**Exhibit J**

SIGNIFICANT ITEMS IN HOUSE, SENATE AND CONFERENCE

APPROPRIATIONS COMMITTEE REPORTS

The following section represents FY 2003 Congressional requirements for
reports and significant items derived from House Report 107-564 and
Senate Report 107-201. These actions discussed below are contingent on
inclusion of similar language and funding in the final FY 2003
appropriation and related reports. Additional items may be transmitted
at a later date as a result of the final Conference report.

**[2003 House Appropriations Committee Report Language
(107-564)]{.underline}**

**Demonstration program for the Cheyenne River Sioux Tribe in South
Dakota --** Bill language is recommended, under Title III\--General
Provisions, providing for a demonstration program for the Cheyenne River
Sioux Tribe in South Dakota. The tribe has reported that, by offering
bonus payments to health professionals, it will be able to hire full
time personnel at less cost than paying for part time contract health
services. The Committee expects the Service to implement this
demonstration program within 30 days of enactment of this Act; to
monitor the program closely; and report to the Committee by April 1,
2003, with an evaluation of the program and recommendations on whether
or not it should be extended in fiscal year 2004.

  ---------- --------- ---------- --------------- ----------- ------------
                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              

                                                              
  ---------- --------- ---------- --------------- ----------- ------------

> [Action Taken or To Be Taken]{.underline}
>
> The Indian Health Service currently has the authority to offer several
> types of bonuses to staff, including those described in the General
> Provisions language in H.R. 5093.  The Cheyenne River Service Unit
> currently uses these authorities to the maximum allowed.  The major
> difficulty in recruiting more staff at Eagle Butte at this time is a
> severe shortage of housing.  All of the government quarters are full
> and the closest place in which rental housing might be available is 20
> miles away.  At this time, there is nothing available.  Other towns
> are even farther away, with some staff living in Pierre, SD, which is
> nearly 100 miles one way from Eagle Butte.  (**Page 139-40**)

**[2003 Senate Appropriations Committee Report Language
(107-201)]{.underline}**

**Expansion of contract service area of the Mississippi Band of Choctaw
Indians -** Within 45 days of receiving a request to expand the contract
health services area of the Mississippi Band of Choctaw Indians to cover
members in the western Tennessee counties of Lauderdale, Shelby and
Tipton, the Director of the Indian Health Service shall rule on such
request. If the request is not approved the Director shall report to the
Committee within 30 days of his ruling the specific reasons for the
denial. Prior to accepting the request for expansion of the service
area, the Service shall consult with the tribe regarding the
documentation and information required by the Service in order to
process the request. (**Page 67-68**)

> [Action Taken or To Be Taken]{.underline}
>
> On May 10, 2002, tribal representatives met with representatives of
> IHS Headquarters. During the meeting, the tribal representatives were
> provided a list of the type of information to be submitted to the
> Nashville Area Director so that a reasonable evaluation of the request
> could be completed.
>
> The Nashville Area Director is waiting for the Tribe to submit the
> requested information to begin the evaluation process. The Nashville
> Area Director will analyze the proposal outlining positive and
> negative features prior to forwarding the document to the Director,
> IHS. Any IHS approval recommendation is not effective until a final
> notice is published in the Federal Register and must be approved by
> the Department of Health and Human Services and OMB.

**Diabetes Prevention and Research** -- The Committee expects the
Service to continue the diabetes prevention and research activities
centered at the National Diabetes Prevention Center in Gallup, New
Mexico, and jointly funded by the Centers for Disease Control. (**Page
67**)

