,,ii #aag? ,,congress #b;d ,session ,s4 #diae ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,septemb] #ba1 #bjbb,mr4 ,b>rasso 7= himself1 ,mr4 ,?une1 ,ms4 ,lummis1 ,mr4 ,r\nds1 ,mr4 ,da9es1 & ,mr4 ,hoev57 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,indian ,affairs ,a ,,bill ,to am5d ! ,indian ,heal? ,c>e ,improvem5t ,act to improve ! recruitm5t & ret5tion ( employees 9 ! ,indian ,heal? ,s]vice1 re/ore acc\ntability 9 ! ,indian ,heal? ,s]vice1 improve heal? s]vices1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb4 #b4 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4,sec4 #b4 ,table ( cont5ts4,,title ,i--,indian ,heal? ,s]vice improvements,sec4 #aja4 ,inc5tives = recruitm5t & ret5tion4,sec4 #ajb4 ,m$ical cr$5tial+ sy/em4,sec4 #ajc4 ,liability protections = heal? pr(essional volunte]s at ,indian ,heal? ,s]vice4,sec4 #ajd4 ,cl>ification reg>d+ eligibility = ,indian ,heal? ,s]vice loan repaym5t program4,sec4 #aje4 ,improvem5ts 9 hir+ practices4,sec4 #ajf4 ,improv$ au?orities ( secret>y to improve acc\ntability ( s5ior executives & employees ( ! ,indian ,heal? ,s]vice4,sec4 #ajg4 ,tribal culture & hi/ory4,sec4 #ajh4 ,/aff+ demon/ration program4,sec4 #aji4 ,rule e/abli%+ ,tribal consultation policy4,sec4 #aaj4 ,treatm5t ( c]ta9 hospitals4,sec4 #aaa4 ,enhanc+ quality ( c>e 9 ! ,indian ,heal? ,s]vice4,sec4 #aab4 ,notification ( inve/igation reg>d+ pr(essional conduct2 submission ( records4,sec4 #aac4 ,m$ical *ap]ones2 ,(fice ( ,pati5t ,advocacy4,sec4 #aad4 ,fitness ( heal? c>e provid]s4,sec4 #aae4 ,/&>ds to improve timel9ess ( c>e4,,title ,,ii--,employee protections,sec4 #bja4 ,employee protections aga9/ retaliation4,sec4 #bjb4 ,"r ( ,f$]al employees to petition ,congress4,sec4 #bjc4 ,fiscal acc\ntability4,,title ,,iii--,reports,sec4 #cja4 ,def9itions4,sec4 #cjb4 ,reports by ! ,secret>y ( ,heal? & ,human ,s]vices4,sec4 #cjc4 ,reports by ! ,comptroll] ,g5]al4,sec4 #cjd4 ,inspector ,g5]al reports4,sec4 #cje4 ,transp>5cy 9 ,,cms surveys4,,title ,,iv--,te*nical amendments,sec4 #dja4 ,te*nical am5dm5ts4 ,i ,indian ,heal? ,s]vice improvem5ts #aja4 ,inc5tives = recruitm5t & ret5tion ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq47 is am5d$ by add+ at ! end ! foll[+3 #abe4 ,inc5tives = recruitm5t & ret5tion 7a7 ,p>ity 9 ,,ihs heal? c>e work=ce p]sonnel & pay sy/em ,! ,secret>y %all e/abli% a p]sonnel & pay sy/em = physicians1 d5ti/s1 nurses1 & o!r heal? c>e pr(essionals employ$ by ! ,s]vice t provides a p]sonnel & pay sy/em t1 to ! maximum ext5t practicable1 is comp>able to ! pay provid$ to physicians1 d5ti/s1 nurses1 & o!r heal? c>e pr(essionals1 respectively1 "u sub*apt]s ,,iii & ,,iv ( *apt] #gd ( title #ch1 ,unit$ ,/ates ,code4 7b7 ,h\s+ v\*]s 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,secret>y may e/abli% a program to provide t5ant-bas$ r5tal assi/ance to an employee ( ! ,s]vice :o-- 7,a7 agrees to s]ve = n less ?an #a ye> at a ,s]vice unit designat$ by ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration z a heal? pr(essional %ortage area 7z def9$ 9 section #ccb7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e7a777 ) ! greate/ /aff+ ne$2 & 7,b7 is a critical employee1 z det]m9$ by ! ,secret>y4 7#b7 ,sunset ,any program e/abli%$ by ! ,secret>y "u p>agraph 7#a7 %all t]m9ate on ! date t is #c ye>s aft] ! date on :i* ! program is e/abli%$4 7#c7 ,reports ,n lat] ?an #a ye> aft] ! date on :i* a program e/abli%$ "u p>agraph 7#a7 is t]m9at$ 9 accordance ) p>agraph 7#b71 ! ,secret>y %all submit to ,congress a report describ+1 ) respect to t program-- 7,a7 ! co/s ( ! program2 7,b7 employee uptake ( ! program2 & 7,c7 ! effects ( ! program on local facility /aff+ ne$s4 7c7 ,adm9i/ration ,! ,secret>y may only provide a b5efit "u subsection 7b7 to-- 7#a7 a full-"t employee :o agrees to s]ve = n less ?an #a ye> 9 ! ,s]vice beg9n+ on ! date ( ! agreem5t2 or 7#b7 a "p-"t employee :o agrees to s]ve = n less ?an #b ye>s 9 ! s]vice beg9n+ on ! date ( ! agreem5t4 4 #ajb4 ,m$ical cr$5tial+ sy/em ,title ,i ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaa et seq47 7z am5d$ by section #aja7 is am5d$ by add+ at ! end ! foll[+3 #abf4 ,m$ical cr$5tial+ sy/em 7a7 ,9 g5]al 7#a7 ,developm5t & implem5tation timel9e ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,secret>y1 act+ ?r\gh ! ,s]vice 7ref]r$ to 9 ?is section z ! ,secret>y71 9 accordance ) subsection 7b71 %all develop & implem5t a ,s]vice-wide c5traliz$ cr$5tial+ sy/em 7ref]r$ to 9 ?is section z ! cr$5tial+ sy/em7 to cr$5tial lic5s$ heal? pr(essionals :o seek to provide heal? c>e s]vices at any ,s]vice unit4 7#b7 ,implem5tation ,9 implem5t+ ! cr$5tial+ sy/em1 ! ,secret>y-- 7,a7 %all n require re-cr$5tial+ ( lic5s$ heal? pr(essionals :o 7 cr$5tial$ us+ exi/+ ,s]vice policy prior to ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb2 & 7,b7 %all-- 7i7 use ! cr$5tial+ sy/em =-- 7,i7 all applications = cr$5tial+ or re-cr$5tial+ ( lic5s$ heal? pr(essionals submitt$ on or aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb2 & 7,,ii7 ! migration into ! cr$5tial+ sy/em ( cr$5tials data t exi/$ prior to implem5tation ( ! cr$5tial+ sy/em2 & 7ii7 ma9ta9 ! e/abli%$ timel9e = re-cr$5tial+ ( lic5s$ heal? pr(essionals :o 7 cr$5tial$ prior to implem5tation ( ! cr$5tial+ sy/em1 z def9$ by ,s]vice policy4 7b7 ,requirem5ts 7#a7 ,9 g5]al ,9 develop+ ! cr$5tial+ sy/em "u subsection 7a71 ! ,secret>y %all ensure t-- 7,a7 cr$5tial+ proc$ures %all be uni=m ?r\gh\t ! ,s]vice2 & 7,b7 ) respect to ea* lic5s$ heal? pr(essional :o successfully completes ! cr$5tial+ proc$ures ( ! cr$5tial+ sy/em1 ! ,secret>y may au?orize ! lic5s$ heal? pr(essional to provide heal? c>e s]vices at any ,s]vice unit4 7#b7 ,exemption ,! requirem5ts describ$ 9 p>agraph 7#a7 %all n apply to lic5s$ heal? pr(essionals :o 7 cr$5tial$ us+ exi/+ ,s]vice policy prior to ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb until ! date on :i* ^? lic5s$ heal? pr(essionals are requir$ to be re-cr$5tial$ 9 accordance ) ! cr$5tial+ sy/em develop$ & implem5t$ "u subsection 7a74 7c7 ,consultation ,9 develop+ ! cr$5tial+ sy/em "u subsection 7a71 ! ,secret>y-- 7#a7 %all consult ) ,indian tribes2 & 7#b7 may consult )-- 7,a7 any public or private association ( m$ical provid]s2 7,b7 any gov]nm5t ag5cy2 or 7,c7 any o!r relevant exp]t1 z det]m9$ by ! ,secret>y4 7d7 ,application 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 a lic5s$ heal? c>e pr(essional may n provide heal? c>e s]vices at any ,s]vice unit1 unless ! lic5s$ heal? c>e pr(essional successfully completes ! cr$5tial+ proc$ures ( ! cr$5tial+ sy/em develop$ & implem5t$ "u subsection 7a74 7#b7 ,exemption ,p>agraph 7#a7 %all n apply to lic5s$ heal? pr(essionals :o 7 cr$5tial$ us+ exi/+ ,s]vice policy prior to ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb until ! date on :i* ^? lic5s$ heal? pr(essionals are requir$ to be re-cr$5tial$ 9 accordance ) ! cr$5tial+ sy/em develop$ & implem5t$ "u subsection 7a74 7e7 ,nonduplication ( ef=ts 7#a7 ,9 g5]al ,to ! ext5t t prior to ! deadl9e describ$ 9 subsection 7a77#a71 ! ,s]vice has begun implem5t+ or has complet$ implem5tation ( a m$ical cr$5tial+ sy/em t o!rwise meets ! requirem5ts ( ?is section1 ! ,s]vice %all n be requir$ to e/abli% a new cr$5tial+ sy/em "u ?is section4 7#b7 ,au?ority ,! ,s]vice may exp& or enhance an exi/+ cr$5tial+ sy/em to meet ! requirem5ts ( ?is section4 7#c7 ,review 7,a7 ,9 g5]al ,n less frequ5tly ?an once e #e ye>s1 ! ,s]vice %all-- 7i7 und]take a =mal review ( ! cr$5tial+ sy/em 9 effect on ! date ( ! review2 & 7ii7 if necess>y1 take action to br+ ! cr$5tial+ sy/em into compliance ) ! requirem5ts ( ?is section4 7,b7 ,consultation ,ea* =mal review conduct$ "u subp>agraph 7,a7 %all be subject to ! consultation requirem5ts "u subsection 7c74 7f7 ,effect ,no?+ 9 ?is section-- 7#a7 negatively impacts ! "r ( an ,indian tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecja et seq472 or 7#b7 applies to su* a compact or contract unless expressly agre$ to by ! ,indian tribe4 4 #ajc4 ,liability protections = heal? pr(essional volunte]s at ,indian ,heal? ,s]vice ,section #bbd ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcc7 is am5d$ by add+ at ! end ! foll[+3 7r7 ,c]ta9 ,indian ,heal? ,s]vice volunte]s deem$ ,public ,heal? ,s]vice employees 7#a7 ,9 g5]al ,= purposes ( ?is section1 a heal? pr(essional volunte] at a ,s]vice unit %all1 9 provid+ a heal? s]vice to an individual1 be deem$ to be an employee ( ! ,public ,heal? ,s]vice = a cal5d> ye> t beg9s dur+ a fiscal ye> = :i* a transf] 0 made "u p>agraph 7#d77;,c74 ,! prec$+ s5t5ce is subject to ! provisions ( ?is subsection4 7#b7 ,conditions ,9 provid+ a heal? s]vice to an individual1 a heal? c>e practition] %all1 = purposes ( ?is subsection1 be consid]$ to be a heal? pr(essional volunte] at a ,s]vice unit if all ( ! foll[+ conditions are met3 7,a7 ,! s]vice is provid$ to ! individual at ! facilities ( a ,s]vice unit1 or ?r\gh (fsite programs or ev5ts c>ri$ out by ! ,s]vice unit4 7,b7 ,! ,s]vice unit is sponsor+ ! heal? c>e practition] pursuant to p>agraph 7#c77;,c74 7,c7 ,! heal? c>e practition] does n receive any comp5sation = ! s]vice f ! individual1 ! ,s]vice unit1 or any ?ird-p>ty pay] 7includ+ reimbursem5t "u any insurance policy or heal? plan1 or "u any ,f$]al or ,/ate heal? b5efits program71 except t ! heal? c>e practition] may receive repaym5t f ! ,s]vice unit = reasonable exp5ses incurr$ by ! heal? c>e practition] 9 ! provision ( ! s]vice to ! individual4 7,d7 ,be=e ! s]vice is provid$1 ! heal? c>e practition] or ! ,s]vice unit po/s a cle> & conspicu\s notice at ! site :]e ! s]vice is provid$ ( ! ext5t to :i* ! legal liability ( ! heal? c>e practition] is limit$ "u ?is subsection4 7,e7 ,at ! "t ! s]vice is provid$1 ! heal? c>e practition] is lic5s$1 c]tifi$1 cr$5tial$1 & privileg$ 9 accordance ) ,s]vice policy & applicable law reg>d+ ! provision ( ! s]vice4 