,i #aae? ,,congress #b;d ,session ,h4 ,r4 #ehgd ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #ah1 #bjah,mrs4 ,noem 7= h]self1 ,mr4 ,bi%op ( ,utah1 ,mr4 ,mull91 ,mrs4 ,mc,morris ,rodg]s1 ,mr4 ,cole1 ,mr4 ,la,malfa1 ,mr4 ,cram]1 ,mrs4 ,radewag51 & ,miss ,gonzlez-,coln ( ,pu]to ,rico7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,natural ,res\rces1 & 9 addition to ! ,committees on ,en]gy & ,comm]ce1 ,ways & ,means1 & ,ov]sight & ,gov]nm5t ,re=m1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d ! ,indian ,heal? ,c>e ,improvem5t ,act to improve ! recruitm5t & ret5tion ( employees 9 ! ,indian ,heal? ,s]vice1 re/ore acc\ntability 9 ! ,indian ,heal? ,s]vice1 improve heal? s]vices1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah4 #b4 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4 ,sec4 #b4 ,table ( cont5ts4 ,,title ,i--,indian ,heal? ,s]vice improvem5ts ,sec4 #aja4 ,inc5tives = recruitm5t & ret5tion4 ,sec4 #ajb4 ,m$ical cr$5tial+ sy/em4 ,sec4 #ajc4 ,liability protections = heal? pr(essional volunte]s at ,indian ,heal? ,s]vice4 ,sec4 #ajd4 ,cl>ification reg>d+ eligibility = ,indian ,heal? ,s]vice loan repaym5t program4 ,sec4 #aje4 ,improvem5ts 9 hir+ practices4 ,sec4 #ajf4 ,improv$ au?orities ( secret>y to improve acc\ntability ( s5ior executives & employees ( ! ,indian ,heal? ,s]vice4 ,sec4 #ajg4 ,tribal culture & hi/ory4 ,sec4 #ajh4 ,/aff+ demon/ration project4 ,sec4 #aji4 ,rule e/abli%+ tribal consultation policy4 ,sec4 #aaj4 ,treatm5t ( c]ta9 hospitals4 ,,title ,,ii--,employee protections ,sec4 #bja4 ,employee protections aga9/ retaliation4 ,sec4 #bjb4 ,"r ( ,f$]al employees to petition ,congress4 ,sec4 #bjc4 ,fiscal acc\ntability4 ,,title ,,iii--,reports ,sec4 #cja4 ,def9itions4 ,sec4 #cjb4 ,reports by ! ,secret>y ( ,heal? & ,human ,s]vices4 ,sec4 #cjc4 ,reports by ! ,comptroll] ,g5]al4 ,sec4 #cjd4 ,inspector ,g5]al reports4 ,sec4 #cje4 ,transp>5cy 9 ,,cms surveys4 ,,title ,,iv--,te*nical am5dm5ts ,sec4 #dja4 ,te*nical am5dm5ts4 ,i ,indian ,heal? ,s]vice improvem5ts #aja4 ,inc5tives = recruitm5t & ret5tion ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq47 is am5d$ by add+ at ! end ! foll[+3 #abe4 ,inc5tives = recruitm5t & ret5tion 7a7 ,p>ity 9 ,,ihs heal? c>e work=ce p]sonnel & pay sy/em ,! ,secret>y %all e/abli% a p]sonnel & pay sy/em = physicians1 d5ti/s1 nurses1 & o!r heal? c>e pr(essionals employ$ by ! ,s]vice t provides a p]sonnel & pay sy/em t1 to ! maximum ext5t practicable1 is comp>able to ! pay provid$ to physicians1 d5ti/s1 nurses1 & o!r heal? c>e pr(essionals1 respectively1 "u sub*apt]s ,,iii & ,,iv ( *apt] #gd ( title #ch1 ,unit$ ,/ates ,code4 7b7 ,relocation co/s ,! ,secret>y may provide to an employee ( ! ,s]vice reimbursem5t = any relocation co/s ! employee incurs if-- 7#a7 ! employee relocates to a ,s]vice area exp]i5c+ a high level ( ne$ = employees1 z det]m9$ by ! ,secret>y2 & 7#b7 ! employee is fill+ a position t w\ld o!rwise be difficult to fill1 z det]m9$ by ! ,secret>y1 9 ! abs5ce ( an inc5tive4 7c7 ,h\s+ v\*]s 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah1 ! ,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 unit designat$ by ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration z a heal? pr(essional %ortage area1 z def9$ 9 section #ccb7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e7a771 ) ! greate/ /aff+ ne$2 & 7,b7 is a critical employee1 z det]m9$ 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* any su* program is e/abli%$4 7d7 ,adm9i/ration 7#a7 ,,opm guidel9es ,! ,secret>y %all c>ry out subsection 7b7 9 accordance ) any guidel9es ( ! ,(fice ( ,p]sonnel ,managem5t relat+ to section #egb ( title #e1 ,code ( ,f$]al ,regulations 7z 9 effect on ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah74 7#b7 ,s]vice agreem5ts ,! ,secret>y may only provide reimbursem5t = any relocation co/s "u subsection 7b7 or any o!r b5efit "u subsection 7c7 to-- 7,a7 a full-"t employee :o agrees to s]ve = n less ?an #a ye> 9 ! ,s]vice1 beg9n+ on ! date ( ! agreem5t2 or 7,b7 a "p-"t employee :o agrees to s]ve = n less ?an #b ye>s 9 ! s]vice beg9n+ on ! date ( ! agreem5t4 4 #ajb4 ,m$ical cr$5tial+ sy/em ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq471 z am5d$ by section #aja1 is fur!r am5d$ by add+ at ! end ! foll[+3 #abf4 ,m$ical cr$5tial+ sy/em 7a7 ,9 g5]al 7#a7 ,developm5t & implem5tation timel9e ,by n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah1 ! ,secret>y1 act+ ?r\gh ! ,s]vice & 9 accordance ) ! requirem5ts describ$ 9 subsection 7b71 %all develop & implem5t a ,s]vice-wide c5traliz$ electronic cr$5tial+ sy/em 7ref]r$ to 9 ?is section z ! cr$5tial+ sy/em7 to cr$5tial lic5s$ heal? pr(essionals :o seek to provide heal? c>e s]vices at any ,s]vice unit1 includ+ physicians1 nurses & physicians assi/ants4 7#b7 ,implem5tation ,9 implem5t+ ! cr$5tial+ sy/em1 ! ,secret>y-- 7,a7 %all n require re-cr$5tial+ ( lic5s$ heal? pr(essionals :o 7 cr$5tial$ us+ exi/+ ,s]vice policy prior to ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah2 & 7,b7 %all-- 7i7 use ! cr$5tial+ sy/em = all new applications ( lic5s$ heal? pr(essionals & ! migration ( cr$5tials data t exi/$ prior to implem5tation into ! sy/em2 7ii7 ma9ta9 ! e/abli%$ timel9e = re-cr$5tial+ ( lic5s$ heal? pr(essionals :o 7 cr$5tial$ prior to implem5tation1 z def9$ by ,s]vice policy2 & 7iii7 review cr$5tials = all pr(essionals 9 ! sy/em1 bas$ on updat$ policies1 on a n less ?an ye>ly basis4 ,lic5s$ heal? pr(essionals ^: cr$5tials w\ld n h be5 approv$ "u ! updat$ policies %all h #ij days to meet ! new requirem5ts4 7b7 ,requirem5ts ,9 develop+ ! cr$5tial+ sy/em "u subsection 7a71 ! ,secret>y %all ensure ! foll[+3 7#a7 ,cr$5tial+ proc$ures %all be uni=m & integrat$ ?r\gh\t ! ,s]vice4 7#b7 ,) respect to ea* lic5s$ heal? pr(essional :o successfully completes ! cr$5tial+ proc$ures ( ! cr$5tial+ sy/em1 ! ,secret>y may au?orize ea* su* pr(essional to provide heal? c>e s]vices at any ,s]vice unit4 7#c7 ,cr$5tial+ proc$ures %all include v]ification ( lic5sure1 education1 employm5t hi/ory1 & crim9al backgr\nd *ecks & hi/ory4 7c7 ,consultation ,9 develop+ ! cr$5tial+ sy/em "u subsection 7a71 ! ,secret>y %all consult ) ,indian ,tribes & may also consult ) any public or private association ( m$ical provid]s1 any gov]nm5t ag5cy1 or o!r relevant exp]t1 z det]m9$ by ! ,secret>y4 7d7 ,application ,a lic5s$ heal? c>e pr(essional may n provide heal? c>e s]vices at any ,s]vice unit1 unless su* pr(essional successfully completes ! cr$5tial+ proc$ures ( ! cr$5tial+ sy/em develop$ "u subsection 7a74 7e7 ,regulations ,! ,secret>y may prescribe su* regulations z may be necess>y to c>ry out ! provisions ( ?is section4 7f7 ,rule ( con/ruction ,no?