,,ii  #aae? ,,congress  #a/ ,session    
,s4 #abej  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #be1 #bjag ,mr4   
,b>rasso 7= himself1 ,mr4 ,?une1 & ,mr4 
,hoev57 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,indian ,affairs  ,a ,,bill  ,to am5d ! 
,indian ,heal? ,c>e ,improvem5t ,act to 
improve ! recruitm5t & ret5tion (       
employees 9 ! ,indian ,heal? ,s]vice1   
re/ore acc\ntability 9 ! ,indian ,heal? 
,s]vice1 improve heal? s]vices1 & = o!r 
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,re/or+ ,acc\ntability 9 ! 
,indian ,heal? ,s]vice ,act ( #bjag4    
#b4 ,table ( cont5ts ,! table ( cont5ts 
= ?is ,act is z foll[s3 ,sec4 #a4 ,%ort 
title4 ,sec4 #b4 ,table ( cont5ts4      
,,title ,i--,indian ,heal? ,s]vice      
improvem5ts ,sec4 #aja4 ,inc5tives =    
recruitm5t & ret5tion4 ,sec4 #ajb4      
,m$ical cr$5tial+ sy/em4 ,sec4 #ajc4    
,liability protections = heal?          
pr(essional volunte]s at ,indian ,heal? 
,s]vice4 ,sec4 #ajd4 ,cl>ification      

reg>d+ eligibility = ,indian ,heal?     
,s]vice loan repaym5t program4 ,sec4    
#aje4 ,improvem5ts 9 hir+ practices4    
,sec4 #ajf4 ,removal or demotion (      
,indian ,heal? ,s]vice employees bas$ on
 p]=mance or misconduct4 ,sec4 #ajg4    
,/&>ds to improve timel9ess ( c>e4 ,sec4
 #ajh4 ,tribal culture & hi/ory4 ,sec4  
#aji4 ,/aff+ demon/ration project4 ,sec4
 #aaj4 ,rule e/abli%+ tribal            
consultation policy4 ,,title            
,,ii--,employee protections ,sec4 #bja4 
,"r ( ,f$]al employees to petition      
,congress4 ,sec4 #bjb4 ,fiscal          
acc\ntability4 ,,title ,,iii--,reports  
,sec4 #cja4 ,def9itions4 ,sec4 #cjb4    
,reports by ! ,secret>y ( ,heal? &      
,human ,s]vices4 ,sec4 #cjc4 ,reports by
 ! ,comptroll] ,g5]al4 ,sec4 #cjd4      
,inspector ,g5]al reports4 ,sec4 #cje4  
,transp>5cy 9 ,,cms surveys4 ,,title    
,,iv--,te*nical am5dm5ts ,sec4 #dja4    
,te*nical am5dm5ts4  ,i ,indian ,heal?  
,s]vice improvem5ts  #aja4 ,inc5tives = 
recruitm5t & ret5tion ,title ,i ( !     

,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afaa et seq47 is am5d$  
by add+ at ! end ! foll[+3  #abe4       
,inc5tives = recruitm5t & ret5tion  7a7 
,p>ity 9 pay ,! ,secret>y %all e/abli% a
 pay sy/em = physicians1 d5ti/s1 nurses1
 & o!r heal? c>e pr(essionals employ$ by
 ! ,s]vice t provides pay t1 to !       
maximum ext5t practicable1 is comp>able 
to ! pay provid$ to physicians1 d5ti/s1 
nurses1 & o!r heal? c>e pr(essionals1   
respectively1 "u sub*apt]s ,,iii & ,,iv 
( *apt] #gd ( title #ch1 ,unit$ ,/ates  
,code4  7b7 ,relocation co/s ,!         
,secret>y may provide to an employee ( !
 ,s]vice reimbursem5t = any relocation  
co/s ! employee incurs if--  7#a7 !     
employee relocates to a ,s]vice area    
exp]i5c+ a high level ( ne$ = employees1
 z det]m9$ by ! ,secret>y2 &  7#b7 !    
employee is fill+ a position t w\ld     
o!rwise be difficult to fill1 z det]m9$ 
by ! ,secret>y1 9 ! abs5ce ( an         
inc5tive4  7c7 ,h\s+ v\*]s  7#a7 ,9     
g5]al ,subject to p>agraph 7#b71 n lat] 

?an #a ye> aft] ! date ( enactm5t ( !   
,re/or+ ,acc\ntability 9 ! ,indian      
,heal? ,s]vice ,act ( #bjag1 ! ,secret>y
 may e/abli% a program to provide       
t5ant-bas$ r5tal assi/ance to an        
employee ( ! ,s]vice :o--  7,a7 agrees  
to s]ve = n less ?an #a ye> at a ,s]vice
 unit designat$ by ! ,adm9i/rator ( !   
,heal? ,res\rces & ,s]vices             
,adm9i/ration z a heal? pr(essional     
%ortage area1 z def9$ 9 section #ccb7;a7
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #bed;e7a772 &  7,b7 is a      
critical employee1 z det]m9$ by !       
,secret>y4  7#b7 ,sunset ,any program   
e/abli%$ by ! ,secret>y "u p>agraph 7#a7
 %all t]m9ate on ! date t is #c ye>s    
aft] ! date on :i* any su* program is   
e/abli%$4  7d7 ,adm9i/ration  7#a7 ,,opm
 guidel9es ,! ,secret>y %all c>ry out   
?is section 9 accordance ) any guidel9es
 ( ! ,(fice ( ,p]sonnel ,managem5t      
relat+ to ! recruitm5t & ret5tion (     
employees1 includ+ section #ege4aji (   
title #e1 ,code ( ,f$]al ,regulations 7z

 9 effect on ! date ( enactm5t ( !      
,re/or+ ,acc\ntability 9 ! ,indian      
,heal? ,s]vice ,act ( #bjag74  7#b7     
,s]vice agreem5ts ,! ,secret>y may only 
provide reimbursem5t = any relocation   
co/s "u subsection 7b7 or any o!r b5efit
 "u subsection 7c7 to--  7,a7 a full-"t 
employee :o agrees to s]ve = n less ?an 
#a ye> 9 ! ,s]vice1 beg9n+ on ! date ( !
 agreem5t2 or  7,b7 a "p-"t employee :o 
agrees to s]ve = n less ?an #b ye>s 9 ! 
s]vice beg9n+ on ! date ( ! agreem5t4  4
  #ajb4 ,m$ical cr$5tial+ sy/em ,title  
,i ( ! ,indian ,heal? ,c>e ,improvem5t  
,act 7#be ,u4,s4,c4 #afaa et seq471 z   
am5d$ by section #aja1 is fur!r am5d$ by
 add+ at ! end ! foll[+3  #abf4 ,m$ical 
cr$5tial+ sy/em  7a7 ,9 g5]al ,by n lat]
 ?an #a ye> aft] ! date ( enactm5t ( !  
,re/or+ ,acc\ntability 9 ! ,indian      
,heal? ,s]vice ,act ( #bjag1 !          
,secret>y1 act+ ?r\gh ! ,s]vice & 9     
accordance ) ! requirem5ts describ$ 9   
subsection 7b71 %all develop & implem5t 
a ,s]vice-wide c5traliz$ cr$5tial+ sy/em

