Assessment of the Indian Health Service Act of 2019

II 116TH CONGRESS 1ST SESSION S. 498 To provide for an independent outside audit of the Indian Health Service. IN THE SENATE OF THE UNITED STATES FEBRUARY 14, 2019 Mr. ROUNDS introduced the following bill; which was read twice and referred to the Committee on Indian Affairs A BILL To provide for an independent outside audit of the Indian Health Service. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Assessment of the In- 4 dian Health Service Act of 2019’’. 5 SEC. 2. ASSESSMENT OF THE INDIAN HEALTH SERVICE. 6 (a) DEFINITIONS.—In this section: 7 (1) REPUTABLE PRIVATE ENTITY.—The term 8 ‘‘reputable private entity’’ means a private entity 9 that— 10 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 2 •S 498 IS (A) has experience with, and proven out- 1 comes in optimizing the performance of, Fed- 2 eral health care delivery systems, the private 3 sector, and health care management; and 4 (B) specializes in implementing large-scale 5 organizational and cultural transformations, es- 6 pecially with respect to health care delivery sys- 7 tems. 8 (2) SECRETARY.—The term ‘‘Secretary’’ means 9 the Secretary of Health and Human Services. 10 (3) SERVICE.—The term ‘‘Service’’ means the 11 Indian Health Service. 12 (b) ASSESSMENT.—Not later than 180 days after the 13 date of enactment of this Act, the Secretary shall enter 14 into one or more contracts with a reputable private entity 15 to conduct an independent assessment of the health care 16 delivery systems and financial management processes of 17 the Service. The Secretary shall not be required to provide 18 a full and open competition in entering into such con- 19 tracts. Such independent assessment shall be made only 20 of Service-operated facilities. 21 (c) PROGRAM INTEGRATOR.— 22 (1) IN GENERAL.—If the Secretary enters into 23 contracts under this section with more than 1 rep- 24 utable private sector entity, the Secretary shall des- 25 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 3 •S 498 IS ignate one such entity that is predominantly a 1 health care organization as the program integrator. 2 (2) RESPONSIBILITIES.—The program inte- 3 grator designated under paragraph (1) shall be re- 4 sponsible for coordinating the outcomes of the as- 5 sessments conducted by the reputable private enti- 6 ties under this section. 7 (d) COORDINATION WITH GAO AND OIG.—As part 8 of planning or designing the assessment described in sub- 9 section (b), the Secretary (or the program integrator des- 10 ignated under subsection (c)(1) acting on behalf of the 11 Secretary) shall consult with the Comptroller General of 12 the United States and the Inspector General of the De- 13 partment of Health and Human Services to minimize du- 14 plications in the areas of study required under subsection 15 (e) and to incorporate the Government Accountability Of- 16 fice’s and Office of Inspector General’s prior, publicly re- 17 leased, and relevant report findings dated January 1, 18 2013, or later, as appropriate. 19 (e) AREAS OF STUDY.—Each assessment conducted 20 under subsection (b) shall address each of the following: 21 (1) Current and projected demographics and 22 unique health care needs of the patient population 23 served by the Service. 24 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 4 •S 498 IS (2) Current and projected health care capabili- 1 ties and resources of the Service, including hospital 2 care, medical services, and other health care fur- 3 nished by non-Service facilities under contract with 4 the Service, to provide timely and accessible care to 5 eligible patients. 6 (3) The authorities and mechanisms under 7 which the Secretary may furnish hospital care, med- 8 ical services, and other health care at non-Service fa- 9 cilities. 10 (4) The appropriate systemwide access standard 11 applicable to hospital care, medical services, and 12 other health care furnished by and through the Serv- 13 ice, including an identification of appropriate access 14 standards for each individual specialty and post-care 15 rehabilitation. 16 (5) The workflow process at each medical facil- 17 ity of the Service for providing hospital care, medical 18 services, or other health care from the Service. 19 (6) The organization, workflow processes, and 20 tools used by the Service to support clinical staffing, 21 access to care, effective length-of-stay management 22 and care transitions, positive patient experience, ac- 23 curate documentation, and subsequent coding of in- 24 patient services. 