S. 465 would require the Secretary of the Department of Health and Human Services (HHS) to enter into one or more contracts with private entities to conduct an independent assessment of the health care delivery systems and financial management processes of the Indian Health Service (IHS). The independent audit would investigate a wide variety of activities within IHS, including the operations of IHS leadership, procurement and contracting policies, medical service provision at each IHS medical facility, and the productivity of each health care provider at IHS, among others. For those purposes, the bill would authorize HHS to spend funds from available appropriations that are not otherwise obligated. Because such spending would occur without further appropriation, it would be considered direct spending and CBO estimates that spending would total $56 million over the 2019-2023 period.
Because the bill would affect direct spending, pay-as-you-go procedures apply. Enacting the bill would not affect revenues.
CBO estimates that enacting the legislation would not increase direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2029.
S. 465 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.