ment of this Act using the updated authorities pro-
vided in the amendments made by this Act. 
(3) The appropriate details of removals, demo-
tions, 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 
(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) Notwithstanding any other provision of law, be-
ginning with the year of the date of enactment of the Re-
storing Accountability in the Indian Health Service Act 
of 2018, 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 
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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. 108. 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— 
‘‘(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-
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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) EFFECT OF STAFFING AWARDS.—No staffing 
resources provided under this section shall reduce the re-
curring base funding for staffing for any Indian Tribe or 
federally managed Service unit. 
‘‘(e) 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-
mittee on Energy and Commerce of the House of Rep-
resentatives, regarding the project, including— 
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‘‘(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. 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 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 2018, the Secretary shall es-
tablish, after meaningful consultation with representatives 
of affected Indian Tribes, a rule establishing a tribal con-
sultation policy for the Service. 
‘‘(b) CONTENTS
OF TRIBAL CONSULTATION POL-
ICY.—The policy established under the rule described in 
subsection (a) shall— 
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‘‘(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 noti-
fied. 
‘‘(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.’’. 
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 published by the Centers for Medicare & Med-
icaid Services in the Federal Register on August 14, 2017, 
and entitled ‘‘Medicare Program; Hospital Inpatient Pro-
spective Payment Systems for Acute Care Hospitals and 
the Long-Term Care Hospital Prospective Payment Sys-
tem and Policy Changes and Fiscal Year 2018 Rates; 
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Quality Reporting Requirements for Specific Providers; 
Medicare and Medicaid Electronic Health Record (EHR) 
Incentive Program Requirements for Eligible Hospitals, 
Critical Access Hospitals, and Eligible Professionals; Pro-
vider-Based Status of Indian Health Service and Tribal 
Facilities and Organizations; Costs Reporting and Pro-
vider Requirements; Agreement Termination Notices’’ (82 
Fed Reg. 37990; 38188–38189), shall apply with respect 
to discharges occurring in fiscal year 2011 and subsequent 
fiscal years. 
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 sections 105 and 106, is further amended by 
adding at the end the following: 
‘‘SEC. 608. EMPLOYEE PROTECTIONS AGAINST RETALIA-
TION. 
‘‘(a) EMPLOYEE ACCOUNTABILITY.— 
‘‘(1) AGENCY
REPORTING
PROCESS
REQUIRE-
MENT.—The Secretary shall designate an official in 
the Department who is not an employee of the Serv-
ice to— 
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‘‘(A) receive reports from an employee of 
the Service who witnesses retaliation against a 
whistleblower, a violation of a patient safety re-
quirement, or other similar conduct; and 
‘‘(B) conduct active and ongoing outreach 
to all employees of the Service about— 
‘‘(i) Federal and Department systems 
for reporting retaliation against whistle-
blowers; and 
‘‘(ii) the duty of individual employees 
of the Service to report violations of pa-
tient safety requirements and other similar 
conduct. 
‘‘(2) OVERSIGHT.—Not later than 3 days after 
the date on which the official designated by the Sec-
retary under paragraph (1) receives a report under 
paragraph (1)(A), the Secretary shall— 
‘‘(A) formally review the report; and 
‘‘(B) provide a copy of such report and any 
other relevant information to the Inspector 
General of the Department. 
‘‘(3) REMOVAL FOR WHISTLEBLOWER RETALIA-
TION.—The Secretary may remove for misconduct 
from the civil service (as defined in section 2101 of 
title 5, United States Code), in accordance with sec-
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tions 606 and 607, an employee of the Service if the 
Secretary determines, after completing a report re-
view described in paragraph (2), that the employee 
has retaliated against a whistleblower and warrants 
removal. 
‘‘(4) 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. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) RETALIATION.—The term ‘retaliation’— 
‘‘(A) means an adverse employment action 
or any significantly adverse action against a 
whistleblower, such as the refusal or delay of 
care provided through the Service; and 
‘‘(B) includes instances where the adverse 
action described in subparagraph (A) is per-
petrated against a family member or friend of 
the whistleblower because of the whistleblower’s 
disclosure of information. 
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‘‘(2) WHISTLEBLOWER.—The term ‘whistle-
blower’ means an employee of Service who discloses 
information— 
‘‘(A) that the employee reasonably believes 
evidences— 
‘‘(i) a violation of any law, rule, or 
regulation; or 
‘‘(ii) gross mismanagement, a gross 
waste of funds, an abuse of authority, or 
a substantial and specific danger to public 
health or safety; and 
‘‘(B) if such disclosure is not specifically 
prohibited by law and if such information is not 
specifically required by Executive Order to be 
kept secret in the interest of national defense or 
the conduct of foreign affairs.’’. 
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 
‘‘(a) IN GENERAL.—The right of’’; and 
(2) by adding at the end the following new sub-
section: 
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‘‘(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-
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 
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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. 
(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— 
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(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. 203. FISCAL ACCOUNTABILITY. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.), as amended by sections 105, 
106, and 201, is further amended by adding at the end 
the following: 
‘‘SEC. 609. 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 2018 or the staffing plan 
under section 301(b) of that Act, the Secretary may 
not receive, obligate, transfer, or expend any 
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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 
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.—Notwithstanding any other 
provision of law, the Secretary shall use amounts 
available to the Indian Health Service that are not 
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obligated or expended, including base budget fund-
ing 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 
‘‘(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-
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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.— 
‘‘(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 
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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.—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.’’. 
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 
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Indian Health Care Improvement Act (25 U.S.C. 
1603). 
SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND 
HUMAN SERVICES. 
(a) IHS PROFESSIONAL HOUSING PLAN.—Not later 
than 1 year after the date the Government Accountability 
Office releases their ongoing report about Indian Health 
Service housing needs, the Secretary shall develop, make 
publicly available, and submit to Congress and the Comp-
troller General of the United States a written plan to ad-
dress the professional housing needs of employees of the 
Service that comports with the practices and recommenda-
tions of the Government Accountability Office relating to 
professional housing. 
(b) PLAN RELATING TO IHS STAFFING NEEDS.— 
Not later than 1 year after the date the Government Ac-
countability Office releases their ongoing report about In-
dian Health Service housing needs, the Secretary shall de-
velop, make publicly available, and submit to Congress and 
the Comptroller General of the United States a written 
plan to address staffing needs in the Service that comports 
with the practices of the Government Accountability Office 
relating to workforce planning. 
(c) INDIAN HEALTH CARE IMPROVEMENT ACT RE-
PORT.—Not later than 1 year after the date of enactment 
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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 
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 5 years after 
the date on which the Comptroller General receives 
the report under section 302(b), the Comptroller 
General shall prepare and submit to Congress a re-
port on the staffing needs of the Service. 
(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 explanation of the various meth-
odologies that the Service utilizes and has pre-
viously utilized to determine the number and 
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type of full-time positions needed at federally 
managed Service units. 
(C) 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. 
(D) 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. 
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(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 not less 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 patient harm events occurring in Service 
units and deferrals 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-
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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-
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— 
‘‘(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 
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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— 
(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). 
VerDate Sep 11 2014 
21:35 Dec 28, 2018
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