,,ib ,union ,calendar ,no4 #hgb #aaeth ,,congress #b;d ,session ,h4 ,r4 #ehgd ,report ,no4 #aae-ajfe1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,may #ah1 #bjah ,mrs4 ,noem 7for herself1 ,mr4 ,bishop of ,utah1 ,mr4 ,mullin1 ,mrs4 ,mc,morris ,rodgers1 ,mr4 ,cole1 ,mr4 ,la,malfa1 ,mr4 ,cramer1 ,mrs4 ,radewagen1 and ,miss ,gonzlez-,coln of ,puerto ,rico7 introduced the following bill2 which was referred to the ,committee on ,natural ,resources1 and in addition to the ,committees on ,energy and ,commerce1 ,ways and ,means1 and ,oversight and ,government ,reform1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,december #c1 #bjah ,reported from the ,committee on ,natural ,resources ,december #c1 #bjah,referral to the ,committees on ,energy and ,commerce1 ,ways and ,means1 and ,oversight and ,government ,reform extended for a period ending not later than ,december #bh1 #bjah ,december #bh1 #bjah;,committees on ,energy and ,commerce1 ,ways and ,means1 and ,oversight and ,government ,reform discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed ,a ,,bill ,to amend the ,indian ,health ,care ,improvement ,act to improve the recruitment and retention of employees in the ,indian ,health ,service1 restore accountability in the ,indian ,health ,service1 improve health services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah4 #b4 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,,title ,i--,indian ,health ,service improvements ,sec4 #aja4 ,incentives for recruitment and retention4 ,sec4 #ajb4 ,medical credentialing system4 ,sec4 #ajc4 ,liability protections for health professional volunteers at ,indian ,health ,service4 ,sec4 #ajd4 ,clarification regarding eligibility for ,indian ,health ,service loan repayment program4 ,sec4 #aje4 ,improvements in hiring practices4 ,sec4 #ajf4 ,improved authorities of secretary to improve accountability of senior executives and employees of the ,indian ,health ,service4 ,sec4 #ajg4 ,tribal culture and history4 ,sec4 #ajh4 ,staffing demonstration project4 ,sec4 #aji4 ,rule establishing tribal consultation policy4 ,sec4 #aaj4 ,treatment of certain hospitals4 ,,title ,,ii--,employee protections ,sec4 #bja4 ,employee protections against retaliation4 ,sec4 #bjb4 ,right of ,federal employees to petition ,congress4 ,sec4 #bjc4 ,fiscal accountability4 ,,title ,,iii--,reports ,sec4 #cja4 ,definitions4 ,sec4 #cjb4 ,reports by the ,secretary of ,health and ,human ,services4 ,sec4 #cjc4 ,reports by the ,comptroller ,general4 ,sec4 #cjd4 ,inspector ,general reports4 ,sec4 #cje4 ,transparency in ,,cms surveys4 ,,title ,,iv--,technical amendments ,sec4 #dja4 ,technical amendments4 ,i ,indian ,health ,service improvements #aja4 ,incentives for recruitment and retention ,title ,i of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaa et seq47 is amended by adding at the end the following3 #abe4 ,incentives for recruitment and retention 7a7 ,parity in ,,ihs health care workforce personnel and pay system ,the ,secretary shall establish a personnel and pay system for physicians1 dentists1 nurses1 and other health care professionals employed by the ,service that provides a personnel and pay system that1 to the maximum extent practicable1 is comparable to the pay provided to physicians1 dentists1 nurses1 and other health care professionals1 respectively1 under subchapters ,,iii and ,,iv of chapter #gd of title #ch1 ,united ,states ,code4 7b7 ,relocation costs ,the ,secretary may provide to an employee of the ,service reimbursement for any relocation costs the employee incurs if-- 7#a7 the employee relocates to a ,service area experiencing a high level of need for employees1 as determined by the ,secretary2 and 7#b7 the employee is filling a position that would otherwise be difficult to fill1 as determined by the ,secretary1 in the absence of an incentive4 7c7 ,housing vouchers 7#a7 ,in general ,subject to paragraph 7#b71 not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah1 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 unit designated by the ,administrator of the ,health ,resources and ,services ,administration as a health professional shortage area1 as defined in section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a771 with the greatest staffing need2 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 any such program is established4 7d7 ,administration 7#a7 ,,opm guidelines ,the ,secretary shall carry out subsection 7b7 in accordance with any guidelines of the ,office of ,personnel ,management relating to section #egb of title #e1 ,code of ,federal ,regulations 7as in effect on the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah74 7#b7 ,service agreements ,the ,secretary may only provide reimbursement for any relocation costs under subsection 7b7 or any other benefit under subsection 7c7 to-- 7,a7 a full-time employee who agrees to serve for not less than #a year in the ,service1 beginning on the date of the agreement2 or 7,b7 a part-time employee who agrees to serve for not less than #b years in the service beginning on the date of the agreement4 4 #ajb4 ,medical credentialing system ,title ,i of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaa et seq471 as amended by section #aja1 is further amended by adding at the end the following3 #abf4 ,medical credentialing system 7a7 ,in general 7#a7 ,development and implementation timeline ,by not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah1 the ,secretary1 acting through the ,service and in accordance with the requirements described in subsection 7b71 shall develop and implement a ,service-wide centralized electronic credentialing system 7referred to in this section as the credentialing system7 to credential licensed health professionals who seek to provide health care services at any ,service unit1 including physicians1 nurses and physicians assistants4 7#b7 ,implementation ,in implementing the credentialing system1 the ,secretary-- 7,a7 shall not require re-credentialing of licensed health professionals who were credentialed using existing ,service policy prior to the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah2 and 7,b7 shall-- 7i7 use the credentialing system for all new applications of licensed health professionals and the migration of credentials data that existed prior to implementation into the system2 7ii7 maintain the established timeline for re-credentialing of licensed health professionals who were credentialed prior to implementation1 as defined by ,service policy2 and 7iii7 review credentials for all professionals in the system1 based on updated policies1 on a not less than yearly basis4 ,licensed health professionals whose credentials would not have been approved under the updated policies shall have #ij days to meet the new requirements4 7b7 ,requirements ,in developing the credentialing system under subsection 7a71 the ,secretary shall ensure the following3 7#a7 ,credentialing procedures shall be uniform and integrated throughout the ,service4 7#b7 ,with respect to each licensed health professional who successfully completes the credentialing procedures of the credentialing system1 the ,secretary may authorize each such professional to provide health care services at any ,service unit4 7#c7 ,credentialing procedures shall include verification of licensure1 education1 employment history1 and criminal background checks and history4 7c7 ,consultation ,in developing the credentialing system under subsection 7a71 the ,secretary shall consult with ,indian ,tribes and may also consult with any public or private association of medical providers1 any government agency1 or other relevant expert1 as determined by the ,secretary4 7d7 ,application ,a licensed health care professional may not provide health care services at any ,service unit1 unless such professional successfully completes the credentialing procedures of the credentialing system developed under subsection 7a74 7e7 ,regulations ,the ,secretary may prescribe such regulations as may be necessary to carry out the provisions of this section4 7f7 ,rule of construction ,nothing in this section may be construed-- 7#a7 to negatively impact the right of an ,indian ,tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq472 and 7#b7 to apply to such a compact or contract unless expressly agreed to by the ,indian ,tribe4 4 #ajc4 ,liability protections for health professional volunteers at ,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 7r7 ,certain ,indian ,health ,service volunteers deemed ,public ,health ,service employees 7#a7 ,in general ,for purposes of this section1 an employee of an ,,ihs urban ,indian health program and a health professional volunteer at a ,service unit shall1 in providing a health 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 ,the preceding sentence is subject to the provisions of this subsection4 7#b7 ,conditions ,in providing a health service to an individual1 a health care practitioner shall1 for purposes of this subsection1 be considered to be a health professional volunteer at a ,service unit if all of the following conditions are met3 7,a7 ,the service is provided to the individual at the facilities of a ,service unit1 or through offsite programs or events carried out by the ,service unit4 7,b7 ,the ,service unit is sponsoring the health care practitioner pursuant to paragraph 7#c77;,c74 7,c7 ,the health care practitioner does not receive any compensation for the service from the individual1 the ,service unit1 or 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 ,service unit 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 ,service unit posts a clear and conspicuous notice at the site where the service is provided of the extent to which the legal liability of the health care practitioner is limited under this subsection4 7,e7 ,at the time the service is provided1 the health care practitioner is licensed1 certified1 credentialed1 and privileged in accordance with ,service policy and applicable law regarding the provision of the service4 7#c7 ,applicability ,subsection 7g7 7other than paragraphs 7#c7 and 7#e77 and subsections 7h71 7i71 and 7l7 apply to an employee of an ,,ihs urban ,indian health program and to a health care practitioner at a ,service unit for purposes of this subsection to the same extent and in the same manner as such subsections apply to an officer1 governing board member1 employee1 or contractor of an entity described in subsection 7g77#d71 subject to paragraph 7#d7 and subject to the following subparagraphs3 7,a7 ,each reference to an entity in subsections 7g71 7h71 7i71 and 7l7 shall be considered to be a reference to an ,,ihs urban ,indian health program or a ,service unit1 as applicable4 7,b7 ,the first sentence of paragraph 7#a7 applies in lieu of the first sentence of subsection 7g77#a77;,a74 7,c7 ,with respect to a ,service unit1 a health care practitioner is not a health professional volunteer at the ,service unit unless the ,service unit sponsors the health care practitioner4 ,for purposes of this subsection1 the ,service unit shall be considered to be sponsoring the health care practitioner if-- 7i7 with respect to the health care practitioner1 the ,service unit submits to the ,secretary an application meeting the requirements of subsection 7g77#a77;,d72 and 7ii7 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 this subsection and subsection 7g77#a77;,e7 to be a health professional volunteer1 this subsection applies to the health care practitioner 7with respect to services performed on behalf of the ,service unit 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 than ,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 employees of an ,,ihs urban ,indian health program or health professional volunteers1 will be paid pursuant to 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 employees of an ,,ihs urban ,indian health program or 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 ,definitions 7,a7 ,,ihs urban ,indian health program ,in this subsection1 the term ,,ihs urban ,indian health program means an urban ,indian health program operated by an urban ,indian organization pursuant to a grant or contract with the ,indian ,health ,service under title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq474 7,b7 ,service unit ,in this subsection1 the term ,service unit has the meaning given the term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7#f7 ,rule of construction ,nothing in this subsection may be construed-- 7,a7 to negatively impact the right of an ,indian ,tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq472 and 7,b7 to apply to such a compact or contract unless expressly agreed to by the ,indian ,tribe4 7#g7 ,effective dates 7,a7 ,in general ,except as provided in subparagraph 7,b71 this subsection shall take effect on ,october #a1 #bjai4 7,b7 ,regulations1 applications1 and reports ,effective on the date of the enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah1 the ,secretary may-- 7i7 prescribe regulations for carrying out this subsection2 and 7ii7 accept and consider applications submitted under paragraph 7#c77;,c77i74 4 #ajd4 ,clarification regarding eligibility for ,indian ,health ,service loan repayment program ,section #ajh of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;a7 is amended-- 7#a7 by amending subparagraph 7,b7 of subsection 7b77#a7 to read as follows3 7,b7 have-- 7i7 7,i7 a degree in a health profession2 and 7,,ii7 a license to practice a health profession in a ,state2 or 7ii7 7,i7 a master's degree in business administration with an