 7ref]r$ to 9 ?is section z ! cr$5tial+ 
sy/em7 to cr$5tial lic5s$ heal?         
pr(essionals :o seek to provide heal?   
c>e s]vices at any ,s]vice unit4  7b7   
,requirem5ts ,9 develop+ ! cr$5tial+    
sy/em "u subsection 7a71 ! ,secret>y    
%all ensure ! foll[+3  7#a7 ,cr$5tial+  
proc$ures %all be uni=m ?r\gh\t !       
,s]vice4  7#b7 ,) respect to ea* lic5s$ 
heal? pr(essional :o successfully       
completes ! cr$5tial+ proc$ures ( !     
cr$5tial+ sy/em1 ! ,secret>y %all       
au?orize ea* su* pr(essional to provide 
heal? c>e s]vices at any ,s]vice unit4  
7c7 ,consultation ,9 develop+ !         
cr$5tial+ sy/em "u subsection 7a71 !    
,secret>y %all consult ) ,indian tribes 
& may also consult ) any public or      
private association ( m$ical provid]s1  
any gov]nm5t ag5cy1 or o!r relevant     
exp]t1 z det]m9$ by ! ,secret>y4  7d7   
,application ,a lic5s$ heal? c>e        
pr(essional may n provide heal? c>e     
s]vices at any ,s]vice unit1 unless su* 
pr(essional successfully completes !    

cr$5tial+ proc$ures ( ! cr$5tial+ sy/em 
develop$ "u subsection 7a74  7e7        
,regulations ,! ,secret>y may prescribe 
su* regulations z may be necess>y to    
c>ry out ! provisions ( ?is section4    
7f7 ,rule ( con/ruction ,?is section may
 n be con/ru$ to inhibit ! au?ority ( an
 ,indian tribe to ent] into or ma9ta9 a 
compact or contract "u ! ,indian        
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et 
seq474  4  #ajc4 ,liability protections 
= heal? pr(essional volunte]s at ,indian
 ,heal? ,s]vice ,section #bbd ( !       
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bcc7 is am5d$ by add+ at !   
end ! foll[+3  7r7 ,c]ta9 ,indian ,heal?
 ,s]vice volunte]s deem$ ,public ,heal? 
,s]vice employees  7#a7 ,9 g5]al ,=     
purposes ( ?is section1 a heal?         
pr(essional volunte] at a ,s]vice unit  
%all1 9 provid+ a heal? s]vice to an    
individual1 be deem$ to be an employee (
 ! ,public ,heal? ,s]vice = a cal5d> ye>
 t beg9s dur+ a fiscal ye> = :i* a      

transf] 0 made "u p>agraph 7#d77;,c74 ,!
 prec$+ s5t5ce is subject to !          
provisions ( ?is subsection4  7#b7      
,conditions ,9 provid+ a heal? s]vice to
 an individual1 a heal? c>e practition] 
%all1 = purposes ( ?is subsection1 be   
consid]$ to be a heal? pr(essional      
volunte] at a ,s]vice unit if all ( !   
foll[+ conditions are met3  7,a7 ,!     
s]vice is provid$ to ! individual at !  
facilities ( a ,s]vice unit1 or ?r\gh   
(fsite programs or ev5ts c>ri$ out by ! 
,s]vice unit4  7,b7 ,! ,s]vice unit is  
sponsor+ ! heal? c>e practition]        
pursuant to p>agraph 7#c77;,c74  7,c7 ,!
 heal? c>e practition] does n receive   
any comp5sation = ! s]vice f !          
individual1 ! ,s]vice unit1 or any      
?ird-p>ty pay] 7includ+ reimbursem5t "u 
any insurance policy or heal? plan1 or  
"u any ,f$]al or ,/ate heal? b5efits    
program71 except t ! heal? c>e          
practition] may receive repaym5t f !    
,s]vice unit = reasonable exp5ses       
incurr$ by ! heal? c>e practition] 9 !  

provision ( ! s]vice to ! individual4   
7,d7 ,be=e ! s]vice is provid$1 ! heal? 
c>e practition] or ! ,s]vice unit po/s a
 cle> & conspicu\s notice at ! site :]e 
! s]vice is provid$ ( ! ext5t to :i* !  
legal liability ( ! heal? c>e           
practition] is limit$ "u ?is subsection4
  7,e7 ,at ! "t ! s]vice is provid$1 !  
heal? c>e practition] is lic5s$ or      
c]tifi$ 9 accordance ) applicable law   
reg>d+ ! provision ( ! s]vice4  7#c7    
,applicability ,subsection 7g7 7o!r ?an 
p>agraphs 7#c7 & 7#e77 & subsections    
7h71 7i71 & 7l7 apply to a heal? c>e    
practition] at a ,s]vice unit = purposes
 ( ?is subsection to ! same ext5t & 9 ! 
same mann] z su* subsections apply to an
 (fic]1 gov]n+ bo>d memb]1 employee1 or 
contractor ( an entity describ$ 9       
subsection 7g77#d71 subject to p>agraph 
7#d7 & subject to ! foll[+ subp>agraphs3
  7,a7 ,ea* ref]5ce to an entity 9      
subsections 7g71 7h71 7i71 & 7l7 %all be
 consid]$ to be a ref]5ce to a ,s]vice  
unit4  7,b7 ,! fir/ s5t5ce ( p>agraph   

7#a7 applies 9 lieu ( ! fir/ s5t5ce (   
subsection 7g77#a77;,a74  7,c7 ,)       
respect to a ,s]vice unit1 a heal? c>e  
practition] is n a heal? pr(essional    
volunte] at ! ,s]vice unit unless !     
,s]vice unit sponsors ! heal? c>e       
practition]4 ,= purposes ( ?is          
subsection1 ! ,s]vice unit %all be      
consid]$ to be sponsor+ ! heal? c>e     
practition] if--  7i7 ) respect to !    
heal? c>e practition]1 ! ,s]vice unit   
submits to ! ,secret>y an application   
meet+ ! requirem5ts ( subsection        
7g77#a77;,d72 &  7ii7 ! ,secret>y1      
pursuant to subsection 7g77#a77;,e71    
det]m9es t ! heal? c>e practition] is   
deem$ to be an employee ( ! ,public     
,heal? ,s]vice4  7,d7 ,9 ! case ( a     
heal? c>e practition] :o is det]m9$ by !
 ,secret>y pursuant to ?is subsection & 
subsection 7g77#a77;,e7 to be a heal?   
pr(essional volunte]1 ?is subsection    
applies to ! heal? c>e practition] 7)   
respect to s]vices p]=m$ on behalf ( !  
,s]vice unit sponsor+ ! heal? c>e       

practition] pursuant to subp>agraph     
7,c77 = any cause ( action aris+ f an   
act or omission ( ! heal? c>e           
practition] occurr+ on or aft] ! date on
 :i* ! ,secret>y makes t det]m9ation4   
7,e7 ,subsection 7g77#a77;,f7 applies to
 a heal? c>e practition] = purposes (   
?is subsection only to ! ext5t t1 9     
provid+ heal? s]vices to an individual1 
ea* ( ! conditions describ$ 9 p>agraph  
7#b7 is met4  7#d7 ,fund+  7,a7 ,9 g5]al
 ,am\nts 9 ! fund e/abli%$ "u subsection
 7k77#b7 %all be available = transf] "u 
subp>agraph 7,c7 = purposes ( c>ry+ out 
?is subsection4  7,b7 ,annual e/imates  
7i7 ,9 g5]al ,n lat] ?an ,may #a ( ea*  
fiscal ye>1 ! ,attorney ,g5]al1 9       
consultation ) ! ,secret>y1 %all submit 
to ,congress a report provid+ an e/imate
 ( ! am\nt ( claims 7toge!r ) relat$    
fees & exp5ses ( witnesses7 t1 by reason
 ( ! acts or omissions ( heal?          
pr(essional volunte]s1 w be paid        
pursuant to ?is section dur+ ! cal5d>   
ye> t beg9s 9 ! foll[+ fiscal ye>4  7ii7

