,,ii  #aad? ,,congress  #b;d ,session   
,s4 #biec  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ai1 #bjaf ,mr4   
,b>rasso 7= himself & ,mr4 ,?une7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,indian ,affairs  ,a ,,bill  ,to promote
 pati5t-c5t]$ c>e & acc\ntability at !  
,indian ,heal? ,s]vice1 & = o!r         
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,indian ,heal? ,s]vice     
,acc\ntability ,act ( #bjaf or ! ,,ihs  
,acc\ntability ,act ( #bjaf4  #b4 ,f9d+s
 ,congress f9ds t--  7#a7 9 #bjaj1 !    
,committee on ,indian ,affairs ( !      
,s5ate held an ov]sight he>+ entitl$ ,9 
,critical ,condition3 ,! ,urg5t ,ne$ to 
,re=m ,indian ,heal? ,s]vice's ,ab]de5  
,area1 dur+ :i* memb]s ( ! ,committee   
li/5$ to te/imony detail+ an            
inve/igation l$ by a =m] ,*airman ( !   
,committee1 ,byron ,dorgan1 includ+ 8   
report on ! ,indian ,heal? ,s]vice      
7ref]r$ to 9 ?is section z ! ,dorgan    
,report72  7#b7 ! ,dorgan ,report f\nd  

evid5ce %[+ ! lack ( quality ( c>e at   
,indian ,heal? ,s]vice facilities 9 !   
,great ,pla9s ,area 7previ\sly ref]r$ to
 z ! ,ab]de5 ,area71 :i* is compris$ (  
,s\? ,dakota1 ,nor? ,dakota1 ,nebraska1 
& ,i[a2  7#c7 9 #bjae-- 7,a7 /aff ( !   
,committee on ,indian ,affairs ( !      
,s5ate inve/igat$ claims t conditions 9 
! ,great ,pla9s ,area _h n improv$2 &   
7,b7 ! ,committee confirm$ t _m issues  
id5tifi$ 9 ! ,dorgan ,report _h n be5   
resolv$ & f\nd t "s problems _h become  
worse & new problems _h develop$2  7#d7 
a culture ( cronyism 9 ! ,indian ,heal? 
,s]vice has fur!r erod$ confid5ce 9 !   
heal? c>e sy/em ( ! ,indian ,heal?      
,s]vice2  7#e7 p]si/5t failures by !    
,indian ,heal? ,s]vice to provide tribal
 citiz5s access to safe1 quality heal?  
c>e h l$ to multiple innoc5t pati5t     
dea?s & ! suff]+ ( pati5ts1 families1 & 
:ole communities2  7#f7 ^? failures h   
be5 ext5sively docum5t$ by ,congress1 ! 
,indian ,heal? ,s]vice1 & ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices1 :i* confirm$

 t sy/emic problems & sub/&>d conditions
 9 ,indian ,heal? ,s]vice facilities    
pose an imm$iate risk to pati5t safety2 
7#g7 ! ,unit$ ,/ates has treaty1 tru/1 &
 /atutory obligations to provide heal?  
c>e to ,am]ican ,indians & ,alaska      
,natives1 :i* ! ,indian ,heal? ,s]vice  
is m&at$ to uphold2 &  7#h7 prioritiz+  
pati5ts & re/or+ fai? 9 ! heal? c>e     
sy/em ( ! ,indian ,heal? ,s]vice        
requires great] transp>5cy1             
acc\ntability1 & /rong lead]%ip4  #c4   
,removal ( ,indian ,heal? ,s]vice       
employees bas$ on p]=mance or misconduct
 ,title ,,vi ( ! ,indian ,heal? ,c>e    
,improvem5t ,act 7#be ,u4,s4,c4 #affa et
 seq47 is am5d$ by add+ at ! end !      
foll[+3  #fje4 ,removal ( ,s]vice       
employees bas$ on p]=mance or misconduct
  7a7 ,def9itions ,9 ?is section &      
sections #fjf ?r\gh #faj3  7#a7         
,employee ,! t]m employee has ! mean+   
giv5 ! t]m 9 section #baje ( title #e1  
,unit$ ,/ates ,code4  7#b7 ,manag]  7,a7
 ,9 g5]al ,! t]m manag] has ! mean+ giv5

 ! t]m managem5t (ficial 9 section      
#gajc7;a7 ( title #e1 ,unit$ ,/ates     
,code4  7,b7 ,inclusions ,! t]m manag]  
includes1 z employ$ at any facility ( ! 
,s]vice-- 7i7 a *ief executive (fic]2   
7ii7 a *ief m$ical (fic]2 &  7iii7 a    
dep>tm5t director4  7#c7 ,misconduct ,! 
t]m misconduct means neglect ( duty1    
malfeasance1 or failure to accept a     
direct$ reassignm5t or to accompany a   
position 9 a transf] ( function4  7#d7  
,p]sonnel action ,! t]m p]sonnel action 
means a removal1 transf]1 or r$uction 9 
grade "u subsection 7b77#b74  7#e7      
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,director ( ! ,s]vice4     
7#f7 ,s5ior executive ,! t]m s5ior      
executive means a c>e] appo9tee 7z t t]m
 is def9$ 9 section #cacb7;a7 ( title   
#e1 ,unit$ ,/ates ,code7 t occupies a   
,s5ior ,executive ,s]vice position4     
7#g7 ,s5ior ,executive ,s]vice position 
,! t]m ,s5ior ,executive ,s]vice        
position has ! mean+ giv5 ! t]m 9       

section #cacb7;a7 ( title #e1 ,unit$    
,/ates ,code4  7#h7 ,sup]visor ,! t]m   
sup]visor has ! mean+ giv5 ! t]m 9      
section #gajc7;a7 ( title #e1 ,unit$    
,/ates ,code4  7b7 ,removal bas$ on     
p]=mance or misconduct  7#a7 ,9 g5]al   
,subject to p>agraph 7#d71 ! ,secret>y  
may remove an employee ( ! ,s]vice f !  
position ! employee occupies if !       
,secret>y det]m9es ! p]=mance or        
misconduct ( ! employee w>rants removal4
  7#b7 ,action ,if ! ,secret>y removes  
an employee "u p>agraph 7#a71 !         
,secret>y may--  7,a7 remove ! employee 
f ! civil s]vice 7z def9$ 9 section     
#baja ( title #e1 ,unit$ ,/ates ,code72 
7,b7 9 ! case ( an individual describ$ 9
 p>agraph 7#c71 transf] ! individual f !
 ,s5ior ,executive ,s]vice position to a
 ,g5]al ,s*$ule position at any grade ( 
! ,g5]al ,s*$ule = :i* ! individual is  
qualifi$ & t ! ,secret>y det]m9es is    
appropriate2 or  7,c7 9 ! case ( a      
manag] or sup]visor1 r$uce ! grade ( !  
manag] or sup]visor to any o!r grade =  