+ 9 ?is section may be con/ru$-- 7#a7 to negatively impact ! "r ( an ,indian ,tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et seq472 & 7#b7 to apply to su* a compact or contract unless expressly agre$ to by ! ,indian ,tribe4 4 #ajc4 ,liability protections = heal? pr(essional volunte]s at ,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 7r7 ,c]ta9 ,indian ,heal? ,s]vice volunte]s deem$ ,public ,heal? ,s]vice employees 7#a7 ,9 g5]al ,= purposes ( ?is section1 an employee ( an ,,ihs urban ,indian heal? program & a heal? pr(essional volunte] at a ,s]vice unit %all1 9 provid+ a heal? 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 ,! prec$+ s5t5ce is subject to ! provisions ( ?is subsection4 7#b7 ,conditions ,9 provid+ a heal? s]vice to an individual1 a heal? c>e practition] %all1 = purposes ( ?is subsection1 be consid]$ to be a heal? pr(essional volunte] at a ,s]vice unit if all ( ! foll[+ conditions are met3 7,a7 ,! s]vice is provid$ to ! individual at ! facilities ( a ,s]vice unit1 or ?r\gh (fsite programs or ev5ts c>ri$ out by ! ,s]vice unit4 7,b7 ,! ,s]vice unit is sponsor+ ! heal? c>e practition] pursuant to p>agraph 7#c77;,c74 7,c7 ,! heal? c>e practition] does n receive any comp5sation = ! s]vice f ! individual1 ! ,s]vice unit1 or any ?ird-p>ty pay] 7includ+ reimbursem5t "u any insurance policy or heal? plan1 or "u any ,f$]al or ,/ate heal? b5efits program71 except t ! heal? c>e practition] may receive repaym5t f ! ,s]vice unit = reasonable exp5ses incurr$ by ! heal? c>e practition] 9 ! provision ( ! s]vice to ! individual4 7,d7 ,be=e ! s]vice is provid$1 ! heal? c>e practition] or ! ,s]vice unit po/s a cle> & conspicu\s notice at ! site :]e ! s]vice is provid$ ( ! 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$1 c]tifi$1 cr$5tial$1 & privileg$ 9 accordance ) ,s]vice policy & applicable law reg>d+ ! provision ( ! s]vice4 7#c7 ,applicability ,subsection 7g7 7o!r ?an p>agraphs 7#c7 & 7#e77 & subsections 7h71 7i71 & 7l7 apply to an employee ( an ,,ihs urban ,indian heal? program & to a heal? c>e practition] at a ,s]vice unit = 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[+ subp>agraphs3 7,a7 ,ea* ref]5ce to an entity 9 subsections 7g71 7h71 7i71 & 7l7 %all be consid]$ to be a ref]5ce to an ,,ihs urban ,indian heal? program or a ,s]vice unit1 z applicable4 7,b7 ,! fir/ s5t5ce ( p>agraph 7#a7 applies 9 lieu ( ! fir/ s5t5ce ( subsection 7g77#a77;,a74 7,c7 ,) respect to a ,s]vice unit1 a heal? c>e practition] is n a heal? pr(essional volunte] at ! ,s]vice unit unless ! ,s]vice unit sponsors ! heal? c>e practition]4 ,= purposes ( ?is subsection1 ! ,s]vice unit %all be consid]$ to be sponsor+ ! heal? c>e practition] if-- 7i7 ) respect to ! heal? c>e practition]1 ! ,s]vice unit submits to ! ,secret>y an application meet+ ! requirem5ts ( subsection 7g77#a77;,d72 & 7ii7 ! ,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 ?is subsection & subsection 7g77#a77;,e7 to be a heal? pr(essional volunte]1 ?is subsection applies to ! heal? c>e practition] 7) respect to s]vices p]=m$ on behalf ( ! ,s]vice unit 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] ?an ,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 ( employees ( an ,,ihs urban ,indian heal? program or heal? pr(essional volunte]s1 w be paid pursuant to ?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 employees ( an ,,ihs urban ,indian heal? program or 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 ,def9itions 7,a7 ,,ihs urban ,indian heal? program ,9 ?is subsection1 ! t]m ,,ihs urban ,indian heal? program means an urban ,indian heal? program op]at$ by an urban ,indian organization pursuant to a grant or contract ) ! ,indian ,heal? ,s]vice "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq474 7,b7 ,s]vice unit ,9 ?is subsection1 ! t]m ,s]vice unit has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#f7 ,rule ( con/ruction ,no?+ 9 ?is subsection may be con/ru$-- 7,a7 to negatively impact ! "r ( an ,indian ,tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et seq472 & 7,b7 to apply to su* a compact or contract unless expressly agre$ to by ! ,indian ,tribe4 7#g7 ,effective dates 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 ?is subsection %all take effect on ,octob] #a1 #bjai4 7,b7 ,regulations1 applications1 & reports ,effective on ! date ( ! enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah1 ! ,secret>y may-- 7i7 prescribe regulations = c>ry+ out ?is subsection2 & 7ii7 accept & consid] applications submitt$ "u p>agraph 7#c77;,c77i74 4 #ajd4 ,cl>ification reg>d+ eligibility = ,indian ,heal? ,s]vice loan repaym5t program ,section #ajh ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;a7 is am5d$-- 7#a7 by am5d+ subp>agraph 7,b7 ( subsection 7b77#a7 to read z foll[s3 7,b7 h-- 7i7 7,i7 a degree 9 a heal? pr(ession2 & 7,,ii7 a lic5se to practice a heal? pr(ession 9 a ,/ate2 or 7ii7 7,i7 a ma/]'s degree 9 bus9ess adm9i/ration ) an emphasis 9 heal? c>e managem5t 7z def9$ by ! ,secret>y71 heal? adm9i/ration1 hospital adm9i/ration1 or public heal?2 & 7,,ii7 a lic5se or c]tification to practice 9 ! field ( bus9ess adm9i/ration1 heal? adm9i/ration1 hospital adm9i/ration1 or public heal? 9 a ,/ate1 if ! ,secret>y