emphasis in health care management 7as defined by the ,secretary71 health administration1 hospital administration1 or public health2 and 7,,ii7 a license or certification to practice in the field of business administration1 health administration1 hospital administration1 or public health in a ,state1 if the ,secretary determines such license or certification necessary for the ,indian health program to which the individual will be assigned2 7iii7 maintain credentials as determined by the system described in section #ajb2 and 7iv7 participate in the training described in section #ajg2 2 7#b7 by amending clause 7iii7 of subsection 7f77#a77;,b7 to read as follows3 7iii7 to serve for a time period 7referred to in this section as the period of obligated service7 equal to-- 7,i7 #b years or such longer period as the individual may agree to serve in the full-time practice of such individual's profession in an ,indian health program to which the individual may be assigned by the ,secretary2 or 7,,ii7 #d years or such longer period as the individual may agree to serve in the half-time practice of such individual's profession in an ,indian health program to which the individual may be assigned by the ,secretary2 2 and 7#c7 in subsection 7g77#b7-- 7,a7 by redesignating subparagraph 7,b7 as subparagraph 7,c72 and 7,b7 in subparagraph 7,a7-- 7i7 by striking the first sentence of the matter preceding clause 7i7 and inserting the following3 ,in the case of an individual who contracts to serve a period of obligated service under subsection 7f77#a77;,b77iii77,i71 for each year of such obligated service1 the ,secretary may pay up to #ce1jjj 7or an amount equal to the amount specified in section #cch;,b7g77#b77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a7;g77#b77;,a777 on behalf of the individual for loans described in paragraph 7#a74 ,in the case of an individual who contracts to serve a period of obligated service under subsection 7f77#a77;,b77iii77,,ii71 for each year of such obligated service1 the ,secretary may pay up to #ag1ejj on behalf of the individual for loans described in paragraph 7#a72 and 7ii7 by striking ,in making a determination and inserting the following3 7,b7 ,in making a determination under this paragraph 4 #aje4 ,improvements in hiring practices 7a7 ,in general ,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 ,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 such title71 a candidate directly to a position within the ,service for which the candidate meets the qualifications standard established by the ,office of ,personnel ,management4 7b7 ,tribal notification ,before appointing1 hiring1 promoting1 transferring1 or reassigning a candidate to a ,senior ,executive ,service position or the position of a manager at an ,area office or ,service unit1 the ,secretary shall provide notice to each ,indian ,tribe located within the defined geographic area of such ,area office or ,service unit1 as the case may be1 of the content of an inclusion in an employment record4 ,each such ,indian ,tribe may submit comment to the ,secretary during the #aj-;day period after the date of such notification regarding such content4 4 7b7 ,in general ,subsection 7c7 of section #b of the ,act of ,december #ae1 #aigi 7#be ,u4,s4,c4 #eaag71 is amended by adding the following3 7#c7 ,,ihs waivers ,the ,secretary of ,health and ,human ,services may1 at the request of an ,indian ,tribe1 seek from each ,indian ,tribe concerned1 a waiver of ,indian preference laws for a personnel action that is with respect to-- 7,a7 an ,indian ,health ,service unit in which #ae percent or more of the total positions or specific health professionals in the ,service unit are not filled by a full-time employee of the ,indian ,health ,service for a period of #f months or longer2 or 7,b7 a former employee of the ,indian ,health ,service or a former tribal employee who was removed from such former employment within1 or demoted for performance or misconduct that occurred during1 the #e-year period following the date of such personnel action4 4 #ajf4 ,improved authorities of secretary to improve accountability of senior executives and employees of the ,indian ,health ,service 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq471 as amended by section #aje1 is further amended by adding at the end the following3 #fjf4 ,improved authorities of secretary to improve accountability of senior executives of the ,indian ,health ,service 7a7 ,authority 7#a7 ,in general ,the ,secretary may1 as provided in this section1 reprimand or suspend1 involuntarily reassign1 demote1 or remove a covered individual from a senior executive position at the ,service if the ,secretary determines that the misconduct or performance of the covered individual warrants such action4 7#b7 ,removal from civil service ,if the ,secretary removes an individual pursuant to paragraph 7#a71 the ,secretary may remove the individual from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code74 7b7 ,rights and procedures 7#a7 ,in general ,a covered individual who is the subject of an action under subsection 7a7 is entitled to-- 7,a7 advance notice of the action and a file containing all evidence in support of the proposed action2 7,b7 be represented by an attorney or other representative of the covered individual's choice2 and 7,c7 grieve the action in accordance with an internal grievance process that the ,secretary shall establish for purposes of this subsection4 7#b7 ,notice 7,a7 ,aggregate period for notice ,the aggregate period for notice1 response1 and decision on an action under subsection 7a7 may not exceed #ae business days4 7,b7 ,response ,the period for the response of a covered individual to a notice under paragraph 7#a77;,a7 of an action under subsection 7a7 shall be #g business days4 7,c7 ,decision ,a decision under this paragraph on an action under subsection 7a7 shall be issued not later than #ae business days after notice of the action is provided to the covered individual under paragraph 7#a77;,a74 ,the decision shall be in writing1 and shall include the specific reasons for the decision4 7#c7 ,grievance process ,the ,secretary shall ensure that the grievance process established under paragraph 7#a77;,c7 takes fewer than #ba days4 7#d7 ,final and conclusive decision ,a decision under paragraph 7#b7 that is not grieved1 and a grievance decision under paragraph 7#c71 shall be final and conclusive4 7#e7 ,judicial review ,a covered individual adversely affected by a decision under paragraph 7#b7 that is not grieved1 or by a grievance decision under paragraph 7#c71 may obtain judicial review of such decision4 7#f7 ,court review ,in any case in which judicial review is sought under paragraph 7#e71 the court shall review the record and may set aside any ,department