‘‘(1) the Committee on Indian Affairs of the 
Senate; 
‘‘(2) the Committee on Health, Education, 
Labor, and Pensions of the Senate; 
‘‘(3) the Committee on Natural Resources of 
the House of Representatives; 
‘‘(4) the Committee on Energy and Commerce 
of the House of Representatives; and 
‘‘(5) the Inspector General of the Department. 
‘‘(e) PROCEDURE.— 
‘‘(1) INAPPLICABILITY.—The procedures under 
chapters 43 and 75 of title 5, United States Code, 
shall not apply to a personnel action. 
‘‘(2) APPEAL.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and subsection (f), an employee sub-
ject to a personnel action may appeal the per-
sonnel action to the Merit Systems Protection 
Board under section 7701 of title 5, United 
States Code. 
‘‘(B) LIMITATION.—An appeal under sub-
paragraph (A) may only be made if the appeal 
is made not later than 7 days after the date of 
the personnel action. 
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‘‘(f) EXPEDITED REVIEW BY ADMINISTRATIVE LAW 
JUDGE.— 
‘‘(1) IN GENERAL.— 
‘‘(A) REFERRAL.—On receipt of an appeal 
under subsection (e)(2)(A), the Merit Systems 
Protection Board shall refer the appeal to an 
administrative law judge pursuant to section 
7701(b)(1) of title 5, United States Code. 
‘‘(B) EXPEDITION.—The administrative 
law judge to whom an appeal is referred under 
subparagraph (A) shall— 
‘‘(i) expedite the appeal under section 
7701(b)(1) of title 5, United States Code; 
and 
‘‘(ii) issue a decision in each case not 
later than 21 days after the date of the ap-
peal. 
‘‘(2) FINALITY.—Notwithstanding any other 
provision of law, including section 7703 of title 5, 
United States Code, the decision of an administra-
tive law judge under paragraph (1) shall be final 
and shall not be subject to any further administra-
tive appeal. 
‘‘(3) FAILURE TO ISSUE DECISION.— 
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‘‘(A) IN GENERAL.—In any case in which 
an administrative law judge fails to issue a de-
cision in accordance with the 21-day require-
ment described in paragraph (1)(B)(ii), the per-
sonnel action shall be treated as final. 
‘‘(B) TRANSPARENCY.—In any case in 
which a personnel action is treated as final 
under subparagraph (A), the Merit Systems 
Protection Board shall, not later than 14 days 
after the date on which the personnel action be-
comes final, submit a letter explaining the rea-
sons why a decision was not issued in accord-
ance with the 21-day requirement described in 
paragraph (1)(B)(ii) to— 
‘‘(i) the Committee on Indian Affairs 
of the Senate; 
‘‘(ii) the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate; 
‘‘(iii) the Committee on Natural Re-
sources of the House of Representatives; 
and 
‘‘(iv) the Committee on Energy and 
Commerce of the House of Representa-
tives. 
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‘‘(4) RESTRICTION.—The Merit Systems Pro-
tection Board or an administrative law judge may 
not stay any personnel action. 
‘‘(5) CESSATION OF PAY INCREASES AND BENE-
FITS.—During the period beginning on the date on 
which an employee appeals a removal from the civil 
service under subsection (e)(2)(A) and ending on the 
date on which the removal becomes final, the em-
ployee may not receive any— 
‘‘(A) increase in rate of pay; or 
‘‘(B) award, bonus, incentive, allowance, 
differential, student loan repayment, special 
payment, or other benefit. 
‘‘(6) ASSISTANCE.—To the maximum extent 
practicable, the Secretary shall provide such infor-
mation and assistance as may be necessary to ensure 
an appeal under this subsection is expedited to— 
‘‘(A) the Merit Systems Protection Board; 
and 
‘‘(B) any administrative law judge to 
whom an appeal under this section is referred. 
‘‘(g) EMPLOYMENT RECORD TRANSPARENCY.—The 
Secretary shall ensure that the employment records for 
any employee subject to a personnel action, regardless of 
whether that personnel action is final, include— 
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‘‘(1) a notation that the employee was subject 
to a personnel action; and 
‘‘(2) a description of the disposition or status of 
the personnel action or any appeal of the personnel 
action under this section. 
