Sec. 110. Enhancing quality of care in the Indian Health Service

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In this section, the terms Area office , Indian tribe , Secretary , Service , Service unit , tribal organization , and Urban Indian organization have the meanings given those terms in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 ). In this subsection, the term governing board means the governing board of the facility of a Service unit. Not later than 1 year after the date of enactment of this Act, the Secretary, in consultation with Indian tribes, governing boards, Area offices, Service units, and other stakeholders, as determined appropriate by the Secretary, shall establish— in accordance with paragraph (3)(A), best practices for governing boards; and in accordance with paragraph (3)(B), best practices for Area offices.

The best practices for governing boards established under paragraph (2)(A) shall include provisions relating to— adequately monitoring the delivery of care at the applicable facility managed by the governing board; ensuring ongoing facility compliance with Federal health care program requirements, including requirements of the Service and the Centers for Medicare & Medicaid Services; handling, documenting, and responding to patient complaints; documenting, addressing, and, if applicable, reporting instances of professional misconduct by facility staff in accordance with applicable Federal and State law; improving facility performance and operations with respect to mandatory and voluntary quality initiatives carried out by the Service and the Centers for Medicare & Medicaid Services; and reporting requirements under Federal law, including with respect to— the Government Performance and Results Act of 1993 ( Public Law 103–62 ; 107 Stat. 285), the GPRA Modernization Act of 2010 ( Public Law 111–352 ; 124 Stat. 3866), and the amendments made by those Acts; and the applicable provisions of titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq. , 1396 et seq.).

The best practices for Area offices established under paragraph (2)(B) shall include provisions relating to— strategies for how to best monitor governing board activities relating to the oversight of— delivery and quality of patient care; documenting and responding to patient complaints and instances of professional misconduct; and facility compliance with Federal health care program requirements, including requirements of the Service and the Centers for Medicare & Medicaid Services; and connecting governing boards, including the applicable facilities of those governing boards, to resources necessary for enhancing patient outcomes and improving facility performance, including through the use of technical assistance.

The best practices established under paragraph

(2)shall be— reported to, in writing, as applicable, all governing boards and Area offices; and incorporated into the Indian Health Manual of the Service. Not later than 1 year after the date of enactment of this Act, the Secretary, in coordination with the Agency for Healthcare Research and Quality, the National Quality Forum, Indian tribes, practitioners and administrators of the Service, and other qualified experts, as determined appropriate by the Secretary, shall undertake a review of the reported quality and performance measures of Service facilities conducted by the Secretary in accordance with— section 306 of title 5, United States Code; section 1115(b) of title 31, United States Code; and any law (including regulations) used in any mandatory or voluntary program of the Centers for Medicare & Medicaid Services. Not later than 6 months after the date on which the review required under subparagraph

