,,ii #aadth ,,congress #b;d ,session ,s4 #biec ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ai1 #bjaf ,mr4 ,barrasso 7for himself and ,mr4 ,thune7 introduced the following bill2 which was read twice and referred to the ,committee on ,indian ,affairs ,a ,,bill ,to promote patient-centered care and accountability at the ,indian ,health ,service1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,indian ,health ,service ,accountability ,act of #bjaf or the ,,ihs ,accountability ,act of #bjaf4 #b4 ,findings ,congress finds that-- 7#a7 in #bjaj1 the ,committee on ,indian ,affairs of the ,senate held an oversight hearing entitled ,in ,critical ,condition3 ,the ,urgent ,need to ,reform ,indian ,health ,service's ,aberdeen ,area1 during which members of the ,committee listened to testimony detailing an investigation led by a former ,chairman of the ,committee1 ,byron ,dorgan1 including his report on the ,indian ,health ,service 7referred to in this section as the ,dorgan ,report72 7#b7 the ,dorgan ,report found evidence showing the lack of quality of care at ,indian ,health ,service facilities in the ,great ,plains ,area 7previously referred to as the ,aberdeen ,area71 which is comprised of ,south ,dakota1 ,north ,dakota1 ,nebraska1 and ,iowa2 7#c7 in #bjae-- 7,a7 staff of the ,committee on ,indian ,affairs of the ,senate investigated claims that conditions in the ,great ,plains ,area had not improved2 and 7,b7 the ,committee confirmed that many issues identified in the ,dorgan ,report had not been resolved and found that some problems had become worse and new problems had developed2 7#d7 a culture of cronyism in the ,indian ,health ,service has further eroded confidence in the health care system of the ,indian ,health ,service2 7#e7 persistent failures by the ,indian ,health ,service to provide tribal citizens access to safe1 quality health care have led to multiple innocent patient deaths and the suffering of patients1 families1 and whole communities2 7#f7 those failures have been extensively documented by ,congress1 the ,indian ,health ,service1 and the ,centers for ,medicare ,medicaid ,services1 which confirmed that systemic problems and substandard conditions in ,indian ,health ,service facilities pose an immediate risk to patient safety2 7#g7 the ,united ,states has treaty1 trust1 and statutory obligations to provide health care to ,american ,indians and ,alaska ,natives1 which the ,indian ,health ,service is mandated to uphold2 and 7#h7 prioritizing patients and restoring faith in the health care system of the ,indian ,health ,service requires greater transparency1 accountability1 and strong leadership4 #c4 ,removal of ,indian ,health ,service employees based on performance or misconduct ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 is amended by adding at the end the following3 #fje4 ,removal of ,service employees based on performance or misconduct 7a7 ,definitions ,in this section and sections #fjf through #faj3 7#a7 ,employee ,the term employee has the meaning given the term in section #baje of title #e1 ,united ,states ,code4 7#b7 ,manager 7,a7 ,in general ,the term manager has the meaning given the term management official in section #gajc7;a7 of title #e1 ,united ,states ,code4 7,b7 ,inclusions ,the term manager includes1 as employed at any facility of the ,service-- 7i7 a chief executive officer2 7ii7 a chief medical officer2 and 7iii7 a department director4 7#c7 ,misconduct ,the term misconduct means neglect of duty1 malfeasance1 or failure to accept a directed reassignment or to accompany a position in a transfer of function4 7#d7 ,personnel action ,the term personnel action means a removal1 transfer1 or reduction in grade under subsection 7b77#b74 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,service4 7#f7 ,senior executive ,the term senior executive means a career appointee 7as that term is defined in section #cacb7;a7 of title #e1 ,united ,states ,code7 that occupies a ,senior ,executive ,service position4 7#g7 ,senior ,executive ,service position ,the term ,senior ,executive ,service position has the meaning given the term in section #cacb7;a7 of title #e1 ,united ,states ,code4 7#h7 ,supervisor ,the term supervisor has the meaning given the term in section #gajc7;a7 of title #e1 ,united ,states ,code4 7b7 ,removal based on performance or misconduct 7#a7 ,in general ,subject to paragraph 7#d71 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 removal4 7#b7 ,action ,if the ,secretary removes an