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86–532 PDF 2003

S. HRG. 108–66

S. 285 S. 555 S. 558

HEARING

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS

UNITED STATES SENATE

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

ON

S. 288

TO ENCOURAGE CONTRACTING BY INDIANS AND INDIAN TRIBES FOR

THE MANAGEMENT OF FEDERAL LAND

S. 555

TO ESTABLISH THE NATIVE AMERICAN HEALTH AND WELLNESS

FOUNDATION

S. 558

TO ELEVATE THE POSITION OF DIRECTOR OF THE INDIAN HEALTH

SERVICE WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO ASSISTANT SECRETARY FOR INDIAN HEALTH

APRIL 9, 2003

WASHINGTON, DC

(
COMMITTEE ON INDIAN AFFAIRS

BEN NIGHTHORSE CAMPBELL, Colorado, Chairman

DANIEL K. INOUYE, Hawaii, Vice Chairman

JOHN McCAIN, Arizona,

PETE V. DOMENICI, New Mexico

CRAIG THOMAS, Wyoming

ORRIN G. HATCH, Utah

JAMES M. INHOFE, Oklahoma

GORDON SMITH, Oregon

LISA MURKOWSKI, Alaska

KENT CONRAD, North Dakota

HARRY REID, Nevada

DANIEL K. AKAKA, Hawaii

BYRON L. DORGAN, North Dakota

TIM JOHNSON, South Dakota

MARIA CANTWELL, Washington

PAUL MOOREHEAD, Majority Staff Director/Chief Counsel

PATRICIA M. ZELL, Minority Staff Director/Chief Counsel

(II)
(III)

C O N T E N T S

Page

S. 285, S. 555, S. 558 text of ................................................................................... 2

Statements:

Benally, Jr., Hoskie, chief executive officer, Our Youth, Our Future .......... 47

Campbell, Hon. Ben Nighthorse, U.S. Senator from Colorado, chairman,

Committee on Indian Affairs ....................................................................... 1

Davis-Wheeler, Julia, chairperson, National Indian Health Board ............. 44

Kopanda, Richard, executive director, Substance Abuse and Mental

Health Services Administration, Rockville, MD ......................................... 40

Lincoln, Michel, deputy director, Indian Health Service .............................. 40

Raub, William, acting assistant secretary for Planning and Evaluation,

Department of Health and Human Services .............................................. 40

APPENDIX

Prepared statements:

Benally, Jr., Hoskie .......................................................................................... 53

Davis-Wheeler, Julia ........................................................................................ 70

Naneng, Myron P., president, Association of Village Council Presidents

(with attachments) ........................................................................................ 75

Raub, William (with attachments) .................................................................. 55

Zacharof, Mike, chairman, Alaska Native health board ............................... 80

(1)

S. 285 S. 558 S. 555

WEDNESDAY, APRIL 9, 2003

U.S. SENATE,

COMMITTEE ON INDIAN AFFAIRS,

Washington, DC.

The committee met, pursuant to notice, at 10:03 a.m. in room

485 Senate Russell Building, Hon. Ben Nighthorse Campbell

(chairman of the committee) presiding.

Present: Senator Campbell.

STATEMENT OF HON. BEN NIGHTHORSE CAMPBELL, U.S. SENATOR FROM COLORADO, CHAIRMAN, COMMITTEE ON INDIAN AFFAIRS

The CHAIRMAN. The committee will be in session. Good morning

and welcome to the Indian Affairs hearing on three modest bills

that I believe will positively impact the health and status of the

Native people if they are enacted. Senator Inouye is running late

and may be here in a little while, but we will go ahead and get

started.

Two of the bills that we will be dealing with this morning will

benefit Indian health by attracting resources and attention to Native health issues, albeit in two different ways. S. 555 will establish

the Native Health and Wellness Foundation to serve as the legal

entity that can receive tribal, private sector and charitable donations for the purposes of Indian health care. S. 558 will enhance

the presence and effectiveness of the Indian Health Service inside

the Department of Health and Human Services by transforming

the Director into an Assistant Secretary for Indian Health. This is

Senator McCain’s bill. And S. 285 is a bill that I have introduced

for three Congresses in a row now to integrate existing alcohol,

drug and mental health programs. Efforts to consolidate disparate

Federal grant programs have been embraced by the tribes in the

past, and have proven successful, such as the employment and

training program known as the 477 program. With S. 285, we are

trying to achieve the same kind of success with alcohol, drug and

mental health programs.