25 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 5 •S 498 IS (7) The staffing level at each medical facility of 1 the Service and the productivity of each health care 2 provider at such medical facility, compared with 3 health care industry performance metrics, which 4 may include an assessment of any of the following: 5 (A) The case load of, and number of pa- 6 tients treated by, each health care provider at 7 such medical facility during an average week. 8 (B) The time spent by such health care 9 provider on matters other than the case load of 10 such health care provider. 11 (C) The percentage of Service personnel 12 carrying out administrative duties compared to 13 direct health care duties, as compared to the 14 percentage of private health care institution 15 personnel carrying out administrative duties 16 compared to direct health care duties. 17 (D) The allocation of the budget of the 18 Service used for administration compared with 19 the allocation of the budget used for direct 20 health care at Service-operated facilities. 21 (E) Any vacancies in positions of full-time 22 equivalent employees that the Service has not 23 filled during the 12-month period beginning on 24 the date on which the position became vacant. 25 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 6 •S 498 IS (F) The disposition of amounts budgeted 1 for full-time equivalent employees that is not 2 used for those employees because the positions 3 of the employees are vacant, including— 4 (i) whether the amounts are rede- 5 ployed; and 6 (ii) if the amounts are redeployed, 7 how the redeployment is determined. 8 (G) With respect to the approximately 9 3,700 Medicaid-reimbursable full-time equiva- 10 lent employees of the Service— 11 (i) the number of those employees who 12 are certified coders; 13 (ii) how that number of employees 14 compares with health care industry stand- 15 ards for staffing of certified coders; and 16 (iii) how much time is spent on train- 17 ing and participating in continuing edu- 18 cation courses once employed by the Serv- 19 ice. 20 (8) The information technology strategies of the 21 Service with respect to furnishing and managing 22 health care, including an identification of any weak- 23 nesses and opportunities with respect to the tech- 24 nology used by the Service, especially those strate- 25 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 7 •S 498 IS gies with respect to clinical documentation of epi- 1 sodes of hospital care, medical services, and other 2 health care, including any clinical images and associ- 3 ated textual reports, furnished by the Service in 4 Service or non-Service facilities. 5 (9) Business processes of the Service, including 6 processes relating to furnishing non-Service health 7 care, insurance identification, third-party revenue 8 collection, and vendor reimbursement, including an 9 identification of mechanisms as follows: 10 (A) To avoid the payment of penalties to 11 vendors. 12 (B) To increase the collection of amounts 13 owed to the Service for hospital care, medical 14 services, or other health care provided by the 15 Service for which reimbursement from a third 16 party is authorized and to ensure that such 17 amounts collected are accurate. 18 (C) To increase the collection of any other 19 amounts owed to the Service with respect to 20 hospital care, medical services, and other health 21 care and to ensure that such amounts collected 22 are accurate. 23 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 8 •S 498 IS (D) To increase the accuracy and timeli- 1 ness of Service payments to vendors and pro- 2 viders. 3 (10) The purchasing, distribution, and use of 4 pharmaceuticals, medical and surgical supplies, med- 5 ical devices, and health care related services by the 6 Service, including the following: 7 (A) The prices paid for, standardization of, 8 and use by the Service of, the following: 9 (i) Pharmaceuticals. 10 (ii) Medical and surgical supplies. 11 (iii) Medical devices. 12 (B) The use by the Service of group pur- 13 chasing arrangements to purchase pharma- 14 ceuticals, medical and surgical supplies, medical 15 devices, and health care related services. 16 (C) The strategy and systems used by the 17 Service to distribute pharmaceuticals, medical 18 and surgical supplies, medical devices, and 19 health care related services to medical facilities 20 of the Service. 