det]m9es su* lic5se or c]tification necess>y = ! ,indian heal? program to :i* ! individual w be assign$2 7iii7 ma9ta9 cr$5tials z det]m9$ by ! sy/em describ$ 9 section #ajb2 & 7iv7 p>ticipate 9 ! tra9+ describ$ 9 section #ajg2 2 7#b7 by am5d+ clause 7iii7 ( subsection 7f77#a77;,b7 to read z foll[s3 7iii7 to s]ve = a "t p]iod 7ref]r$ to 9 ?is section z ! p]iod ( obligat$ s]vice7 equal to-- 7,i7 #b ye>s or su* long] p]iod z ! individual may agree to s]ve 9 ! full-"t practice ( su* individual's pr(ession 9 an ,indian heal? program to :i* ! individual may be assign$ by ! ,secret>y2 or 7,,ii7 #d ye>s or su* long] p]iod z ! individual may agree to s]ve 9 ! half-"t practice ( su* individual's pr(ession 9 an ,indian heal? program to :i* ! individual may be assign$ by ! ,secret>y2 2 & 7#c7 9 subsection 7g77#b7-- 7,a7 by r$esignat+ subp>agraph 7,b7 z subp>agraph 7,c72 & 7,b7 9 subp>agraph 7,a7-- 7i7 by /rik+ ! fir/ s5t5ce ( ! matt] prec$+ clause 7i7 & ins]t+ ! foll[+3 ,9 ! case ( an individual :o contracts to s]ve a p]iod ( obligat$ s]vice "u subsection 7f77#a77;,b77iii77,i71 = ea* ye> ( su* obligat$ s]vice1 ! ,secret>y may pay up to #ce1jjj 7or an am\nt equal to ! am\nt specifi$ 9 section #cch;,b7g77#b77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a7;g77#b77;,a777 on behalf ( ! individual = loans describ$ 9 p>agraph 7#a74 ,9 ! case ( an individual :o contracts to s]ve a p]iod ( obligat$ s]vice "u subsection 7f77#a77;,b77iii77,,ii71 = ea* ye> ( su* obligat$ s]vice1 ! ,secret>y may pay up to #ag1ejj on behalf ( ! individual = loans describ$ 9 p>agraph 7#a72 & 7ii7 by /rik+ ,9 mak+ a det]m9ation & ins]t+ ! foll[+3 7,b7 ,9 mak+ a det]m9ation "u ?is p>agraph 4 #aje4 ,improvem5ts 9 hir+ practices 7a7 ,9 g5]al ,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 ,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 ( su* title71 a c&idate directly to a position )9 ! ,s]vice = :i* ! c&idate meets ! qualifications /&>d e/abli%$ by ! ,(fice ( ,p]sonnel ,managem5t4 7b7 ,tribal notification ,be=e appo9t+1 hir+1 promot+1 transf]r+1 or reassign+ 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 provide notice to ea* ,indian ,tribe locat$ )9 ! def9$ geographic area ( su* ,area (fice or ,s]vice unit1 z ! case may be1 ( ! cont5t ( an inclusion 9 an employm5t record4 ,ea* su* ,indian ,tribe may submit comm5t to ! ,secret>y dur+ ! #aj-;day p]iod aft] ! date ( su* notification reg>d+ su* cont5t4 4 7b7 ,9 g5]al ,subsection 7c7 ( section #b ( ! ,act ( ,decemb] #ae1 #aigi 7#be ,u4,s4,c4 #eaag71 is am5d$ by add+ ! foll[+3 7#c7 ,,ihs waiv]s ,! ,secret>y ( ,heal? & ,human ,s]vices may1 at ! reque/ ( an ,indian ,tribe1 seek f ea* ,indian ,tribe conc]n$1 a waiv] ( ,indian pref]5ce laws = a p]sonnel action t is ) respect to-- 7,a7 an ,indian ,heal? ,s]vice unit 9 :i* #ae p]c5t or m ( ! total positions or specific heal? pr(essionals 9 ! ,s]vice unit are n fill$ by a full-"t employee ( ! ,indian ,heal? ,s]vice = a p]iod ( #f mon?s or long]2 or 7,b7 a =m] employee ( ! ,indian ,heal? ,s]vice or a =m] tribal employee :o 0 remov$ f su* =m] employm5t )91 or demot$ = p]=mance or misconduct t occurr$ dur+1 ! #e-ye> p]iod foll[+ ! date ( su* p]sonnel action4 4 #ajf4 ,improv$ au?orities ( secret>y to improve acc\ntability ( s5ior executives & employees ( ! ,indian ,heal? ,s]vice 7a7 ,9 g5]al ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq471 z am5d$ by section #aje1 is fur!r am5d$ by add+ at ! end ! foll[+3 #fjf4 ,improv$ au?orities ( secret>y to improve acc\ntability ( s5ior executives ( ! ,indian ,heal? ,s]vice 7a7 ,au?ority 7#a7 ,9 g5]al ,! ,secret>y may1 z provid$ 9 ?is section1 reprim& or susp5d1 involunt>ily reassign1 demote1 or remove a cov]$ individual f a s5ior executive position at ! ,s]vice if ! ,secret>y det]m9es t ! misconduct or p]=mance ( ! cov]$ individual w>rants su* action4 7#b7 ,removal f civil s]vice ,if ! ,secret>y removes an individual pursuant to p>agraph 7#a71 ! ,secret>y may remove ! individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code74 7b7 ,rights & proc$ures 7#a7 ,9 g5]al ,a cov]$ individual :o is ! subject ( an action "u subsection 7a7 is entitl$ to-- 7,a7 advance notice ( ! action & a file conta9+ all evid5ce 9 support ( ! propos$ action2 7,b7 be repres5t$ by an attorney or o!r repres5tative ( ! cov]$ individual's *oice2 & 7,c7 grieve ! action 9 accordance ) an int]nal grievance process t ! ,secret>y %all e/abli% = purposes ( ?is subsection4 7#b7 ,notice 7,a7 ,aggregate p]iod = notice ,! aggregate p]iod = notice1 response1 & decision on an action "u subsection 7a7 may n exce$ #ae bus9ess days4 7,b7 ,response ,! p]iod = ! response ( a cov]$ individual to a notice "u p>agraph 7#a77;,a7 ( an action "u subsection 7a7 %all be #g bus9ess days4 7,c7 ,decision ,a decision "u ?is p>agraph on an action "u subsection 7a7 %all be issu$ n lat] ?an #ae bus9ess days aft] notice ( ! action is provid$ to ! cov]$ individual "u p>agraph 7#a77;,a74 ,! decision %all be 9 writ+1 & %all include ! specific reasons = ! decision4 7#c7 ,grievance process ,! ,secret>y %all ensure t ! grievance process e/abli%$ "u p>agraph 7#a77;,c7 takes few] ?an #ba days4 7#d7 ,f9al & conclusive decision ,a decision "u p>agraph 7#b7 t is n griev$1 & a grievance decision "u p>agraph 7#c71 %all be f9al & conclusive4 7#e7 ,judicial review ,a cov]$ individual adv]sely affect$ by a decision "u p>agraph 7#b7 t is n griev$1 or by a grievance decision "u p>agraph 7#c71 may obta9 judicial review ( su* decision4 7#f7 ,c\rt review ,9 any case 9 :i* judicial review is s\ght "u p>agraph 7#e71 ! c\rt %all review ! record & may set aside any ,dep>tm5t action f\nd to be-- 7,a7 arbitr>y1 caprici\s1 an abuse ( discretion1 or o!rwise n 9 accordance ) a provision ( law2 7,b7 obta9$ )\t proc$ures requir$ by a provision ( law hav+ be5 foll[$2 or 7,c7 unsupport$ by sub/antial evid5ce4 7c7 ,relation to o!r provisions ( law ,section #ceib7;b77#a7 ( title #e1 ,unit$ ,/ates ,code1 does n apply to