 ,applicability ,subsection 7k77#a77;,b7
 applies to ! e/imate "u clause 7i7     
relat+ to heal? pr(essional volunte]s to
 ! same ext5t & 9 ! same mann] z t      
subsection applies to ! e/imate "u t    
subsection relat+ to (fic]s1 gov]n+ bo>d
 memb]s1 employees1 & contractors (     
entities describ$ 9 subsection 7g77#d74 
7,c7 ,transf]s ,n lat] ?an ,decemb] #ca 
( ea* fiscal ye>1 ! ,secret>y %all      
transf] f ! fund "u subsection 7k77#b7  
to ! appropriate acc\nts 9 ! ,treasury  
an am\nt equal to ! e/imate made "u     
subp>agraph 7,b7 = ! cal5d> ye> beg9n+ 9
 t fiscal ye>1 subject to ! ext5t (     
am\nts 9 ! fund4  7#e7 ,def9ition (     
s]vice unit ,9 ?is subsection1 ! t]m    
,s]vice unit has ! mean+ giv5 ! t]m 9   
section #d ( ! ,indian ,heal? ,c>e      
,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 
7#f7 ,rule ( con/ruction ,no?+ 9 ?is    
subsection %all be con/ru$ to inhibit ! 
au?ority ( an ,indian tribe to ent] into
 or ma9ta9 a compact or contract "u !   
,indian ,self-,det]m9ation & ,education 

,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et 
seq474  7#g7 ,effective dates  7,a7 ,9  
g5]al ,except z provid$ 9 subp>agraph   
7,b71 ?is subsection %all take effect on
 ,octob] #a1 #bjai4  7,b7 ,regulations1 
applications1 & reports ,effective on ! 
date ( ! enactm5t ( ! ,re/or+           
,acc\ntability 9 ! ,indian ,heal?       
,s]vice ,act ( #bjag1 ! ,secret>y may-- 
7i7 prescribe regulations = c>ry+ out   
?is subsection2 &  7ii7 accept & consid]
 applications submitt$ "u p>agraph      
7#c77;,c77i74  4  #ajd4 ,cl>ification   
reg>d+ eligibility = ,indian ,heal?     
,s]vice loan repaym5t program ,section  
#ajh ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afaf;a7 is am5d$--
 7#a7 by am5d+ subp>agraph 7,b7 (       
subsection 7b77#a7 to read z foll[s3    
7,b7 h-- 7i7 7,i7 a degree 9 a heal?    
pr(ession2 &  7,,ii7 a lic5se to        
practice a heal? pr(ession 9 a ,/ate2 or
  7ii7 7,i7 a degree 9 bus9ess          
adm9i/ration ) an emphasis 9 heal? c>e  
managem5t 7z def9$ by ! ,secret>y71     

heal? adm9i/ration1 hospital            
adm9i/ration1 or public heal?2 &  7,,ii7
 a lic5se or c]tification to practice 9 
! field ( bus9ess adm9i/ration1 heal?   
adm9i/ration1 hospital adm9i/ration1 or 
public heal? 9 a ,/ate1 if ! ,secret>y  
det]m9es su* lic5se or c]tification     
necess>y = ! ,indian heal? program to   
:i* ! individual w be assign$2  2  7#b7 
by am5d+ clause 7iii7 ( subsection      
7f77#a77;,b7 to read z foll[s3  7iii7 to
 s]ve = a "t p]iod 7ref]r$ to 9 ?is     
section z ! p]iod ( obligat$ s]vice7    
equal to--  7,i7 #b ye>s or su* long]   
p]iod z ! individual may agree to s]ve 9
 ! full-"t practice ( su* individual's  
pr(ession 9 an ,indian heal? program to 
:i* ! individual may be assign$ by !    
,secret>y2 or  7,,ii7 #d ye>s or su*    
long] p]iod z ! individual may agree to 
s]ve 9 ! half-"t practice ( su*         
individual's pr(ession 9 an ,indian     
heal? program to :i* ! individual may be
 assign$ by ! ,secret>y2  2 &  7#c7 9   
subsection 7g77#b7-- 7,a7 by r$esignat+ 

subp>agraph 7,b7 z subp>agraph 7,c72 &  
7,b7 9 subp>agraph 7,a7-- 7i7 by /rik+ !
 fir/ s5t5ce ( ! matt] prec$+ clause 7i7
 & ins]t+ ! foll[+3 ,9 ! case ( an      
individual :o contracts to s]ve a p]iod 
( obligat$ s]vice "u subsection         
7f77#a77;,b77iii77,i71 = ea* ye> ( su*  
obligat$ s]vice1 ! ,secret>y may pay up 
to #ce1jjj 7or an am\nt equal to ! am\nt
 specifi$ 9 section #cch;,b7g77#b77;,a7 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #bedl-#a7;g77#b77;,a777 on    
behalf ( ! individual = loans describ$ 9
 p>agraph 7#a74 ,9 ! case ( an          
individual :o contracts to s]ve a p]iod 
( obligat$ s]vice "u subsection         
7f77#a77;,b77iii77,,ii71 = ea* ye> ( su*
 obligat$ s]vice1 ! ,secret>y may pay up
 to #ag1ejj on behalf ( ! individual =  
loans describ$ 9 p>agraph 7#a72 &  7ii7 
by /rik+ ,9 mak+ a det]m9ation & ins]t+ 
! foll[+3  7,b7 ,9 mak+ a det]m9ation "u
 ?is p>agraph  4  #aje4 ,improvem5ts 9  
hir+ practices  7a7 ,9 g5]al ,title ,,vi
 ( ! ,indian ,heal? ,c>e ,improvem5t    

,act 7#be ,u4,s4,c4 #affa et seq47 is   
am5d$ by add+ at ! end ! foll[+3  #fje4 
,improvem5ts 9 hir+ practices  7a7      
,direct hire au?ority ,! ,secret>y may  
appo9t1 )\t reg>d to sub*apt] ,i ( *apt]
 #cc ( title #e1 ,unit$ ,/ates ,code    
7o!r ?an sections #ccjc & #ccbh ( su*   
title71 a c&idate directly to a position
 )9 ! ,s]vice = :i* ! c&idate meets !   
job description ( ! ,(fice ( ,p]sonnel  
,managem5t4  7b7 ,tribal notification   
,be=e appo9t+1 hir+1 promot+1 transf]r+1
 or reassign+ a c&idate to a ,s5ior     
,executive ,s]vice position or !        
position ( a manag] at an ,area (fice or
 ,s]vice unit1 ! ,secret>y %all provide 
notice to ea* ,indian tribe locat$ )9 ! 
def9$ geographic area ( su* ,area (fice 
or ,s]vice unit1 z ! case may be1 ( !   
cont5t ( an inclusion 9 an employm5t    
record "u section #fjf7;j74  4  7b7 ,9  
g5]al ,subsection 7c7 ( section #b ( !  
,act ( ,decemb] #ae1 #aigi 7#be         
,u4,s4,c4 #eaag71 is am5d$ by add+ !    
foll[+3  7#c7 ,,ihs waiv]s ,! ,secret>y 

