming hos-
pital or outpatient facility; and 
(II) is eligible for payments 
under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(ii) INCLUSION.—The term ‘‘eligible 
facility’’ includes a tribally operated facil-
ity, if that facility consents to participating 
in the program. 
(C) 
PROGRAM.—The 
term 
‘‘program’’ 
means the compliance assistance program es-
tablished under paragraph (2). 
(D) TRIBALLY OPERATED FACILITY.—The 
term ‘‘tribally operated facility’’ means a facil-
ity operated by an Indian tribe, a tribal organi-
zation, or an Urban Indian organization that— 
(i) is an underperforming hospital or 
outpatient facility; and 
(ii) is eligible for payments under title 
XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). 
(2) ESTABLISHMENT OF PROGRAM.—Not later 
than 1 year after the date of enactment of this Act, 
the Secretary, in coordination with the Adminis-
trator and quality improvement organizations having 
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a contract with the Secretary under part B of title 
XI of the Social Security Act (42 U.S.C. 1320c et 
seq.), shall establish a compliance assistance pro-
gram for eligible facilities. 
(3) METHODOLOGY.—The Secretary shall es-
tablish a methodology for determining which eligible 
facilities shall participate in the program, which 
shall take into account the following factors: 
(A) The number and severity of facility de-
ficiencies with respect to applicable require-
ments under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.). 
(B) The history of provider misconduct or 
patient harm at the facility. 
(C) Whether there is high staff turnover at 
the facility. 
(D) Whether the facility has low perform-
ance on program quality measures, relative to 
other facilities of the Service, in accordance 
with reported quality and performance meas-
ures conducted by the Secretary in accordance 
with— 
(i) section 306 of title 5, United 
States Code; 
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(ii) section 1115(b) of title 31, United 
States Code; and 
(iii) any law (including regulations) 
used in any mandatory or voluntary pro-
gram of the Centers for Medicare & Med-
icaid Services. 
(4) SELECTION OF FACILITIES.— 
(A) IN GENERAL.—The Secretary, in co-
ordination with the Administrator, shall select 
not less than 25 percent of the eligible facilities 
to participate in the program using the method-
ology established under paragraph (3). 
(B) PARTICIPATION.— 
(i) IN GENERAL.—An eligible facility 
selected to participate in the program 
under subparagraph (A) shall be required 
to participate in the program. 
(ii) REQUIREMENT.—The Secretary 
shall ensure that, at all times during the 
period beginning on the date of establish-
ment of the program and the date on 
which the program terminates under para-
graph (8), not less than 25 percent of eli-
gible facilities are participating in the pro-
gram. 
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(C) TERM OF PARTICIPATION.— 
(i) IN
GENERAL.—Subject to clause 
(ii), an eligible facility selected to partici-
pate in the program under subparagraph 
(A) shall participate in the program for a 
period of 2 years. 
(ii) WAIVER.—If the Secretary, in co-
ordination with the Administrator, certifies 
that an eligible facility participating in the 
program has improved on its performance 
to a satisfactory level, as determined by 
the Secretary, then the eligible facility does 
not have to participate in the program for 
the full 2-year period. 
(D) PARTICIPATION LIMIT.—An eligible fa-
cility may participate in the program for more 
than 1 2-year period. 
(5) PROGRAM
COMPONENTS.—The program 
shall provide on-site consultation and educational 
programming for eligible facilities to ensure those el-
igible facilities are— 
(A) meeting Federal requirements of the 
Service and any conditions of participation ap-
plicable under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.); and 
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(B) satisfactorily implementing any quality 
initiatives and programs established by the 
Service or the Centers for Medicare & Medicaid 
Services. 
(6) ENFORCEMENT
OR
NONCOMPLIANCE
AC-
TIONS.— 
(A) IN GENERAL.—The program shall be 
conducted independently of any enforcement ac-
tions under the Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) or non-
compliance actions taken by the Administrator 
with respect to noncompliance with conditions 
of participation applicable under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et 
seq.), unless, while carrying out the program, 
the Secretary or the Administrator, as applica-
ble, encounters a triggering event, as deter-
mined by the Secretary or the Administrator, as 
applicable, that would necessitate an enforce-
ment action or noncompliance action. 
(B) TRIGGERING EVENT ENCOUNTERED.— 
If a triggering event is encountered by the Sec-
retary or Administrator under subparagraph 
(A), the eligible facility shall continue to partici-
pate in the program so long as the facility— 
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(i) remains eligible for payments 
under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.); and 
(ii) continues to meet all of the condi-
tions and requirements for such payments 
which are applicable under such title. 