an action "u subsection 7a74 7d7 ,def9itions ,9 ?is section3 7#a7 ,cov]$ individual ,! t]m cov]$ individual means a c>e] appo9tee 7z t t]m is def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code74 7#b7 ,misconduct ,! t]m misconduct includes neglect ( duty1 malfeasance1 or failure to accept a direct$ reassignm5t or to accompany a position 9 a transf] ( function4 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,s]vice4 7#d7 ,s5ior executive position ,! t]m s5ior executive position means a ,s5ior ,executive ,s]vice position 7z t t]m is def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code74 #fjg4 ,improv$ au?orities ( secret>y to improve acc\ntability ( employees ( ! ,indian ,heal? ,s]vice 7a7 ,9 g5]al 7#a7 ,au?ority ,! ,secret>y may remove1 demote1 or susp5d a cov]$ individual :o is an employee ( ! ,s]vice if ! ,secret>y det]m9es ! p]=mance or misconduct ( ! cov]$ individual w>rants su* removal1 demotion1 or susp5sion4 7#b7 ,actions ,if ! ,secret>y removes1 demotes1 or susp5ds a cov]$ individual pursuant to p>agraph 7#a71 ! ,secret>y may-- 7,a7 remove ! cov]$ individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code72 7,b7 demote ! cov]$ individual by means ( a r$uction 9 grade = :i* ! cov]$ individual is qualifi$1 t ! ,secret>y det]m9es is appropriate1 & t r$uces ! annual rate ( pay ( ! cov]$ individual2 or 7,c7 susp5d ! cov]$ individual4 7b7 ,pay ( c]ta9 demot$ individuals 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 any cov]$ individual subject to a demotion "u subsection 7a77#b7 %all1 beg9n+ on ! date ( su* demotion1 receive ! annual rate ( pay applicable to su* grade4 7#b7 ,re/rictions 7,a7 ,prohibition on adm9i/rative leave ,a cov]$ individual subject to a demotion "u subsection 7a77#b7 may n be plac$ on adm9i/rative leave dur+ ! p]iod dur+ :i* an appeal 7if any7 "u ?is section is ongo+1 & may only receive pay if ! cov]$ individual reports = duty or is approv$ to use accru$ unus$ annual1 sick1 family m$ical1 milit>y1 or c\rt leave4 7,b7 ,re/riction on pay & b5efits ,if a cov]$ individual subject to a demotion "u subsection 7a77#b7 does n report = duty or receive approval to use accru$ unus$ leave1 su* cov]$ individual %all n receive pay or o!r b5efits pursuant to subsection 7d77#e74 7c7 ,proc$ures 7#a7 ,9 g5]al 7,a7 ,aggregate p]iod ,! aggregate p]iod = notice1 response1 & f9al decision 9 a removal1 demotion1 or susp5sion "u ?is section may n exce$ #ae bus9ess days4 7,b7 ,p]iod = response ,! p]iod = ! response ( a cov]$ individual to a notice ( a propos$ removal1 demotion1 or susp5sion "u ?is section %all be #g bus9ess days4 7,c7 ,repres5tation by attorney or o!r repres5tative ,p>agraph 7#c7 ( subsection 7b7 ( section #geac ( title #e1 ,unit$ ,/ates ,code1 %all apply ) respect to a removal1 demotion1 or susp5sion "u ?is section4 7,d7 ,proc$ures sup]s$+ ,c,b,as ,! proc$ures 9 ?is subsection %all sup]s$e any collective b>ga9+ agreem5t to ! ext5t t su* agreem5t is inconsi/5t ) su* proc$ures4 7#b7 ,f9al decision ,! ,secret>y %all issue a f9al decision ) respect to a removal1 demotion1 or susp5sion "u ?is section n lat] ?an #ae bus9ess days aft] ! ,secret>y provides notice1 includ+ a file conta9+ all ! evid5ce 9 support ( ! propos$ action1 to ! cov]$ individual ( ! removal1 demotion1 or susp5sion4 ,! decision %all be 9 writ+ & %all include ! specific reasons = ! decision4 7#c7 ,p]=mance appraisal ,! proc$ures "u *apt] #dc ( title #e1 ,unit$ ,/ates ,code1 %all n apply to a removal1 demotion1 or susp5sion "u ?is section4 7#d7 ,appeal to m]it sy/ems protection bo>d 7,a7 ,9 g5]al ,subject to subp>agraph 7,b7 & subsection 7d71 any removal or demotion "u ?is section1 & any susp5sion ( m ?an #ad days "u ?is section1 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d1 :i* %all ref] su* appeal to an adm9i/rative judge pursuant to section #ggja7;b77#a7 ( title #e1 ,unit$ ,/ates ,code4 7,b7 ,"t p]iod ,an appeal "u subp>agraph 7,a7 ( a removal1 demotion1 or susp5sion may only be made if su* appeal is made n lat] ?an #aj bus9ess days aft] ! date ( su* removal1 demotion1 or susp5sion4 7d7 ,exp$it$ review 7#a7 ,9 g5]al ,^u receipt ( an appeal "u subsection 7c77#d77;,a71 ! adm9i/rative judge %all exp$ite any su* appeal "u section #ggja7;b77#a7 ( title #e1 ,unit$ ,/ates ,code1 &1 9 any su* case1 %all issue a f9al & complete decision n lat] ?an #ahj days aft] ! date ( ! appeal4 7#b7 ,uphold+ decision 7,a7 ,9 g5]al ,not)/&+ section #ggja7;c77#a77;,b7 ( title #e1 ,unit$ ,/ates ,code1 ! adm9i/rative judge %all uphold ! decision ( ! ,secret>y to remove1 demote1 or susp5d an employee "u subsection 7a7 if ! decision is support$ by sub/antial evid5ce4 7,b7 ,prohibition ( mitigation ,not)/&+ title #e1 ,unit$ ,/ates ,code1 or any o!r provision ( law1 if ! decision ( ! ,secret>y is support$ by sub/antial evid5ce1 ! adm9i/rative judge %all n mitigate ! p5alty prescrib$ by ! ,secret>y4 7#c7 ,appeal to m]it sy/ems protection bo>d 7,a7 ,9 g5]al ,! decision ( ! adm9i/rative judge "u p>agraph 7#a7 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d4 7,b7 ,uphold+ decision ,not)/&+ section #ggja7;c77#a77;,b7 ( title #e1 ,unit$ ,/ates ,code1 ! ,m]it ,sy/ems ,protection ,bo>d %all uphold ! decision ( ! ,secret>y to remove1 demote1 or susp5d an employee "u subsection 7a7 if ! decision is support$ by sub/antial evid5ce4 7,c7 ,prohibition ( mitigation ,not)/&+ title #e1 ,unit$ ,/ates ,code1 or any o!r provision ( law1 if ! decision ( ! ,secret>y is support$ by sub/antial evid5ce1 ! ,m]it ,sy/ems ,protection ,bo>d %all n mitigate ! p5alty prescrib$ by ! ,secret>y4 7#d7 ,report ,9 any case 9 :i* ! adm9i/rative judge _c issue a decision 9 accordance ) ! #ahj-;day requirem5t "u p>agraph 7#a71 ! ,m]it ,sy/ems ,protection ,bo>d %all1 n lat] ?an #ad bus9ess days aft] ! expiration ( ! #ahj-;day p]iod1 submit to ! appropriate committees ( ,congress a report t expla9s ! reasons :y a decision 0 n issu$ 9 accordance ) su* requirem5t4 7#e7 ,appeal ,a decision ( ! ,m]it ,sy/ems ,protection ,bo>d "u p>agraph 7#c7 may be appeal$ to ! ,unit$ ,/ates ,c\rt ( ,appeals = ! ,f$]al ,circuit pursuant to section #ggjc ( title #e1 ,unit$ ,/ates ,code1 or to any c\rt ( appeals ( compet5t jurisdiction pursuant to subsection 7b77#a77;,b7 ( su* section4 7#f7 ,prohibition aga9/ /ays ,! ,m]it ,sy/ems ,protection ,bo>d may n /ay any removal or demotion "u ?is section1 except z provid$ 9 section #abad7;b7 ( title #e1 ,unit$ ,/ates ,code4 7#g7 ,re/riction on pay & b5efits dur+ appeal ,dur+ ! p]iod beg9n+ on ! date on :i* a cov]$ individual appeals a removal f ! civil s]vice "u subsection 7c7 & end+ on ! date t ! ,unit$ ,/ates ,c\rt ( ,appeals = ! ,f$]al ,circuit issues a f9al decision on su* appeal1 su* cov]$ individual may n receive any pay1 aw>ds1 bonuses1 inc5tives1 all[ances1 diff]5tials1 /ud5t loan repaym5ts1 special paym5ts1 or b5efits relat$ to ! employm5t ( ! individual by ! ,s]vice4 7#h7 ,in=mation to exp$ite appeal ,to ! maximum ext5t practicable1 ! ,secret>y %all provide to ! ,m]it ,sy/ems ,protection ,bo>d su* in=mation & assi/ance z may be necess>y to ensure an appeal "u ?is subsection is exp$it$4 7#i7 ,backpay ,if an employee prevails on appeal "u ?is section1 ! employee %all be entitl$ to backpay 7z provid$ 9 section #eeif ( title #e1 ,unit$ ,/ates ,code74 7#aj7 ,applicable timel9es & proc$ures ,if an employee :o is subject to a collective b>ga9+ agreem5t *ooses to grieve an action tak5 "u ?is section ?r\gh a grievance proc$ure provid$ "u ! collective b>ga9+ agreem5t1 ! timel9es & proc$ures set =? 9 subsection 7c7 & ?is subsection %all apply4 7e7 ,alleg$ prohibit$ p]sonnel practice ,9 ! case ( a cov]$ individual seek+ corrective action 7or on behalf ( :om corrective action is s\ght7 f ! ,(fice ( ,special ,c\nsel bas$ on an alleg$ prohibit$ p]sonnel practice describ$ 9 section #bcjb7;b7 ( title #e1 ,unit$ ,/ates ,code1 ! ,secret>y may n remove1 demote1 or susp5d su* cov]$ individual "u subsection 7a7 )\t ! approval ( ! ,special ,c\nsel "u section #abad7;f7 ( title #e1 ,unit$ ,/ates ,code4 7f7 ,t]m9ation ( inve/igations by ,(fice ( ,special ,c\nsel 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,special ,c\nsel 7e/abli%$ by section #abaa ( title #e1 ,unit$ ,/ates ,code7 may t]m9ate an inve/igation ( a prohibit$ p]sonnel practice alleg$ by an employee or =m] employee ( ! ,s]vice aft] ! ,special ,c\nsel provides to ! employee or =m] employee a writt5 /atem5t ( ! reasons = ! t]m9ation ( ! inve/igation4 7#b7 ,admissibility ,! /atem5t describ$ 9 p>agraph 7#a7 may n be admissible z evid5ce 9 any judicial or adm9i/rative proce$+ )\t ! cons5t ( ! employee or =m] employee describ$ 9 p>agraph 7#a74 7g7 ,vacancies ,9 ! case ( a cov]$ individual :o is remov$ or demot$ "u subsection 7a71 to ! maximum ext5t feasible1 ! ,secret>y %all fill ! vacancy aris+ z a result ( su* removal or demotion4 7h7 ,def9itions ,9 ?is section3 7#a7 ,cov]$ individual ,! t]m cov]$ individual means an individual occupy+ a position at ! ,s]vice1 b does n include-- 7,a7 an individual occupy+ a s5ior executive position 7z def9$ 9 section #fjf7;d772 7,b7 an individual :o has n complet$ a probation>y or trial p]iod2 or 7,c7 a political appo9tee4 7#b7 ,grade ,! t]m grade has ! mean+ giv5 su* t]m 9 section #geaa7;a7 ( title #e1 ,unit$ ,/ates ,code4 7#c7 ,misconduct ,! t]m misconduct includes neglect ( duty1 malfeasance1 or failure to accept a direct$ reassignm5t or to accompany a position 9 a transf] ( function4 7#d7 ,political appo9tee ,! t]m political appo9tee means an individual :o is-- 7,a7 employ$ 9 a position describ$ "u sections #ecab ?r\gh #ecaf ( title #e1 ,unit$ ,/ates ,code 7relat+ to ! ,executive ,s*$ule72 7,b7 a limit$ 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 7,c7 employ$ 9 a position ( a confid5tial or policy-det]m9+ "* "u s*$ule ,c ( subp>t ,c ( "p #bac ( title #e1 ,code ( ,f$]al ,regulations1 or successor regulation4 7#e7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,s]vice4 7#f7 ,susp5d ,! t]m susp5d means ! plac+ ( an employee1 = discipl9>y reasons1 9 a tempor>y /atus )\t duties & pay = a p]iod 9 excess ( #ad days4 4 7b7 ,con=m+ am5dm5ts ,section #dcjc7;f7 ( title #e1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 p>agraph 7#c71 by /rik+ or at ! end2 7#b7 9 p>agraph 7#d71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7#e7 any removal or demotion "u section #fjg ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 4 7c7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices or ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all submit a report to ,congress t includes ! foll[+3 7#a7 ,! numb] ( employees ( ! ,indian ,heal? ,s]vice :o 7 remov$1 demot$1 or susp5d$ 9 ! #a-ye> p]iod be=e ! date ( enactm5t ( ?is ,act4 7#b7 ,! numb] ( employees ( ! ,indian ,heal? ,s]vice :o 7 remov$1 demot$1 or susp5d$ 9 ! #a-ye> p]iod aft] ! date ( enactm5t ( ?is ,act us+ ! updat$ au?orities provid$ 9 ! am5dm5ts made by ?is ,act4 7#c7 ,! appropriate details ( removals1 demotions1 & susp5sions t l5d necess>y context4 #ajg4 ,tribal culture & hi/ory ,section #aac ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;f7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ a program & ins]t+ an annual m&atory tra9+ program2 & 7,b7 by /rik+ appropriate employees ( ! ,s]vice & ins]t+ employees ( ! ,s]vice1 locum t55s m$ical provid]s1 heal?c>e volunte]s1 & o!r contract$ employees :o "w at ,s]vice hospitals or o!r ,s]vice units & ^: employm5t requires regul> direct pati5t access2 & 7#b7 by add+ at ! end ! foll[+3 7c7 ,not)/&+ any o!r provision ( law1 beg9n+ ) ! ye> ( ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah1 ea* employee or provid] describ$ 9 subsection 7a7 :o ent]s into a contract ) ! ,s]vice on or aft] ! date ( su* implem5tation %all1 z a condition ( employm5t1 annually p>ticipate 9 & complete su* tra9+ program4 ,= purposes ( ! prec$+ s5t5ce1 p>ticipation 9 su* tra9+ program may n be consid]$ complete = ! ye> involv$ until ! individual satisfies ea* requirem5t1 includ+ te/+1 if applicable1 ( ! tra9+ program = su* ye>1 z specifi$ by ! ,secret>y4 4 #ajh4 ,/aff+ demon/ration project ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 is am5d$ by add+ at ! end ! foll[+3 #hcc4 ,/aff+ demon/ration project 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all e/abli% a demon/ration project t au?orizes ! ,s]vice to provide f$]ally manag$ ,s]vice units ) additional /aff+ res\rces ) ! goal t ! res\rces become self-su/a9+4 7b7 ,selection ,9 select+ ,s]vice units = p>ticipation1 ! ,secret>y %all consid] :e!r a ,s]vice unit s]vices an ,indian ,tribe t-- 7#a7 has utiliz$ or contribut$ sub/antial tribal funds to con/ruct a heal? facility us$ by ! ,s]vice or id5tifi$ 9 ! ma/] plan = ! ,s]vice unit2 7#b7 is locat$ 9 a ,/ate or ,/ates ) ,m$icaid reimbursem5ts plans or policies t w increase ! likelihood t ! /aff+ res\rces provid$ w be self-su/a9+2 & 7#c7 is op]at+ a heal? facility describ$ 9 p>agraph 7#a7 "u hi/orical /aff+ ratios t h n be5 equaliz$ or updat$ by ! ,s]vice or any o!r ,s]vice program to reflect curr5t /aff+ ne$s4 7c7 ,duration ,/aff+ res\rces provid$ to a ,s]vice unit "u ?is section %all be = a duration t ! ,secret>y1 9 consultation ) ! applicable ,indian ,tribe1 det]m9es appropriate1 except t ea* /aff+ position provid$ %all be = a p]iod ( n less ?an #c fiscal ye>s4 7d7 ,effect ( /aff+ aw>ds ,no /aff+ res\rces provid$ "u ?is section %all r$uce ! recurr+ base fund+ = /aff+ = any ,indian ,tribe or f$]ally manag$ ,s]vice unit4 7e7 ,report ,n lat] ?an #e ye>s aft] ! ,secret>y ends ! demon/ration project "u ?is section1 ! ,secret>y %all prep>e & submit a report to ! ,committee on ,indian ,affairs & ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 & ! ,committee on ,natural ,res\rces & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 reg>d+ ! project1 includ+-- 7#a7 :e!r ! /aff+ res\rces result$ 9 additional rev5ue = ! ,s]vice unit suffici5t to ma9ta9 ! /aff on a p]man5t basis2 7#b7 ! levels to :i* ! /aff+ res\rces r$uc$ ! unmet /aff+ ne$ = ! ,s]vice unit2 & 7#c7 :e!r ! demon/ration project c\ld be deploy$ to r$uce unmet /aff+ ne$s ?r\gh\t ! ,s]vice4 4 #aji4 ,rule e/abli%+ tribal consultation policy ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq471 z am5d$ by section #ajh1 is fur!r am5d$ by add+ at ! end ! foll[+3 #hcd4 ,rule e/abli%+ tribal consultation policy 7a7 ,9 ,g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah1 ! ,secret>y %all e/abli%1 aft] mean+ful consultation ) repres5tatives ( affect$ ,indian ,tribes1 a rule e/abli%+ a tribal consultation policy = ! ,s]vice4 7b7 ,cont5ts ( tribal consultation policy ,! policy e/abli%$ "u ! rule describ$ 9 subsection 7a7 %all-- 7#a7 update1 & replace1 ! tribal consultation policy e/abli%$ "u ,circul> ,no4 #bjjf-ja ( ! ,s]vice1 or any successor policy2 & 7#b7 include ! foll[+3 7,a7 ,a process = det]m9+ :5 ! ,s]vice w notify ,indian ,tribes1 & a description ( h[ ! ,indian ,tribes %\ld be notifi$4 7,b7 ,a det]m9ation ( :at actions or ag5cy decisions by ! ,s]vice w trigg] a requirem5t = mean+ful consultation ) ,indian ,tribes4 7,c7 ,a det]m9ation ( :at actions con/itute mean+ful consultation ) ,indian ,tribes4 4 #aaj4 ,treatm5t ( c]ta9 hospitals ,! ,p>allel ,l[-,volume ,hospital ,paym5t ,adju/m5t ,reg>d+ ,hospitals ,op]at$ by ! ,indian ,heal? ,s]vices 7,,ihs7 or a ,tribe provisions describ$ 9 ! f9al rule publi%$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 9 ! ,f$]al ,regi/] on ,augu/ #ad1 #bjag1 & entitl$ ,m$ic>e ,program2 ,hospital ,inpati5t ,prospective ,paym5t ,sy/ems = ,acute ,c>e ,hospitals & ! ,long-,t]m ,c>e ,hospital ,prospective ,paym5t ,sy/em & ,policy ,*anges & ,fiscal ,ye> #bjah ,rates2 ,quality ,report+ ,requirem5ts = ,specific ,provid]s2 ,m$ic>e & ,m$icaid ,electronic ,heal? ,record 7,,ehr7 ,inc5tive ,program ,requirem5ts = ,eligible ,hospitals1 ,critical ,access ,hospitals1 & ,eligible ,pr(essionals2 ,provid]-,bas$ ,/atus ( ,indian ,heal? ,s]vice & ,tribal ,facilities & ,organizations2 ,co/s ,report+ & ,provid] ,requirem5ts2 ,agreem5t ,t]m9ation ,notices 7#hb ,f$ ,reg4 #cgiij2 #chahh-chahi71 %all apply ) respect to dis*>ges occurr+ 9 fiscal ye> #bjaa & subsequ5t fiscal ye>s4 ,,ii ,employee protections #bja4 ,employee protections aga9/ retaliation 7a7 ,9 g5]al ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq471 z am5d$ by sections #aje & #ajf1 is fur!r am5d$ by add+ at ! end ! foll[+3 #fjh4 ,employee protections aga9/ retaliation 7a7 ,employee acc\ntability 7#a7 ,ag5cy report+ process requirem5t ,! ,secret>y %all designate an (ficial 9 ! ,dep>tm5t :o is n an employee ( ! ,s]vice to-- 7,a7 receive reports f an employee ( ! ,s]vice :o witnesses retaliation aga9/ a :i/lebl[]1 a violation ( a pati5t safety requirem5t1 or o!r simil> conduct2 & 7,b7 conduct active & ongo+ outrea* to all employees ( ! ,s]vice ab\t-- 7i7 ,f$]al & ,dep>tm5t sy/ems = report+ retaliation aga9/ :i/lebl[]s2 & 7ii7 ! duty ( individual employees ( ! ,s]vice to report violations ( pati5t safety requirem5ts & o!r simil> conduct4 7#b7 ,ov]sight ,n lat] ?an #c days aft] ! date on :i* ! (ficial designat$ by ! ,secret>y "u p>agraph 7#a7 receives a report "u p>agraph 7#a77;,a71 ! ,secret>y %all-- 7,a7 =mally review ! report2 & 7,b7 provide a copy ( su* report & any o!r relevant in=mation to ! ,inspector ,g5]al ( ! ,dep>tm5t4 7#c7 ,removal = :i/lebl[] retaliation ,! ,secret>y may remove = misconduct f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code71 9 accordance ) sections #fjf & #fjg1 an employee ( ! ,s]vice if ! ,secret>y det]m9es1 aft] complet+ a report review describ$ 9 p>agraph 7#b71 t ! employee has retaliat$ aga9/ a :i/lebl[] & w>rants removal4 7#d7 ,enhanc+ protections = :i/lebl[]s ,! ,secret>y %all c>ry out any actions det]m9$ necess>y by ! ,secret>y to enhance protection = :i/lebl[]s1 includ+ id5tify+ appropriate ,s]vice employees & requir+ ! employees to complete ! ,(fice ( ,special ,c\nsel's ,:i/lebl[] ,c]tification ,program4 7b7 ,def9itions ,9 ?is section3 7#a7 ,retaliation ,! t]m retaliation-- 7,a7 means an adv]se employm5t action or any significantly adv]se action aga9/ a :i/lebl[]1 su* z ! refusal or delay ( c>e provid$ ?r\gh ! ,s]vice2 & 7,b7 includes in/ances :]e ! adv]se action describ$ 9 subp>agraph 7,a7 is p]petrat$ aga9/ a family memb] or fri5d ( ! :i/lebl[] because ( ! :i/lebl[]'s disclosure ( in=mation4 7#b7 ,:i/lebl[] ,! t]m :i/lebl[] means an employee ( ,s]vice :o discloses in=mation-- 7,a7 t ! employee reasonably believes evid5ces-- 7i7 a violation ( any law1 rule1 or regulation2 or 7ii7 gross mismanagem5t1 a gross wa/e ( funds1 an abuse ( au?ority1 or a sub/antial & specific dang] to public heal? or safety2 & 7,b7 if su* disclosure is n specifically prohibit$ by law & if su* in=mation is n specifically requir$ by ,executive ,ord] to be kept secret 9 ! int]e/ ( national def5se or ! conduct ( =eign affairs4 4 #bjb4 ,"r ( ,f$]al employees to petition ,congress 7a7 ,adv]se action = violation ( "r ,to petition ,congress ,section #gbaa ( title #e1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by /rik+ ,! "r ( & ins]t+ 7a7 ,9 g5]al4--,! "r (2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7b7 ,adv]se action ,an employee :o int]f]es ) or d5ies a "r protect$ "u subsection 7a7 %all be subject to any adv]se action describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 ( section #geab1 9 accordance ) ! proc$ure describ$ 9 section #geac & any o!r applicable proc$ure4 4 7b7 ,electronic notification ( "r ( employees ( ,indian ,heal? ,s]vice 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y71 act+ ?r\gh ! ,director ( ! ,indian ,heal? ,s]vice1 %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 to petition ,congress "u section #gbaa ( title #e1 ,unit$ ,/ates ,code4 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$]al employee "u su* section %all be subject to an adv]se action describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 ( section #geab ( title #e1 ,unit$ ,/ates ,code1 includ+ a susp5sion = m ?an #ad days )\t pay44 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 subsection 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&um1 z ! case may be4 7#e7 ,notice ,9 ! case ( an approval "u p>agraph 7#d71 n lat] ?an #cj days aft] su* approval1 ! ,secret>y %all-- 7,a7 provide to ea* employee ( ! ,indian ,heal? ,s]vice an electronic copy ( ! approv$ memor&um2 & 7,b7 po/ su* memor&um 9 a cle> & conspicu\s place on ! website ( ! ,indian ,heal? ,s]vice = a p]iod n less ?an #abj days4 7#f7 ,revis$ memor&um ,9 ! case ( a disapproval "u p>agraph 7#d71 n lat] ?an #ae days aft] su* disapproval1 ! ,secret>y %all submit a revis$ memor&um to ! ,inspector ,g5]al = approval "u p>agraph 7#d74 #bjc4 ,fiscal acc\ntability ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq471 z am5d$ by sections #aje1 #ajf1 & #bja1 is fur!r 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 ! pr(essional h\s+ plan "u section #cja7;a7 ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjah or ! /aff+ plan "u section #cja7;b7 ( 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 until ! pr(essional h\s+ plan or /aff+ plan1 z ! case may be1 is submitt$4 7#b7 ,individual describ$ ,an individual describ$ 9 ?is p>agraph is an individual employ$ 9 a position 9 ! ,s]vice t is a position-- 7,a7 describ$ "u sections #ecab ?r\gh #ecaf ( title #e1 ,unit$ ,/ates ,code2 7,b7 plac$ 9 level ,,iv or ,v ( ! ,executive ,s*$ule "u section #ecag ( title #e1 ,unit$ ,/ates ,code2 7,c7 z 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 7,d7 "u section #bac4ccja or #bac4ccjb ( title #e1 ,code ( ,f$]al ,regulations4 7b7 ,prioritization ( pati5t c>e 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y %all use am\nts available to ! ,indian ,heal? ,s]vice t are n obligat$ or exp5d$1 includ+ base budget fund+ & ?ird p>ty collections1 dur+ ! fiscal ye> = :i* ! am\nts are made available1 & t rema9 available1 only to support pati5t c>e by us+ su* funds = ! co/s (-- 7,a7 ess5tial m$ical equipm5t2 7,b7 pur*as$ or ref]r$ c>e2 or 7,c7 /aff+4 7#b7 ,special rule ,9 us+ am\nts "u p>agraph 7#a71 ! ,secret>y %all ensure t1 9 any case :]e ! am\nts 7 orig9ally made available = a p>ticul> ,s]vice unit1 su* am\nts are us$ to b5efit ,indians s]v$ by t ,s]vice unit4 7#c7 ,re/rictions ,! ,secret>y may n use am\nts describ$ 9 p>agraph 7#a7-- 7,a7 to remodel or int]ior decorate any ,area (fice2 or 7,b7 to increase ! rate ( pay ( any employee ( an ,area (fice4 7c7 ,sp5d+ reports ,n lat] ?an #ij days aft] ! end ( ea* qu>t] ( a fiscal ye>1 ! ,secret>y %all submit a report describ+ ! au?orizations1 exp5ditures1 outlays1 transf]s1 reprogramm+1 & obligations ( ea* level ( ! ,s]vice1 includ+ ! headqu>t]s1 ea* ,area (fice1 ea* ,s]vice unit1 & ea* heal? cl9ic or facility1 to-- 7#a7 ea* ,indian ,tribe2 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 ,subject to p>agraph 7#b71 n lat] ?an #ahj days aft] ! end ( ea* fiscal ye>1 ! ,secret>y %all provide to ea* entity describ$ 9 p>agraphs 7#a7 ?r\gh 7#c7 ( subsection 7c7 a report 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 ,) respect to any *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+ su* *ange4 7e7 ,rule ( con/ruction ,no?