:i* ! individual is qualifi$ & t !      
,secret>y det]m9es is appropriate4  7#c7
 ,individual describ$ ,an individual    
ref]r$ to 9 p>agraph 7#b77;,b7 is a     
s5ior executive t-- 7,a7 previ\sly      
occupi$ a p]man5t position )9 !         
competitive s]vice 7z t t]m is def9$ 9  
section #bajb ( title #e1 ,unit$ ,/ates 
,code72 or  7,b7 previ\sly occupi$ a    
p]man5t position )9 ! except$ s]vice 7z 
t t]m is def9$ 9 section #bajc ( title  
#e1 ,unit$ ,/ates ,code74  7#d7 ,due    
process ,be=e an employee may be subject
 to a p]sonnel action1 ! ,secret>y %all 
provide to ! employee--  7,a7 n less ?an
 #aj days be=e ! p]sonnel action1 writt5
 notice ( ! propos$ p]sonnel action2 &  
7,b7 an opportunity & reasonable "t to  
answ] orally or 9 writ+4  7c7 ,pay (    
c]ta9 individuals  7#a7 ,9 g5]al        
,not)/&+ any o!r provision ( law1       
includ+ ! requirem5ts ( section #ceid ( 
title #e1 ,unit$ ,/ates ,code1 any      
individual transf]r$ to a ,g5]al ,s*$ule
 position "u subsection 7b77#b77;,b7 or 

subject to a r$uction 9 grade "u        
subsection 7b77#b77;,c7 %all1 beg9n+ on 
! date ( ! transf]1 receive ! annual    
rate ( pay applicable to ! position4    
7#b7 ,requirem5ts  7,a7 ,9 g5]al ,an    
individual transf]r$ to a ,g5]al ,s*$ule
 position "u subsection 7b77#b77;,b7 or 
subject to a r$uction 9 grade "u        
subsection 7b77#b77;,c7--  7i7 may n be 
plac$ on adm9i/rative leave or any o!r  
category ( paid leave dur+ ! p]iod dur+ 
:i* an appeal 7if any7 "u subsection    
7e77#b77;,a7 is ongo+2 &  7ii7 may only 
receive pay if ! individual-- 7,i7      
reports = duty2 &  7,,ii7 p]=ms a prim>y
 duty or an alt]native prim>y duty1 z   
ea* t]m is describ$ 9 section #eea4ajd (
 title #e1 ,code ( ,f$]al ,regulations  
7or a successor regulation74  7,b7      
,failure to report ,if an individual    
transf]r$ to a ,g5]al ,s*$ule position  
"u subsection 7b77#b77;,b7 or subject to
 a r$uction 9 grade "u subsection       
7b77#b77;,c7 does n report = duty1      
pursuant to subsection 7f77#e71 !       

individual %all n receive any increase 9
 rate ( pay or o!r b5efit4  7d7 ,notice 
to ,congress ,n lat] ?an #cj days aft] !
 date on :i* ! ,secret>y takes a        
p]sonnel action1 ! ,secret>y %all       
submit1 9 writ+1 a notice ( ! p]sonnel  
action & ! reason = ! p]sonnel action   
to--  7#a7 ! ,committee on ,indian      
,affairs ( ! ,s5ate2  7#b7 ! ,committee 
on ,heal?1 ,education1 ,labor1 &        
,p5sions ( ! ,s5ate2  7#c7 ! ,committee 
on ,natural ,res\rces ( ! ,h\se (       
,repres5tatives2  7#d7 ! ,committee on  
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives2 &  7#e7 ! ,inspector   
,g5]al ( ! ,dep>tm5t4  7e7 ,proc$ure    
7#a7 ,inapplicability ,! proc$ures "u   
*apt]s #dc & #ge ( title #e1 ,unit$     
,/ates ,code1 %all n apply to a p]sonnel
 action4  7#b7 ,appeal  7,a7 ,9 g5]al   
,subject to subp>agraph 7,b7 &          
subsection 7f71 an employee subject to a
 p]sonnel action may appeal ! p]sonnel  
action to ! ,m]it ,sy/ems ,protection   
,bo>d "u section #ggja ( title #e1      

,unit$ ,/ates ,code4  7,b7 ,limitation  
,an appeal "u subp>agraph 7,a7 may only 
be made if ! appeal is made n lat] ?an  
#g days aft] ! date ( ! p]sonnel action4
  7f7 ,exp$it$ review by adm9i/rative   
law judge  7#a7 ,9 g5]al  7,a7 ,ref]ral 
,on receipt ( an appeal "u subsection   
7e77#b77;,a71 ! ,m]it ,sy/ems           
,protection ,bo>d %all ref] ! appeal to 
an adm9i/rative law judge pursuant to   
section #ggja7;b77#a7 ( title #e1 ,unit$
 ,/ates ,code4  7,b7 ,exp$ition ,!      
adm9i/rative law judge to :om an appeal 
is ref]r$ "u subp>agraph 7,a7 %all-- 7i7
 exp$ite ! appeal "u section            
#ggja7;b77#a7 ( title #e1 ,unit$ ,/ates 
,code2 &  7ii7 issue a decision 9 ea*   
case n lat] ?an #ba days aft] ! date ( !
 appeal4  7#b7 ,f9ality ,not)/&+ any o!r
 provision ( law1 includ+ section #ggjc 
( title #e1 ,unit$ ,/ates ,code1 !      
decision ( an adm9i/rative law judge "u 
p>agraph 7#a7 %all be f9al & %all n be  
subject to any fur!r adm9i/rative       
appeal4  7#c7 ,failure to issue decision

