,,ii  #aaeth ,,congress  #ast ,session  
,s4 #dfe  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #bh1      
#bjag,mr4 ,rounds introduced the        
following bill2 which was read twice and
 referred to the ,committee on ,indian  
,affairs  ,a ,,bill  ,to provide for an 
independent outside audit of the ,indian
 ,health ,service4  #a4 ,short title    
,this ,act may be cited as the          
,independent ,outside ,audit of the     
,indian ,health ,service ,act of #bjag4 
#b4 ,independent outside audit of the   
,indian ,health ,service  7a7           
,definitions ,in this section3 7#a7     
,reputable private entity ,the term     
reputable private entity means a private
 entity that--  7,a7 has experience     
with1 and proven outcomes in optimizing 
the performance of1 ,federal health care
 delivery systems1 the private sector1  
and health care management2 and  7,b7   
specializes in implementing large-scale 
organizational and cultural             
transformations1 especially with respect

 to health care delivery systems4  7#b7 
,secretary ,the term ,secretary means   
the ,secretary of ,health and ,human    
,services4  7#c7 ,service ,the term     
,service means the ,indian ,health      
,service4  7b7 ,assessment ,not later   
than #ij days after the date of         
enactment of this ,act1 the ,secretary  
shall enter into one or more contracts  
with a reputable private entity to      
conduct an independent assessment of the
 health care delivery systems and       
financial management processes of the   
,service4  7c7 ,program integrator  7#a7
 ,in general ,if the ,secretary enters  
into contracts under this section with  
more than #a reputable private sector   
entity1 the ,secretary shall designate  
one such entity that is predominantly a 
health care organization as the program 
integrator4  7#b7 ,responsibilities ,the
 program integrator designated under    
paragraph 7#a7 shall be responsible for 
coordinating the outcomes of the        
assessments conducted by the reputable  

private entities under this section4    
7d7 ,areas of study ,each assessment    
conducted under subsection 7b7 shall    
address each of the following3 7#a7     
,current and projected demographics and 
unique health care needs of the patient 
population served by the ,service4  7#b7
 ,current and projected health care     
capabilities and resources of the       
,service1 including hospital care1      
medical services1 and other health care 
furnished by non-,service facilities    
under contract with the ,service1 to    
provide timely and accessible care to   
eligible patients4  7#c7 ,the           
authorities and mechanisms under which  
the ,secretary may furnish hospital     
care1 medical services1 and other health
 care at non-,service facilities1       
including whether it is recommended that
 the ,secretary have the authority to   
furnish such care and services at such  
facilities through the completion of    
episodes of care4  7#d7 ,the appropriate
 systemwide access standard applicable  

to hospital care1 medical services1 and 
other health care furnished by and      
through the ,service1 including an      
identification of appropriate access    
standards for each individual specialty 
and post-care rehabilitation4  7#e7 ,the
 workflow process at each medical       
facility of the ,service for scheduling 
appointments to receive hospital care1  
medical services1 or other health care  
from the ,service4  7#f7 ,the           
organization1 workflow processes1 and   
tools used by the ,service to support   
clinical staffing1 access to care1      
effective length-of-stay management and 
care transitions1 positive patient      
experience1 accurate documentation1 and 
subsequent coding of inpatient services4
  7#g7 ,the staffing level at each      
medical facility of the ,service and the
 productivity of each health care       
provider at such medical facility1      
compared with health care industry      
performance metrics1 which may include  
an assessment of any of the following3  

7,a7 ,the case load of1 and number of   
patients treated by1 each health care   
provider at such medical facility during
 an average week4  7,b7 ,the time spent 
by such health care provider on matters 
other than the case load of such health 
care provider4  7,c7 ,the amount of     
personnel used for administration       
compared with direct health care in the 
,service being comparable to the amount 
used for administration compared with   
direct health care in private health    
care institutions4  7,d7 ,the allocation
 of the budget of the ,service used for 
administration compared with the        
allocation of the budget used for direct
 health care at ,service-operated       
facilities4  7,e7 ,any vacancies in     
positions of full-time equivalent       
employees that the ,service-- 7i7 does  
not intend to fill2 or  7ii7 has not    
filled during the #ab-month period      
beginning on the date on which the      
position became vacant4  7,f7 ,the      
disposition of amounts budgeted for     

full-time equivalent employees that is  
not used for those employees because the
 positions of the employees are vacant1 
including--  7i7 whether the amounts are
 redeployed2 and  7ii7 if the amounts   
are redeployed1 how the redeployment is 
determined4  7,g7 ,with respect to the  
approximately #c1gjj                    
,medicaid-reimbursable full-time        
equivalent employees of the ,service--  
7i7 the number of those employees who   
are certified coders2 and  7ii7 whether 
that number of employees is necessary4  
7#h7 ,the information technology        
strategies of the ,service with respect 
to furnishing and managing health care1 
including an identification of any      
weaknesses and opportunities with       
respect to the technology used by the   
,service1 especially those strategies   
with respect to clinical documentation  
of episodes of hospital care1 medical   
services1 and other health care1        
including any clinical images and       
associated textual reports1 furnished by

 the ,service in ,service or            
non-,service facilities4  7#i7 ,business
 processes of the ,service1 including   
processes relating to furnishing        
non-,service health care1 insurance     
identification1 third-party revenue     
collection1 and vendor reimbursement1   
including an identification of          
mechanisms as follows3  7,a7 ,to avoid  
the payment of penalties to vendors4    
7,b7 ,to increase the collection of     
amounts owed to the ,service for        
hospital care1 medical services1 or     
other health care provided by the       
,service for which reimbursement from a 
third party is authorized and to ensure 
that such amounts collected are         
accurate4  7,c7 ,to increase the        
collection of any other amounts owed to 
the ,service with respect to hospital   
care1 medical services1 and other health
 care and to ensure that such amounts   
collected are accurate4  7,d7 ,to       
increase the accuracy and timeliness of 
,service payments to vendors and        

