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) by amending subparagraph (B) of sub-
section (b)(1) to read as follows: 
‘‘(B) have— 
‘‘(i)(I) a degree in a health profession; 
and 
‘‘(II) a license to practice a health 
profession in a State; or 
‘‘(ii)(I) a master’s degree in business 
administration with an emphasis in health 
care management (as defined by the Sec-
retary), health administration, hospital ad-
ministration, or public health; and 
‘‘(II) a license or certification to prac-
tice in the field of business administration, 
health administration, hospital administra-
tion, or public health in a State, if the Sec-
retary determines such license or certifi-
cation necessary for the Indian health pro-
gram to which the individual will be as-
signed; 
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‘‘(iii) maintain credentials as deter-
mined by the system described in section 
102; and 
‘‘(iv) participate in the training de-
scribed in section 107;’’; 
(2) by amending clause (iii) of subsection 
(f)(1)(B) to read as follows: 
‘‘(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 such 
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 such 
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)— 
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(A) by redesignating subparagraph (B) as 
subparagraph (C); and 
(B) in subparagraph (A)— 
(i) by striking the first sentence of the 
matter preceding clause (i) and inserting 
the following: ‘‘In the case of an individual 
who contracts to serve a period of obli-
gated 
service 
under 
subsection 
(f)(1)(B)(iii)(I), for each year of such obli-
gated 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 Service Act (42 
U.S.C. 254l–1(g)(2)(A))) on behalf of the 
individual for loans described in paragraph 
(1). In the case of an individual who con-
tracts to serve a period of obligated service 
under subsection (f)(1)(B)(iii)(II), for each 
year of such obligated service, the Sec-
retary may pay up to $17,500 on behalf of 
the individual for loans described in para-
graph (1)’’; and 
(ii) by striking ‘‘In making a deter-
mination’’ and inserting the following: 
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‘‘(B) In making a determination under this 
paragraph’’. 
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 such 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.—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 located within 
the defined geographic area of such Area office or Service 
unit, as the case may be, of the content of an inclusion 
in an employment record. Each such Indian Tribe may 
submit comment to the Secretary during the 10-day period 
after the date of such notification regarding such con-
tent.’’. 
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(b) IN GENERAL.—Subsection (c) of section 2 of the 
Act of December 15, 1979 (25 U.S.C. 5117), is amended 
by adding the following: 
‘‘(3) IHS WAIVERS.—The Secretary of Health 
and Human Services may, at the request of an In-
dian Tribe, seek from each Indian Tribe concerned, 
a waiver of Indian preference laws for a personnel 
action that is with respect to— 
‘‘(A) an Indian Health Service unit in 
which 15 percent or more of the total positions 
or specific health professionals in the Service 
unit are not filled by a full-time employee of the 
Indian Health Service for a period of 6 months 
or longer; or 
‘‘(B) a former employee of the Indian 
Health Service or a former tribal employee who 
was removed from such former employment 
within, or demoted for performance or mis-
conduct that occurred during, the 5-year period 
following the date of such personnel action.’’. 
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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 further amended by adding 
at the end the following: 
‘‘SEC. 606. IMPROVED AUTHORITIES OF SECRETARY TO IM-
PROVE ACCOUNTABILITY OF SENIOR EXECU-
TIVES OF THE INDIAN HEALTH SERVICE. 
‘‘(a) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may, as pro-
vided in this section, reprimand or suspend, involun-
tarily reassign, demote, or remove a covered indi-
vidual from a senior executive position at the Service 
if the Secretary determines that the misconduct or 
performance of the covered individual warrants such 
action. 
‘‘(2) REMOVAL FROM CIVIL SERVICE.—If the 
Secretary removes an individual pursuant to para-
graph (1), the Secretary may remove the individual 
from the civil service (as defined in section 2101 of 
title 5, United States Code). 
‘‘(b) RIGHTS AND PROCEDURES.— 
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ered individual under paragraph (1)(A). The 
decision shall be in writing, and shall include 
the specific reasons for the decision. 
‘‘(3) GRIEVANCE
PROCESS.—The Secretary 
shall ensure that the grievance process established 
under paragraph (1)(C) takes fewer than 21 days. 
