```

[Senate Report 108-75]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 143
108th Congress                                                   Report
                                 SENATE
 1st Session                                                     108-75

======================================================================

 
TO AUTHORIZE THE INTEGRATION AND CONSOLIDATION OF ALCOHOL AND SUBSTANCE 
ABUSE PROGRAMS AND SERVICES PROVIDED BY INDIAN TRIBAL GOVERNMENTS, AND 
                           FOR OTHER PURPOSES

                                _______
                                

                 June 18, 2003.--Ordered to be printed

                                _______
                                

   Mr. Campbell, from the Committee on Indian Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 285]

    The Committee on Indian Affairs to which was referred the 
bill (S. 285) to authorize the integration and consolidation of 
alcohol and substance abuse programs and services provided by 
Indian tribal governments, and for other purposes, having 
considered the same, reports favorably thereon with an 
amendment in the nature of a substitute and recommends that the 
bill as amended do pass.

                                Purpose

    The Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2003 (S. 285) has two primary purposes.
    The first purpose is to enable Indian tribes to create a 
simpler and more efficient delivery system for alcohol, 
substance abuse, and mental health treatment services by 
consolidating and integrating administrative, management and 
accounting functions into a single program, and thereby 
recognizing that tribal governments, as the local entities 
directly responsible for the well-being of their populations, 
can best determine the most appropriate policies and methods 
for achieving these goals in their communities.
    The second purpose is to reauthorize the Indian Alcohol and 
Substance Abuse Prevention and Treatment Act of 1986.

                               Background

    Native communities are increasingly plagued by mental 
health problems and alcohol and substance abuse at staggering 
rates and this abuse is wreaking havoc on Native families 
across the country. The incidence of alcohol and substance 
abuse among American Indian and Alaskan Native adults is far 
greater than that of the general population. Alcoholism occurs 
among American Indian and Alaskan Natives at a rate that is 
579% greater than the general population. Deaths due to 
alcoholism occur at a rate that is 627% higher than that of the 
general population, and the trend is worsening. During the ten 
years between 1987 and 1996, the rate of deaths due to 
alcoholism increased 57% among American Indians and Alaskan 
Natives.
    Similarly, alcohol continues to be an important risk factor 
associated with the top three killers of American Indian and 
Alaskan Native youth--accidents, suicide, and homicide. Based 
on 1996 data, the rate of mortality due to alcoholism among 
American Indian and Alaskan Native youth ages 15 to 24 was 3.4 
per 100,000 which is 11 times the rate for white youth of the 
same ages. The same data show a suicide rate among American 
Indian and Alaskan Native youth of 34 per 100,000, a rate which 
is 2.5 times the rate for the general population.
    Native Americans also have higher rates of alcohol and drug 
use than any other racial or ethnic group in America, another 
worsening trend. The drug-related death rate for American 
Indian and Alaskan Native--already 65% higher than the general 
population--increased 240% between 1981 and 1996.
    Despite previous treatment and preventive efforts, 
alcoholism and substance abuse continue to be prevalent among 
Native youth: a 2001 study by the Harvard School of Public 
Health found that Native college students had the highest rates 
of ``binge'' drinking among all college ethnic groups. In a 
2001 study by the National Household Survey on Drug Abuse, 
22.1% of American Indian and Alaskan Native teens reported the 
use of marijuana, cocaine, and other illicit substances. The 
Survey also found that 35% of Native youth used alcohol.
    Reports issued by the Indian Health Service (IHS) indicate 
that mental health and social problems are associated with more 
than one-third of the demands made on Indian health facilities 
for services. Data gathered by IHS and corroborated with data 
from the Substance Abuse and Mental Health Services 
Administration (SAMHSA) demonstrates that Native people have 
the highest rates of mental distress of all ethnic and racial 
groups in the United States.
    The Federal government offers several disparate and 
currently uncoordinated mental health and substance abuse 
prevention and treatment programs for which Indian tribes and 
tribal health organizations are eligible to receive funding. 
Amounts available for the operation of these programs are 
generally very small.
    Pursuant to the Tribal Self Governance Amendments Act of 
2000 (Pub. L. 106-260), the Department of Health and Human 
Services (DHHS) conducted ``a study to determine the 
feasibility of a tribal self-governance demonstration project 
for appropriate programs, services, functions, and activities 
(or portions thereof) of [DHHS].'' Essentially, the study was 
aimed at identifying those DHHS programs that could be 
consolidated by tribes into a self-governance compact, or that 
would be useful to a self-governance compact, but could not be 
consolidated due to statutory restrictions.
    Mental health related programs that were identified 
included the Community Services Block Grant, Child Welfare 
Services, Promoting Safe and Stable Families, Family Violence 
Prevention, and the Administration on Aging's Grants for Native 
Americans, as well as various IHS programs. Additionally, a 
couple of significant programs under SAMHSA, the Community 
Mental Health Block Grant and the Substance Abuse Prevention 
and Treatment Block Grant, were identified as appropriate for 
consolidation, but due to statutory restrictions cannot be 
distributed in block grants to tribes. Other possible candidate 
programs include those administered by the National Institutes 
of Health--National Institute on Alcohol Abuse and Alcoholism, 
which includes several different grant programs for minorities 
and the prevention of alcohol abuse.
    Even in those instances where Indian tribes and tribal 
organizations are able to access program funding from several 
different sources, the amounts are generally so meager and the 
auditing and reporting requirements so onerous, that it is 
simply not cost effective to attempt to operate a program which 
combines multiple sources of available funding.
    S. 285 addresses these problems by allowing for the 
submission of a plan to consolidate funding and develop a 
single plan to meet auditing and other reporting requirements. 
In the process, the Indian tribe or tribal organization is 
encouraged to access several funding sources, make one report 
to the Federal government on the use of funds, and to operate 
these programs so that the resources are effectively targeted 
at the communities that need them.
    S. 285 will authorize and encourage Indian tribes and 
tribal organizations to streamline alcohol and substance abuse 
and mental health programs through consolidation and 
integration of mental health diagnosis and treatment programs, 
including alcohol and substance abuse prevention, diagnosis, 
and treatment programs, and to provide unified and more 
effective services to Native Americans with mental health and 
substance abuse-related illnesses.
    S. 285 tracks the highly-successful ``477 model'' that 
Indian tribes and tribal organizations have used to effectively 
integrate and consolidate employment, training and related 
services through the Indian Employment Training and Related 
Services Demonstration Act of 1992 (Pub. L. 102-477).
    Pursuant to S. 285 an applicant tribe or Indian health 
organization can file a single comprehensive plan to draw and 
coordinate resources from many Federal agencies and administer 
them through one office, which will be housed in the DHHS. To 
facilitate this inter-agency resource transfer, Secretaries of 
the agencies designated in the bill are required to negotiate 
and enter into a memorandum of agreement.
    Assisting Indian tribes and tribal organizations to access 
alternative sources of funding for mental health services can 
potentially increase the overall level of health care in Indian 
country. In addition, recent studies by SAMHSA indicate that 
preventive mental health programs can save substantial amounts 
from having to be spent on medical treatment.

                      Summary of Major Provisions

1. Overview and coordinating agency status

    The Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2003 authorizes the Secretary of the DHHS 
to be the Federal official in charge of establishing the 
framework for integration and coordination of Native American 
alcohol, substance abuse, and mental health programs at the 
Federal level. The Secretary is the logical candidate to lead 
this effort as the Secretary oversees the operation of key 
agencies within the DHHS which provide funding in the area of 
alcohol, substance abuse and mental health treatment. 
Additionally, the Secretary is in the best position to 
successfully negotiate with other Federal departments for a 
memorandum of agreement to effectuate the purposes of S. 285.
    S. 285 designates the IHS as the ``coordinating agency'' 
for the consolidation program. Because the IHS has considerable 
experience implementing the provisions of the Indian Self 
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq), and is responsible for administering the great majority 
of Indian health programs, the activities envisioned by S. 285 
make the Service an ideal point of coordination for the 
consolidation program.

2. Definitions

    A definition of ``substance abuse'' is included in the bill 
in response to concerns expressed by Committee members that 
program monies consolidated under the bill could not be used to 
treat inhalant abuse, which is a growing problem among American 
Indian and Alaskan Native youth.
    It is the intent of the Committee that funds used under 
this legislation be used to treat inhalant abuse where a tribe 
or tribal consortia determines such uses to be necessary.
    Definitions of ``automated clinical information system'' 
and ``Indian behavioral health care program'' are also included 
in the bill as amended. The term automated clinical information 
systems refers to computer software and/or hardware 
specifically designed for use in a clinical health care 
setting. The term Indian behavioral health care program is 
defined to express the intent of the Committee to include 
within the purview of this act all Federal programs and, 
necessarily, related Federal funding, for alcohol, substance 
abuse prevention, diagnosis and treatment and mental health 
analysis, counseling, treatment, support and related programs 
for Indians and Indian tribes.
    It is the intend of the Committee that, for purposes of 
this Act, the term ``Indian tribe'' be broadly defined. There 
are multiple types of non-profit organizations and clinics, as 
well as Indian tribes and intertribal consortium, that shoulder 
the responsibility of delivering critically needed alcohol and 
substance abuse, and mental health services to American 
Indians. Some clinics and organizations operate only on 
reservations, serving only one tribal community, others operate 
in urban settings, serving a number of different tribal 
communities.

3. Types of programs that are eligible for consolidation

    Section 104 of the bill, as amended, addresses the 
different types of programs which may be included in plans for 
consolidation under this legislation. Previous versions of the 
bill authorized only those programs which are formula-funded. 
In the 106th Congress, the Committee was made aware that 
formula funding is rarely used to fund alcohol and substance 
abuse programs, and that the majority of funds used for these 
programs are provided through competitive grant or other 
programs.
    Accordingly, the Committee drafted the authorization in S. 
285 to include grant programs and other types of funding that 
may be distributed for the treatment of alcohol, substance 
abuse or mental health treatment. The Committee intends that 
tribes have significant latitude in securing funding sources 
for inclusion in a consolidated plan.
    The DHHS has expressed concerns that certain program 
funding sources, such as SAMHSA's Community Mental Health Block 
Grant and the Substance Abuse Prevention and Treatment Block 
Grant, might need statutory amendments to work effectively with 
the S. 285 consolidation program. Therefore, the Native 
American Alcohol and Substance Abuse Program Consolidation Act 
of 2003 has been amended from prior versions of the bill to 
allow for inclusion of grant funding, as noted below, such as 
that which tribes receive from the SAMHSA.
    In drafting section 104 of S. 285, considerable thought was 
given to the provision which allows grant funds to be 
consolidated. The Committee recognizes that without the 
inclusion of grant monies this program authority would be 
ineffective because the majority of monies available to tribes 
for the treatment of alcohol and substance abuse problems are 
distributed through grants.
    The Committee intends that the enactment of S. 285 should 
not be used as a justification for the denial of grant 
applications submitted by tribes because the DHHS prefers that 
the funds not be consolidated. At the same time, the Committee 
desires to protect the integrity of the grant process. 
Accordingly, the tribe must still apply for and secure a 
competitive grant before it can include the grant funding in a 
consolidation plan.
    Section 104 also accommodates the granting agency by 
allowing consolidation where the plan to include grant funds is 
essentially the same as the requirements of the grant program. 
This allows some flexibility for the tribe but still requires 
conformity to the requirements of the grant program.

4. Initiation of program

    Under the Native American Alcohol and Substance Abuse 
Program Consolidation Act of 2003, the Secretary is obligated 
to develop and implement the interdepartmentalMemorandum of 
Agreement (MOA) at the Cabinet level. This MOA will provide the 
framework for the implementation and operation of the consolidation 
program among relevant Federal agencies.
    Initially, the Committee expects that the departments of 
Health and Human Services, Interior, Justice and Education will 
cooperate in the development of the MOA. Eventually, each 
Federal department or agency which funds alcohol, substance 
abuse and mental health programs can be expected to be 
signatories to the MOA and to participate in a meaningful way.
    The Committee expects that, similar to the MOA developed to 
implement Congress' mandate in Pub. L. 102-477, the MOA 
required by the Native American Alcohol and Substance Abuse 
Program Consolidation Act of 2003 will address the following 
issues:
    1. Advising tribal governments regarding their eligibility 
to integrate programs and how they may develop and implement a 
tribal plan for consolidation of funds.
    2. Procedures for the review and approval of plans, 
including time lines for their review and approval.
    3. The agreement which will be used by tribes and Federal 
departments or agencies to govern their relationships under the 
program. It is anticipated that the agreement that is currently 
being used will provide guidance to the Secretaries who enter 
into the Memorandum of Agreement.
    4. An expedited process for the review of waiver 
applications from tribes participating in this program. 
Additionally, it is anticipated that appeals from a denial will 
also be accelerated.
    5. An agreement and procedure for the timely payment of 
funds to tribes participating in the program.
    The Committee expects that the opportunity to access this 
program will be extended to all tribes that express a desire to 
participate.

5. Review and approval of tribal plans

    Central to the success of this program is a deliberative 
and comprehensive plan to develop, consolidate and implement 
programs in an integrated manner. It is the belief of the 
Committee that tribes can best determine where scarce resources 
will be used most economically and what type of services are 
most appropriate to serve their communities. Accordingly, the 
Federal agencies that administer program funds which are 
authorized to be consolidated under this legislation are 
expected to give deference to tribal allocations of resources 
and program design.
    The Secretaries are expected to allow tribes a great deal 
of flexibility in designing the plans which will be submitted 
pursuant to this legislation. Creativity in the use of multi-
year plans, mix of services and innovative approaches to 
treatment should not be stifled. The primary objective of the 
Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2003 is the reduction of the incidence of 
alcohol and substance abuse, and other mental health 
afflictions suffered by American Indians and Alaskan Natives.
    It is clear that ``mainstream'' treatment approaches to 
treating these problems have not been effective and that tribal 
involvement in developing new and culturally appropriate 
services are needed. It is expected that the Secretary will 
keep this in mind when reviewing plans under the act. The 
Committee believes that in reviewing such plans, the Secretary 
should focus on the following issues:
    1. Does the plan effectively address the purposes of the 
program, how those purposes meet tribal goals to address the 
existing problems, and what is the projected effect the program 
is expected to have on individuals served?
    2. Does the plan lay out an overall strategy for dealing 
with alcohol and substance abuse and mental health problems 
within the tribe's service area?
    3. Does the plan integrate other available resources?
    Where tribes or tribal consortia have integrated or have an 
intent to consolidate competitive grant programs, it is 
expected that Federal agencies will provide maximum flexibility 
to program participants who are attempting to match grant 
requirements to tribal needs. The character of a grant program 
is relevant but, unless there is a statutory mandate, serious 
consideration should be given to allowing a tribe or 
organization whose plan does not match with the requirements of 
a grant to consolidate funds.
    The Committee is cognizant that, to be effective, proposed 
tribal consolidation plans, must account for the timing, 
availability and receipt of the program funding to be 
consolidated. The DHHS has expressed concerns about the ability 
to adequately review tribal plans without such information. 
Therefore, as part of the substitute amendment to S. 285 
adopted by the Committee, section 107 was clarified to specify 
that information regarding the timing, availability and receipt 
of program funding must be included in a tribal consolidation 
plan, or the plan may be disapproved by the Secretary.

6. Use of technology

    The language in section 108 regarding use of program funds 
for acquisition of technology by lease, license or purchase, or 
for training to use such technology, is intended to clarify 
that, in developing a consolidation program, tribes and tribal 
consortia are authorized and encouraged to utilize modern 
technological advances in computer hardware and software, 
communications and other electronic devices.
    In the private health care industry, such advances have 
proven to greatly improve efficiencies in clinical practices, 
as well as in third party and Medicare/Medicaid billing. It is 
the intent of the Committee that S. 285 be interpreted to give 
tribal clinics the widest latitude in adopting industry best 
practices, for the purpose of providing the highest quality 
health care to Indian people possible given the limited budgets 
on which most such facilities operate.
    It is also the intent of the Committee that tribal health 
facilities and Federal agencies utilize the authorization under 
this legislation to develop modern, reliable and valid systems 
to improve the accountability, quality and continuity of the 
mental health and substance abuse programs serving Indian 
people, while at the same time more efficiently utilizing the 
funding received and the ability to bill third party providers 
and access the Medicaid/Medicare system.
    Concerns were also expressed by DHHS that Indian tribes or 
clinics may ``unwisely'' overinvest in technology. To address 
those concerns, changes were made in previous versions of the 
bill, clarifying the importance of not cutting program 
activities when acquiring technology.
    Specifically, this concern was addressed in the section 
detailing the required elements of a tribal plan. Pursuant to 
section 105, paragraph (4), a tribal consolidation plan must 
contain a ``descri[ption of] the manner in which services are 
to be integrated and delivered and the results expected under 
the plan (including, if implemented, the manner and expected 
results of implementation of an automated clinical information 
system)''. Section 108, which provides the authority for tribes 
to acquire technology, conditions that authority on compliance 
with the requirements of an approved plan.
    Similarly, DHHS' concern was addressed in the section 
specifying grounds for the Secretary to disapprove a tribal 
plan. In section 107, subparagraph (b)(1)(C) the Secretary may 
disapprove a plan if--``the plan provides for the purchase, 
lease, license, or training for, an automated clinical 
information system, but the purchase, lease, license, or 
training would require aggregate expenditures of program 
funding at such a level as would render other program 
activities substantially ineffectual''.
    To be certain that the Secretary has all of the necessary 
information to review and approve or disapprove a tribal plan, 
subsection 105(5) requires a tribal plan to ``identify the 
projected expenditures under the plan in a single budget''.
    While the Committee appreciates the DHHS concerns, the 
Committee is confident that the consolidation plan requirements 
contained in section 105, and the authority given to the 
Secretary in section 107 to disapprove a tribal plan that does 
not meet those requirements, provides sufficient opportunity 
for the Secretary to insure the continued efficacy of program 
services under a consolidation plan.

7. Waiver authority

    One of the purposes of S. 285 is to simplify Federal 
requirements pertaining to the operation of Federal programs. 
As part of the plan submission and review process, the bill 
provides that the tribe and Federal government review the plan 
and identify any rules, regulations, policies, procedures or 
underlying statutory provisions which need to be waived in 
order to successfully implement the plan. The Committee expects 
that unless a Federal requirement is central to the nature of 
the program involved, it should be considered an appropriate 
requirement to be waived under the authority provided in 
section 106.
    The DHHS has expressed concerns that the scope of the 
waivers that can be requested by tribes and tribal consortia 
and organizations may be too broad to effectively assess the 
appropriateness of waivers. This concern was addressed in the 
previous version of the bill, and that language was carried 
forward in S. 285.
    Specifically, section 106, subsection (c), in providing 
authority for waiver of statutory, regulatory, or policy 
requirements, expressly states that the head of the affected 
Federal agency cannot waive a requirement that ``is 
inconsistent with--(3) any underlying statutory objective or 
purpose of a program to be consolidated under the plan, to such 
a degree as would render ineffectual activities funded under 
the program.'' Section 106 is further strengthened by section 
107, subsection (b), which allows the Secretary to disapprove a 
plan that ``identifies waivers that cannot be waived under 
section 106(c).''

8. Amendment made to S. 285 as introduced

    During the business meeting at which S. 285 was approved by 
the Committee, a substitute amendment was adopted which 
contained several amendments to the bill as introduced. The 
primary amendments are the following:
    1. The rationales for Secretarial disapproval of a tribal 
consolidation plan were clarified to specify that information 
regarding the timing, availability and receipt of program 
funding must be included in a tribal consolidation plan, or the 
plan may be disapproved.
    2. The designated role of the IHS was amended from being 
``Lead Agency'' to that of ``Coordinating Agency.''
    3. Reauthorization of the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act through Fiscal Year 2008 was 
added.

                          Legislative History

    S. 285 was introduced on February 4, 2003, by Senator 
Campbell for himself, and was referred to the Committee on 
Indian Affairs. Senators Domenici and Murkowski were added as a 
cosponsors on February 10, 2003. Senator Inouye was also added 
as a cosponsor on May 13, 2003.
    A predecessor bill to S. 285 (S. 210) was introduced by 
Senator Campbell in the 107th Congress. The bill was reported 
out of Committee on July 10, 2002, and was approved by the 
Senate on September 17, 2002, but was never than up by the 
House of Representatives.
    On April 9, 2003, the Committee held a hearing on S. 285 at 
which testimony was provided by the DDHS, the National Indian 
Health Board (``NIHB''), and Our Youth Our Future, Inc. 
(``OYOF''), a nonprofit Native American substance abuse clinic. 
Both the NIHB and OYOF testified in favor of S. 285. The DHHS 
expressed some concerns with the bill, which were addressed in 
a substitute amendment.
    Subsequent to the hearing, Committee staff determined that 
the best method of effecting a reauthorization of the Indian 
Alcohol and Substance Abuse Prevention and treatment Act of 
1986 (ASAP) was to include it in S. 285. The ASAP waslast 
authorized in FY2001. A new Title II was added to the substitute 
amendment to S. 285, providing for reauthorization of the ASAP through 
Fiscal Year 2008.

                      Section-by-Section Analysis

    Section 1. Short Title; Table of Contents. The Act may be 
cited as the Native American Alcohol and Substance Abuse 
Program Consolidation Act of 2003. Section 1 also contains a 
Table of Contents.

 Title I--Integration and Consolidation of Alcohol and Substance Abuse 
                         Programs and Services

    Sec. 101. Purposes. The purposes of this Act are to enable 
Indian tribes to consolidate and integrate alcohol and other 
substance abuse programs, and mental health and related 
programs, and to assist Indian tribes in maximizing the use of 
public, tribal, human and financial resources for Indian 
behavioral healthcare programs.
    Sec. 102. Definitions. This section contains definitions 
for Automated Clinical Information System, Federal Agency, 
Indian, Indian Behavioral Healthcare Program (which includes 
alcohol and substance abuse, and mental health programs), 
Indian Tribe, Secretary and Substance Abuse.
    Sec. 103. Plans. This section provides that the Secretary 
of Health and Human Services, in cooperation with the other 
appropriate Secretaries shall, upon the receipt of an 
acceptable plan from an Indian tribe, authorize the tribe to 
consolidate its Federally-funded Indian behavioral healthcare 
programs into a single, coordinated, comprehensive program, 
that uses, to the extent necessary, an automated clinical 
information system to better manage services, costs and 
reporting requirements.
    Sec. 104. Programs Affected. Section 104 provides that the 
programs that may be integrated include Indian behavioral 
healthcare programs under which an Indian tribe is eligible for 
receipt of funds under a statutory or administrative formula, 
competitive or other grant program, or any other funding 
scheme. In the case of grant funding, a tribe must obtain 
permission to consolidate from the agency that is awarding the 
grant or, in the alternative, tailor its reporting structure 
closely to the reporting required by the grant program.
    Sec. 105. Plan Requirements. The requirements for plan 
submitted by an applicant tribe or tribal organization under 
this Act are to: identify the programs to be integrated, 
consistent with the purposes of this Act; describe a 
comprehensive program strategy, including technology 
assessments; describe how the services are to be integrated, 
delivered and budgeted, including the implementation of an 
automated clinical information system, if used; identify any 
statutory provisions, regulations, policies or procedures that 
the tribe believes need to be waived; and be approved by the 
appropriate tribal or tribal organization governing body.
    Sec. 106. Plan Review. In reviewing the plan the Secretary 
is to consult with the other Federal agencies providing funding 
and with the tribe or tribal organization. The parties shall 
identify any waivers necessary to enable implementation of the 
plan. Affected agencies shall have the authority to provide 
waivers, unless the affected agency determines that such a 
waiver is inconsistent with the purposes of this Act, any 
statutory requirements applicable to the program to be 
integrated, or the underlying statutory objectives or purposes 
of a program to be integrated.
    Sec. 107. Plan Approval. The Secretary shall have 90 days 
after the receipt of a tribe's plan to approve or disapprove 
the plan. If the plan is disapproved, the tribal government 
shall be informed, in writing, of the reasons for the 
disapproval and shall be given an opportunity to amend its plan 
or petition for reconsideration by the Secretary.
    Sec. 108. Use of Funds for Technology. Indian tribes and 
tribal organizations are authorized by this section to acquire 
technology for an automated clinical information system, as 
long as such acquisition is in accordance with a plan approved 
by the Secretary.
    Sec. 109. Federal Responsibilities. Paragraph (a) provides 
that within 180 days following the date ofenactment of this 
Act, the appropriate Secretaries shall enter into an interdepartmental 
memorandum of agreement providing for the implementation of the plans 
authorized under this Act. The Coordinating Agency under this Act is 
the Indian Health Service, within the Department of Health and Human 
Services. The responsibilities of the IHS will include: The use of a 
single report format to be used by a tribe to report on the activities 
undertaken by the plan and on all plan expenditures, and the 
development of a single system of Federal oversight for the plan, 
including the provision of technical assistance to tribes and convening 
of a meeting not less than two times during each fiscal year between 
the affected Federal agencies and tribes and tribal organizations. 
Paragraph (b) provides that the single report format shall be developed 
by the Secretary of HHS and should contain information that will allow 
a determination that the tribe has complied with the requirements 
incorporated in its approved plan.
    Sec. 110. No Reduction in Amounts. In no case shall the 
amount of Federal funds available to a participating tribe 
involved in any project be reduced as a result of the enactment 
of this Act.
    Sec. 111. Interagency Fund Transfers Authorized. The 
appropriate Secretaries are authorized to take such action as 
necessary to provide for interagency transfer of funds 
otherwise available to a tribe.
    Sec. 112. Administration of Funds; Excess Funds. Program 
funds shall be administered to allow for a determination that 
funds from specific programs are spent on allowable activities; 
however, tribes are not required to maintain separate records 
tracing any services or activities conducted under approved 
plans to the individual programs under which funds were 
authorized. All administrative costs may be commingled and 
participating Indian tribes shall be entitled to the full 
amount of such costs.
    Sec. 113. Fiscal Accountability. Nothing in this Act shall 
be construed to interfere with the ability of the Secretary to 
fulfill his responsibilities for the safeguarding of Federal 
funds.
    Sec. 114. Report on Statutory and Other Barriers to 
Integration. Within two years after the date of enactment of 
this Act, the Secretary of HHS shall submit a report to the 
Committee on Indian Affairs of the Senate and the Committee on 
Resources of the House of Representatives on the implementation 
of this program. Within five years after the date of the 
enactment of this Act, the Secretary of HHS shall submit a 
report to the Committee on Indian Affairs of the Senate and the 
Committee on Resources of the House of Representatives on the 
results of the implementation of the program, which identifies 
statutory barriers to the ability of tribes to integrate more 
effectively their mental health programs and services.
    Sec. 115. Assignment of Federal Personnel to State Indian 
Alcohol and Drug Treatment Programs. Any State with an Indian 
behavioral healthcare program targeted to Indian tribes shall 
be eligible to receive, at no cost to the State, such Federal 
personnel assignments deemed appropriate to help insure the 
success of such program.

Title II--Reauthorization of Certain Indian Alcohol and Substance Abuse 
                   Prevention and Treatment Programs

    Sec. 201. Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986. This section reauthorizes the Indian 
Alcohol and Substance Abuse Prevention and Treatment Act of 
1986 for each of fiscal years 2004 through 2008.
    Sec. 202. Effective Date. This section make the 
reauthorization effective on the date of enactment of this Act.

            Committee Recommendation and Tabulation of Vote

    On May 14, 2003, the Committee, in an open business 
session, considered S. 285 and approved an amendment in the 
nature of a substitute to S. 285, and ordered the substitute 
amendment favorably reported to the full Senate with a 
recommendation that the substitute amendment do pass.

                   Cost and Budgetary Considerations

    The cost estimate for S. 285 as calculated by the 
Congressional Budget Office, is set forth below:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, June 2, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 285, the Native 
American Alcohol and Substance Abuse Program Consolidation Act 
of 2003.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Eric Rollins.
            Sincerely,
                                     Douglas Holtz-Eakin, Director.
    Enclosure.

S. 285--Native American Alcohol and Substance Abuse Program 
        Consolidation Act of 2003

    Summary: S. 285 would authorize the appropriation of such 
sums as necessary for fiscal year 2004 through 2008 for the 
Bureau of Indian Affairs (BIA) to provide assistance to Indian 
tribes to prevent alcohol and substance abuse. The bill also 
would permit Indian tribes to consolidate alcohol and substance 
abuse programs that are currently funded through a number of 
federal agencies.
    CBO estimates that implementing S. 285 would cost $38 
million in 2004 and $226 million over the 2004-2008 period, 
assuming the appropriation of the necessary funds. Almost all 
of those costs would be for BIA programs to prevent alcohol and 
substance abuse. The bill would have no effect on direct 
spending or revenues.
    S. 285 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA). 
By allowing tribes to consolidate programs for behavioral 
health care, including substance abuse, the bill would provide 
tribes with greater programmatic flexibility.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 285 is shown in the following table. The 
costs of this legislation fall within budget functions 450 
(regional and community development) and 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                                       By fiscal year, in millions of dollars--
                                                                    --------------------------------------------
                                                                       2004     2005     2006     2007     2008
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

BIA Substance Abuse Programs:
    Estimated Authorization Level..................................       47       47       47       47       47
    Estimated Outlays..............................................       37       47       47       47       47
Consolidation of Alcohol and Substance Abuse Programs:
    Estimated Authorization Level..................................        1        *        *        *        *
    Estimated Outlays..............................................        1        *        *        *        *
Spending Under S. 285:
    Estimated Authorization Level..................................       48       47       47       47       47
    Estimated Outlays..............................................       38       47       47       47      47
----------------------------------------------------------------------------------------------------------------
*=Less than $500,000.

    Basis of estimate:
            BIA alcohol and substance abuse prevention
    S. 285 would authorize the appropriation of such sums as 
are necessary through 2008 for the Bureau of Indian Affairs to 
provide assistance to Indian tribes to prevent alcohol and 
other substance abuse. Such programs would include law 
enforcement and judicial training, emergency shelters for 
youth, and juvenile detention centers. No funds were provided 
for this program in 2003, but based on the level of funding 
authorized for such programs in previous years, and information 
from the Bureau of Indian Affairs regarding demand for various 
programs under this title, CBO estimates that implementing 
these provisions would cost $37 million in fiscal year 2004 and 
$225 million over the 2004-2008 period.
            Consolidation of alcohol and substance abuse programs
    S. 285 would permit Indian tribes to consolidate alcohol 
and substance abuse programs that are currently funded through 
a number of federal agencies. Under the bill, tribes would 
submit plans to the Department of Health and Human Services 
(HHS) for approval. HHS would approve or reject plans after 
consulting with the federal agencies that would be affected. 
During this approval process, these agencies would be able to 
waive statutory andother requirements to enable tribes to 
implement their plans. CBO estimates that the costs of approving plans, 
monitoring their implementation, and providing technical assistance 
would cost about $600,000 in 2004, and $350,000 annually in later 
years.
    S. 285 also would require HHS to submit reports on the 
bill's implementation within two and five years of enactment. 
CBO estimates that these reports would each cost less than 
$100,000. The additional costs of the provisions in S. 285 that 
deal with program consolidation would be borne by the Indian 
Health Service (IHS), the lead agency for the bill's 
implementation.
    Intergovernmental and private-sector impact: S. 285 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. By allowing tribes to consolidate programs for 
behavioral health care, including substance abuse, the bill 
would provide tribes with greater programmatic flexibility.
    Estimate prepared by: Federal Costs: Lanette Walker and 
Eric Rollins. Impact on State, Local, and Tribal Governments: 
Marjorie Miller. Impact on the Private Sector: Cecil McPherson.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

               Regulatory and Paperwork Impact Statement

    Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires that each report accompanying a bill to 
evaluate the regulatory and paperwork impact that would be 
incurred in carrying out the bill. The Committee has concluded 
that S. 285 will reduce regulatory or paperwork requirements 
and impacts.

                        Executive Communications

    A copy of a letter from the Department of Health and Human 
Services (DHHS) dated June 6, 2003, is set out below.

                The Secretary of Health and Human Services,
                                      Washington, DC, June 6, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: We take this opportunity to advice you 
of the views of the Department of Health and Human Services 
(HHS) and the Department of the Interior on S. 285, the 
``Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2003'', as recently ordered reported by 
your Committee.
    The Administration supports the principle that Indian 
Tribes best know how to meet the needs of their members for 
programs such as those addressed by S. 285. However, we 
continue to have the serious concerns about title I 
(Integration and Consolidation of Alcohol and Substance Abuse 
Programs and Services) that we stated in our recent testimony 
before the Committee (copy attached) and in an HHS report on 
similar legislation (S. 210) in the 107th Congress. Therefore, 
we cannot support title I of S. 285 as currently drafted.
    Our concerns about title I, which are fully discussed in 
our recent testimony, are: (1) lack of clear delineation of 
affected programs and of permissible uses of consolidated 
funds; (2) limitation on the flexibility of the Secretary in 
considering the merits of waiver request; (3) insufficient time 
for appropriate Federal decisionmaking; (4) designation of the 
Indian Health Service as the lead (or coordinating) agency; (5) 
lack of control on the possible use of grant funds for 
administrative overhead and information technology; and (6) 
lack of adequate and effective Federal oversight for 
consolidated programs. We look forward to working with you to 
address our concerns on title I.
    The Administration does not object to title II 
(Reauthorization of Certain Indian Alcohol and Substance Abuse 
Prevention and Treatment Programs). The Department of the 
Interior (Interior) advises that its Bureau of Indian Affairs 
(BIA) has recently reorganized. Under the new reorganization, 
the Office of Alcohol and Substance Abuse Prevention reports 
directly to the Deputy Director of Tribal Services, who reports 
to the Director of the Bureau of Indian Affairs. BIA placed the 
Office of Alcohol and Substance Abuse Prevention under the 
Deputy Director of Tribal Services to enhance BIA's 
responsiveness for social and community programs. Under the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act 
of 1986 (the Act), the Office of Alcohol and Substance Abuse 
Prevention is located within the Office of the Assistant 
Secretary for Indian Affairs. Interior requests, therefore, to 
be consistent with the reorganization and to better meet the 
needs of tribal communities, that a new provision be added to 
S. 285 to reflect this organizational change. Such a new 
provision would amend section 4207 of the Act (25 U.S.C. 2413) 
by striking ``Office of the Assistant Secretary of Interior for 
Indian Affairs'' and inserting ``Bureau of Indian Affairs'', 
and by striking ``Assistant Secretary of the Interior for 
Indian Affairs'' and inserting ``Director of the Bureau of 
Indian Affairs''.
    Thank you for considering these views on S. 285.
    The Office of Management and Budget has advised that there 
is no objection to the presentation of this report from the 
standpoint of the Administration's program.
            Sincerely,
                                                 Tommy G. Thompson.

                        Changes in Existing Law

    In compliance with subsection 12 of rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the bill S. 285, as ordered reported, are shown as follows 
(existing law proposed to be omitted is enclosed in black 
brackets, new matter is printed in italic, existing law in 
which no change is proposed is shown in roman):

                           Public Law 99-570

    A bill to strengthen Federal efforts to encourage foreign 
cooperation in eradicating illicit drug crops and in halting 
international drug traffic, to improve enforcement of Federal 
drug laws and enhance interdiction of illicit drug shipments, 
to provide strong Federal leadership in establishing effective 
drug abuse prevention and education programs, to expand Federal 
support for drug abuse treatment and rehabilitation efforts, 
and for other purposes.
    Be it enacted by the Senate and House of Representatives of 
the United States in Congress assembled,

 TITLE IV--INDIAN ALCOHOL AND SUBSTANCE ABUSE PREVENTION AND TREATMENT 
PROGRAMS

           *       *       *       *       *       *       *

SEC. 4206. * * *

           *       *       *       *       *       *       *

    (d) [(1) The Secretary] (1) In General.--The Secretary of 
the Interior may make grants to Indian tribes adopting a 
resolution pursuant to subsection (a) to provide technical 
assistance in the development of a Tribal Action Plan. The 
Secretary shall allocate funds based on need.
    [(2) There are authorized to be appropriated for grants 
under this subsection not more than $2,000,000 for fiscal year 
1993 and such sums as are necessary for each of the fiscal 
years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.]
    (2) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this subsection such sums as 
are necessary for each of fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4206. * * *

           *       *       *       *       *       *       *

    [(f) Grants for training, education, and prevention 
programs.
    [(1) The Secretary] (f) Grants for In-School Training 
Programs.--
          (1) In general.--The Secretary of the Interior may 
        make grants to Indian tribes adopting a resolution 
        pursuant to subsection (a) to implement and develop 
        community and in-school training, education, and 
        prevention programs on alcohol and substance abuse, 
        fetal alcohol syndrome and fetal alcohol effect.
          [(2) Funds] (2) Use of funds.--Funds provided under 
        this section may be used for, but are not limited to, 
        the development and implementation of tribal programs 
        for--
                  (A) youth employment;
                  (B) youth recreation;
                  (C) youth cultural activities;
                  (D) community awareness programs; and
                  (E) community training and education 
                programs.
          [(3) There are authorized to be appropriated to carry 
        out the provisions of this subsection $5,000,000 for 
        fiscal year 1993 and such sums as are necessary for 
        each of the fiscal years 1994, 1995, 1996, 1997, 1998, 
        1999, and 2000.] (3) Authorization of appropriations.--
        There are authorized to be appropriated to carry out 
        this subsection such sums as are necessary for each of 
        fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4210. * * *

           *       *       *       *       *       *       *

    [(b) Authorization of Appropriations. There are authorized 
to be appropriated to carry out this section $500,000 for 
fiscal year 1993 and such sums as may be necessary for each of 
the fiscal years 1994, 1995, 996, 1997, 1998, 1999, and 2000.] 
(b) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section such sums as are 
necessary for each of fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4212. * * *

    (a) [The Assistant Secretary of Indian Affairs] (1) In 
General.--The Assistant Secretary of Indian Affairs shall 
develop and implement pilot programs in selected schoolsfunded 
by the Bureau of Indian Affairs (subject to the approval of the local 
school board or contract school board) to determine the effectiveness 
of summer youth programs in furthering the purposes and goals of the 
Indian Alcohol and Substance Abuse Prevention Act of 1986. [The 
Assistant Secretary shall]
    (2) Defrayment of Costs._The Assistant Secretary shall 
defray all costs associated with the actual operation and 
support of the pilot programs in the school from funds 
appropriated for this section. [For the pilot programs there 
are authorized to be appropriated such sums as may be necessary 
for each of the fiscal years 1987, 1988, 1993, 1994, 1995, 
1996, 1997, 1998, 1999, and 2000.]
    (3) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this subsection such sums as 
are necessary for each of fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4213. * * *

           *       *       *       *       *       *       *

    (e)[(1) For the planning and design, construction, and 
renovation of, or purchase or lease of land or facilities for, 
emergency shelters and half-way houses to provide emergency 
care for Indian youth, there are authorized to be appropriated 
$10,000,000 for fiscal year 1993 and such sums as may be 
necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
1998, 1999, and 2000.
    [(2) For the staffing and operation of emergency shelters 
and half-way houses, there are authorized to be appropriated 
$5,000,000 for fiscal year 1993 and $7,000,000 for each of the 
fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.
    [(3) The Secretary of the Interior shall allocate funds 
appropriated pursuant to this subsection on the basis of 
priority of need of the various Indian tribes and such funds, 
when allocated, shall be subject to contracting or available 
for grants pursuant to the Indian Self-Determination Act.](1) 
In General._There are authorized to be appropriated to carry 
out planning and design, construction, and renovation of, or to 
purchase or lease land or facilities for, emergency shelters 
and halfway houses to provide emergency care for Indian youth, 
such sums as are necessary for each of fiscal years 2004 
through 2008.
    (2) Staffing and Operation.--There is authorized to be 
appropriated for staffing and operation of emergency shelters 
and halfway houses described in paragraph (1) $7,000,000 for 
each of fiscal years 2004 through 2008.
    (3) Allocation.--(A) In General.--The Secretary of the 
Interior shall allocate funds made available under this 
subsection to Indian tribes on the basis of priority of need of 
the Indian tribes.
    (B) Contracting and Grants.--Funds allocated under 
subparagraph (A) shall be subject to contracting or available 
for grants under the Indian Self-Determination Act (25 U.S.C. 
Sec. 450f et seq.).
    [(4) Funds] (4) Conditions for Use._Funds appropriated 
under the authority of this subsection may be used by any 
Indian tribe or tribal organization to purchase or lease any 
land or facilities if--
          (A) the Secretary of the Interior determines that no 
        Federal land or facilities are reasonably available for 
        emergency shelters or halfway houses described in 
        subsection (a) to serve the needs of that Indian tribe 
        or tribal organization, and
          (B) the Indian tribe or tribal organization enters 
        into an agreement with the Secretary of the Interior 
        that requires the Indian tribe or tribal organization 
        to use the land or facilities for emergency shelters or 
        half-way houses described in subsection (a).
    [(5) Nothing in this Act may be construed] (5) Effect on 
Other Authority._Nothing in this Act--
          (A) [to limit] limits the authority for contracts 
        with, or grants to, Indian tribes or tribal 
        organizations under the Indian Self-Determination Act 
        for the construction, improvement, renovation, 
        operation, repair, land acquisition, or maintenance of 
        tribal juvenile detention facilities, emergency 
        shelters, or half-way [houses, or] houses; or
          (B) [to require] requires a lease of tribal 
        facilities to the United States to qualify for 
        financial assistance for the facilities under this or 
        any other Act.

           *       *       *       *       *       *       *

SEC. 4216. * * *

    (a) * * *
          [(3) For the purpose of providing the assistance 
        required by this subsection, there are authorized to be 
        appropriated--
                  [(A) $500,000 under paragraph (1)(A) for 
                fiscal year 1993 and such sums as may be 
                necessary for each of the fiscal years 1994, 
                1995, 1996, 1997, 1998, 1999, and 2000,
                  [(B) $500,000 under paragraph (1) (B) for 
                fiscal year 1993 and such sums as may be 
                necessary for each of the fiscal years 1994, 
                1995, 1996, 1997, 1998, 1999, and 2000, and
                  [(C) $500,000 under paragraph (1) (C) for 
                fiscal year 1993 and such sums as may be 
                necessary for each of the fiscal years 1994, 
                1995, 1996, 1997, 1998, 1999, and 2000.]
          (3) Authorization of appropriations.--There is 
        authorized to be appropriated--
                  (A) to carry out paragraph (1)(A), $1,000,000 
                for each of fiscal years 2004 through 2008; and
                  (B) to carry out provisions of this 
                subsection other than paragraph (1)(A), such 
                sums as are necessary for each of fiscal years 
                2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4218. * * *

           *       *       *       *       *       *       *

    [(b) Authorization. For the purposes of providing the 
training required by subsection (a), there are authorized to be 
appropriated $2,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999 and 2000.]
    (b) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as are 
necessary for each of fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

SEC. 4220. * * *

           *       *       *       *       *       *       *

    [(b) Authorization.
          [(1) For the purpose of constructing or renovating 
        juvenile detention centers as provided in subsection 
        (a), there are authorized to be appropriated 
        $10,000,000 for fiscal year 1993s and such sums as may 
        be necessary for each of the fiscal years 1994, 1995, 
        1996, 1997, 1998, 1999, and 2000.
          [(2) for the purpose of staffing and operating 
        juvenile detention centers, there are authorized to be 
        appropriated $7,000,000 for fiscal year 1993 and such 
        sums as may be necessary for each of the fiscal years 
        1994, 1995, 1996, 1997, 1998, 1999, and 2000.]
    (b) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as are 
necessary for each of fiscal years 2004 through 2008.

           *       *       *       *       *       *       *

                                

```