employee under paragraph 7#a71 the ,secretary may-- 7,a7 remove the employee from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code72 7,b7 in the case of an individual described in paragraph 7#c71 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 appropriate2 or 7,c7 in the case of a manager or supervisor1 reduce the grade of the manager or supervisor to any other grade for which the individual is qualified and that the ,secretary determines is appropriate4 7#c7 ,individual described ,an individual referred to in paragraph 7#b77;,b7 is a senior executive that-- 7,a7 previously occupied a permanent position within the competitive service 7as that term is defined in section #bajb of title #e1 ,united ,states ,code72 or 7,b7 previously occupied a permanent position within the excepted service 7as that term is defined in section #bajc of title #e1 ,united ,states ,code74 7#d7 ,due process ,before an employee may be subject to a personnel action1 the ,secretary shall provide to the employee-- 7,a7 not less than #aj days before the personnel action1 written notice of the proposed personnel action2 and 7,b7 an opportunity and reasonable time to answer orally or in writing4 7c7 ,pay of certain individuals 7#a7 ,in general ,notwithstanding any other provision of law1 including the requirements of section #ceid of title #e1 ,united ,states ,code1 any individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7 shall1 beginning on the date of the transfer1 receive the annual rate of pay applicable to the position4 7#b7 ,requirements 7,a7 ,in general ,an individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7-- 7i7 may not be placed on administrative leave or any other category of paid leave during the period during which an appeal 7if any7 under subsection 7e77#b77;,a7 is ongoing2 and 7ii7 may only receive pay if the individual-- 7,i7 reports for duty2 and 7,,ii7 performs a primary duty or an alternative primary duty1 as each term is described in section #eea4ajd of title #e1 ,code of ,federal ,regulations 7or a successor regulation74 7,b7 ,failure to report ,if an individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7 does not report for duty1 pursuant to subsection 7f77#e71 the individual shall not receive any increase in rate of pay or other benefit4 7d7 ,notice to ,congress ,not later than #cj days after the date on which the ,secretary takes a personnel action1 the ,secretary shall submit1 in writing1 a notice of the personnel action and the reason for the personnel action to-- 7#a7 the ,committee on ,indian ,affairs of the ,senate2 7#b7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7#c7 the ,committee on ,natural ,resources of the ,house of ,representatives2 7#d7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 and 7#e7 the ,inspector ,general of the ,department4 7e7 ,procedure 7#a7 ,inapplicability ,the procedures under chapters #dc and #ge of title #e1 ,united ,states ,code1 shall not apply to a personnel action4 7#b7 ,appeal 7,a7 ,in general ,subject to subparagraph 7,b7 and subsection 7f71 an employee subject to a personnel action may appeal the personnel action to the ,merit ,systems ,protection ,board under section #ggja of title #e1 ,united ,states ,code4 7,b7 ,limitation ,an appeal under subparagraph 7,a7 may only be made if the appeal is made not later than #g days after the date of the personnel action4 7f7 ,expedited review by administrative law judge 7#a7 ,in general 7,a7 ,referral ,on receipt of an appeal under subsection 7e77#b77;,a71 the ,merit ,systems ,protection ,board shall refer the appeal to an administrative law judge pursuant to section #ggja7;b77#a7 of title #e1 ,united ,states ,code4 7,b7 ,expedition ,the administrative law judge to whom an appeal is referred under subparagraph 7,a7 shall-- 7i7 expedite the appeal under section #ggja7;b77#a7 of title #e1 ,united ,states ,code2 and 7ii7 issue a decision in each case not later than #ba days after the date of the appeal4 7#b7 ,finality ,notwithstanding any other provision of law1 including section #ggjc of title #e1 ,united ,states ,code1 the decision of an administrative law judge under paragraph 7#a7 shall be final and shall not be subject to any further administrative appeal4 7#c7 ,failure to issue decision 7,a7 ,in general ,in any case in which an administrative law judge fails to issue a decision in accordance with the #ba-;day requirement described in paragraph 7#a77;,b77ii71 the personnel action shall be treated as final4 7,b7 ,transparency ,in any case in which a personnel action is treated as final under subparagraph 7,a71 the ,merit ,systems ,protection ,board shall1 not later than #ad days after the date on which the personnel action becomes final1 submit a letter explaining the reasons why a decision was not issued in accordance with the #ba-;day requirement described in paragraph 7#a77;,b77ii7 to-- 7i7 the ,committee on ,indian ,affairs of the ,senate2 7ii7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7iii7 the ,committee on ,natural ,resources of the ,house of ,representatives2 and 7iv7 the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7#d7 ,restriction ,the ,merit ,systems ,protection ,board or an administrative law judge may not stay any personnel action4 7#e7 ,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 7e77#b77;,a7 and ending on the date on which the removal becomes final1 the employee may not receive any-- 7,a7 increase in rate of pay2 or 7,b7 award1 bonus1 incentive1 allowance1 differential1 student loan repayment1 special payment1 or other benefit4 7#f7 ,assistance ,to the maximum extent practicable1 the ,secretary shall provide such information and assistance as may be necessary to ensure an appeal under this subsection is expedited to-- 7,a7 the ,merit ,systems ,protection ,board2 and 7,b7 any administrative law judge to whom an appeal under this section is referred4 7g7 ,employment record transparency ,the ,secretary shall ensure that the employment records for any employee subject to a personnel action1 regardless of whether that personnel action is final1 include-- 7#a7 a notation that the employee was subject to a personnel action2 and 7#b7 a description of the disposition or status of the personnel action or any appeal of the personnel action under this section4 7h7 ,relation to title #e1 ,united ,states ,code 7#a7 ,additional authority ,the personnel action authorities provided to the ,secretary under this section are in addition to the authorities provided under chapters #dc and #ge of title #e1 ,united ,states ,code4 7#b7 ,removal of senior executives ,section #ceib7;b77#a7 of title #e1 ,united ,states ,code1 shall not apply to a personnel action4 4 #d4 ,improvements in hiring practices 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #c7 is amended by adding at the end the following3 #fjf4 ,improvements in hiring practices 7a7 ,direct hire authority ,the ,secretary may appoint1 without regard to subchapter ,i of chapter #cc of title #e1 ,united ,states ,code 7other than sections #ccjc and #ccbh of that title71 a candidate directly to a position within the ,service for which the candidate meets ,office of ,personnel ,management qualification standards4 7b7 ,preference ,to enhance recruitment and retention of employees of the ,service1 the ,secretary may waive the requirements of the ,indian preference laws 7as defined in section #b7;e7 of ,public ,law #if-ace 7#be ,u4,s4,c4 #dgb;a7e777 with respect to hiring a candidate to a position in a ,service unit on written request or resolution of an ,indian tribe located within the applicable ,service unit4 7c7 ,tribal consultation 7#a7 ,in general ,subject to paragraph 7#b71 before appointing1 hiring1 promoting1 or transferring a candidate to a ,senior ,executive ,service position or the position of a manager at an ,area office or ,service unit1 the ,secretary shall meaningfully and expeditiously consult with ,indian tribes located within the applicable ,service area or ,service unit4 7#b7 ,exception 7,a7 ,in general ,if the ,secretary determines that emergency circumstances exist that may negatively impact patient health or safety if the position is not filled1 the ,secretary may appoint a candidate to a ,senior ,executive ,service or manager position at an ,area office or ,service unit for a temporary time period only1 not to exceed #ahj days4 7,b7 ,notice ,the ,secretary shall notify1 in writing1 each ,indian tribe located within the applicable ,service area or ,service unit of the appointment not fewer than #g days prior to exercising the authority described in subparagraph 7,a74 7d7 ,notice of removal based on performance or misconduct ,before appointing1 hiring1 promoting1 or transferring a candidate to a ,senior ,executive ,service position or the position of a manager or supervisor at an ,area office or ,service unit1 the ,secretary shall provide to ,indian tribes located within the applicable ,service area the content of an inclusion in an employment record