7#c7 ,applicability ,subsection 7g7 7o!r ?an p>agraphs 7#c7 & 7#e77 & subsections 7h71 7i71 & 7l7 apply to a heal? c>e practition] at a ,s]vice unit = purposes ( ?is subsection to ! same ext5t & 9 ! same mann] z su* subsections apply to an (fic]1 gov]n+ bo>d memb]1 employee1 or contractor ( an entity describ$ 9 subsection 7g77#d71 subject to p>agraph 7#d7 & subject to ! foll[+ subp>agraphs3 7,a7 ,ea* ref]5ce to an entity 9 subsections 7g71 7h71 7i71 & 7l7 %all be consid]$ to be a ref]5ce to a ,s]vice unit4 7,b7 ,! fir/ s5t5ce ( p>agraph 7#a7 applies 9 lieu ( ! fir/ s5t5ce ( subsection 7g77#a77;,a74 7,c7 ,) respect to a ,s]vice unit1 a heal? c>e practition] is n a heal? pr(essional volunte] at ! ,s]vice unit unless ! ,s]vice unit sponsors ! heal? c>e practition]4 ,= purposes ( ?is subsection1 ! ,s]vice unit %all be consid]$ to be sponsor+ ! heal? c>e practition] if-- 7i7 ) respect to ! heal? c>e practition]1 ! ,s]vice unit submits to ! ,secret>y an application meet+ ! requirem5ts ( subsection 7g77#a77;,d72 & 7ii7 ! ,secret>y1 pursuant to subsection 7g77#a77;,e71 det]m9es t ! heal? c>e practition] is deem$ to be an employee ( ! ,public ,heal? ,s]vice4 7,d7 ,9 ! case ( a heal? c>e practition] :o is det]m9$ by ! ,secret>y pursuant to ?is subsection & subsection 7g77#a77;,e7 to be a heal? pr(essional volunte]1 ?is subsection applies to ! heal? c>e practition] 7) respect to s]vices p]=m$ on behalf ( ! ,s]vice unit sponsor+ ! heal? c>e practition] pursuant to subp>agraph 7,c77 = any cause ( action aris+ f an act or omission ( ! heal? c>e practition] occurr+ on or aft] ! date on :i* ! ,secret>y makes t det]m9ation4 7,e7 ,subsection 7g77#a77;,f7 applies to a heal? c>e practition] = purposes ( ?is subsection only to ! ext5t t1 9 provid+ heal? s]vices to an individual1 ea* ( ! conditions describ$ 9 p>agraph 7#b7 is met4 7#d7 ,fund+ 7,a7 ,9 g5]al ,am\nts 9 ! fund e/abli%$ "u subsection 7k77#b7 %all be available = transf] "u subp>agraph 7,c7 = purposes ( c>ry+ out ?is subsection4 7,b7 ,annual e/imates 7i7 ,9 g5]al ,n lat] ?an ,may #a ( ea* fiscal ye>1 ! ,attorney ,g5]al1 9 consultation ) ! ,secret>y1 %all submit to ,congress a report provid+ an e/imate ( ! am\nt ( claims 7toge!r ) relat$ fees & exp5ses ( witnesses7 t1 by reason ( ! acts or omissions ( heal? pr(essional volunte]s1 w be paid pursuant to ?is section dur+ ! cal5d> ye> t beg9s 9 ! foll[+ fiscal ye>4 7ii7 ,applicability ,subsection 7k77#a77;,b7 applies to ! e/imate "u clause 7i7 relat+ to heal? pr(essional volunte]s to ! same ext5t & 9 ! same mann] z t subsection applies to ! e/imate "u t subsection relat+ to (fic]s1 gov]n+ bo>d memb]s1 employees1 & contractors ( entities describ$ 9 subsection 7g77#d74 7,c7 ,transf]s ,n lat] ?an ,decemb] #ca ( ea* fiscal ye>1 ! ,secret>y %all transf] f ! fund "u subsection 7k77#b7 to ! appropriate acc\nts 9 ! ,treasury an am\nt equal to ! e/imate made "u subp>agraph 7,b7 = ! cal5d> ye> beg9n+ 9 t fiscal ye>1 subject to ! ext5t ( am\nts 9 ! fund4 7#e7 ,def9ition ( s]vice unit 7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m ,s]vice unit has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7,b7 ,inclusion ,9 ?is subsection1 ! t]m ,s]vice unit includes an urban ,indian organization ) :i* ! ,indian ,heal? ,s]vice has ent]$ into a contract )1 or to :i* ! ,indian ,heal? ,s]vice has made a grant1 "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afea et seq474 7#f7 ,effect ,no?+ 9 ?is subsection-- 7,a7 negatively impacts ! "r ( an ,indian tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd et seq472 or 7,b7 applies to su* a compact or contract unless expressly agre$ to by ! ,indian tribe4 7#g7 ,effective dates 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 ?is subsection %all take effect on ,octob] #a1 #bjbb4 7,b7 ,regulations1 applications1 & reports ,effective on ! date ( ! enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,secret>y may-- 7i7 prescribe regulations = c>ry+ out ?is subsection2 & 7ii7 accept & consid] applications submitt$ "u p>agraph 7#c77;,c77i74 4 #ajd4 ,cl>ification reg>d+ eligibility = ,indian ,heal? ,s]vice loan repaym5t program ,section #ajh ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;a7 is am5d$-- 7#a7 9 subsection 7b77#a71 by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 h-- 7i7 7,i7 a degree 9 a heal? pr(ession2 & 7,,ii7 a lic5se to practice a heal? pr(ession 9 a ,/ate2 or 7ii7 7,i7 a ma/]'s degree 9 bus9ess adm9i/ration ) an emphasis 9 heal? c>e managem5t 7z def9$ by ! ,secret>y71 heal? adm9i/ration1 hospital adm9i/ration1 or public heal?2 & 7,,ii7 a lic5se or c]tification to practice 9 ! field ( bus9ess adm9i/ration1 heal? adm9i/ration1 hospital adm9i/ration1 or public heal? 9 a ,/ate1 if ! ,secret>y det]m9es ! lic5se or c]tification is necess>y = ! ,indian heal? program to :i* ! individual w be assign$2 2 7#b7 9 subsection 7f77#a77;,b71 by /rik+ clause 7iii7 & ins]t+ ! foll[+3 7iii7 to s]ve = a "t p]iod 7ref]r$ to 9 ?is section z ! p]iod ( obligat$ s]vice7 equal to-- 7,i7 #b ye>s or su* long] p]iod z ! individual may agree to s]ve 9 ! full-"t practice ( ! individual's pr(ession 9 an ,indian heal? program to :i* ! individual may be assign$ by ! ,secret>y2 or 7,,ii7 #d ye>s or su* long] p]iod z ! individual may agree to s]ve 9 ! half-"t practice ( ! individual's pr(ession 9 an ,indian heal? program to :i* ! individual may be assign$ by ! ,secret>y2 2 & 7#c7 9 subsection 7g77#b7-- 7,a7 9 subp>agraph 7,b71 by /rik+ 7,b7 ,any arrangem5t & ins]t+ ! foll[+3 7,c7 ,deadl9e = repaym5ts ,any arrangem5t 2 7,b7 subp>agraph 7,a71 9 ! second s5t5ce ( ! matt] prec$+ clause 7i71 by /rik+ ,9 mak+ a det]m9ation & ins]t+ ! foll[+3 7,b7 ,det]m9ation ( am\nt ( paym5t ,9 mak+ a det]m9ation "u ?is p>agraph 2 & 7,c7 by /rik+ 7#b77;,a7 ,= ea* ye> & all t foll[s ?r\gh p>agraph 7#a74 & ins]t+ ! foll[+3 7#b7 ,au?oriz$ ,paym5ts 7,a7 ,am\nt ( paym5t 7i7 ,full-"t practice ,9 ! case ( an individual :o contracts to s]ve a p]iod ( obligat$ s]vice "u subsection 7f77#a77;,b77iii77,i71 = ea* ye> ( ! obligat$ s]vice1 ! ,secret>y may pay up to #ce1jjj 7or an am\nt equal to ! am\nt specifi$ 9 section #cch;,b7g77#b77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a7;g77#b77;,a777 on behalf ( ! individual = loans describ$ 9 p>agraph 7#a74 7ii7 ,half-"t ,9 ! case ( an individual :o contracts to s]ve a p]iod ( obligat$ s]vice "u subsection 7f77#a77;,b77iii77,,ii71 = ea* ye> ( su* obligat$ s]vice1 ! ,secret>y may pay up to #ag1ejj on behalf ( ! individual = loans describ$ 9 p>agraph 7#a74 4 #aje4 ,improvem5ts 9 hir+ practices 7a7 ,9 g5]al ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 is am5d$ by add+ at ! end ! foll[+3 #fje4 ,improvem5ts 9 hir+ practices 7a7 ,direct hire au?ority ,! ,secret>y may appo9t1 )\t reg>d to sub*apt] ,i ( *apt] #cc ( title #e1 ,unit$ ,/ates ,code 7o!r ?an sections #ccjc & #ccbh ( t title71 a c&idate directly to a position )9 ! ,s]vice = :i* ! c&idate meets ! qualifications /&>d e/abli%$ by ! ,(fice ( ,p]sonnel ,managem5t4 7b7 ,tribal notification 7#a7 ,9 g5]al ,be=e appo9t+1 hir+1 promot+1 transf]r+1 or reassign+ a c&idate to a ,s5ior ,executive ,s]vice position or ! position ( a manag] at an ,area (fice or ,s]vice unit1 ! ,secret>y %all provide notice to ea* ,indian tribe locat$ )9 ! def9$ geographic area ( ! ,area (fice or ,s]vice unit1 z applicable1 ( ! cont5t ( an inclusion 9 an employm5t record4 7#b7 ,comm5t p]iod ,ea* ,indian tribe t receives notification "u p>agraph 7#a7 may submit to ! ,secret>y comm5ts dur+ ! #aj-;day p]iod aft] ! date ( notification4 4 7b7 ,,ihs waiv]s ,section #b7;c7 ( ,public ,law #if-ace 7#be ,u4,s4,c4 #eaag7;c77 is am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 by /rik+ 7#b7 ,! provisions & ins]t+ ! foll[+3 7#b7 ,application to c]ta9 individuals ,! provisions 2 7,b7 by ins]t+ or 7#c7 aft] p>agraph 7#a72 & 7,c7 by /rik+ section #aaca7;f7 ( ! ,education ,am5dm5ts ( #aigh 7#be ,u4,s4,c4 #bjaa7;f72 #ib ,/at4 #bcbd7 & ins]t+ section #aacb7;f7 ( ! ,education ,am5dm5ts ( #aigh 7#be ,u4,s4,c4 #bjab7;f772 7#b7 by /rik+ 7c77#a7 ,not)/&+ & ins]t+ ! foll[+3 7c7 ,waiv] ( applicability 9 p]sonnel actions 7#a7 ,9 g5]al ,not)/&+ 2 & 7#c7 by add+ at ! end ! foll[+3 7#c7 ,,ihs waiv]s 7,a7 ,9 g5]al ,at ! reque/ ( a conc]n$ ,indian tribe1 ! ,secret>y ( ,heal? & ,human ,s]vices may seek f ea* ,indian tribe conc]n$ a waiv] ( ,indian pref]5ce laws = a p]sonnel action t is ) respect to-- 7i7 a ,s]vice unit 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 9 :i*-- 7,i7 #ae p]c5t or great] ( ! total positions are n fill$ by a full-"t employee ( ! ,indian ,heal? ,s]vice = a p]iod ( #f mon?s or long]2 or 7,,ii7 #ae p]c5t or great] ( a specific heal? pr(essional position are n fill$ by a full-"t employee ( ! ,indian ,heal? ,s]vice = a p]iod ( #f mon?s or long]2 or 7ii7 a =m] employee ( ! ,indian ,heal? ,s]vice1 or a =m] ,tribal employee1 :o 0 remov$ f ! employm5t dur+1 or demot$ = p]=mance or misconduct t occurr$ dur+1 ! #e-ye> p]iod foll[+ ! date ( ! p]sonnel action4 7,b7 ,limitation ,a waiv] may only be reque/$ "u subp>agraph 7,a7 = a p]sonnel action t is ) respect to an employee describ$ 9 clause 7ii7 ( t subp>agraph if ! reason = ! removal or demotion ( ! employee did n result f an action und]tak5 by ! employee t 0 report$ to ! ,national ,practition] ,data ,bank4 7,c7 ,re/riction ,! ,secret>y ( ,heal? & ,human ,s]vices may only approve a waiv] "u subp>agraph 7,a7 if ! waiv] is fir/ reque/$ by a conc]n$ ,indian tribe4 4 #ajf4 ,improv$ au?orities ( secret>y to improve acc\ntability ( s5ior executives & employees ( ! ,indian ,heal? ,s]vice 7a7 ,9 g5]al ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #aje7 is am5d$ by add+ at ! end ! foll[+3 #fjf4 ,improv$ au?orities ( ,secret>y to improve acc\ntability ( s5ior executives ( ! ,indian ,heal? ,s]vice 7a7 ,def9itions ,9 ?is section3 7#a7 ,cov]$ individual ,! t]m cov]$ individual means a c>e] appo9tee 7z def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code74 7#b7 ,misconduct ,! t]m misconduct includes-- 7,a7 neglect ( duty2 7,b7 malfeasance2 7,c7 failure to accept a direct$ reassignm5t2 & 7,d7 failure to accompany a position 9 a transf] ( function4 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y1 act+ ?r\gh ! ,s]vice4 7#d7 ,s5ior executive position ,! t]m s5ior executive position means a ,s5ior ,executive ,s]vice position 7z def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code74 7b7 ,au?ority 7#a7 ,9 g5]al ,! ,secret>y may1 9 accordance ) ?is section1 reprim&1 susp5d1 involunt>ily reassign1 demote1 or remove a cov]$ individual f a s5ior executive position at ! ,s]vice if ! ,secret>y det]m9es t ! misconduct or p]=mance ( ! cov]$ individual w>rants su* an action4 7#b7 ,removal f civil s]vice ,if ! ,secret>y removes a cov]$ individual pursuant to p>agraph 7#a71 ! ,secret>y may remove ! individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code74 7c7 ,rights & proc$ures 7#a7 ,9 g5]al ,a cov]$ individual :o is ! subject ( an action or removal1 z applicable1 "u subsection 7b7 is entitl$-- 7,a7 to advance notice ( ! action or removal2 7,b7 to access a file conta9+ all evid5ce 9 support ( ! propos$ action or removal2 7,c7 to be repres5t$ by an attorney or o!r repres5tative ( ! cov]$ individual's *oice2 & 7,d7 to grieve ! decision on ! action or removal "u p>agraph 7#b7 9 accordance ) ! int]nal grievance process e/abli%$ by ! ,secret>y "u p>agraph 7#c74 7#b7 ,notice2 response2 decision 7,a7 ,9 g5]al ,! aggregate p]iod = notice1 response1 & decision on an action or removal "u subsection 7b7 may n exce$ #ae bus9ess days4 7,b7 ,response ,a cov]$ individual receiv+ a notice "u p>agraph 7#a77;,a7 ( an action or removal1 z applicable1 "u subsection 7b7 %all h n m ?an #g bus9ess days to respond to ! notice4 7,c7 ,decision 7i7 ,9 g5]al ,! ,secret>y %all issue a decision on an action or removal1 z applicable1 "u subsection 7b7 n lat] ?an #ae bus9ess days aft] ! date on :i* notice ( ! action or removal1 z applicable1 is receiv$ by ! applicable cov]$ individual "u p>agraph 7#a77;,a74 7ii7 ,requirem5ts ,a decision "u clause 7i7-- 7,i7 %all be 9 writ+2 & 7,,ii7 %all include ! specific reasons = ! decision4 7,d7 ,f9al & conclusive decision ,a decision "u ?is p>agraph t is n griev$ "u p>agraph 7#c7 by ! deadl9e describ$ 9 t p>agraph %all be f9al & conclusive4 7#c7 ,grievance process 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% an int]nal grievance process "u :i* a cov]$ individual may grieve a decision issu$ "u p>agraph 7#b7 n lat] ?an ! date t is #g bus9ess days aft] ! date on :i* ! decision "u t p>agraph 0 issu$4 7,b7 ,total p]iod ,! ,secret>y %all issue a decision = :i* an int]nal grievance process is initiat$ "u subp>agraph 7,a7 n lat] ?an #ba bus9ess days aft] ! date on :i* ! grievance process is initiat$ by ! cov]$ individual4 7,c7 ,f9al & conclusive decision ,a grievance decision "u ?is p>agraph %all be f9al & conclusive4 7#d7 ,judicial review ,a cov]$ individual adv]sely affect$ by a decision "u p>agraph 7#b7 t is n griev$1 or by a grievance decision "u p>agraph 7#c71 may obta9 judicial review ( ! decision4 7#e7 ,c\rt review ,9 any case 9 :i* judicial review is s\ght "u p>agraph 7#d71 ! c\rt %all review ! record & may set aside any action ( ! ,dep>tm5t or ! ,s]vice f\nd to be-- 7,a7 arbitr>y1 caprici\s1 an abuse ( discretion1 or o!rwise n 9 accordance ) a provision ( law2 7,b7 obta9$ )\t proc$ures requir$ by a provision ( law hav+ be5 foll[$2 or 7,c7 unsupport$ by sub/antial evid5ce4 7d7 ,relation to o!r provisions ( law ,section #ceib7;b77#a7 ( title #e1 ,unit$ ,/ates ,code1 %all n apply to an action "u subsection 7b74 #fjg4 ,improv$ au?orities ( ,secret>y to improve acc\ntability ( employees ( ! ,indian ,heal? ,s]vice 7a7 ,def9itions ,9 ?is section3 7#a7 ,cov]$ individual 7,a7 ,9 g5]al ,! t]m cov]$ individual means an individual occupy+ a position at ! ,s]vice4 7,b7 ,exclusions ,! t]m cov]$ individual does n include-- 7i7 an individual occupy+ a s5ior executive position 7z def9$ 9 section #fjf7;a772 7ii7 an individual :o has n complet$ a probation>y or trial p]iod2 or 7iii7 a political appo9tee4 7#b7 ,grade ,! t]m grade has ! mean+ giv5 ! t]m 9 section #geaa7;a7 ( title #e1 ,unit$ ,/ates ,code4 7#c7 ,misconduct ,! t]m misconduct includes-- 7,a7 neglect ( duty2 7,b7 malfeasance2 7,c7 failure to accept a direct$ reassignm5t2 & 7,d7 failure to accompany a position 9 a transf] ( function4 7#d7 ,political appo9tee ,! t]m political appo9tee means an individual :o is-- 7,a7 employ$ 9 a position describ$ 9 any ( sections #ecab ?r\gh #ecaf ( title #e1 ,unit$ ,/ates ,code 7relat+ to ! ,executive ,s*$ule72 7,b7 a limit$ t]m appo9tee1 limit$ em]g5cy appo9tee1 or nonc>e] appo9tee 7z ^? t]ms are def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code72 or 7,c7 employ$ 9 a position ( a confid5tial or policy-det]m9+ "* "u s*$ule ,c ( subp>t ,c ( "p #bac ( title #e1 ,code ( ,f$]al ,regulations 7or a successor regulation74 7#e7 ,secret>y ,! t]m ,secret>y means ! ,secret>y1 act+ ?r\gh ! ,s]vice4 7#f7 ,susp5d ,! t]m susp5d means ! plac+ ( an employee1 = discipl9>y reasons1 9 a tempor>y /atus )\t duties & pay = a p]iod 9 excess ( #ad days4 7b7 ,au?ority 7#a7 ,9 g5]al ,! ,secret>y may1 9 accordance ) ?is section1 remove1 demote1 or susp5d a cov]$ individual f employm5t at ! ,s]vice if ! ,secret>y det]m9es t ! p]=mance or misconduct ( ! cov]$ individual w>rants su* an action4 7#b7 ,actions ,if ! ,secret>y removes1 demotes1 or susp5ds a cov]$ individual pursuant to p>agraph 7#a71 ! ,secret>y may-- 7,a7 remove ! cov]$ individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code72 7,b7 demote ! cov]$ individual by means (-- 7i7 a r$uction 9 grade = :i* ! cov]$ individual is qualifi$1 z ! ,secret>y det]m9es appropriate2 & 7ii7 a r$uction ( ! annual rate ( pay ( ! cov]$ individual2 or 7,c7 susp5d ! cov]$ individual f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code74 7c7 ,pay ( c]ta9 demot$ individuals 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 any cov]$ individual subject to a demotion by means ( a r$uction 9 grade "u subsection 7b77#b77;,b7 %all1 beg9n+ on ! date ( ! demotion1 receive ! annual rate ( pay applicable to ! r$uc$ grade4 7#b7 ,re/rictions 7,a7 ,prohibition on adm9i/rative leave ,a cov]$ individual subject to a demotion "u subsection 7b77#b77;,b7-- 7i7 may n be plac$ on adm9i/rative leave dur+ ! p]iod dur+ :i* an appeal 7if any7 "u ?is section is ongo+2 & 7ii7 may only receive pay if ! cov]$ individual reports = duty or is approv$ to use accru$ unus$ annual1 sick1 family m$ical1 milit>y1 or c\rt leave4 7,b7 ,re/riction on pay & b5efits ,if a cov]$ individual subject to a demotion "u subsection 7b77#b77;,b7 does n report = duty 7& has n receiv$ approval to use accru$ unus$ leave "u subp>agraph 7,a77ii771 ! cov]$ individual %all n receive pay or o!r b5efits pursuant to subsection 7e77#g74 7d7 ,rights & proc$ures 7#a7 ,9 g5]al ,a cov]$ individual :o is ! subject ( an action or removal1 z applicable1 "u subsection 7b7 is entitl$-- 7,a7 to advance notice ( ! action or removal2 7,b7 to access a file conta9+ all evid5ce 9 support ( ! propos$ action or removal2 7,c7 to be repres5t$ by an attorney or o!r repres5tative ( ! cov]$ individual's *oice2 & 7,d7 to grieve ! decision on ! action or removal "u p>agraph 7#b7 9 accordance ) ! int]nal grievance process e/abli%$ by ! ,secret>y "u p>agraph 7#c74 7#b7 ,notice2 response2 decision 7,a7 ,aggregate p]iod ,! aggregate p]iod = notice1 response1 & a f9al decision on an action "u subsection 7b7 may n exce$ #ae bus9ess days4 7,b7 ,response ,a cov]$ individual receiv+ a notice "u p>agraph 7#a77;,a7 ( an action or removal "u subsection 7b7 %all h n m ?an #g bus9ess days to respond to ! notice4 7,c7 ,f9al & conclusive decision 7i7 ,9 g5]al ,! ,secret>y %all issue a f9al & conclusive decision on an action or removal "u subsection 7b7 n lat] ?an #ae bus9ess days aft] ! date on :i* ! notice ( ! action is receiv$ by ! applicable cov]$ individual "u p>agraph 7#a77;,a74 7ii7 ,requirem5ts ,a decision "u clause 7i7-- 7,i7 %all be 9 writ+2 & 7,,ii7 %all include ! specific reasons = ! decision4 7#c7 ,grievance process 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% an int]nal grievance process "u :i* a cov]$ individual may grieve a decision issu$ "u p>agraph 7#b7 n lat] ?an ! date t is #g bus9ess days aft] ! date on :i* ! decision "u t p>agraph 0 issu$4 7,b7 ,total p]iod ,! ,secret>y %all issue a decision = :i* an int]nal grievance process is initiat$ "u subp>agraph 7,a7 n lat] ?an #ba bus9ess days aft] ! date on :i* ! grievance process is initiat$ by ! cov]$ individual4 7,c7 ,f9al & conclusive decision ,a grievance decision "u ?is p>agraph %all be f9al & conclusive4 7#d7 ,proc$ures sup]s$+ ,c,b,as ,! proc$ures "u ?is subsection %all sup]s$e any collective b>ga9+ agreem5t to ! ext5t t su* an agreem5t is inconsi/5t ) ! proc$ures4 7#e7 ,p]=mance appraisal ,! proc$ures "u *apt] #dc ( title #e1 ,unit$ ,/ates ,code1 %all n apply to an action "u subsection 7b74 7#f7 ,appeal to m]it sy/ems protection bo>d 7,a7 ,9 g5]al ,subject to subp>agraph 7,b7 & subsection 7e71 any removal1 demotion1 or susp5sion ( m ?an #ad days "u subsection 7b7 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d1 :i* %all ref] su* appeal to an adm9i/rative law judge pursuant to section #ggja7;b77#a7 ( title #e1 ,unit$ ,/ates ,code4 7,b7 ,"t p]iod ,an appeal "u subp>agraph 7,a7 ( a removal1 demotion1 or susp5sion may only be made if ! appeal is made n lat] ?an #aj bus9ess days aft] ! date ( ! removal1 demotion1 or susp5sion4 7e7 ,exp$it$ review 7#a7 ,9 g5]al ,on receipt ( an appeal "u subsection 7d77#f77;,a71 ! applicable adm9i/rative law judge %all-- 7,a7 exp$ite ! appeal "u section #ggja7;b77#a7 ( title #e1 ,unit$ ,/ates ,code2 & 7,b7 issue a f9al & complete decision on ! appeal n lat] ?an #ahj days aft] ! date ( ! appeal4 7#b7 ,uphold+ decision 7,a7 ,9 g5]al ,not)/&+ section #ggja7;c77#a77;,b7 ( title #e1 ,unit$ ,/ates ,code1 ! adm9i/rative law judge %all uphold ! decision ( ! ,secret>y to remove1 demote1 or susp5d an employee "u subsection 7b7 if ! decision is support$ by sub/antial evid5ce4 7,b7 ,prohibition ( mitigation ,not)/&+ title #e1 ,unit$ ,/ates ,code1 or any o!r provision ( law1 if ! decision ( ! ,secret>y to remove1 demote1 or susp5d an employee "u subsection 7b7 is support$ by sub/antial evid5ce1 ! adm9i/rative law judge %all n mitigate ! p5alty prescrib$ by ! ,secret>y4 7#c7 ,appeal to m]it sy/ems protection bo>d 7,a7 ,9 g5]al ,! decision ( ! adm9i/rative law judge "u p>agraph 7#a7 may be appeal$ to ! ,m]it ,sy/ems ,protection ,bo>d4 7,b7 ,uphold+ decision ,not)/&+ section #ggja7;c77#a77;,b7 ( title #e1 ,unit$ ,/ates ,code1 ! ,m]it ,sy/ems ,protection ,bo>d %all uphold ! decision ( ! ,secret>y to remove1 demote1 or susp5d an employee "u subsection 7b7 if ! decision is support$ by sub/antial evid5ce4 7,c7 ,prohibition ( mitigation ,not)/&+ title #e1 ,unit$ ,/ates ,code1 or any o!r provision ( law1 if ! decision ( ! ,secret>y is support$ by sub/antial evid5ce1 ! ,m]it ,sy/ems ,protection ,bo>d %all n mitigate ! p5alty prescrib$ by ! ,secret>y4 7#d7 ,report ,9 any case 9 :i* an adm9i/rative law judge _c issue a f9al & complete decision by ! deadl9e describ$ 9 p>agraph 7#a77;,b71 ! ,m]it ,sy/ems ,protection ,bo>d %all1 n lat] ?an #ad bus9ess days aft] ! deadl9e expires1 submit to ! appropriate committees ( ,congress a report t expla9s ! reasons :y a decision 0 n issu$ by ! deadl9e4 7#e7 ,appeal ,a decision ( ! ,m]it ,sy/ems ,protection ,bo>d "u p>agraph 7#c7 may be appeal$ to ! ,unit$ ,/ates ,c\rt ( ,appeals = ! ,f$]al ,circuit pursuant to section #ggjc ( title #e1 ,unit$ ,/ates ,code1 or to any c\rt ( appeals ( compet5t jurisdiction pursuant to subsection 7b77#a77;,b7 ( t section4 7#f7 ,prohibition aga9/ /ays ,! ,m]it ,sy/ems ,protection ,bo>d may n /ay any removal or demotion "u subsection 7b71 except z provid$ 9 section #abad7;b7 ( title #e1 ,unit$ ,/ates ,code4 7#g7 ,re/riction on pay & b5efits dur+ appeal 7,a7 ,9 g5]al 7i7 ,re/riction on pay & b5efits ,dur+ ! p]iod describ$ 9 clause 7ii71 a cov]$ individual may n receive any pay & b5efits describ$ 9 subp>agraph 7,b74 7ii7 ,p]iod describ$ ,! p]iod ref]r$ to 9 clause 7i7 is ! p]iod-- 7,i7 beg9n+ on ! date on :i* a cov]$ individual appeals "u ?is section a removal f ! civil s]vice "u subsection 7b77#b77;,a72 & 7,,ii7 end+ on ! lat] (-- 7aa7 ! date on :i* ! ,m]it ,sy/ems ,protection ,bo>d issues a f9al decision on ! appeal "u p>agraph 7#c72 & 7bb7 ! date on :i* ! ,unit$ ,/ates ,c\rt ( ,appeals = ! ,f$]al ,circuit issues a f9al decision on ! appeal "u p>agraph 7#e74 7,b7 ,pay & b5efits describ$ ,! pay & b5efits ref]r$ to 9 subp>agraph 7,a77i7 are any pay1 aw>ds1 bonuses1 inc5tives1 all[ances1 diff]5tials1 /ud5t loan repaym5ts1 special paym5ts1 or b5efits relat$ to ! employm5t ( ! individual by ! ,s]vice4 7#h7 ,in=mation to exp$ite appeal ,to ! maximum ext5t practicable1 ! ,secret>y %all provide to ! ,m]it ,sy/ems ,protection ,bo>d su* in=mation & assi/ance z may be necess>y to ensure an appeal "u ?is subsection is exp$it$4 7#i7 ,backpay ,if an employee prevails on appeal "u ?is section1 ! employee %all be entitl$ to backpay 7z provid$ 9 section #eeif ( title #e1 ,unit$ ,/ates ,code74 7#aj7 ,applicable timel9es & proc$ures ,if an employee :o is subject to a collective b>ga9+ agreem5t *ooses to grieve an action tak5 "u ?is section ?r\gh a grievance proc$ure provid$ "u ! collective b>ga9+ agreem5t1 ! timel9es & proc$ures describ$ 9 subsection 7d7 & ?is subsection %all apply4 7f7 ,alleg$ prohibit$ p]sonnel practice ,9 ! case ( a cov]$ individual seek+ corrective action 7or on behalf ( :om corrective action is s\ght7 f ! ,(fice ( ,special ,c\nsel bas$ on an alleg$ prohibit$ p]sonnel practice describ$ 9 section #bcjb7;b7 ( title #e1 ,unit$ ,/ates ,code1 ! ,secret>y may n remove1 demote1 or susp5d ! cov]$ individual "u subsection 7b7 )\t ! approval ( ! ,special ,c\nsel "u section #abad7;f7 ( title #e1 ,unit$ ,/ates ,code4 7g7 ,t]m9ation ( inve/igations by ,(fice ( ,special ,c\nsel 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,special ,c\nsel e/abli%$ by section #abaa ( title #e1 ,unit$ ,/ates ,code1 may t]m9ate an inve/igation ( a prohibit$ p]sonnel practice alleg$ by an employee or =m] employee ( ! ,s]vice aft] ! ,special ,c\nsel provides to ! employee or =m] employee a writt5 /atem5t ( ! reasons = ! t]m9ation ( ! inve/igation4 7#b7 ,admissibility ,! /atem5t describ$ 9 p>agraph 7#a7 may n be admissible z evid5ce 9 any judicial or adm9i/rative proce$+ )\t ! cons5t ( ! employee or =m] employee describ$ 9 p>agraph 7#a74 7h7 ,vacancies ,9 ! case ( a cov]$ individual :o is remov$ or demot$ "u subsection 7b71 to ! maximum ext5t practicable1 ! ,secret>y %all fill ! vacancy aris+ z a result ( ! removal or demotion4 4 7b7 ,con=m+ am5dm5ts ,section #dcjc7;f7 ( title #e1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 9 p>agraph 7#c71 by /rik+ or at ! end2 7#b7 9 p>agraph 7#d71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7#e7 any removal or demotion "u section #fjg ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 4 7c7 ,report ,n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices or ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 z appropriate1 %all submit to ,congress a report t includes in=mation on-- 7#a7 ! numb] ( employees ( ! ,indian ,heal? ,s]vice :o 7 remov$1 demot$1 or susp5d$ dur+ ! #a-ye> p]iod prec$+ ! date ( enactm5t ( ?is ,act2 7#b7 ! numb] ( employees ( ! ,indian ,heal? ,s]vice :o 7 remov$1 demot$1 or susp5d$ dur+ ! #a-ye> p]iod beg9n+ on ! date ( enactm5t ( ?is ,act pursuant to ! am5dm5ts made by ?is section2 & 7#c7 ! appropriate details ( any su* removals1 demotions1 & susp5sions t l5d necess>y context4 #ajg4 ,tribal culture & hi/ory ,section #aac ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afaf;f7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ a program & ins]t+ an annual m&atory tra9+ program2 & 7,b7 by /rik+ appropriate employees ( ! ,s]vice & ins]t+ employees ( ! ,s]vice1 locum t55s m$ical provid]s1 heal?c>e volunte]s1 & o!r contract$ employees :o "w at ,s]vice hospitals or o!r ,s]vice units & ^: employm5t requires regul> direct pati5t access2 & 7#b7 by add+ at ! end ! foll[+3 7c7 ,requirem5t ,to complete tra9+ program ,not)/&+ any o!r provision ( law1 beg9n+ on ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ea* employee or provid] describ$ 9 subsection 7a7 :o ent]s into a contract ) ! ,s]vice %all1 z a condition ( employm5t1 annually p>ticipate 9 & complete ! program e/abli%$ "u subsection 7a74 4 #ajh4 ,/aff+ demon/ration program ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 is am5d$ by add+ at ! end ! foll[+3 #hcc4 ,/aff+ demon/ration program 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,secret>y1 act+ ?r\gh ! ,s]vice 7ref]r$ to 9 ?is section z ! ,secret>y71 %all e/abli% a demon/ration program 7ref]r$ to 9 ?is section z ! demon/ration program7 "u :i* ! ,s]vice may provide ,s]vice units ) additional /aff+ res\rces1 ) ! goal t ! res\rces become self-su/a9+4 7b7 ,selection ,9 select+ ,s]vice units = p>ticipation 9 ! demon/ration program1 ! ,secret>y %all consid] :e!r a ,s]vice unit s]vices an ,indian tribe t-- 7#a7 has utiliz$ or contribut$ sub/antial ,tribal funds to con/ruct a heal? facility us$ by ! ,s]vice or id5tifi$ 9 ! ma/] plan = ! ,s]vice unit2 7#b7 is locat$ 9 #a or m ,/ates ) ,m$icaid reimbursem5ts plans or policies t w increase ! likelihood t ! /aff+ res\rces provid$ w be self-su/a9+2 & 7#c7 is op]at+ a heal? facility describ$ 9 p>agraph 7#a7 "u hi/orical /aff+ ratios1 z det]m9$ by ! ,secret>y1 t h n be5 equaliz$ or updat$ by ! ,s]vice or any o!r ,s]vice program to reflect curr5t /aff+ ne$s4 7c7 ,duration ,/aff+ res\rces provid$ to a ,s]vice unit "u ! demon/ration program %all be provid$ = a duration t ! ,secret>y1 9 consultation ) ! applicable ,indian tribe1 det]m9es appropriate1 on ! condition t ea* /aff+ position provid$ %all be = a p]iod ( n less ?an #c fiscal ye>s4 7d7 ,effect ( /aff+ aw>ds ,no /aff+ res\rces provid$ "u ! demon/ration program %all r$uce ! recurr+ base fund+ = /aff+ = any ,indian tribe or ,s]vice unit4 7e7 ,sunset ,! demon/ration program e/abli%$ "u subsection 7a7 %all t]m9ate on ! date t is #d ye>s aft] ! date on :i* ! demon/ration program is e/abli%$4 7f7 ,report ,n lat] ?an #a ye> aft] ! date on :i* ! demon/ration program t]m9ates "u subsection 7e71 ! ,secret>y %all submit to ! ,committee on ,indian ,affairs & ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,natural ,res\rces & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report describ+ ! demon/ration program1 includ+ in=mation on-- 7#a7 :e!r ! /aff+ res\rces provid$ "u ! demon/ration program result$ 9 additional rev5ue = ! applicable ,s]vice unit suffici5t to ma9ta9 ! /aff on a p]man5t basis2 7#b7 ! levels to :i* ! /aff+ res\rces provid$ "u ! demon/ration program r$uc$ ! unmet /aff+ ne$ = ! applicable ,s]vice unit2 & 7#c7 :e!r ! demon/ration program c\ld be deploy$ p]man5tly to r$uce unmet /aff+ ne$s ?r\gh\t ! ,s]vice4 4 #aji4 ,rule e/abli%+ ,tribal consultation policy ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #ajh7 is am5d$ by add+ at ! end ! foll[+3 #hcd4 ,rule e/abli%+ ,tribal consultation policy 7a7 ,9 ,g5]al ,n lat] ?an ,decemb] #ca1 #bjbc1 ! ,secret>y %all e/abli%1 & once e #e ye>s !reaft]1 ! ,secret>y %all update1 aft] mean+ful consultation ) repres5tatives ( affect$ ,indian tribes1 a rule e/abli%+ a ,tribal consultation policy = ! ,s]vice4 7b7 ,cont5ts ( tribal consultation policy ,! policy e/abli%$ "u ! rule "u subsection 7a7 %all-- 7#a7 