  7,a7 ,9 g5]al ,9 any case 9 :i* an    
adm9i/rative law judge fails to issue a 
decision 9 accordance ) ! #ba-;day      
requirem5t describ$ 9 p>agraph          
7#a77;,b77ii71 ! p]sonnel action %all be
 treat$ z f9al4  7,b7 ,transp>5cy ,9 any
 case 9 :i* a p]sonnel action is treat$ 
z f9al "u subp>agraph 7,a71 ! ,m]it     
,sy/ems ,protection ,bo>d %all1 n lat]  
?an #ad days aft] ! date on :i* !       
p]sonnel action becomes f9al1 submit a  
lett] expla9+ ! reasons :y a decision 0 
n issu$ 9 accordance ) ! #ba-;day       
requirem5t describ$ 9 p>agraph          
7#a77;,b77ii7 to--  7i7 ! ,committee on 
,indian ,affairs ( ! ,s5ate2  7ii7 !    
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate2  7iii7 ! 
,committee on ,natural ,res\rces ( !    
,h\se ( ,repres5tatives2 &  7iv7 !      
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives4  7#d7          
,re/riction ,! ,m]it ,sy/ems ,protection
 ,bo>d or an adm9i/rative law judge may 
n /ay any p]sonnel action4  7#e7        

,cessation ( pay increases & b5efits    
,dur+ ! p]iod beg9n+ on ! date on :i* an
 employee appeals a removal f ! civil   
s]vice "u subsection 7e77#b77;,a7 & end+
 on ! date on :i* ! removal becomes     
f9al1 ! employee may n receive any--    
7,a7 increase 9 rate ( pay2 or  7,b7    
aw>d1 bonus1 inc5tive1 all[ance1        
diff]5tial1 /ud5t loan repaym5t1 special
 paym5t1 or o!r b5efit4  7#f7 ,assi/ance
 ,to ! maximum ext5t practicable1 !     
,secret>y %all provide su* in=mation &  
assi/ance z may be necess>y to ensure an
 appeal "u ?is subsection is exp$it$    
to--  7,a7 ! ,m]it ,sy/ems ,protection  
,bo>d2 &  7,b7 any adm9i/rative law     
judge to :om an appeal "u ?is section is
 ref]r$4  7g7 ,employm5t record         
transp>5cy ,! ,secret>y %all ensure t ! 
employm5t records = any employee subject
 to a p]sonnel action1 reg>dless ( :e!r 
t p]sonnel action is f9al1 include--    
7#a7 a notation t ! employee 0 subject  
to a p]sonnel action2 &  7#b7 a         
description ( ! disposition or /atus ( !

 p]sonnel action or any appeal ( !      
p]sonnel action "u ?is section4  7h7    
,relation to title #e1 ,unit$ ,/ates    
,code  7#a7 ,additional au?ority ,!     
p]sonnel action au?orities provid$ to ! 
,secret>y "u ?is section are 9 addition 
to ! au?orities provid$ "u *apt]s #dc & 
#ge ( title #e1 ,unit$ ,/ates ,code4    
7#b7 ,removal ( s5ior executives        
,section #ceib7;b77#a7 ( title #e1      
,unit$ ,/ates ,code1 %all n apply to a  
p]sonnel action4  4  #d4 ,improvem5ts 9 
hir+ practices  7a7 ,9 g5]al ,title ,,vi
 ( ! ,indian ,heal? ,c>e ,improvem5t    
,act 7#be ,u4,s4,c4 #affa et seq47 7z   
am5d$ by section #c7 is am5d$ by add+ at
 ! end ! foll[+3  #fjf4 ,improvem5ts 9  
hir+ practices  7a7 ,direct hire        
au?ority ,! ,secret>y may appo9t1 )\t   
reg>d to sub*apt] ,i ( *apt] #cc ( title
 #e1 ,unit$ ,/ates ,code 7o!r ?an       
sections #ccjc & #ccbh ( t title71 a    
c&idate directly to a position )9 !     
,s]vice = :i* ! c&idate meets ,(fice (  
,p]sonnel ,managem5t qualification      

/&>ds4  7b7 ,pref]5ce ,to enhance       
recruitm5t & ret5tion ( employees ( !   
,s]vice1 ! ,secret>y may waive !        
requirem5ts ( ! ,indian pref]5ce laws 7z
 def9$ 9 section #b7;e7 ( ,public ,law  
#if-ace 7#be ,u4,s4,c4 #dgb;a7e777 )    
respect to hir+ a c&idate to a position 
9 a ,s]vice unit on writt5 reque/ or    
resolution ( an ,indian tribe locat$ )9 
! applicable ,s]vice unit4  7c7 ,tribal 
consultation  7#a7 ,9 g5]al ,subject to 
p>agraph 7#b71 be=e appo9t+1 hir+1      
promot+1 or transf]r+ a c&idate to a    
,s5ior ,executive ,s]vice position or ! 
position ( a manag] at an ,area (fice or
 ,s]vice unit1 ! ,secret>y %all         
mean+fully & exp$iti\sly consult )      
,indian tribes locat$ )9 ! applicable   
,s]vice area or ,s]vice unit4  7#b7     
,exception  7,a7 ,9 g5]al ,if !         
,secret>y det]m9es t em]g5cy            
circum/ances exi/ t may negatively      
impact pati5t heal? or safety if !      
position is n fill$1 ! ,secret>y may    
appo9t a c&idate to a ,s5ior ,executive 

