Title: Restoring Accountability in the Indian Health Service Act of 2017
Policy area: Native Americans

Summary:
Restoring Accountability in the Indian Health Service Act of 2017
This bill amends the Indian Health Care Improvement Act to require the Department of Health and Human Services (HHS) to establish a pay system for health care professionals employed by Indian Health Service (IHS) that is competitive with the salary of health care professionals employed by the Veterans Health Administration. HHS may establish incentives related to IHS employee recruitment and retention by providing relocation costs and rental assistance to employees under certain circumstances.
In addition, IHS must:
Liability protections are given to certain health care professionals who volunteer at IHS facilities.
The bill expands the IHS student loan repayment program to include loan repayments for degrees related to health administration.
HHS may: (1) directly hire candidates to positions within IHS; and (2) remove, transfer, or demote certain IHS employees based on performance or misconduct.
HHS must establish a tribal consultation policy for IHS.
The bill establishes: (1) whistle blower protections for IHS employees, and (2) requirements concerning IHS fiscal accountability and transparency.


[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1250 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1250

    To amend the Indian Health Care Improvement Act to improve the 
 recruitment 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 SENATE OF THE UNITED STATES

                              May 25, 2017

 Mr. Barrasso (for himself, Mr. Thune, and Mr. Hoeven) introduced the 
 following bill; which was read twice and referred to the Committee on 
                             Indian Affairs

_______________________________________________________________________

                                 A BILL


 
    To amend the Indian Health Care Improvement Act to improve the 
 recruitment and retention of employees in the Indian Health Service, 
  restore accountability in the Indian Health Service, improve health 
                   services, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Restoring Accountability in the 
Indian Health Service Act of 2017''.

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 repayment 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 RETENTION.

    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 RETENTION.

    ``(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 provides pay that, to the maximum extent 
practicable, is comparable 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 provide 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--
                    ``(A) agrees to serve for not less than 1 year at a 
                Service unit designated by the Administrator of the 
                Health Resources and Services Administration as a 
                health professional shortage 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 guidelines of the Office of 
        Personnel Management relating to the recruitment and retention 
        of employees, including 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 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, beginning 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 beginning 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, acting through the Service and in 
accordance with the requirements 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 provide health 
care services at any Service unit.
    ``(b) Requirements.--In developing the credentialing system under 
subsection (a), the Secretary shall ensure the following:
            ``(1) Credentialing procedures shall be uniform throughout 
        the Service.
            ``(2) With respect to each licensed health professional 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 
determined by the Secretary.
    ``(d) Application.--A licensed health care professional may not 
provide health care services at any Service unit, unless such 
professional successfully completes the credentialing procedures of the 
credentialing system developed under subsection (a).
    ``(e) Regulations.--The Secretary may prescribe such regulations as 
may be necessary to carry out the provisions 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 Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 5304 et seq.).''.

SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL 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 following:
    ``(r) Certain Indian Health Service Volunteers Deemed Public Health 
Service Employees.--
            ``(1) In general.--For purposes of this section, 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 Public 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 service 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 individual 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 
                receive repayment from the Service unit for reasonable 
                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 practitioner is limited under this 
                subsection.
                    ``(E) At the time the service is provided, the 
                health care practitioner is licensed or certified in 
                accordance with 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 a 
        health care practitioner at a Service unit for purposes of this 
        subsection 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 subsections 
                (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 professional volunteer at 
                the Service unit unless the Service unit sponsors the 
                health care practitioner. For purposes of this 
                subsection, the Service unit shall be considered to be 
                sponsoring 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 
                        subsection (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 practitioner who 
                is determined by the Secretary pursuant to this 
                subsection and subsection (g)(1)(E) to be a health 
                professional volunteer, this subsection applies to the 
                health care practitioner (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 occurring 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 health services to an 
                individual, each of the conditions 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 Secretary, shall submit 
                        to Congress a report providing an estimate of 
                        the amount of claims (together with related 
                        fees and expenses 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 begins 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 to officers, governing 
                        board members, employees, and contractors of 
                        entities described in subsection (g)(4).
                    ``(C) Transfers.--Not later than December 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 subparagraph (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 authority of an Indian tribe 
        to enter into or maintain a compact or contract under the 
        Indian Self-Determination 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 effect on 
                October 1, 2019.
                    ``(B) Regulations, applications, and reports.--
                Effective on the date of the enactment of the Restoring 
                Accountability in the Indian 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 INDIAN 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 subsection (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 
                        administration with an emphasis in health care 
                        management (as defined by the Secretary), 
                        health administration, hospital administration, 
                        or public health; and
                            ``(II) a license or certification to 
                        practice in the field of business 
                        administration, health administration, hospital 
                        administration, or public health in a State, if 
                        the Secretary determines such license or 
                        certification necessary for the Indian health 
                        program to which the individual will be 
                        assigned;'';
            (2) by amending clause (iii) of subsection (f)(1)(B) to 
        read as follows:
                            ``(iii) to serve for a time period 
                        (referred to in this section as the `period of 
                        obligated service') equal to--
                                    ``(I) 2 years or such longer period 
                                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 individual 
                                may be assigned by the Secretary; or
                                    ``(II) 4 years or such longer 
                                period 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 individual 
                                may be assigned by the Secretary;''; 
                                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 obligated 
                        service under subsection (f)(1)(B)(iii)(I), for 
                        each year of such obligated 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 contracts 
                        to serve a period of obligated service under 
                        subsection (f)(1)(B)(iii)(II), for each year of 
                        such obligated service, the Secretary may pay 
                        up to $17,500 on behalf of the individual for 
                        loans described in paragraph (1)''; and
                            (ii) by striking ``In making a 
                        determination'' 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 amended 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 within the Service for which the candidate meets the job 
description 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).''.
    (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 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 formal tribal employee who was removed 
                from such former employment within, or demoted for 
                performance or misconduct 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 PERFORMANCE 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:

``SEC. 606. REMOVAL OR DEMOTION OF SERVICE EMPLOYEES BASED ON 
              PERFORMANCE OR MISCONDUCT.

    ``(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 accept a directed reassignment 
        or to accompany a position in a transfer of function.
            ``(4) Personnel action.--The term `personnel action' means 
        a removal, transfer, or reduction in grade under subsection 
        (b)(2).
            ``(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 executive' 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 Misconduct.--
            ``(1) In general.--Subject to paragraph (4), the Secretary 
        may remove an employee of the Service 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 employee under 
        paragraph (1), the Secretary may--
                    ``(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 General Schedule 
                position at any grade of the General Schedule for which 
                the individual is qualified and that the Secretary 
                determines is appropriate; or
                    ``(C) in the case of a manager or supervisor, 
                reduce the grade of the manager or supervisor to any 
                other grade for which the individual is qualified and 
                that the Secretary determines is appropriate.
            ``(3) Individual described.--An individual referred to in 
        paragraph (2)(B) is a senior executive that--
                    ``(A) previously occupied a permanent position 
                within the competitive service (as that term is defined 
                in section 2102 of title 5, United States Code); or
                    ``(B) previously occupied a permanent position 
                within the excepted service (as that term is 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 personnel 
                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 section 3594 of title 5, 
        United States Code, any individual 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 transferred to a 
                General Schedule position under subsection (b)(2)(B) or 
                subject to a reduction in grade under subsection 
                (b)(2)(C)--
                            ``(i) may not be placed on administrative 
                        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 
                        individual--
                                    ``(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 individual 
                transferred to a General Schedule position 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 action to--
            ``(1) the Committee on Indian Affairs of the Senate;
            ``(2) the Committee on Health, Education, Labor, and 
        Pensions of the Senate;
            ``(3) the Committee on Natural Resources of the House of 
        Representatives;
            ``(4) the Committee on Energy and Commerce of the House of 
        Representatives; and
            ``(5) the Inspector General of the Department.
    ``(e) Procedure.--
            ``(1) Inapplicability.--The procedures under chapters 43 
        and 75 of title 5, United States Code, shall not apply to a 
        personnel action.
            ``(2) Appeal.--
                    ``(A) In general.--Subject to subparagraph (B) and 
                subsection (f), an employee subject to a personnel 
                action may appeal the personnel action to the Merit 
                Systems Protection Board under section 7701 of title 5, 
                United States Code.
                    ``(B) Limitation.--An appeal under subparagraph (A) 
                may only be made if the appeal is made not later than 7 
                days after the date of the personnel action.
    ``(f) Expedited Review by Administrative Law Judge.--
            ``(1) In general.--
                    ``(A) Referral.--On receipt of an appeal under 
                subsection (e)(2)(A), the Merit Systems Protection 
                Board shall refer the appeal to an administrative law 
                judge pursuant to section 7701(b)(1) of title 5, United 
                States Code.
                    ``(B) Expedition.--The administrative law judge to 
                whom an appeal is referred under subparagraph (A) 
                shall--
                            ``(i) expedite the appeal under section 
                        7701(b)(1) of title 5, United States Code; and
                            ``(ii) issue a decision in each case not 
                        later than 21 days after the date of the 
                        appeal.
            ``(2) Finality.--Notwithstanding any other provision of 
        law, including section 7703 of title 5, United States Code, the 
        decision of an administrative law judge under paragraph (1) 
        shall be final and shall not be subject to any further 
        administrative appeal.
            ``(3) Failure to issue decision.--
                    ``(A) In general.--In any case in which an 
                administrative law judge fails to issue a decision in 
                accordance with the 21-day requirement described in 
                paragraph (1)(B)(ii), the personnel action shall be 
                treated as final.
                    ``(B) Transparency.--In any case in which a 
                personnel action is treated as final under subparagraph 
                (A), the Merit Systems Protection Board shall, not 
                later than 14 days after the date on which the 
                personnel action becomes final, submit a letter 
                explaining the reasons why a decision was not issued in 
                accordance with the 21-day requirement described in 
                paragraph (1)(B)(ii) to--
                            ``(i) the Committee on Indian Affairs of 
                        the Senate;
                            ``(ii) the Committee on Health, Education, 
                        Labor, and Pensions of the Senate;
                            ``(iii) the Committee on Natural Resources 
                        of the House of Representatives; and
                            ``(iv) the Committee on Energy and Commerce 
                        of the House of Representatives.
            ``(4) Restriction.--The Merit Systems Protection Board or 
        an administrative law judge may not stay any personnel action.
            ``(5) Cessation of pay increases and benefits.--During the 
        period beginning on the date on which an employee appeals a 
        removal from the civil service under subsection (e)(2)(A) and 
        ending on the date on which the removal becomes final, the 
        employee may not receive any--
                    ``(A) increase in rate of pay; or
                    ``(B) award, bonus, incentive, allowance, 
                differential, student loan repayment, special payment, 
                or other benefit.
            ``(6) Assistance.--To the maximum extent practicable, the 
        Secretary shall provide such information and assistance as may 
        be necessary to ensure an appeal under this subsection is 
        expedited to--
                    ``(A) the Merit Systems Protection Board; and
                    ``(B) any administrative law judge to whom an 
                appeal under this section is referred.
    ``(g) Employment Record Transparency.--The Secretary shall ensure 
that the employment records for any employee subject to a personnel 
action, regardless of whether that personnel action is final, include--
            ``(1) a notation that the employee was subject to a 
        personnel action; and
            ``(2) a description of the disposition or status of the 
        personnel action or any appeal of the personnel action under 
        this section.
    ``(h) Relation to Title 5, United States Code.--
            ``(1) Additional authority.--The personnel action 
        authorities provided to the Secretary under this section are in 
        addition to the authorities provided under chapters 43 and 75 
        of title 5, United States Code.
            ``(2) Removal of senior executives.--Section 3592(b)(1) of 
        title 5, United States Code, shall not apply to a personnel 
        action.''.