under section #fje7;g74 4 7b7 ,,gao report on ,,ihs staffing needs 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report assessing staffing needs in the ,indian ,health ,service4 7#b7 ,contents ,the report described in paragraph 7#a7 shall include-- 7,a7 a description of the number and type of full-time equivalent employees needed at each facility of the ,indian ,health ,service and amounts required for those employees2 7,b7 an assessment of the use of independent contractors instead of full-time equivalent employees2 and 7,c7 recommendations to address staffing needs in the ,indian ,health ,service4 7c7 ,staffing plan ,not later than #a year after the date on which the ,comptroller ,general of the ,united ,states submits the report under subsection 7b71 the ,secretary shall submit to ,congress a written plan to address staffing needs in the ,indian ,health ,service based on the recommendations described in paragraph 7#b77;,c7 of that subsection4 #e4 ,incentives for recruitment and retention 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #d7;a77 is amended by adding at the end the following3 #fjg4 ,incentives for recruitment and retention 7a7 ,rewarding quality performance 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary may grant or rescind bonuses or other benefits to employees of the ,service-- 7,a7 to promote patient safety2 7,b7 to promote quality of performance of the employees2 or 7,c7 to improve recruitment and retention of employees in the ,service4 7#b7 ,quality incentives ,the ,secretary may grant a bonus under paragraph 7#a7 to a manager or supervisor in the ,service who identifies one or more ways-- 7,a7 to improve patient care2 or 7,b7 to reduce waste1 fraud1 or abuse4 7b7 ,pay system ,the ,secretary shall establish a pay system for physicians1 dentists1 nurses1 and other health care professionals employed by the ,service that provides pay that1 to the maximum extent practicable1 is comparable to the pay provided to physicians1 dentists1 nurses1 and other health care professionals under chapter #gd of title #ch1 ,united ,states ,code4 7c7 ,relocation costs ,the ,secretary may provide to an employee of the ,service the costs the employee incurs in the relocation of the employee if1 as determined by the ,secretary-- 7#a7 the employee relocates to a ,service area experiencing a high level of need for employees2 and 7#b7 the employee will accept a position that is likely to be difficult to fill in the absence of an incentive4 7d7 ,performance-,based retention bonuses ,to improve retention of employees in the ,service1 the ,secretary may provide to an employee of the ,service a bonus based on the performance of the employee4 7e7 ,administration 7#a7 ,,opm guidelines ,the ,secretary shall carry out subsections 7a7 through 7d7 in accordance with guidelines of the ,office of ,personnel ,management for recruitment and retention1 including section #ege4aji of title #e1 ,code of ,federal ,regulations 7as in effect on the date of enactment of this ,act74 7#b7 ,service agreements ,the ,secretary may only provide a bonus1 pay increase1 relocation cost1 or other benefit under subsections 7a7 through 7d7 to an employee who agrees to serve for not less than #a year in the ,service4 7f7 ,housing vouchers 7#a7 ,in general ,subject to paragraph 7#b71 not later than #a year after the date of enactment of this section1 the ,secretary may establish a program to provide tenant-based rental assistance to an employee of the ,service who-- 7,a7 agrees to serve for not less than #a year at a ,service facility designated by the ,administrator of the ,health ,resources and ,services ,administration as a health professional shortage area2 and 7,b7 is a critical employee1 as determined by the ,secretary4 7#b7 ,sunset ,any program established by the ,secretary under paragraph 7#a7 shall terminate on the date that is #c years after the date on which the program is established4 4 7b7 ,,gao report on ,,ihs professional housing 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report identifying professional housing needs for employees of the ,indian ,health ,service4 7#b7 ,contents ,the report described in paragraph 7#a7 shall include-- 7,a7 an evaluation of any existing assessments and projections for the professional housing needs of employees of the ,indian ,health ,service2 7,b7 an accurate and independent assessment of the professional housing needs of employees of the ,indian ,health ,service for each ,service area 