,s]vice or manag] position at an ,area  
(fice or ,s]vice unit = a tempor>y "t   
p]iod only1 n to exce$ #ahj days4  7,b7 
,notice ,! ,secret>y %all notify1 9     
writ+1 ea* ,indian tribe locat$ )9 !    
applicable ,s]vice area or ,s]vice unit 
( ! appo9tm5t n few] ?an #g days prior  
to ex]cis+ ! au?ority describ$ 9        
subp>agraph 7,a74  7d7 ,notice ( removal
 bas$ on p]=mance or misconduct ,be=e   
appo9t+1 hir+1 promot+1 or transf]r+ a  
c&idate to a ,s5ior ,executive ,s]vice  
position or ! position ( a manag] or    
sup]visor at an ,area (fice or ,s]vice  
unit1 ! ,secret>y %all provide to       
,indian tribes locat$ )9 ! applicable   
,s]vice area ! cont5t ( an inclusion 9  
an employm5t record "u section #fje7;g74
  4  7b7 ,,gao report on ,,ihs /aff+    
ne$s  7#a7 ,9 g5]al ,n lat] ?an #a ye>  
aft] ! date ( enactm5t ( ?is ,act1 !    
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report       
assess+ /aff+ ne$s 9 ! ,indian ,heal?   
,s]vice4  7#b7 ,cont5ts ,! report       

describ$ 9 p>agraph 7#a7 %all include-- 
7,a7 a description ( ! numb] & type (   
full-"t equival5t employees ne$$ at ea* 
facility ( ! ,indian ,heal? ,s]vice &   
am\nts requir$ = ^? employees2  7,b7 an 
assessm5t ( ! use ( indep5d5t           
contractors in/ead ( full-"t equival5t  
employees2 &  7,c7 recomm5dations to    
address /aff+ ne$s 9 ! ,indian ,heal?   
,s]vice4  7c7 ,/aff+ plan ,n lat] ?an #a
 ye> aft] ! date on :i* ! ,comptroll]   
,g5]al ( ! ,unit$ ,/ates submits !      
report "u subsection 7b71 ! ,secret>y   
%all submit to ,congress a writt5 plan  
to address /aff+ ne$s 9 ! ,indian ,heal?
 ,s]vice bas$ on ! recomm5dations       
describ$ 9 p>agraph 7#b77;,c7 ( t       
subsection4  #e4 ,inc5tives = recruitm5t
 & ret5tion  7a7 ,9 g5]al ,title ,,vi ( 
! ,indian ,heal? ,c>e ,improvem5t ,act  
7#be ,u4,s4,c4 #affa et seq47 7z am5d$  
by section #d7;a77 is am5d$ by add+ at !
 end ! foll[+3  #fjg4 ,inc5tives =      
recruitm5t & ret5tion  7a7 ,rew>d+      
quality p]=mance  7#a7 ,9 g5]al ,not)/&+

 any o!r provision ( law1 ! ,secret>y   
may grant or resc9d bonuses or o!r      
b5efits to employees ( ! ,s]vice--  7,a7
 to promote pati5t safety2  7,b7 to     
promote quality ( p]=mance ( !          
employees2 or  7,c7 to improve          
recruitm5t & ret5tion ( employees 9 !   
,s]vice4  7#b7 ,quality inc5tives ,!    
,secret>y may grant a bonus "u p>agraph 
7#a7 to a manag] or sup]visor 9 !       
,s]vice :o id5tifies "o or m ways--     
7,a7 to improve pati5t c>e2 or  7,b7 to 
r$uce wa/e1 fraud1 or abuse4  7b7 ,pay  
sy/em ,! ,secret>y %all e/abli% a pay   
sy/em = physicians1 d5ti/s1 nurses1 &   
o!r heal? c>e pr(essionals employ$ by ! 
,s]vice t provides pay t1 to ! maximum  
ext5t practicable1 is comp>able to ! pay
 provid$ to physicians1 d5ti/s1 nurses1 
& o!r heal? c>e pr(essionals "u *apt]   
#gd ( title #ch1 ,unit$ ,/ates ,code4   
7c7 ,relocation co/s ,! ,secret>y may   
provide to an employee ( ! ,s]vice !    
co/s ! employee incurs 9 ! relocation ( 
! employee if1 z det]m9$ by !           

,secret>y--  7#a7 ! employee relocates  
to a ,s]vice area exp]i5c+ a high level 
( ne$ = employees2 &  7#b7 ! employee w 
accept a position t is likely to be     
difficult to fill 9 ! abs5ce ( an       
inc5tive4  7d7 ,p]=mance-,bas$ ret5tion 
bonuses ,to improve ret5tion ( employees
 9 ! ,s]vice1 ! ,secret>y may provide to
 an employee ( ! ,s]vice a bonus bas$ on
 ! p]=mance ( ! employee4  7e7          
,adm9i/ration  7#a7 ,,opm guidel9es ,!  
,secret>y %all c>ry out subsections 7a7 
?r\gh 7d7 9 accordance ) guidel9es ( !  
,(fice ( ,p]sonnel ,managem5t =         
recruitm5t & ret5tion1 includ+ section  
#ege4aji ( title #e1 ,code ( ,f$]al     
,regulations 7z 9 effect on ! date (    
enactm5t ( ?is ,act74  7#b7 ,s]vice     
agreem5ts ,! ,secret>y may only provide 
a bonus1 pay increase1 relocation co/1  
or o!r b5efit "u subsections 7a7 ?r\gh  
7d7 to an employee :o agrees to s]ve = n
 less ?an #a ye> 9 ! ,s]vice4  7f7 ,h\s+
 v\*]s  7#a7 ,9 g5]al ,subject to       
p>agraph 7#b71 n lat] ?an #a ye> aft] ! 

date ( enactm5t ( ?is section1 !        
,secret>y may e/abli% a program to      
provide t5ant-bas$ r5tal assi/ance to an
 employee ( ! ,s]vice :o--  7,a7 agrees 
to s]ve = n less ?an #a ye> at a ,s]vice
 facility designat$ by ! ,adm9i/rator ( 
! ,heal? ,res\rces & ,s]vices           
,adm9i/ration z a heal? pr(essional     
%ortage area2 &  7,b7 is a critical     
employee1 z det]m9$ by ! ,secret>y4     
7#b7 ,sunset ,any program e/abli%$ by ! 
,secret>y "u p>agraph 7#a7 %all t]m9ate 
on ! date t is #c ye>s aft] ! date on   
:i* ! program is e/abli%$4  4  7b7 ,,gao
 report on ,,ihs pr(essional h\s+  7#a7 
,9 g5]al ,n lat] ?an #a ye> aft] ! date 
( enactm5t ( ?is ,act1 ! ,comptroll]    
,g5]al ( ! ,unit$ ,/ates %all submit to 
,congress a report id5tify+ pr(essional 
h\s+ ne$s = employees ( ! ,indian ,heal?
 ,s]vice4  7#b7 ,cont5ts ,! report      
describ$ 9 p>agraph 7#a7 %all include-- 
7,a7 an evaluation ( any exi/+          
assessm5ts & projections = ! pr(essional
 h\s+ ne$s ( employees ( ! ,indian      

