,,ii #aaeth ,,congress #ast ,session ,s4 #abej ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #be1 #bjag ,mr4 ,barrasso 7for himself1 ,mr4 ,thune1 and ,mr4 ,hoeven7 introduced the following bill2 which was read twice and referred to the ,committee on ,indian ,affairs ,a ,,bill ,to amend the ,indian ,health ,care ,improvement ,act to improve the recruitment and retention of employees in the ,indian ,health ,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 #bjag4 #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 ,removal or demotion of ,indian ,health ,service employees based on performance or misconduct4 ,sec4 #ajg4 ,standards to improve timeliness of care4 ,sec4 #ajh4 ,tribal culture and history4 ,sec4 #aji4 ,staffing demonstration project4 ,sec4 #aaj4 ,rule establishing tribal consultation policy4 ,,title ,,ii--,employee protections ,sec4 #bja4 ,right of ,federal employees to petition ,congress4 ,sec4 #bjb4 ,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 pay ,the ,secretary shall establish a pay system for physicians1 dentists1 nurses1 and other health care professionals employed by the ,service that provides pay that1 to the maximum extent practicable1 is comparable to the pay provided to physicians1 dentists1 nurses1 and other health care 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 #bjag1 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;e7a772 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 this section in accordance with any guidelines of the ,office of ,personnel ,management relating to the recruitment and retention of employees1 including section #ege4aji 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 #bjag74 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 ,by not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjag1 the ,secretary1 acting through the ,service and in accordance with the requirements described in subsection 7b71 shall develop and implement a ,service-wide centralized 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 unit4 7b7 ,requirements ,in developing the credentialing system under subsection 7a71 the ,secretary shall ensure the following3 7#a7 ,credentialing procedures shall be uniform throughout the ,service4 7#b7 ,with respect to each licensed health professional who successfully completes the credentialing procedures of the credentialing system1 the ,secretary shall authorize each such professional to provide health care services at any ,service unit4 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 ,this section may not be construed to inhibit the authority of an ,indian tribe to enter into or maintain a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq474 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 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 licensed or certified in accordance with applicable law regarding the provision of the service4 7#c7 ,applicability ,subsection 7g7 7other than paragraphs 7#c7 and 7#e77 and subsections 7h71 7i71 and 7l7 apply to a health care practitioner at a ,service unit for purposes of this subsection to the same extent and in the same manner as such subsections apply to an 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 a ,service unit4 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 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 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 ,definition of 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 shall be construed to inhibit the authority of an ,indian tribe to enter into or maintain a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq474 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 #bjag1 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 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 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 job description of 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 record under section #fjf7;j74 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 shall 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 #bj percent or more of the positions in the ,service unit are not filled by a full-time employee of the ,indian ,health ,service for a period of #f months or longer2 or 7,b7 a former employee of the ,indian ,health ,service or a formal tribal employee who was removed from such former employment within1 or demoted for performance or misconduct that occurred during1 the #e-year period the date of such personnel action4 4 #ajf4 ,removal or demotion of ,indian ,health ,service employees based on performance or misconduct ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq471 as amended by section #aje1 is further amended by adding at the end the following3 #fjf4 ,removal or demotion of ,service employees based on performance or misconduct 7a7 ,definitions ,in this section and section #fjg3 7#a7 ,employee ,the term employee has the meaning given the term in section #baje of title #e1 ,united ,states ,code4 7#b7 ,manager 7,a7 ,in general ,the term manager has the meaning given the term management official in section #gajc7;a7 of title #e1 ,united ,states ,code4 7,b7 ,inclusions ,the term manager includes1 as employed at any facility of the ,service-- 7i7 a chief executive officer2 7ii7 a chief medical officer2 and 7iii7 a department director4 7#c7 ,misconduct ,the term misconduct means neglect of duty1 malfeasance1 or failure to accept a directed reassignment or to accompany a position in a transfer of function4 7#d7 ,personnel action ,the term personnel action means a removal1 