I 
115TH CONGRESS 
1ST SESSION H. R. 2662 
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 25, 2017 
Mrs. NOEM (for herself, Mr. BISHOP of Utah, Mr. MULLIN, Mrs. MCMORRIS 
RODGERS, and Mr. COLE) introduced the following bill; which was re-
ferred to the Committee on Natural Resources, and in addition to the 
Committees on Energy and Commerce, Ways and Means, and Oversight 
and Government Reform, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
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. 
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 2017’’. 
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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. Removal or demotion of Indian Health Service employees based on 
performance or misconduct. 
Sec. 107. Standards to improve timeliness of care. 
Sec. 108. Tribal culture and history. 
Sec. 109. Staffing demonstration project. 
Sec. 110. Rule establishing tribal consultation policy. 
TITLE II—EMPLOYEE PROTECTIONS 
Sec. 201. Right of Federal employees to petition Congress. 
Sec. 202. 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. 
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: 
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‘‘SEC. 125. INCENTIVES FOR RECRUITMENT AND RETEN-
TION. 
‘‘(a) PARITY IN PAY.—The Secretary shall establish 
a pay system for physicians, dentists, nurses, and other 
health care professionals employed by the Service that pro-
vides pay that, to the maximum extent practicable, is com-
parable to the pay provided to physicians, dentists, nurses, 
and other health care professionals, respectively, under 
subchapters 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 
‘‘(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 2017, the Secretary may establish a 
program to provide tenant-based rental assistance to 
an employee of the Service who— 
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‘‘(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)); 
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.— 
‘‘(1) OPM GUIDELINES.—The Secretary shall 
carry out this section in accordance with any guide-
lines of the Office of Personnel Management relating 
to the recruitment and retention of employees, in-
cluding section 575.109 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 2017). 
‘‘(2) SERVICE
AGREEMENTS.—The Secretary 
may only provide reimbursement for any relocation 
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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.—By not later than 1 year after 
the date of enactment of the Restoring Accountability in 
the Indian Health Service Act of 2017, the Secretary, act-
ing through the Service and in accordance with the re-
quirements described in subsection (b), shall develop and 
implement a Service-wide centralized credentialing system 
(referred to in this section as the ‘credentialing system’) 
to credential licensed health professionals who seek to pro-
vide health care services at any Service unit. 
‘‘(b) 
REQUIREMENTS.—In 
developing 
the 
credentialing system under subsection (a), the Secretary 
shall ensure the following: 
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‘‘(1) Credentialing procedures shall be uniform 
throughout the Service. 
‘‘(2) With respect to each licensed health pro-
fessional 
who 
successfully 
completes 
the 
credentialing procedures of the credentialing system, 
the Secretary shall authorize each such professional 
to provide health care services at any Service unit. 
‘‘(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.—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 
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Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 5304 et seq.).’’. 
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, a health professional volunteer at a Service 
unit shall, in providing a health service to an indi-
vidual, be deemed to be an employee of the Public 
Health Service for a calendar year that begins dur-
ing 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: 
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‘‘(A) The service is provided to the indi-
vidual at the facilities of a Service unit, or 
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. 
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‘‘(E) At the time the service is provided, 
the health care practitioner is licensed or cer-
tified in accordance with applicable law regard-
ing the provision of the service. 
‘‘(3) APPLICABILITY.—Subsection (g) (other 
than paragraphs (3) and (5)) and subsections (h), 
(i), and (l) apply to a health care practitioner at a 
Service unit for purposes of this subsection to the 
same extent and in the same manner as such sub-
sections apply to an officer, governing board mem-
ber, employee, or contractor of an entity described in 
subsection (g)(4), subject to paragraph (4) and sub-
ject 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 a Service unit. 
‘‘(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 health professional 
volunteers, will be paid pursuant to this 
section during the calendar year that be-
gins in the following fiscal year. 
‘‘(ii) 
APPLICABILITY.—Subsection 
(k)(1)(B) applies to the estimate under 
clause (i) relating to health professional 
volunteers to the same extent and in the 
same manner as that subsection applies to 
the estimate under that subsection relating 
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to officers, governing board members, em-
ployees, and contractors of entities de-
scribed 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) DEFINITION OF SERVICE UNIT.—In this 
subsection, 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). 
‘‘(6) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to inhibit the au-
thority of an Indian tribe to enter into or maintain 
a compact or contract under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
5304 et seq.). 
‘‘(7) EFFECTIVE DATES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), this subsection shall take ef-
fect on October 1, 2019. 
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‘‘(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 2017, the Secretary 
may— 
‘‘(i) prescribe regulations for carrying 
out this subsection; and 
‘‘(ii) accept and consider applications 
submitted under paragraph (3)(C)(i).’’. 
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 degree in business adminis-
tration with an emphasis in health care 
management (as defined by the Secretary), 
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health administration, hospital administra-
tion, 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;’’; 
(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 
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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)— 
(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 
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the individual for loans described in para-
graph (1)’’; and 
(ii) by striking ‘‘In making a deter-
mination’’ and inserting the following: 
‘‘(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 job de-
scription of the Office of Personnel Management. 
‘‘(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 under section 606(j).’’. 
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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 shall 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 20 percent or more of the positions in the 
Service unit are not filled by a full-time em-
ployee 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 formal tribal employee who 
was removed from such former employment 
within, or demoted for performance or mis-
conduct that occurred during, the 5-year period 
the date of such personnel action.’’. 
