[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