( ,heal? & ,human ,s]vices %all seek f  
ea* ,indian tribe conc]n$1 a waiv] (    
,indian pref]5ce laws = a p]sonnel      
action t is ) respect to--  7,a7 an     
,indian ,heal? ,s]vice unit 9 :i* #bj   
p]c5t or m ( ! positions 9 ! ,s]vice    
unit are n fill$ by a full-"t employee (
 ! ,indian ,heal? ,s]vice = a p]iod ( #f
 mon?s or long]2 or  7,b7 a =m] employee
 ( ! ,indian ,heal? ,s]vice or a =mal   
tribal employee :o 0 remov$ f su* =m]   
employm5t )91 or demot$ = p]=mance or   
misconduct t occurr$ dur+1 ! #e-ye>     
p]iod ! date ( su* p]sonnel action4  4  
#ajf4 ,removal or demotion ( ,indian    
,heal? ,s]vice employees bas$ on        
p]=mance or misconduct ,title ,,vi ( !  
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #affa et seq471 z am5d$  
by section #aje1 is fur!r am5d$ by add+ 
at ! end ! foll[+3  #fjf4 ,removal or   
demotion ( ,s]vice employees bas$ on    
p]=mance or misconduct  7a7 ,def9itions 
,9 ?is section & section #fjg3 7#a7     
,employee ,! t]m employee has ! mean+   

giv5 ! t]m 9 section #baje ( title #e1  
,unit$ ,/ates ,code4  7#b7 ,manag]  7,a7
 ,9 g5]al ,! t]m manag] has ! mean+ giv5
 ! t]m managem5t (ficial 9 section      
#gajc7;a7 ( title #e1 ,unit$ ,/ates     
,code4  7,b7 ,inclusions ,! t]m manag]  
includes1 z employ$ at any facility ( ! 
,s]vice--  7i7 a *ief executive (fic]2  
7ii7 a *ief m$ical (fic]2 &  7iii7 a    
dep>tm5t director4  7#c7 ,misconduct ,! 
t]m misconduct means neglect ( duty1    
malfeasance1 or failure to accept a     
direct$ reassignm5t or to accompany a   
position 9 a transf] ( function4  7#d7  
,p]sonnel action ,! t]m p]sonnel action 
means a removal1 transf]1 or r$uction 9 
grade "u subsection 7b77#b74  7#e7      
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,director ( ! ,s]vice4     
7#f7 ,s5ior executive ,! t]m s5ior      
executive means a c>e] appo9tee 7z t t]m
 is def9$ 9 section #cacb7;a7 ( title   
#e1 ,unit$ ,/ates ,code74  7#g7 ,s5ior  
,executive ,s]vice position ,! t]m      

,s5ior ,executive ,s]vice position has !
 mean+ giv5 ! t]m 9 section #cacb7;a7 ( 
title #e1 ,unit$ ,/ates ,code4  7#h7    
,sup]visor ,! t]m sup]visor has ! mean+ 
giv5 ! t]m 9 section #gajc7;a7 ( title  
#e1 ,unit$ ,/ates ,code4  7b7 ,removal  
bas$ on p]=mance or misconduct  7#a7 ,9 
g5]al ,subject to p>agraph 7#d71 !      
,secret>y may remove an employee ( !    
,s]vice f ! position ! employee occupies
 if ! ,secret>y det]m9es ! p]=mance or  
misconduct ( ! employee w>rants removal4
  7#b7 ,action ,if ! ,secret>y removes  
an employee "u p>agraph 7#a71 !         
,secret>y may-- 7,a7 remove ! employee f
 ! civil s]vice 7z def9$ 9 section #baja
 ( title #e1 ,unit$ ,/ates ,code72  7,b7
 9 ! case ( an individual describ$ 9    
p>agraph 7#c71 transf] ! individual f ! 
,s5ior ,executive ,s]vice position to a 
,g5]al ,s*$ule position at any grade ( !
 ,g5]al ,s*$ule = :i* ! individual is   
qualifi$ & t ! ,secret>y det]m9es is    
appropriate2 or  7,c7 9 ! case ( a      
manag] or sup]visor1 r$uce ! grade ( !  

manag] or sup]visor to any o!r grade =  
:i* ! individual is qualifi$ & t !      
,secret>y det]m9es is appropriate4  7#c7
 ,individual describ$ ,an individual    
ref]r$ to 9 p>agraph 7#b77;,b7 is a     
s5ior executive t-- 7,a7 previ\sly      
occupi$ a p]man5t position )9 !         
competitive s]vice 7z t t]m is def9$ 9  
section #bajb ( title #e1 ,unit$ ,/ates 
,code72 or  7,b7 previ\sly occupi$ a    
p]man5t position )9 ! except$ s]vice 7z 
t t]m is def9$ 9 section #bajc ( title  
#e1 ,unit$ ,/ates ,code74  7#d7 ,due    
process ,be=e an employee may be subject
 to a p]sonnel action1 ! ,secret>y %all 
provide to ! employee--  7,a7 n less ?an
 #aj days be=e ! p]sonnel action1 writt5
 notice ( ! propos$ p]sonnel action2 &  
7,b7 an opportunity & reasonable "t to  
answ] orally or 9 writ+4  7c7 ,pay (    
c]ta9 individuals  7#a7 ,9 g5]al        
,not)/&+ any o!r provision ( law1       
includ+ ! requirem5ts ( section #ceid ( 
title #e1 ,unit$ ,/ates ,code1 any      
individual transf]r$ to a ,g5]al ,s*$ule

 position "u subsection 7b77#b77;,b7 or 
subject to a r$uction 9 grade "u        
subsection 7b77#b77;,c7 %all1 beg9n+ on 
! date ( ! transf]1 receive ! annual    
rate ( pay applicable to ! position4    
7#b7 ,requirem5ts  7,a7 ,9 g5]al ,an    
individual transf]r$ to a ,g5]al ,s*$ule
 position "u subsection 7b77#b77;,b7 or 
subject to a r$uction 9 grade "u        
subsection 7b77#b77;,c7--  7i7 may n be 
plac$ on adm9i/rative leave or any o!r  
category ( paid leave dur+ ! p]iod dur+ 
:i* an appeal 7if any7 "u subsection    
7e77#b77;,a7 is ongo+2 &  7ii7 may only 
receive pay if ! individual-- 7,i7      
reports = duty2 &  7,,ii7 p]=ms a prim>y
 duty or an alt]native prim>y duty1 z   
ea* t]m is describ$ 9 section #eea4ajd (
 title #e1 ,code ( ,f$]al ,regulations  
7or a successor regulation74  7,b7      
,failure to report ,if an individual    
transf]r$ to a ,g5]al ,s*$ule position  
"u subsection 7b77#b77;,b7 or subject to
 a r$uction 9 grade "u subsection       
7b77#b77;,c7 does n report = duty1      

pursuant to subsection 7f77#c77;,b71 !  
individual %all n receive any increase 9
 rate ( pay or o!r b5efit4  7d7 ,notice 
to ,congress ,n lat] ?an #cj days aft] !
 date on :i* ! ,secret>y takes a        
p]sonnel action1 ! ,secret>y %all       
submit1 9 writ+1 a notice ( ! p]sonnel  
action & ! reason = ! p]sonnel action   
to--  7#a7 ! ,committee on ,indian      
,affairs ( ! ,s5ate2  7#b7 ! ,committee 
on ,heal?1 ,education1 ,labor1 &        
,p5sions ( ! ,s5ate2  7#c7 ! ,committee 
on ,natural ,res\rces ( ! ,h\se (       
,repres5tatives2  7#d7 ! ,committee on  
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives2 &  7#e7 ! ,inspector   
,g5]al ( ! ,dep>tm5t4  7e7 ,proc$ure    
7#a7 ,inapplicability ,! proc$ures "u   
*apt]s #dc & #ge ( title #e1 ,unit$     
,/ates ,code1 %all n apply to a p]sonnel
 action4  7#b7 ,appeal  7,a7 ,9 g5]al   
,subject to subp>agraph 7,b7 &          
subsection 7f71 an employee subject to a
 p]sonnel action may appeal ! p]sonnel  
action to ! ,m]it ,sy/ems ,protection   