[Text of S. 285, S. 555, and S. 558 Follow:]
2

1

II

108TH CONGRESS

1ST SESSION 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.

IN THE SENATE OF THE UNITED STATES

FEBRUARY 4, 2003

Mr. CAMPBELL introduced the following bill; which was read twice and

referred to the Committee on Indian Affairs

A BILL

To authorize the integration and consolidation of alcohol

and substance abuse programs and services provided by

Indian tribal governments, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Native American Alco5 hol and Substance Abuse Program Consolidation Act of

6 2003’’.

7 SEC. 2. PURPOSES.

8 The purposes of this Act are—
3

2

•S 285 IS

1 (1) to enable Indian tribes to consolidate and

2 integrate alcohol and other substance abuse preven3 tion, diagnosis, and treatment programs, and mental

4 health and related programs, to provide unified and

5 more effective and efficient services to Indians af6 flicted with mental health, alcohol, or other sub7 stance abuse problems;

8 (2) to recognize that Indian tribes can best de9 termine the goals and methods for establishing and

10 implementing prevention, diagnosis, and treatment

11 programs for their communities, consistent with the

12 policy of self-determination;

13 (3) to encourage and facilitate the implementa14 tion of an automated clinical information system to

15 complement the Indian health care delivery system;

16 (4) to authorize the use of Federal funds to

17 purchase, lease, license, or provide training for tech18 nology for an automated clinical information system

19 that incorporates clinical, financial, and reporting

20 capabilities for Indian behavioral health care pro21 grams;

22 (5) to encourage quality assurance policies and

23 procedures, and empower Indian tribes through

24 training and use of technology, to significantly en-
4

3

•S 285 IS

1 hance the delivery of, and treatment results from,

2 Indian behavioral health care programs;

3 (6) to assist Indian tribes in maximizing use of

4 public, tribal, human, and financial resources in de5 veloping effective, understandable, and meaningful

6 practices under Indian behavioral health care pro7 grams; and

8 (7) to encourage and facilitate timely and effec9 tive analysis and evaluation of Indian behavioral

10 health care programs.

11 SEC. 3. DEFINITIONS.

12 In this Act:

13 (1) AUTOMATED CLINICAL INFORMATION SYS14 TEM.—The term ‘‘automated clinical information

15 system’’ means an automated computer software

16 system that can be used to manage clinical, finan17 cial, and reporting information for Indian behavioral

18 health care programs.

19 (2) FEDERAL AGENCY.—The term ‘‘Federal

20 agency’’ has the meaning given the term ‘‘agency’’

21 in section 551 of title 5, United States Code.

22 (3) INDIAN.—The term ‘‘Indian’’ has the mean23 ing given the term in section 4 of the Indian Self24 Determination and Education Assistance Act (25

25 U.S.C. 450b).
5

4

•S 285 IS

1 (4) INDIAN BEHAVIORAL HEALTH CARE PRO2 GRAM.—The term ‘‘Indian behavioral health care

3 program’’ means a federally funded program, for the

4 benefit of Indians, to prevent, diagnose, or treat, or

5 enhance the ability to prevent, diagnose, or treat—

6 (A) mental health problems; or

7 (B) alcohol or other substance abuse prob8 lems.

9 (5) INDIAN TRIBE.—

10 (A) IN GENERAL.—The term ‘‘Indian

11 tribe’’ has the meaning given the term in sec12 tion 4 of the Indian Self Determination and

13 Education Assistance Act (25 U.S.C. 450b).

14 (B) INCLUSIONS.—The term ‘‘Indian

15 tribe’’, in a case in which an intertribal consor16 tium, tribal organization, or Indian health cen17 ter is authorized to carry out 1 or more pro18 grams, services, functions, or activities of an In19 dian tribe under this Act, includes the inter20 tribal consortium, tribal organization, or Indian

21 health center.

22 (6) SECRETARY.—The term ‘‘Secretary’’ means

23 the Secretary of Health and Human Services.

24 (7) SUBSTANCE ABUSE.—The term ‘‘substance

25 abuse’’ includes—
6

5

•S 285 IS

1 (A) the illegal use or abuse of a drug or

2 an inhalant; and

3 (B) the abuse of tobacco or a related prod4 uct.