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 7,c7 a discussion and conclusion on whether the assessments and projections described in subparagraph 7,a7 accurately reflect the professional housing needs of employees of the ,indian ,health ,service described in subparagraph 7,b72 and 7,d7 recommendations for establishing appropriate means for the ,indian ,health ,service to accurately assess professional housing needs in the future4 7c7 ,housing plan ,not later than #a year after the date on which the ,comptroller ,general of the ,united ,states submits the report under subsection 7b71 the ,secretary shall submit to ,congress a written plan to address the professional housing needs of the ,indian ,health ,service based on the recommendations described in paragraph 7#b77;,d7 of that subsection4 #f4 ,employee protections against retaliation 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #e7;a77 is amended by adding at the end the following3 #fjh4 ,employee protections against retaliation 7a7 ,employee accountability 7#a7 ,mandatory reporting ,an employee of the ,service who witnesses retaliation against a whistleblower1 a violation of patient safety requirements1 or other similar conduct shall make a report of the conduct to an official in the ,department who-- 7,a7 is designated by the ,secretary of ,health and ,human ,services to receive those reports2 and 7,b7 is not an employee of the ,service4 7#b7 ,oversight ,the ,secretary of ,health and ,human ,services shall provide a copy of each report described in paragraph 7#a7 and any other relevant information to the ,inspector ,general of the ,department of ,health and ,human ,services by not later than #c days after receipt of the report by the designated official described in that paragraph4 7#c7 ,removal ,the ,secretary may remove for misconduct from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code71 in accordance with section #fje1 an employee of the ,service who retaliates against a whistleblower4 7b7 ,agency accountability 7#a7 ,in general ,the ,secretary shall formally review each claim of-- 7,a7 discrimination against an employee of the ,service2 or 7,b7 retaliation against a whistleblower in the ,service4 7#b7 ,annual reports to ,congress ,the ,secretary shall submit to ,congress each year a report describing the status or disposition of each claim described in paragraph 7#a74 4 7b7 ,,gao report 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report examining protections for whistleblowers in the ,indian ,health ,service 7referred to in this subsection as the ,service74 7#b7 ,contents ,the report described in paragraph 7#a7 shall include-- 7,a7 a follow-up investigation on the investigation of the ,committee on ,indian ,affairs of the ,senate entitled ,in ,critical ,condition3 ,the ,urgent ,need to ,reform the ,indian ,health ,service's ,aberdeen ,area2 7,b7 a discussion and conclusion on whether the ,service has taken proper steps to ensure that whistleblowers are not retaliated against2 7,c7 recommendations for changes in ,service policy relating to whistleblowers2 and 7,d7 a discussion and conclusion on whether the official email accounts of employees of the ,service are being monitored4 #g4 ,right of employees to petition ,congress 7a7 ,action for violation of right of ,federal employees ,section #gbaa of title #e1 ,united ,states ,code1 is amended-- 7#a7 by striking ,the right of and inserting 7a7 ,in general4--,the right of2 and 7#b7 by adding at the end the following3 7b7 ,adverse action ,an employee who interferes with or denies a right protected under this section shall1 in accordance with subchapter ,,ii of chapter #ge1 or other applicable procedures1 be subject to an adverse action described in paragraphs 7#a7 through 7#e7 of section #geab4 4 7b7 ,electronic notification of right of ,indian ,health ,service employees 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,indian ,health ,service 7referred to in this subsection as the ,secretary7 shall1 in accordance with paragraphs 7#b7 through 7#f71 provide to each employee of the ,indian ,health ,service1 and electronically post1 a memorandum providing notice of the right of employees under section #gbaa of title #e1 ,united ,states ,code 7relating to employees' right to petition ,congress74 7#b7 ,contents ,the memorandum described in paragraph 7#a7 shall include the following statement3 ,it is a violation of section #gbaa of title #e1 ,united ,states ,code1 for any ,federal agency or employee to require