update1 & replace1 ! ,tribal consultation policy e/abli%$ "u ,circul> ,no4 #bjjf-ja ( ! ,s]vice 7or any successor policy72 & 7#b7 include-- 7,a7 a process = det]m9+ :5 & h[ ! ,s]vice w notify ,indian tribes ( ! availability ( mean+ful consultation2 7,b7 a det]m9ation ( :i* actions or ag5cy decisions by ! ,s]vice w trigg] a requirem5t = mean+ful consultation ) ,indian tribes2 & 7,c7 a det]m9ation ( :i* actions con/itute mean+ful consultation ) ,indian tribes4 4 #aaj4 ,treatm5t ( c]ta9 hospitals ,! ,p>allel ,l[-,volume ,hospital ,paym5t ,adju/m5t ,reg>d+ ,hospitals ,op]at$ by ! ,indian ,heal? ,s]vices 7,,ihs7 or a ,tribe provisions describ$ 9 ! f9al rule ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices entitl$ ,m$ic>e ,program2 ,hospital ,inpati5t ,prospective ,paym5t ,sy/ems = ,acute ,c>e ,hospitals & ! ,long-,t]m ,c>e ,hospital ,prospective ,paym5t ,sy/em & ,policy ,*anges & ,fiscal ,ye> #bjah ,rates2 ,quality ,report+ ,requirem5ts = ,specific ,provid]s2 ,m$ic>e & ,m$icaid ,electronic ,heal? ,record 7,,ehr7 ,inc5tive ,program ,requirem5ts = ,eligible ,hospitals1 ,critical ,access ,hospitals1 & ,eligible ,pr(essionals2 ,provid]-,bas$ ,/atus ( ,indian ,heal? ,s]vice & ,tribal ,facilities & ,organizations2 ,co/s ,report+ & ,provid] ,requirem5ts2 ,agreem5t ,t]m9ation ,notices 7#hb ,f$ ,reg4 #cgiij2 #chahh-chahi 7,augu/ #ad1 #bjag771 %all apply ) respect to dis*>ges occurr+ 9 fiscal ye> #bjaa & ea* fiscal ye> !reaft]4 #aaa4 ,enhanc+ quality ( c>e 9 ! ,indian ,heal? ,s]vice 7a7 ,,ihcia def9itions ,9 ?is section1 ! t]ms ,area (fice1 ,indian tribe1 ,secret>y1 ,s]vice1 ,s]vice unit1 tribal organization1 & ,urban ,indian organization h ! mean+s giv5 ^? t]ms 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7b7 ,be/ practices = gov]n+ bo>d & area (fice meet+s 7#a7 ,def9ition ( gov]n+ bo>d ,9 ?is subsection1 ! t]m gov]n+ bo>d means ! gov]n+ bo>d ( ! facility ( a ,s]vice unit4 7#b7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y1 9 consultation ) ,indian tribes1 gov]n+ bo>ds1 ,area (fices1 ,s]vice units1 & o!r /akehold]s1 z det]m9$ appropriate by ! ,secret>y1 %all e/abli%-- 7,a7 9 accordance ) p>agraph 7#c77;,a71 be/ practices = gov]n+ bo>ds2 & 7,b7 9 accordance ) p>agraph 7#c77;,b71 be/ practices = ,area (fices4 7#c7 ,requirem5ts 7,a7 ,gov]n+ bo>d be/ practices ,! be/ practices = gov]n+ bo>ds e/abli%$ "u p>agraph 7#b77;,a7 %all include provisions relat+ to-- 7i7 adequately monitor+ ! deliv]y ( c>e at ! applicable facility manag$ by ! gov]n+ bo>d2 7ii7 ensur+ ongo+ facility compliance ) ,f$]al heal? c>e program requirem5ts1 includ+ requirem5ts ( ! ,s]vice & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7iii7 h&l+1 docum5t+1 & respond+ to pati5t compla9ts2 7iv7 docum5t+1 address+1 &1 if applicable1 report+ in/ances ( pr(essional misconduct by facility /aff 9 accordance ) applicable ,f$]al & ,/ate law2 7v7 improv+ facility p]=mance & op]ations ) respect to m&atory & volunt>y quality initiatives c>ri$ out by ! ,s]vice & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 & 7vi7 report+ requirem5ts "u ,f$]al law1 includ+ ) respect to-- 7,i7 ! ,gov]nm5t ,p]=mance & ,results ,act ( #aiic 7,public ,law #ajc-fb2 #ajg ,/at4 #bhe71 ! ,,gpra ,mod]nization ,act ( #bjaj 7,public ,law #aaa-ceb2 #abd ,/at4 #chff71 & ! am5dm5ts made by ^? ,acts2 & 7,,ii7 ! applicable provisions ( titles ,,xviii & ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq41 #acif et seq474 7,b7 ,area (fice be/ practices ,! be/ practices = ,area (fices e/abli%$ "u p>agraph 7#b77;,b7 %all include provisions relat+ to-- 7i7 /rategies = h[ to be/ monitor gov]n+ bo>d activities relat+ to ! ov]sight (-- 7,i7 deliv]y & quality ( pati5t c>e2 7,,ii7 docum5t+ & respond+ to pati5t compla9ts & in/ances ( pr(essional misconduct2 & 7,,iii7 facility compliance ) ,f$]al heal? c>e program requirem5ts1 includ+ requirem5ts ( ! ,s]vice & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 & 7ii7 connect+ gov]n+ bo>ds1 includ+ ! applicable facilities ( ^? gov]n+ bo>ds1 to res\rces necess>y = enhanc+ pati5t outcomes & improv+ facility p]=mance1 includ+ ?r\gh ! use ( te*nical assi/ance4 7#d7 ,publication ,! be/ practices e/abli%$ "u p>agraph 7#b7 %all be-- 7,a7 report$ to1 9 writ+1 z applicable1 all gov]n+ bo>ds & ,area (fices2 & 7,b7 incorporat$ into ! ,indian ,heal? ,manual ( ! ,s]vice4 7c7 ,review ( quality & p]=mance measures 7#a7 ,review 7,a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y1 9 coord9ation ) ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,national ,quality ,=um1 ,indian tribes1 practition]s & adm9i/rators ( ! ,s]vice1 & o!r qualifi$ exp]ts1 z det]m9$ appropriate by ! ,secret>y1 %all und]take a review ( ! report$ quality & p]=mance measures ( ,s]vice facilities conduct$ by ! ,secret>y 9 accordance )-- 7i7 section #cjf ( title #e1 ,unit$ ,/ates ,code2 7ii7 section #aaae7;b7 ( title #ca1 ,unit$ ,/ates ,code2 & 7iii7 any law 7includ+ regulations7 us$ 9 any m&atory or volunt>y program ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7,b7 ,report ,n lat] ?an #f mon?s aft] ! date on :i* ! review requir$ "u subp>agraph 7,a7 is complet$1 ! ,secret>y %all submit to ,congress a report on ! details & f9d+s ( t review1 :i* %all include an assessm5t (-- 7i7 ! suitability ( measures us$ z ( ! date ( enactm5t ( ?is ,act = ! applicable ,s]vice facility1 tak+ into consid]ation ! pati5t volume ( ! facility1 ! mix ( pati5t cases at ! facility1 ! geographic location ( ! facility1 & m$ical pr(essional %ortage designations at ! facility1 z det]m9$ by ! ,secret>y2 & 7ii7 ! ext5t to :i* ! p]=mance & quality measures are outcome-bas$ or process-bas$ measures4 7#b7 ,adoption ,n lat] ?an #a ye> aft] ! date on :i* ! report requir$ "u p>agraph 7#a77;,b7 is submitt$ to ,congress1 ! ,s]vice1 9 coord9ation ) ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all adopt1 & assi/ ,s]vice facilities to adopt1 to ! ext5t practicable1 m suitable1 z comp>$ to ^? quality & p]=mance measures adopt$ prior to ! submission ( t report1 quality & p]=mance measures1 includ+ measures t are m outcome-bas$ & process-bas$1 9 accordance ) ! factors describ$ 9 p>agraph 7#a77;,b77i74 7#c7 ,,gao report ,n lat] ?an #a ye> aft] ! date on :i* ! report requir$ "u p>agraph 7#a77;,b7 is submitt$ to ,congress1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on *all5ges relat+ to quality measure & data collection 9 ,s]vice facilities1 :i* %all include-- 7,a7 b>ri]s to ! adoption ( relevant p]=mance & quality measures 9 ,s]vice facilities2 & 7,b7 recomm5dations = h[ ! ,s]vice1 o!r ,f$]al ag5cies1 & /akehold]s c assi/ ,s]vice facilities 9 adopt+ suitable quality & p]=mance measures4 7d7 ,compliance assi/ance program 7#a7 ,def9itions ,9 ?is subsection3 7,a7 ,adm9i/rator ,! t]m ,adm9i/rator means ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7,b7 ,eligible facility 7i7 ,9 g5]al ,! t]m eligible facility means a facility op]at$ by ! ,s]vice t-- 7,i7 is an und]p]=m+ hospital or outpati5t facility2 & 7,,ii7 is eligible = paym5ts "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7ii7 ,inclusion ,! t]m eligible facility includes a tribally op]at$ facility1 if t facility cons5ts to p>ticipat+ 9 ! program4 7,c7 ,program ,! t]m program means ! compliance assi/ance program e/abli%$ "u p>agraph 7#b74 7,d7 ,tribally op]at$ facility ,! t]m tribally op]at$ facility means a facility op]at$ by an ,indian tribe1 a tribal organization1 or an ,urban ,indian organization t-- 7i7 is an und]p]=m+ hospital or outpati5t facility2 & 7ii7 is eligible = paym5ts "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#b7 ,e/abli%m5t ( program ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y1 9 coord9ation ) ! ,adm9i/rator & quality improvem5t organizations hav+ a contract ) ! ,secret>y "u "p ,b ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq471 %all e/abli% a compliance assi/ance program = eligible facilities4 7#c7 ,me?odology ,! ,secret>y %all e/abli% a me?odology = det]m9+ :i* eligible facilities %all p>ticipate 9 ! program1 :i* %all take into acc\nt ! foll[+ factors3 7,a7 ,! numb] & sev]ity ( facility defici5cies ) respect to applicable requirem5ts "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7,b7 ,! hi/ory ( provid] misconduct or pati5t h>m at ! facility4 7,c7 ,:e!r !re is high /aff turnov] at ! facility4 7,d7 ,:e!r ! facility has l[ p]=mance on program quality measures1 relative to o!r facilities ( ! ,s]vice1 9 accordance ) report$ quality & p]=mance measures conduct$ by ! ,secret>y 9 accordance )-- 7i7 section #cjf ( title #e1 ,unit$ ,/ates ,code2 7ii7 section #aaae7;b7 ( title #ca1 ,unit$ ,/ates ,code2 & 7iii7 any law 7includ+ regulations7 us$ 9 any m&atory or volunt>y program ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#d7 ,selection ( facilities 7,a7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) ! ,adm9i/rator1 %all select n less ?an #be p]c5t ( ! eligible facilities to p>ticipate 9 ! program us+ ! me?odology e/abli%$ "u p>agraph 7#c74 7,b7 ,p>ticipation 7i7 ,9 g5]al ,an eligible facility select$ to p>ticipate 9 ! program "u subp>agraph 7,a7 %all be requir$ to p>ticipate 9 ! program4 7ii7 ,requirem5t ,! ,secret>y %all ensure t1 at all times dur+ ! p]iod beg9n+ on ! date ( e/abli%m5t ( ! program & ! date on :i* ! program t]m9ates "u p>agraph 7#h71 n less ?an #be p]c5t ( eligible facilities are p>ticipat+ 9 ! program4 7,c7 ,t]m ( p>ticipation 7i7 ,9 g5]al ,subject to clause 7ii71 an eligible facility select$ to p>ticipate 9 ! program "u subp>agraph 7,a7 %all p>ticipate 9 ! program = a p]iod ( #b ye>s4 7ii7 ,waiv] ,if ! ,secret>y1 9 coord9ation ) ! ,adm9i/rator1 c]tifies t an eligible facility p>ticipat+ 9 ! program has improv$ on its p]=mance to a satisfactory level1 z det]m9$ by ! ,secret>y1 !n ! eligible facility does n h to p>ticipate 9 ! program = ! full #b-ye> p]iod4 7,d7 ,p>ticipation limit ,an eligible facility may