> [Action Taken or To Be Taken]{.underline}
>
> The Indian Health Service (IHS) and in consultation with tribal
> leaders on the Tribal Leaders Diabetes Committee (TLDC) has
> contributed \$1 million from the Special Diabetes Program for Indians
> (SDPI) Balanced Budget Act funds to CDC each year since 1998 for the
> purpose of supporting the National Diabetes Prevention Center (NDPC)
> located in Gallup, New Mexico. Additionally, the TLDC made
> recommendation to the IHS Director to continue support to the NDPC in
> FY 2003 with \$1 million from the Omnibus Appropriations Act funds,
> which the Director approved.
>
> The IHS recognizes that the NDPC, coordinated by the CDC, is working
> in close partnership with IHS and the TLDC to provide services and
> disseminate research information that will meet the needs of tribes
> nationwide. The IHS National Diabetes Program fully supports
> continuation of this activity.
>
> It is the intent of the IHS to continue the diabetes prevention and
> research activities centered at the National Diabetes Prevention
> Center in Gallup, New Mexico and jointly funded by the CDC. The IHS
> Interim Director, Dr Grim, will provide a final decision after
> consultation with tribal leaders in early 2003.

**Sanitation Facilities Construction** -- The Committee has included
bill language that would prohibit the use of Indian Health Service
appropriated funds for sanitation facilities construction associated
with new homes funded with grants by housing programs of the Department
of Housing and Urban Development (DHUD). (**Page 68**)

> [Action Taken or To Be Taken]{.underline}
>
> The IHS has continued to follow the direction from Congress to not
> serve new homes funded by the housing programs of the Department of
> Housing and Urban Development (DHUD).  The passage of the Native
> American Housing Assistance and Self Determination Act of 1996
> (NAHASDA) has led to more flexibility in how housing programs funding
> is spent.  With this increased flexibility many Tribally Designated
> Housing Entities have developed housing projects that not only
> construct new homes, but also purchase new homes, including mobile
> homes or renovated existing homes.  This has created a challenge in
> determining which DHUD housing projects are eligible for service using
> IHS funds.  If the Indian Health Service uses housing support funds to
> serve any of these DHUD housing projects, then there will be less
> funding available to serve other categories of new and like-new homes
> which would further impact the backlog of existing homes.
>
> For the last 11 years approximately one-half of Sanitation Facilities
> Construction funding was obligated to provide service to new and
> like-new homes, with the first priority for funding being those
> projects serving homes provided by the Bureau of Indian Affairs
> Housing Improvement Program (BIAHIP).  Also, onsite sanitation
> facilities for homes occupied by individuals with medical referrals
> continue to be serviced with these funds.  Headquarters based on a
> review of each Areas request determines funding allocation for each
> Area.  Funding priority is given to projects which provide first time
> sanitation facilities to homes in BIAHIP Categories B, C, and D (new
> homes and homes receiving major renovations brining the homes up to
> like new condition).

 

**Drinking water system for the Shoshone-Bannock Tribes-** The Committee
strongly encourages the Indian Health Service, from its Sanitation
Facilities Construction program, to continue to fund at the highest
level possible within the current IHS priority list, construction of a
new drinking water system for the Shoshone‑Bannock Tribes of the Fort
Hall Reservation in Idaho. (**Page 68**)

