text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Independent Outside Audit of the 
  Indian Health Service Act of 2017''.
  
  SEC. 2. INDEPENDENT OUTSIDE AUDIT 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 90 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.
      (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) 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, including whether 
          it is recommended that the Secretary have the authority to 
          furnish such care and services at such facilities through the 
          completion of episodes of care.
              (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 scheduling appointments to receive 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 amount of personnel used for administration 
                  compared with direct health care in the Service being 
                  comparable to the amount used for administration 
                  compared with direct health care in private health care 
                  institutions.
                      (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--
                              (i) does not intend to fill; or
                              (ii) 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; and
                              (ii) whether that number of employees is 
                          necessary.
              (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 for a lack in transparency in the 
                  culture of the Service, 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) How the implementation of self-governance 
                  policies has impacted health care delivery.
                      (C) The communication to area office directors on 
                  distribution decisionmaking.
                      (D) How the tribal and residual shares are 
                  determined for each Indian tribe and the amounts of 
                  those shares.
                      (E) 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 the 
                  5 fiscal years prior to the date of enactment of this 
                  Act; 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) Any other items the reputable private entity 
          determines should be addressed in the independent assessment of 
          the Service.
      (e) Report on Assessment.--
              (1) Submission to secretary.--Not later than 240 days after 
          the date 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.
      (f) Funding.--The Secretary shall use, to carry out this section, 
  such amounts as are necessary from other amounts available to the 
  Secretary that are not otherwise obligated.
target: Independent Outside Audit of the Indian Health Service Act of 2017 This bill requires the Department of Health and Human Services to contract with private entities to assess the health care delivery systems and financial management of the Indian Health Service (IHS). The assessment must address IHS issues including:  the demographics and health care needs of the patient population, health care capabilities and resources, staffing levels at medical facilities and the productivity of each health care provider, information technology strategies related to providing health care, business processes, the competency of leadership regarding specified issues, tracking patients eligible for other federal health care programs, and  the number of procurement contracts and awards under the Buy Indian Act.  
feat_title: Independent Outside Audit of the Indian Health Service Act of 2017