IB 
Union Calendar No. 872 
115TH CONGRESS 
2D SESSION 
H. R. 5874 
[Report No. 115–1065, Part I] 
To amend the Indian Health Care Improvement Act to improve the 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 
MAY 18, 2018 
Mrs. NOEM (for herself, Mr. BISHOP of Utah, Mr. MULLIN, Mrs. MCMORRIS 
RODGERS, Mr. COLE, Mr. LAMALFA, Mr. CRAMER, Mrs. RADEWAGEN, 
and Miss GONZA´LEZ-COLO´N of Puerto Rico) introduced the following bill; 
which was referred to the Committee on Natural Resources, and in addi-
tion to the Committees on Energy and Commerce, Ways and Means, and 
Oversight and Government Reform, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
DECEMBER 3, 2018 
Reported from the Committee on Natural Resources 
DECEMBER 3, 2018 
Referral to the Committees on Energy and Commerce, Ways and Means, and 
Oversight and Government Reform extended for a period ending not later 
than December 28, 2018 
DECEMBER 28, 2018 
Committees on Energy and Commerce, Ways and Means, and Oversight and 
Government Reform discharged; committed to the Committee of the 
Whole House on the State of the Union and ordered to be printed 
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A BILL 
To amend the Indian Health Care Improvement Act to 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. 
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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 2018’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—INDIAN HEALTH SERVICE IMPROVEMENTS 
Sec. 101. Incentives for recruitment and retention. 
Sec. 102. Medical credentialing system. 
Sec. 103. Liability protections for health professional volunteers at Indian 
Health Service. 
Sec. 104. Clarification regarding eligibility for Indian Health Service loan 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 project. 
Sec. 109. Rule establishing tribal consultation policy. 
Sec. 110. Treatment of certain hospitals. 
TITLE II—EMPLOYEE PROTECTIONS 
Sec. 201. Employee protections against retaliation. 
Sec. 202. Right of Federal employees to petition Congress. 
Sec. 203. Fiscal accountability. 
TITLE III—REPORTS 
Sec. 301. Definitions. 
Sec. 302. Reports by the Secretary of Health and Human Services. 
Sec. 303. Reports by the Comptroller General. 
Sec. 304. Inspector General reports. 
Sec. 305. Transparency in CMS surveys. 
TITLE IV—TECHNICAL AMENDMENTS 
Sec. 401. Technical amendments. 
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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) RELOCATION COSTS.—The Secretary may pro-
vide to an employee of the Service reimbursement for any 
relocation costs the employee incurs if— 
‘‘(1) the employee relocates to a Service area 
experiencing a high level of need for employees, as 
determined by the Secretary; and 
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‘‘(2) the employee is filling a position that 
would otherwise be difficult to fill, as determined by 
the Secretary, in the absence of an incentive. 
‘‘(c) HOUSING VOUCHERS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
not later than 1 year after the date of enactment of 
the Restoring Accountability in the Indian Health 
Service Act of 2018, the Secretary may establish a 
program to provide tenant-based rental assistance to 
an employee of the Service who— 
‘‘(A) agrees to serve for not less than 1 
year at a Service unit designated by the 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 any 
such program is established. 
‘‘(d) ADMINISTRATION.— 
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‘‘(1) OPM GUIDELINES.—The Secretary shall 
carry out subsection (b) in accordance with any 
guidelines of the Office of Personnel Management 
relating to section 572 of title 5, Code of Federal 
Regulations (as in effect on the date of enactment 
of the Restoring Accountability in the Indian Health 
Service Act of 2018). 
‘‘(2) SERVICE
AGREEMENTS.—The Secretary 
may only provide reimbursement for any relocation 
costs under subsection (b) or any other benefit 
under subsection (c) to— 
‘‘(A) a full-time employee who agrees to 
serve for not less than 1 year in the Service, be-
ginning on the date of the agreement; or 
‘‘(B) a part-time employee who agrees to 
serve for not less than 2 years in the service be-
ginning on the date of the agreement.’’. 
SEC. 102. MEDICAL CREDENTIALING SYSTEM. 
Title I of the Indian Health Care Improvement Act 
(25 U.S.C. 1611 et seq.), as amended by section 101, is 
further amended by adding at the end the following: 
‘‘SEC. 126. MEDICAL CREDENTIALING SYSTEM. 
‘‘(a) IN GENERAL.— 
‘‘(1) DEVELOPMENT
AND
IMPLEMENTATION 
TIMELINE.—By not later than 1 year after the date 
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of enactment of the Restoring Accountability in the 
Indian Health Service Act of 2018, the Secretary, 
acting through the Service and in accordance with 
the requirements described in subsection (b), shall 
develop and implement a Service-wide centralized 
electronic credentialing system (referred to in this 
section as the ‘credentialing system’) to credential li-
censed health professionals who seek to provide 
health care services at any Service unit, including 
physicians, nurses and physicians assistants. 
