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1 H.R. 6535, a Bill to Deem an Urban Indian Organization and Employees thereof to Be a Part of the Public Health Service for the Purposes of Certain Claims for Personal Injury, as Ordered Reported by the House Committee on Natural Resources on July 29, 2020 1 (September 2, 2020)

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  1   Congressional Budget Office
\   Cost Estimate


September 2, 2020


By Fiscal Year, Iillions of Dollars 2020           2020-2025             2020-2030


Direct Spending (Outlays)

Revenues
Increase or Decrease (-)
in the Deficit


0


0

0


6


0

6


22


0

22


H.R. 6535 would include Urban Indian Health Programs (UIHPs) and their employees in the
pool of individuals and entities that receive liability protection under the Federal Tort Claims
Act (FTCA). Under  the FTCA, the federal government pays for court judgments and
compromise  settlements of lawsuits out of the Judgement Fund. The Judgment Fund is a
permanent, indefinite appropriation that is available to pay monetary awards against the
United States that are judicially or administratively ordered. Under current law, UIHPs are
health care organizations that are grantees of the Indian Health Service (IHS) but are not
considered federal entities and therefore their employees are not covered under the FTCA.

For this estimate, CBO used information from the Department of Treasury's Bureau of the
Fiscal Service about the number and level of payments from the Judgement Fund that were
used to settle claims and litigation on behalf of IHS employees. While UIHPs are not part of
IHS, they provide similar services, and CBO expects they would experience a similar rate of
lawsuits and settlements.

According to the Judgement Fund data, over the last five years an average of about
$19.5 million has been paid out for medical malpractice claims against IHS employees, or
about $2,700 per year per IHS clinical employee. UIHPs employ about 1,150 clinical
workers and CBO  estimates that payments from the Judgement Fund would total about

                See also CBO's Cost Estimates Explained, www.cbo.gov/publication/54437;
  How CBO Prepares Cost Estimates, www.cbo.gov/publication/53519; and Glossary, www.cbogov/publication/42904.

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