action found to be-- 7,a7 arbitrary1 capricious1 an abuse of discretion1 or otherwise not in accordance with a provision of law2 7,b7 obtained without procedures required by a provision of law having been followed2 or 7,c7 unsupported by substantial evidence4 7c7 ,relation to other provisions of law ,section #ceib7;b77#a7 of title #e1 ,united ,states ,code1 does not apply to an action under subsection 7a74 7d7 ,definitions ,in this section3 7#a7 ,covered individual ,the term covered individual means a career appointee 7as that term is defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7#b7 ,misconduct ,the term misconduct includes neglect of duty1 malfeasance1 or failure to accept a directed reassignment or to accompany a position in a transfer of function4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,service4 7#d7 ,senior executive position ,the term senior executive position means a ,senior ,executive ,service position 7as that term is defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 #fjg4 ,improved authorities of secretary to improve accountability of employees of the ,indian ,health ,service 7a7 ,in general 7#a7 ,authority ,the ,secretary may remove1 demote1 or suspend a covered individual who is an employee of the ,service if the ,secretary determines the performance or misconduct of the covered individual warrants such removal1 demotion1 or suspension4 7#b7 ,actions ,if the ,secretary removes1 demotes1 or suspends a covered individual pursuant to paragraph 7#a71 the ,secretary may-- 7,a7 remove the covered individual from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code72 7,b7 demote the covered individual by means of a reduction in grade for which the covered individual is qualified1 that the ,secretary determines is appropriate1 and that reduces the annual rate of pay of the covered individual2 or 7,c7 suspend the covered individual4 7b7 ,pay of certain demoted individuals 7#a7 ,in general ,notwithstanding any other provision of law1 any covered individual subject to a demotion under subsection 7a77#b7 shall1 beginning on the date of such demotion1 receive the annual rate of pay applicable to such grade4 7#b7 ,restrictions 7,a7 ,prohibition on administrative leave ,a covered individual subject to a demotion under subsection 7a77#b7 may not be placed on administrative leave during the period during which an appeal 7if any7 under this section is ongoing1 and may only receive pay if the covered individual reports for duty or is approved to use accrued unused annual1 sick1 family medical1 military1 or court leave4 7,b7 ,restriction on pay and benefits ,if a covered individual subject to a demotion under subsection 7a77#b7 does not report for duty or receive approval to use accrued unused leave1 such covered individual shall not receive pay or other benefits pursuant to subsection 7d77#e74 7c7 ,procedures 7#a7 ,in general 7,a7 ,aggregate period ,the aggregate period for notice1 response1 and final decision in a removal1 demotion1 or suspension under this section may not exceed #ae business days4 7,b7 ,period for response ,the period for the response of a covered individual to a notice of a proposed removal1 demotion1 or suspension under this section shall be #g business days4 7,c7 ,representation by attorney or other representative ,paragraph 7#c7 of subsection 7b7 of section #geac of title #e1 ,united ,states ,code1 shall apply with respect to a removal1 demotion1 or suspension under this section4 7,d7 ,procedures superseding ,c,b,as ,the procedures in this subsection shall supersede any collective bargaining agreement to the extent that such agreement is inconsistent with such procedures4 7#b7 ,final decision ,the ,secretary shall issue a final decision with respect to a removal1 demotion1 or suspension under this section not later than #ae business days after the ,secretary provides notice1 including a file containing all the evidence in support of the proposed action1 to the covered individual of the removal1 demotion1 or suspension4 ,the decision shall be in writing and shall include the specific reasons for the decision4 7#c7 ,performance appraisal ,the procedures under chapter #dc of title #e1 ,united ,states ,code1 shall not apply to a removal1 demotion1 or suspension under this section4 7#d7 ,appeal to merit systems protection board 7,a7 ,in general ,subject to subparagraph 7,b7 and subsection 7d71 any removal or demotion under this section1 and any suspension of more than #ad days under this section1 may be appealed to the ,merit ,systems ,protection ,board1 which shall refer such appeal to an administrative judge pursuant to section #ggja7;b77#a7 of title #e1 ,united ,states ,code4 7,b7 ,time period ,an appeal under subparagraph 7,a7 of a removal1 demotion1 or suspension may only be made if such appeal is made not later than #aj business days after the date of such removal1 demotion1 or suspension4 7d7 ,expedited review 7#a7 ,in general ,upon receipt of an appeal under subsection 7c77#d77;,a71 the administrative judge shall expedite any such appeal under section #ggja7;b77#a7 of title #e1 ,united ,states ,code1 and1 in any such case1 shall issue a final and complete decision not later than #ahj days after the date of the appeal4 7#b7 ,upholding decision 7,a7 ,in general ,notwithstanding section #ggja7;c77#a77;,b7 of title #e1 ,united ,states ,code1 the administrative judge shall uphold the decision of the ,secretary to remove1 demote1 or suspend an employee under subsection 7a7 if the decision is supported by substantial evidence4 7,b7 ,prohibition of mitigation ,notwithstanding title #e1 ,united ,states ,code1 or any other provision of law1 if the decision of the ,secretary is supported by substantial evidence1 the administrative judge shall not mitigate the penalty prescribed by the ,secretary4 7#c7 ,appeal to merit systems protection board 7,a7 ,in general ,the decision of the administrative judge under paragraph 7#a7 may be appealed to the ,merit ,systems ,protection ,board4 7,b7 ,upholding decision ,notwithstanding section #ggja7;c77#a77;,b7 of title #e1 ,united ,states ,code1 the ,merit ,systems ,protection ,board shall uphold the decision of the ,secretary to remove1 demote1 or suspend an employee under subsection 7a7 if the decision is supported by substantial evidence4 7,c7 ,prohibition of mitigation ,notwithstanding title #e1 ,united ,states ,code1 or any other provision of law1 if the decision of the ,secretary is supported by substantial evidence1 the ,merit ,systems ,protection ,board shall not mitigate the penalty prescribed by the ,secretary4 7#d7 ,report ,in any case in which the administrative judge cannot issue a decision in accordance with the #ahj-;day requirement under paragraph 7#a71 the ,merit ,systems ,protection ,board