‘‘(h) RELATION
TO
TITLE
5, UNITED
STATES 
CODE.— 
‘‘(1) ADDITIONAL AUTHORITY.—The personnel 
action authorities provided to the Secretary under 
this section are in addition to the authorities pro-
vided under chapters 43 and 75 of title 5, United 
States Code. 
‘‘(2) REMOVAL OF SENIOR EXECUTIVES.—Sec-
tion 3592(b)(1) of title 5, United States Code, shall 
not apply to a personnel action.’’. 
SEC. 107. 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) IN GENERAL.—Not later than 180 days after 
the date of enactment of the Restoring Accountability in 
the Indian Health Service Act of 2017, the Secretary, act-
ing through the Service, shall— 
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‘‘(1) establish, by regulation, standards to 
measure the timeliness of the provision of health 
care services in Service facilities; and 
‘‘(2) provide such standards to each Service 
unit. 
‘‘(b) DATA COLLECTION.—The Secretary, acting 
through the Service, shall develop a process for each Serv-
ice unit to submit to the Secretary data with respect to 
the standards established under subsection (a)(1).’’. 
SEC. 108. TRIBAL CULTURE AND HISTORY. 
Section 113 of the Indian Health Care Improvement 
Act (25 U.S.C. 1616f ) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘a program’’ and inserting 
‘‘an annual mandatory training program’’; and 
(B) by striking ‘‘appropriate employees of 
the Service’’ and inserting ‘‘employees of the 
Service, locum tenens medical providers, and 
other contracted employees who work at Service 
hospitals or other Service units and whose em-
ployment requires regular direct patient ac-
cess’’; and 
(2) by adding at the end the following: 
‘‘(c) Notwithstanding any other provision of law, be-
ginning with the year of the date of enactment of the Re-
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storing Accountability in the Indian Health Service Act 
of 2017, each employee or provider described in subsection 
(a) who enters into a contract with the Service on or after 
the date of such implementation shall, as a condition of 
employment, annually participate in and complete such 
training program. For purposes of the preceding sentence, 
participation in such training program may not be consid-
ered complete for the year involved until the individual 
satisfies each requirement, including testing, if applicable, 
of the training program for such year, as specified by the 
Secretary.’’. 
SEC. 109. STAFFING DEMONSTRATION PROJECT. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) is amended by adding at 
the end the following: 
‘‘SEC. 833. STAFFING DEMONSTRATION PROJECT. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall establish a demonstration project that 
authorizes the Service to provide federally managed Serv-
ice units with additional staffing resources with the goal 
that the resources become self-sustaining. 
‘‘(b) SELECTION.—In selecting Service units for par-
ticipation, the Secretary shall consider whether a Service 
unit services an Indian tribe that— 
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‘‘(1) has utilized or contributed substantial trib-
al funds to construct a health facility used by the 
Service or identified in the master plan for the Serv-
ice unit; 
‘‘(2) is located in a State or 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 that 
have not been equalized or updated by the Service 
or any other Service program to reflect current 
staffing needs. 
‘‘(c) DURATION.—Staffing resources provided to a 
Service unit under this section shall be for a duration that 
the Secretary, in consultation with the applicable Indian 
tribe, determines appropriate, except that each staffing 
position provided shall be for a period of not less than 
3 fiscal years. 
‘‘(d) REPORT.—Not later than 5 years after the Sec-
retary ends the demonstration project under this section, 
the Secretary shall prepare and submit a report to the 
Committee on Indian Affairs and the Committee on 
Health, Education, Labor, and Pensions of the Senate, 
and the Committee on Natural Resources and the Com-
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mittee on Energy and Commerce of the House of Rep-
resentatives, regarding the project, including— 
‘‘(1) whether the staffing resources resulted in 
additional revenue for the Service unit sufficient to 
maintain the staff on a permanent basis; 
‘‘(2) the levels to which the staffing resources 
reduced the unmet staffing need for the Service unit; 
and 
‘‘(3) whether the demonstration project could 
be deployed to reduce unmet staffing needs through-
out the Service.’’. 
SEC. 110. 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 109, 
is further amended by adding at the end the following: 
‘‘SEC. 834. RULE ESTABLISHING TRIBAL CONSULTATION 
POLICY. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of the Restoring Accountability in the 
Indian Health Service Act of 2017, the Secretary shall es-
tablish, through the negotiated rulemaking process de-
scribed in subsection (b), a rule establishing a tribal con-
sultation policy for the Service. 