+ 9 ?is section may be con/ru$-- 7#a7 to negatively impact ! "r ( an ,indian ,tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et seq472 & 7#b7 to apply to su* a compact or contract unless expressly agre$ to by ! ,indian ,tribe4 4 ,,iii ,reports #cja4 ,def9itions ,9 ?is title3 7#a7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#b7 ,s]vice ,! t]m ,s]vice means ! ,indian ,heal? ,s]vice4 7#c7 ,s]vice unit ,! t]m ,s]vice unit has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 #cjb4 ,reports by ! ,secret>y ( ,heal? & ,human ,s]vices 7a7 ,,ihs ,pr(essional h\s+ plan ,n lat] ?an #a ye> aft] ! date ! ,gov]nm5t ,acc\ntability ,(fice releases _! ongo+ report ab\t ,indian ,heal? ,s]vice h\s+ ne$s1 ! ,secret>y %all develop1 make publicly available1 & submit to ,congress & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates a writt5 plan to address ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice t comports ) ! practices & recomm5dations ( ! ,gov]nm5t ,acc\ntability ,(fice relat+ to pr(essional h\s+4 7b7 ,plan relat+ to ,,ihs /aff+ ne$s ,n lat] ?an #a ye> aft] ! date ! ,gov]nm5t ,acc\ntability ,(fice releases _! ongo+ report ab\t ,indian ,heal? ,s]vice h\s+ ne$s1 ! ,secret>y %all develop1 make publicly available1 & submit to ,congress & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates a writt5 plan to address /aff+ ne$s 9 ! ,s]vice t comports ) ! practices ( ! ,gov]nm5t ,acc\ntability ,(fice relat+ to work=ce plann+4 7c7 ,indian ,heal? ,c>e ,improvem5t ,act report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 & ea* ye> !reaft] = a p]iod ( #e ye>s1 ! ,secret>y %all develop1 make publicly available1 & submit to ,congress a report on ! data submitt$ "u section #dab7;b7 ( ! ,indian ,heal? ,c>e ,improvem5t ,act1 z am5d$ by section #ajg4 7d7 ,quality ( ,c>e & ,/aff+ report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 & ea* ye> !reaft]1 ! ,secret>y %all develop & submit to ,congress a report on ! data obta9$ "u section #ajh1 ) an emphasis on quality ( c>e & access to c>e4 #cjc4 ,reports by ! ,comptroll] ,g5]al 7a7 ,,ihs ,h\s+ ne$s report 7#a7 ,9 g5]al ,n lat] ?an #e ye>s aft] ! date on :i* ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates receives ! pr(essional h\s+ plan "u section #cjb7;a71 ! ,comptroll] ,g5]al %all develop & submit to ,congress a report4 7#b7 ,cont5ts ,! report requir$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,an evaluation ( any exi/+1 z ( ! date ( ! report1 assessm5ts & projections = ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice1 includ+ discussion & conclusion z to :e!r exi/+ assessm5ts & projections accurately reflect ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice4 7,b7 ,an assessm5t ( ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice = ea* ,s]vice area 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 7,c7 ,an assessm5t ( ! pr(essional h\s+ plan develop$ by ! ,secret>y "u section #cjb7;a74 7b7 ,,ihs /aff+ ne$s report 7#a7 ,9 g5]al ,n lat] ?an #e ye>s aft] ! date on :i* ! ,comptroll] ,g5]al receives ! report "u section #cjb7;b71 ! ,comptroll] ,g5]al %all prep>e & submit to ,congress a report on ! /aff+ ne$s ( ! ,s]vice4 7#b7 ,cont5ts ,! report requir$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a description ( ! numb] & type ( full-"t positions ne$$ at ea* facility ( ! ,s]vice & ! am\nt ( funds necess>y to ma9ta9 su* positions4 7,b7 ,an explanation ( ! v>i\s me?odologies t ! ,s]vice utilizes & has previ\sly utiliz$ to det]m9e ! numb] & type ( full-"t positions ne$$ at f$]ally manag$ ,s]vice units4 7,c7 ,an assessm5t ( ! use ( indep5d5t contractors1 includ+ ! numb] ( indep5d5t contractors hir$ to fill vacant full-"t positions & am\nts sp5t on indep5d5t contractors :o provide heal? c>e s]vices4 7,d7 ,an assessm5t ( ! /aff+ plan develop$ by ! ,secret>y "u section #cjb7;b74 7c7 ,:i/lebl[] protections report 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all develop & submit to ,congress a report on ! efficacy ( exi/+ protections = :i/lebl[]s 9 ! ,s]vice4 7#b7 ,cont5ts ,! report requir$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,a discussion & conclusion z to :e!r ! ,s]vice has tak5 prop] /eps to prev5t retaliation aga9/ :i/lebl[]s4 7,b7 ,if applicable1 any recomm5dations = *anges to ! policy ( ! ,s]vice ) respect to :i/lebl[]s4 7,c7 ,a discussion & conclusion z to :e!r ! (ficial email acc\nts ( employees ( ! ,s]vice are appropriately monitor$4 #cjd4 ,inspector ,g5]al reports 7a7 ,pati5t c>e reports 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & n less ?an e #c ye>s !reaft]1 ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all develop & submit to ,congress & ! ,s]vice a report on pati5t h>m ev5ts occurr+ 9 ,s]vice units & def]rals & d5ials ( c>e ( pati5ts ( ! ,s]vice4 7#b7 ,cont5ts ,! report requir$ "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,an evaluation ( ! numb] & k9d ( ev5ts t contribute to pati5t dea?s 9 a ,s]vice unit & recomm5dations reg>d+ r$uc+ ! numb] ( pati5t dea?s4 7,b7 ,an evaluation ( ! ,s]vice's track+ & report+ (1 & response to1 pati5t h>m ev5ts & recomm5dations reg>d+ h[ to improve su* track+1 report+1 & response4 7,c7 ,! effects ( def]rals & d5ials ( c>e on pati5ts ( ! ,s]vice1 includ+ pati5t outcomes1 & recomm5dations reg>d+ h[ to r$uce def]rals & d5ials ( c>e4 7b7 ,report+ sy/ems audit ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,inspector ,g5]al %all-- 7#a7 conduct an audit ( report+ sy/ems ( ! ,s]vice1 z ( ! date ( enactm5t ( ?is ,act2 & 7#b7 provide to ! ,s]vice recomm5dations & te*nical assi/ance reg>d+ implem5tation ( improv$ report+ sy/ems1 proc$ures1 /&>ds1 & protocols4 #cje4 ,transp>5cy 9 ,,cms surveys ,section #ahhj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieqq7 is am5d$ 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 ( p>ticipat+ ,indian ,heal? ,s]vice facilities 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 po/$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 ,su* po/+ %all comply ) ! ,f$]al regulations conc]n+ ! privacy ( individually id5tifiable heal? in=mation promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif4 4 ,,iv ,te*nical am5dm5ts #dja4 ,te*nical am5dm5ts ,! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja et seq47 is am5d$-- 7#a7 by /rik+ contract heal? s]vice ea* place su* t]m appe>s 7reg>dless ( cas+ & typeface & includ+ 9 ! head+s7 & ins]t+ pur*as$_/ref]r$ c>e 7) appropriate cas+ & typeface72 & 7#b7 by /rik+ contract heal? s]vices ea* place su* t]m appe>s 7reg>dless ( cas+ & typeface & includ+ 9 ! head+s7 & ins]t+ pur*as$_/ref]r$ c>e 7) appropriate cas+ & typeface74