,,ii #aafth ,,congress #ast ,session ,s4 #dih ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #ad1 #bjai,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 ,assessment of the ,indian ,health ,service ,act of #bjai4 #b4 ,assessment 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 #ahj 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 ,the ,secretary shall not be required to provide a full and open competition in entering into such contracts4 ,such independent assessment shall be made only of ,service-operated facilities4 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 ,coordination with ,,gao and ,,oig ,as part of planning or designing the assessment described in subsection 7b71 the ,secretary 7or the program integrator designated under subsection 7c77#a7 acting on behalf of the ,secretary7 shall consult with the ,comptroller ,general of the ,united ,states and the ,inspector ,general of the ,department of ,health and ,human ,services to minimize duplications in the areas of study required under subsection 7e7 and to incorporate the ,government ,accountability ,office's and ,office of ,inspector ,general's prior1 publicly released1 and relevant report findings dated ,january #a1 #bjac1 or later1 as appropriate4 7e7 ,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 facilities4 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 providing 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 percentage of ,service personnel carrying out administrative duties compared to direct health care duties1 as compared to the percentage of private health care institution personnel carrying out administrative duties compared to direct health care duties4 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 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 7ii7 how that number of employees compares with health care industry standards for staffing of certified coders2 and 7iii7 how much time is spent on training and participating in continuing education courses once employed by the ,service4 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 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 ,the communication to area office directors on distribution decisionmaking4 7,c7 ,how the tribal and residual shares are determined for each ,indian tribe and the amounts of those shares4 7,d7 ,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 #bjae1 #bjaf1 #bjag1 and #bjah2 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 ,an assessment of the availability of cancer services for populations living on large1 rural ,indian reservations1 individual billing information1 and reimbursement claims of patients4 7#ag7 ,any other items determined to be addressed during the course of the assessment4 7f7 ,report on assessment 7#a7 ,submission to secretary ,not later than #bdj days after the date that 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 7g7 ,funding for independent outside assessment ,the ,secretary shall use such amounts as are necessary from other amounts available to the ,secretary that are not otherwise obligated to fund the contract under subsection 7b74 ,such amounts shall not come from funds available to the ,indian ,health ,service4