transfer1 or reduction in grade under subsection 7b77#b74 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,service4 7#f7 ,senior executive ,the term senior executive means a career appointee 7as that term is defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7#g7 ,senior ,executive ,service position ,the term ,senior ,executive ,service position has the meaning given the term in section #cacb7;a7 of title #e1 ,united ,states ,code4 7#h7 ,supervisor ,the term supervisor has the meaning given the term in section #gajc7;a7 of title #e1 ,united ,states ,code4 7b7 ,removal based on performance or misconduct 7#a7 ,in general ,subject to paragraph 7#d71 the ,secretary may remove an employee of the ,service from the position the employee occupies if the ,secretary determines the performance or misconduct of the employee warrants removal4 7#b7 ,action ,if the ,secretary removes an employee under paragraph 7#a71 the ,secretary may-- 7,a7 remove the employee from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code72 7,b7 in the case of an individual described in paragraph 7#c71 transfer the individual from the ,senior ,executive ,service position to a ,general ,schedule position at any grade of the ,general ,schedule for which the individual is qualified and that the ,secretary determines is appropriate2 or 7,c7 in the case of a manager or supervisor1 reduce the grade of the manager or supervisor to any other grade for which the individual is qualified and that the ,secretary determines is appropriate4 7#c7 ,individual described ,an individual referred to in paragraph 7#b77;,b7 is a senior executive that-- 7,a7 previously occupied a permanent position within the competitive service 7as that term is defined in section #bajb of title #e1 ,united ,states ,code72 or 7,b7 previously occupied a permanent position within the excepted service 7as that term is defined in section #bajc of title #e1 ,united ,states ,code74 7#d7 ,due process ,before an employee may be subject to a personnel action1 the ,secretary shall provide to the employee-- 7,a7 not less than #aj days before the personnel action1 written notice of the proposed personnel action2 and 7,b7 an opportunity and reasonable time to answer orally or in writing4 7c7 ,pay of certain individuals 7#a7 ,in general ,notwithstanding any other provision of law1 including the requirements of section #ceid of title #e1 ,united ,states ,code1 any individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7 shall1 beginning on the date of the transfer1 receive the annual rate of pay applicable to the position4 7#b7 ,requirements 7,a7 ,in general ,an individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7-- 7i7 may not be placed on administrative leave or any other category of paid leave during the period during which an appeal 7if any7 under subsection 7e77#b77;,a7 is ongoing2 and 7ii7 may only receive pay if the individual-- 7,i7 reports for duty2 and 7,,ii7 performs a primary duty or an alternative primary duty1 as each term is described in section #eea4ajd of title #e1 ,code of ,federal ,regulations 7or a successor regulation74 7,b7 ,failure to report ,if an individual transferred to a ,general ,schedule position under subsection 7b77#b77;,b7 or subject to a reduction in grade under subsection 7b77#b77;,c7 does not report for duty1 pursuant to subsection 7f77#c77;,b71 the individual shall not receive any increase in rate of pay or other benefit4 7d7 ,notice to ,congress ,not later than #cj days after the date on which the ,secretary takes a personnel action1 the ,secretary shall submit1 in writing1 a notice of the personnel action and the reason for the personnel action to-- 7#a7 the ,committee on ,indian ,affairs of the ,senate2 7#b7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7#c7 the ,committee on ,natural ,resources of the ,house of ,representatives2 7#d7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 and 7#e7 the ,inspector ,general of the ,department4 7e7 ,procedure 7#a7 ,inapplicability ,the procedures under chapters #dc and #ge of title #e1 ,united ,states ,code1 shall not apply to a personnel action4 7#b7 ,appeal 7,a7 ,in general ,subject to subparagraph 7,b7 and subsection 7f71 an employee subject to a personnel action may appeal the personnel action to the ,merit ,systems ,protection ,board under section #ggja of title #e1 ,united ,states ,code4 7,b7 ,limitation ,an appeal under subparagraph 7,a7 may only be made if the appeal is made not later than #g days after the date of the personnel action4 7f7 ,expedited review by administrative law judge 7#a7 ,in general 7,a7 ,referral ,on receipt of an appeal under subsection 7e77#b77;,a71 the ,merit ,systems ,protection ,board shall refer the appeal to an administrative law judge pursuant to section #ggja7;b77#a7 of title #e1 ,united ,states ,code4 7,b7 ,expedition ,the administrative law judge to whom an appeal is referred under subparagraph 7,a7 shall-- 7i7 expedite the appeal under section #ggja7;b77#a7 of title #e1 ,united ,states ,code2 and 7ii7 issue a decision in each case not later than #ba days after the date of the appeal4 7#b7 ,finality ,notwithstanding any other provision of law1 including section #ggjc of title #e1 ,united ,states ,code1 the decision of an administrative law judge under paragraph 7#a7 shall be final and shall not be subject to any further administrative appeal4 7#c7 ,failure to issue decision 7,a7 ,in general ,in any case in which an administrative law judge fails to issue a decision in accordance with the #ba-;day requirement