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INDIAN ALCOHOL AND SUBSTANCE ABUSE 

MEMORANDUM OF AGREEMENT (MOA) 

BETWEEN 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS), 

U.S. DEPARTMENT OF THE INTERIOR (DOl), 

AND 

U.S. DEPARTMENT OF JUSTICE (DOJ) 

I. Purpose and Parties 

This MOA coordinates the efforts ofHHS, DOl, and DOJ to assist American Indian and 

Alaska Native communities in achieving their goals in the prevention, intervention, and/or 

treatment of alcohol and substance use disorders. The purpose of this MOA is to establish 

the framework for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) through the Office of Indian Alcohol and Substance Abuse (OIASA); Indian 

Health Service (IHS); Bureau of Indian Affairs (BIA); Bureau of Indian Education (BIE); 

and, components of DOJ, to implem~nt certain provisions of the Indian Health Care 

Improvement Act (IHCIA) and the Indian Alcohol and Substance Abuse Prevention and 

Treatment Act of 1986 (hereafter referred to as "lASAPTA"), as amended by the Tribal 

Law and Order Act of 2010 ("TLOA"), that results in the coordination of resources and 

programs. 

This MOA replaces and supersedes two previous MOAs that were entered into pursuant to 

provisions of the IHCIA, enacted under Section 10221 of the Affordable Care Act (P .L. 111 -

148), and IASAPT A, as amended by TLOA: 

• The October 2009 Memorandum of Agreement between the Indian Health Service of the 

Department of Health and Human Services and the Bureau of Indian Affairs and Bureau 

of Indian Education of the Department of the Interior on Indian Alcohol and Substance 

Abuse Prevention, as amended on March 1, 2011, and 

• The Indian Alcohol and Substance Abuse Memorandum of Agreement between U.S. 

Department of Health and Human Services, U.S. Department of the Interior, and U.S. 

Department of Justice, published at 76 Fed. Reg. 47599 (Aug. 5, 201 1). 
This MOA coordinates HHS, DOl, and DOJ efforts in order to reduce duplication, improve 

efficiency, and target joint outcomes that improve the health and well-being of Indians. 

II. Background 

Congress has found and declared that "the Federal Government has a historical 

relationship and unique legal and moral responsibility to Indian tribes and their 

members;" that "included in this responsibility is the treaty, statutory, and historical 

obligation to assist the Indian tribes in meeting the health and social needs of their 

members;" and that alcohol and substance misuse are "the most severe health and social 

problem[s] facing Indian tribes and [their members]" 25 U.S.C. § 2401 (1), (2), & (3). In 

a 2014 National Survey on Drug Use and Health report, the rate of substance dependence 

or misuse among persons aged 12 or older was higher among American Indians or Alaska 

Natives than any other population group. Among other issues, underage drinking 

increases the risk of suicide and homicide, physical and sexual assault, using and 

misusing other drugs, and is a risk factor for heavy drinking later in life. 

III. Authority for MOA 

The Indian Health Care Improvement Act as permanently reauthorized under Section 10221 

ofthe Affordable Care Act (P.L. 111-148) and the Indian Alcohol and Substance Abuse 

Prevention and Treatment Act (Title IV, Subtitle C of Public Law 99- 570), as amended by 

Section 241 of Title II of the TLOA of 2010 (P .L. 111-211 ). 

IV. Policy 

It is the policy ofHHS, DOl, and DOJ that all activities undertaken pursuant to this MOA, 

shall be done in a manner that is least disruptive to tribal control. All new activities 

undertaken pursuant to this MOA shall supplement, not supplant, ongoing activities and 

programs. The Secretary of HHS, the Secretary of the Interior, and the Attorney General, 

acting through their respective departments, shall implement this MOA in cooperation 

with Indian tribes. 

