‘‘SEC. 610. FISCAL ACCOUNTABILITY. 
‘‘(a) MANAGEMENT OF FUNDS.— 
‘‘(1) IN
GENERAL.—If the Secretary fails to 
submit a professional housing plan under section 
302(a) of the Restoring Accountability in the Indian 
Health Service Act of 2022 or a staffing plan under 
section 302(b) of that Act by the applicable dead-
line, the Secretary may not receive, obligate, trans-
fer, or expend any amounts for a salary increase or 
bonus of an individual described in paragraph (2) 
until the professional housing plan or staffing plan, 
as applicable, is submitted. 
‘‘(2) INDIVIDUAL
DESCRIBED.—An individual 
referred to in paragraph (1) is an individual em-
ployed in the Service— 
‘‘(A) in a position that is— 
‘‘(i) described in any of sections 5312 
through 5316 of title 5, United States 
Code; 
‘‘(ii) placed in level IV or V of the Ex-
ecutive Schedule under section 5317 of 
title 5, United States Code; or 
‘‘(iii) described in section 213.3301 or 
213.3302 of title 5, Code of Federal Regu-
lations (or a successor regulation); or 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00079
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(B) as a limited term appointee, limited 
emergency appointee, or noncareer appointee 
(as those terms are defined in section 3132(a) 
of title 5, United States Code). 
‘‘(b) PRIORITIZATION OF PATIENT CARE.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall use amounts 
available to the Service that are not obligated or ex-
pended, including base budget funding and third 
party collections, during the fiscal year for which the 
amounts are made available, and that remain avail-
able, only to support patient care by using the 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any case where the amounts were originally made 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, the amounts 
are used to benefit Indians served by that Service 
unit. 
‘‘(3) HHS PLAN.—Each applicable fiscal year, 
the Secretary, in consultation with Indian tribes, 
shall establish a plan for distributing the amounts 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00080
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
described in paragraph (1) across the categories of 
uses described in subparagraphs (A) through (C) of 
that paragraph. 
‘‘(4) RESTRICTIONS.—The Secretary may not 
use amounts described in paragraph (1)— 
‘‘(A) to remodel or interior decorate any 
Area office; or 
‘‘(B) to increase the rate of pay of any em-
ployee of an Area office. 
‘‘(c) SPENDING REPORTS.—Not later than 90 days 
after the end of each fiscal year, the Secretary shall sub-
mit a report describing the authorizations, expenditures, 
outlays, transfers, reprogramming, and obligations of each 
level of the Service, including the headquarters, each Area 
office, each Service unit, and each health clinic or facility, 
to— 
‘‘(1) each Indian tribe; 
‘‘(2) in the Senate— 
‘‘(A) the Committee on Indian Affairs; 
‘‘(B) the Committee on Health, Education, 
Labor, and Pensions; 
‘‘(C) the Committee on Appropriations; 
and 
‘‘(D) the Committee on the Budget; and 
‘‘(3) in the House of Representatives— 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00081
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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.— 
‘‘(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 the change. 
‘‘(e) 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 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00082
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(2) applies to such a compact or contract un-
less expressly agreed to by the Indian tribe.’’. 
TITLE III—REPORTS 
SEC. 301. DEFINITIONS. 
In this title: 
(1) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(2) SERVICE.—The term ‘‘Service’’ means the 
Indian Health Service. 
(3) SERVICE UNIT.—The term ‘‘Service unit’’ 
has the meaning given the term in section 4 of the 
Indian Health Care Improvement Act (25 U.S.C. 
1603). 
(4) TRIBAL
HEALTH
PROGRAM.—The term 
‘‘tribal health program’’ has the meaning given the 
term in section 4 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603). 
SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND 
HUMAN SERVICES. 
(a) IHS PROFESSIONAL HOUSING PLAN.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall develop, make publicly available, and submit to 
Congress and the Comptroller General of the United 
States a written plan to address the professional 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00083
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
housing needs of employees of the Service and em-
ployees of tribal health programs that comports with 
the practices and recommendations of the Govern-
ment Accountability Office relating to professional 
housing included in the most recent report of the 
Government Accountability Office regarding Indian 
Health Service housing needs. 
(2) REQUIREMENT.—The plan under paragraph 
(1) shall include, at a minimum, projections for the 
professional housing needs for— 
(A) the 1-year period following the date of 
the plan; 
(B) the 5-year period following the date of 
the plan; and 
(C) the 10-year period following the date 
of the plan. 
(b) PLAN RELATING TO IHS STAFFING NEEDS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date on which the Government Accountability 
Office releases the report described in subsection (a), 
the Secretary shall develop, make publicly available, 
and submit to Congress and the Comptroller General 
of the United States a written plan to address the 
staffing needs of the Service and tribal health pro-
grams that comports with the practices and rec-
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00084
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
ommendations of the Government Accountability Of-
fice relating to workforce planning included in the 
report. 
(2) REQUIREMENT.—The plan under paragraph 
(1) shall include, at a minimum, projections for the 
staffing needs for— 
(A) the 1-year period following the date of 
the plan; 
(B) the 5-year period following the date of 
the plan; and 
(C) the 10-year period following the date 
of the plan. 