described in paragraph 7#a77;,b77ii71 the personnel action shall be treated as final4 7,b7 ,transparency ,in any case in which a personnel action is treated as final under subparagraph 7,a71 the ,merit ,systems ,protection ,board shall1 not later than #ad days after the date on which the personnel action becomes final1 submit a letter explaining the reasons why a decision was not issued in accordance with the #ba-;day requirement described in paragraph 7#a77;,b77ii7 to-- 7i7 the ,committee on ,indian ,affairs of the ,senate2 7ii7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7iii7 the ,committee on ,natural ,resources of the ,house of ,representatives2 and 7iv7 the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7#d7 ,restriction ,the ,merit ,systems ,protection ,board or an administrative law judge may not stay any personnel action4 7#e7 ,cessation of pay increases and benefits ,during the period beginning on the date on which an employee appeals a removal from the civil service under subsection 7e77#b77;,a7 and ending on the date on which the removal becomes final1 the employee may not receive any-- 7,a7 increase in rate of pay2 or 7,b7 award1 bonus1 incentive1 allowance1 differential1 student loan repayment1 special payment1 or other benefit4 7#f7 ,assistance ,to the maximum extent practicable1 the ,secretary shall provide such information and assistance as may be necessary to ensure an appeal under this subsection is expedited to-- 7,a7 the ,merit ,systems ,protection ,board2 and 7,b7 any administrative law judge to whom an appeal under this section is referred4 7g7 ,employment record transparency ,the ,secretary shall ensure that the employment records for any employee subject to a personnel action1 regardless of whether that personnel action is final1 include-- 7#a7 a notation that the employee was subject to a personnel action2 and 7#b7 a description of the disposition or status of the personnel action or any appeal of the personnel action under this section4 7h7 ,relation to title #e1 ,united ,states ,code 7#a7 ,additional authority ,the personnel action authorities provided to the ,secretary under this section are in addition to the authorities provided under chapters #dc and #ge of title #e1 ,united ,states ,code4 7#b7 ,removal of senior executives ,section #ceib7;b77#a7 of title #e1 ,united ,states ,code1 shall not apply to a personnel action4 4 #ajg4 ,standards to improve timeliness of care ,title ,,iv of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afda et seq47 is amended by adding at the end the following3 #dab4 ,standards to improve timeliness of care 7a7 ,in general ,not later than #ahj days after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjag1 the ,secretary1 acting through the ,service1 shall-- 7#a7 establish1 by regulation1 standards to measure the timeliness of the provision of health care services in ,service facilities2 and 7#b7 provide such standards to each ,service unit4 7b7 ,data collection ,the ,secretary1 acting through the ,service1 shall develop a process for each ,service unit to submit to the ,secretary data with respect to the standards established under subsection 7a77#a74 4 #ajh4 ,tribal culture and history ,section #aac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;f 7 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 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 #bjag1 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 #aji4 ,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 ,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 #aaj4 ,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 #aji1 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 #bjag1 the ,secretary shall establish1 through the negotiated rulemaking process described in subsection 7b71 a rule establishing a tribal consultation policy for the ,service4 7b7 ,negotiated rulemaking ,before publishing a proposed rule described in subsection 7a71 the ,secretary shall follow the provisions of subchapter ,,iii of chapter #e of title #e1 ,united ,states ,code 7commonly known as the ,negotiated ,rulemaking ,act of #aiij74 7c7 ,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 ,,ii ,employee protections #bja4 ,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 #bjb4 ,fiscal accountability ,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 #fjg4 ,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 #bjag 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 ,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 ,this section may not be construed to inhibit the authority of an ,indian tribe to enter into or maintain a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq474 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 #ij days after the date of enactment of this ,act1 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 #ij days after the date of the enactment of this ,act1 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 #cjc4 ,reports by the ,comptroller ,general 7a7 ,,ihs ,housing needs report 7#a7 ,in general ,not later than #a year 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 report on the professional housing needs of employees of the ,service4 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 #a year 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 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,c7 ,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 every #b 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 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