V. Coordination of Efforts 

The federal partners identified in IHCIA and IASAPTA (HHS, DOl, and DOJ) oversee 

programs, including prevention and treatment programs, that respond to the consequences 

of substance (including alcohol and drugs) misuse and substance use disorders and their 

impact on public safety and health (e.g., education, social services, justice services, law 

enforcement, behavioral health, acute and chronic medical care services). There is a need 

to align, leverage, and coordinate federal efforts and resources at multiple levels within the 

applicable partner departments to effectuate more comprehensive prevention, treatment, 

and recovery services and programs for American Indian and Alaska Native individuals, 

families, and communities. 

HHS, DOl, and DOJ, as applicable, shall coordinate existing alcohol and substance use, 

child abuse and neglect, and family violence programs and resources. HHS, DOl, and 

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DOJ will also develop and maintain a sustainable partnership infrastructure that engages 

other federal agencies and offers a holistic approach to addressing alcohol and substance 

use issues faced by American Indians and Alaska Natives in the following areas: 

1. Scope of Problem: HHS, DOl, and DOJ, through the Coordinating Committee (see 

Section VII below), will coordinate with other federal agencies, Indian tribes, and 

other non-federal partners to determine from available data the scope of alcohol and 

substance use and co-occurring conditions. 

In accordance with 25 U.S.C. § 2413(b)(2)(A), SAMHSA shall have responsibility 

for coordinating with other federal partners to monitor the: (a) determination of the 

scope of alcohol and substance misuse among Indian tribes, including the fmancial 

and human cost; and (b) assessment of the existing and needed resources for the 

prevention of alcohol and substance misuse and the treatment of Indians affected by 

alcohol and substance use disorders. 

IHS shall assume responsibility for determination of the scope of the problem of 

alcohol and substance misuse and mental illness among Indians, including data on the 

number of Indians eligible for IHS services who are directly or indirectly affected by 

alcohol and substance use and the financial and human cost; assessment of the 

existing and needed resources for the prevention of alcohol and substance misuse and 

the treatment oflndians; estimation of the funding necessary to adequately support a 

program of prevention, treatment and recovery of alcohol and substance use. IHS 

shall provide available data to the Coordinating Committee. 

DOl shall provide to the Coordinating Committee available data on the scope of child 

abuse and family violence among Indians and the unmet need for additional services, 

resources, and programs necessary to improve the health and well-being of Indians. 

2. Minimum Program Standards: HHS, DOl, and DOJ, through the Coordinating 

Committee and in consultation with tribes, will develop and establish minimum 

program standards, as appropriate, for alcohol and substance use treatment, 

emergency medical assessments, transitional housing and emergency shelters. These 

standards may be based upon existing federal, state, or tribal standards. 

3. Identification of Programs and Resources: SAMHSA, through OIASA, will take 

the lead role, in coordination with IHS, DOl, and DOJ, in compiling a listing of 

federal, state, tribal, local, and private alcohol and substance use programs and 

resources. HHS, DOl, and DOJ, via the Coordinating Committee, will coordinate 

with tribes and other non-federal partners to identify existing federal, state, local, and 

private services, resources, and programs that could be useful in the development of 

Tribal Action Plans (TAPs). 

4. TAP Development: The federal partners commit to coordinating available programs 

and resources to facilitate the establishment ofT APs for all tribes as described at 25 

U.S.C. § 2412, and to cooperate fully with any tribe that adopts a resolution (or 

legally-equivalent action) to establish and implement its TAP. The purpose of aT AP 

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is to coordinate available resources and programs in an effort to combat alcohol and 

substance misuse among the tribe's members. SAMHSA will serve as the point of 

contact for Indian Tribes regarding the implementation ofT APs. Where a tribe does 

not resolve to develop aT AP, the federal partners commit to identify and coordinate 

their available programs and resources for such tribe. 

5. Newsletter: DOl shall publish the newsletter described in 25 U.S.C. § 2416(a) on a 

quarterly basis and include reviews of exemplary alcohol and substance use programs. 

The newsletter shall be circulated without charge to schools, tribal offices, BIA agency 

and area offices, IHS' area and service unit offices, IHS's alcohol programs, and other 

entities providing alcohol and substance use related services or resources to Indians. 

HHS will cooperate to the extent allowable by agency resources to provide relevant 

content for the newsletter. 

6. Law Enforcement and Judicial Training: BIA, Office of Justice Services (OJS), in 

coordination with DOJ, will develop and implement the law enforcement and judicial 

personnel training, as described in 25 U.S.C. § 2451 , with other agencies providing 

support, as appropriate. 

7. Child Protection, Child Welfare, and Child Abuse and Neglect Data: BIA, Office 

of Indian Services (OIS), in coordination with, DOJ and IHS will seek input from 

local tribes to define the scope of services appropriate to tribal area needs; identify 

available resources for Indian children who are affected by alcohol and substance use 

and who are at risk for abuse and/or neglect; and strengthen interagency, 

multidisciplinary approaches to prevent abuse and neglect of such children. 

As provided in 25 U.S.C. § 2434, and in accordance with applicable confidentiality laws, 

including 42 U.S.C. 290dd-2 and 42 CFR part 2, BIA (OIS) will compile annual data 

relating to the number and types of child abuse and neglect cases and the type of 

assistance provided. The cases will be categorized by involvement of alcohol and 

substance use, recurrence and involvement of minor siblings, when possible. 

In the compilation and reporting of the data, all necessary measures will be taken to 

preserve the confidentiality of families and individuals and to protect personallyidentifiable information from unauthorized or inappropriate use and disclosure. 

8. Juvenile Detention Centers: BIA (OJS) and DOJ, in consultation with tribal leaders 

and tribal justice officials, developed a long-term plan for the construction, 

renovation, and operation oflndian juvenile detention and treatment centers and 

alternatives to detention for juvenile offenders, as described in 25 U.S.C. § 2453, and 

issued a report entitled, "TLOA Long Term Plan to Build and Enhance Tribal Justice 

Systems (August 2011) that can be located at 

https://www.justice.gov/sites/defaultlfiles/triballlegacy/2014/02/06/tloa-tspaug20ll.pdf. Federal partners will continue to coordinate on the implementation of 

the plan. 

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9. Model Juvenile Code: DOJ and DOl, in consultation with HHS (SAMHSA), and in 

cooperation with tribal leaders, tribal law enforcement, and tribal justice systems 

developed a Model Indian Juvenile Code as described in 25 U.S.C. § 2425 which will 

be published in the Federal Register by the end of2016. Federal partners will 

continue to coordinate on supporting the use of this Model Code by interested tribes. 

10. BIE-IHS Collaboration and Local MOAs: IHS and BIE will collaborate in 

mutually beneficial ways: 

Youth Regional Treatment Centers {YRTCs): lHS and BIE will work collaboratively to 

establish educational partnerships through regional MOAs between IHS federallyoperated YRTCs and BIE schools to address the educational needs of the Indian youth 

receiving treatment in YRTCs. IHS will continue to provide funding support for the 

operation of its existing YRTCs. Each MOA will be tailored for the provision of an 

accredited educational program, including options for distance learning and appropriate 

equipment and resources to support the educational requirements for residential youth as 

part of the holistic care they receive. 

VI. Coordination Responsibilities 

SAMHSA is charged with, among other things, improving coordination among federal 

agencies and departments carrying out the IASAPTA (25 U.S.C. § 2413(b)(l)(A)). 

SAMHSA, acting through its OIASA, shall provide for ongoing process and performance 

review and improvement of the coordination among federal partners, between federal 

partners and tribes, and collaborating federal departments and agencies with regard to 

Indian alcohol, substance use, and related programming. 

OIASA shall coordinate with federal partners and collaborating departments and agencies 

to provide the most effective, accessible, culturally-adaptive, medically-sound, and 

evidence-based services to address the causes, correlates, and effects of alcohol and 

substance use affecting Indian communities. OIASA shall also coordinate with federal 

partners on ways to monitor the performance and compliance of the relevant federal 

programs in achieving the goals and purposes of this MOA in accordance with 25 U.S.C. § 

2413(b )(2)(A), and serve as a point of contact for tribes and Tribal Coordinating 

Committees as described at 25 U.S.C. § 2413(b )(2)(8). 

VII. Committees and Workgroups 

Federal coordination will occur through interdepartmental committees and workgroups, 

which will include: (1) an Executive Committee comprised of Principals ofHHS (IHS 

and SAMHSA), DOl (BIA and BIE), and DOJ; (2) a Coordinating Committee comprised 

of representatives from federal partners, and (3) workgroups that include participation 

from the federal partners, collaborating agencies, and national experts on the topics taken 

up by the workgroups. 

In order to assure that coordination efforts are pursued in a continuing and timely fashion, 

the Executive Committee, Coordinating Committee, and workgroups will meet routinely. 

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These committees are intended to ensure that relevant guidance and direction are provided, 

activities supported by this MOA are reviewed routinely, relevant information is shared, 

progress is reported continually and an annual progress report is compiled, and new areas 

for coordination are explored as the need arises. In addition, other meetings may be 

arranged to support specific projects. 

In order to accomplish the purposes of this MOA, the federal partners and collaborating 

agencies may realign or otherwise restructure any workgroup functioning under the 

auspices of the Coordinating Committee. 

VIII. Tribal Consultation 

Consistent with Executive Order 13175 ofNovember 6, 2000, the Presidential 

Memorandum on Tribal Consultation ofNovember 5, 2009, applicable federal law, and 

their specific consultation policies, the federal partners will coordinate consultation 

activities, as necessary, relating to this MOA. 

IX. Period of Agreement 

This MOA shall be effective from the last date of all signatures and remain in effect until 

terminated by applicable federal law or the parties to the MOA acting jointly, or until 

there is a change in law authorizing and requiring an MOA. 

X. Review, Modification, and Provisions for Amending the MOA 

Under the direction of the Executive Committee, and through the Coordinating 

Committee, shall review this MOA annually within a month of the anniversary of the 

signing of the MOA. The MOA, or any of its specific provisions, may be modified with 

the written approval of each signatory to the MOA. Such approval must be provided in 

writing and must be signed by an authorized representative of the signatories. OIASA 

will publish a copy of the amended MOA in the Federal Register and DOl (BIA) will 

disseminate it to each federally recognized Indian tribe. 

- XI. Discontinuance of Participation 

A party may, subject to applicable federal law, by written notice (with at least 60 calendar 

days notification to each of the other parties) end its participation in this MOA, in whole 

or in part, when that party determines that it is unable to continue participation in the 

activities of this MOA. 

XII. Disclosure of Information 

The parties to this MOA will comply with all applicable federal laws and regulations 

governing the disclosure of information, including but not limited to the Freedom of 

Information Act, as amended (5 U.S.C. § 552), the Privacy Act of 1974, as amended (5 

U.S.C. § 552a), the Health Insurance Portability and Accountability Act, and 42 U.S.C. 

§290dd-2 and 42 C.F.R. Part 2. Where disclosure of information generated under this 

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MOA is requested and pennitted by law, the parties to this MOA will provide notice to 

collaborating agencies, through the Coordinating Committee, prior to disclosure. This 

MOA does not contemplate the use or disclosure of alcohol or drug use disorder treatment 

patient records, except as expressly permitted by law. 

XIII. Limitations 

Nothing in this MOA constitutes an obligation of funds by any of the pruties or an 

authorization to engage in activities that are inconsistent with applicable law or policy. 

Similarly, nothing in this MOA restricts or otherwise limits departments from engaging 

in activities that are otherwise consistent with applicable law or policy. 

In addition, nothing in this MOA creates or conveys any rights or potential causes of 

action to any person, federally recognized Indian tribe, or other entity that may be 

affected by this MOA. All activities and projects initiated or implemented as a result of 

this MOA are subject to the availability of appropriated funds. Nothing in this MOA 

precludes the signatories from entering into interdepartmental agreements for services. 

Under this MOA, no transfer of funds or full-time equivalency is required between 

federal partner departments. 

XIV. Approval by Signatories 

Syl 

~4-M. Burwell ll1.~ Secretary of Health and Human Services 

Secretary of the Interior 

clmna

Loretta E. Lynch 

. L~ DEC 0 6 2016 

Attorney General 

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