(7) IMPLEMENTATION.—The Secretary shall 
carry out the program in coordination with quality 
improvement organizations having a contract with 
the Secretary under part B of title XI of the Social 
Security Act (42 U.S.C. 1320c et seq.). 
(8) SUNSET.—The program shall terminate 6 
years after the date on which the program is estab-
lished. 
(9) REPORT.—Not later than 1 year after the 
date on which the program terminates under para-
graph (8), the Comptroller General of the United 
States shall submit to Congress a report evaluating 
the effectiveness of the program, which shall include, 
to the extent practicable— 
(A) detailed data on changes in the patient 
experience at eligible facilities that participated 
in the program; 
(B) a description of the compliance status 
of eligible facilities that participated in the pro-
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gram with requirements of the Service and any 
conditions of participation applicable under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.); and 
(C) a description of the progress by eligible 
facilities that participated in the program in 
meeting the goals of quality improvement activi-
ties of the Department of Health and Human 
Services. 
SEC. 112. NOTIFICATION OF INVESTIGATION REGARDING 
PROFESSIONAL CONDUCT; SUBMISSION OF 
RECORDS. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) (as amended by section 109) 
is amended by adding at the end the following: 
‘‘SEC. 835. NOTIFICATION OF INVESTIGATION REGARDING 
PROFESSIONAL CONDUCT; SUBMISSION OF 
RECORDS. 
‘‘(a) REPORT.—Not later than 14 calendar days after 
the date on which the Service undertakes an investigation 
into the professional conduct of a licensee of a State, the 
Secretary, acting through the Service, shall notify the rel-
evant State medical board of the investigation. 
‘‘(b) SUBMISSION OF RECORDS.—Not later than 14 
calendar days after the date on which the Service gen-
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erates records relating to an investigation conducted by 
the Service into the professional conduct of a licensee of 
a State, the Secretary, acting through the Service, shall 
provide the records to the relevant State medical board.’’. 
SEC. 113. MEDICAL CHAPERONES; OFFICE OF PATIENT AD-
VOCACY. 
(a) MEDICAL CHAPERONES.—Title II of the Indian 
Health Care Improvement Act is amended by inserting 
after section 223 (25 U.S.C. 1621v) the following: 
‘‘SEC. 224. MEDICAL CHAPERONES. 
‘‘(a) INDIAN HEALTH SERVICE.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall, at the request of a pa-
tient of the Service, provide to the patient a medical 
chaperone, to be present during any medical exam-
ination of the patient provided by or through the 
Service. 
‘‘(2) REQUIREMENTS.—The Secretary, acting 
through the Service, shall— 
‘‘(A) notify patients of the Service of the 
right to have a medical chaperone present dur-
ing a medical examination provided by or 
through the Service; and 
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‘‘(B) ensure that the right described in 
subparagraph (A) is provided to each patient in 
each Service unit. 
‘‘(b) OTHER PROVIDERS OF SERVICES.—An Indian 
tribe, tribal organization, or any other Indian health pro-
gram may use amounts made available under this Act to 
provide, at the request of a patient to whom the Indian 
tribe, tribal organization, or Indian health program is pro-
viding health care services, a medical chaperone to the pa-
tient, to be present during any medical examination of the 
patient provided by the Indian tribe or tribal organiza-
tion.’’. 
(b) INDIAN HEALTH SERVICE OFFICE OF PATIENT 
ADVOCACY.—Title VI of the Indian Health Care Improve-
ment Act (25 U.S.C. 1661 et seq.) (as amended by section 
106) is amended by adding at the end the following: 
‘‘SEC. 608. OFFICE OF PATIENT ADVOCACY. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) DIRECTOR.—The term ‘Director’ means 
the Director of the Office. 
‘‘(2) OFFICE.—The term ‘Office’ means the Of-
fice of Patient Advocacy established by subsection 
(b). 
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‘‘(b) ESTABLISHMENT.—There is established within 
the Department an office, to be known as the ‘Office of 
Patient Advocacy’. 
‘‘(c) DIRECTOR.—The Office shall be headed by a Di-
rector, who shall— 
‘‘(1) be appointed by the Secretary from among 
individuals qualified to perform the duties of the po-
sition; and 
‘‘(2) report directly to the Secretary. 