a ,federal employee to seek approval1 guidance1 or any other form of input prior to contacting ,congress with information1 even if that information is in relation to the job responsibilities of the employee4 ,a ,federal employee found to have interfered with or denied the right of another ,federal employee may be subject to an adverse action described in paragraphs 7#a7 through 7#e7 of section #geab of title #e1 ,united ,states ,code1 including suspension without pay for a period of more than #ad days44 7#c7 ,submission ,not later than #cj days after the date of enactment of this ,act1 the ,secretary shall submit the memorandum described in paragraph 7#a7 to the ,inspector ,general of the ,department of ,health and ,human ,services 7referred to in this section as the ,inspector ,general7 for approval4 7#d7 ,approval or disapproval ,not later than #cj days after the submission of the memorandum under paragraph 7#c71 or a revised memorandum under paragraph 7#f71 the ,inspector ,general shall approve or disapprove the memorandum or the revised memorandum4 7#e7 ,notice ,not later than #cj days after approval of the memorandum or the revised memorandum under paragraph 7#d71 the ,secretary shall-- 7,a7 provide to each employee of the ,indian ,health ,service an electronic copy of the memorandum2 and 7,b7 post the memorandum in a clear and conspicuous place on the website of the ,indian ,health ,service for a period of not fewer than #abj days4 7#f7 ,revised memorandum ,if the ,inspector ,general disapproves the memorandum or a revised memorandum under paragraph 7#d71 not later than #ae days after the disapproval1 the ,secretary shall submit a revised memorandum to the ,inspector ,general for approval under paragraph 7#d74 #h4 ,liability protections for health professional volunteers in the ,indian ,health ,service ,section #bbd of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcc7 is amended by adding at the end the following3 7q7 ,certain ,indian ,health ,service volunteers deemed ,public ,health ,service employees 7#a7 ,in general 7,a7 ,for purposes of this section1 a health professional volunteer at a ,service unit or ,service area 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 7referred to in this subsection as a covered entity7 shall1 in providing a health professional service to an individual1 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 7#d77;,c74 7,b7 ,subparagraph 7,a7 is subject to this subsection4 7#b7 ,conditions ,in providing a health service to an individual1 a health care practitioner shall for purposes of this subsection be considered to be a health professional volunteer at a covered entity if all of the following conditions are met3 7,a7 ,the service is provided to the individual at the facilities of a covered entity1 or through offsite programs or events carried out by the covered entity4 7,b7 ,the covered entity is sponsoring the health care practitioner pursuant to paragraph 7#c77;,b74 7,c7 ,the health care practitioner does not receive any compensation for the service from the individual or from any third-party payer 7including reimbursement under any insurance policy or health plan1 or under any ,federal or ,state health benefits program71 except that the health care practitioner may receive repayment from the covered entity for reasonable expenses incurred by the health care practitioner in the provision of the service to the individual4 7,d7 ,before the service is provided1 the health care practitioner or the covered entity 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 subsection4 7,e7 ,at the time the service is provided1 the health care practitioner is licensed or certified in accordance with applicable law regarding the provision of the service4 7#c7 ,applicability ,subsection 7g7 7other than paragraphs 7#c7 and 7#e7 of that subsection7 and subsections 7h71 7i71 and 7l7 apply to a health care practitioner at a covered entity for purposes of this subsection to the same extent and in the same manner as such subsections apply to an officer1 governing board member1 employee1 or contractor of an entity described in subsection 7g77#d71 subject to paragraph 7#d7 and subject to the following3 7,a7 ,each reference to an entity described in subsection 7g77#d7 shall be considered to be a reference to a covered entity4 7,b7 ,paragraph 7#a77;,a7 applies in lieu of the first sentence of subsection 7g77#a77;,a74 7,c7 7i7 ,with respect to a covered entity1 a health care practitioner is not a health