p>ticipate 9 ! program = m ?an #a #b-ye> p]iod4 7#e7 ,program compon5ts ,! program %all provide on-site consultation & educational programm+ = eligible facilities to ensure ^? eligible facilities are-- 7,a7 meet+ ,f$]al requirem5ts ( ! ,s]vice & any conditions ( p>ticipation applicable "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 & 7,b7 satisfactorily implem5t+ any quality initiatives & programs e/abli%$ by ! ,s]vice or ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#f7 ,en=cem5t or noncompliance actions 7,a7 ,9 g5]al ,! program %all be conduct$ indep5d5tly ( any en=cem5t actions "u ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja et seq47 or noncompliance actions tak5 by ! ,adm9i/rator ) respect to noncompliance ) conditions ( p>ticipation applicable "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 unless1 :ile c>ry+ out ! program1 ! ,secret>y or ! ,adm9i/rator1 z applicable1 enc\nt]s a trigg]+ ev5t1 z det]m9$ by ! ,secret>y or ! ,adm9i/rator1 z applicable1 t w\ld necessitate an en=cem5t action or noncompliance action4 7,b7 ,trigg]+ ev5t enc\nt]$ ,if a trigg]+ ev5t is enc\nt]$ by ! ,secret>y or ,adm9i/rator "u subp>agraph 7,a71 ! eligible facility %all cont9ue to p>ticipate 9 ! program s long z ! facility-- 7i7 rema9s eligible = paym5ts "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 & 7ii7 cont9ues to meet all ( ! conditions & requirem5ts = su* paym5ts :i* are applicable "u su* title4 7#g7 ,implem5tation ,! ,secret>y %all c>ry out ! program 9 coord9ation ) quality improvem5t organizations hav+ a contract ) ! ,secret>y "u "p ,b ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;c et seq474 7#h7 ,sunset ,! program %all t]m9ate #f ye>s aft] ! date on :i* ! program is e/abli%$4 7#i7 ,report ,n lat] ?an #a ye> aft] ! date on :i* ! program t]m9ates "u p>agraph 7#h71 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report evaluat+ ! effectiv5ess ( ! program1 :i* %all include1 to ! ext5t practicable-- 7,a7 detail$ data on *anges 9 ! pati5t exp]i5ce at eligible facilities t p>ticipat$ 9 ! program2 7,b7 a description ( ! compliance /atus ( eligible facilities t p>ticipat$ 9 ! program ) requirem5ts ( ! ,s]vice & any conditions ( p>ticipation applicable "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 & 7,c7 a description ( ! progress by eligible facilities t p>ticipat$ 9 ! program 9 meet+ ! goals ( quality improvem5t activities ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 #aab4 ,notification ( inve/igation reg>d+ pr(essional conduct2 submission ( records ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afga et seq47 7z am5d$ by section #aji7 is am5d$ by add+ at ! end ! foll[+3 #hce4 ,notification ( inve/igation reg>d+ pr(essional conduct2 submission ( records 7a7 ,report ,n lat] ?an #ad cal5d> days aft] ! date on :i* ! ,s]vice und]takes an inve/igation into ! pr(essional conduct ( a lic5see ( a ,/ate1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all notify ! relevant ,/ate m$ical bo>d ( ! inve/igation4 7b7 ,submission ( records ,n lat] ?an #ad cal5d> days aft] ! date on :i* ! ,s]vice g5]ates records relat+ to an inve/igation conduct$ by ! ,s]vice into ! pr(essional conduct ( a lic5see ( a ,/ate1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all provide ! records to ! relevant ,/ate m$ical bo>d4 4 #aac4 ,m$ical *ap]ones2 ,(fice ( ,pati5t ,advocacy 7a7 ,m$ical *ap]ones ,title ,,ii ( ! ,indian ,heal? ,c>e ,improvem5t ,act is am5d$ by ins]t+ aft] section #bbc 7#be ,u4,s4,c4 #afbav7 ! foll[+3 #bbd4 ,m$ical *ap]ones 7a7 ,indian ,heal? ,s]vice 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all1 at ! reque/ ( a pati5t ( ! ,s]vice1 provide to ! pati5t a m$ical *ap]one1 to be pres5t dur+ any m$ical exam9ation ( ! pati5t provid$ by or ?r\gh ! ,s]vice4 7#b7 ,requirem5ts ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all-- 7,a7 notify pati5ts ( ! ,s]vice ( ! "r to h a m$ical *ap]one pres5t dur+ a m$ical exam9ation provid$ by or ?r\gh ! ,s]vice2 & 7,b7 ensure t ! "r describ$ 9 subp>agraph 7,a7 is provid$ to ea* pati5t 9 ea* ,s]vice unit4 7b7 ,o!r provid]s ( s]vices ,an ,indian tribe1 tribal organization1 or any o!r ,indian heal? program may use am\nts made available "u ?is ,act to provide1 at ! reque/ ( a pati5t to :om ! ,indian tribe1 tribal organization1 or ,indian heal? program is provid+ heal? c>e s]vices1 a m$ical *ap]one to ! pati5t1 to be pres5t dur+ any m$ical exam9ation ( ! pati5t provid$ by ! ,indian tribe or tribal organization4 4 7b7 ,indian ,heal? ,s]vice ,(fice ( ,pati5t ,advocacy ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #ajf7 is am5d$ by add+ at ! end ! foll[+3 #fjh4 ,(fice ( ,pati5t ,advocacy 7a7 ,def9itions ,9 ?is section3 7#a7 ,director ,! t]m ,director means ! ,director ( ! ,(fice4 7#b7 ,(fice ,! t]m ,(fice means ! ,(fice ( ,pati5t ,advocacy e/abli%$ by subsection 7b74 7b7 ,e/abli%m5t ,!re is e/abli%$ )9 ! ,dep>tm5t an (fice1 to be kn[n z ! ,(fice ( ,pati5t ,advocacy4 7c7 ,director ,! ,(fice %all be head$ by a ,director1 :o %all-- 7#a7 be appo9t$ by ! ,secret>y f among individuals qualifi$ to p]=m ! duties ( ! position2 & 7#b7 report directly to ! ,secret>y4 7d7 ,duties 7#a7 ,9 g5]al ,! ,(fice %all c>ry out a pati5t advocacy program ( ! ,s]vice1 "u :i* ! ,(fice %all-- 7,a7 employ pati5t advocates to advocate on behalf ( ,indians ) respect to heal? c>e s]vices s\ght or receiv$ ?r\gh ! ,s]vice2 7,b7 provide to ^? pati5t advocates tra9+ to ensure ! advocates c>ry out ! responsibilities describ$ 9 p>agraph 7#b72 & 7,c7 9 z _m prom95t locations z ! ,director det]m9es to be appropriate to be se5 by ! l>ge/ p]c5tage ( pati5ts & family memb]s ( pati5ts at ea* ,s]vice unit1 display-- 7i7 ! purposes ( ! pati5t advocacy program2 7ii7 ! contact in=mation = a pati5t advocate employ$ at ! ,s]vice unit2 & 7iii7 a description ( ! rights & responsibilities ( pati5ts & family memb]s ( pati5ts at ! ,s]vice unit4 7#b7 ,pati5t advocate responsibilities ,! responsibilities ( a pati5t advocate employ$ by ! ,(fice %all include ! foll[+3 7,a7 ,resolv+ any compla9ts by ,indian pati5ts ) respect to heal? c>e s]vices provid$ by or ?r\gh ! ,s]vice t _c be resolv$ at-- 7i7 ! po9t ( s]vice2 or 7ii7 a high] level easily accessible to ! pati5t4 7,b7 ,express+ to ,indians _! rights & responsibilities z pati5ts 9 receiv+ heal? c>e s]vices ?r\gh ! ,s]vice4 7,c7 ,pres5t+ at v>i\s meet+s1 & to v>i\s committees1 a description ( any issues exp]i5c$ by ,indians 9 receiv+ heal? c>e s]vices ?r\gh ! ,s]vice4 7,d7 ,manag+ a pati5t advocate track+ sy/em1 if applicable4 7,e7 ,compil+ data relat+ to any compla9ts made to ! advocate by ,indians ) respect to ! receipt ( heal? c>e s]vices ?r\gh ! ,s]vice1 & ! satisfaction ( ,indians ) ^? s]vices1 to det]m9e :e!r !re exi/ any tr5ds 9 ^? data4 7,f7 ,ensur+ t a process exi/s = ! di/ribution ( data compil$ "u subp>agraph 7,e7 to ,indian heal? programs1 appropriate lead]s1 committees1 & s]vice provid]s1 & /aff ( ! ,s]vice4 7,g7 ,id5tify+1 n less frequ5tly ?an qu>t]ly1 opportunities = improvem5t 9 ! provision ( heal? c>e s]vices to ,indians by or ?r\gh ! ,s]vice1 includ+ bas$ on compla9ts by ,indian pati5ts or imm$iate family memb]s4 7,h7 ,ensur+ t any significant compla9t by an ,indian pati5t or family memb] ) respect to heal? c>e provid$ by or ?r\gh ! ,s]vice is br\ght to ! att5tion ( appropriate /aff ( ! ,s]vice or ,indian heal? program = ! purpose ( assess+ :e!r fur!r analysis ( ! problem is requir$ at ! ,s]vice1 ,s]vice area1 ,s]vice unit1 or ,indian heal? program level4 7,i7 ,support+ any o!r pati5t advocacy programs c>ri$ out by ! ,dep>tm5t4 7,j7 ,ensur+ t all appeals & f9al decisions ) respect to ! receipt ( heal? c>e s]vices ?r\gh ! ,s]vice are ent]$ into a pati5t advocate track+ sy/em ( ! ,(fice1 if applicable4 7,k7 ,und]/&+ all laws1 directives1 & o!r rules relat+ to ! rights & responsibilities ( ,indians 9 receiv+ heal? c>e s]vices ?r\gh ! ,s]vice1 includ+ ! appeals processes available to ,indian pati5ts & imm$iate family memb]s4 7,l7 ,ensur+ t ,indians receiv+ behavioral heal? s]vices "u title ,,vii 7& any surrogate decisionmak]s = su* ,indians7 are aw>e ( ! "r ( ,indians-- 7i7 to seek repres5tation f sy/ems e/abli%$ "u section #ajc ( ! ,protection & ,advocacy = ,m5tally ,ill ,individuals ,act ( #aihf 7#db ,u4,s4,c4 #ajhjc72 7ii7 to protect & advocate = ! rights ( ,indians exp]i5c+ behavioral heal? issues2 & 7iii7 to inve/igate incid5ts ( abuse & neglect ( ,indians exp]i5c+ behavioral heal? issues4 7,m7 ,a*iev+ compliance ) any applicable requirem5ts e/abli%$ by ! ,secret>y ) respect to ! inspection ( controll$ sub/ances 7z def9$ 9 section #ajb ( ! ,controll$ ,sub/ances ,act 7#ba ,u4,s4,c4 #hjb774 7,n7 ,docum5t+ pot5tially ?reat5+ behavior & report+ t behavior to ! appropriate au?orities4 7#c7 ,tra9+ ,! ,director %all ensure t ! tra9+ provid$ to pati5t advocates "u p>agraph 7#a77;,b7 is consi/5t ?r\gh\t ! ,(fice1 includ+ ) respect to any m&atory tra9+ or c]tification /&>ds approv$ by ! ,director4 4 #aad4 ,fitness ( heal? c>e provid]s 7a7 ,9 g5]al ,title ,,viii ( ! ,indian ,heal? ,c>e ,improvem5t ,act is am5d$ by ins]t+ aft] section #hjb 7#be ,u4,s4,c4 #afgb7 ! foll[+3 #hjc4 ,fitness ( heal? c>e provid]s 7a7 ,additional requirem5ts = hir+ ( heal? c>e provid]s by ,s]vice ,z "p ( ! hir+ process = ea* heal? c>e provid] position at ! ,s]vice aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,director %all require f ! m$ical bo>d ( ea* ,/ate 9 :i* ! heal? c>e provid] has or _h a m$ical lic5se-- 7#a7 in=mation on any violation ( ! requirem5ts ( ! m$ical lic5se ( ! heal? c>e provid] dur+ ! #bj-ye> p]iod end+ on ! date on :i* ! heal? c>e provid] is be+ consid]$ = a position at ! ,s]vice2 & 7#b7 in=mation on :e!r ! heal? c>e provid] has ent]$ into any settlem5t agreem5t = a discipl9>y *>ge relat+ to ! practice ( m$ic9e by ! heal? c>e provid]4 7b7 ,provision ( in=mation on ,s]vice heal? c>e