SEC. 303. REPORTS BY THE COMPTROLLER GENERAL. 
(a) IHS HOUSING NEEDS REPORT.—Not later than 
2 years after the date on which the Comptroller General 
of the United States receives the professional housing plan 
under section 302(a), the Comptroller General shall de-
velop and submit to Congress a report that includes— 
(1) an assessment of the professional housing 
plan; 
(2) an evaluation of any existing, as of the date 
of the report, assessments and projections for the 
professional housing needs of employees of the Serv-
ice and employees of tribal health programs, includ-
ing a discussion and conclusions as to whether the 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00085
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
existing assessments and projections accurately re-
flect the professional housing needs of employees of 
the Service and employees of tribal health programs; 
and 
(3) an assessment of the professional housing 
needs of— 
(A) employees of the Service for each Serv-
ice area (as defined in section 4 of the Indian 
Health Care Improvement Act (25 U.S.C. 
1603)); and 
(B) employees of tribal health programs 
for each Indian tribe, as applicable. 
(b) IHS STAFFING NEEDS REPORT.— 
(1) IN GENERAL.—Not later than 2 years after 
the date on which the Comptroller General receives 
the plan relating to IHS staffing needs under sec-
tion 302(b), the Comptroller General shall prepare 
and submit to Congress a report on the staffing 
needs of the Service and tribal health programs. 
(2) CONTENTS.—The report under paragraph 
(1) shall include— 
(A) an assessment of the staffing plan re-
ferred to in paragraph (1); 
(B) a description of— 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00086
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
(i) the number and type of full-time 
positions needed at each facility of the 
Service and at each tribal health program; 
and 
(ii) the amount of funds necessary to 
maintain those positions; 
(C) an explanation of the various meth-
odologies that the Service uses and has pre-
viously used to determine the number and type 
of full-time positions needed at federally man-
aged Service units; and 
(D) an assessment of the use of inde-
pendent contractors, including— 
(i) the number of independent con-
tractors hired to fill vacant full-time posi-
tions; and 
(ii) the amount of funds spent on 
independent 
contractors 
who 
provide 
health care services. 
(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, including the protections 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00087
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
implemented pursuant to sections 201 and 202 and 
the amendments made by those sections. 
(2) CONTENTS.—The report under paragraph 
(1) shall include— 
(A) a discussion and conclusions 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; and 
(C) a discussion and conclusions as to 
whether the official email accounts of employees 
of the Service are appropriately monitored. 
SEC. 304. INSPECTOR GENERAL REPORTS. 
(a) PATIENT CARE REPORTS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, and not less fre-
quently than every 3 years thereafter, the Inspector 
General of the Department of Health and Human 
Services shall develop and submit to Congress and 
the Service a report on— 
(A) patient harm events and patient deaths 
occurring in Service units; 
(B) deferrals and denials of care of pa-
tients of the Service; and 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00088
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
(C) the standards to improve the timeli-
ness of care, developed in accordance with sec-
tion 412 of the Indian Health Care Improve-
ment Act (as added by section 115), and qual-
ity of care at Service facilities, including quality 
and performance measures developed 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. 
(2) CONTENTS.—The report under paragraph 
(1) shall include— 
(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 how the Service 
tracks, reports, and responds to patient harm 
events and patient deaths and recommendations 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00089
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
regarding how to improve the tracking, report-
ing, and response; and 
(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 of the Department of Health and Human Services 
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-
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 of participating Indian 
Health Service facilities to assess the compliance of each 
hospital or skilled nursing facility of the Indian Health 
Service with— 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00090
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(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. 
(a) DEFINITIONS.—Section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603) is amended— 
(1) in paragraph (5), by striking the paragraph 
designation and heading and all that follows through 
‘‘means’’ and inserting the following: 
‘‘(5) PURCHASED/REFERRED CARE.—The term 
‘purchased/referred care’ means’’; and 
(2) by redesignating paragraph (5) and para-
graphs (6) through (15) as paragraph (15) and 
paragraphs (5) through (14), respectively, and mov-
ing the paragraphs so as to appear in numerical 
order. 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00091
Fmt 6652
Sfmt 6201
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS
(b) TECHNICAL AMENDMENTS.—The Indian Health 
Care Improvement Act (25 U.S.C. 1601 et seq.) is amend-
ed— 
(1) by striking ‘‘contract health service’’ each 
place it appears (regardless of casing and typeface 
and including in the headings) and inserting ‘‘pur-
chased/referred care’’ (with appropriate casing and 
typeface); and 
(2) by striking ‘‘contract health services’’ each 
place it appears (regardless of casing and typeface 
and including in the headings) and inserting ‘‘pur-
chased/referred care’’ (with appropriate casing and 
typeface). 
Æ 
VerDate Sep 11 2014 
22:56 Sep 28, 2022
Jkt 029200
PO 00000
Frm 00092
Fmt 6652
Sfmt 6301
E:\BILLS\H8937.IH
H8937
pamtmann on DSKBC07HB2PROD with BILLS