providers4  7#aj7 ,the purchasing1      
distribution1 and use of                
pharmaceuticals1 medical and surgical   
supplies1 medical devices1 and health   
care related services by the ,service1  
including the following3  7,a7 ,the     
prices paid for1 standardization of1 and
 use by the ,service of1 the following3 
7i7 ,pharmaceuticals4  7ii7 ,medical and
 surgical supplies4  7iii7 ,medical     
devices4  7,b7 ,the use by the ,service 
of group purchasing arrangements to     
purchase pharmaceuticals1 medical and   
surgical supplies1 medical devices1 and 
health care related services4  7,c7 ,the
 strategy and systems used by the       
,service to distribute pharmaceuticals1 
medical and surgical supplies1 medical  
devices1 and health care related        
services to medical facilities of the   
,service4  7#aa7 ,the process of the    
,service for carrying out construction  
and maintenance projects at medical     
facilities of the ,service and the      
medical facility leasing program of the 

,service1 including--  7,a7 whether the 
maintenance budget is updated or        
increased to reflect increases in       
maintenance costs with the addition of  
new facilities and whether any increase 
is sufficient to support the growth of  
the facilities2 and  7,b7 what the      
process is for facilities that reach the
 end of their proposed life cycle4      
7#ab7 ,the competency of leadership with
 respect to culture1 accountability1    
reform readiness1 leadership            
development1 physician alignment1       
employee engagement1 succession         
planning1 and performance management1   
including--  7,a7 the reasons for a lack
 in transparency in the culture of the  
,service1 leading tribal leadership to  
request increased transparency and more 
open communication between the ,service 
and the people served by the ,service2  
and  7,b7 whether any checks and        
balances exist to assess potential fraud
 or misuse of amounts within the        
,service4  7#ac7 ,the lack of a funding 

formula to distribute base funding to   
the #ab ,service areas1 including the   
following3  7,a7 ,the establishment of  
the current process of funding being    
distributed based on historical         
allocations and not on need such as     
population growth1 number of facilities1
 etc4  7,b7 ,how the implementation of  
self-governance policies has impacted   
health care delivery4  7,c7 ,the        
communication to area office directors  
on distribution decisionmaking4  7,d7   
,how the tribal and residual shares are 
determined for each ,indian tribe and   
the amounts of those shares4  7,e7 ,the 
auditing or evaluation process used by  
the ,service to determine whether       
amounts are distributed and expended    
appropriately1 including--  7i7 whether 
periodic or end-of-year records document
 the actual distributions2 and  7ii7    
whether any auditing or evaluation is   
conducted in accordance with generally  
accepted accounting principles or other 
appropriate practices4  7#ad7 ,whether  

the ,service tracks patients eligible   
for two or more of either the ,medicaid 
program under title ,,xix of the ,social
 ,security ,act 7#db ,u4,s4,c4 #acif et 
seq471 health care received through the 
,service1 or any other ,federal health  
care program 7referred to in this       
section as dual eligible patients74 ,if 
so1 how dual eligible patients are      
managed4  7#ae7 ,the number of          
procurement contracts entered into and  
awards made by the ,service under       
section #bc of the ,act of ,june #be1   
#aiaj 7commonly known as the ,buy       
,indian ,act7 7#be ,u4,s4,c4 #dg71 and a
 comparison of that number1 with--  7,a7
 the total number of procurement        
contracts entered into and awards made  
by the ,service during the #e fiscal    
years prior to the date of enactment of 
this ,act2 and  7,b7 the process used by
 the ,service facilities to ensure      
compliance with section #bc of the ,act 
of ,june #be1 #aiaj 7commonly known as  
the ,buy ,indian ,act7 7#be ,u4,s4,c4   

#dg74  7#af7 ,any other items the       
reputable private entity determines     
should be addressed in the independent  
assessment of the ,service4  7e7 ,report
 on assessment  7#a7 ,submission to     
secretary ,not later than #bdj days     
after the date a contract is entered    
into under subsection 7b71 the entity   
carrying out the assessment under the   
contract shall--  7,a7 complete the     
assessment2 and  7,b7 submit to the     
,secretary a report describing the      
findings and recommendations of the     
entity with respect to the assessment4  
7#b7 ,submission to congress            
,immediately on receipt of the report   
under paragraph 7#a77;,b71 the          
,secretary shall submit the report to-- 
7,a7 the appropriate committees of      
,congress1 including-- 7i7 the          
,committee on ,appropriations of the    
,senate2 and  7ii7 the ,committee on    
,appropriations of the ,house of        
,representatives2  7,b7 the ,majority   
,leader of the ,senate2  7,c7 the       

,minority ,leader of the ,senate2  7,d7 
the ,speaker of the ,house of           
,representatives2 and  7,e7 the         
,minority ,leader of the ,house of      
,representatives4  7#c7 ,publication    
,not later than #cj days after receiving
 the report under paragraph 7#a77;,b71  
the ,secretary shall publish such report
 in the ,federal ,register and on an    
,internet website of the ,service that  
is accessible to the public4  7f7       
,funding ,the ,secretary shall use1 to  
carry out this section1 such amounts as 
are necessary from other amounts        
available to the ,secretary that are not
 otherwise obligated4