SEC. 107. STANDARDS TO IMPROVE TIMELINESS OF CARE.

    Title IV of the Indian Health Care Improvement Act (25 U.S.C. 1641 
et seq.) is amended by adding at the end the following:

``SEC. 412. STANDARDS TO IMPROVE TIMELINESS OF CARE.

    ``(a) In General.--Not later than 180 days after the date of 
enactment of the Restoring Accountability in the Indian Health Service 
Act of 2017, the Secretary, acting through the Service, shall--
            ``(1) establish, by regulation, standards to measure the 
        timeliness of the provision of health care services in Service 
        facilities; and
            ``(2) provide such standards to each Service unit.
    ``(b) Data Collection.--The Secretary, acting through the Service, 
shall develop a process for each Service unit to submit to the 
Secretary data with respect to the standards established under 
subsection (a)(1).''.

SEC. 108. 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, and other contracted 
                employees 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, beginning with 
the year of the date of enactment of the Restoring Accountability in 
the Indian Health Service Act of 2017, 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 training program. 
For purposes of the preceding sentence, participation in such training 
program may not be considered 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. 109. 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 Service units with additional staffing 
resources with the goal that the resources become self-sustaining.
    ``(b) Selection.--In selecting Service units for participation, the 
Secretary shall consider whether a Service unit services an Indian 
tribe that--
            ``(1) has utilized or contributed substantial tribal funds 
        to construct a health facility used by the Service or 
        identified in the master plan for the Service unit;
            ``(2) is located in a State or States with Medicaid 
        reimbursements plans or policies that will increase the 
        likelihood that the staffing resources provided 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) Report.--Not later than 5 years after the Secretary 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 Committee on Energy and 
Commerce of the House of Representatives, regarding the project, 
including--
            ``(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 throughout the Service.''.

