; (2) the levels to which the staffing resources provided under the demonstration program reduced the unmet staffing need for the applicable Service unit; and (3) whether the demonstration program could be deployed permanently to reduce unmet staffing needs throughout the Service. . 109. Rule establishing Tribal consultation policy Title VIII of the Indian Health Care Improvement Act ( 25 U.S.C. 1671 et seq. ) (as amended by section 108) is amended by adding at the end the following: 834. Rule establishing Tribal consultation policy (a) In General Not later than December 31, 2023, the Secretary shall establish, and once every 5 years thereafter, the Secretary shall update, after meaningful consultation with representatives of affected Indian tribes, a rule establishing a Tribal consultation policy for the Service. (b) Contents of tribal consultation policy The policy established under the rule under subsection (a) shall— (1) update, and replace, the Tribal consultation policy established under Circular No. 2006–01 of the Service (or any successor policy); and (2) include— (A) a process for determining when and how the Service will notify Indian tribes of the availability of meaningful consultation; (B) a determination of which actions or agency decisions by the Service will trigger a requirement for meaningful consultation with Indian tribes