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‘‘(b) NEGOTIATED RULEMAKING.—Before publishing 
a proposed rule described in subsection (a), the Secretary 
shall follow the provisions of subchapter III of chapter 5 
of title 5, United States Code (commonly known as the 
‘Negotiated Rulemaking Act of 1990’). 
‘‘(c) CONTENTS
OF TRIBAL CONSULTATION POL-
ICY.—The policy established under the rule described in 
subsection (a) shall— 
‘‘(1) update, and replace, the tribal consultation 
policy established under Circular No. 2006–01 of the 
Service, or any successor policy; and 
‘‘(2) include the following: 
‘‘(A) A process for determining when the 
Service will notify Indian tribes, and a descrip-
tion of how the Indian tribes should be notified. 
‘‘(B) A determination of what actions or 
agency decisions by the Service will trigger a re-
quirement for meaningful consultation with In-
dian tribes. 
‘‘(C) A determination of what actions con-
stitute meaningful consultation with Indian 
tribes.’’. 
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TITLE II—EMPLOYEE 
PROTECTIONS 
SEC. 201. RIGHT OF FEDERAL EMPLOYEES TO PETITION 
CONGRESS. 
(a) ADVERSE ACTION FOR VIOLATION OF RIGHT TO 
PETITION CONGRESS.—Section 7211 of title 5, United 
States Code, is amended— 
(1) by striking ‘‘The right of’’ and inserting 
‘‘(a) IN GENERAL.—The right of’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(b) ADVERSE ACTION.—An employee who interferes 
with or denies a right protected under subsection (a) shall 
be subject to any adverse action described in paragraphs 
(1) through (5) of section 7512, in accordance with the 
procedure described in section 7513 and any other 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 (referred to in this subsection as 
the ‘‘Secretary’’), acting through the Director of the 
Indian Health Service, shall, in accordance with 
paragraphs (2) through (6), provide to each em-
ployee of the Indian Health Service, and electroni-
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cally post, a memorandum providing notice of the 
right to petition Congress under section 7211 of title 
5, United States Code. 
(2) CONTENTS.—The memorandum described 
in paragraph (1) shall include the following state-
ment: ‘‘It is a violation of section 7211 of title 5, 
United States Code, for any Federal agency or em-
ployee 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 
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 paragraphs (1) 
through (5) of section 7512 of title 5, United States 
Code, including a suspension for more than 14 days 
without pay.’’. 
(3) SUBMISSION.—Not later than 30 days after 
the date of enactment of this Act, the Secretary 
shall submit the memorandum described in para-
graph (1) to the Inspector General of the Depart-
ment of Health and Human Services (referred to in 
this subsection as the ‘‘Inspector General’’) for ap-
proval. 
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(4) APPROVAL
OR
DISAPPROVAL.—Not later 
than 30 days after the submission of the memo-
randum under paragraph (3), or a revised memo-
randum under paragraph (6), the Inspector General 
shall approve or disapprove the memorandum or re-
vised memorandum, as the case may be. 
(5) NOTICE.—In the case of an approval under 
paragraph (4), not later than 30 days after such ap-
proval, the Secretary shall— 
(A) provide to each employee of the Indian 
Health Service an electronic copy of the ap-
proved memorandum; and 
(B) post such memorandum in a clear and 
conspicuous place on the website of the Indian 
Health Service for a period not less than 120 
days. 
(6) REVISED MEMORANDUM.—In the case of a 
disapproval under paragraph (4), not later than 15 
days after such disapproval, the Secretary shall sub-
mit a revised memorandum to the Inspector General 
for approval under paragraph (4). 
SEC. 202. FISCAL ACCOUNTABILITY. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.), as amended by sections 105 and 
106 is further amended by adding at the end the following: 
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‘‘SEC. 607. FISCAL ACCOUNTABILITY. 
‘‘(a) MANAGEMENT OF FUNDS.— 
‘‘(1) IN
GENERAL.—If the Secretary fails to 
submit the professional housing plan under section 
301(a) of the Restoring Accountability in the Indian 
Health Service Act of 2017 or the staffing plan 
under section 301(b) of that Act, the Secretary may 
not receive, obligate, transfer, or expend any 
amounts for a salary increase or bonus of an indi-
vidual described in paragraph (2) until the profes-
sional housing plan or staffing plan, as the case may 
be, is submitted. 
