[Congressional Bills 118th Congress] [From the U.S. Government Publishing Office] [H.R. 8966 Introduced in House (IH)] <DOC> 118th CONGRESS 2d Session H. R. 8966 To amend the Indian Health Care Improvement Act to improve the recruitment and retention of employees in the Indian Health Service, restore accountability in the Indian Health Service, improve health services, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES July 9, 2024 Mr. Johnson of South Dakota introduced the following bill; which was referred to the Committee on Natural Resources, and in addition to the Committees on Energy and Commerce, Ways and Means, and Oversight and Accountability, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned _______________________________________________________________________ A BILL To amend the Indian Health Care Improvement Act to improve the recruitment and retention of employees in the Indian Health Service, restore accountability in the Indian Health Service, improve health services, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Restoring Accountability in the Indian Health Service Act of 2024''. SEC. 2. TABLE OF CONTENTS. The table of contents for this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. TITLE I--INDIAN HEALTH SERVICE IMPROVEMENTS Sec. 101. Incentives for recruitment and retention. Sec. 102. Medical credentialing system. Sec. 103. Liability protections for health professional volunteers at Indian Health Service. Sec. 104. Clarification regarding eligibility for Indian Health Service loan repayment program. Sec. 105. Improvements in hiring practices. Sec. 106. Improved authorities of secretary to improve accountability of senior executives and employees of the Indian Health Service. Sec. 107. Tribal culture and history. Sec. 108. Staffing demonstration program. Sec. 109. Rule establishing Tribal consultation policy. Sec. 110. Treatment of certain hospitals. Sec. 111. Enhancing quality of care in the Indian Health Service. Sec. 112. Notification of investigation regarding professional conduct; submission of records. Sec. 113. Fitness of health care providers. Sec. 114. Standards to improve timeliness of care. TITLE II--EMPLOYEE PROTECTIONS Sec. 201. Employee protections against retaliation. Sec. 202. Right of Federal employees to petition Congress. Sec. 203. Fiscal accountability. TITLE III--REPORTS Sec. 301. Definitions. Sec. 302. Reports by the Secretary of Health and Human Services. Sec. 303. Reports by the Comptroller General. Sec. 304. Inspector General reports. Sec. 305. Transparency in CMS surveys. TITLE IV--TECHNICAL AMENDMENTS Sec. 401. Technical amendments. TITLE I--INDIAN HEALTH SERVICE IMPROVEMENTS SEC. 101. INCENTIVES FOR RECRUITMENT AND RETENTION. Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) is amended by adding at the end the following: ``SEC. 125. INCENTIVES FOR RECRUITMENT AND RETENTION. ``(a) Parity in IHS Health Care Workforce Personnel and Pay System.--The Secretary shall establish a personnel and pay system for physicians, dentists, nurses, and other health care professionals employed by the Service that provides a personnel and pay system that, to the maximum extent practicable, is comparable to the pay provided to physicians, dentists, nurses, and other health care professionals, respectively, under subchapters III and IV of chapter 74 of title 38, United States Code. ``(b) Housing Vouchers.-- ``(1) In general.--Subject to paragraph (2), not later than 1 year after the date of enactment of the Restoring Accountability in the Indian Health Service Act of 2024, the Secretary may establish a program to provide tenant-based rental assistance to an employee of the Service who-- ``(A) agrees to serve for not less than 1 year at a Service unit designated by the Administrator of the Health Resources and Services Administration as a health professional shortage area (as defined in section 332(a) of the Public Health Service Act (42 U.S.C. 254e(a))) with the greatest staffing need; and ``(B) is a critical employee, as determined by the Secretary. ``(2) Sunset.--Any program established by the Secretary under paragraph (1) shall terminate on the date that is 3 years after the date on which the program is established. ``(3) Reports.--Not later than 1 year after the date on which a program established under paragraph (1) is terminated in accordance with paragraph (2), the Secretary shall submit to Congress a report describing, with respect to that program-- ``(A) the costs of the program; ``(B) employee uptake of the program; and ``(C) the effects of the program on local facility staffing needs. ``(c) Administration.--The Secretary may only provide a benefit under subsection (b) to-- ``(1) a full-time employee who agrees to serve for not less than 1 year in the Service beginning on the date of the agreement; or ``(2) a part-time employee who agrees to serve for not less than 2 years in the service beginning on the date of the agreement.''. SEC. 102. MEDICAL CREDENTIALING SYSTEM. Title I of the Indian Health Care Improvement Act (25 U.S.C. 1611 et seq.) (as amended by section 101) is amended by adding at the end the following: ``SEC. 126. MEDICAL CREDENTIALING SYSTEM. ``(a) In General.-- ``(1) Development and implementation timeline.--Not later than 1 year after the date of enactment of the Restoring Accountability in the Indian Health Service Act of 2024, the Secretary, acting through the Service (referred to in this section as the `Secretary'), in accordance with subsection (b), shall develop and implement a Service-wide centralized credentialing system (referred to in this section as the `credentialing system') to credential licensed health professionals who seek to provide health care services at any Service unit. ``(2) Implementation.--In implementing the credentialing system, the Secretary-- ``(A) 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 2024; and ``(B) shall-- ``(i) use the credentialing system for-- ``(I) 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 2024; and ``(II) the migration into the credentialing system of credentials data that existed prior to implementation of the credentialing system; and ``(ii) maintain the established timeline for re-credentialing of licensed health professionals who were credentialed prior to implementation of the credentialing system, as defined by Service policy. ``(b) Requirements.-- ``(1) In general.--In developing the credentialing system under subsection (a), the Secretary shall ensure that-- ``(A) credentialing procedures shall be uniform throughout the Service; and ``(B) with respect to each licensed health professional who successfully completes the credentialing procedures of the credentialing system, the Secretary may authorize the licensed health professional to provide health care services at any Service unit. ``(2) Exemption.