,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #dih  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #ad1 #bjai,mr4
 ,r\nds introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,indian ,affairs  ,a ,,bill  ,to provide
 = an indep5d5t outside audit ( !       
,indian ,heal? ,s]vice4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,assessm5t ( 
! ,indian ,heal? ,s]vice ,act ( #bjai4  
#b4 ,assessm5t ( ! ,indian ,heal?       
,s]vice  7a7 ,def9itions ,9 ?is section3
 7#a7 ,reputable private entity ,! t]m  
reputable private entity means a private
 entity t--  7,a7 has exp]i5ce )1 &     
prov5 outcomes 9 optimiz+ ! p]=mance (1 
,f$]al heal? c>e deliv]y sy/ems1 !      
private sector1 & heal? c>e managem5t2 &
  7,b7 specializes 9 implem5t+          
l>ge-scale organizational & cultural    
trans=mations1 especially ) respect to  
heal? c>e deliv]y sy/ems4  7#b7         
,secret>y ,! t]m ,secret>y means !      
,secret>y ( ,heal? & ,human ,s]vices4   
7#c7 ,s]vice ,! t]m ,s]vice means !     

,indian ,heal? ,s]vice4  7b7 ,assessm5t 
,n lat] ?an #ahj days aft] ! date (     
enactm5t ( ?is ,act1 ! ,secret>y %all   
ent] into "o or m contracts ) a         
reputable private entity to conduct an  
indep5d5t assessm5t ( ! heal? c>e       
deliv]y sy/ems & f9ancial managem5t     
processes ( ! ,s]vice4 ,! ,secret>y %all
 n be requir$ to provide a full & op5   
competition 9 ent]+ into su* contracts4 
,su* indep5d5t assessm5t %all be made   
only ( ,s]vice-op]at$ facilities4  7c7  
,program integrator  7#a7 ,9 g5]al ,if !
 ,secret>y ent]s into contracts "u ?is  
section ) m ?an #a reputable private    
sector entity1 ! ,secret>y %all         
designate "o su* entity t is pr$om9antly
 a heal? c>e organization z ! program   
integrator4  7#b7 ,responsibilities ,!  
program integrator designat$ "u p>agraph
 7#a7 %all be responsible = coord9at+ ! 
outcomes ( ! assessm5ts conduct$ by !   
reputable private entities "u ?is       
section4  7d7 ,coord9ation ) ,,gao &    
,,oig ,z "p ( plann+ or design+ !       

assessm5t describ$ 9 subsection 7b71 !  
,secret>y 7or ! program integrator      
designat$ "u subsection 7c77#a7 act+ on 
behalf ( ! ,secret>y7 %all consult ) !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates & !
 ,inspector ,g5]al ( ! ,dep>tm5t (      
,heal? & ,human ,s]vices to m9imize     
duplications 9 ! areas ( /udy requir$ "u
 subsection 7e7 & to incorporate !      
,gov]nm5t ,acc\ntability ,(fice's &     
,(fice ( ,inspector ,g5]al's prior1     
publicly releas$1 & relevant report     
f9d+s dat$ ,janu>y #a1 #bjac1 or lat]1 z
 appropriate4  7e7 ,areas ( /udy ,ea*   
assessm5t conduct$ "u subsection 7b7    
%all address ea* ( ! foll[+3 7#a7       
,curr5t & project$ demographics & unique
 heal? c>e ne$s ( ! pati5t population   
s]v$ by ! ,s]vice4  7#b7 ,curr5t &      
project$ heal? c>e capabilities &       
res\rces ( ! ,s]vice1 includ+ hospital  
c>e1 m$ical s]vices1 & o!r heal? c>e    
furni%$ by non-,s]vice facilities "u    
contract ) ! ,s]vice1 to provide timely 
& accessible c>e to eligible pati5ts4   

7#c7 ,! au?orities & me*anisms "u :i* ! 
,secret>y may furni% hospital c>e1      
m$ical s]vices1 & o!r heal? c>e at      
non-,s]vice facilities4  7#d7 ,!        
appropriate sy/emwide access /&>d       
applicable to hospital c>e1 m$ical      
s]vices1 & o!r heal? c>e furni%$ by &   
?r\gh ! ,s]vice1 includ+ an             
id5tification ( appropriate access /&>ds
 = ea* individual specialty & po/-c>e   
rehabilitation4  7#e7 ,! workfl[ process
 at ea* m$ical facility ( ! ,s]vice =   
provid+ hospital c>e1 m$ical s]vices1 or
 o!r heal? c>e f ! ,s]vice4  7#f7 ,!    
organization1 workfl[ processes1 & tools
 us$ by ! ,s]vice to support cl9ical    
/aff+1 access to c>e1 effective         
l5g?-(-/ay managem5t & c>e transitions1 
positive pati5t exp]i5ce1 accurate      
docum5tation1 & subsequ5t cod+ (        
inpati5t s]vices4  7#g7 ,! /aff+ level  
at ea* m$ical facility ( ! ,s]vice & !  
productivity ( ea* heal? c>e provid] at 
su* m$ical facility1 comp>$ ) heal? c>e 
indu/ry p]=mance metrics1 :i* may       

include an assessm5t ( any ( ! foll[+3  
7,a7 ,! case load (1 & numb] ( pati5ts  
treat$ by1 ea* heal? c>e provid] at su* 
m$ical facility dur+ an av]age week4    
7,b7 ,! "t sp5t by su* heal? c>e provid]
 on matt]s o!r ?an ! case load ( su*    
heal? c>e provid]4  7,c7 ,! p]c5tage (  
,s]vice p]sonnel c>ry+ out adm9i/rative 
duties comp>$ to direct heal? c>e       
duties1 z comp>$ to ! p]c5tage ( private
 heal? c>e in/itution p]sonnel c>ry+ out
 adm9i/rative duties comp>$ to direct   
heal? c>e duties4  7,d7 ,! allocation ( 
! budget ( ! ,s]vice us$ = adm9i/ration 
comp>$ ) ! allocation ( ! budget us$ =  
direct heal? c>e at ,s]vice-op]at$      
facilities4  7,e7 ,any vacancies 9      
positions ( full-"t equival5t employees 
t ! ,s]vice has n fill$ dur+ ! #ab-mon? 
p]iod beg9n+ on ! date on :i* ! position
 became vacant4  7,f7 ,! disposition (  
am\nts budget$ = full-"t equival5t      
employees t is n us$ = ^? employees     
because ! positions ( ! employees are   
vacant1 includ+--  7i7 :e!r ! am\nts are

 r$eploy$2 &  7ii7 if ! am\nts are      
r$eploy$1 h[ ! r$eploym5t is det]m9$4   
7,g7 ,) respect to ! approximately      
#c1gjj ,m$icaid-reimbursable full-"t    
equival5t employees ( ! ,s]vice--  7i7 !
 numb] ( ^? employees :o are c]tifi$    
cod]s2  7ii7 h[ t numb] ( employees     
comp>es ) heal? c>e indu/ry /&>ds =     
/aff+ ( c]tifi$ cod]s2 &  7iii7 h[ mu*  
"t is sp5t on tra9+ & p>ticipat+ 9      
cont9u+ education c\rses once employ$ by
 ! ,s]vice4  7#h7 ,! in=mation te*nology
 /rategies ( ! ,s]vice ) respect to     
furni%+ & manag+ heal? c>e1 includ+ an  
id5tification ( any weaknesses &        
opportunities ) respect to ! te*nology  
us$ by ! ,s]vice1 especially ^?         
/rategies ) respect to cl9ical          
docum5tation ( episodes ( hospital c>e1 
m$ical s]vices1 & o!r heal? c>e1 includ+
 any cl9ical images & associat$ textual 
reports1 furni%$ by ! ,s]vice 9 ,s]vice 
or non-,s]vice facilities4  7#i7        
,bus9ess processes ( ! ,s]vice1 includ+ 
processes relat+ to furni%+ non-,s]vice 

heal? c>e1 insurance id5tification1     
?ird-p>ty rev5ue collection1 & v5dor    
reimbursem5t1 includ+ an id5tification (
 me*anisms z foll[s3  7,a7 ,to avoid !  
paym5t ( p5alties to v5dors4  7,b7 ,to  
increase ! collection ( am\nts ow$ to ! 
,s]vice = hospital c>e1 m$ical s]vices1 
or o!r heal? c>e provid$ by ! ,s]vice = 
:i* reimbursem5t f a ?ird p>ty is       
au?oriz$ & to ensure t su* am\nts       
collect$ are accurate4  7,c7 ,to        
increase ! collection ( any o!r am\nts  
ow$ to ! ,s]vice ) respect to hospital  
c>e1 m$ical s]vices1 & o!r heal? c>e &  
to ensure t su* am\nts collect$ are     
accurate4  7,d7 ,to increase ! accuracy 
& timel9ess ( ,s]vice paym5ts to v5dors 
& provid]s4  7#aj7 ,! pur*as+1          
di/ribution1 & use ( ph>maceuticals1    
m$ical & surgical supplies1 m$ical      
devices1 & heal? c>e relat$ s]vices by !
 ,s]vice1 includ+ ! foll[+3  7,a7 ,!    
prices paid =1 /&>dization (1 & use by !
 ,s]vice (1 ! foll[+3 7i7               
,ph>maceuticals4  7ii7 ,m$ical &        

surgical supplies4  7iii7 ,m$ical       
devices4  7,b7 ,! use by ! ,s]vice (    
gr\p pur*as+ arrangem5ts to pur*ase     
ph>maceuticals1 m$ical & surgical       
supplies1 m$ical devices1 & heal? c>e   
relat$ s]vices4  7,c7 ,! /rategy &      
sy/ems us$ by ! ,s]vice to di/ribute    
ph>maceuticals1 m$ical & surgical       
supplies1 m$ical devices1 & heal? c>e   
relat$ s]vices to m$ical facilities ( ! 
,s]vice4  7#aa7 ,! process ( ! ,s]vice =
 c>ry+ out con/ruction & ma9t5ance      
projects at m$ical facilities ( !       
,s]vice & ! m$ical facility leas+       
program ( ! ,s]vice1 includ+--  7,a7    
:e!r ! ma9t5ance budget is updat$ or    
increas$ to reflect increases 9         
ma9t5ance co/s ) ! addition ( new       
facilities & :e!r any increase is       
suffici5t to support ! gr[? ( !         
facilities2 &  7,b7 :at ! process is =  
facilities t rea* ! end ( _! propos$    
life cycle4  7#ab7 ,! compet5cy (       
lead]%ip ) respect to culture1          
acc\ntability1 re=m read9ess1 lead]%ip  

developm5t1 physician alignm5t1 employee
 engagem5t1 succession plann+1 &        
p]=mance managem5t1 includ+--  7,a7 !   
reasons lead+ tribal lead]%ip to reque/ 
increas$ transp>5cy & m op5             
communication betwe5 ! ,s]vice & ! p    
s]v$ by ! ,s]vice2 &  7,b7 :e!r any     
*ecks & balances exi/ to assess pot5tial
 fraud or misuse ( am\nts )9 ! ,s]vice4 
7#ac7 ,! lack ( a fund+ =mula to        
di/ribute base fund+ to ! #ab ,s]vice   
areas1 includ+ ! foll[+3  7,a7 ,!       
e/abli%m5t ( ! curr5t process ( fund+   
be+ di/ribut$ bas$ on hi/orical         
allocations & n on ne$ su* z population 
gr[?1 numb] ( facilities1 etc4  7,b7 ,! 
communication to area (fice directors on
 di/ribution decisionmak+4  7,c7 ,h[ !  
tribal & residual %>es are det]m9$ = ea*
 ,indian tribe & ! am\nts ( ^? %>es4    
7,d7 ,! audit+ or evaluation process us$
 by ! ,s]vice to det]m9e :e!r am\nts are
 di/ribut$ & exp5d$ appropriately1      
includ+--  7i7 :e!r p]iodic or end-(-ye>
 records docum5t ! actual di/ributions2 

&  7ii7 :e!r any audit+ or evaluation is
 conduct$ 9 accordance ) g5]ally accept$
 acc\nt+ pr9ciples or o!r appropriate   
practices4  7#ad7 ,:e!r ! ,s]vice tracks
 pati5ts eligible = two or m ( ei!r !   
,m$icaid program "u title ,,xix ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq471 heal? c>e receiv$ ?r\gh 
! ,s]vice1 or any o!r ,f$]al heal? c>e  
program 7ref]r$ to 9 ?is section z dual 
eligible pati5ts74 ,if s1 h[ dual       
eligible pati5ts are manag$4  7#ae7 ,!  
numb] ( procurem5t contracts ent]$ into 
& aw>ds made by ! ,s]vice "u section #bc
 ( ! ,act ( ,june #be1 #aiaj 7commonly  
kn[n z ! ,buy ,indian ,act7 7#be        
,u4,s4,c4 #dg71 & a comp>ison ( t numb]1
 )--  7,a7 ! total numb] ( procurem5t   
contracts ent]$ into & aw>ds made by !  
,s]vice dur+ #bjae1 #bjaf1 #bjag1 &     
#bjah2 &  7,b7 ! process us$ by !       
,s]vice facilities to ensure compliance 
) section #bc ( ! ,act ( ,june #be1     
#aiaj 7commonly kn[n z ! ,buy ,indian   
,act7 7#be ,u4,s4,c4 #dg74  7#af7 ,an   

assessm5t ( ! availability ( canc]      
s]vices = populations liv+ on l>ge1     
rural ,indian res]vations1 individual   
bill+ in=mation1 & reimbursem5t claims (
 pati5ts4  7#ag7 ,any o!r items det]m9$ 
to be address$ dur+ ! c\rse ( !         
assessm5t4  7f7 ,report on assessm5t    
7#a7 ,submission to secret>y ,n lat] ?an
 #bdj days aft] ! date t a contract is  
ent]$ into "u subsection 7b71 ! entity  
c>ry+ out ! assessm5t "u ! contract     
%all--  7,a7 complete ! assessm5t2 &    
7,b7 submit to ! ,secret>y a report     
describ+ ! f9d+s & recomm5dations ( !   
entity ) respect to ! assessm5t4  7#b7  
,submission to congress ,imm$iately on  
receipt ( ! report "u p>agraph          
7#a77;,b71 ! ,secret>y %all submit !    
report to--  7,a7 ! appropriate         
committees ( ,congress1 includ+-- 7i7 ! 
,committee on ,appropriations ( !       
,s5ate2 &  7ii7 ! ,committee on         
,appropriations ( ! ,h\se (             
,repres5tatives2  7,b7 ! ,majority      
,lead] ( ! ,s5ate2  7,c7 ! ,m9ority     

,lead] ( ! ,s5ate2  7,d7 ! ,speak] ( !  
,h\se ( ,repres5tatives2 &  7,e7 !      
,m9ority ,lead] ( ! ,h\se (             
,repres5tatives4  7#c7 ,publication ,n  
lat] ?an #cj days aft] receiv+ ! report 
"u p>agraph 7#a77;,b71 ! ,secret>y %all 
publi% su* report 9 ! ,f$]al ,regi/] &  
on an ,int]net website ( ! ,s]vice t is 
accessible to ! public4  7g7 ,fund+ =   
indep5d5t outside assessm5t ,! ,secret>y
 %all use su* am\nts z are necess>y f   
o!r am\nts available to ! ,secret>y t   
are n o!rwise obligat$ to fund !        
contract "u subsection 7b74 ,su* am\nts 
%all n come f funds available to !      
,indian ,heal? ,s]vice4