‘‘(2) INDIVIDUAL
DESCRIBED.—An individual 
described in this paragraph is an individual em-
ployed in a position in the Service that is a posi-
tion— 
‘‘(A) 
described 
under 
sections 
5312 
through 5316 of title 5, United States Code; 
‘‘(B) placed in level IV or V of the Execu-
tive Schedule under section 5317 of title 5, 
United States Code; 
‘‘(C) as a limited term appointee, limited 
emergency appointee, or noncareer appointee in 
the Senior Executive Service, as defined under 
paragraphs (5), (6), and (7), respectively, of 
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section 3132(a) of title 5, United States Code; 
or 
‘‘(D) under section 213.3301 or 213.3302 
of title 5, Code of Federal Regulations. 
‘‘(b) PRIORITIZATION OF PATIENT CARE.— 
‘‘(1) IN
GENERAL.—The Secretary shall use 
amounts available to the Indian Health Service that 
are not obligated or expended, including base budget 
funding and third party collections, during the fiscal 
year for which the amounts are made available, and 
that remain available, only to support patient care 
by using such funds for the costs of— 
‘‘(A) essential medical equipment; 
‘‘(B) purchased or referred care; or 
‘‘(C) staffing. 
‘‘(2) SPECIAL RULE.—In using amounts under 
paragraph (1), the Secretary shall ensure that, in 
any case where the amounts were originally made 
available for a particular Service unit, such amounts 
are used to benefit Indians served by that Service 
unit. 
‘‘(3) RESTRICTIONS.—The Secretary may not 
use amounts described in paragraph (1)— 
‘‘(A) to remodel or interior decorate any 
Area office; or 
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‘‘(B) to increase the rate of pay of any em-
ployee of an Area office. 
‘‘(c) SPENDING REPORTS.—Not later than 90 days 
after the end of each quarter of a fiscal year, the Secretary 
shall submit a report describing the authorizations, ex-
penditures, outlays, transfers, reprogramming, and obliga-
tions of each level of the Service, including the head-
quarters, each Area office, each Service unit, and each 
health clinic or facility, to— 
‘‘(1) each Indian tribe; 
‘‘(2) in the Senate— 
‘‘(A) the Committee on Indian Affairs; 
‘‘(B) the Committee on Health, Education, 
Labor, and Pensions; 
‘‘(C) the Committee on Appropriations; 
and 
‘‘(D) the Committee on the Budget; and 
‘‘(3) in the House of Representatives— 
‘‘(A) the Committee on Natural Resources; 
‘‘(B) the Committee on Energy and Com-
merce; 
‘‘(C) the Committee on Appropriations; 
and 
‘‘(D) the Committee on the Budget. 
‘‘(d) STATUS REPORTS.— 
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‘‘(1) IN GENERAL.—Subject to paragraph (2), 
not later than 180 days after the end of each fiscal 
year, the Secretary shall provide to each entity de-
scribed in paragraphs (1) through (3) of subsection 
(c) a report describing the safety, billing, certifi-
cation, credential, and compliance statuses of each 
facility managed, operated, or otherwise supported 
by the Service. 
‘‘(2) UPDATES.—With respect to any change of 
a status described in paragraph (1), the Secretary 
shall immediately provide to each entity described in 
paragraphs (1) through (3) of subsection (c) an up-
date describing such change. 
‘‘(e) RULE OF CONSTRUCTION.—This section may 
not be construed to inhibit the authority of an Indian tribe 
to enter into or maintain a compact or contract under the 
Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 5304 et seq.).’’. 
TITLE III—REPORTS 
SEC. 301. DEFINITIONS. 
In this title: 
(1) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(2) SERVICE.—The term ‘‘Service’’ means the 
Indian Health Service. 
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of this Act, and each year thereafter for a period of 5 
years, the Secretary shall develop, make publicly available, 
and submit to Congress a report on the data submitted 
under section 412(b) of the Indian Health Care Improve-
ment Act, as amended by section 107. 
SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 
(a) IHS HOUSING NEEDS REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date on which the Comptroller General of the 
United States receives the professional housing plan 
under section 302(a), the Comptroller General shall 
develop and submit to Congress a report on the pro-
fessional housing needs of employees of the Service. 
