[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 498 Introduced in Senate (IS)]
<DOC>
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Assessment of the Indian Health
Service Act of 2019''.
SEC. 2. ASSESSMENT OF THE INDIAN HEALTH SERVICE.
(a) Definitions.--In this section:
(1) Reputable private entity.--The term ``reputable private
entity'' means a private entity that--
(A) has experience with, and proven outcomes in
optimizing the performance of, Federal health care
delivery systems, the private sector, and health care
management; and
(B) specializes in implementing large-scale
organizational and cultural transformations, especially
with respect to health care delivery systems.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(3) Service.--The term ``Service'' means the Indian Health
Service.
(b) Assessment.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall enter into one or more
contracts with a reputable private entity to conduct an independent
assessment of the health care delivery systems and financial management
processes of the Service. The Secretary shall not be required to
provide a full and open competition in entering into such contracts.
Such independent assessment shall be made only of Service-operated
facilities.
(c) Program Integrator.--
(1) In general.--If the Secretary enters into contracts
under this section with more than 1 reputable private sector
entity, the Secretary shall designate one such entity that is
predominantly a health care organization as the program
integrator.
(2) Responsibilities.--The program integrator designated
under paragraph (1) shall be responsible for coordinating the
outcomes of the assessments conducted by the reputable private
entities under this section.
(d) Coordination With GAO and OIG.--As part of planning or
designing the assessment described in subsection (b), the Secretary (or
the program integrator designated under subsection (c)(1) acting on
behalf of the Secretary) shall consult with the Comptroller General of
the United States and the Inspector General of the Department of Health
and Human Services to minimize duplications in the areas of study
required under subsection (e) and to incorporate the Government
Accountability Office's and Office of Inspector General's prior,
publicly released, and relevant report findings dated January 1, 2013,
or later, as appropriate.
(e) Areas of Study.--Each assessment conducted under subsection (b)
shall address each of the following:
(1) Current and projected demographics and unique health
care needs of the patient population served by the Service.
(2) Current and projected health care capabilities and
resources of the Service, including hospital care, medical
services, and other health care furnished by non-Service
facilities under contract with the Service, to provide timely
and accessible care to eligible patients.
(3) The authorities and mechanisms under which the
Secretary may furnish hospital care, medical services, and
other health care at non-Service facilities.
(4) The appropriate systemwide access standard applicable
to hospital care, medical services, and other health care
furnished by and through the Service, including an
identification of appropriate access standards for each
individual specialty and post-care rehabilitation.
(5) The workflow process at each medical facility of the
Service for providing hospital care, medical services, or other
health care from the Service.
(6) The organization, workflow processes, and tools used by
the Service to support clinical staffing, access to care,
effective length-of-stay management and care transitions,
positive patient experience, accurate documentation, and
subsequent coding of inpatient services.
(7) The staffing level at each medical facility of the
Service and the productivity of each health care provider at
such medical facility, compared with health care industry
performance metrics, which may include an assessment of any of
the following:
(A) The case load of, and number of patients
treated by, each health care provider at such medical
facility during an average week.
(B) The time spent by such health care provider on
matters other than the case load of such health care
provider.
(C) The percentage of Service personnel carrying
out administrative duties compared to direct health
care duties, as compared to the percentage of private
health care institution personnel carrying out
administrative duties compared to direct health care
duties.
(D) The allocation of the budget of the Service
used for administration compared with the allocation of
the budget used for direct health care at Service-
operated facilities.
(E) Any vacancies in positions of full-time
equivalent employees that the Service has not filled
during the 12-month period beginning on the date on
which the position became vacant.
(F) The disposition of amounts budgeted for full-
time equivalent employees that is not used for those
employees because the positions of the employees are
vacant, including--
(i) whether the amounts are redeployed; and
(ii) if the amounts are redeployed, how the
redeployment is determined.
(G) With respect to the approximately 3,700
Medicaid-reimbursable full-time equivalent employees of
the Service--
(i) the number of those employees who are
certified coders;
(ii) how that number of employees compares
with health care industry standards for
staffing of certified coders; and
(iii) how much time is spent on training
and participating in continuing education
courses once employed by the Service.
(8) The information technology strategies of the Service
with respect to furnishing and managing health care, including
an identification of any weaknesses and opportunities with
respect to the technology used by the Service, especially those
strategies with respect to clinical documentation of episodes
of hospital care, medical services, and other health care,
including any clinical images and associated textual reports,
furnished by the Service in Service or non-Service facilities.
(9) Business processes of the Service, including processes
relating to furnishing non-Service health care, insurance
identification, third-party revenue collection, and vendor
reimbursement, including an identification of mechanisms as
follows:
(A) To avoid the payment of penalties to vendors.
(B) To increase the collection of amounts owed to
the Service for hospital care, medical services, or
other health care provided by the Service for which
reimbursement from a third party is authorized and to
ensure that such amounts collected are accurate.