,bo>d "u section #ggja ( title #e1      
,unit$ ,/ates ,code4  7,b7 ,limitation  
,an appeal "u subp>agraph 7,a7 may only 
be made if ! appeal is made n lat] ?an  
#g days aft] ! date ( ! p]sonnel action4
  7f7 ,exp$it$ review by adm9i/rative   
law judge  7#a7 ,9 g5]al  7,a7 ,ref]ral 
,on receipt ( an appeal "u subsection   
7e77#b77;,a71 ! ,m]it ,sy/ems           
,protection ,bo>d %all ref] ! appeal to 
an adm9i/rative law judge pursuant to   
section #ggja7;b77#a7 ( title #e1 ,unit$
 ,/ates ,code4  7,b7 ,exp$ition ,!      
adm9i/rative law judge to :om an appeal 
is ref]r$ "u subp>agraph 7,a7 %all-- 7i7
 exp$ite ! appeal "u section            
#ggja7;b77#a7 ( title #e1 ,unit$ ,/ates 
,code2 &  7ii7 issue a decision 9 ea*   
case n lat] ?an #ba days aft] ! date ( !
 appeal4  7#b7 ,f9ality ,not)/&+ any o!r
 provision ( law1 includ+ section #ggjc 
( title #e1 ,unit$ ,/ates ,code1 !      
decision ( an adm9i/rative law judge "u 
p>agraph 7#a7 %all be f9al & %all n be  
subject to any fur!r adm9i/rative       

appeal4  7#c7 ,failure to issue decision
  7,a7 ,9 g5]al ,9 any case 9 :i* an    
adm9i/rative law judge fails to issue a 
decision 9 accordance ) ! #ba-;day      
requirem5t describ$ 9 p>agraph          
7#a77;,b77ii71 ! p]sonnel action %all be
 treat$ z f9al4  7,b7 ,transp>5cy ,9 any
 case 9 :i* a p]sonnel action is treat$ 
z f9al "u subp>agraph 7,a71 ! ,m]it     
,sy/ems ,protection ,bo>d %all1 n lat]  
?an #ad days aft] ! date on :i* !       
p]sonnel action becomes f9al1 submit a  
lett] expla9+ ! reasons :y a decision 0 
n issu$ 9 accordance ) ! #ba-;day       
requirem5t describ$ 9 p>agraph          
7#a77;,b77ii7 to--  7i7 ! ,committee on 
,indian ,affairs ( ! ,s5ate2  7ii7 !    
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate2  7iii7 ! 
,committee on ,natural ,res\rces ( !    
,h\se ( ,repres5tatives2 &  7iv7 !      
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives4  7#d7          
,re/riction ,! ,m]it ,sy/ems ,protection
 ,bo>d or an adm9i/rative law judge may 

n /ay any p]sonnel action4  7#e7        
,cessation ( pay increases & b5efits    
,dur+ ! p]iod beg9n+ on ! date on :i* an
 employee appeals a removal f ! civil   
s]vice "u subsection 7e77#b77;,a7 & end+
 on ! date on :i* ! removal becomes     
f9al1 ! employee may n receive any--    
7,a7 increase 9 rate ( pay2 or  7,b7    
aw>d1 bonus1 inc5tive1 all[ance1        
diff]5tial1 /ud5t loan repaym5t1 special
 paym5t1 or o!r b5efit4  7#f7 ,assi/ance
 ,to ! maximum ext5t practicable1 !     
,secret>y %all provide su* in=mation &  
assi/ance z may be necess>y to ensure an
 appeal "u ?is subsection is exp$it$    
to--  7,a7 ! ,m]it ,sy/ems ,protection  
,bo>d2 &  7,b7 any adm9i/rative law     
judge to :om an appeal "u ?is section is
 ref]r$4  7g7 ,employm5t record         
transp>5cy ,! ,secret>y %all ensure t ! 
employm5t records = any employee subject
 to a p]sonnel action1 reg>dless ( :e!r 
t p]sonnel action is f9al1 include--    
7#a7 a notation t ! employee 0 subject  
to a p]sonnel action2 &  7#b7 a         

description ( ! disposition or /atus ( !
 p]sonnel action or any appeal ( !      
p]sonnel action "u ?is section4  7h7    
,relation to title #e1 ,unit$ ,/ates    
,code  7#a7 ,additional au?ority ,!     
p]sonnel action au?orities provid$ to ! 
,secret>y "u ?is section are 9 addition 
to ! au?orities provid$ "u *apt]s #dc & 
#ge ( title #e1 ,unit$ ,/ates ,code4    
7#b7 ,removal ( s5ior executives        
,section #ceib7;b77#a7 ( title #e1      
,unit$ ,/ates ,code1 %all n apply to a  
p]sonnel action4  4  #ajg4 ,/&>ds to    
improve timel9ess ( c>e ,title ,,iv ( ! 
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afda et seq47 is am5d$  
by add+ at ! end ! foll[+3  #dab4 ,/&>ds
 to improve timel9ess ( c>e  7a7 ,9     
g5]al ,n lat] ?an #ahj days aft] ! date 
( enactm5t ( ! ,re/or+ ,acc\ntability 9 
! ,indian ,heal? ,s]vice ,act ( #bjag1 !
 ,secret>y1 act+ ?r\gh ! ,s]vice1 %all--
  7#a7 e/abli%1 by regulation1 /&>ds to 
measure ! timel9ess ( ! provision (     
heal? c>e s]vices 9 ,s]vice facilities2 

&  7#b7 provide su* /&>ds to ea* ,s]vice
 unit4  7b7 ,data collection ,!         
,secret>y1 act+ ?r\gh ! ,s]vice1 %all   
develop a process = ea* ,s]vice unit to 
submit to ! ,secret>y data ) respect to 
! /&>ds e/abli%$ "u subsection 7a77#a74 
4  #ajh4 ,tribal culture & hi/ory       
,section #aac ( ! ,indian ,heal? ,c>e   
,improvem5t ,act 7#be ,u4,s4,c4 #afaf;f 
7 is am5d$-- 7#a7 9 subsection 7a7--    
7,a7 by /rik+ a program & ins]t+ an     
annual m&atory tra9+ program2 &  7,b7 by
 /rik+ appropriate employees ( ! ,s]vice
 & ins]t+ employees ( ! ,s]vice1 locum  
t55s m$ical provid]s1 & o!r contract$   
employees :o "w at ,s]vice hospitals or 
o!r ,s]vice units & ^: employm5t        
requires regul> direct pati5t access2 & 
7#b7 by add+ at ! end ! foll[+3  7c7    
,not)/&+ any o!r provision ( law1 beg9n+
 ) ! ye> ( ! date ( enactm5t ( ! ,re/or+
 ,acc\ntability 9 ! ,indian ,heal?      
,s]vice ,act ( #bjag1 ea* employee or   
provid] describ$ 9 subsection 7a7 :o    
ent]s into a contract ) ! ,s]vice on or 

aft] ! date ( su* implem5tation %all1 z 
a condition ( employm5t1 annually       
p>ticipate 9 & complete su* tra9+       
program4 ,= purposes ( ! prec$+ s5t5ce1 
p>ticipation 9 su* tra9+ program may n  
be consid]$ complete = ! ye> involv$    
until ! individual satisfies ea*        
requirem5t1 includ+ te/+1 if applicable1
 ( ! tra9+ program = su* ye>1 z specifi$
 by ! ,secret>y4  4  #aji4 ,/aff+       
demon/ration project ,title ,,viii ( !  
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afga et seq47 is am5d$  
by add+ at ! end ! foll[+3  #hcc4 ,/aff+
 demon/ration project  7a7 ,9 g5]al ,!  
,secret>y1 act+ ?r\gh ! ,s]vice1 %all   
e/abli% a demon/ration project t        
au?orizes ! ,s]vice to provide f$]ally  
manag$ ,s]vice units ) additional /aff+ 
res\rces ) ! goal t ! res\rces become   
self-su/a9+4  7b7 ,selection ,9 select+ 
,s]vice units = p>ticipation1 !         
,secret>y %all consid] :e!r a ,s]vice   
unit s]vices an ,indian tribe t--  7#a7 
has utiliz$ or contribut$ sub/antial    