(A)is completed, the Secretary shall submit to Congress a report on the details and findings of that review, which shall include an assessment of— the suitability of measures used as of the date of enactment of this Act for the applicable Service facility, taking into consideration the patient volume of the facility, the mix of patient cases at the facility, the geographic location of the facility, and medical professional shortage designations at the facility, as determined by the Secretary; and the extent to which the performance and quality measures are outcome-based or process-based measures. Not later than 1 year after the date on which the report required under paragraph (1)(B) is submitted to Congress, the Service, in coordination with the Centers for Medicare & Medicaid Services, shall adopt, and assist Service facilities to adopt, to the extent practicable, more suitable, as compared to those quality and performance measures adopted prior to the submission of that report, quality and performance measures, including measures that are more outcome-based and process-based, in accordance with the factors described in paragraph (1)(B)(i). Not later than 1 year after the date on which the report required under paragraph (1)(B) is submitted to Congress, the Comptroller General of the United States shall submit to Congress a report on challenges relating to quality measure and data collection in Service facilities, which shall include— barriers to the adoption of relevant performance and quality measures in Service facilities; and recommendations for how the Service, other Federal agencies, and stakeholders can assist Service facilities in adopting suitable quality and performance measures. In this subsection: The term Administrator means the Administrator of the Centers for Medicare & Medicaid Services. The term eligible facility means a facility operated by the Service that— is an underperforming hospital or outpatient facility; and is eligible for payments under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). The term eligible facility includes a tribally operated facility, if that facility consents to participating in the program. The term program means the compliance assistance program established under paragraph (2). The term tribally operated facility means a facility operated by an Indian tribe, a tribal organization, or an Urban Indian organization that— is an underperforming hospital or outpatient facility; and is eligible for payments under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). Not later than 1 year after the date of enactment of this Act, the Secretary, in coordination with the Administrator and quality improvement organizations having a contract with the Secretary under part B of title XI of the Social Security Act ( 42 U.S.C. 1320c et seq. ), shall establish a compliance assistance program for eligible facilities. The Secretary shall establish a methodology for determining which eligible facilities shall participate in the program, which shall take into account the following factors: The number and severity of facility deficiencies with respect to applicable requirements under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). The history of provider misconduct or patient harm at the facility. Whether there is high staff turnover at the facility. Whether the facility has low performance on program quality measures, relative to other facilities of the Service, in accordance with reported quality and performance measures conducted by the Secretary in accordance with— section 306 of title 5, United States Code; section 1115(b) of title 31, United States Code; and any law (including regulations) used in any mandatory or voluntary program of the Centers for Medicare & Medicaid Services. The Secretary, in coordination with the Administrator, shall select not less than 25 percent of the eligible facilities to participate in the program using the methodology established under paragraph (3). An eligible facility selected to participate in the program under subparagraph

(A)shall be required to participate in the program. The Secretary shall ensure that, at all times during the period beginning on the date of establishment of the program and the date on which the program terminates under paragraph (8), not less than 25 percent of eligible facilities are participating in the program. Subject to clause (ii), an eligible facility selected to participate in the program under subparagraph

(A)shall participate in the program for a period of 2 years. If the Secretary, in coordination with the Administrator, certifies that an eligible facility participating in the program has improved on its performance to a satisfactory level, as determined by the Secretary, then the eligible facility does not have to participate in the program for the full 2-year period. An eligible facility may participate in the program for more than 1 2-year period. The program shall provide on-site consultation and educational programming for eligible facilities to ensure those eligible facilities are— meeting Federal requirements of the Service and any conditions of participation applicable under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); and satisfactorily implementing any quality initiatives and programs established by the Service or the Centers for Medicare & Medicaid Services. The program shall be conducted independently of any enforcement actions under the Indian Health Care Improvement Act ( 25 U.S.C. 1601 et seq. ) or noncompliance actions taken by the Administrator with respect to noncompliance with conditions of participation applicable under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), unless, while carrying out the program, the Secretary or the Administrator, as applicable, encounters a triggering event, as determined by the Secretary or the Administrator, as applicable, that would necessitate an enforcement action or noncompliance action. If a triggering event is encountered by the Secretary or Administrator under subparagraph (A), the eligible facility shall continue to participate in the program so long as the facility— remains eligible for payments under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); and continues to meet all of the conditions and requirements for such payments which are applicable under such title. The Secretary shall carry out the program in coordination with quality improvement organizations having a contract with the Secretary under part B of title XI of the Social Security Act ( 42 U.S.C. 1320c et seq. ). The program shall terminate 6 years after the date on which the program is established. Not later than 1 year after the date on which the program terminates under paragraph (8), the Comptroller General of the United States shall submit to Congress a report evaluating the effectiveness of the program, which shall include, to the extent practicable— detailed data on changes in the patient experience at eligible facilities that participated in the program; a description of the compliance status of eligible facilities that participated in the program with requirements of the Service and any conditions of participation applicable under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); and a description of the progress by eligible facilities that participated in the program in meeting the goals of quality improvement activities of the Department of Health and Human Services.

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