,heal? ,s]vice2  7,b7 an accurate &     
indep5d5t assessm5t ( ! pr(essional h\s+
 ne$s ( employees ( ! ,indian ,heal?    
,s]vice = ea* ,s]vice area 7z def9$ 9   
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc772
  7,c7 a discussion & conclusion on :e!r
 ! assessm5ts & projections describ$ 9  
subp>agraph 7,a7 accurately reflect !   
pr(essional h\s+ ne$s ( employees ( !   
,indian ,heal? ,s]vice describ$ 9       
subp>agraph 7,b72 &  7,d7 recomm5dations
 = e/abli%+ appropriate means = !       
,indian ,heal? ,s]vice to accurately    
assess pr(essional h\s+ ne$s 9 ! future4
  7c7 ,h\s+ plan ,n lat] ?an #a ye> aft]
 ! date on :i* ! ,comptroll] ,g5]al ( ! 
,unit$ ,/ates submits ! report "u       
subsection 7b71 ! ,secret>y %all submit 
to ,congress a writt5 plan to address ! 
pr(essional h\s+ ne$s ( ! ,indian ,heal?
 ,s]vice bas$ on ! recomm5dations       
describ$ 9 p>agraph 7#b77;,d7 ( t       
subsection4  #f4 ,employee protections  
aga9/ retaliation  7a7 ,9 g5]al ,title  

,,vi ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #affa et seq47 7z  
am5d$ by section #e7;a77 is am5d$ by    
add+ at ! end ! foll[+3  #fjh4 ,employee
 protections aga9/ retaliation  7a7     
,employee acc\ntability  7#a7 ,m&atory  
report+ ,an employee ( ! ,s]vice :o     
witnesses retaliation aga9/ a :i/lebl[]1
 a violation ( pati5t safety            
requirem5ts1 or o!r simil> conduct %all 
make a report ( ! conduct to an (ficial 
9 ! ,dep>tm5t :o--  7,a7 is designat$ by
 ! ,secret>y ( ,heal? & ,human ,s]vices 
to receive ^? reports2 &  7,b7 is n an  
employee ( ! ,s]vice4  7#b7 ,ov]sight ,!
 ,secret>y ( ,heal? & ,human ,s]vices   
%all provide a copy ( ea* report        
describ$ 9 p>agraph 7#a7 & any o!r      
relevant in=mation to ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices by n lat] ?an #c days aft]     
receipt ( ! report by ! designat$       
(ficial describ$ 9 t p>agraph4  7#c7    
,removal ,! ,secret>y may remove =      
misconduct f ! civil s]vice 7z def9$ 9  

section #baja ( title #e1 ,unit$ ,/ates 
,code71 9 accordance ) section #fje1 an 
employee ( ! ,s]vice :o retaliates aga9/
 a :i/lebl[]4  7b7 ,ag5cy acc\ntability 
7#a7 ,9 g5]al ,! ,secret>y %all =mally  
review ea* claim (-- 7,a7 discrim9ation 
aga9/ an employee ( ! ,s]vice2 or  7,b7 
retaliation aga9/ a :i/lebl[] 9 !       
,s]vice4  7#b7 ,annual reports to       
,congress ,! ,secret>y %all submit to   
,congress ea* ye> a report describ+ !   
/atus or disposition ( ea* claim        
describ$ 9 p>agraph 7#a74  4  7b7 ,,gao 
report  7#a7 ,9 g5]al ,n lat] ?an #a ye>
 aft] ! date ( enactm5t ( ?is ,act1 !   
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report exam9+
 protections = :i/lebl[]s 9 ! ,indian   
,heal? ,s]vice 7ref]r$ to 9 ?is         
subsection z ! ,s]vice74  7#b7 ,cont5ts 
,! report describ$ 9 p>agraph 7#a7 %all 
include-- 7,a7 a foll[-up inve/igation  
on ! inve/igation ( ! ,committee on     
,indian ,affairs ( ! ,s5ate entitl$ ,9  
,critical ,condition3 ,! ,urg5t ,ne$ to 

,re=m ! ,indian ,heal? ,s]vice's ,ab]de5
 ,area2  7,b7 a discussion & conclusion 
on :e!r ! ,s]vice has tak5 prop] /eps to
 ensure t :i/lebl[]s are n retaliat$    
aga9/2  7,c7 recomm5dations = *anges 9  
,s]vice policy relat+ to :i/lebl[]s2 &  
7,d7 a discussion & conclusion on :e!r !
 (ficial email acc\nts ( employees ( !  
,s]vice are be+ monitor$4  #g4 ,"r (    
employees to petition ,congress  7a7    
,action = violation ( "r ( ,f$]al       
employees ,section #gbaa ( title #e1    
,unit$ ,/ates ,code1 is am5d$-- 7#a7 by 
/rik+ ,! "r ( & ins]t+ 7a7 ,9 g5]al4--,!
 "r (2 &  7#b7 by add+ at ! end !       
foll[+3  7b7 ,adv]se action ,an employee
 :o int]f]es ) or d5ies a "r protect$ "u
 ?is section %all1 9 accordance )       
sub*apt] ,,ii ( *apt] #ge1 or o!r       
applicable proc$ures1 be subject to an  
adv]se action describ$ 9 p>agraphs 7#a7 
?r\gh 7#e7 ( section #geab4  4  7b7     
,electronic notification ( "r ( ,indian 
,heal? ,s]vice employees  7#a7 ,9 g5]al 
,! ,secret>y ( ,heal? & ,human ,s]vices1