SEC. 110. 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 109, 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 2017, the Secretary shall establish, through the negotiated 
rulemaking process described in subsection (b), a rule establishing a 
tribal consultation policy for the Service.
    ``(b) Negotiated Rulemaking.--Before publishing a proposed rule 
described in subsection (a), the Secretary shall follow the provisions 
of subchapter III of chapter 5 of title 5, United States Code (commonly 
known as the `Negotiated Rulemaking Act of 1990').
    ``(c) Contents of Tribal Consultation Policy.--The policy 
established under the rule described in subsection (a) shall--
            ``(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 description of how the 
                Indian tribes should be notified.
                    ``(B) A determination of what actions or agency 
                decisions by the Service will trigger a requirement for 
                meaningful consultation with Indian tribes.
                    ``(C) A determination of what actions constitute 
                meaningful consultation with Indian tribes.''.

                     TITLE II--EMPLOYEE PROTECTIONS

SEC. 201. 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 subsection:
    ``(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 
applicable procedure.''.
    (b) Electronic Notification of Right of Employees 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 
        employee of the Indian Health Service, and electronically 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 statement: ``It is a violation of 
        section 7211 of title 5, United States Code, for any Federal 
        agency or employee to require a Federal employee to seek 
        approval, guidance, or any other form of input prior to 
        contacting Congress with information, even if that information 
        is in relation to the job responsibilities of the employee. A 
        Federal employee found to have interfered with or denied the 
        right of another Federal 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 paragraph (1) to the Inspector General 
        of the Department of Health and Human Services (referred to in 
        this subsection as the ``Inspector General'') for approval.
            (4) Approval or disapproval.--Not later than 30 days after 
        the submission of the memorandum under paragraph (3), or a 
        revised memorandum under paragraph (6), the Inspector General 
        shall approve or disapprove the memorandum or revised 
        memorandum, as the case may be.
            (5) Notice.--In the case of an approval under paragraph 
        (4), not later than 30 days after such approval, the Secretary 
        shall--
                    (A) provide to each employee of the Indian Health 
                Service an electronic copy of the approved 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 submit a revised memorandum to the 
        Inspector General for approval under paragraph (4).

SEC. 202. FISCAL ACCOUNTABILITY.

    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. 607. 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 2017 or the 
        staffing plan under section 301(b) of that Act, the Secretary 
        may not receive, obligate, transfer, 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 the case may be, is submitted.
            ``(2) Individual described.--An individual described in 
        this paragraph is an individual employed in a position in the 
        Service that is a position--
                    ``(A) described under sections 5312 through 5316 of 
                title 5, United States Code;
                    ``(B) placed in level IV or V of the Executive 
                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.--The Secretary shall use amounts 
        available to the Indian Health Service that are not obligated 
        or expended, including base budget funding 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 employee 
                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, 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--
                    ``(A) the Committee on Natural Resources;
                    ``(B) the Committee on Energy and Commerce;
                    ``(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 described in paragraphs (1) through (3) 
        of subsection (c) a report describing the safety, billing, 
        certification, 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 update describing such change.
    ``(e) 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 Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 5304 et seq.).''.

                           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).

SEC. 302. REPORTS BY THE SECRETARY OF HEALTH AND HUMAN SERVICES.

    (a) IHS Professional Housing Plan.--Not later than 90 days 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 housing 
needs of employees of the Service that comports with the practices and 
recommendations of the Government Accountability Office relating to 
professional housing.
    (b) Plan Relating to IHS Staffing Needs.--Not later than 90 days 
after the date of the 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 
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 Report.--Not later than 1 
year after the date of enactment of this Act, and each year thereafter 
for a period of 5 years, the Secretary shall develop, make publicly 
available, and submit to Congress a report on the data submitted under 
section 412(b) of the Indian Health Care Improvement Act, as amended by 
section 107.

SEC. 303. REPORTS BY THE COMPTROLLER GENERAL.

    (a) IHS Housing Needs Report.--
            (1) In general.--Not later than 1 year 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 develop and submit to Congress a report on the 
        professional housing needs of employees of the Service.
            (2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    (A) An evaluation of any existing, as of the date 
                of the report, assessments and projections for the 
                professional housing needs of employees of the Service, 
                including discussion and conclusion as to whether 
                existing assessments and 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 1 year 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 report 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 assessment of the use of independent 
                contractors, including the number of independent 
                contractors hired to fill vacant full-time positions 
                and amounts spent on independent contractors who 
                provide health care services.
                    (C) An assessment of the staffing plan developed 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 report on the efficacy of existing 
        protections for whistleblowers 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.
                    (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 every 2 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 reducing 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 patient 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 improved 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 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 Medicare & Medicaid 
Services. Such posting shall comply with the Federal regulations 
concerning the privacy of individually 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 inserting ``purchased/referred care'' 
        (with appropriate casing 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 inserting ``purchased/referred 
        care'' (with appropriate casing and typeface).
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