‘‘(4) FINAL AND CONCLUSIVE DECISION.—A de-
cision under paragraph (2) that is not grieved, and 
a grievance decision under paragraph (3), shall be 
final and conclusive. 
‘‘(5) 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 such 
decision. 
‘‘(6) COURT REVIEW.—In any case in which ju-
dicial review is sought under paragraph (5), the 
court shall review the record and may set aside any 
Department action 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. 
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‘‘(c) RELATION TO OTHER PROVISIONS OF LAW.— 
Section 3592(b)(1) of title 5, United States Code, does 
not apply to an action under subsection (a). 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) COVERED
INDIVIDUAL.—The term ‘cov-
ered individual’ means a career appointee (as that 
term is defined in section 3132(a) of title 5, United 
States Code). 
‘‘(2) MISCONDUCT.—The term ‘misconduct’ in-
cludes neglect of duty, malfeasance, or failure to ac-
cept a directed reassignment or to accompany a po-
sition in a transfer of function. 
‘‘(3) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services, acting 
through the Director of the Service. 
‘‘(4) SENIOR EXECUTIVE POSITION.—The term 
‘senior executive position’ means a Senior Executive 
Service position (as that term is defined in section 
3132(a) of title 5, United States Code). 
‘‘SEC. 607. IMPROVED AUTHORITIES OF SECRETARY TO IM-
PROVE ACCOUNTABILITY OF EMPLOYEES OF 
THE INDIAN HEALTH SERVICE. 
‘‘(a) IN GENERAL.— 
‘‘(1) AUTHORITY.—The Secretary may remove, 
demote, or suspend a covered individual who is an 
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employee of the Service if the Secretary determines 
the performance or misconduct of the covered indi-
vidual warrants such removal, demotion, or suspen-
sion. 
‘‘(2) ACTIONS.—If the Secretary removes, de-
motes, or suspends a covered individual pursuant to 
paragraph (1), the Secretary may— 
‘‘(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 a reduction in grade for which the 
covered individual is qualified, that the Sec-
retary determines is appropriate, and that re-
duces the annual rate of pay of the covered in-
dividual; or 
‘‘(C) suspend the covered individual. 
‘‘(b) PAY OF CERTAIN DEMOTED INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, any covered individual subject to a 
demotion under subsection (a)(2) shall, beginning on 
the date of such demotion, receive the annual rate 
of pay applicable to such grade. 
‘‘(2) RESTRICTIONS.— 
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‘‘(A) PROHIBITION
ON
ADMINISTRATIVE 
LEAVE.—A covered individual subject to a de-
motion under subsection (a)(2) may not be 
placed on administrative leave during the period 
during which an appeal (if any) under this sec-
tion is ongoing, and may only receive pay if the 
covered individual reports for duty or is ap-
proved to use accrued unused annual, sick, fam-
ily medical, military, or court leave. 
‘‘(B) RESTRICTION
ON
PAY
AND
BENE-
FITS.—If a covered individual subject to a de-
motion under subsection (a)(2) does not report 
for duty or receive approval to use accrued un-
used leave, such covered individual shall not re-
ceive pay or other benefits pursuant to sub-
section (d)(5). 
‘‘(c) PROCEDURES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) AGGREGATE PERIOD.—The aggregate 
period for notice, response, and final decision in 
a removal, demotion, or suspension under this 
section may not exceed 15 business days. 
‘‘(B) PERIOD FOR RESPONSE.—The period 
for the response of a covered individual to a no-
tice of a proposed removal, demotion, or sus-
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pension under this section shall be 7 business 
days. 
‘‘(C) REPRESENTATION BY ATTORNEY OR 
OTHER
REPRESENTATIVE.—Paragraph (3) of 
subsection (b) of section 7513 of title 5, United 
States Code, shall apply with respect to a re-
moval, demotion, or suspension under this sec-
tion. 
‘‘(D) PROCEDURES SUPERSEDING CBAS.— 
The procedures in this subsection shall super-
sede any collective bargaining agreement to the 
extent that such agreement is inconsistent with 
such procedures. 