shall1 not later than #ad business days after the expiration of the #ahj-;day period1 submit to the appropriate committees of ,congress a report that explains the reasons why a decision was not issued in accordance with such requirement4 7#e7 ,appeal ,a decision of the ,merit ,systems ,protection ,board under paragraph 7#c7 may be appealed to the ,united ,states ,court of ,appeals for the ,federal ,circuit pursuant to section #ggjc of title #e1 ,united ,states ,code1 or to any court of appeals of competent jurisdiction pursuant to subsection 7b77#a77;,b7 of such section4 7#f7 ,prohibition against stays ,the ,merit ,systems ,protection ,board may not stay any removal or demotion under this section1 except as provided in section #abad7;b7 of title #e1 ,united ,states ,code4 7#g7 ,restriction on pay and benefits during appeal ,during the period beginning on the date on which a covered individual appeals a removal from the civil service under subsection 7c7 and ending on the date that the ,united ,states ,court of ,appeals for the ,federal ,circuit issues a final decision on such appeal1 such covered individual may not receive any pay1 awards1 bonuses1 incentives1 allowances1 differentials1 student loan repayments1 special payments1 or benefits related to the employment of the individual by the ,service4 7#h7 ,information to expedite appeal ,to the maximum extent practicable1 the ,secretary shall provide to the ,merit ,systems ,protection ,board such information and assistance as may be necessary to ensure an appeal under this subsection is expedited4 7#i7 ,backpay ,if an employee prevails on appeal under this section1 the employee shall be entitled to backpay 7as provided in section #eeif of title #e1 ,united ,states ,code74 7#aj7 ,applicable timelines and procedures ,if an employee who is subject to a collective bargaining agreement chooses to grieve an action taken under this section through a grievance procedure provided under the collective bargaining agreement1 the timelines and procedures set forth in subsection 7c7 and this subsection shall apply4 7e7 ,alleged prohibited personnel practice ,in the case of a covered individual seeking corrective action 7or on behalf of whom corrective action is sought7 from the ,office of ,special ,counsel based on an alleged prohibited personnel practice described in section #bcjb7;b7 of title #e1 ,united ,states ,code1 the ,secretary may not remove1 demote1 or suspend such covered individual under subsection 7a7 without the approval of the ,special ,counsel under section #abad7;f7 of title #e1 ,united ,states ,code4 7f7 ,termination of investigations by ,office of ,special ,counsel 7#a7 ,in general ,notwithstanding any other provision of law1 the ,special ,counsel 7established by section #abaa of title #e1 ,united ,states ,code7 may terminate an investigation of a prohibited personnel practice alleged by an employee or former employee of the ,service after the ,special ,counsel provides to the employee or former employee a written statement of the reasons for the termination of the investigation4 7#b7 ,admissibility ,the statement described in paragraph 7#a7 may not be admissible as evidence in any judicial or administrative proceeding without the consent of the employee or former employee described in paragraph 7#a74 7g7 ,vacancies ,in the case of a covered individual who is removed or demoted under subsection 7a71 to the maximum extent feasible1 the ,secretary shall fill the vacancy arising as a result of such removal or demotion4 7h7 ,definitions ,in this section3 7#a7 ,covered individual ,the term covered individual means an individual occupying a position at the ,service1 but does not include-- 7,a7 an individual occupying a senior executive position 7as defined in section #fjf7;d772 7,b7 an individual who has not completed a probationary or trial period2 or 7,c7 a political appointee4 7#b7 ,grade ,the term grade has the meaning given such term in section #geaa7;a7 of title #e1 ,united ,states ,code4 7#c7 ,misconduct ,the term misconduct includes neglect of duty1 malfeasance1 or failure to accept a directed reassignment or to accompany a position in a transfer of function4 7#d7 ,political appointee ,the term political appointee means an individual who is-- 7,a7 employed in a position described under sections #ecab through #ecaf of title #e1 ,united ,states ,code 7relating to the ,executive ,schedule72 7,b7 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 7,c7 employed in a position of a confidential or policy-determining character under schedule ,c of subpart ,c of part #bac of title #e1 ,code of ,federal ,regulations1 or successor regulation4 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,service4 7#f7 ,suspend ,the term suspend means the placing of an employee1 for disciplinary reasons1 in a temporary status without duties and pay for a period in excess of #ad days4 4 7b7 ,conforming amendments ,section #dcjc7;f7 of title #e1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#c71 by striking or at the end2 7#b7 in paragraph 7#d71 by striking the period at the end and inserting 1 or2 and 7#c7 by adding at the end the following3 7#e7 any removal or demotion under section #fjg of the ,indian ,health ,care ,improvement ,act4 4 7c7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services or the ,inspector ,general of the ,department of ,health and ,human ,services shall submit a report to ,congress that includes the following3 7#a7 ,the number of employees of the ,indian ,health ,service who were removed1 demoted1 or suspended in the #a-year period before the date of enactment of this ,act4 7#b7 ,the number of employees of the ,indian ,health ,service who were removed1 demoted1 or suspended in the #a-year period after the date of enactment of this ,act using the updated authorities provided in the amendments made by this ,act4 7#c7 ,the appropriate details of removals1 demotions1 and suspensions that lend necessary context4 #ajg4 ,tribal culture and history ,section #aac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;f7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking a program and inserting an annual mandatory training program2 and 7,b7 by striking appropriate employees of the ,service and inserting employees of the ,service1 locum tenens medical providers1 healthcare volunteers1 and other contracted employees who work at ,service hospitals or other ,service units and whose employment requires regular direct patient access2 and 7#b7 by adding at the end the following3 7c7 ,notwithstanding any other provision of law1 beginning with the year of the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah1 each employee or provider described in subsection 7a7 who enters into a contract with the ,service on or after the date of