(C) To increase the collection of any other amounts
owed to the Service with respect to hospital care,
medical services, and other health care and to ensure
that such amounts collected are accurate.
(D) To increase the accuracy and timeliness of
Service payments to vendors and providers.
(10) The purchasing, distribution, and use of
pharmaceuticals, medical and surgical supplies, medical
devices, and health care related services by the Service,
including the following:
(A) The prices paid for, standardization of, and
use by the Service of, the following:
(i) Pharmaceuticals.
(ii) Medical and surgical supplies.
(iii) Medical devices.
(B) The use by the Service of group purchasing
arrangements to purchase pharmaceuticals, medical and
surgical supplies, medical devices, and health care
related services.
(C) The strategy and systems used by the Service to
distribute pharmaceuticals, medical and surgical
supplies, medical devices, and health care related
services to medical facilities of the Service.
(11) The process of the Service for carrying out
construction and maintenance projects at medical facilities of
the Service and the medical facility leasing program of the
Service, including--
(A) whether the maintenance budget is updated or
increased to reflect increases in maintenance costs
with the addition of new facilities and whether any
increase is sufficient to support the growth of the
facilities; and
(B) what the process is for facilities that reach
the end of their proposed life cycle.
(12) The competency of leadership with respect to culture,
accountability, reform readiness, leadership development,
physician alignment, employee engagement, succession planning,
and performance management, including--
(A) the reasons leading tribal leadership to
request increased transparency and more open
communication between the Service and the people served
by the Service; and
(B) whether any checks and balances exist to assess
potential fraud or misuse of amounts within the
Service.
(13) The lack of a funding formula to distribute base
funding to the 12 Service areas, including the following:
(A) The establishment of the current process of
funding being distributed based on historical
allocations and not on need such as population growth,
number of facilities, etc.
(B) The communication to area office directors on
distribution decisionmaking.
(C) How the tribal and residual shares are
determined for each Indian tribe and the amounts of
those shares.
(D) The auditing or evaluation process used by the
Service to determine whether amounts are distributed
and expended appropriately, including--
(i) whether periodic or end-of-year records
document the actual distributions; and
(ii) whether any auditing or evaluation is
conducted in accordance with generally accepted
accounting principles or other appropriate
practices.
(14) Whether the Service tracks patients eligible for two
or more of either the Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), health care
received through the Service, or any other Federal health care
program (referred to in this section as ``dual eligible
patients''). If so, how dual eligible patients are managed.
(15) The number of procurement contracts entered into and
awards made by the Service under section 23 of the Act of June
25, 1910 (commonly known as the ``Buy Indian Act'') (25 U.S.C.
47), and a comparison of that number, with--
(A) the total number of procurement contracts
entered into and awards made by the Service during
2015, 2016, 2017, and 2018; and
(B) the process used by the Service facilities to
ensure compliance with section 23 of the Act of June
25, 1910 (commonly known as the ``Buy Indian Act'') (25
U.S.C. 47).
(16) An assessment of the availability of cancer services
for populations living on large, rural Indian reservations,
individual billing information, and reimbursement claims of
patients.
(17) Any other items determined to be addressed during the
course of the assessment.
(f) Report on Assessment.--
(1) Submission to secretary.--Not later than 240 days after
the date that a contract is entered into under subsection (b),
the entity carrying out the assessment under the contract
shall--
(A) complete the assessment; and
(B) submit to the Secretary a report describing the
findings and recommendations of the entity with respect
to the assessment.
(2) Submission to congress.--Immediately on receipt of the
report under paragraph (1)(B), the Secretary shall submit the
report to--
(A) the appropriate committees of Congress,
including--
(i) the Committee on Appropriations of the
Senate; and
(ii) the Committee on Appropriations of the
House of Representatives;
(B) the Majority Leader of the Senate;
(C) the Minority Leader of the Senate;
(D) the Speaker of the House of Representatives;
and
(E) the Minority Leader of the House of
Representatives.
(3) Publication.--Not later than 30 days after receiving
the report under paragraph (1)(B), the Secretary shall publish
such report in the Federal Register and on an Internet website
of the Service that is accessible to the public.
(g) Funding for Independent Outside Assessment.--The Secretary
shall use such amounts as are necessary from other amounts available to
the Secretary that are not otherwise obligated to fund the contract
under subsection (b). Such amounts shall not come from funds available
to the Indian Health Service.
<all>
Assessment of the Indian Health Service Act of 2019
#498 | S Congress #116
Policy Area: Native Americans
Subjects: Accounting and auditingComputers and information technologyCongressional oversightDepartment of Health and Human ServicesExecutive agency funding and structureGovernment studies and investigationsHealth facilities and institutionsHealth information and medical recordsHealth personnelHealth programs administration and fundingHealth technology, devices, suppliesIndian social and development programsMedicaidMinority healthPublic contracts and procurement
Last Action: Read twice and referred to the Committee on Indian Affairs. (2/14/2019)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text