‘‘(d) DUTIES.— 
‘‘(1) IN GENERAL.—The Office shall carry out 
a patient advocacy program of the Service, under 
which the Office shall— 
‘‘(A) employ patient advocates to advocate 
on behalf of Indians with respect to health care 
services sought or received through the Service; 
‘‘(B) provide to those patient advocates 
training to ensure the advocates carry out the 
responsibilities described in paragraph (2); and 
‘‘(C) in as many prominent locations as 
the Director determines to be appropriate to be 
seen by the largest percentage of patients and 
family members of patients at each Service 
unit, display— 
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‘‘(i) the purposes of the patient advo-
cacy program; 
‘‘(ii) the contact information for a pa-
tient advocate employed at the Service 
unit; and 
‘‘(iii) a description of the rights and 
responsibilities of patients and family 
members of patients at the Service unit. 
‘‘(2) PATIENT ADVOCATE RESPONSIBILITIES.— 
The responsibilities of a patient advocate employed 
by the Office shall include the following: 
‘‘(A) Resolving any complaints by Indian 
patients with respect to health care services 
provided by or through the Service that cannot 
be resolved at— 
‘‘(i) the point of service; or 
‘‘(ii) a higher level easily accessible to 
the patient. 
‘‘(B) Expressing to Indians their rights 
and responsibilities as patients in receiving 
health care services through the Service. 
‘‘(C) Presenting at various meetings, and 
to various committees, a description of any 
issues experienced by Indians in receiving 
health care services through the Service. 
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‘‘(D) Managing a patient advocate track-
ing system, if applicable. 
‘‘(E) Compiling data relating to any com-
plaints made to the advocate by Indians with 
respect to the receipt of health care services 
through the Service, and the satisfaction of In-
dians with those services, to determine whether 
there exist any trends in those data. 
‘‘(F) Ensuring that a process exists for the 
distribution of data compiled under subpara-
graph (E) to Indian health programs, appro-
priate leaders, committees, and service pro-
viders, and staff of the Service. 
‘‘(G) Identifying, not less frequently than 
quarterly, opportunities for improvement in the 
provision of health care services to Indians by 
or through the Service, including based on com-
plaints by Indian patients or immediate family 
members. 
‘‘(H) Ensuring that any significant com-
plaint by an Indian patient or family member 
with respect to health care provided by or 
through the Service is brought to the attention 
of appropriate staff of the Service or Indian 
health program for the purpose of assessing 
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whether further analysis of the problem is re-
quired at the Service, Service area, Service unit, 
or Indian health program level. 
‘‘(I) Supporting any other patient advocacy 
programs carried out by the Department. 
‘‘(J) Ensuring that all appeals and final 
decisions with respect to the receipt of health 
care services through the Service are entered 
into a patient advocate tracking system of the 
Office, if applicable. 
‘‘(K) Understanding all laws, directives, 
and other rules relating to the rights and re-
sponsibilities of Indians in receiving health care 
services through the Service, including the ap-
peals processes available to Indian patients and 
immediate family members. 
‘‘(L) Ensuring that Indians receiving be-
havioral health services under title VII (and any 
surrogate decisionmakers for such Indians) are 
aware of the right of Indians— 
‘‘(i) to seek representation from sys-
tems established under section 103 of the 
Protection and Advocacy for Mentally Ill 
Individuals Act of 1986 (42 U.S.C. 
10803); 
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‘‘(ii) to protect and advocate for the 
rights of Indians experiencing behavioral 
health issues; and 
‘‘(iii) to investigate incidents of abuse 
and neglect of Indians experiencing behav-
ioral health issues. 
‘‘(M) Achieving compliance with any appli-
cable requirements established by the Secretary 
with respect to the inspection of controlled sub-
stances (as defined in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802)). 
‘‘(N) Documenting potentially threatening 
behavior and reporting that behavior to the ap-
propriate authorities. 
‘‘(3) TRAINING.—The Director shall ensure 
that the training provided to patient advocates 
under paragraph (1)(B) is consistent throughout the 
Office, including with respect to any mandatory 
training or certification standards approved by the 
Director.’’. 
SEC. 114. FITNESS OF HEALTH CARE PROVIDERS. 
(a) IN GENERAL.—Title VIII of the Indian Health 
Care Improvement Act is amended by inserting after sec-
tion 802 (25 U.S.C. 1672) the following: 
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‘‘SEC. 803. FITNESS OF HEALTH CARE PROVIDERS. 