--The requirements described in paragraph (1) 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 2024 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 (a). ``(c) Consultation.--In developing the credentialing system under subsection (a), the Secretary-- ``(1) shall consult with Indian tribes; and ``(2) may consult with-- ``(A) any public or private association of medical providers; ``(B) any government agency; or ``(C) any other relevant expert, as determined by the Secretary. ``(d) Application.-- ``(1) In general.--Subject to paragraph (2), a licensed health care professional may not provide health care services at any Service unit, unless the licensed health care professional successfully completes the credentialing procedures of the credentialing system developed and implemented under subsection (a). ``(2) Exemption.--Paragraph (1) 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 2024 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 (a). ``(e) Nonduplication of Efforts.-- ``(1) In general.--To the extent that prior to the deadline described in subsection (a)(1), the Service has begun implementing or has completed implementation of a medical credentialing system that otherwise meets the requirements of this section, the Service shall not be required to establish a new credentialing system under this section. ``(2) Authority.--The Service may expand or enhance an existing credentialing system to meet the requirements of this section. ``(3) Review.-- ``(A) In general.--Not less frequently than once every 5 years, the Service shall-- ``(i) undertake a formal review of the credentialing system in effect on the date of the review; and ``(ii) if necessary, take action to bring the credentialing system into compliance with the requirements of this section. ``(B) Consultation.--Each formal review conducted under subparagraph (A) shall be subject to the consultation requirements under subsection (c). ``(f) Effect.--Nothing in this section-- ``(1) negatively impacts the right of an Indian tribe to enter into a compact or contract under the Indian Self- Determination and Education Assistance Act (25 U.S.C. 5301 et seq.); or ``(2) applies to such a compact or contract unless expressly agreed to by the Indian tribe.''. SEC. 103. LIABILITY PROTECTIONS FOR HEALTH PROFESSIONAL VOLUNTEERS AT INDIAN HEALTH SERVICE. Section 224 of the Public Health Service Act (42 U.S.C. 233) is amended by adding at the end the following: ``(r) Certain Indian Health Service Volunteers Deemed Public Health Service Employees.-- ``(1) In general.--For purposes of this section, a health professional volunteer at a Service unit shall, in providing a health service to an individual, 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 (4)(C). The preceding sentence is subject to the provisions of this subsection. ``(2) Conditions.--In providing a health service to an individual, a health care practitioner shall, for purposes of this subsection, be considered to be a health professional volunteer at a Service unit if all of the following conditions are met: ``(A) The service is provided to the individual at the facilities of a Service unit, or through offsite programs or events carried out by the Service unit. ``(B) The Service unit is sponsoring the health care practitioner pursuant to paragraph (3)(C). ``(C) The health care practitioner does not receive any compensation for the service from the individual, the Service unit, or any third-party payer (including reimbursement under any insurance policy or health plan, or under any Federal or State health benefits program), 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 individual. ``(D) Before the service is provided, 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 subsection. ``(E) At the time the service is provided, the health care practitioner is licensed, certified, credentialed, and privileged in accordance with Service policy and applicable law regarding the provision of the service. ``(3) Applicability.--Subsection (g) (other than paragraphs (3) and (5)) and subsections (h), (i), and (l) 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 officer, governing board member, employee, or contractor of an entity described in subsection (g)(4), subject to paragraph (4) and subject to the following subparagraphs: ``(A) Each reference to an entity in subsections (g), (h), (i), and (l) shall be considered to be a reference to a Service unit. ``(B) The first sentence of paragraph (1) applies in lieu of the first sentence of subsection (g)(1)(A). ``(C) With respect to a Service unit, a health care practitioner is not a health professional volunteer at the Service unit unless the Service unit sponsors the health care practitioner. For purposes of this subsection, the Service unit shall be considered to be sponsoring the health care practitioner if-- ``(i) with respect to the health care practitioner, the Service unit submits to the Secretary an application meeting the requirements of subsection (g)(1)(D); and ``(ii) the Secretary, pursuant to subsection (g)(1)(E), determines that the health care practitioner is deemed to be an employee of the Public Health Service. ``(D) In the case of a health care practitioner who is determined by the Secretary pursuant to this subsection and subsection (g)(1)(E) to be a health professional volunteer, this subsection applies to the health care practitioner (with respect to services performed on behalf of the Service unit sponsoring the health care practitioner pursuant to subparagraph (C)) 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 determination. ``(E) Subsection (g)(1)(F) applies to a health care practitioner for purposes of this subsection only to the extent that, in providing health services to an individual, each of the conditions described in paragraph (2) is met. ``(4) Funding.-- ``(A) In general.--Amounts in the fund established under subsection (k)(2) shall be available for transfer under subparagraph (C) for purposes of carrying out this subsection. ``(B) Annual estimates.-- ``(i) In general.--Not later than May 1 of each fiscal year, the Attorney General, in consultation with the Secretary, shall submit to Congress a report providing an estimate of the amount of claims (together with related fees and expenses of witnesses) that, by reason of the acts or omissions of health professional volunteers, will be paid pursuant to this section during the calendar year that begins in the following fiscal year. ``(ii) Applicability.--Subsection (k)(1)(B) applies to the estimate under clause (i) 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 officers, governing board members, employees, and