5 SEC. 4. PLANS.

6 The Secretary, in cooperation with the Secretary of

7 Labor, the Secretary of the Interior, the Secretary of Edu8 cation, the Secretary of Housing and Urban Development,

9 the Attorney General, and the Secretary of Transpor10 tation, as appropriate, shall, on receipt of a plan accept11 able to the Secretary that is submitted by an Indian tribe,

12 authorize the Indian tribe to carry out a demonstration

13 project to coordinate, in accordance with the plan, the In14 dian behavioral health care programs of the Indian tribe

15 in a manner that integrates the program services into a

16 single, coordinated, comprehensive program that uses, to

17 the extent necessary, an automated clinical information

18 system to better manage administrative and clinical serv19 ices, costs, and reporting requirements through the con20 solidation and integration of administrative and clinical

21 functions.

22 SEC. 5. PROGRAMS AFFECTED.

23 Programs that may be integrated in a demonstration

24 project described in section 4 are—
7

6

•S 285 IS

1 (1) an Indian behavioral health care program

2 under which an Indian tribe is eligible for the receipt

3 of funds under a statutory or administrative for4 mula;

5 (2) an Indian behavioral health care program

6 under which an Indian tribe is eligible for receipt of

7 funds through competitive or other grants, if—

8 (A)(i) the Indian tribe provides notice to

9 the appropriate agency regarding the intentions

10 of the Indian tribe to include the Indian behav11 ioral health care program in the plan that the

12 Indian tribe submits to the Secretary; and

13 (ii) the agency consents to the inclusion of

14 the grant in the plan; or

15 (B)(i) the Indian tribe elects to include the

16 Indian behavioral health care program in the

17 plan; and

18 (ii) the administrative requirements con19 tained in the plan are essentially the same as

20 the administrative requirements applicable to a

21 grant under the Indian behavioral health care

22 program; and

23 (3) an Indian behavioral health care program

24 under which an Indian tribe is eligible to receive

25 funds under any other funding scheme.
8

7

•S 285 IS

1 SEC. 6. PLAN REQUIREMENTS.

2 A plan of an Indian tribe submitted under section 4

3 shall—

4 (1) identify the programs to be integrated;

5 (2) be consistent with this Act;

6 (3) describe a comprehensive strategy that—

7 (A) identifies the full range of existing and

8 potential alcohol and substance abuse and men9 tal health treatment and prevention programs

10 available on and near the service area of the In11 dian tribe; and

12 (B) may include site and technology as13 sessments and any necessary computer hard14 ware installation and support;

15 (4) describe the manner in which services are to

16 be integrated and delivered and the results expected

17 under the plan (including, if implemented, the man18 ner and expected results of implementation of an

19 automated clinical information system);

20 (5) identify the projected expenditures under

21 the plan in a single budget;

22 (6) identify the agency or agencies in the In23 dian tribe to be involved in the delivery of the serv24 ices integrated under the plan;

25 (7) identify any statutory provisions, regula26 tions, policies, or procedures that the Indian tribe
9

8

•S 285 IS

1 requests be waived in order to implement the plan;

2 and

3 (8) be approved by the governing body of the

4 Indian tribe.

5 SEC. 7. PLAN REVIEW.

6 (a) CONSULTATION.—On receipt of a plan from an

7 Indian tribe under section 4, the Secretary shall consult

8 with—

9 (1) the head of each Federal agency providing

10 funds to be used to implement the plan; and

11 (2) the Indian tribe.

12 (b) IDENTIFICATION OF WAIVERS.—Each party con13 sulting on the implementation of a plan under section 4

14 shall identify any waivers of statutory requirements or of

15 Federal agency regulations, policies, or procedures that

16 the party determines to be necessary to enable the Indian

17 tribe to implement the plan.

18 (c) WAIVERS.—Notwithstanding any other provision

19 of law, the head of a Federal agency may waive any statu20 tory requirement, regulation, policy, or procedure promul21 gated by the Federal agency is identified by the Indian

22 tribe or the Federal agency under subsection (b) unless

23 the head of the affected Federal agency determines that

24 a waiver is inconsistent with—

25 (1) this Act;
10

9

•S 285 IS

1 (2) any statutory requirement applicable to the

2 program to be integrated under the plan that is spe3 cifically applicable to Indian programs; and

4 (3) any underlying statutory objective or pur5 pose of a program to be consolidated under the plan,

6 to such a degree as would render ineffectual activi7 ties funded under the program.