such implementation shall1 as a condition of employment1 annually participate in and complete such training program4 ,for purposes of the preceding sentence1 participation in such training program may not be considered complete for the year involved until the individual satisfies each requirement1 including testing1 if applicable1 of the training program for such year1 as specified by the ,secretary4 4 #ajh4 ,staffing demonstration project ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 is amended by adding at the end the following3 #hcc4 ,staffing demonstration project 7a7 ,in general ,the ,secretary1 acting through the ,service1 shall establish a demonstration project that authorizes the ,service to provide federally managed ,service units with additional staffing resources with the goal that the resources become self-sustaining4 7b7 ,selection ,in selecting ,service units for participation1 the ,secretary shall consider whether a ,service unit services an ,indian ,tribe that-- 7#a7 has utilized or contributed substantial tribal funds to construct a health facility used by the ,service or identified in the master plan for the ,service unit2 7#b7 is located in a ,state or ,states with ,medicaid reimbursements plans or policies that will increase the likelihood that the staffing resources provided will be self-sustaining2 and 7#c7 is operating a health facility described in paragraph 7#a7 under historical staffing ratios that have not been equalized or updated by the ,service or any other ,service program to reflect current staffing needs4 7c7 ,duration ,staffing resources provided to a ,service unit under this section shall be for a duration that the ,secretary1 in consultation with the applicable ,indian ,tribe1 determines appropriate1 except that each staffing position provided shall be for a period of not less than #c fiscal years4 7d7 ,effect of staffing awards ,no staffing resources provided under this section shall reduce the recurring base funding for staffing for any ,indian ,tribe or federally managed ,service unit4 7e7 ,report ,not later than #e years after the ,secretary ends the demonstration project under this section1 the ,secretary shall prepare and submit a report to the ,committee on ,indian ,affairs and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and the ,committee on ,natural ,resources and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 regarding the project1 including-- 7#a7 whether the staffing resources resulted in additional revenue for the ,service unit sufficient to maintain the staff on a permanent basis2 7#b7 the levels to which the staffing resources reduced the unmet staffing need for the ,service unit2 and 7#c7 whether the demonstration project could be deployed to reduce unmet staffing needs throughout the ,service4 4 #aji4 ,rule establishing tribal consultation policy ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq471 as amended by section #ajh1 is further amended by adding at the end the following3 #hcd4 ,rule establishing tribal consultation policy 7a7 ,in ,general ,not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah1 the ,secretary shall establish1 after meaningful consultation with representatives of affected ,indian ,tribes1 a rule establishing a tribal consultation policy for the ,service4 7b7 ,contents of tribal consultation policy ,the policy established under the rule described in subsection 7a7 shall-- 7#a7 update1 and replace1 the tribal consultation policy established under ,circular ,no4 #bjjf-ja of the ,service1 or any successor policy2 and 7#b7 include the following3 7,a7 ,a process for determining when the ,service will notify ,indian ,tribes1 and a description of how the ,indian ,tribes should be notified4 7,b7 ,a determination of what actions or agency decisions by the ,service will trigger a requirement for meaningful consultation with ,indian ,tribes4 7,c7 ,a determination of what actions constitute meaningful consultation with ,indian ,tribes4 4 #aaj4 ,treatment of certain hospitals ,the ,parallel ,low-,volume ,hospital ,payment ,adjustment ,regarding ,hospitals ,operated by the ,indian ,health ,services 7,,ihs7 or a ,tribe provisions described in the final rule published by the ,centers for ,medicare ,medicaid ,services in the ,federal ,register on ,august #ad1 #bjag1 and entitled ,medicare ,program2 ,hospital ,inpatient ,prospective ,payment ,systems for ,acute ,care ,hospitals and the ,long-,term ,care ,hospital ,prospective ,payment ,system and ,policy ,changes and ,fiscal ,year #bjah ,rates2 ,quality ,reporting ,requirements for ,specific ,providers2 ,medicare and ,medicaid ,electronic ,health ,record 7,,ehr7 ,incentive ,program ,requirements for ,eligible ,hospitals1 ,critical ,access ,hospitals1 and ,eligible ,professionals2 ,provider-,based ,status of ,indian ,health ,service and ,tribal ,facilities and ,organizations2 ,costs ,reporting and ,provider ,requirements2 ,agreement ,termination ,notices 7#hb ,fed ,reg4 #cgiij2 #chahh-chahi71 shall apply with respect to discharges occurring in fiscal year #bjaa and subsequent fiscal years4 ,,ii ,employee protections #bja4 ,employee protections against retaliation 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq471 as amended by sections #aje and #ajf1 is further amended by adding at the end the following3 #fjh4 ,employee protections against retaliation 7a7 ,employee accountability 7#a7 ,agency reporting process requirement ,the ,secretary shall designate an official in the ,department who is not an employee of the ,service to-- 7,a7 receive reports from an employee of the ,service who witnesses retaliation against a whistleblower1 a violation of a patient safety requirement1 or other similar conduct2 and 7,b7 conduct active and ongoing outreach to all employees of the ,service about-- 7i7 ,federal and ,department systems for reporting retaliation against whistleblowers2 and 7ii7 the duty of individual employees of the ,service to report violations of patient safety requirements and other similar conduct4 7#b7 ,oversight ,not later than #c days after the date on which the official designated by the ,secretary under paragraph 7#a7 receives a report under paragraph 7#a77;,a71 the ,secretary shall-- 7,a7 formally review the report2 and 7,b7 provide a copy of such report and any other relevant information to the ,inspector ,general of the ,department4 7#c7 ,removal for whistleblower retaliation ,the ,secretary may remove for misconduct from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code71 in accordance with sections #fjf and #fjg1 an employee of the ,service if the ,secretary determines1 after completing a report review described in paragraph 7#b71 that the employee has retaliated against a whistleblower and warrants removal4 7#d7 ,enhancing protections