tribal funds to con/ruct a heal?        
facility us$ by ! ,s]vice or id5tifi$ 9 
! ma/] plan = ! ,s]vice unit2  7#b7 is  
locat$ 9 a ,/ate or ,/ates ) ,m$icaid   
reimbursem5ts plans or policies t w     
increase ! likelihood t ! /aff+ res\rces
 provid$ w be self-su/a9+2 &  7#c7 is   
op]at+ a heal? facility describ$ 9      
p>agraph 7#a7 "u hi/orical /aff+ ratios 
t h n be5 equaliz$ or updat$ by !       
,s]vice or any o!r ,s]vice program to   
reflect curr5t /aff+ ne$s4  7c7         
,duration ,/aff+ res\rces provid$ to a  
,s]vice unit "u ?is section %all be = a 
duration t ! ,secret>y1 9 consultation )
 ! applicable ,indian tribe1 det]m9es   
appropriate1 except t ea* /aff+ position
 provid$ %all be = a p]iod ( n less ?an 
#c fiscal ye>s4  7d7 ,report ,n lat] ?an
 #e ye>s aft] ! ,secret>y ends !        
demon/ration project "u ?is section1 !  
,secret>y %all prep>e & submit a report 
to ! ,committee on ,indian ,affairs & ! 
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate1 & !      

,committee on ,natural ,res\rces & !    
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives1 reg>d+ !       
project1 includ+--  7#a7 :e!r ! /aff+   
res\rces result$ 9 additional rev5ue = !
 ,s]vice unit suffici5t to ma9ta9 ! /aff
 on a p]man5t basis2  7#b7 ! levels to  
:i* ! /aff+ res\rces r$uc$ ! unmet /aff+
 ne$ = ! ,s]vice unit2 &  7#c7 :e!r !   
demon/ration project c\ld be deploy$ to 
r$uce unmet /aff+ ne$s ?r\gh\t !        
,s]vice4  4  #aaj4 ,rule e/abli%+ tribal
 consultation policy ,title ,,viii ( !  
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afga et seq471 z am5d$  
by section #aji1 is fur!r am5d$ by add+ 
at ! end ! foll[+3  #hcd4 ,rule e/abli%+
 tribal consultation policy  7a7 ,9     
,g5]al ,n lat] ?an #a ye> aft] ! date ( 
enactm5t ( ! ,re/or+ ,acc\ntability 9 ! 
,indian ,heal? ,s]vice ,act ( #bjag1 !  
,secret>y %all e/abli%1 ?r\gh !         
negotiat$ rulemak+ process describ$ 9   
subsection 7b71 a rule e/abli%+ a tribal
 consultation policy = ! ,s]vice4  7b7  

,negotiat$ rulemak+ ,be=e publi%+ a     
propos$ rule describ$ 9 subsection 7a71 
! ,secret>y %all foll[ ! provisions (   
sub*apt] ,,iii ( *apt] #e ( title #e1   
,unit$ ,/ates ,code 7commonly kn[n z !  
,negotiat$ ,rulemak+ ,act ( #aiij74  7c7
 ,cont5ts ( tribal consultation policy  
,! policy e/abli%$ "u ! rule describ$ 9 
subsection 7a7 %all-- 7#a7 update1 &    
replace1 ! tribal consultation policy   
e/abli%$ "u ,circul> ,no4 #bjjf-ja ( !  
,s]vice1 or any successor policy2 &     
7#b7 include ! foll[+3 7,a7 ,a process =
 det]m9+ :5 ! ,s]vice w notify ,indian  
tribes1 & a description ( h[ ! ,indian  
tribes %\ld be notifi$4  7,b7 ,a        
det]m9ation ( :at actions or ag5cy      
decisions by ! ,s]vice w trigg] a       
requirem5t = mean+ful consultation )    
,indian tribes4  7,c7 ,a det]m9ation (  
:at actions con/itute mean+ful          
consultation ) ,indian tribes4  4  ,,ii 
,employee protections  #bja4 ,"r (      
,f$]al employees to petition ,congress  
7a7 ,adv]se action = violation ( "r ,to 

petition ,congress ,section #gbaa (     
title #e1 ,unit$ ,/ates ,code1 is       
am5d$--  7#a7 by /rik+ ,! "r ( & ins]t+ 
7a7 ,9 g5]al4--,! "r (2 &  7#b7 by add+ 
at ! end ! foll[+ new subsection3  7b7  
,adv]se action ,an employee :o int]f]es 
) or d5ies a "r protect$ "u subsection  
7a7 %all be subject to any adv]se action
 describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 ( 
section #geab1 9 accordance ) ! proc$ure
 describ$ 9 section #geac & any o!r     
applicable proc$ure4  4  7b7 ,electronic
 notification ( "r ( employees ( ,indian
 ,heal? ,s]vice  7#a7 ,9 g5]al ,!       
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is subsection z !         
,secret>y71 act+ ?r\gh ! ,director ( !  
,indian ,heal? ,s]vice1 %all1 9         
accordance ) p>agraphs 7#b7 ?r\gh 7#f71 
provide to ea* employee ( ! ,indian     
,heal? ,s]vice1 & electronically po/1 a 
memor&um provid+ notice ( ! "r to       
petition ,congress "u section #gbaa (   
title #e1 ,unit$ ,/ates ,code4  7#b7    
,cont5ts ,! memor&um describ$ 9 p>agraph

 7#a7 %all include ! foll[+ /atem5t3 ,x 
is a violation ( section #gbaa ( title  
#e1 ,unit$ ,/ates ,code1 = any ,f$]al   
ag5cy or employee to require a ,f$]al   
employee to seek approval1 guidance1 or 
any o!r =m ( input prior to contact+    
,congress ) in=mation1 ev5 if t         
in=mation is 9 relation to ! job        
responsibilities ( ! employee4 ,a ,f$]al
 employee f\nd to h int]f]$ ) or d5i$ ! 
"r ( ano!r ,f$]al employee "u su*       
section %all be subject to an adv]se    
action describ$ 9 p>agraphs 7#a7 ?r\gh  
7#e7 ( section #geab ( title #e1 ,unit$ 
,/ates ,code1 includ+ a susp5sion = m   
?an #ad days )\t pay44  7#c7 ,submission
 ,n lat] ?an #cj days aft] ! date (     
enactm5t ( ?is ,act1 ! ,secret>y %all   
submit ! memor&um describ$ 9 p>agraph   
7#a7 to ! ,inspector ,g5]al ( !         
,dep>tm5t ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is subsection z !         
,inspector ,g5]al7 = approval4  7#d7    
,approval or disapproval ,n lat] ?an #cj
 days aft] ! submission ( ! memor&um "u 

p>agraph 7#c71 or a revis$ memor&um "u  
p>agraph 7#f71 ! ,inspector ,g5]al %all 
approve or disapprove ! memor&um or     
revis$ memor&um1 z ! case may be4  7#e7 
,notice ,9 ! case ( an approval "u      
p>agraph 7#d71 n lat] ?an #cj days aft] 
su* approval1 ! ,secret>y %all--  7,a7  
provide to ea* employee ( ! ,indian     
,heal? ,s]vice an electronic copy ( !   
approv$ memor&um2 &  7,b7 po/ su*       
memor&um 9 a cle> & conspicu\s place on 
! website ( ! ,indian ,heal? ,s]vice = a
 p]iod n less ?an #abj days4  7#f7      
,revis$ memor&um ,9 ! case ( a          
disapproval "u p>agraph 7#d71 n lat] ?an
 #ae days aft] su* disapproval1 !       
,secret>y %all submit a revis$ memor&um 
to ! ,inspector ,g5]al = approval "u    
p>agraph 7#d74  #bjb4 ,fiscal           
acc\ntability ,title ,,vi ( ! ,indian   
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #affa et seq471 z am5d$ by    
sections #aje & #ajf1 is fur!r am5d$ by 
add+ at ! end ! foll[+3  #fjg4 ,fiscal  
acc\ntability  7a7 ,managem5t ( funds   