8 SEC. 8. PLAN APPROVAL.

9 (a) IN GENERAL.—Not later than 90 days after the

10 date of receipt by the Secretary of a plan under section

11 4, the Secretary shall inform the Indian tribe that submit12 ted the plan, in writing, of the approval or disapproval

13 of the plan (including any request for a waiver that is

14 made as part of the plan).

15 (b) DISAPPROVAL.—

16 (1) IN GENERAL.—The Secretary may dis17 approve a plan if—

18 (A) the plan does not provide sufficient in19 formation for the Secretary to adequately re20 view the plan for compliance with this Act;

21 (B) the plan does not comply with this

22 Act;

23 (C) the plan provides for the purchase,

24 lease, license, or training for, an automated

25 clinical information system, but the purchase,
11

10

•S 285 IS

1 lease, license, or training would require aggre2 gate expenditures of program funding at such a

3 level as would render other program substan4 tially ineffectual; or

5 (D)(i) the plan identifies waivers that can6 not be waived under section 7(c); and

7 (ii) the plan would be rendered substan8 tially ineffectual without the waivers.

9 (2) NOTICE.—If a plan is disapproved under

10 subsection (a), the Secretary shall—

11 (A) inform the Indian tribe, in writing, of

12 the reasons for the disapproval; and

13 (B) provide the Indian tribe an

14 opportunity—

15 (i) to amend and resubmit the plan;

16 or

17 (ii) to petition the Secretary to recon18 sider the disapproval (including reconsider19 ing the disapproval of any waiver requested

20 by the Indian tribe).

21 SEC. 9. USE OF FUNDS FOR TECHNOLOGY.

22 Notwithstanding any requirement applicable to an In23 dian behavioral health care program of an Indian tribe

24 that is integrated under a demonstration project described

25 in section 4, the Indian tribe may use funds made avail-
12

11

•S 285 IS

1 able under the program to purchase, lease, license, or pro2 vide training for technology for an automated clinical in3 formation system if the purchase, lease, licensing of, or

4 provision of training is conducted in accordance with a

5 plan approved by the Secretary under section 8.

6 SEC. 10. FEDERAL RESPONSIBILITIES.

7 (a) RESPONSIBILITIES OF THE INDIAN HEALTH

8 SERVICE.—

9 (1) MEMORANDUM OF UNDERSTANDING.—Not

10 later than 180 days after the date of enactment of

11 this Act, the Secretary, the Secretary of the Interior,

12 the Secretary of Labor, the Secretary of Education,

13 the Secretary of Housing and Urban Development,

14 the Attorney General, and the Secretary of Trans15 portation shall enter into a memorandum of agree16 ment providing for the implementation of the plans

17 approved under section 8.

18 (2) LEAD AGENCY.—The lead agency under

19 this Act shall be the Indian Health Service.

20 (3) RESPONSIBILITIES.—The responsibilities of

21 the lead agency under this Act shall include—

22 (A) the development of a single reporting

23 format—

24 (i) relating to each plan for a dem25 onstration project submitted under section
13

12

•S 285 IS

1 4, which shall be used by an Indian tribe

2 to report activities carried out under the

3 plan; and

4 (ii) relating to the projected expendi5 tures for the individual plan, which shall

6 be used by an Indian tribe to report all

7 plan expenditures;

8 (B) the development of a single system of

9 Federal oversight for the plan, which shall be

10 implemented by the lead agency;

11 (C) the provision of, or arrangement for

12 provision of, technical assistance to an Indian

13 tribe that is appropriate to support and imple14 ment the plan, delivered under an arrangement

15 subject to the approval of the Indian tribe par16 ticipating in the project (except that an Indian

17 tribe shall have the authority to accept or reject

18 the plan for providing the technical assistance

19 and the technical assistance provider); and

20 (D) the convening by an appropriate offi21 cial of the lead agency (who shall be an official

22 appointed by and with the advice and consent

23 of the Senate) and a representative of the In24 dian tribes that carry out projects under this

25 Act, in consultation with each of the Indian
14

13

•S 285 IS

1 tribes that participate in projects under this

2 Act, of a meeting at least twice during each fis3 cal year, for the purpose of providing an oppor4 tunity for all Indian tribes that carry out

5 projects under this Act to discuss issues relat6 ing to the implementation of this Act with offi7 cials of each agency specified in paragraph (1).

8 (b) REPORT REQUIREMENTS.—

9 (1) IN GENERAL.—The single reporting formats

10 described in subsection (a)(3)(A) shall be developed

11 by the Secretary in accordance with this Act.

12 (2) INFORMATION.—The single reporting for13 mat, together with records maintained on the con14 solidated program at the tribal level, shall contain

15 such information as the Secretary determines will—

16 (A) allow the Secretary to determine

17 whether the Indian tribe has complied with the

18 requirements incorporated in the approved plan

19 of the Indian tribe; and

20 (B) provide assurances to the Secretary

21 that the Indian tribe has complied with all—

22 (i) applicable statutory requirements;

23 and

24 (ii) applicable regulatory requirements

25 that have not been waived.
15

14

•S 285 IS

1 SEC. 11. NO REDUCTION IN AMOUNTS.

2 In no case shall the amount of Federal funds avail3 able to an Indian tribe involved in any project under this

4 Act be reduced as a result of the enactment of this Act.

5 SEC. 12. INTERAGENCY FUND TRANSFERS.

6 The Secretary, the Secretary of the Interior, the Sec7 retary of Labor, the Secretary of Education, the Secretary

8 of Housing and Urban Development, the Attorney Gen9 eral, or the Secretary of Transportation, as appropriate,

10 may take such action as is necessary to provide for the

11 interagency transfer of funds otherwise available to an In12 dian tribe in order to carry out this Act.

13 SEC. 13. ADMINISTRATION OF FUNDS; EXCESS FUNDS.

14 (a) ADMINISTRATION OF FUNDS.—

15 (1) IN GENERAL.—Program funds shall be ad16 ministered under this Act in such a manner as to

17 allow for a determination by the Secretary that

18 funds made available for specific programs (or an

19 amount equal to the amount used from each pro20 gram) are expended on activities authorized under

21 the program.

22 (2) SEPARATE RECORDS NOT REQUIRED.—

23 Nothing in this section requires an Indian tribe—

24 (A) to maintain separate records tracing

25 any service provided or activity conducted under

26 the approved plan of the Indian tribe to the in-
16

15

•S 285 IS

1 dividual programs under which funds were au2 thorized; or

3 (B) to allocate expenditures among individ4 ual programs.

5 (b) EXCESS FUNDS.—With respect to administrative

6 costs of carrying out the approved plan of an Indian tribe

7 under this Act—

8 (1) all administrative costs under the approved

9 plan may be commingled;

10 (2) an Indian tribe that carries out a dem11 onstration program under such an approved plan

12 shall be entitled to receive reimbursement for the

13 full amount of those costs in accordance with regula14 tions of each program or department; and

15 (3) if the Indian tribe, after paying administra16 tive costs associated with carrying out the approved

17 plans, realizes excess administrative funds, those

18 funds shall not be counted for Federal audit pur19 poses if the excess funds are used for the purposes

20 provided for under this Act.

21 SEC. 14. FISCAL ACCOUNTABILITY.

22 Nothing in this Act affects the authority of the Sec23 retary or the lead agency to safeguard Federal funds in

24 accordance with chapter 75 of title 31, United States

25 Code.
17

16

•S 285 IS

1 SEC. 15. REPORT ON STATUTORY AND OTHER BARRIERS TO

2 INTEGRATION.

3 (a) PRELIMINARY REPORT.—Not later than 2 years

4 after the date of enactment of this Act, the Secretary shall

5 submit to the Committee on Indian Affairs of the Senate

6 and the Committee on Resources of the House of Rep7 resentatives a preliminary report that describes the imple8 mentation of this Act.

9 (b) FINAL REPORT.—Not later than 5 years after the

10 date of enactment of this Act, the Secretary shall submit

11 to the Committee on Indian Affairs of the Senate and the

12 Committee on Resources of the House of Representatives

13 a final report that—

14 (1) describes the results of implementation of

15 this Act; and

16 (2) identifies statutory barriers to the ability of

17 Indian tribes to integrate more effectively alcohol

18 and substance abuse services in a manner consistent

19 with this Act.

20 SEC. 15. ASSIGNMENT OF FEDERAL PERSONNEL TO STATE

21 INDIAN ALCOHOL AND DRUG TREATMENT OR

22 MENTAL HEALTH PROGRAMS.

23 Any State with an alcohol and substance abuse or

24 mental health program targeted toward Indian tribes shall

25 be eligible to receive, at no cost to the State, such Federal

26 personnel assignments as the Secretary, in accordance
18

17

•S 285 IS

1 with the applicable provisions of subchapter IV of chapter

2 33 of title 5, United States Code, determines to be appro3 priate to help ensure the success of the program.