provid]s to ,/ate m$ical bo>ds ,not)/&+ section #eeb;a ( title #e1 ,unit$ ,/ates ,code1 ) respect to ea* heal? c>e provid] ( ! ,s]vice :o has violat$ a requirem5t ( ! m$ical lic5se ( ! heal? c>e provid]1 ! ,director %all provide to ! m$ical bo>d ( ea* ,/ate 9 :i* ! heal? c>e provid] is lic5s$ detail$ in=mation ) respect to ! violation1 reg>dless ( :e!r ! m$ical bo>d has =mally reque/$ t in=mation4 4 7b7 ,report on compliance by ,indian ,heal? ,s]vice ) reviews ( heal? c>e provid]s leav+ ,s]vice or transf]r+ to o!r facilities ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,indian ,heal? ,s]vice %all submit to ! ,committee on ,indian ,affairs ( ! ,s5ate & ! ,committee on ,natural ,res\rces ( ! ,h\se ( ,repres5tatives a report on ! compliance by ! ,indian ,heal? ,s]vice ) ! policy ( ! ,indian ,heal? ,s]vice-- 7#a7 to conduct a review ( ea* heal? c>e provid] ( ! ,indian ,heal? ,s]vice :o transf]s to ano!r m$ical facility ( ! ,indian ,heal? ,s]vice1 resigns1 retires1 or is t]m9at$ to det]m9e :e!r !re are any conc]ns1 compla9ts1 or allegations ( violations relat+ to ! m$ical practice ( ! heal? c>e provid]2 & 7#b7 to take appropriate action ) respect to any conc]n1 compla9t1 or allegation describ$ 9 p>agraph 7#a74 #aae4 ,/&>ds to improve timel9ess ( c>e ,title ,,iv ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afda et seq47 is am5d$ by add+ at ! end ! foll[+3 #dab4 ,/&>ds to improve timel9ess ( c>e 7a7 ,regulations 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 ! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all-- 7,a7 e/abli%1 by regulation1 /&>ds to measure ! timel9ess ( ! provision ( heal? c>e s]vices 9 ,s]vice facilities2 & 7,b7 provide su* /&>ds to ea* ,s]vice unit4 7#b7 ,data collection ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 %all develop a process = ea* ,s]vice unit to submit to ! ,secret>y data ) respect to ! /&>ds e/abli%$ "u p>agraph 7#a77;,a74 7b7 ,annual reports 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb1 & annually !reaft]1 ea* ,area (fice %all submit to ! ,secret>y a report on ! metrics report$ by ,s]vice units relat+ to ! timel9ess ( ! provision ( heal? c>e s]vices 9 ,s]vice facilities )9 ea* ,s]vice unit4 7#b7 ,publication ,! ,secret>y %all make ea* report receiv$ "u p>agraph 7#a7 publicly available on ! website ( ! ,s]vice4 4 ,,ii ,employee protections #bja4 ,employee protections aga9/ retaliation 7a7 ,9 g5]al ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #aac7;b77 is am5d$ by add+ at ! end ! foll[+3 #fji4 ,employee protections aga9/ retaliation 7a7 ,def9itions ,9 ?is section3 7#a7 ,in=mation ,! t]m in=mation means in=mation-- 7,a7 ! disclosure ( :i* is n specifically prohibit$ by law2 & 7,b7 t is n specifically requir$ by ,executive ord] to be kept secret 9 ! int]e/ ( national def5se or ! conduct ( =eign affairs4 7#b7 ,retaliation ,! t]m retaliation1 ) respect to a :i/lebl[]1 means-- 7,a7 an adv]se employm5t action aga9/ ! :i/lebl[]2 7,b7 a significantly adv]se action aga9/ ! :i/lebl[]1 su* z ! refusal or delay ( c>e provid$ ?r\gh ! ,s]vice2 & 7,c7 an adv]se action describ$ 9 subp>agraph 7,a7 or 7,b7 aga9/ a family memb] or fri5d ( ! :i/lebl[]4 7#c7 ,:i/lebl[] ,! t]m :i/lebl[] means an employee ( ! ,s]vice :o discloses in=mation t ! employee reasonably believes evid5ces-- 7,a7 a violation ( any law1 rule1 regulation1 or ,s]vice policy2 or 7,b7 gross mismanagem5t1 a gross wa/e ( funds1 an abuse ( au?ority1 or a sub/antial & specific dang] to public heal? or safety4 7b7 ,employee acc\ntability 7#a7 ,designat$ (ficial ,! ,secret>y %all designate an (ficial 9 ! ,dep>tm5t :o is n an employee ( ! ,s]vice to receive reports "u p>agraph 7#b74 7#b7 ,m&atory report+ ,an employee ( ! ,s]vice :o witnesses retaliation aga9/ a :i/lebl[]1 a violation ( a pati5t safety requirem5t1 or o!r simil> conduct %all submit to ! (ficial designat$ "u p>agraph 7#a7 a report ( ! conduct4 7#c7 ,ov]sight ,n lat] ?an #c days aft] ! date on :i* ! (ficial designat$ "u p>agraph 7#a7 receives a report "u p>agraph 7#b71 ! ,secret>y %all-- 7,a7 =mally review ! report2 & 7,b7 provide a copy ( ! report & any o!r relevant in=mation to ! ,inspector ,g5]al ( ! ,dep>tm5t4 7#d7 ,removal = :i/lebl[] retaliation 7,a7 ,9 g5]al ,! ,secret>y may remove = misconduct f ! civil s]vice 7z def9$ 9 section #baja ( title #e1 ,unit$ ,/ates ,code71 9 accordance ) section #fjf or #fjg1 z applicable1 an employee ( ! ,s]vice if ! ,secret>y det]m9es1 aft] complet+ a review describ$ 9 p>agraph 7#c71 t ! employee has retaliat$ aga9/ a :i/lebl[] & w>rants removal = misconduct4 7,b7 ,retaliation z misconduct ,retaliation by an employee aga9/ a :i/lebl[]1 z describ$ 9 subp>agraph 7,a71 %all be consid]$ to be misconduct = purposes ( sections #fjf & #fjg4 7#e7 ,enhanc+ protections = :i/lebl[]s ,! ,secret>y %all c>ry out any actions det]m9$ necess>y by ! ,secret>y to enhance protection = :i/lebl[]s1 includ+ id5tify+ appropriate ,s]vice employees & requir+ ! employees to complete ! ,(fice ( ,special ,c\nsel's ,:i/lebl[] ,c]tification ,program4 4 #bjb4 ,"r ( ,f$]al employees to petition ,congress 7a7 ,adv]se action = violation ( "r to petition ,congress ,section #gbaa ( title #e1 ,unit$ ,/ates ,code1 is am5d$-- 7#a7 by /rik+ ,! "r ( & ins]t+ ! foll[+3 7a7 ,9 g5]al ,! "r ( 2 & 7#b7 by add+ at ! end ! foll[+3 7b7 ,adv]se action ,an employee :o int]f]es ) or d5ies a "r protect$ "u subsection 7a7 %all be subject to any adv]se action describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 ( section #geab1 9 accordance ) ! proc$ure describ$ 9 section #geac & any o!r applicable proc$ure4 4 7b7 ,electronic notification ( "r ( employees ( ,indian ,heal? ,s]vice 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,indian ,heal? ,s]vice 7ref]r$ to 9 ?is subsection z ! ,secret>y71 %all provide1 9 accordance ) p>agraphs 7#b7 ?r\gh 7#e71 to ea* employee ( ! ,indian ,heal? ,s]vice notice ( ! "r to petition ,congress "u section #gbaa ( title #e1 ,unit$ ,/ates ,code4 7#b7 ,memor&um ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,inspector ,g5]al7 a memor&um t includes ! foll[+ /atem5t3 ,x is a violation ( section #gbaa ( title #e1 ,unit$ ,/ates ,code1 = any ,f$]al ag5cy or employee to require a ,f$]al employee to seek approval1 guidance1 or any o!r =m ( input prior to contact+ ,congress ) in=mation1 ev5 if t in=mation is 9 relation to ! job responsibilities ( ! employee4 ,a ,f$]al employee f\nd to h int]f]$ ) or d5i$ ! "r ( ano!r ,f$]al employee "u su* section %all be subject to an adv]se action describ$ 9 any ( p>agraphs 7#a7 ?r\gh 7#e7 ( section #geab ( title #e1 ,unit$ ,/ates ,code1 includ+ a susp5sion = m ?an #ad days )\t pay44 7#c7 ,approval or disapproval 7,a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date on :i* ! memor&um is submitt$ "u p>agraph 7#b71 ! ,inspector ,g5]al %all approve or disapprove ! memor&um4 7,b7 ,disapproval ,if ! ,inspector ,g5]al disapproves ! memor&um1 ! ,inspector ,g5]al %all advise ! ,secret>y on :at *anges to ! memor&um are necess>y = approval4 7#d7 ,notice ,if ! memor&um is approv$ "u p>agraph 7#c71 n lat] ?an #cj days aft] ! date ( ! approval1 ! ,secret>y %all-- 7,a7 provide to ea* employee ( ! ,indian ,heal? ,s]vice an electronic copy ( ! approv$ memor&um2 & 7,b7 po/ ! memor&um 9 a cle> & conspicu\s place on ! website ( ! ,indian ,heal? ,s]vice4 7#e7 ,revis$ memor&um 7,a7 ,9 g5]al ,if ! memor&um is disapprov$ "u p>agraph 7#c71 n lat] ?an #ae days aft] ! date ( disapproval1 ! ,secret>y %all submit to ! ,inspector ,g5]al a revis$ memor&um t incorporates ! *anges advis$ "u subp>agraph 7,b7 ( t p>agraph4 7,b7 ,approval or disapproval ,n lat] ?an #cj days aft] ! date on :i* ! revis$ memor&um is submitt$ "u subp>agraph 7,a71 ! ,inspector ,g5]al %all approve ! revis$ memor&um4 7,c7 ,notice ,n lat] ?an #cj days aft] ! date on :i* a revis$ memor&um is approv$ "u ?is p>agraph1 ! ,secret>y %all provide notice ( ! memor&um 9 accordance ) p>agraph 7#d74 #bjc4 ,fiscal acc\ntability ,title ,,vi ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affa et seq47 7z am5d$ by section #bja7 is am5d$ by add+ at ! end ! foll[+3 #faj4 ,fiscal acc\ntability 7a7 ,managem5t ( funds 7#a7 ,9 g5]al ,if ! ,secret>y fails to submit a pr(essional h\s+ plan "u section #cjb7;a7 ( ! ,re/or+ ,acc\ntability 9 ! ,indian ,heal? ,s]vice ,act ( #bjbb or a /aff+ plan "u section #cjb7;b7 ( t ,act by ! applicable deadl9e1 ! ,secret>y may n receive1 obligate1 transf]1 or exp5d any am\nts = a sal>y increase or bonus ( an individual describ$ 9 p>agraph 7#b7 until ! pr(essional h\s+ plan or /aff+ plan1 z applicable1 is submitt$4 7#b7 ,individual describ$ ,an individual ref]r$ to 9 p>agraph 7#a7 is an individual employ$ 9 ! ,s]vice-- 7,a7 9 a position t is-- 7i7 describ$ 9 any ( sections #ecab ?r\gh #ecaf ( title #e1 ,unit$ ,/ates ,code2 7ii7 plac$ 9 level ,,iv or ,v ( ! ,executive ,s*$ule "u section #ecag ( title #e1 ,unit$ ,/ates ,code2 or 7iii7 describ$ 9 section #bac4ccja or #bac4ccjb ( title #e1 ,code ( ,f$]al ,regulations 7or a successor regulation72 or 7,b7 z a limit$ t]m appo9tee1 limit$ em]g5cy appo9tee1 or nonc>e] appo9tee 7z ^? t]ms are def9$ 9 section #cacb7;a7 ( title #e1 ,unit$ ,/ates ,code74 7b7 ,prioritization ( pati5t c>e 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! ,secret>y %all use am\nts available to ! ,s]vice t are n obligat$ or exp5d$1 includ+ base budget fund+ & ?ird p>ty collections1 dur+ ! fiscal ye> = :i* ! am\nts are made available1 & t rema9 available1 only to support pati5t c>e by us+ ! funds = ! co/s (-- 7,a7 ess5tial m$ical equipm5t2 7,b7 pur*as$ or ref]r$ c>e2 or 7,c7 /aff+4 7#b7 ,special rule ,9 us+ am\nts "u p>agraph 7#a71 ! ,secret>y %all ensure t1 9 any case :]e ! am\nts 7 orig9ally made available = a p>ticul> ,s]vice unit1 ! am\nts are us$ to b5efit ,indians s]v$ by t ,s]vice unit4 7#c7 ,,hhs plan ,ea* applicable fiscal ye>1 ! ,secret>y1 9 consultation ) ,indian tribes1 %all e/abli% a plan = di/ribut+ ! am\nts describ$ 9 p>agraph 7#a7 across ! categories ( uses describ$ 9 subp>agraphs 7,a7 ?r\gh 7,c7 ( t p>agraph4 7#d7 ,re/rictions ,! ,secret>y may n use am\nts describ$ 9 p>agraph 7#a7-- 7,a7 to remodel or int]ior decorate any ,area (fice2 or 7,b7 to increase ! rate ( pay ( any employee ( an ,area (fice4 7c7 ,sp5d+ reports ,n lat] ?an #ij days aft] ! end ( ea* fiscal ye>1 ! ,secret>y %all submit a report describ+ ! au?orizations1 exp5ditures1 outlays1 transf]s1 reprogramm+1 & obligations ( ea* level ( ! ,s]vice1 includ+ ! headqu>t]s1 ea* ,area (fice1 ea* ,s]vice unit1 & ea* heal? cl9ic or facility1 to-- 7#a7 ea* ,indian tribe2 7#b7 9 ! ,s5ate-- 7,a7 ! ,committee on ,indian ,affairs2 7,b7 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions2 7,c7 ! ,committee on ,appropriations2 & 7,d7 ! ,committee on ! ,budget2 & 7#c7 9 ! ,h\se ( ,repres5tatives-- 7,a7 ! ,committee on ,natural ,res\rces2 7,b7 ! ,committee on ,en]gy & ,comm]ce2 7,c7 ! ,committee on ,appropriations2 & 7,d7 ! ,committee on ! ,budget4 7d7 ,/atus reports 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 n lat] ?an #ahj days aft] ! end ( ea* fiscal ye>1 ! ,secret>y %all provide to ea* entity describ$ 9 p>agraphs 7#a7 ?r\gh 7#c7 ( subsection 7c7 a report describ+ ! safety1 bill+1 c]tification1 cr$5tial1 & compliance /atuses ( ea* facility manag$1 op]at$1 or o!rwise support$ by ! ,s]vice4 7#b7 ,updates ,) respect to any *ange ( a /atus describ$ 9 p>agraph 7#a71 ! ,secret>y %all imm$iately provide to ea* entity describ$ 9 p>agraphs 7#a7 ?r\gh 7#c7 ( subsection 7c7 an update describ+ ! *ange4 7e7 ,effect ,no?+ 9 ?is section-- 7#a7 negatively impacts ! "r ( an ,indian tribe to ent] into a compact or contract "u ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecja et seq472 or 7#b7 applies to su* a compact or contract unless expressly agre$ to by ! ,indian tribe4 4 ,,iii ,reports #cja4 ,def9itions ,9 ?is title3 7#a7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#b7 ,s]vice ,! t]m ,s]vice means ! ,indian ,heal? ,s]vice4 7#c7 ,s]vice unit ,! t]m ,s]vice unit has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 7#d7 ,tribal heal? program ,! t]m tribal heal? program has ! mean+ giv5 ! t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 #cjb4 ,reports by ! ,secret>y ( ,heal? & ,human ,s]vices 7a7 ,,ihs pr(essional h\s+ plan 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all develop1 make publicly available1 & submit to ,congress & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates a writt5 plan to address ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice & employees ( tribal heal? programs t comports ) ! practices & recomm5dations ( ! ,gov]nm5t ,acc\ntability ,(fice relat+ to pr(essional h\s+ includ$ 9 ! mo/ rec5t report ( ! ,gov]nm5t ,acc\ntability ,(fice reg>d+ ,indian ,heal? ,s]vice h\s+ ne$s4 7#b7 ,requirem5t ,! plan "u p>agraph 7#a7 %all include1 at a m9imum1 projections = ! pr(essional h\s+ ne$s =-- 7,a7 ! #a-ye> p]iod foll[+ ! date ( ! plan2 7,b7 ! #e-ye> p]iod foll[+ ! date ( ! plan2 & 7,c7 ! #aj-ye> p]iod foll[+ ! date ( ! plan4 7b7 ,plan relat+ to ,,ihs /aff+ ne$s 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date on :i* ! ,gov]nm5t ,acc\ntability ,(fice releases ! report describ$ 9 subsection 7a71 ! ,secret>y %all develop1 make publicly available1 & submit to ,congress & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates a writt5 plan to address ! /aff+ ne$s ( ! ,s]vice & tribal heal? programs t comports ) ! practices & recomm5dations ( ! ,gov]nm5t ,acc\ntability ,(fice relat+ to work=ce plann+ includ$ 9 ! report4 7#b7 ,requirem5t ,! plan "u p>agraph 7#a7 %all include1 at a m9imum1 projections = ! /aff+ ne$s =-- 7,a7 ! #a-ye> p]iod foll[+ ! date ( ! plan2 7,b7 ! #e-ye> p]iod foll[+ ! date ( ! plan2 & 7,c7 ! #aj-ye> p]iod foll[+ ! date ( ! plan4 #cjc4 ,reports by ! ,comptroll] ,g5]al 7a7 ,,ihs h\s+ ne$s report ,n lat] ?an #b ye>s aft] ! date on :i* ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates receives ! pr(essional h\s+ plan "u section #cjb7;a71 ! ,comptroll] ,g5]al %all develop & submit to ,congress a report t includes-- 7#a7 an assessm5t ( ! pr(essional h\s+ plan2 7#b7 an evaluation ( any exi/+1 z ( ! date ( ! report1 assessm5ts & projections = ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice & employees ( tribal heal? programs1 includ+ a discussion & conclusions z to :e!r ! exi/+ assessm5ts & projections accurately reflect ! pr(essional h\s+ ne$s ( employees ( ! ,s]vice & employees ( tribal heal? programs2 & 7#c7 an assessm5t ( ! pr(essional h\s+ ne$s (-- 7,a7 employees ( ! ,s]vice = ea* ,s]vice area 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 & 7,b7 employees ( tribal heal? programs = ea* ,indian tribe1 z applicable4 7b7 ,,ihs /aff+ ne$s report 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date on :i* ! ,comptroll] ,g5]al receives ! plan relat+ to ,,ihs /aff+ ne$s "u section #cjb7;b71 ! ,comptroll] ,g5]al %all prep>e & submit to ,congress a report on ! /aff+ ne$s ( ! ,s]vice & tribal heal? programs4 7#b7 ,cont5ts ,! report "u p>agraph 7#a7 %all include-- 7,a7 an assessm5t ( ! /aff+ plan ref]r$ to 9 p>agraph 7#a72 7,b7 a description (-- 7i7 ! numb] & type ( full-"t positions ne$$ at ea* facility ( ! ,s]vice & at ea* tribal heal? program2 & 7ii7 ! am\nt ( funds necess>y to ma9ta9 ^? positions2 7,c7 an explanation ( ! v>i\s me?odologies t ! ,s]vice uses & has previ\sly us$ to det]m9e ! numb] & type ( full-"t positions ne$$ at f$]ally manag$ ,s]vice units2 & 7,d7 an assessm5t ( ! use ( indep5d5t contractors1 includ+-- 7i7 ! numb] ( indep5d5t contractors hir$ to fill vacant full-"t positions2 & 7ii7 ! am\nt ( funds sp5t on indep5d5t contractors :o provide heal? c>e s]vices4 7c7 ,:i/lebl[] protections report 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all develop & submit to ,congress a report on ! efficacy ( exi/+ protections = :i/lebl[]s 9 ! ,s]vice1 includ+ ! protections implem5t$ pursuant to sections #bja & #bjb & ! am5dm5ts made by ^? sections4 7#b7 ,cont5ts ,! report "u p>agraph 7#a7 %all include-- 7,a7 a discussion & conclusions z to :e!r ! ,s]vice has tak5 prop] /eps to prev5t retaliation aga9/ :i/lebl[]s2 7,b7 if applicable1 any recomm5dations = *anges to ! policy ( ! ,s]vice ) respect to :i/lebl[]s2 & 7,c7 a discussion & conclusions z to :e!r ! (ficial email acc\nts ( employees ( ! ,s]vice are appropriately monitor$4 #cjd4 ,inspector ,g5]al reports 7a7 ,pati5t c>e reports 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & n less frequ5tly ?an e #c ye>s !reaft]1 ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all develop & submit to ,congress & ! ,s]vice a report on-- 7,a7 pati5t h>m ev5ts & pati5t dea?s occurr+ 9 ,s]vice units2 7,b7 def]rals & d5ials ( c>e ( pati5ts ( ! ,s]vice2 & 7,c7 ! /&>ds to improve ! timel9ess ( c>e1 develop$ 9 accordance ) section #dab ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7z add$ by section #aae71 & quality ( c>e at ,s]vice facilities1 includ+ quality & p]=mance measures develop$ by ! ,secret>y 9 accordance )-- 7i7 section #cjf ( title #e1 ,unit$ ,/ates ,code2 7ii7 section #aaae7;b7 ( title #ca1 ,unit$ ,/ates ,code2 & 7iii7 any law 7includ+ regulations7 us$ 9 any m&atory or volunt>y program ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#b7 ,cont5ts ,! report "u p>agraph 7#a7 %all include-- 7,a7 an evaluation ( ! numb] & k9d ( ev5ts t contribute to pati5t dea?s 9 a ,s]vice unit & recomm5dations reg>d+ r$uc+ ! numb] ( pati5t dea?s2 7,b7 an evaluation ( h[ ! ,s]vice tracks1 reports1 & responds to pati5t h>m ev5ts & pati5t dea?s & recomm5dations reg>d+ h[ to improve ! track+1 report+1 & response2 & 7,c7 ! effects ( def]rals & d5ials ( c>e on pati5ts ( ! ,s]vice1 includ+ pati5t outcomes1 & recomm5dations reg>d+ h[ to r$uce def]rals & d5ials ( c>e4 7b7 ,report+ sy/ems audit ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all-- 7#a7 conduct an audit ( report+ sy/ems ( ! ,s]vice1 z ( ! date ( enactm5t ( ?is ,act2 & 7#b7 provide to ! ,s]vice recomm5dations & te*nical assi/ance reg>d+ implem5tation ( improv$ report+ sy/ems1 proc$ures1 /&>ds1 & protocols4 #cje4 ,transp>5cy 9 ,,cms surveys ,section #ahhj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieqq7 is am5d$ by add+ at ! end ! foll[+3 7g7 7#a7 ,n less frequ5tly ?an once e #b ye>s1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all conduct surveys ( p>ticipat+ ,indian ,heal? ,s]vice facilities to assess ! compliance ( ea* hospital or skill$ nurs+ facility ( ! ,indian ,heal? ,s]vice )-- 7,a7 section #ahfg2 & 7,b7 conditions ( p>ticipation 9 ! program "u ?is title4 7#b7 ,ea* survey complet$ "u ?is subsection %all be po/$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 ,su* po/+ %all comply ) ! ,f$]al regulations conc]n+ ! privacy ( individually id5tifiable heal? in=mation promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif4 4 ,,iv ,te*nical am5dm5ts #dja4 ,te*nical am5dm5ts 7a7 ,def9itions ,section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc7 is am5d$-- 7#a7 9 p>agraph 7#e71 by /rik+ ! p>agraph designation & head+ & all t foll[s ?r\gh means & ins]t+ ! foll[+3 7#e7 ,pur*as$_/ref]r$ c>e ,! t]m pur*as$_/ref]r$ c>e means 2 & 7#b7 by r$esignat+ p>agraph 7#e7 & p>agraphs 7#f7 ?r\gh 7#ae7 z p>agraph 7#ae7 & p>agraphs 7#e7 ?r\gh 7#ad71 respectively1 & mov+ ! p>agraphs s z to appe> 9 num]ical ord]4 7b7 ,te*nical am5dm5ts ,! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja et seq47 is am5d$-- 7#a7 by /rik+ contract heal? s]vice ea* place x appe>s 7reg>dless ( cas+ & typeface & includ+ 9 ! head+s7 & ins]t+ pur*as$_/ref]r$ c>e 7) appropriate cas+ & typeface72 & 7#b7 by /rik+ contract heal? s]vices ea* place x appe>s 7reg>dless ( cas+ & typeface & includ+ 9 ! head+s7 & ins]t+ pur*as$_/ref]r$ c>e 7) appropriate cas+ & typeface74