; (2) in paragraph (4), by striking the period at the end and inserting , or ; and (3) by adding at the end the following: (5) any removal or demotion under section 607 of the Indian Health Care Improvement Act. . (c) Report Not later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services or the Inspector General of the Department of Health and Human Services shall submit a report to Congress that includes the following: (1) The number of employees of the Indian Health Service who were removed, demoted, or suspended in the 1-year period before the date of enactment of this Act. (2) The number of employees of the Indian Health Service who were removed, demoted, or suspended in the 1-year period after the date of enactment of this Act using the updated authorities provided in the amendments made by this Act. (3) The appropriate details of removals, demotions, and suspensions that lend necessary context. 107. Tribal culture and history Section 113 of the Indian Health Care Improvement Act ( 25 U.S.C. 1616f ) is amended— (1) in subsection (a)— (A) by striking a program and inserting an annual mandatory training program ; and (B) by striking appropriate employees of the Service and inserting employees of the Service, locum tenens medical providers, healthcare volunteers, and other contracted employees who work at Service hospitals or other Service units and whose employment requires regular direct patient access