(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
(A) An evaluation of any existing, as of the 
date of the report, assessments and projections 
for the professional housing needs of employees 
of the Service, including discussion and conclu-
sion as to whether existing assessments and 
projections accurately reflect the professional 
housing needs of employees of the Service. 
(B) An assessment of the professional 
housing needs of employees of the Service for 
each Service area (as defined in section 4 of the 
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Indian Health Care Improvement Act (25 
U.S.C. 1603)). 
(C) An assessment of the professional 
housing plan developed by the Secretary under 
section 302(a). 
(b) IHS STAFFING NEEDS REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date on which the Comptroller General receives 
the report under section 302(b) of this Act, the 
Comptroller General shall prepare and submit to 
Congress a report on the staffing needs of the Serv-
ice. 
(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
(A) A description of the number and type 
of full-time positions needed at each facility of 
the Service and the amount of funds necessary 
to maintain such positions. 
(B) An assessment of the use of inde-
pendent contractors, including the number of 
independent contractors hired to fill vacant full- 
time positions and amounts spent on inde-
pendent contractors who provide health care 
services. 
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(C) An assessment of the staffing plan de-
veloped by the Secretary under section 302(b). 
(c) WHISTLEBLOWER PROTECTIONS REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Comptroller 
General shall develop and submit to Congress a re-
port on the efficacy of existing protections for whis-
tleblowers in the Service. 
(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
(A) A discussion and conclusion as to 
whether the Service has taken proper steps to 
prevent retaliation against whistleblowers. 
(B) If applicable, any recommendations for 
changes to the policy of the Service with respect 
to whistleblowers. 
(C) A discussion and conclusion as to 
whether the official email accounts of employees 
of the Service are appropriately monitored. 
SEC. 304. INSPECTOR GENERAL REPORTS. 
(a) PATIENT CARE REPORTS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, and every 2 years 
thereafter, the Inspector General of the Department 
of Health and Human Services shall develop and 
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submit to Congress and the Service a report on pa-
tient harm events occurring in Service units and de-
ferrals and denials of care of patients of the Service. 
(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
(A) An evaluation of the number and kind 
of events that contribute to patient deaths in a 
Service unit and recommendations regarding re-
ducing the number of patient deaths. 
(B) An evaluation of the Service’s tracking 
and reporting of, and response to, patient harm 
events and recommendations regarding how to 
improve such tracking, reporting, and response. 
(C) The effects of deferrals and denials of 
care on patients of the Service, including pa-
tient outcomes, and recommendations regarding 
how to reduce deferrals and denials of care. 
(b) REPORTING SYSTEMS AUDIT.—Not later than 2 
years after the date of enactment of this Act, the Inspector 
General shall— 
(1) conduct an audit of reporting systems of the 
Service, as of the date of enactment of this Act; and 
(2) provide to the Service recommendations and 
technical assistance regarding implementation of im-
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proved reporting systems, procedures, standards, 
and protocols. 
SEC. 305. TRANSPARENCY IN CMS SURVEYS. 
Section 1880 of the Social Security Act (42 U.S.C. 
1395qq) is amended by adding at the end the following: 
‘‘(g)(1) Not less frequently than once every 2 years, 
the Administrator of the Centers for Medicare & Medicaid 
Services shall conduct surveys to assess the compliance of 
each hospital or skilled nursing facility of the Indian 
Health Service with— 
‘‘(A) section 1867; and 
‘‘(B) conditions of participation in the program 
under this title. 
‘‘(2) Each survey completed under this subsection 
shall be posted on the Internet website of the Centers for 
Medicare & Medicaid Services. Such posting shall comply 
with the Federal regulations concerning the privacy of in-
dividually identifiable health information promulgated 
under section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996.’’. 
TITLE IV—TECHNICAL 
AMENDMENTS 
SEC. 401. TECHNICAL AMENDMENTS. 
The Indian Health Care Improvement Act (25 U.S.C. 
1601 et seq.) is amended— 
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(1) by striking ‘‘contract health service’’ each 
place such term appears (regardless of casing and 
typeface and including in the headings) and insert-
ing ‘‘purchased/referred care’’ (with appropriate cas-
ing and typeface); and 
(2) by striking ‘‘contract health services’’ each 
place such term appears (regardless of casing and 
typeface and including in the headings) and insert-
ing ‘‘purchased/referred care’’ (with appropriate cas-
ing and typeface). 
Æ 
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