‘‘(a) ADDITIONAL REQUIREMENTS FOR HIRING OF 
HEALTH CARE PROVIDERS BY SERVICE.—As part of the 
hiring process for each health care provider position at 
the Service after the date of enactment of the Restoring 
Accountability in the Indian Health Service Act of 2022, 
the Director shall require from the medical board of each 
State in which the health care provider has or had a med-
ical license— 
‘‘(1) information on any violation of the re-
quirements of the medical license of the health care 
provider during the 20-year period ending on the 
date on which the health care provider is being con-
sidered for a position at the Service; and 
‘‘(2) information on whether the health care 
provider has entered into any settlement agreement 
for a disciplinary charge relating to the practice of 
medicine by the health care provider. 
‘‘(b) PROVISION
OF
INFORMATION
ON
SERVICE 
HEALTH
CARE
PROVIDERS
TO
STATE
MEDICAL 
BOARDS.—Notwithstanding section 552a of title 5, United 
States Code, with respect to each health care provider of 
the Service who has violated a requirement of the medical 
license of the health care provider, the Director shall pro-
vide to the medical board of each State in which the health 
care provider is licensed detailed information with respect 
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to the violation, regardless of whether the medical board 
has formally requested that information.’’. 
(b) REPORT ON COMPLIANCE BY INDIAN HEALTH 
SERVICE WITH REVIEWS OF HEALTH CARE PROVIDERS 
LEAVING SERVICE OR TRANSFERRING TO OTHER FACILI-
TIES.—Not later than 180 days after the date of enact-
ment of this Act, the Director of the Indian Health Service 
shall submit to the Committee on Indian Affairs of the 
Senate and the Committee on Natural Resources of the 
House of Representatives a report on the compliance by 
the Indian Health Service with the policy of the Indian 
Health Service— 
(1) to conduct a review of each health care pro-
vider of the Indian Health Service who transfers to 
another medical facility of the Indian Health Serv-
ice, resigns, retires, or is terminated to determine 
whether there are any concerns, complaints, or alle-
gations of violations relating to the medical practice 
of the health care provider; and 
(2) to take appropriate action with respect to 
any concern, complaint, or allegation described in 
paragraph (1). 
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SEC. 115. STANDARDS TO IMPROVE TIMELINESS OF CARE. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 412. STANDARDS TO IMPROVE TIMELINESS OF CARE. 
‘‘(a) REGULATIONS.— 
‘‘(1) IN GENERAL.—Not later than 180 days 
after the date of enactment of the Restoring Ac-
countability in the Indian Health Service Act of 
2022, the Secretary, acting through the Service, 
shall— 
‘‘(A) establish, by regulation, standards to 
measure the timeliness of the provision of 
health care services in Service facilities; and 
‘‘(B) provide such standards to each Serv-
ice unit. 
‘‘(2) DATA COLLECTION.—The Secretary, act-
ing through the Service, shall develop a process for 
each Service unit to submit to the Secretary data 
with respect to the standards established under 
paragraph (1)(A). 
‘‘(b) ANNUAL REPORTS.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the Restoring Account-
ability in the Indian Health Service Act of 2022, 
and annually thereafter, each Area office shall sub-
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mit to the Secretary a report on the metrics re-
ported by Service units relating to the timeliness of 
the provision of health care services in Service facili-
ties within each Service unit. 
‘‘(2) PUBLICATION.—The Secretary shall make 
each report received under paragraph (1) publicly 
available on the website of the Service.’’. 
TITLE II—EMPLOYEE 
PROTECTIONS 
SEC. 201. EMPLOYEE PROTECTIONS AGAINST RETALIA-
TION. 
(a) IN GENERAL.—Title VI of the Indian Health 
Care Improvement Act (25 U.S.C. 1661 et seq.) (as 
amended by section 113(b)) is amended by adding at the 
end the following: 
‘‘SEC. 609. EMPLOYEE PROTECTIONS AGAINST RETALIA-
TION. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) INFORMATION.—The term ‘information’ 
means information— 
‘‘(A) the disclosure of which is not specifi-
cally prohibited by law; and 
‘‘(B) that is not specifically required by 
Executive order to be kept secret in the interest 
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of national defense or the conduct of foreign af-
fairs. 
‘‘(2) RETALIATION.—The term ‘retaliation’, 
with respect to a whistleblower, means— 
‘‘(A) an adverse employment action against 
the whistleblower; 
‘‘(B) a significantly adverse action against 
the whistleblower, such as the refusal or delay 
of care provided through the Service; and 
‘‘(C) an adverse action described in sub-
paragraph (A) or (B) against a family member 
or friend of the whistleblower. 