Æ
19

1

II

108TH CONGRESS

1ST SESSION S. 555

To establish the Native American Health and Wellness Foundation, and

for other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 6, 2003

Mr. CAMPBELL (for himself and Mr. INOUYE) introduced the following bill;

which was read twice and referred to the Committee on Indian Affairs

A BILL

To establish the Native American Health and Wellness

Foundation, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Native American

5 Health and Wellness Foundation Act of 2003’’.

6 SEC. 2. NATIVE AMERICAN HEALTH AND WELLNESS FOUN7 DATION.

8 (a) IN GENERAL.—The Indian Self-Determination

9 and Education Assistance Act (25 U.S.C. 450 et seq.) is

10 amended by adding at the end the following:
20

2

•S 555 IS

1 ‘‘TITLE VIII—NATIVE AMERICAN

2 HEALTH AND WELLNESS

3 FOUNDATION

4 ‘‘SEC. 801. DEFINITIONS.

5 ‘‘In this title:

6 ‘‘(1) BOARD.—The term ‘Board’ means the

7 Board of Directors of the Foundation.

8 ‘‘(2) FOUNDATION.—The term ‘Foundation’

9 means the Native American Health and Wellness

10 Foundation established under section 802.

11 ‘‘(3) SECRETARY.—The term ‘Secretary’ means

12 the Secretary of Health and Human Services.

13 ‘‘(4) SERVICE.—The term ‘Service’ means the

14 Indian Health Service of the Department of Health

15 and Human Services.

16 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS

17 FOUNDATION.

18 ‘‘(a) IN GENERAL.—As soon as practicable after the

19 date of enactment of this title, the Secretary shall estab20 lish, under the laws of the District of Columbia and in

21 accordance with this title, the Native American Health

22 and Wellness Foundation.

23 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation

24 shall have perpetual existence.

25 ‘‘(c) NATURE OF CORPORATION.—The Foundation—
21

3

•S 555 IS

1 ‘‘(1) shall be a charitable and nonprofit feder2 ally chartered corporation; and

3 ‘‘(2) shall not be an agency or instrumentality

4 of the United States.

5 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.—

6 The Foundation shall be incorporated and domiciled in the

7 District of Columbia.

8 ‘‘(e) PURPOSES.—The purposes of the Foundation

9 shall be—

10 ‘‘(1) to encourage, accept, and administer pri11 vate gifts of real and personal property, and any in12 come from or interest in such gifts, for the benefit

13 of, or in support of, the mission of the Service;

14 ‘‘(2) to undertake and conduct such other ac15 tivities as will further the health and wellness activi16 ties and opportunities of Native Americans; and

17 ‘‘(3) to participate with and assist Federal,

18 State, and tribal governments, agencies, entities, and

19 individuals in undertaking and conducting activities

20 that will further the health and wellness activities

21 and opportunities of Native Americans.

22 ‘‘(f) BOARD OF DIRECTORS.—

23 ‘‘(1) IN GENERAL.—The Board of Directors

24 shall be the governing body of the Foundation.
22

4

•S 555 IS

1 ‘‘(2) POWERS.—The Board may exercise, or

2 provide for the exercise of, the powers of the Foun3 dation.

4 ‘‘(3) SELECTION.—

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), the number of members of the

7 Board, the manner of selection of the members

8 (including the filling of vacancies), and the

9 terms of office of the members shall be as pro10 vided in the constitution and bylaws of the

11 Foundation.

12 ‘‘(B) REQUIREMENTS.—

13 ‘‘(i) NUMBER OF MEMBERS.—The

14 Board shall have at least 11 members, 2 of

15 whom shall be the Secretary and the Di16 rector of the Indian Health Service, who

17 shall serve as nonvoting members.

18 ‘‘(ii) INITIAL VOTING MEMBERS.—The

19 initial voting members of the Board—

20 ‘‘(I) shall be appointed by the

21 Secretary not later than 180 days

22 after the date on which the Founda23 tion is established; and

24 ‘‘(II) shall have staggered terms

25 (as determined by the Secretary).
23

5

•S 555 IS

1 ‘‘(iii) QUALIFICATION.—The members

2 of the Board shall be United States citi3 zens who are knowledgeable or experienced

4 in Native American health care and related

5 matters.

6 ‘‘(C) COMPENSATION.—A member of the

7 Board shall not receive compensation for service

8 as a member, but shall be reimbursed for actual

9 and necessary travel and subsistence expenses

10 incurred in the performance of the duties of the

11 Foundation.

12 ‘‘(g) OFFICERS.—

13 ‘‘(1) IN GENERAL.—The officers of the Founda14 tion shall be—

15 ‘‘(A) a secretary, elected from among the

16 members of the Board; and

17 ‘‘(B) any other officers provided for in the

18 constitution and bylaws of the Foundation.

19 ‘‘(2) SECRETARY.—The secretary of the Foun20 dation shall serve, at the direction of the Board, as

21 the chief operating officer of the Foundation.

22 ‘‘(3) ELECTION.—The manner of election, term

23 of office, and duties of the officers of the Founda24 tion shall be as provided in the constitution and by25 laws of the Foundation.
24

6

•S 555 IS

1 ‘‘(h) POWERS.—The Foundation—

2 ‘‘(1) shall adopt a constitution and bylaws for

3 the management of the property of the Foundation

4 and the regulation of the affairs of the Foundation;

5 ‘‘(2) may adopt and alter a corporate seal;

6 ‘‘(3) may enter into contracts;

7 ‘‘(4) may acquire (through a gift or otherwise),

8 own, lease, encumber, and transfer real or personal

9 property as necessary or convenient to carry out the

10 purposes of the Foundation;

11 ‘‘(5) may sue and be sued; and

12 ‘‘(6) may perform any other act necessary and

13 proper to carry out the purposes of the Foundation.

14 ‘‘(i) PRINCIPAL OFFICE.—

15 ‘‘(1) IN GENERAL.—The principal office of the

16 Foundation shall be in the District of Columbia.

17 ‘‘(2) ACTIVITIES; OFFICES.—The activities of

18 the Foundation may be conducted, and offices may

19 be maintained, throughout the United States in ac20 cordance with the constitution and bylaws of the

21 Foundation.

22 ‘‘(j) SERVICE OF PROCESS.—The Foundation shall

23 comply with the law on service of process of each State

24 in which the Foundation is incorporated and of each State

25 in which the Foundation carries on activities.
25

7

•S 555 IS

1 ‘‘(k) LIABILITY OF OFFICERS, EMPLOYEES, AND

2 AGENTS.—

3 ‘‘(1) IN GENERAL.—The Foundation shall be

4 liable for the acts of the officers, employees, and

5 agents of the Foundation acting within the scope of

6 their authority.

7 ‘‘(2) PERSONAL LIABILITY.—A member of the

8 Board shall be personally liable only for gross neg9 ligence in the performance of the duties of the mem10 ber.

11 ‘‘(l) RESTRICTIONS.—

12 ‘‘(1) LIMITATION ON SPENDING.—Beginning

13 with the fiscal year following the first full fiscal year

14 during which the Foundation is in operation, the ad15 ministrative costs of the Foundation shall not exceed

16 10 percent of the sum of—

17 ‘‘(A) the amounts transferred to the Foun18 dation under subsection (m) during the preced19 ing fiscal year; and

20 ‘‘(B) donations received from private

21 sources during the preceding fiscal year.

22 ‘‘(2) APPOINTMENT AND HIRING.—The ap23 pointment of officers and employees of the Founda24 tion shall be subject to the availability of funds.
26

8

•S 555 IS

1 ‘‘(3) STATUS.—A member of the Board or offi2 cer, employee, or agent of the Foundation shall not

3 by reason of association with the Foundation be con4 sidered to be an officer, employee, or agent of the

5 United States.

6 ‘‘(m) TRANSFER OF DONATED FUNDS.—The Sec7 retary may transfer to the Foundation funds held by the

8 Department of Health and Human Services under the Act

9 of August 5, 1954 (42 U.S.C. 2001 et seq.) if the transfer

10 or use of the funds is not prohibited by any term under

11 which the funds were donated.

12 ‘‘(n) AUDITS.—The Foundation shall comply with

13 section 10101 of title 36, United States Code, as if the

14 Foundation were a corporation under part B of subtitle

15 II of that title.

16 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

17 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub18 ject to subsection (b), during the 5-year period beginning

19 on the date on which the Foundation is established, the

20 Secretary—

21 ‘‘(1) may provide personnel, facilities, and other

22 administrative support services to the Foundation;

23 ‘‘(2) may provide funds to reimburse the travel

24 expenses of the members of the Board; and
27

9

•S 555 IS

1 ‘‘(3) shall require and accept reimbursements

2 from the Foundation for—

3 ‘‘(A) services provided under paragraph

4 (1); and

5 ‘‘(B) funds provided under paragraph (2).