SEC. 106. REMOVAL OR DEMOTION OF INDIAN HEALTH 
SERVICE EMPLOYEES BASED ON PERFORM-
ANCE OR MISCONDUCT. 
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: 
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‘‘SEC. 606. REMOVAL OR DEMOTION OF SERVICE EMPLOY-
EES 
BASED 
ON 
PERFORMANCE 
OR 
MIS-
CONDUCT. 
‘‘(a) DEFINITIONS.—In this section and section 607: 
‘‘(1) EMPLOYEE.—The term ‘employee’ has the 
meaning given the term in section 2105 of title 5, 
United States Code. 
‘‘(2) MANAGER.— 
‘‘(A) IN GENERAL.—The term ‘manager’ 
has the meaning given the term ‘management 
official’ in section 7103(a) of title 5, United 
States Code. 
‘‘(B) INCLUSIONS.—The term ‘manager’ 
includes, as employed at any facility of the 
Service— 
‘‘(i) a chief executive officer; 
‘‘(ii) a chief medical officer; and 
‘‘(iii) a department director. 
‘‘(3) MISCONDUCT.—The term ‘misconduct’ 
means neglect of duty, malfeasance, or failure to ac-
cept a directed reassignment or to accompany a po-
sition in a transfer of function. 
‘‘(4) PERSONNEL
ACTION.—The term ‘per-
sonnel action’ means a removal, transfer, or reduc-
tion in grade under subsection (b)(2). 
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‘‘(5) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services, acting 
through the Director of the Service. 
‘‘(6) SENIOR EXECUTIVE.—The term ‘senior ex-
ecutive’ means a career appointee (as that term is 
defined in section 3132(a) of title 5, United States 
Code). 
‘‘(7) SENIOR EXECUTIVE SERVICE POSITION.— 
The term ‘Senior Executive Service position’ has the 
meaning given the term in section 3132(a) of title 
5, United States Code. 
‘‘(8) SUPERVISOR.—The term ‘supervisor’ has 
the meaning given the term in section 7103(a) of 
title 5, United States Code. 
‘‘(b) REMOVAL BASED ON PERFORMANCE OR MIS-
CONDUCT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (4), 
the Secretary may remove an employee of the Serv-
ice from the position the employee occupies if the 
Secretary determines the performance or misconduct 
of the employee warrants removal. 
‘‘(2) ACTION.—If the Secretary removes an em-
ployee under paragraph (1), the Secretary may— 
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‘‘(A) remove the employee from the civil 
service (as defined in section 2101 of title 5, 
United States Code); 
‘‘(B) in the case of an individual described 
in paragraph (3), transfer the individual from 
the Senior Executive Service position to a Gen-
eral Schedule position at any grade of the Gen-
eral Schedule for which the individual is quali-
fied and that the Secretary determines is appro-
priate; or 
‘‘(C) in the case of a manager or super-
visor, reduce the grade of the manager or su-
pervisor to any other grade for which the indi-
vidual is qualified and that the Secretary deter-
mines is appropriate. 
‘‘(3) INDIVIDUAL
DESCRIBED.—An individual 
referred to in paragraph (2)(B) is a senior executive 
that— 
‘‘(A) previously occupied a permanent posi-
tion within the competitive service (as that term 
is defined in section 2102 of title 5, United 
States Code); or 
‘‘(B) previously occupied a permanent posi-
tion within the excepted service (as that term is 
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defined in section 2103 of title 5, United States 
Code). 
‘‘(4) DUE PROCESS.—Before an employee may 
be subject to a personnel action, the Secretary shall 
provide to the employee— 
‘‘(A) not less than 10 days before the per-
sonnel action, written notice of the proposed 
personnel action; and 
‘‘(B) an opportunity and reasonable time 
to answer orally or in writing. 
‘‘(c) PAY OF CERTAIN INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, including the requirements of sec-
tion 3594 of title 5, United States Code, any indi-
vidual transferred to a General Schedule position 
under subsection (b)(2)(B) or subject to a reduction 
in grade under subsection (b)(2)(C) shall, beginning 
on the date of the transfer, receive the annual rate 
of pay applicable to the position. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) IN GENERAL.—An individual trans-
ferred to a General Schedule position under 
subsection (b)(2)(B) or subject to a reduction 
in grade under subsection (b)(2)(C)— 
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‘‘(i) may not be placed on administra-
tive leave or any other category of paid 
leave during the period during which an 
appeal (if any) under subsection (e)(2)(A) 
is ongoing; and 
‘‘(ii) may only receive pay if the indi-
vidual— 
‘‘(I) reports for duty; and 
‘‘(II) performs a primary duty or 
an alternative primary duty, as each 
term is described in section 551.104 
of title 5, Code of Federal Regulations 
(or a successor regulation). 
‘‘(B) FAILURE
TO
REPORT.—If an indi-
vidual transferred to a General Schedule posi-
tion under subsection (b)(2)(B) or subject to a 
reduction in grade under subsection (b)(2)(C) 
does not report for duty, pursuant to subsection 
(f)(3)(B), the individual shall not receive any 
increase in rate of pay or other benefit. 
‘‘(d) NOTICE TO CONGRESS.—Not later than 30 days 
after the date on which the Secretary takes a personnel 
action, the Secretary shall submit, in writing, a notice of 
the personnel action and the reason for the personnel ac-
tion to— 
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