‘‘(2) IMPLEMENTATION.—In implementing the 
credentialing system, the Secretary— 
‘‘(A) shall not require re-credentialing of 
licensed 
health 
professionals 
who 
were 
credentialed using existing Service policy prior 
to the date of enactment of the Restoring Ac-
countability in the Indian Health Service Act of 
2018; and 
‘‘(B) shall— 
‘‘(i) use the credentialing system for 
all new applications of licensed health pro-
fessionals and the migration of credentials 
data that existed prior to implementation 
into the system; 
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‘‘(ii) maintain the established timeline 
for re-credentialing of licensed health pro-
fessionals who were credentialed prior to 
implementation, as defined by Service pol-
icy; and 
‘‘(iii) review credentials for all profes-
sionals in the system, based on updated 
policies, on a not less than yearly basis. Li-
censed health professionals whose creden-
tials would not have been approved under 
the updated policies shall have 90 days to 
meet the new requirements. 
‘‘(b) 
REQUIREMENTS.—In 
developing 
the 
credentialing system under subsection (a), the Secretary 
shall ensure the following: 
‘‘(1) Credentialing procedures shall be uniform 
and integrated throughout the Service. 
‘‘(2) With respect to each licensed health pro-
fessional 
who 
successfully 
completes 
the 
credentialing procedures of the credentialing system, 
the Secretary may authorize each such professional 
to provide health care services at any Service unit. 
‘‘(3) Credentialing procedures shall include 
verification of licensure, education, employment his-
tory, and criminal background checks and history. 
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‘‘(c) 
CONSULTATION.—In 
developing 
the 
credentialing system under subsection (a), the Secretary 
shall consult with Indian Tribes and may also consult with 
any public or private association of medical providers, any 
government agency, or other relevant expert, as deter-
mined by the Secretary. 
‘‘(d) APPLICATION.—A licensed health care profes-
sional may not provide health care services at any Service 
unit, unless such professional successfully completes the 
credentialing procedures of the credentialing system devel-
oped under subsection (a). 
‘‘(e) REGULATIONS.—The Secretary may prescribe 
such regulations as may be necessary to carry out the pro-
visions of this section. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion may be construed— 
‘‘(1) to negatively impact the right of an Indian 
Tribe to enter into a compact or contract under the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 5304 et seq.); and 
‘‘(2) to apply to such a compact or contract un-
less expressly agreed to by the Indian Tribe.’’. 
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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, an employee of an IHS urban Indian health 
program and a health professional volunteer at a 
Service unit shall, in providing a health service to an 
individual, be deemed to be an employee of the Pub-
lic Health Service for a calendar year that begins 
during a fiscal year for which a transfer was made 
under paragraph (4)(C). The preceding sentence is 
subject to the provisions of this subsection. 
‘‘(2) CONDITIONS.—In providing a health 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 
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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. 
‘‘(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 
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Service policy and applicable law regarding the 
provision of the service. 
‘‘(3) APPLICABILITY.—Subsection (g) (other 
than paragraphs (3) and (5)) and subsections (h), 
(i), and (l) apply to an employee of an IHS urban 
Indian health program and to a health care practi-
tioner at a Service unit for purposes of this sub-
section to the same extent and in the same manner 
as such subsections apply to an officer, governing 
board member, employee, or contractor of an entity 
described in subsection (g)(4), subject to paragraph 
(4) and subject to the following subparagraphs: 
‘‘(A) Each reference to an entity in sub-
sections (g), (h), (i), and (l) shall be considered 
to be a reference to an IHS urban Indian 
health program or a Service unit, as applicable. 
‘‘(B) The first sentence of paragraph (1) 
applies in lieu of the first sentence of subsection 
(g)(1)(A). 
‘‘(C) With respect to a Service unit, a 
health care practitioner is not a health profes-
sional volunteer at the Service unit unless the 
Service unit sponsors the health care practi-
tioner. For purposes of this subsection, the 
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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 
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 
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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 employees of an IHS 
urban Indian health program or health 
professional volunteers, will be paid pursu-
ant to this section during the calendar year 
that begins in the following fiscal year. 
‘‘(ii) 
APPLICABILITY.—Subsection 
(k)(1)(B) applies to the estimate under 
clause (i) relating to employees of an IHS 
urban Indian health program or health 
professional volunteers to the same extent 
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and in the same manner as that subsection 
applies to the estimate under that sub-
section relating to officers, governing board 
members, employees, and contractors of 
entities described 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) DEFINITIONS.— 
‘‘(A) IHS URBAN
INDIAN
HEALTH
PRO-
GRAM.—In this subsection, the term ‘IHS 
urban Indian health program’ means an urban 
Indian health program operated by an urban 
Indian organization pursuant to a grant or con-
tract with the Indian Health Service under title 
V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.). 
‘‘(B) SERVICE UNIT.—In this subsection, 
the term ‘Service unit’ has the meaning given 
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the term in section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603). 
‘‘(6) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection may be construed— 
‘‘(A) to negatively impact the right of an 
Indian Tribe to enter into a compact or con-
tract under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5304 et 
seq.); and 
‘‘(B) to apply to such a compact or con-
tract 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, 2019. 
‘‘(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 2018, the Secretary 
may— 
‘‘(i) prescribe regulations for carrying 
out this subsection; and 
‘‘(ii) accept and consider applications 
submitted under paragraph (3)(C)(i).’’. 
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