 act+ ?r\gh ! ,director ( ! ,indian     
,heal? ,s]vice 7ref]r$ to 9 ?is         
subsection z ! ,secret>y7 %all1 9       
accordance ) p>agraphs 7#b7 ?r\gh 7#f71 
provide to ea* employee ( ! ,indian     
,heal? ,s]vice1 & electronically po/1 a 
memor&um provid+ notice ( ! "r (        
employees "u section #gbaa ( title #e1  
,unit$ ,/ates ,code 7relat+ to          
employees' "r to petition ,congress74   
7#b7 ,cont5ts ,! memor&um describ$ 9    
p>agraph 7#a7 %all include ! foll[+     
/atem5t3 ,x is a violation ( section    
#gbaa ( title #e1 ,unit$ ,/ates ,code1 =
 any ,f$]al ag5cy or employee to require
 a ,f$]al employee to seek approval1    
guidance1 or any o!r =m ( input prior to
 contact+ ,congress ) in=mation1 ev5 if 
t in=mation is 9 relation to ! job      
responsibilities ( ! employee4 ,a ,f$]al
 employee f\nd to h int]f]$ ) or d5i$ ! 
"r ( ano!r ,f$]al employee may be       
subject to an adv]se action describ$ 9  
p>agraphs 7#a7 ?r\gh 7#e7 ( section     
#geab ( title #e1 ,unit$ ,/ates ,code1  

includ+ susp5sion )\t pay = a p]iod ( m 
?an #ad days44  7#c7 ,submission ,n lat]
 ?an #cj days aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y %all submit !     
memor&um describ$ 9 p>agraph 7#a7 to !  
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices 7ref]r$ to 9 ?is     
section z ! ,inspector ,g5]al7 =        
approval4  7#d7 ,approval or disapproval
 ,n lat] ?an #cj days aft] ! submission 
( ! memor&um "u p>agraph 7#c71 or a     
revis$ memor&um "u p>agraph 7#f71 !     
,inspector ,g5]al %all approve or       
disapprove ! memor&um or ! revis$       
memor&um4  7#e7 ,notice ,n lat] ?an #cj 
days aft] approval ( ! memor&um or !    
revis$ memor&um "u p>agraph 7#d71 !     
,secret>y %all--  7,a7 provide to ea*   
employee ( ! ,indian ,heal? ,s]vice an  
electronic copy ( ! memor&um2 &  7,b7   
po/ ! memor&um 9 a cle> & conspicu\s    
place on ! website ( ! ,indian ,heal?   
,s]vice = a p]iod ( n few] ?an #abj     
days4  7#f7 ,revis$ memor&um ,if !      
,inspector ,g5]al disapproves ! memor&um

 or a revis$ memor&um "u p>agraph 7#d71 
n lat] ?an #ae days aft] ! disapproval1 
! ,secret>y %all submit a revis$        
memor&um to ! ,inspector ,g5]al =       
approval "u p>agraph 7#d74  #h4         
,liability protections = heal?          
pr(essional volunte]s 9 ! ,indian ,heal?
 ,s]vice ,section #bbd ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcc7
 is am5d$ by add+ at ! end ! foll[+3    
7q7 ,c]ta9 ,indian ,heal? ,s]vice       
volunte]s deem$ ,public ,heal? ,s]vice  
employees  7#a7 ,9 g5]al  7,a7 ,=       
purposes ( ?is section1 a heal?         
pr(essional volunte] at a ,s]vice unit  
or ,s]vice area 7z ^? t]ms are def9$ 9  
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 
7ref]r$ to 9 ?is subsection z a cov]$   
entity7 %all1 9 provid+ a heal?         
pr(essional s]vice to an individual1 be 
deem$ to be an employee ( ! ,public     
,heal? ,s]vice = a cal5d> ye> t beg9s   
dur+ a fiscal ye> = :i* a transf] 0 made
 "u p>agraph 7#d77;,c74  7,b7           

,subp>agraph 7,a7 is subject to ?is     
subsection4  7#b7 ,conditions ,9 provid+
 a heal? s]vice to an individual1 a     
heal? c>e practition] %all = purposes ( 
?is subsection be consid]$ to be a heal?
 pr(essional volunte] at a cov]$ entity 
if all ( ! foll[+ conditions are met3   
7,a7 ,! s]vice is provid$ to !          
individual at ! facilities ( a cov]$    
entity1 or ?r\gh (fsite programs or     
ev5ts c>ri$ out by ! cov]$ entity4  7,b7
 ,! cov]$ entity is sponsor+ ! heal? c>e
 practition] pursuant to p>agraph       
7#c77;,b74  7,c7 ,! heal? c>e           
practition] does n receive any          
comp5sation = ! s]vice f ! individual or
 f any ?ird-p>ty pay] 7includ+          
reimbursem5t "u any insurance policy or 
heal? plan1 or "u any ,f$]al or ,/ate   
heal? b5efits program71 except t ! heal?
 c>e practition] may receive repaym5t f 
! cov]$ entity = reasonable exp5ses     
incurr$ by ! heal? c>e practition] 9 !  
provision ( ! s]vice to ! individual4   
7,d7 ,be=e ! s]vice is provid$1 ! heal? 

c>e practition] or ! cov]$ entity po/s a
 cle> & conspicu\s notice at ! site :]e 
! s]vice is provid$ ( ! ext5t to :i* !  
legal liability ( ! heal? c>e           
practition] is limit$ "u ?is subsection4
  7,e7 ,at ! "t ! s]vice is provid$1 !  
heal? c>e practition] is lic5s$ or      
c]tifi$ 9 accordance ) applicable law   
reg>d+ ! provision ( ! s]vice4  7#c7    
,applicability ,subsection 7g7 7o!r ?an 
p>agraphs 7#c7 & 7#e7 ( t subsection7 & 
subsections 7h71 7i71 & 7l7 apply to a  
heal? c>e practition] at a cov]$ entity 
= purposes ( ?is subsection to ! same   
ext5t & 9 ! same mann] z su* subsections
 apply to an (fic]1 gov]n+ bo>d memb]1  
employee1 or contractor ( an entity     
describ$ 9 subsection 7g77#d71 subject  
to p>agraph 7#d7 & subject to ! foll[+3 
7,a7 ,ea* ref]5ce to an entity describ$ 
9 subsection 7g77#d7 %all be consid]$ to
 be a ref]5ce to a cov]$ entity4  7,b7  
,p>agraph 7#a77;,a7 applies 9 lieu ( !  
fir/ s5t5ce ( subsection 7g77#a77;,a74  
7,c7 7i7 ,) respect to a cov]$ entity1 a