> [Action Taken or To Be Taken]{.underline}
>
> The Indian Health Service has funded needed projects to address this
> issue using the Sanitation Deficiency System to determine the funding
> priority.  These projects continue to receive a high priority for
> funding because of the high health risk attributed to the groundwater
> contamination prevalent on the Fort Hall Reservation.  Beginning in
> 1991, IHS funded an engineering study to identify and characterize
> groundwater contamination affecting domestic water systems on the Fort
> Hall Indian Reservation.  This study found that the entire aquifer
> underlying the Reservation was contaminated with Ethylene Dibromide
> (EDB) in concentrations exceeding the Safe Drinking Water Act Maximum
> Contaminant Level.
>
>  
>
> In 1994, IHS, BIA and DHUD funded a project to drill test wells to
> locate a water source to replace the contaminated wells serving the
> Fort Hall Agency Compound.  It also provided filters on individual
> well water systems as a temporary measure to remove EDB.  A clean
> aquifer with adequate capacity was identified.
>
>  
>
> Since 1997, IHS, HUD, and USDA-Rural Utility Service (RUS) have been
> funding projects to construct two new wells, a new storage tank,
> pumphouse, transmission mains and distribution lines to bring new
> water sources to the Fort Hall Agency Compound, For Hall Townsite, and
> scattered homes in the surrounding area to the south, southeast, and
> southwest.
>
>  
>
> Sixteen projects have been funded from FY 1996 through FY 2002 to
> serve approximately 620 homes.
>
>  
>
> As a result, most of the homes to the south of the Agency and Townsite
> have been served.  There remain homes to the west of the Townsite and
> in the southwest portion of the Reservation north of Chubbuck, which
> do not have community water service available.  The Tribes, IHS and
> USDA-RUS met in 2001 to review the needs for the Reservation and to
> tour the areas, which lack community water service.  As a result of
> that meeting, the Tribe is applying for financial assistance from
> USDA-RUS.  Several Fort Hall sanitation system deficiencies were
> reported in the FY 2002 Indian Health Service Sanitation Deficiency
> System, including additional extensions of the new water system. 
>
>  
>
> We will continue to work with the Tribes and other agencies to
> identify funds needed to construct adequate water main extensions to
> serve additional Indian Homes on the Reservation.  Further, we will
> continue to work with the Tribes to identify sanitation deficiencies
> and to coordinate efforts to secure funds towards correcting them.

**Facilities Priority System** \-- Last year, the Committee instructed
the Indian Health Service to continue its review of the facilities
priority system with the goal of better reflecting the full range of
need for facilities in Indian country. Since that time, the Committee
understands that a work group assembled by the facilities appropriations
tribal advisory board has completed a draft report for the board's
consideration. That report is available to the public through the
Service's web site. Once the board has had the opportunity to consider
the group's recommendations, a final report will be issued for
consideration by the tribes and the Service. Upon issuance of the final
report, the Committee expects that future budget requests will better
reflect the range of needs identified by the report. (**Page 68**)

[Action Taken and to be taken]{.underline}

> The Facilities Needs Assessment Workgroup, which was established by
> the Director, IHS to review the criteria for assessing and
> prioritizing facilities need in Indian Country, met 5 times between
> January 2001 and January 2002 and reported to the Facilities
> Appropriation Advisory Board (FAAB) on its recommendations in February
> 2002. The FAAB has reviewed these recommendations and made minor
> modifications. These modified recommendations are being used to
> develop a draft priority system methodology which will be submitted
> for tribal consultation in 2003. Integral to this is the development
> of Area wide health services and facilities master plans to identify
> and address the health system needs. This is currently underway in
> several areas. Although the work that has occurred over the past two
> years will provide criteria that will potentially better reflect the
> full range of facility needs in Indian country. The Facilities Need
> Assessment Workgroup along with the FAAB recommended that projects
> identified through the existing priority system continue. It is
> expected that tribes will complete there comments and that IHS will
> finalize a revised priority system based on these comments.

**Small Ambulatory Program** **\--** The Committee is concerned about
reports that the small ambulatory grant program lacks representation
from tribes in the eastern region of the United States. While
recognizing that this is a competitive program, the Committee encourages
the Service to consider geographic distribution as one of the criteria
for selection in applications that are otherwise similarly evaluated.
(**Page 69**)

## Action Taken or To Be Taken

> On November 24, 2000 the IHS sent to all Tribes a proposed criteria to
> rank Small Ambulatory Program funding applications for consultation
> and comments. In June 2001 the criteria was finalized based on the
> Tribal consultation and actual implementation occurred in January 2002
> by an objective review team. The Small Ambulatory Program Selections
> are made solely on the competitive merits of the applications
> submitted. No consideration is given to the geographical region in the
> United States of America in which the proposed projects are located.
> The quality of the application affects the review of its merits. The
> current process does not allow any favoritism to enter into the
> objective selection process that is clearly identified in the
> Application Kit. To address the concern expressed in the Senate
> Report, when additional funding is appropriated for this program, the
> selection process will be reviewed again with tribal members
> participating in the IHS Facilities Appropriation Advisory Board to
> determine if there is a need to revisit the process through tribal
> consultation again.