7#a7 ,9 g5]al ,if ! ,secret>y fails to  
submit ! pr(essional h\s+ plan "u       
section #cja7;a7 ( ! ,re/or+            
,acc\ntability 9 ! ,indian ,heal?       
,s]vice ,act ( #bjag or ! /aff+ plan "u 
section #cja7;b7 ( t ,act1 ! ,secret>y  
may n receive1 obligate1 transf]1 or    
exp5d any am\nts = a sal>y increase or  
bonus ( an individual describ$ 9        
p>agraph 7#b7 until ! pr(essional h\s+  
plan or /aff+ plan1 z ! case may be1 is 
submitt$4  7#b7 ,individual describ$ ,an
 individual describ$ 9 ?is p>agraph is  
an individual employ$ 9 a position 9 !  
,s]vice t is a position--  7,a7 describ$
 "u sections #ecab ?r\gh #ecaf ( title  
#e1 ,unit$ ,/ates ,code2  7,b7 plac$ 9  
level ,,iv or ,v ( ! ,executive ,s*$ule 
"u section #ecag ( title #e1 ,unit$     
,/ates ,code2  7,c7 z a limit$ t]m      
appo9tee1 limit$ em]g5cy appo9tee1 or   
nonc>e] appo9tee 9 ! ,s5ior ,executive  
,s]vice1 z def9$ "u p>agraphs 7#e71     
7#f71 & 7#g71 respectively1 ( section   
#cacb7;a7 ( title #e1 ,unit$ ,/ates     

,code2 or  7,d7 "u section #bac4ccja or 
#bac4ccjb ( title #e1 ,code ( ,f$]al    
,regulations4  7b7 ,prioritization (    
pati5t c>e  7#a7 ,9 g5]al ,! ,secret>y  
%all use am\nts available to ! ,indian  
,heal? ,s]vice t are n obligat$ or      
exp5d$1 includ+ base budget fund+ & ?ird
 p>ty collections1 dur+ ! fiscal ye> =  
:i* ! am\nts are made available1 & t    
rema9 available1 only to support pati5t 
c>e by us+ su* funds = ! co/s (--  7,a7 
ess5tial m$ical equipm5t2  7,b7 pur*as$ 
or ref]r$ c>e2 or  7,c7 /aff+4  7#b7    
,special rule ,9 us+ am\nts "u p>agraph 
7#a71 ! ,secret>y %all ensure t1 9 any  
case :]e ! am\nts 7 orig9ally made      
available = a p>ticul> ,s]vice unit1 su*
 am\nts are us$ to b5efit ,indians s]v$ 
by t ,s]vice unit4  7#c7 ,re/rictions ,!
 ,secret>y may n use am\nts describ$ 9  
p>agraph 7#a7-- 7,a7 to remodel or      
int]ior decorate any ,area (fice2 or    
7,b7 to increase ! rate ( pay ( any     
employee ( an ,area (fice4  7c7 ,sp5d+  
reports ,n lat] ?an #ij days aft] ! end 

( ea* qu>t] ( a fiscal ye>1 ! ,secret>y 
%all submit a report describ+ !         
au?orizations1 exp5ditures1 outlays1    
transf]s1 reprogramm+1 & obligations (  
ea* level ( ! ,s]vice1 includ+ !        
headqu>t]s1 ea* ,area (fice1 ea* ,s]vice
 unit1 & ea* heal? cl9ic or facility1   
to--  7#a7 ea* ,indian tribe2  7#b7 9 ! 
,s5ate--  7,a7 ! ,committee on ,indian  
,affairs2  7,b7 ! ,committee on ,heal?1 
,education1 ,labor1 & ,p5sions2  7,c7 ! 
,committee on ,appropriations2 &  7,d7 !
 ,committee on ! ,budget2 &  7#c7 9 !   
,h\se ( ,repres5tatives-- 7,a7 !        
,committee on ,natural ,res\rces2  7,b7 
! ,committee on ,en]gy & ,comm]ce2  7,c7
 ! ,committee on ,appropriations2 &     
7,d7 ! ,committee on ! ,budget4  7d7    
,/atus reports  7#a7 ,9 g5]al ,subject  
to p>agraph 7#b71 n lat] ?an #ahj days  
aft] ! end ( ea* fiscal ye>1 ! ,secret>y
 %all provide to ea* entity describ$ 9  
p>agraphs 7#a7 ?r\gh 7#c7 ( subsection  
7c7 a report describ+ ! safety1 bill+1  
c]tification1 cr$5tial1 & compliance    

/atuses ( ea* facility manag$1 op]at$1  
or o!rwise support$ by ! ,s]vice4  7#b7 
,updates ,) respect to any *ange ( a    
/atus describ$ 9 p>agraph 7#a71 !       
,secret>y %all imm$iately provide to ea*
 entity describ$ 9 p>agraphs 7#a7 ?r\gh 
7#c7 ( subsection 7c7 an update describ+
 su* *ange4  7e7 ,rule ( con/ruction    
,?is section may n be con/ru$ to inhibit
 ! au?ority ( an ,indian tribe to ent]  
into or ma9ta9 a compact or contract "u 
! ,indian ,self-,det]m9ation &          
,education ,assi/ance ,act 7#be         
,u4,s4,c4 #ecjd et seq474  4  ,,iii     
,reports  #cja4 ,def9itions ,9 ?is      
title3 7#a7 ,secret>y ,! t]m ,secret>y  
means ! ,secret>y ( ,heal? & ,human     
,s]vices4  7#b7 ,s]vice ,! t]m ,s]vice  
means ! ,indian ,heal? ,s]vice4  7#c7   
,s]vice unit ,! t]m ,s]vice unit has !  
mean+ giv5 ! t]m 9 section #d ( !       
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afjc74  #cjb4 ,reports  
by ! ,secret>y ( ,heal? & ,human        
,s]vices  7a7 ,,ihs ,pr(essional h\s+   

plan ,n lat] ?an #ij days aft] ! date ( 
enactm5t ( ?is ,act1 ! ,secret>y %all   
develop1 make publicly available1 &     
submit to ,congress & ! ,comptroll]     
,g5]al ( ! ,unit$ ,/ates a writt5 plan  
to address ! pr(essional h\s+ ne$s (    
employees ( ! ,s]vice t comports ) !    
practices & recomm5dations ( ! ,gov]nm5t
 ,acc\ntability ,(fice relat+ to        
pr(essional h\s+4  7b7 ,plan relat+ to  
,,ihs /aff+ ne$s ,n lat] ?an #ij days   
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y %all develop1 make publicly   
available1 & submit to ,congress & !    
,comptroll] ,g5]al ( ! ,unit$ ,/ates a  
writt5 plan to address /aff+ ne$s 9 !   
,s]vice t comports ) ! practices ( !    
,gov]nm5t ,acc\ntability ,(fice relat+  
to work=ce plann+4  7c7 ,indian ,heal?  
,c>e ,improvem5t ,act report ,n lat] ?an
 #a ye> aft] ! date ( enactm5t ( ?is    
,act1 & ea* ye> !reaft] = a p]iod ( #e  
ye>s1 ! ,secret>y %all develop1 make    
publicly available1 & submit to         
,congress a report on ! data submitt$ "u