professional volunteer at the covered entity unless the covered entity sponsors the health care practitioner4 7ii7 ,for purposes of this subsection1 the covered entity shall be considered to be sponsoring the health care practitioner if-- 7,i7 with respect to the health care practitioner1 the covered entity submits to the ,secretary an application meeting the requirements of subsection 7g77#a77;,d72 and 7,,ii7 the ,secretary1 pursuant to subsection 7g77#a77;,e71 determines that the health care practitioner is deemed to be an employee of the ,public ,health ,service4 7,d7 ,in the case of a health care practitioner who is determined by the ,secretary pursuant to subsection 7g77#a77;,e7 to be a health professional volunteer at the covered entity1 this subsection applies to the health care practitioner 7with respect to services performed on behalf of the covered entity sponsoring the health care practitioner pursuant to subparagraph 7,c77 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 determination4 7,e7 ,subsection 7g77#a77;,f7 applies to a health care practitioner for purposes of this subsection only to the extent that1 in providing health services to an individual1 each of the conditions described in paragraph 7#b7 is met4 7#d7 ,funding 7,a7 ,in general ,amounts in the fund established under subsection 7k77#b7 shall be available for transfer under subparagraph 7,c7 for purposes of carrying out this subsection4 7,b7 ,annual estimates 7i7 ,in general ,not later ,may #a of each fiscal year1 the ,attorney ,general1 in consultation with the ,secretary1 shall submit to ,congress a report providing an estimate of the amount of claims 7together with related fees and expenses of witnesses7 that1 by reason of the acts or omissions of health professional volunteers1 will be paid under this section during the calendar year that begins in the following fiscal year4 7ii7 ,applicability ,subsection 7k77#a77;,b7 applies to the estimate under clause 7i7 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 officers1 governing board members1 employees1 and contractors of entities described in subsection 7g77#d74 7,c7 ,transfers ,not later than ,december #ca of each fiscal year1 the ,secretary shall transfer from the fund under subsection 7k77#b7 to the appropriate accounts in the ,treasury an amount equal to the estimate made under subparagraph 7,b7 for the calendar year beginning in that fiscal year1 subject to the extent of amounts in the fund4 7#e7 ,effective dates 7,a7 ,in general ,except as provided in subparagraph 7,b71 this subsection takes effect on ,october #a1 #bjag4 7,b7 ,regulations1 applications1 and reports ,effective on the date of the enactment of this subsection-- 7i7 the ,secretary may-- 7,i7 issue regulations for carrying out this subsection2 and 7,,ii7 accept and consider applications submitted under paragraph 7#c77;,c72 and 7ii7 the ,attorney ,general may submit to ,congress a report under paragraph 7#d77;,b74 4 #i4 ,fiscal accountability ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #f7;a77 is amended by adding at the end the following3 #fji4 ,fiscal accountability 7a7 ,management of funds 7#a7 ,in general ,if the ,secretary fails to submit the staffing plan in accordance with section #d7;c7 of the ,indian ,health ,service ,accountability ,act of #bjaf or the housing plan in accordance with section #e7;c7 of that ,act1 the ,secretary may not receive1 obligate1 transfer1 or expend any amounts for a salary increase or bonus of an individual described in paragraph 7#b7 before the applicable plan is submitted in accordance with section #d7;c7 or section #e7;c7 of that ,act1 as applicable4 7#b7 ,individual described ,an individual referred to in paragraph 7#a7 is-- 7,a7 an individual who-- 7i7 is employed in a position described in sections #ecab through #ecaf of title #e1 ,united ,states ,code 7relating to the ,executive ,schedule72 7ii7 is a limited term appointee1 limited emergency appointee1 or noncareer appointee in the ,senior ,executive ,service1 as defined under paragraphs 7#e71 7#f71 and 7#g71 respectively1 of section #cacb7;a7 of title #e1 ,united ,states ,code2 or 7iii7 is employed in a position in the executive branch of the ,government of a confidential or policy-determining nature under schedule ,c of subpart ,c of part #bac of title #e1 ,code of ,federal ,regulations2 or 7,b7 a senior executive 7as defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7b7 ,prioritization of patient care 7#a7 ,in general ,the ,secretary shall use amounts that are not obligated or expended during the fiscal year for which the amounts are made available1 and that remain available1 only to support patient care1 specifically for-- 7,a7 costs of essential medical equipment2 7,b7 the ,purchased_/,referred ,care program2 or 7,c7 any other purpose approved by the ,secretary after consultation with appropriate ,indian tribes4 7#b7 ,restrictions ,the ,secretary shall not use amounts described in paragraph 7#a7 for-- 7,a7 interior decorating or remodeling of a facility of the ,service2 or 7,b7 an increase in rate of pay for an employee of an ,area office4 7c7 ,spending reports ,the ,secretary shall provide a report each quarter of a fiscal year describing the expenditures1 outlays1 transfers1 reprogramming1 obligations1 and other spending of each level of the ,service1 including the headquarters1 each ,area office1 each ,service unit1 and each facility1 to-- 7#a7 ,indian tribes2 7#b7 in the ,senate-- 7,a7 the ,committee on ,indian ,affairs2 7,b7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions2 7,c7 the ,committee on ,appropriations2 and 7,d7 the ,committee on the ,budget2 and 7#c7 in the ,house of ,representatives-- 7,a7 the ,committee on ,natural ,resources2 7,b7 the ,committee on ,energy and ,commerce2 7,c7 the ,committee on ,appropriations2 and 7,d7 the ,committee on the ,budget4 7d7 ,status reports 7#a7 ,in general ,the ,secretary shall provide to each entity described in paragraphs 7#a7 through 7#c7 of subsection 7c7 a report each quarter of a fiscal year1 except as provided in paragraph 7#b71 describing the safety1 billing1 certification1 credential1 and compliance statuses of each facility managed1 operated1 or otherwise supported by the ,service4 7#b7 ,updates ,on a change of a status described in paragraph 7#a71 the ,secretary shall immediately provide to each entity described in paragraphs 7#a7 through 7#c7 of subsection 7c7 an update describing the change4 4 #aj4 ,transparency and accountability for patient safety 7a7 ,transparency and accountability ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #i7 is amended by adding at the end the following3 #faj4 ,transparency and accountability for patient safety 7a7 ,transparency ,the ,secretary shall ensure that all surveys1 reports1 and other materials of the ,centers for ,medicare ,medicaid ,services relating to patient safety and compliance are posted on the websites of each hospital and clinic wholly or partially owned1 operated1 managed1 or funded by the ,service4 7b7 ,accountability 7#a7 ,in general ,the ,inspector ,general of the ,department 7referred to in this section as the ,inspector ,general7 shall investigate each patient death in which the ,service is alleged to be involved by an act or omission4 7#b7 ,notice ,the ,secretary shall notify the ,inspector ,general of each patient death that occurs-- 7,a7 in a facility of the ,service2 or 7,b7 under the care of the ,service4 7#c7 ,reports ,not less frequently than once each year1 the ,inspector ,general shall provide to ,indian tribes in the relevant ,service area and ,congress a report describing the investigations described in paragraph 7#a74 7#d7 ,disclosure ,on completion of each investigation described in paragraph 7#a71 the ,inspector ,general shall provide to the family of the deceased patient information relating to-- 7,a7 the findings of the investigation2 and 7,b7 any action taken by the ,inspector ,general1 including any criminal referral4 7c7 ,quality monitoring ,the ,secretary1 in consultation with the ,inspector ,general1 shall establish within the ,service a program to monitor the quality of patient care in the ,service4 7d7 ,reporting systems ,the ,inspector ,general shall-- 7#a7 conduct an audit of reporting systems of the ,service as of the date of enactment of this section2 and 7#b7 provide to the ,service recommendations and technical assistance to implement improved reporting systems1 procedures1 standards1 and protocols4 4 7b7 ,compliance surveys ,section #ahhj of the ,social ,security ,act 7#db ,u4,s4,c4 #acieqq7 is amended by adding at the end the following3 7g7 7#a7 ,not less frequently than once every #b years1 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-- 7,a7 section #ahfg2 and 7,b7 conditions of participation in the program under this title4 7#b7 ,each survey completed under this subsection shall be made available on the public ,internet website of the ,centers for ,medicare ,medicaid ,services4 4