‘‘(3) WHISTLEBLOWER.—The term ‘whistle-
blower’ means an employee of the Service who dis-
closes information that the employee reasonably be-
lieves evidences— 
‘‘(A) a violation of any law, rule, regula-
tion, or Service policy; or 
‘‘(B) gross mismanagement, a gross waste 
of funds, an abuse of authority, or a substantial 
and specific danger to public health or safety. 
‘‘(b) EMPLOYEE ACCOUNTABILITY.— 
‘‘(1) DESIGNATED
OFFICIAL.—The Secretary 
shall designate an official in the Department who is 
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not an employee of the Service to receive reports 
under paragraph (2). 
‘‘(2) MANDATORY REPORTING.—An employee of 
the Service who witnesses retaliation against a whis-
tleblower, a violation of a patient safety requirement, 
or other similar conduct shall submit to the official 
designated under paragraph (1) a report of the con-
duct. 
‘‘(3) OVERSIGHT.—Not later than 3 days after 
the date on which the official designated under para-
graph (1) receives a report under paragraph (2), the 
Secretary shall— 
‘‘(A) formally review the report; and 
‘‘(B) provide a copy of the report and any 
other relevant information to the Inspector 
General of the Department. 
‘‘(4) REMOVAL FOR WHISTLEBLOWER RETALIA-
TION.— 
‘‘(A) IN GENERAL.—The Secretary may re-
move for misconduct from the civil service (as 
defined in section 2101 of title 5, United States 
Code), in accordance with section 606 or 607, 
as applicable, an employee of the Service if the 
Secretary determines, after completing a review 
described in paragraph (3), that the employee 
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has retaliated against a whistleblower and war-
rants removal for misconduct. 
‘‘(B) RETALIATION AS MISCONDUCT.—Re-
taliation by an employee against a whistle-
blower, as described in subparagraph (A), shall 
be considered to be misconduct for purposes of 
sections 606 and 607. 
‘‘(5) ENHANCING PROTECTIONS FOR WHISTLE-
BLOWERS.—The Secretary shall carry out any ac-
tions determined necessary by the Secretary to en-
hance protection for whistleblowers, including identi-
fying appropriate Service employees and requiring 
the employees to complete the Office of Special 
Counsel’s Whistleblower Certification Program.’’. 
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 the 
following: 
‘‘(a) IN GENERAL.—The right of’’; and 
(2) by adding at the end the following: 
‘‘(b) ADVERSE ACTION.—An employee who interferes 
with or denies a right protected under subsection (a) shall 
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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 appli-
cable procedure.’’. 
(b) ELECTRONIC NOTIFICATION OF RIGHT OF EM-
PLOYEES OF INDIAN HEALTH SERVICE.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the 
Indian Health Service (referred to in this subsection 
as the ‘‘Secretary’’), shall provide, in accordance 
with paragraphs (2) through (5), to each employee 
of the Indian Health Service notice of the right to 
petition Congress under section 7211 of title 5, 
United States Code. 
(2) MEMORANDUM.—Not later than 30 days 
after the date of enactment of this Act, the Sec-
retary shall submit to the Inspector General of the 
Department of Health and Human Services (re-
ferred to in this subsection as the ‘‘Inspector Gen-
eral’’) a memorandum that includes 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 ap-
proval, guidance, or any other form of input prior to 
contacting Congress with information, even if that 
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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 Fed-
eral employee under such section shall be subject to 
an adverse action described in any of paragraphs (1) 
through (5) of section 7512 of title 5, United States 
Code, including a suspension for more than 14 days 
without pay.’’. 
(3) APPROVAL OR DISAPPROVAL.— 
(A) IN GENERAL.—Not later than 30 days 
after the date on which the memorandum is 
submitted under paragraph (2), the Inspector 
General shall approve or disapprove the memo-
randum. 
(B) DISAPPROVAL.—If the Inspector Gen-
eral disapproves the memorandum, the Inspec-
tor General shall advise the Secretary on what 
changes to the memorandum are necessary for 
approval. 
(4) NOTICE.—If the memorandum is approved 
under paragraph (3), not later than 30 days after 
the date of the approval, the Secretary shall— 
(A) provide to each employee of the Indian 
Health Service an electronic copy of the ap-
proved memorandum; and 
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