 heal? c>e practition] is n a heal?     
pr(essional volunte] at ! cov]$ entity  
unless ! cov]$ entity sponsors ! heal?  
c>e practition]4  7ii7 ,= purposes ( ?is
 subsection1 ! cov]$ entity %all be     
consid]$ to be sponsor+ ! heal? c>e     
practition] if--  7,i7 ) respect to !   
heal? c>e practition]1 ! cov]$ entity   
submits to ! ,secret>y an application   
meet+ ! requirem5ts ( subsection        
7g77#a77;,d72 &  7,,ii7 ! ,secret>y1    
pursuant to subsection 7g77#a77;,e71    
det]m9es t ! heal? c>e practition] is   
deem$ to be an employee ( ! ,public     
,heal? ,s]vice4  7,d7 ,9 ! case ( a     
heal? c>e practition] :o is det]m9$ by !
 ,secret>y pursuant to subsection       
7g77#a77;,e7 to be a heal? pr(essional  
volunte] at ! cov]$ entity1 ?is         
subsection applies to ! heal? c>e       
practition] 7) respect to s]vices p]=m$ 
on behalf ( ! cov]$ entity sponsor+ !   
heal? c>e practition] pursuant to       
subp>agraph 7,c77 = any cause ( action  
aris+ f an act or omission ( ! heal? c>e

 practition] occurr+ on or aft] ! date  
on :i* ! ,secret>y makes t det]m9ation4 
7,e7 ,subsection 7g77#a77;,f7 applies to
 a heal? c>e practition] = purposes (   
?is subsection only to ! ext5t t1 9     
provid+ heal? s]vices to an individual1 
ea* ( ! conditions describ$ 9 p>agraph  
7#b7 is met4  7#d7 ,fund+  7,a7 ,9 g5]al
 ,am\nts 9 ! fund e/abli%$ "u subsection
 7k77#b7 %all be available = transf] "u 
subp>agraph 7,c7 = purposes ( c>ry+ out 
?is subsection4  7,b7 ,annual e/imates  
7i7 ,9 g5]al ,n lat] ,may #a ( ea*      
fiscal ye>1 ! ,attorney ,g5]al1 9       
consultation ) ! ,secret>y1 %all submit 
to ,congress a report provid+ an e/imate
 ( ! am\nt ( claims 7toge!r ) relat$    
fees & exp5ses ( witnesses7 t1 by reason
 ( ! acts or omissions ( heal?          
pr(essional volunte]s1 w be paid "u ?is 
section dur+ ! cal5d> ye> t beg9s 9 !   
foll[+ fiscal ye>4  7ii7 ,applicability 
,subsection 7k77#a77;,b7 applies to !   
e/imate "u clause 7i7 relat+ to heal?   
pr(essional volunte]s to ! same ext5t & 

9 ! same mann] z t subsection applies to
 ! e/imate "u t subsection relat+ to    
(fic]s1 gov]n+ bo>d memb]s1 employees1 &
 contractors ( entities describ$ 9      
subsection 7g77#d74  7,c7 ,transf]s ,n  
lat] ?an ,decemb] #ca ( ea* fiscal ye>1 
! ,secret>y %all transf] f ! fund "u    
subsection 7k77#b7 to ! appropriate     
acc\nts 9 ! ,treasury an am\nt equal to 
! e/imate made "u subp>agraph 7,b7 = !  
cal5d> ye> beg9n+ 9 t fiscal ye>1       
subject to ! ext5t ( am\nts 9 ! fund4   
7#e7 ,effective dates  7,a7 ,9 g5]al    
,except z provid$ 9 subp>agraph 7,b71   
?is subsection takes effect on ,octob]  
#a1 #bjag4  7,b7 ,regulations1          
applications1 & reports ,effective on ! 
date ( ! enactm5t ( ?is subsection--    
7i7 ! ,secret>y may-- 7,i7 issue        
regulations = c>ry+ out ?is subsection2 
&  7,,ii7 accept & consid] applications 
submitt$ "u p>agraph 7#c77;,c72 &  7ii7 
! ,attorney ,g5]al may submit to        
,congress a report "u p>agraph          
7#d77;,b74  4  #i4 ,fiscal acc\ntability

 ,title ,,vi ( ! ,indian ,heal? ,c>e    
,improvem5t ,act 7#be ,u4,s4,c4 #affa et
 seq47 7z am5d$ by section #f7;a77 is   
am5d$ by add+ at ! end ! foll[+3  #fji4 
,fiscal acc\ntability  7a7 ,managem5t ( 
funds  7#a7 ,9 g5]al ,if ! ,secret>y    
fails to submit ! /aff+ plan 9          
accordance ) section #d7;c7 ( ! ,indian 
,heal? ,s]vice ,acc\ntability ,act (    
#bjaf or ! h\s+ plan 9 accordance )     
section #e7;c7 ( t ,act1 ! ,secret>y may
 n receive1 obligate1 transf]1 or exp5d 
any am\nts = a sal>y increase or bonus (
 an individual describ$ 9 p>agraph 7#b7 
be=e ! applicable plan is submitt$ 9    
accordance ) section #d7;c7 or section  
#e7;c7 ( t ,act1 z applicable4  7#b7    
,individual describ$ ,an individual     
ref]r$ to 9 p>agraph 7#a7 is-- 7,a7 an  
individual :o--  7i7 is employ$ 9 a     
position describ$ 9 sections #ecab ?r\gh
 #ecaf ( title #e1 ,unit$ ,/ates ,code  
7relat+ to ! ,executive ,s*$ule72  7ii7 
is a limit$ t]m appo9tee1 limit$ em]g5cy
 appo9tee1 or nonc>e] appo9tee 9 !      