for whistleblowers ,the ,secretary shall carry out any actions determined necessary by the ,secretary to enhance protection for whistleblowers1 including identifying appropriate ,service employees and requiring the employees to complete the ,office of ,special ,counsel's ,whistleblower ,certification ,program4 7b7 ,definitions ,in this section3 7#a7 ,retaliation ,the term retaliation-- 7,a7 means an adverse employment action or any significantly adverse action against a whistleblower1 such as the refusal or delay of care provided through the ,service2 and 7,b7 includes instances where the adverse action described in subparagraph 7,a7 is perpetrated against a family member or friend of the whistleblower because of the whistleblower's disclosure of information4 7#b7 ,whistleblower ,the term whistleblower means an employee of ,service who discloses information-- 7,a7 that the employee reasonably believes evidences-- 7i7 a violation of any law1 rule1 or regulation2 or 7ii7 gross mismanagement1 a gross waste of funds1 an abuse of authority1 or a substantial and specific danger to public health or safety2 and 7,b7 if such disclosure is not specifically prohibited by law and if such information is not specifically required by ,executive ,order to be kept secret in the interest of national defense or the conduct of foreign affairs4 4 #bjb4 ,right of ,federal employees to petition ,congress 7a7 ,adverse action for violation of right ,to petition ,congress ,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 following new subsection3 7b7 ,adverse action ,an employee who interferes with or denies a right protected under subsection 7a7 shall be subject to any adverse action described in paragraphs 7#a7 through 7#e7 of section #geab1 in accordance with the procedure described in section #geac and any other applicable procedure4 4 7b7 ,electronic notification of right of employees of ,indian ,health ,service 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,director of the ,indian ,health ,service1 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 to petition ,congress under section #gbaa of title #e1 ,united ,states ,code4 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 under such section shall be subject to an adverse action described in paragraphs 7#a7 through 7#e7 of section #geab of title #e1 ,united ,states ,code1 including a suspension for more than #ad days without pay44 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 subsection 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 revised memorandum1 as the case may be4 7#e7 ,notice ,in the case of an approval under paragraph 7#d71 not later than #cj days after such approval1 the ,secretary shall-- 7,a7 provide to each employee of the ,indian ,health ,service an electronic copy of the approved memorandum2 and 7,b7 post such memorandum in a clear and conspicuous place on the website of the ,indian ,health ,service for a period not less than #abj days4 7#f7 ,revised memorandum ,in the case of a disapproval under paragraph 7#d71 not later than #ae days after such disapproval1 the ,secretary shall submit a revised memorandum to the ,inspector ,general for approval under paragraph 7#d74 #bjc4 ,fiscal accountability ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq471 as amended by sections #aje1 #ajf1 and #bja1 is further 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 professional housing plan under section #cja7;a7 of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjah or the staffing plan under section #cja7;b7 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 until the professional housing plan or staffing plan1 as the case may be1 is submitted4 7#b7 ,individual described ,an individual described in this paragraph is an individual employed in a position in the ,service that is a position-- 7,a7 described under sections #ecab through #ecaf of title #e1 ,united ,states ,code2 7,b7 placed in level ,,iv or ,v of the ,executive ,schedule under section #ecag of title #e1 ,united ,states ,code2 7,c7 as 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 7,d7 under section #bac4ccja or #bac4ccjb of title #e1 ,code of ,federal ,regulations4 7b7 ,prioritization of patient care 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall use amounts available to the ,indian ,health ,service that are not obligated or expended1 including base budget funding and third party collections1 during the fiscal year for which the amounts are made available1 and that remain available1 only to support patient care by using such funds for the costs of-- 7,a7 essential medical equipment2 7,b7 purchased or referred care2 or 7,c7 staffing4 7#b7 ,special rule ,in using amounts under paragraph 7#a71 the ,secretary shall ensure that1 in any case where the amounts were originally made available for a particular ,service unit1 such amounts are used to benefit ,indians served by that ,service unit4 7#c7 ,restrictions ,the ,secretary may not use amounts described in paragraph 7#a7-- 7,a7 to remodel or interior decorate any ,area office2 or 7,b7 to increase the rate of pay of any employee of an ,area office4 7c7 ,spending reports ,not later than #ij days after the end of each quarter of a fiscal year1 the ,secretary shall submit a report describing the authorizations1 expenditures1 outlays1 transfers1 reprogramming1 and obligations of each level of the ,service1 including the headquarters1 each ,area office1 each ,service unit1 and each health clinic or facility1 to-- 7#a7 each ,indian ,tribe2 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 ,subject to paragraph 7#b71 not later than #ahj days after the end of each fiscal year1 the ,secretary shall provide to each entity described in paragraphs 7#a7 through 7#c7 of subsection 7c7 a report describing the safety1 billing1 certification1 credential1 and compliance statuses of each facility managed1 operated1 or otherwise supported by the ,service4 7#b7 ,updates ,with respect to any 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 such change4 7e7 ,rule of construction ,nothing in this section may be construed-- 7#a7 to negatively impact the right of an ,indian ,tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq472 and 7#b7 to apply to such a compact or contract unless expressly agreed to by the ,indian ,tribe4 4 ,,iii ,reports #cja4 ,definitions ,in this title3 7#a7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#b7 ,service ,the term ,service means the ,indian ,health ,service4 7#c7 ,service unit ,the term ,service unit has the meaning given the term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 #cjb4 ,reports by the ,secretary of ,health and ,human ,services 7a7 ,,ihs ,professional housing plan ,not later than #a year after the date the ,government ,accountability ,office releases their ongoing report about ,indian ,health ,service housing needs1 the ,secretary shall develop1 make publicly available1 and submit to ,congress and the ,comptroller ,general of the ,united ,states a written plan to address the professional housing needs of employees of the ,service that comports with the practices and recommendations of the ,government ,accountability ,office relating to professional housing4 7b7 ,plan relating to ,,ihs staffing needs ,not later than #a year after the date the ,government ,accountability ,office releases their ongoing report about ,indian ,health ,service housing needs1 the ,secretary shall develop1 make publicly available1 and submit to ,congress and the ,comptroller ,general of the ,united ,states a written plan to address staffing needs in the ,service that comports with the practices of the ,government ,accountability ,office relating to workforce planning4 7c7 ,indian ,health ,care ,improvement ,act report ,not later than #a year after the date of enactment of this ,act1 and each year thereafter for a period of #e years1 the ,secretary shall develop1 make publicly available1 and submit to ,congress a report on the data submitted under section #dab7;b7 of the ,indian ,health ,care ,improvement ,act1 as amended by section #ajg4 7d7 ,quality of ,care and ,staffing report ,not later than #a year after the date of enactment of this ,act1 and each year thereafter1 the ,secretary shall develop and submit to ,congress a report on the data obtained under section #ajh1 with an emphasis on quality of care and access to care4 #cjc4 ,reports by the ,comptroller ,general 7a7 ,,ihs ,housing needs report 7#a7 ,in general ,not later than #e years after the date on which the ,comptroller ,general of the ,united ,states receives the professional housing plan under section #cjb7;a71 the ,comptroller ,general shall develop and submit to ,congress a report4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,an evaluation of any existing1 as of the date of the report1 assessments and projections for the professional housing needs of employees of the ,service1 including discussion and conclusion as to whether existing assessments and projections accurately reflect the professional housing needs of employees of the ,service4 7,b7 ,an assessment of the professional housing needs of employees of the ,service for each ,service area 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,c7 ,an assessment of the professional housing plan developed by the ,secretary under section #cjb7;a74 7b7 ,,ihs staffing needs report 7#a7 ,in general ,not later than #e years after the date on which the ,comptroller ,general receives the report under section #cjb7;b71 the ,comptroller ,general shall prepare and submit to ,congress a report on the staffing needs of the ,service4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,a description of the number and type of full-time positions needed at each facility of the ,service and the amount of funds necessary to maintain such positions4 7,b7 ,an explanation of the various methodologies that the ,service utilizes and has previously utilized to determine the number and type of full-time positions needed at federally managed ,service units4 7,c7 ,an assessment of the use of independent contractors1 including the number of independent contractors hired to fill vacant full-time positions and amounts spent on independent contractors who provide health care services4 7,d7 ,an assessment of the staffing plan developed by the ,secretary under section #cjb7;b74 7c7 ,whistleblower protections report 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general shall develop and submit to ,congress a report on the efficacy of existing protections for whistleblowers in the ,service4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,a discussion and conclusion as to whether the ,service has taken proper steps to prevent retaliation against whistleblowers4 7,b7 ,if applicable1 any recommendations for changes to the policy of the ,service with respect to whistleblowers4 7,c7 ,a discussion and conclusion as to whether the official email accounts of employees of the ,service are appropriately monitored4 #cjd4 ,inspector ,general reports 7a7 ,patient care reports 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 and not less than every #c years thereafter1 the ,inspector ,general of the ,department of ,health and ,human ,services shall develop and submit to ,congress and the ,service a report on patient harm events occurring in ,service units and deferrals and denials of care of patients of the ,service4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,an evaluation of the number and kind of events that contribute to patient deaths in a ,service unit and recommendations regarding reducing the number of patient deaths4 7,b7 ,an evaluation of the ,service's tracking and reporting of1 and response to1 patient harm events and recommendations regarding how to improve such tracking1 reporting1 and response4 7,c7 ,the effects of deferrals and denials of care on patients of the ,service1 including patient outcomes1 and recommendations regarding how to reduce deferrals and denials of care4 7b7 ,reporting systems audit ,not later than #b years after the date of enactment of this ,act1 the ,inspector ,general shall-- 7#a7 conduct an audit of reporting systems of the ,service1 as of the date of enactment of this ,act2 and 7#b7 provide to the ,service recommendations and technical assistance regarding implementation of improved reporting systems1 procedures1 standards1 and protocols4 #cje4 ,transparency in ,,cms 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 of participating ,indian ,health ,service facilities 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 posted on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 ,such posting shall comply with the ,federal regulations concerning the privacy of individually identifiable health information promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 4 ,,iv ,technical amendments #dja4 ,technical amendments ,the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afja et seq47 is amended-- 7#a7 by striking contract health service each place such term appears 7regardless of casing and typeface and including in the headings7 and inserting purchased_/referred care 7with appropriate casing and typeface72 and 7#b7 by striking contract health services each place such term appears 7regardless of casing and typeface and including in the headings7 and inserting purchased_/referred care 7with appropriate casing and typeface74 ,december #bh1 #bjah ,committees on ,energy and ,commerce1 ,ways and ,means1 and ,oversight and ,government ,reform discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed