,,ii #aagth ,,congress #b;d ,session ,s4 #diae ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #ba1 #bjbb,mr4 ,barrasso 7for himself1 ,mr4 ,thune1 ,ms4 ,lummis1 ,mr4 ,rounds1 ,mr4 ,daines1 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 #bjbb4 #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 ,improved authorities of secretary to improve accountability of senior executives and employees of the ,indian ,health ,service4,sec4 #ajg4 ,tribal culture and history4,sec4 #ajh4 ,staffing demonstration program4,sec4 #aji4 ,rule establishing ,tribal consultation policy4,sec4 #aaj4 ,treatment of certain hospitals4,sec4 #aaa4 ,enhancing quality of care in the ,indian ,health ,service4,sec4 #aab4 ,notification of investigation regarding professional conduct2 submission of records4,sec4 #aac4 ,medical chaperones2 ,office of ,patient ,advocacy4,sec4 #aad4 ,fitness of health care providers4,sec4 #aae4 ,standards to improve timeliness of care4,,title ,,ii--,employee protections,sec4 #bja4 ,employee protections against retaliation4,sec4 #bjb4 ,right of ,federal employees to petition ,congress4,sec4 #bjc4 ,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 ,,ihs health care workforce personnel and pay system ,the ,secretary shall establish a personnel and pay system for physicians1 dentists1 nurses1 and other health care professionals employed by the ,service that provides a personnel and pay system 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 ,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 #bjbb1 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 area 7as defined in section #ccb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a777 with the greatest staffing need2 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 the program is established4 7#c7 ,reports ,not later than #a year after the date on which a program established under paragraph 7#a7 is terminated in accordance with paragraph 7#b71 the ,secretary shall submit to ,congress a report describing1 with respect to that program-- 7,a7 the costs of the program2 7,b7 employee uptake of the program2 and 7,c7 the effects of the program on local facility staffing needs4 7c7 ,administration ,the ,secretary may only provide a benefit under subsection 7b7 to-- 7#a7 a full-time employee who agrees to serve for not less than #a year in the ,service 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 seq47 7as amended by section #aja7 is amended by adding at the end the following3 #abf4 ,medical credentialing system 7a7 ,in general 7#a7 ,development and implementation timeline ,not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 the ,secretary1 acting through the ,service 7referred to in this section as the ,secretary71 in accordance with 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 7#b7 ,implementation ,in implementing the credentialing system1 the ,secretary-- 7,a7 shall not require re-credentialing of licensed health professionals who were credentialed using existing ,service policy prior to the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb2 and 7,b7 shall-- 7i7 use the credentialing system for-- 7,i7 all applications for credentialing or re-credentialing of licensed health professionals submitted on or after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb2 and 7,,ii7 the migration into the credentialing system of credentials data that existed prior to implementation of the credentialing system2 and 7ii7 maintain the established timeline for re-credentialing of licensed health professionals who were credentialed prior to implementation of the credentialing system1 as defined by ,service policy4 7b7 ,requirements 7#a7 ,in general ,in developing the credentialing system under subsection 7a71 the ,secretary shall ensure that-- 7,a7 credentialing procedures shall be uniform throughout the ,service2 and 7,b7 with respect to each licensed health professional who successfully completes the credentialing procedures of the credentialing system1 the ,secretary may authorize the licensed health professional to provide health care services at any ,service unit4 7#b7 ,exemption ,the requirements described in paragraph 7#a7 shall not apply to licensed health professionals who were credentialed using existing ,service policy prior to the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb until the date on which those licensed health professionals are required to be re-credentialed in accordance with the credentialing system developed and implemented under subsection 7a74 7c7 ,consultation ,in developing the credentialing system under subsection 7a71 the ,secretary-- 7#a7 shall consult with ,indian tribes2 and 7#b7 may consult with-- 7,a7 any public or private association of medical providers2 7,b7 any government agency2 or 7,c7 any other relevant expert1 as determined by the ,secretary4 7d7 ,application 7#a7 ,in general ,subject to paragraph 7#b71 a licensed health care professional may not provide health care services at any ,service unit1 unless the licensed health care professional successfully completes the credentialing procedures of the credentialing system developed and implemented under subsection 7a74 7#b7 ,exemption ,paragraph 7#a7 shall not apply to licensed health professionals who were credentialed using existing ,service policy prior to the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb until the date on which those licensed health professionals are required to be re-credentialed in accordance with the credentialing system developed and implemented under subsection 7a74 7e7 ,nonduplication of efforts 7#a7 ,in general ,to the extent that prior to the deadline described in subsection 7a77#a71 the ,service has begun implementing or has completed implementation of a medical credentialing system that otherwise meets the requirements of this section1 the ,service shall not be required to establish a new credentialing system under this section4 7#b7 ,authority ,the ,service may expand or enhance an existing credentialing system to meet the requirements of this section4 7#c7 ,review 7,a7 ,in general ,not less frequently than once every #e years1 the ,service shall-- 7i7 undertake a formal review of the credentialing system in effect on the date of the review2 and 7ii7 if necessary1 take action to bring the credentialing system into compliance with the requirements of this section4 7,b7 ,consultation ,each formal review conducted under subparagraph 7,a7 shall be subject to the consultation requirements under subsection 7c74 7f7 ,effect ,nothing in this section-- 7#a7 negatively impacts the right of an ,indian tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecja et seq472 or 7#b7 applies to such a compact or contract unless expressly agreed to by the ,indian tribe4 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 licensed1 certified1 credentialed1 and privileged in accordance with ,service policy and 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 7,a7 ,in general ,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,b7 ,inclusion ,in this subsection1 the term ,service unit includes an urban ,indian organization with which the ,indian ,health ,service has entered into a contract with1 or to which the ,indian ,health ,service has made a grant1 under title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq474 7#f7 ,effect ,nothing in this subsection-- 7,a7 negatively impacts the right of an ,indian tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd et seq472 or 7,b7 applies to such a compact or contract unless expressly agreed to by the ,indian tribe4 7#g7 ,effective dates 7,a7 ,in general ,except as provided in subparagraph 7,b71 this subsection shall take effect on ,october #a1 #bjbb4 7,b7 ,regulations1 applications1 and reports ,effective on the date of the enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 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 in subsection 7b77#a71 by striking subparagraph 7,b7 and inserting the following3 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 master's 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 the license or certification is necessary for the ,indian health program to which the individual will be assigned2 2 7#b7 in subsection 7f77#a77;,b71 by striking clause 7iii7 and inserting the following3 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 the 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 the 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 in subparagraph 7,b71 by striking 7,b7 ,any arrangement and inserting the following3 7,c7 ,deadline for repayments ,any arrangement 2 7,b7 subparagraph 7,a71 in the second sentence of the matter preceding clause 7i71 by striking ,in making a determination and inserting the following3 7,b7 ,determination of amount of payment ,in making a determination under this paragraph 2 and 7,c7 by striking 7#b77;,a7 ,for each year and all that follows through paragraph 7#a74 and inserting the following3 7#b7 ,authorized ,payments 7,a7 ,amount of payment 7i7 ,full-time practice ,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 the 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 7ii7 ,half-time ,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#a74 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 that title71 a candidate directly to a position within the ,service for which the candidate meets the qualifications standard established by the ,office of ,personnel ,management4 7b7 ,tribal notification 7#a7 ,in general ,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 the ,area office or ,service unit1 as applicable1 of the content of an inclusion in an employment record4 7#b7 ,comment period ,each ,indian tribe that receives notification under paragraph 7#a7 may submit to the ,secretary comments during the #aj-;day period after the date of notification4 4 7b7 ,,ihs waivers ,section #b7;c7 of ,public ,law #if-ace 7#be ,u4,s4,c4 #eaag7;c77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 by striking 7#b7 ,the provisions and inserting the following3 7#b7 ,application to certain individuals ,the provisions 2 7,b7 by inserting or 7#c7 after paragraph 7#a72 and 7,c7 by striking section #aaca7;f7 of the ,education ,amendments of #aigh 7#be ,u4,s4,c4 #bjaa7;f72 #ib ,stat4 #bcbd7 and inserting section #aacb7;f7 of the ,education ,amendments of #aigh 7#be ,u4,s4,c4 #bjab7;f772 7#b7 by striking 7c77#a7 ,notwithstanding and inserting the following3 7c7 ,waiver of applicability in personnel actions 7#a7 ,in general ,notwithstanding 2 and 7#c7 by adding at the end the following3 7#c7 ,,ihs waivers 7,a7 ,in general ,at the request of a concerned ,indian tribe1 the ,secretary of ,health and ,human ,services may seek from each ,indian tribe concerned a waiver of ,indian preference laws for a personnel action that is with respect to-- 7i7 a ,service unit 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 in which-- 7,i7 #ae percent or greater of the total positions are not filled by a full-time employee of the ,indian ,health ,service for a period of #f months or longer2 or 7,,ii7 #ae percent or greater of a specific health professional position are not filled by a full-time employee of the ,indian ,health ,service for a period of #f months or longer2 or 7ii7 a former employee of the ,indian ,health ,service1 or a former ,tribal employee1 who was removed from the employment during1 or demoted for performance or misconduct that occurred during1 the #e-year period following the date of the personnel action4 7,b7 ,limitation ,a waiver may only be requested under subparagraph 7,a7 for a personnel action that is with respect to an employee described in clause 7ii7 of that subparagraph if the reason for the removal or demotion of the employee did not result from an action undertaken by the employee that was reported to the ,national ,practitioner ,data ,bank4 7,c7 ,restriction ,the ,secretary of ,health and ,human ,services may only approve a waiver under subparagraph 7,a7 if the waiver is first requested by a concerned ,indian tribe4 4 #ajf4 ,improved authorities of secretary to improve accountability of senior executives and employees of the ,indian ,health ,service 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #aje7 is amended by adding at the end the following3 #fjf4 ,improved authorities of ,secretary to improve accountability of senior executives of the ,indian ,health ,service 7a7 ,definitions ,in this section3 7#a7 ,covered individual ,the term covered individual means a career appointee 7as defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7#b7 ,misconduct ,the term misconduct includes-- 7,a7 neglect of duty2 7,b7 malfeasance2 7,c7 failure to accept a directed reassignment2 and 7,d7 failure to accompany a position in a transfer of function4 7#c7 ,secretary ,the term ,secretary means the ,secretary1 acting through the ,service4 7#d7 ,senior executive position ,the term senior executive position means a ,senior ,executive ,service position 7as defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7b7 ,authority 7#a7 ,in general ,the ,secretary may1 in accordance with this section1 reprimand1 suspend1 involuntarily reassign1 demote1 or remove a covered individual from a senior executive position at the ,service if the ,secretary determines that the misconduct or performance of the covered individual warrants such an action4 7#b7 ,removal from civil service ,if the ,secretary removes a covered individual pursuant to paragraph 7#a71 the ,secretary may remove the individual from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code74 7c7 ,rights and procedures 7#a7 ,in general ,a covered individual who is the subject of an action or removal1 as applicable1 under subsection 7b7 is entitled-- 7,a7 to advance notice of the action or removal2 7,b7 to access a file containing all evidence in support of the proposed action or removal2 7,c7 to be represented by an attorney or other representative of the covered individual's choice2 and 7,d7 to grieve the decision on the action or removal under paragraph 7#b7 in accordance with the internal grievance process established by the ,secretary under paragraph 7#c74 7#b7 ,notice2 response2 decision 7,a7 ,in general ,the aggregate period for notice1 response1 and decision on an action or removal under subsection 7b7 may not exceed #ae business days4 7,b7 ,response ,a covered individual receiving a notice under paragraph 7#a77;,a7 of an action or removal1 as applicable1 under subsection 7b7 shall have not more than #g business days to respond to the notice4 7,c7 ,decision 7i7 ,in general ,the ,secretary shall issue a decision on an action or removal1 as applicable1 under subsection 7b7 not later than #ae business days after the date on which notice of the action or removal1 as applicable1 is received by the applicable covered individual under paragraph 7#a77;,a74 7ii7 ,requirements ,a decision under clause 7i7-- 7,i7 shall be in writing2 and 7,,ii7 shall include the specific reasons for the decision4 7,d7 ,final and conclusive decision ,a decision under this paragraph that is not grieved under paragraph 7#c7 by the deadline described in that paragraph shall be final and conclusive4 7#c7 ,grievance process 7,a7 ,in general ,the ,secretary shall establish an internal grievance process under which a covered individual may grieve a decision issued under paragraph 7#b7 not later than the date that is #g business days after the date on which the decision under that paragraph was issued4 7,b7 ,total period ,the ,secretary shall issue a decision for which an internal grievance process is initiated under subparagraph 7,a7 not later than #ba business days after the date on which the grievance process is initiated by the covered individual4 7,c7 ,final and conclusive decision ,a grievance decision under this paragraph shall be final and conclusive4 7#d7 ,judicial review ,a covered individual adversely affected by a decision under paragraph 7#b7 that is not grieved1 or by a grievance decision under paragraph 7#c71 may obtain judicial review of the decision4 7#e7 ,court review ,in any case in which judicial review is sought under paragraph 7#d71 the court shall review the record and may set aside any action of the ,department or the ,service found to be-- 7,a7 arbitrary1 capricious1 an abuse of discretion1 or otherwise not in accordance with a provision of law2 7,b7 obtained without procedures required by a provision of law having been followed2 or 7,c7 unsupported by substantial evidence4 7d7 ,relation to other provisions of law ,section #ceib7;b77#a7 of title #e1 ,united ,states ,code1 shall not apply to an action under subsection 7b74 #fjg4 ,improved authorities of ,secretary to improve accountability of employees of the ,indian ,health ,service 7a7 ,definitions ,in this section3 7#a7 ,covered individual 7,a7 ,in general ,the term covered individual means an individual occupying a position at the ,service4 7,b7 ,exclusions ,the term covered individual does not include-- 7i7 an individual occupying a senior executive position 7as defined in section #fjf7;a772 7ii7 an individual who has not completed a probationary or trial period2 or 7iii7 a political appointee4 7#b7 ,grade ,the term grade has the meaning given the term in section #geaa7;a7 of title #e1 ,united ,states ,code4 7#c7 ,misconduct ,the term misconduct includes-- 7,a7 neglect of duty2 7,b7 malfeasance2 7,c7 failure to accept a directed reassignment2 and 7,d7 failure to accompany a position in a transfer of function4 7#d7 ,political appointee ,the term political appointee means an individual who is-- 7,a7 employed in a position described in any of sections #ecab through #ecaf of title #e1 ,united ,states ,code 7relating to the ,executive ,schedule72 7,b7 a limited term appointee1 limited emergency appointee1 or noncareer appointee 7as those terms are defined in section #cacb7;a7 of title #e1 ,united ,states ,code72 or 7,c7 employed in a position of a confidential or policy-determining character under schedule ,c of subpart ,c of part #bac of title #e1 ,code of ,federal ,regulations 7or a successor regulation74 7#e7 ,secretary ,the term ,secretary means the ,secretary1 acting through the ,service4 7#f7 ,suspend ,the term suspend means the placing of an employee1 for disciplinary reasons1 in a temporary status without duties and pay for a period in excess of #ad days4 7b7 ,authority 7#a7 ,in general ,the ,secretary may1 in accordance with this section1 remove1 demote1 or suspend a covered individual from employment at the ,service if the ,secretary determines that the performance or misconduct of the covered individual warrants such an action4 7#b7 ,actions ,if the ,secretary removes1 demotes1 or suspends a covered individual pursuant to paragraph 7#a71 the ,secretary may-- 7,a7 remove the covered individual from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code72 7,b7 demote the covered individual by means of-- 7i7 a reduction in grade for which the covered individual is qualified1 as the ,secretary determines appropriate2 and 7ii7 a reduction of the annual rate of pay of the covered individual2 or 7,c7 suspend the covered individual from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code74 7c7 ,pay of certain demoted individuals 7#a7 ,in general ,notwithstanding any other provision of law1 any covered individual subject to a demotion by means of a reduction in grade under subsection 7b77#b77;,b7 shall1 beginning on the date of the demotion1 receive the annual rate of pay applicable to the reduced grade4 7#b7 ,restrictions 7,a7 ,prohibition on administrative leave ,a covered individual subject to a demotion under subsection 7b77#b77;,b7-- 7i7 may not be placed on administrative leave during the period during which an appeal 7if any7 under this section is ongoing2 and 7ii7 may only receive pay if the covered individual reports for duty or is approved to use accrued unused annual1 sick1 family medical1 military1 or court leave4 7,b7 ,restriction on pay and benefits ,if a covered individual subject to a demotion under subsection 7b77#b77;,b7 does not report for duty 7and has not received approval to use accrued unused leave under subparagraph 7,a77ii771 the covered individual shall not receive pay or other benefits pursuant to subsection 7e77#g74 7d7 ,rights and procedures 7#a7 ,in general ,a covered individual who is the subject of an action or removal1 as applicable1 under subsection 7b7 is entitled-- 7,a7 to advance notice of the action or removal2 7,b7 to access a file containing all evidence in support of the proposed action or removal2 7,c7 to be represented by an attorney or other representative of the covered individual's choice2 and 7,d7 to grieve the decision on the action or removal under paragraph 7#b7 in accordance with the internal grievance process established by the ,secretary under paragraph 7#c74 7#b7 ,notice2 response2 decision 7,a7 ,aggregate period ,the aggregate period for notice1 response1 and a final decision on an action under subsection 7b7 may not exceed #ae business days4 7,b7 ,response ,a covered individual receiving a notice under paragraph 7#a77;,a7 of an action or removal under subsection 7b7 shall have not more than #g business days to respond to the notice4 7,c7 ,final and conclusive decision 7i7 ,in general ,the ,secretary shall issue a final and conclusive decision on an action or removal under subsection 7b7 not later than #ae business days after the date on which the notice of the action is received by the applicable covered individual under paragraph 7#a77;,a74 7ii7 ,requirements ,a decision under clause 7i7-- 7,i7 shall be in writing2 and 7,,ii7 shall include the specific reasons for the decision4 7#c7 ,grievance process 7,a7 ,in general ,the ,secretary shall establish an internal grievance process under which a covered individual may grieve a decision issued under paragraph 7#b7 not later than the date that is #g business days after the date on which the decision under that paragraph was issued4 7,b7 ,total period ,the ,secretary shall issue a decision for which an internal grievance process is initiated under subparagraph 7,a7 not later than #ba business days after the date on which the grievance process is initiated by the covered individual4 7,c7 ,final and conclusive decision ,a grievance decision under this paragraph shall be final and conclusive4 7#d7 ,procedures superseding ,c,b,as ,the procedures under this subsection shall supersede any collective bargaining agreement to the extent that such an agreement is inconsistent with the procedures4 7#e7 ,performance appraisal ,the procedures under chapter #dc of title #e1 ,united ,states ,code1 shall not apply to an action under subsection 7b74 7#f7 ,appeal to merit systems protection board 7,a7 ,in general ,subject to subparagraph 7,b7 and subsection 7e71 any removal1 demotion1 or suspension of more than #ad days under subsection 7b7 may be appealed to the ,merit ,systems ,protection ,board1 which shall refer such appeal to an administrative law judge pursuant to section #ggja7;b77#a7 of title #e1 ,united ,states ,code4 7,b7 ,time period ,an appeal under subparagraph 7,a7 of a removal1 demotion1 or suspension may only be made if the appeal is made not later than #aj business days after the date of the removal1 demotion1 or suspension4 7e7 ,expedited review 7#a7 ,in general ,on receipt of an appeal under subsection 7d77#f77;,a71 the applicable administrative law judge shall-- 7,a7 expedite the appeal under section #ggja7;b77#a7 of title #e1 ,united ,states ,code2 and 7,b7 issue a final and complete decision on the appeal not later than #ahj days after the date of the appeal4 7#b7 ,upholding decision 7,a7 ,in general ,notwithstanding section #ggja7;c77#a77;,b7 of title #e1 ,united ,states ,code1 the administrative law judge shall uphold the decision of the ,secretary to remove1 demote1 or suspend an employee under subsection 7b7 if the decision is supported by substantial evidence4 7,b7 ,prohibition of mitigation ,notwithstanding title #e1 ,united ,states ,code1 or any other provision of law1 if the decision of the ,secretary to remove1 demote1 or suspend an employee under subsection 7b7 is supported by substantial evidence1 the administrative law judge shall not mitigate the penalty prescribed by the ,secretary4 7#c7 ,appeal to merit systems protection board 7,a7 ,in general ,the decision of the administrative law judge under paragraph 7#a7 may be appealed to the ,merit ,systems ,protection ,board4 7,b7 ,upholding decision ,notwithstanding section #ggja7;c77#a77;,b7 of title #e1 ,united ,states ,code1 the ,merit ,systems ,protection ,board shall uphold the decision of the ,secretary to remove1 demote1 or suspend an employee under subsection 7b7 if the decision is supported by substantial evidence4 7,c7 ,prohibition of mitigation ,notwithstanding title #e1 ,united ,states ,code1 or any other provision of law1 if the decision of the ,secretary is supported by substantial evidence1 the ,merit ,systems ,protection ,board shall not mitigate the penalty prescribed by the ,secretary4 7#d7 ,report ,in any case in which an administrative law judge cannot issue a final and complete decision by the deadline described in paragraph 7#a77;,b71 the ,merit ,systems ,protection ,board shall1 not later than #ad business days after the deadline expires1 submit to the appropriate committees of ,congress a report that explains the reasons why a decision was not issued by the deadline4 7#e7 ,appeal ,a decision of the ,merit ,systems ,protection ,board under paragraph 7#c7 may be appealed to the ,united ,states ,court of ,appeals for the ,federal ,circuit pursuant to section #ggjc of title #e1 ,united ,states ,code1 or to any court of appeals of competent jurisdiction pursuant to subsection 7b77#a77;,b7 of that section4 7#f7 ,prohibition against stays ,the ,merit ,systems ,protection ,board may not stay any removal or demotion under subsection 7b71 except as provided in section #abad7;b7 of title #e1 ,united ,states ,code4 7#g7 ,restriction on pay and benefits during appeal 7,a7 ,in general 7i7 ,restriction on pay and benefits ,during the period described in clause 7ii71 a covered individual may not receive any pay and benefits described in subparagraph 7,b74 7ii7 ,period described ,the period referred to in clause 7i7 is the period-- 7,i7 beginning on the date on which a covered individual appeals under this section a removal from the civil service under subsection 7b77#b77;,a72 and 7,,ii7 ending on the later of-- 7aa7 the date on which the ,merit ,systems ,protection ,board issues a final decision on the appeal under paragraph 7#c72 and 7bb7 the date on which the ,united ,states ,court of ,appeals for the ,federal ,circuit issues a final decision on the appeal under paragraph 7#e74 7,b7 ,pay and benefits described ,the pay and benefits referred to in subparagraph 7,a77i7 are any pay1 awards1 bonuses1 incentives1 allowances1 differentials1 student loan repayments1 special payments1 or benefits related to the employment of the individual by the ,service4 7#h7 ,information to expedite appeal ,to the maximum extent practicable1 the ,secretary shall provide to the ,merit ,systems ,protection ,board such information and assistance as may be necessary to ensure an appeal under this subsection is expedited4 7#i7 ,backpay ,if an employee prevails on appeal under this section1 the employee shall be entitled to backpay 7as provided in section #eeif of title #e1 ,united ,states ,code74 7#aj7 ,applicable timelines and procedures ,if an employee who is subject to a collective bargaining agreement chooses to grieve an action taken under this section through a grievance procedure provided under the collective bargaining agreement1 the timelines and procedures described in subsection 7d7 and this subsection shall apply4 7f7 ,alleged prohibited personnel practice ,in the case of a covered individual seeking corrective action 7or on behalf of whom corrective action is sought7 from the ,office of ,special ,counsel based on an alleged prohibited personnel practice described in section #bcjb7;b7 of title #e1 ,united ,states ,code1 the ,secretary may not remove1 demote1 or suspend the covered individual under subsection 7b7 without the approval of the ,special ,counsel under section #abad7;f7 of title #e1 ,united ,states ,code4 7g7 ,termination of investigations by ,office of ,special ,counsel 7#a7 ,in general ,notwithstanding any other provision of law1 the ,special ,counsel established by section #abaa of title #e1 ,united ,states ,code1 may terminate an investigation of a prohibited personnel practice alleged by an employee or former employee of the ,service after the ,special ,counsel provides to the employee or former employee a written statement of the reasons for the termination of the investigation4 7#b7 ,admissibility ,the statement described in paragraph 7#a7 may not be admissible as evidence in any judicial or administrative proceeding without the consent of the employee or former employee described in paragraph 7#a74 7h7 ,vacancies ,in the case of a covered individual who is removed or demoted under subsection 7b71 to the maximum extent practicable1 the ,secretary shall fill the vacancy arising as a result of the removal or demotion4 4 7b7 ,conforming amendments ,section #dcjc7;f7 of title #e1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#c71 by striking or at the end2 7#b7 in paragraph 7#d71 by striking the period at the end and inserting 1 or2 and 7#c7 by adding at the end the following3 7#e7 any removal or demotion under section #fjg of the ,indian ,health ,care ,improvement ,act4 4 7c7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services or the ,inspector ,general of the ,department of ,health and ,human ,services1 as appropriate1 shall submit to ,congress a report that includes information on-- 7#a7 the number of employees of the ,indian ,health ,service who were removed1 demoted1 or suspended during the #a-year period preceding the date of enactment of this ,act2 7#b7 the number of employees of the ,indian ,health ,service who were removed1 demoted1 or suspended during the #a-year period beginning on the date of enactment of this ,act pursuant to the amendments made by this section2 and 7#c7 the appropriate details of any such removals1 demotions1 and suspensions that lend necessary context4 #ajg4 ,tribal culture and history ,section #aac of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;f7 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 healthcare volunteers1 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 ,requirement ,to complete training program ,notwithstanding any other provision of law1 beginning on the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 each employee or provider described in subsection 7a7 who enters into a contract with the ,service shall1 as a condition of employment1 annually participate in and complete the program established under subsection 7a74 4 #ajh4 ,staffing demonstration program ,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 program 7a7 ,in general ,not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 the ,secretary1 acting through the ,service 7referred to in this section as the ,secretary71 shall establish a demonstration program 7referred to in this section as the demonstration program7 under which the ,service may provide ,service units with additional staffing resources1 with the goal that the resources become self-sustaining4 7b7 ,selection ,in selecting ,service units for participation in the demonstration program1 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 or more ,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 ratios1 as determined by the ,secretary1 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 the demonstration program shall be provided for a duration that the ,secretary1 in consultation with the applicable ,indian tribe1 determines appropriate1 on the condition that each staffing position provided shall be for a period of not less than #c fiscal years4 7d7 ,effect of staffing awards ,no staffing resources provided under the demonstration program shall reduce the recurring base funding for staffing for any ,indian tribe or ,service unit4 7e7 ,sunset ,the demonstration program established under subsection 7a7 shall terminate on the date that is #d years after the date on which the demonstration program is established4 7f7 ,report ,not later than #a year after the date on which the demonstration program terminates under subsection 7e71 the ,secretary shall submit to the ,committee on ,indian ,affairs and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,natural ,resources and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report describing the demonstration program1 including information on-- 7#a7 whether the staffing resources provided under the demonstration program resulted in additional revenue for the applicable ,service unit sufficient to maintain the staff on a permanent basis2 7#b7 the levels to which the staffing resources provided under the demonstration program reduced the unmet staffing need for the applicable ,service unit2 and 7#c7 whether the demonstration program could be deployed permanently to reduce unmet staffing needs throughout the ,service4 4 #aji4 ,rule establishing ,tribal consultation policy ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #ajh7 is amended by adding at the end the following3 #hcd4 ,rule establishing ,tribal consultation policy 7a7 ,in ,general ,not later than ,december #ca1 #bjbc1 the ,secretary shall establish1 and once every #e years thereafter1 the ,secretary shall update1 after meaningful consultation with representatives of affected ,indian tribes1 a rule establishing a ,tribal consultation policy for the ,service4 7b7 ,contents of tribal consultation policy ,the policy established under the rule under subsection 7a7 shall-- 7#a7 update1 and replace1 the ,tribal consultation policy established under ,circular ,no4 #bjjf-ja of the ,service 7or any successor policy72 and 7#b7 include-- 7,a7 a process for determining when and how the ,service will notify ,indian tribes of the availability of meaningful consultation2 7,b7 a determination of which actions or agency decisions by the ,service will trigger a requirement for meaningful consultation with ,indian tribes2 and 7,c7 a determination of which actions constitute meaningful consultation with ,indian tribes4 4 #aaj4 ,treatment of certain hospitals ,the ,parallel ,low-,volume ,hospital ,payment ,adjustment ,regarding ,hospitals ,operated by the ,indian ,health ,services 7,,ihs7 or a ,tribe provisions described in the final rule of the ,centers for ,medicare ,medicaid ,services entitled ,medicare ,program2 ,hospital ,inpatient ,prospective ,payment ,systems for ,acute ,care ,hospitals and the ,long-,term ,care ,hospital ,prospective ,payment ,system and ,policy ,changes and ,fiscal ,year #bjah ,rates2 ,quality ,reporting ,requirements for ,specific ,providers2 ,medicare and ,medicaid ,electronic ,health ,record 7,,ehr7 ,incentive ,program ,requirements for ,eligible ,hospitals1 ,critical ,access ,hospitals1 and ,eligible ,professionals2 ,provider-,based ,status of ,indian ,health ,service and ,tribal ,facilities and ,organizations2 ,costs ,reporting and ,provider ,requirements2 ,agreement ,termination ,notices 7#hb ,fed ,reg4 #cgiij2 #chahh-chahi 7,august #ad1 #bjag771 shall apply with respect to discharges occurring in fiscal year #bjaa and each fiscal year thereafter4 #aaa4 ,enhancing quality of care in the ,indian ,health ,service 7a7 ,,ihcia definitions ,in this section1 the terms ,area office1 ,indian tribe1 ,secretary1 ,service1 ,service unit1 tribal organization1 and ,urban ,indian organization have the meanings given those terms in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7b7 ,best practices for governing board and area office meetings 7#a7 ,definition of governing board ,in this subsection1 the term governing board means the governing board of the facility of a ,service unit4 7#b7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 in consultation with ,indian tribes1 governing boards1 ,area offices1 ,service units1 and other stakeholders1 as determined appropriate by the ,secretary1 shall establish-- 7,a7 in accordance with paragraph 7#c77;,a71 best practices for governing boards2 and 7,b7 in accordance with paragraph 7#c77;,b71 best practices for ,area offices4 7#c7 ,requirements 7,a7 ,governing board best practices ,the best practices for governing boards established under paragraph 7#b77;,a7 shall include provisions relating to-- 7i7 adequately monitoring the delivery of care at the applicable facility managed by the governing board2 7ii7 ensuring ongoing facility compliance with ,federal health care program requirements1 including requirements of the ,service and the ,centers for ,medicare ,medicaid ,services2 7iii7 handling1 documenting1 and responding to patient complaints2 7iv7 documenting1 addressing1 and1 if applicable1 reporting instances of professional misconduct by facility staff in accordance with applicable ,federal and ,state law2 7v7 improving facility performance and operations with respect to mandatory and voluntary quality initiatives carried out by the ,service and the ,centers for ,medicare ,medicaid ,services2 and 7vi7 reporting requirements under ,federal law1 including with respect to-- 7,i7 the ,government ,performance and ,results ,act of #aiic 7,public ,law #ajc-fb2 #ajg ,stat4 #bhe71 the ,,gpra ,modernization ,act of #bjaj 7,public ,law #aaa-ceb2 #abd ,stat4 #chff71 and the amendments made by those ,acts2 and 7,,ii7 the applicable provisions of titles ,,xviii and ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq474 7,b7 ,area office best practices ,the best practices for ,area offices established under paragraph 7#b77;,b7 shall include provisions relating to-- 7i7 strategies for how to best monitor governing board activities relating to the oversight of-- 7,i7 delivery and quality of patient care2 7,,ii7 documenting and responding to patient complaints and instances of professional misconduct2 and 7,,iii7 facility compliance with ,federal health care program requirements1 including requirements of the ,service and the ,centers for ,medicare ,medicaid ,services2 and 7ii7 connecting governing boards1 including the applicable facilities of those governing boards1 to resources necessary for enhancing patient outcomes and improving facility performance1 including through the use of technical assistance4 7#d7 ,publication ,the best practices established under paragraph 7#b7 shall be-- 7,a7 reported to1 in writing1 as applicable1 all governing boards and ,area offices2 and 7,b7 incorporated into the ,indian ,health ,manual of the ,service4 7c7 ,review of quality and performance measures 7#a7 ,review 7,a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 in coordination with the ,agency for ,healthcare ,research and ,quality1 the ,national ,quality ,forum1 ,indian tribes1 practitioners and administrators of the ,service1 and other qualified experts1 as determined appropriate by the ,secretary1 shall undertake a review of the reported quality and performance measures of ,service facilities conducted by the ,secretary in accordance with-- 7i7 section #cjf of title #e1 ,united ,states ,code2 7ii7 section #aaae7;b7 of title #ca1 ,united ,states ,code2 and 7iii7 any law 7including regulations7 used in any mandatory or voluntary program of the ,centers for ,medicare ,medicaid ,services4 7,b7 ,report ,not later than #f months after the date on which the review required under subparagraph 7,a7 is completed1 the ,secretary shall submit to ,congress a report on the details and findings of that review1 which shall include an assessment of-- 7i7 the suitability of measures used as of the date of enactment of this ,act for the applicable ,service facility1 taking into consideration the patient volume of the facility1 the mix of patient cases at the facility1 the geographic location of the facility1 and medical professional shortage designations at the facility1 as determined by the ,secretary2 and 7ii7 the extent to which the performance and quality measures are outcome-based or process-based measures4 7#b7 ,adoption ,not later than #a year after the date on which the report required under paragraph 7#a77;,b7 is submitted to ,congress1 the ,service1 in coordination with the ,centers for ,medicare ,medicaid ,services1 shall adopt1 and assist ,service facilities to adopt1 to the extent practicable1 more suitable1 as compared to those quality and performance measures adopted prior to the submission of that report1 quality and performance measures1 including measures that are more outcome-based and process-based1 in accordance with the factors described in paragraph 7#a77;,b77i74 7#c7 ,,gao report ,not later than #a year after the date on which the report required under paragraph 7#a77;,b7 is submitted to ,congress1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on challenges relating to quality measure and data collection in ,service facilities1 which shall include-- 7,a7 barriers to the adoption of relevant performance and quality measures in ,service facilities2 and 7,b7 recommendations for how the ,service1 other ,federal agencies1 and stakeholders can assist ,service facilities in adopting suitable quality and performance measures4 7d7 ,compliance assistance program 7#a7 ,definitions ,in this subsection3 7,a7 ,administrator ,the term ,administrator means the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7,b7 ,eligible facility 7i7 ,in general ,the term eligible facility means a facility operated by the ,service that-- 7,i7 is an underperforming hospital or outpatient facility2 and 7,,ii7 is eligible for payments under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7ii7 ,inclusion ,the term eligible facility includes a tribally operated facility1 if that facility consents to participating in the program4 7,c7 ,program ,the term program means the compliance assistance program established under paragraph 7#b74 7,d7 ,tribally operated facility ,the term tribally operated facility means a facility operated by an ,indian tribe1 a tribal organization1 or an ,urban ,indian organization that-- 7i7 is an underperforming hospital or outpatient facility2 and 7ii7 is eligible for payments under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#b7 ,establishment of program ,not later than #a year after the date of enactment of this ,act1 the ,secretary1 in coordination with the ,administrator and quality improvement organizations having a contract with the ,secretary under part ,b of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq471 shall establish a compliance assistance program for eligible facilities4 7#c7 ,methodology ,the ,secretary shall establish a methodology for determining which eligible facilities shall participate in the program1 which shall take into account the following factors3 7,a7 ,the number and severity of facility deficiencies with respect to applicable requirements under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7,b7 ,the history of provider misconduct or patient harm at the facility4 7,c7 ,whether there is high staff turnover at the facility4 7,d7 ,whether the facility has low performance on program quality measures1 relative to other facilities of the ,service1 in accordance with reported quality and performance measures conducted by the ,secretary in accordance with-- 7i7 section #cjf of title #e1 ,united ,states ,code2 7ii7 section #aaae7;b7 of title #ca1 ,united ,states ,code2 and 7iii7 any law 7including regulations7 used in any mandatory or voluntary program of the ,centers for ,medicare ,medicaid ,services4 7#d7 ,selection of facilities 7,a7 ,in general ,the ,secretary1 in coordination with the ,administrator1 shall select not less than #be percent of the eligible facilities to participate in the program using the methodology established under paragraph 7#c74 7,b7 ,participation 7i7 ,in general ,an eligible facility selected to participate in the program under subparagraph 7,a7 shall be required to participate in the program4 7ii7 ,requirement ,the ,secretary shall ensure that1 at all times during the period beginning on the date of establishment of the program and the date on which the program terminates under paragraph 7#h71 not less than #be percent of eligible facilities are participating in the program4 7,c7 ,term of participation 7i7 ,in general ,subject to clause 7ii71 an eligible facility selected to participate in the program under subparagraph 7,a7 shall participate in the program for a period of #b years4 7ii7 ,waiver ,if the ,secretary1 in coordination with the ,administrator1 certifies that an eligible facility participating in the program has improved on its performance to a satisfactory level1 as determined by the ,secretary1 then the eligible facility does not have to participate in the program for the full #b-year period4 7,d7 ,participation limit ,an eligible facility may participate in the program for more than #a #b-year period4 7#e7 ,program components ,the program shall provide on-site consultation and educational programming for eligible facilities to ensure those eligible facilities are-- 7,a7 meeting ,federal requirements of the ,service and any conditions of participation applicable under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7,b7 satisfactorily implementing any quality initiatives and programs established by the ,service or the ,centers for ,medicare ,medicaid ,services4 7#f7 ,enforcement or noncompliance actions 7,a7 ,in general ,the program shall be conducted independently of any enforcement actions under the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afja et seq47 or noncompliance actions taken by the ,administrator with respect to noncompliance with conditions of participation applicable under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 unless1 while carrying out the program1 the ,secretary or the ,administrator1 as applicable1 encounters a triggering event1 as determined by the ,secretary or the ,administrator1 as applicable1 that would necessitate an enforcement action or noncompliance action4 7,b7 ,triggering event encountered ,if a triggering event is encountered by the ,secretary or ,administrator under subparagraph 7,a71 the eligible facility shall continue to participate in the program so long as the facility-- 7i7 remains eligible for payments under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7ii7 continues to meet all of the conditions and requirements for such payments which are applicable under such title4 7#g7 ,implementation ,the ,secretary shall carry out the program in coordination with quality improvement organizations having a contract with the ,secretary under part ,b of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq474 7#h7 ,sunset ,the program shall terminate #f years after the date on which the program is established4 7#i7 ,report ,not later than #a year after the date on which the program terminates under paragraph 7#h71 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report evaluating the effectiveness of the program1 which shall include1 to the extent practicable-- 7,a7 detailed data on changes in the patient experience at eligible facilities that participated in the program2 7,b7 a description of the compliance status of eligible facilities that participated in the program with requirements of the ,service and any conditions of participation applicable under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7,c7 a description of the progress by eligible facilities that participated in the program in meeting the goals of quality improvement activities of the ,department of ,health and ,human ,services4 #aab4 ,notification of investigation regarding professional conduct2 submission of records ,title ,,viii of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afga et seq47 7as amended by section #aji7 is amended by adding at the end the following3 #hce4 ,notification of investigation regarding professional conduct2 submission of records 7a7 ,report ,not later than #ad calendar days after the date on which the ,service undertakes an investigation into the professional conduct of a licensee of a ,state1 the ,secretary1 acting through the ,service1 shall notify the relevant ,state medical board of the investigation4 7b7 ,submission of records ,not later than #ad calendar days after the date on which the ,service generates records relating to an investigation conducted by the ,service into the professional conduct of a licensee of a ,state1 the ,secretary1 acting through the ,service1 shall provide the records to the relevant ,state medical board4 4 #aac4 ,medical chaperones2 ,office of ,patient ,advocacy 7a7 ,medical chaperones ,title ,,ii of the ,indian ,health ,care ,improvement ,act is amended by inserting after section #bbc 7#be ,u4,s4,c4 #afbav7 the following3 #bbd4 ,medical chaperones 7a7 ,indian ,health ,service 7#a7 ,in general ,the ,secretary1 acting through the ,service1 shall1 at the request of a patient of the ,service1 provide to the patient a medical chaperone1 to be present during any medical examination of the patient provided by or through the ,service4 7#b7 ,requirements ,the ,secretary1 acting through the ,service1 shall-- 7,a7 notify patients of the ,service of the right to have a medical chaperone present during a medical examination provided by or through the ,service2 and 7,b7 ensure that the right described in subparagraph 7,a7 is provided to each patient in each ,service unit4 7b7 ,other providers of services ,an ,indian tribe1 tribal organization1 or any other ,indian health program may use amounts made available under this ,act to provide1 at the request of a patient to whom the ,indian tribe1 tribal organization1 or ,indian health program is providing health care services1 a medical chaperone to the patient1 to be present during any medical examination of the patient provided by the ,indian tribe or tribal organization4 4 7b7 ,indian ,health ,service ,office of ,patient ,advocacy ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #ajf7 is amended by adding at the end the following3 #fjh4 ,office of ,patient ,advocacy 7a7 ,definitions ,in this section3 7#a7 ,director ,the term ,director means the ,director of the ,office4 7#b7 ,office ,the term ,office means the ,office of ,patient ,advocacy established by subsection 7b74 7b7 ,establishment ,there is established within the ,department an office1 to be known as the ,office of ,patient ,advocacy4 7c7 ,director ,the ,office shall be headed by a ,director1 who shall-- 7#a7 be appointed by the ,secretary from among individuals qualified to perform the duties of the position2 and 7#b7 report directly to the ,secretary4 7d7 ,duties 7#a7 ,in general ,the ,office shall carry out a patient advocacy program of the ,service1 under which the ,office shall-- 7,a7 employ patient advocates to advocate on behalf of ,indians with respect to health care services sought or received through the ,service2 7,b7 provide to those patient advocates training to ensure the advocates carry out the responsibilities described in paragraph 7#b72 and 7,c7 in as many prominent locations as the ,director determines to be appropriate to be seen by the largest percentage of patients and family members of patients at each ,service unit1 display-- 7i7 the purposes of the patient advocacy program2 7ii7 the contact information for a patient advocate employed at the ,service unit2 and 7iii7 a description of the rights and responsibilities of patients and family members of patients at the ,service unit4 7#b7 ,patient advocate responsibilities ,the responsibilities of a patient advocate employed by the ,office shall include the following3 7,a7 ,resolving any complaints by ,indian patients with respect to health care services provided by or through the ,service that cannot be resolved at-- 7i7 the point of service2 or 7ii7 a higher level easily accessible to the patient4 7,b7 ,expressing to ,indians their rights and responsibilities as patients in receiving health care services through the ,service4 7,c7 ,presenting at various meetings1 and to various committees1 a description of any issues experienced by ,indians in receiving health care services through the ,service4 7,d7 ,managing a patient advocate tracking system1 if applicable4 7,e7 ,compiling data relating to any complaints made to the advocate by ,indians with respect to the receipt of health care services through the ,service1 and the satisfaction of ,indians with those services1 to determine whether there exist any trends in those data4 7,f7 ,ensuring that a process exists for the distribution of data compiled under subparagraph 7,e7 to ,indian health programs1 appropriate leaders1 committees1 and service providers1 and staff of the ,service4 7,g7 ,identifying1 not less frequently than quarterly1 opportunities for improvement in the provision of health care services to ,indians by or through the ,service1 including based on complaints by ,indian patients or immediate family members4 7,h7 ,ensuring that any significant complaint by an ,indian patient or family member with respect to health care provided by or through the ,service is brought to the attention of appropriate staff of the ,service or ,indian health program for the purpose of assessing whether further analysis of the problem is required at the ,service1 ,service area1 ,service unit1 or ,indian health program level4 7,i7 ,supporting any other patient advocacy programs carried out by the ,department4 7,j7 ,ensuring that all appeals and final decisions with respect to the receipt of health care services through the ,service are entered into a patient advocate tracking system of the ,office1 if applicable4 7,k7 ,understanding all laws1 directives1 and other rules relating to the rights and responsibilities of ,indians in receiving health care services through the ,service1 including the appeals processes available to ,indian patients and immediate family members4 7,l7 ,ensuring that ,indians receiving behavioral health services under title ,,vii 7and any surrogate decisionmakers for such ,indians7 are aware of the right of ,indians-- 7i7 to seek representation from systems established under section #ajc of the ,protection and ,advocacy for ,mentally ,ill ,individuals ,act of #aihf 7#db ,u4,s4,c4 #ajhjc72 7ii7 to protect and advocate for the rights of ,indians experiencing behavioral health issues2 and 7iii7 to investigate incidents of abuse and neglect of ,indians experiencing behavioral health issues4 7,m7 ,achieving compliance with any applicable requirements established by the ,secretary with respect to the inspection of controlled substances 7as defined in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb774 7,n7 ,documenting potentially threatening behavior and reporting that behavior to the appropriate authorities4 7#c7 ,training ,the ,director shall ensure that the training provided to patient advocates under paragraph 7#a77;,b7 is consistent throughout the ,office1 including with respect to any mandatory training or certification standards approved by the ,director4 4 #aad4 ,fitness of health care providers 7a7 ,in general ,title ,,viii of the ,indian ,health ,care ,improvement ,act is amended by inserting after section #hjb 7#be ,u4,s4,c4 #afgb7 the following3 #hjc4 ,fitness of health care providers 7a7 ,additional requirements for hiring of health care providers by ,service ,as part of the hiring process for each health care provider position at the ,service after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 the ,director shall require from the medical board of each ,state in which the health care provider has or had a medical license-- 7#a7 information on any violation of the requirements of the medical license of the health care provider during the #bj-year period ending on the date on which the health care provider is being considered for a position at the ,service2 and 7#b7 information on whether the health care provider has entered into any settlement agreement for a disciplinary charge relating to the practice of medicine by the health care provider4 7b7 ,provision of information on ,service health care providers to ,state medical boards ,notwithstanding section #eeb;a of title #e1 ,united ,states ,code1 with respect to each health care provider of the ,service who has violated a requirement of the medical license of the health care provider1 the ,director shall provide to the medical board of each ,state in which the health care provider is licensed detailed information with respect to the violation1 regardless of whether the medical board has formally requested that information4 4 7b7 ,report on compliance by ,indian ,health ,service with reviews of health care providers leaving ,service or transferring to other facilities ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,indian ,health ,service shall submit to the ,committee on ,indian ,affairs of the ,senate and the ,committee on ,natural ,resources of the ,house of ,representatives a report on the compliance by the ,indian ,health ,service with the policy of the ,indian ,health ,service-- 7#a7 to conduct a review of each health care provider of the ,indian ,health ,service who transfers to another medical facility of the ,indian ,health ,service1 resigns1 retires1 or is terminated to determine whether there are any concerns1 complaints1 or allegations of violations relating to the medical practice of the health care provider2 and 7#b7 to take appropriate action with respect to any concern1 complaint1 or allegation described in paragraph 7#a74 #aae4 ,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 ,regulations 7#a7 ,in general ,not later than #ahj days after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 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 7#b7 ,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 paragraph 7#a77;,a74 7b7 ,annual reports 7#a7 ,in general ,not later than #a year after the date of enactment of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb1 and annually thereafter1 each ,area office shall submit to the ,secretary a report on the metrics reported by ,service units relating to the timeliness of the provision of health care services in ,service facilities within each ,service unit4 7#b7 ,publication ,the ,secretary shall make each report received under paragraph 7#a7 publicly available on the website of the ,service4 4 ,,ii ,employee protections #bja4 ,employee protections against retaliation 7a7 ,in general ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #aac7;b77 is amended by adding at the end the following3 #fji4 ,employee protections against retaliation 7a7 ,definitions ,in this section3 7#a7 ,information ,the term information means information-- 7,a7 the disclosure of which is not specifically prohibited by law2 and 7,b7 that is not specifically required by ,executive order to be kept secret in the interest of national defense or the conduct of foreign affairs4 7#b7 ,retaliation ,the term retaliation1 with respect to a whistleblower1 means-- 7,a7 an adverse employment action against the whistleblower2 7,b7 a significantly adverse action against the whistleblower1 such as the refusal or delay of care provided through the ,service2 and 7,c7 an adverse action described in subparagraph 7,a7 or 7,b7 against a family member or friend of the whistleblower4 7#c7 ,whistleblower ,the term whistleblower means an employee of the ,service who discloses information that the employee reasonably believes evidences-- 7,a7 a violation of any law1 rule1 regulation1 or ,service policy2 or 7,b7 gross mismanagement1 a gross waste of funds1 an abuse of authority1 or a substantial and specific danger to public health or safety4 7b7 ,employee accountability 7#a7 ,designated official ,the ,secretary shall designate an official in the ,department who is not an employee of the ,service to receive reports under paragraph 7#b74 7#b7 ,mandatory reporting ,an employee of the ,service who witnesses retaliation against a whistleblower1 a violation of a patient safety requirement1 or other similar conduct shall submit to the official designated under paragraph 7#a7 a report of the conduct4 7#c7 ,oversight ,not later than #c days after the date on which the official designated under paragraph 7#a7 receives a report under paragraph 7#b71 the ,secretary shall-- 7,a7 formally review the report2 and 7,b7 provide a copy of the report and any other relevant information to the ,inspector ,general of the ,department4 7#d7 ,removal for whistleblower retaliation 7,a7 ,in general ,the ,secretary may remove for misconduct from the civil service 7as defined in section #baja of title #e1 ,united ,states ,code71 in accordance with section #fjf or #fjg1 as applicable1 an employee of the ,service if the ,secretary determines1 after completing a review described in paragraph 7#c71 that the employee has retaliated against a whistleblower and warrants removal for misconduct4 7,b7 ,retaliation as misconduct ,retaliation by an employee against a whistleblower1 as described in subparagraph 7,a71 shall be considered to be misconduct for purposes of sections #fjf and #fjg4 7#e7 ,enhancing protections for whistleblowers ,the ,secretary shall carry out any actions determined necessary by the ,secretary to enhance protection for whistleblowers1 including identifying appropriate ,service employees and requiring the employees to complete the ,office of ,special ,counsel's ,whistleblower ,certification ,program4 4 #bjb4 ,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 the following3 7a7 ,in general ,the right of 2 and 7#b7 by adding at the end the following3 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 ,services1 acting through the ,director of the ,indian ,health ,service 7referred to in this subsection as the ,secretary71 shall provide1 in accordance with paragraphs 7#b7 through 7#e71 to each employee of the ,indian ,health ,service notice of the right to petition ,congress under section #gbaa of title #e1 ,united ,states ,code4 7#b7 ,memorandum ,not later than #cj days after the date of enactment of this ,act1 the ,secretary shall submit to the ,inspector ,general of the ,department of ,health and ,human ,services 7referred to in this subsection as the ,inspector ,general7 a memorandum that includes 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 any of 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 ,approval or disapproval 7,a7 ,in general ,not later than #cj days after the date on which the memorandum is submitted under paragraph 7#b71 the ,inspector ,general shall approve or disapprove the memorandum4 7,b7 ,disapproval ,if the ,inspector ,general disapproves the memorandum1 the ,inspector ,general shall advise the ,secretary on what changes to the memorandum are necessary for approval4 7#d7 ,notice ,if the memorandum is approved under paragraph 7#c71 not later than #cj days after the date of the 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 the memorandum in a clear and conspicuous place on the website of the ,indian ,health ,service4 7#e7 ,revised memorandum 7,a7 ,in general ,if the memorandum is disapproved under paragraph 7#c71 not later than #ae days after the date of disapproval1 the ,secretary shall submit to the ,inspector ,general a revised memorandum that incorporates the changes advised under subparagraph 7,b7 of that paragraph4 7,b7 ,approval or disapproval ,not later than #cj days after the date on which the revised memorandum is submitted under subparagraph 7,a71 the ,inspector ,general shall approve the revised memorandum4 7,c7 ,notice ,not later than #cj days after the date on which a revised memorandum is approved under this paragraph1 the ,secretary shall provide notice of the memorandum in accordance with paragraph 7#d74 #bjc4 ,fiscal accountability ,title ,,vi of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affa et seq47 7as amended by section #bja7 is amended by adding at the end the following3 #faj4 ,fiscal accountability 7a7 ,management of funds 7#a7 ,in general ,if the ,secretary fails to submit a professional housing plan under section #cjb7;a7 of the ,restoring ,accountability in the ,indian ,health ,service ,act of #bjbb or a staffing plan under section #cjb7;b7 of that ,act by the applicable deadline1 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 applicable1 is submitted4 7#b7 ,individual described ,an individual referred to in paragraph 7#a7 is an individual employed in the ,service-- 7,a7 in a position that is-- 7i7 described in any of sections #ecab through #ecaf of title #e1 ,united ,states ,code2 7ii7 placed in level ,,iv or ,v of the ,executive ,schedule under section #ecag of title #e1 ,united ,states ,code2 or 7iii7 described in section #bac4ccja or #bac4ccjb of title #e1 ,code of ,federal ,regulations 7or a successor regulation72 or 7,b7 as a limited term appointee1 limited emergency appointee1 or noncareer appointee 7as those terms are defined in section #cacb7;a7 of title #e1 ,united ,states ,code74 7b7 ,prioritization of patient care 7#a7 ,in general ,notwithstanding any other provision of law1 the ,secretary shall use amounts available to the ,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 the 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 the amounts are used to benefit ,indians served by that ,service unit4 7#c7 ,,hhs plan ,each applicable fiscal year1 the ,secretary1 in consultation with ,indian tribes1 shall establish a plan for distributing the amounts described in paragraph 7#a7 across the categories of uses described in subparagraphs 7,a7 through 7,c7 of that paragraph4 7#d7 ,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 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 the change4 7e7 ,effect ,nothing in this section-- 7#a7 negatively impacts the right of an ,indian tribe to enter into a compact or contract under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecja et seq472 or 7#b7 applies to such a compact or contract unless expressly agreed to by the ,indian tribe4 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 7#d7 ,tribal health program ,the term tribal health program 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 7#a7 ,in general ,not later than #a year 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 and employees of tribal health programs that comports with the practices and recommendations of the ,government ,accountability ,office relating to professional housing included in the most recent report of the ,government ,accountability ,office regarding ,indian ,health ,service housing needs4 7#b7 ,requirement ,the plan under paragraph 7#a7 shall include1 at a minimum1 projections for the professional housing needs for-- 7,a7 the #a-year period following the date of the plan2 7,b7 the #e-year period following the date of the plan2 and 7,c7 the #aj-year period following the date of the plan4 7b7 ,plan relating to ,,ihs staffing needs 7#a7 ,in general ,not later than #a year after the date on which the ,government ,accountability ,office releases the report described in subsection 7a71 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 staffing needs of the ,service and tribal health programs that comports with the practices and recommendations of the ,government ,accountability ,office relating to workforce planning included in the report4 7#b7 ,requirement ,the plan under paragraph 7#a7 shall include1 at a minimum1 projections for the staffing needs for-- 7,a7 the #a-year period following the date of the plan2 7,b7 the #e-year period following the date of the plan2 and 7,c7 the #aj-year period following the date of the plan4 #cjc4 ,reports by the ,comptroller ,general 7a7 ,,ihs housing needs report ,not later than #b years 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 that includes-- 7#a7 an assessment of the professional housing plan2 7#b7 an evaluation of any existing1 as of the date of the report1 assessments and projections for the professional housing needs of employees of the ,service and employees of tribal health programs1 including a discussion and conclusions as to whether the existing assessments and projections accurately reflect the professional housing needs of employees of the ,service and employees of tribal health programs2 and 7#c7 an assessment of the professional housing needs of-- 7,a7 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 #afjc772 and 7,b7 employees of tribal health programs for each ,indian tribe1 as applicable4 7b7 ,,ihs staffing needs report 7#a7 ,in general ,not later than #b years after the date on which the ,comptroller ,general receives the plan relating to ,,ihs staffing needs under section #cjb7;b71 the ,comptroller ,general shall prepare and submit to ,congress a report on the staffing needs of the ,service and tribal health programs4 7#b7 ,contents ,the report under paragraph 7#a7 shall include-- 7,a7 an assessment of the staffing plan referred to in paragraph 7#a72 7,b7 a description of-- 7i7 the number and type of full-time positions needed at each facility of the ,service and at each tribal health program2 and 7ii7 the amount of funds necessary to maintain those positions2 7,c7 an explanation of the various methodologies that the ,service uses and has previously used to determine the number and type of full-time positions needed at federally managed ,service units2 and 7,d7 an assessment of the use of independent contractors1 including-- 7i7 the number of independent contractors hired to fill vacant full-time positions2 and 7ii7 the amount of funds spent on independent contractors who provide health care services4 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 ,service1 including the protections implemented pursuant to sections #bja and #bjb and the amendments made by those sections4 7#b7 ,contents ,the report under paragraph 7#a7 shall include-- 7,a7 a discussion and conclusions as to whether the ,service has taken proper steps to prevent retaliation against whistleblowers2 7,b7 if applicable1 any recommendations for changes to the policy of the ,service with respect to whistleblowers2 and 7,c7 a discussion and conclusions 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 not less frequently than every #c 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-- 7,a7 patient harm events and patient deaths occurring in ,service units2 7,b7 deferrals and denials of care of patients of the ,service2 and 7,c7 the standards to improve the timeliness of care1 developed in accordance with section #dab of the ,indian ,health ,care ,improvement ,act 7as added by section #aae71 and quality of care at ,service facilities1 including quality and performance measures developed by the ,secretary in accordance with-- 7i7 section #cjf of title #e1 ,united ,states ,code2 7ii7 section #aaae7;b7 of title #ca1 ,united ,states ,code2 and 7iii7 any law 7including regulations7 used in any mandatory or voluntary program of the ,centers for ,medicare ,medicaid ,services4 7#b7 ,contents ,the report under paragraph 7#a7 shall include-- 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 deaths2 7,b7 an evaluation of how the ,service tracks1 reports1 and responds to patient harm events and patient deaths and recommendations regarding how to improve the tracking1 reporting1 and response2 and 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 of the ,department of ,health and ,human ,services 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 of participating ,indian ,health ,service facilities 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 7a7 ,definitions ,section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc7 is amended-- 7#a7 in paragraph 7#e71 by striking the paragraph designation and heading and all that follows through means and inserting the following3 7#e7 ,purchased_/referred care ,the term purchased_/referred care means 2 and 7#b7 by redesignating paragraph 7#e7 and paragraphs 7#f7 through 7#ae7 as paragraph 7#ae7 and paragraphs 7#e7 through 7#ad71 respectively1 and moving the paragraphs so as to appear in numerical order4 7b7 ,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 it 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 it appears 7regardless of casing and typeface and including in the headings7 and inserting purchased_/referred care 7with appropriate casing and typeface74