,s5ior ,executive ,s]vice1 z def9$ "u   
p>agraphs 7#e71 7#f71 & 7#g71           
respectively1 ( section #cacb7;a7 (     
title #e1 ,unit$ ,/ates ,code2 or  7iii7
 is employ$ 9 a position 9 ! executive  
bran* ( ! ,gov]nm5t ( a confid5tial or  
policy-det]m9+ nature "u s*$ule ,c (    
subp>t ,c ( "p #bac ( title #e1 ,code ( 
,f$]al ,regulations2 or  7,b7 a s5ior   
executive 7z def9$ 9 section #cacb7;a7 (
 title #e1 ,unit$ ,/ates ,code74  7b7   
,prioritization ( pati5t c>e  7#a7 ,9   
g5]al ,! ,secret>y %all use am\nts t are
 n obligat$ or exp5d$ dur+ ! fiscal ye> 
= :i* ! am\nts are made available1 & t  
rema9 available1 only to support pati5t 
c>e1 specifically =--  7,a7 co/s (      
ess5tial m$ical equipm5t2  7,b7 !       
,pur*as$_/,ref]r$ ,c>e program2 or  7,c7
 any o!r purpose approv$ by ! ,secret>y 
aft] consultation ) appropriate ,indian 
tribes4  7#b7 ,re/rictions ,! ,secret>y 
%all n use am\nts describ$ 9 p>agraph   
7#a7 =--  7,a7 int]ior decorat+ or      
remodel+ ( a facility ( ! ,s]vice2 or   

7,b7 an increase 9 rate ( pay = an      
employee ( an ,area (fice4  7c7 ,sp5d+  
reports ,! ,secret>y %all provide a     
report ea* qu>t] ( a fiscal ye> describ+
 ! exp5ditures1 outlays1 transf]s1      
reprogramm+1 obligations1 & o!r sp5d+ ( 
ea* level ( ! ,s]vice1 includ+ !        
headqu>t]s1 ea* ,area (fice1 ea* ,s]vice
 unit1 & ea* facility1 to--  7#a7       
,indian tribes2  7#b7 9 ! ,s5ate--  7,a7
 ! ,committee on ,indian ,affairs2  7,b7
 ! ,committee on ,heal?1 ,education1    
,labor1 & ,p5sions2  7,c7 ! ,committee  
on ,appropriations2 &  7,d7 ! ,committee
 on ! ,budget2 &  7#c7 9 ! ,h\se (      
,repres5tatives-- 7,a7 ! ,committee on  
,natural ,res\rces2  7,b7 ! ,committee  
on ,en]gy & ,comm]ce2  7,c7 ! ,committee
 on ,appropriations2 &  7,d7 !          
,committee on ! ,budget4  7d7 ,/atus    
reports  7#a7 ,9 g5]al ,! ,secret>y %all
 provide to ea* entity describ$ 9       
p>agraphs 7#a7 ?r\gh 7#c7 ( subsection  
7c7 a report ea* qu>t] ( a fiscal ye>1  
except z provid$ 9 p>agraph 7#b71       

describ+ ! safety1 bill+1 c]tification1 
cr$5tial1 & compliance /atuses ( ea*    
facility manag$1 op]at$1 or o!rwise     
support$ by ! ,s]vice4  7#b7 ,updates   
,on a *ange ( a /atus describ$ 9        
p>agraph 7#a71 ! ,secret>y %all         
imm$iately provide to ea* entity        
describ$ 9 p>agraphs 7#a7 ?r\gh 7#c7 (  
subsection 7c7 an update describ+ !     
*ange4  4  #aj4 ,transp>5cy &           
acc\ntability = pati5t safety  7a7      
,transp>5cy & acc\ntability ,title ,,vi 
( ! ,indian ,heal? ,c>e ,improvem5t ,act
 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ 
by section #i7 is am5d$ by add+ at ! end
 ! foll[+3  #faj4 ,transp>5cy &         
acc\ntability = pati5t safety  7a7      
,transp>5cy ,! ,secret>y %all ensure t  
all surveys1 reports1 & o!r mat]ials ( !
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices    
relat+ to pati5t safety & compliance are
 po/$ on ! websites ( ea* hospital &    
cl9ic :olly or p>tially own$1 op]at$1   
manag$1 or fund$ by ! ,s]vice4  7b7     
,acc\ntability  7#a7 ,9 g5]al ,!        

,inspector ,g5]al ( ! ,dep>tm5t 7ref]r$ 
to 9 ?is section z ! ,inspector ,g5]al7 
%all inve/igate ea* pati5t dea? 9 :i* ! 
,s]vice is alleg$ to be involv$ by an   
act or omission4  7#b7 ,notice ,!       
,secret>y %all notify ! ,inspector      
,g5]al ( ea* pati5t dea? t occurs-- 7,a7
 9 a facility ( ! ,s]vice2 or  7,b7 "u !
 c>e ( ! ,s]vice4  7#c7 ,reports ,n less
 frequ5tly ?an once ea* ye>1 !          
,inspector ,g5]al %all provide to       
,indian tribes 9 ! relevant ,s]vice area
 & ,congress a report describ+ !        
inve/igations describ$ 9 p>agraph 7#a74 
7#d7 ,disclosure ,on completion ( ea*   
inve/igation describ$ 9 p>agraph 7#a71 !
 ,inspector ,g5]al %all provide to !    
family ( ! deceas$ pati5t in=mation     
relat+ to--  7,a7 ! f9d+s ( !           
inve/igation2 &  7,b7 any action tak5 by
 ! ,inspector ,g5]al1 includ+ any       
crim9al ref]ral4  7c7 ,quality monitor+ 
,! ,secret>y1 9 consultation ) !        
,inspector ,g5]al1 %all e/abli% )9 !    
,s]vice a program to monitor ! quality (

 pati5t c>e 9 ! ,s]vice4  7d7 ,report+  
sy/ems ,! ,inspector ,g5]al %all-- 7#a7 
conduct an audit ( report+ sy/ems ( !   
,s]vice z ( ! date ( enactm5t ( ?is     
section2 &  7#b7 provide to ! ,s]vice   
recomm5dations & te*nical assi/ance to  
implem5t improv$ report+ sy/ems1        
proc$ures1 /&>ds1 & protocols4  4  7b7  
,compliance surveys ,section #ahhj ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieqq7 is am5d$ by add+ at ! end !    
foll[+3  7g7 7#a7 ,n less frequ5tly ?an 
once e #b ye>s1 ! ,adm9i/rator ( !      
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices %all
 conduct surveys to assess ! compliance 
( ea* hospital or skill$ nurs+ facility 
( ! ,indian ,heal? ,s]vice )--  7,a7    
section #ahfg2 &  7,b7 conditions (     
p>ticipation 9 ! program "u ?is title4  
7#b7 ,ea* survey complet$ "u ?is        
subsection %all be made available on !  
public ,int]net website ( ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices4  4