 section #dab7;b7 ( ! ,indian ,heal?    
,c>e ,improvem5t ,act1 z am5d$ by       
section #ajg4  #cjc4 ,reports by !      
,comptroll] ,g5]al  7a7 ,,ihs ,h\s+ ne$s
 report  7#a7 ,9 g5]al ,n lat] ?an #a   
ye> aft] ! date on :i* ! ,comptroll]    
,g5]al ( ! ,unit$ ,/ates receives !     
pr(essional h\s+ plan "u section        
#cjb7;a71 ! ,comptroll] ,g5]al %all     
develop & submit to ,congress a report  
on ! pr(essional h\s+ ne$s ( employees (
 ! ,s]vice4  7#b7 ,cont5ts ,! report    
requir$ "u p>agraph 7#a7 %all include ! 
foll[+3 7,a7 ,an evaluation ( any exi/+1
 z ( ! date ( ! report1 assessm5ts &    
projections = ! pr(essional h\s+ ne$s ( 
employees ( ! ,s]vice1 includ+          
discussion & conclusion z to :e!r exi/+ 
assessm5ts & projections accurately     
reflect ! pr(essional h\s+ ne$s (       
employees ( ! ,s]vice4  7,b7 ,an        
assessm5t ( ! pr(essional h\s+ ne$s (   
employees ( ! ,s]vice = ea* ,s]vice area
 7z def9$ 9 section #d ( ! ,indian      
,heal? ,c>e ,improvem5t ,act 7#be       

,u4,s4,c4 #afjc774  7,c7 ,an assessm5t (
 ! pr(essional h\s+ plan develop$ by !  
,secret>y "u section #cjb7;a74  7b7     
,,ihs /aff+ ne$s report  7#a7 ,9 g5]al  
,n lat] ?an #a ye> aft] ! date on :i* ! 
,comptroll] ,g5]al receives ! report "u 
section #cjb7;b71 ! ,comptroll] ,g5]al  
%all prep>e & submit to ,congress a     
report on ! /aff+ ne$s ( ! ,s]vice4     
7#b7 ,cont5ts ,! report requir$ "u      
p>agraph 7#a7 %all include ! foll[+3    
7,a7 ,a description ( ! numb] & type (  
full-"t positions ne$$ at ea* facility (
 ! ,s]vice & ! am\nt ( funds necess>y to
 ma9ta9 su* positions4  7,b7 ,an        
assessm5t ( ! use ( indep5d5t           
contractors1 includ+ ! numb] ( indep5d5t
 contractors hir$ to fill vacant full-"t
 positions & am\nts sp5t on indep5d5t   
contractors :o provide heal? c>e        
s]vices4  7,c7 ,an assessm5t ( ! /aff+  
plan develop$ by ! ,secret>y "u section 
#cjb7;b74  7c7 ,:i/lebl[] protections   
report  7#a7 ,9 g5]al ,n lat] ?an #a ye>
 aft] ! date ( enactm5t ( ?is ,act1 !   

,comptroll] ,g5]al %all develop & submit
 to ,congress a report on ! efficacy (  
exi/+ protections = :i/lebl[]s 9 !      
,s]vice4  7#b7 ,cont5ts ,! report       
requir$ "u p>agraph 7#a7 %all include ! 
foll[+3 7,a7 ,a discussion & conclusion 
z to :e!r ! ,s]vice has tak5 prop] /eps 
to prev5t retaliation aga9/ :i/lebl[]s4 
7,b7 ,if applicable1 any recomm5dations 
= *anges to ! policy ( ! ,s]vice )      
respect to :i/lebl[]s4  7,c7 ,a         
discussion & conclusion z to :e!r !     
(ficial email acc\nts ( employees ( !   
,s]vice are appropriately monitor$4     
#cjd4 ,inspector ,g5]al reports  7a7    
,pati5t c>e reports  7#a7 ,9 g5]al ,n   
lat] ?an #b ye>s aft] ! date ( enactm5t 
( ?is ,act1 & e #b ye>s !reaft]1 !      
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices %all develop & submit
 to ,congress & ! ,s]vice a report on   
pati5t h>m ev5ts occurr+ 9 ,s]vice units
 & def]rals & d5ials ( c>e ( pati5ts ( !
 ,s]vice4  7#b7 ,cont5ts ,! report      
requir$ "u p>agraph 7#a7 %all include ! 

foll[+3 7,a7 ,an evaluation ( ! numb] & 
k9d ( ev5ts t contribute to pati5t dea?s
 9 a ,s]vice unit & recomm5dations      
reg>d+ r$uc+ ! numb] ( pati5t dea?s4    
7,b7 ,an evaluation ( ! ,s]vice's track+
 & report+ (1 & response to1 pati5t h>m 
ev5ts & recomm5dations reg>d+ h[ to     
improve su* track+1 report+1 & response4
  7,c7 ,! effects ( def]rals & d5ials ( 
c>e on pati5ts ( ! ,s]vice1 includ+     
pati5t outcomes1 & recomm5dations reg>d+
 h[ to r$uce def]rals & d5ials ( c>e4   
7b7 ,report+ sy/ems audit ,n lat] ?an #b
 ye>s aft] ! date ( enactm5t ( ?is ,act1
 ! ,inspector ,g5]al %all--  7#a7       
conduct an audit ( report+ sy/ems ( !   
,s]vice1 z ( ! date ( enactm5t ( ?is    
,act2 &  7#b7 provide to ! ,s]vice      
recomm5dations & te*nical assi/ance     
reg>d+ implem5tation ( improv$ report+  
sy/ems1 proc$ures1 /&>ds1 & protocols4  
#cje4 ,transp>5cy 9 ,,cms surveys       
,section #ahhj ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acieqq7 is am5d$ by
 add+ at ! end ! foll[+3  7g7 7#a7 ,n   

less frequ5tly ?an once e #b ye>s1 !    
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all conduct surveys  
to assess ! compliance ( ea* hospital or
 skill$ nurs+ facility ( ! ,indian      
,heal? ,s]vice )--  7,a7 section #ahfg2 
&  7,b7 conditions ( p>ticipation 9 !   
program "u ?is title4  7#b7 ,ea* survey 
complet$ "u ?is subsection %all be po/$ 
on ! ,int]net website ( ! ,c5t]s =      
,m$ic>e  ,m$icaid ,s]vices4 ,su* po/+   
%all comply ) ! ,f$]al regulations      
conc]n+ ! privacy ( individually        
id5tifiable heal? in=mation promulgat$  
"u section #bfd7;c7 ( ! ,heal?          
,insurance ,portability & ,acc\ntability
 ,act ( #aiif4  4  ,,iv ,te*nical       
am5dm5ts  #dja4 ,te*nical am5dm5ts ,!   
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afja et seq47 is am5d$--
 7#a7 by /rik+ contract heal? s]vice ea*
 place su* t]m appe>s 7reg>dless ( cas+ 
& typeface & includ+ 9 ! head+s7 &      
ins]t+ pur*as$_/ref]r$ c>e 7)           
appropriate cas+ & typeface72 &  7#b7 by

 /rik+ contract heal? s]vices ea* place 
su* t]m appe>s 7reg>dless ( cas+ &      
typeface & includ+ 9 ! head+s7 & ins]t+ 
pur*as$_/ref]r$ c>e 7) appropriate cas+ 
& typeface74