21 (11) The process of the Service for carrying out 22 construction and maintenance projects at medical fa- 23 cilities of the Service and the medical facility leasing 24 program of the Service, including— 25 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 9 •S 498 IS (A) whether the maintenance budget is up- 1 dated or increased to reflect increases in main- 2 tenance costs with the addition of new facilities 3 and whether any increase is sufficient to sup- 4 port the growth of the facilities; and 5 (B) what the process is for facilities that 6 reach the end of their proposed life cycle. 7 (12) The competency of leadership with respect 8 to culture, accountability, reform readiness, leader- 9 ship development, physician alignment, employee en- 10 gagement, succession planning, and performance 11 management, including— 12 (A) the reasons leading tribal leadership to 13 request increased transparency and more open 14 communication between the Service and the 15 people served by the Service; and 16 (B) whether any checks and balances exist 17 to assess potential fraud or misuse of amounts 18 within the Service. 19 (13) The lack of a funding formula to distribute 20 base funding to the 12 Service areas, including the 21 following: 22 (A) The establishment of the current proc- 23 ess of funding being distributed based on his- 24 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 10 •S 498 IS torical allocations and not on need such as pop- 1 ulation growth, number of facilities, etc. 2 (B) The communication to area office di- 3 rectors on distribution decisionmaking. 4 (C) How the tribal and residual shares are 5 determined for each Indian tribe and the 6 amounts of those shares. 7 (D) The auditing or evaluation process 8 used by the Service to determine whether 9 amounts are distributed and expended appro- 10 priately, including— 11 (i) whether periodic or end-of-year 12 records document the actual distributions; 13 and 14 (ii) whether any auditing or evalua- 15 tion is conducted in accordance with gen- 16 erally accepted accounting principles or 17 other appropriate practices. 18 (14) Whether the Service tracks patients eligi- 19 ble for two or more of either the Medicaid program 20 under title XIX of the Social Security Act (42 21 U.S.C. 1396 et seq.), health care received through 22 the Service, or any other Federal health care pro- 23 gram (referred to in this section as ‘‘dual eligible pa- 24 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 11 •S 498 IS tients’’). If so, how dual eligible patients are man- 1 aged. 2 (15) The number of procurement contracts en- 3 tered into and awards made by the Service under 4 section 23 of the Act of June 25, 1910 (commonly 5 known as the ‘‘Buy Indian Act’’) (25 U.S.C. 47), 6 and a comparison of that number, with— 7 (A) the total number of procurement con- 8 tracts entered into and awards made by the 9 Service during 2015, 2016, 2017, and 2018; 10 and 11 (B) the process used by the Service facili- 12 ties to ensure compliance with section 23 of the 13 Act of June 25, 1910 (commonly known as the 14 ‘‘Buy Indian Act’’) (25 U.S.C. 47). 15 (16) An assessment of the availability of cancer 16 services for populations living on large, rural Indian 17 reservations, individual billing information, and re- 18 imbursement claims of patients. 19 (17) Any other items determined to be ad- 20 dressed during the course of the assessment. 21 (f) REPORT ON ASSESSMENT.— 22 (1) SUBMISSION TO SECRETARY.—Not later 23 than 240 days after the date that a contract is en- 24 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohnson on DSK79L0C42 with BILLS 12 •S 498 IS tered into under subsection (b), the entity carrying 1 out the assessment under the contract shall— 2 (A) complete the assessment; and 3 (B) submit to the Secretary a report de- 4 scribing the findings and recommendations of 5 the entity with respect to the assessment. 6 (2) SUBMISSION TO CONGRESS.—Immediately 7 on receipt of the report under paragraph (1)(B), the 8 Secretary shall submit the report to— 9 (A) the appropriate committees of Con- 10 gress, including— 11 (i) the Committee on Appropriations 12 of the Senate; and 13 (ii) the Committee on Appropriations 14 of the House of Representatives; 15 (B) the Majority Leader of the Senate; 16 (C) the Minority Leader of the Senate; 17 (D) the Speaker of the House of Rep- 18 resentatives; and 19 (E) the Minority Leader of the House of 20 Representatives. 21 (3) PUBLICATION.—Not later than 30 days 22 after receiving the report under paragraph (1)(B), 23 the Secretary shall publish such report in the Fed- 24 VerDate Sep 11 2014 04:03 Feb 22, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S498.IS S498 kjohns [Text truncated for display. Full text available on Congress.gov.]