‘‘(2) FINAL
DECISION.—The Secretary shall 
issue a final decision with respect to a removal, de-
motion, or suspension under this section not later 
than 15 business days after the Secretary provides 
notice, including a file containing all the evidence in 
support of the proposed action, to the covered indi-
vidual of the removal, demotion, or suspension. The 
decision shall be in writing and shall include the spe-
cific reasons for the decision. 
‘‘(3) PERFORMANCE
APPRAISAL.—The proce-
dures under chapter 43 of title 5, United States 
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Code, shall not apply to a removal, demotion, or sus-
pension under this section. 
‘‘(4) APPEAL TO MERIT SYSTEMS PROTECTION 
BOARD.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B) and subsection (d), any removal or 
demotion under this section, and any suspen-
sion of more than 14 days under this section, 
may be appealed to the Merit Systems Protec-
tion Board, which shall refer such appeal to an 
administrative 
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 such appeal is 
made not later than 10 business days after the 
date of such removal, demotion, or suspension. 
‘‘(d) EXPEDITED REVIEW.— 
‘‘(1) IN GENERAL.—Upon receipt of an appeal 
under subsection (c)(4)(A), the administrative judge 
shall expedite any such appeal under section 
7701(b)(1) of title 5, United States Code, and, in 
any such case, shall issue a final and complete deci-
sion not later than 180 days after the date of the 
appeal. 
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‘‘(6) PROHIBITION AGAINST STAYS.—The Merit 
Systems Protection Board may not stay any removal 
or demotion under this section, except as provided in 
section 1214(b) of title 5, United States Code. 
‘‘(7) RESTRICTION ON PAY AND BENEFITS DUR-
ING APPEAL.—During the period beginning on the 
date on which a covered individual appeals a removal 
from the civil service under subsection (c) and end-
ing on the date that the United States Court of Ap-
peals for the Federal Circuit issues a final decision 
on such appeal, such covered individual may not re-
ceive any pay, awards, bonuses, incentives, allow-
ances, differentials, student loan repayments, special 
payments, or benefits related 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. 
‘‘(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). 
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‘‘(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 set forth in 
subsection (c) and this subsection shall apply. 
‘‘(e) 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 such covered individual 
under subsection (a) without the approval of the Special 
Counsel under section 1214(f) of title 5, United States 
Code. 
‘‘(f) TERMINATION OF INVESTIGATIONS BY OFFICE 
OF SPECIAL COUNSEL.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Special Counsel (established by 
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 
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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). 
‘‘(g) VACANCIES.—In the case of a covered individual 
who is removed or demoted under subsection (a), to the 
maximum extent feasible, the Secretary shall fill the va-
cancy arising as a result of such removal or demotion. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) COVERED
INDIVIDUAL.—The term ‘cov-
ered individual’ means an individual occupying a po-
sition at the Service, but does not include— 
‘‘(A) an individual occupying a senior exec-
utive position (as defined in section 606(d)); 
‘‘(B) an individual who has not completed 
a probationary or trial period; or 
‘‘(C) a political appointee. 
‘‘(2) GRADE.—The term ‘grade’ has the mean-
ing given such term in section 7511(a) of title 5, 
United States Code. 
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‘‘(3) MISCONDUCT.—The term ‘misconduct’ in-
cludes neglect of duty, malfeasance, or failure to ac-
cept a directed reassignment or to accompany a po-
sition in a transfer of function. 
‘‘(4) POLITICAL APPOINTEE.—The term ‘polit-
ical appointee’ means an individual who is— 
‘‘(A) employed in a position described 
under 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 in 
the Senior Executive Service, as defined under 
paragraphs (5), (6), and (7), respectively, of 
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 successor regu-
lation. 
‘‘(5) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services, acting 
through the Director of the Service. 
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‘‘(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) 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.’’. 
(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 shall submit a report 
to Congress that includes the following: 
(1) The number of employees of the Indian 
Health Service who were removed, demoted, or sus-
pended in the 1-year period before the date of enact-
ment of this Act. 
(2) The number of employees of the Indian 
Health Service who were removed, demoted, or sus-
pended in the 1-year period after the date of enact-
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