6 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted

7 under subsection (a)(3)—

8 ‘‘(1) shall be deposited in the Treasury of the

9 United States to the credit of the applicable appro10 priations account; and

11 ‘‘(2) shall be chargeable for the cost of provid12 ing services described in subsection (a)(1) and travel

13 expenses described in subsection (a)(2).

14 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The

15 Secretary may continue to provide facilities and necessary

16 support services to the Foundation after the termination

17 of the 5-year period specified in subsection (a) if the facili18 ties and services—

19 ‘‘(1) are available; and

20 ‘‘(2) are provided on reimbursable cost basis.’’.

21 (b) TECHNICAL AMENDMENTS.—The Indian Self-De22 termination and Education Assistance Act is amended—

23 (1) by redesignating title V (as added by sec24 tion 1302 of the American Indian Education Foun-
28

10

•S 555 IS

1 dation Act of 2000) (25 U.S.C. 458bbb et seq.)) as

2 title VII;

3 (2) by redesignating sections 501, 502, and 503

4 (as added by section 1302 of the American Indian

5 Education Foundation Act of 2000) as sections 701,

6 702, and 703, respectively; and

7 (3) in subsection (a)(2) of section 702 and

8 paragraph (2) of section 703 (as redesignated by

9 paragraph (2)), by striking ‘‘section 501’’ and in10 serting ‘‘section 701’’.

Æ
29

1

II

108TH CONGRESS

1ST SESSION S. 558

To elevate the position of Director of the Indian Health Service within

the Department of Health and Human Services to Assistant Secretary

for Indian Health, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 6, 2003

Mr. MCCAIN (for himself, Mr. BINGAMAN, Mr. CAMPBELL, Mrs. MURRAY, Mr.

JOHNSON, and Mr. DOMENICI) introduced the following bill; which was

read twice and referred to the Committee on Indian Affairs

A BILL

To elevate the position of Director of the Indian Health

Service within the Department of Health and Human

Services to Assistant Secretary for Indian Health, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. OFFICE OF ASSISTANT SECRETARY FOR INDIAN

4 HEALTH.

5 (a) DEFINITIONS.—In this section:

6 (1) ASSISTANT SECRETARY.—The term ‘‘Assist7 ant Secretary’’ means the Assistant Secretary for

8 Indian Health appointed under subsection (b)(2)(A).
30

2

•S 558 IS

1 (2) DEPARTMENT.—The term ‘‘Department’’

2 means the Department of Health and Human Serv3 ices.

4 (3) OFFICE.—The term ‘‘Office’’ means the Of5 fice of the Assistant Secretary for Indian Health es6 tablished by subsection (b)(1).

7 (4) SECRETARY.—The term ‘‘Secretary’’ means

8 the Secretary of Health and Human Services.

9 (b) ESTABLISHMENT.—

10 (1) IN GENERAL.—There is established within

11 the Department the Office of the Assistant Sec12 retary for Indian Health.

13 (2) ASSISTANT SECRETARY.—

14 (A) IN GENERAL.—Except as provided in

15 subparagraph (B), the Office shall be headed by

16 an Assistant Secretary for Indian Health, to be

17 appointed by the President, by and with the ad18 vice and consent of the Senate.

19 (B) CONTINUED SERVICE BY INCUM20 BENT.—The individual serving in the position

21 of Director of the Indian Health Service on the

22 day before the date of enactment of this Act

23 may serve as Assistant Secretary at the pleas24 ure of the President after the date of enactment

25 of this Act.
31

3

•S 558 IS

1 (3) DUTIES.—The position of Assistant Sec2 retary is established to, in a manner consistent with

3 the government-to-government relationship between

4 the United States and Indian tribes—

5 (A) facilitate advocacy for the development

6 of appropriate Indian health policy; and

7 (B) promote consultation on matters relat8 ing to Indian health.

9 (c) ASSISTANT SECRETARY FOR INDIAN HEALTH.—

10 In addition to the functions performed as of the date of

11 enactment of this Act by the Director of the Indian Health

12 Service, the Assistant Secretary shall—

13 (1) report directly to the Secretary concerning

14 all policy- and budget-related matters affecting In15 dian health;

16 (2) collaborate with the Assistant Secretary for

17 Health concerning appropriate matters of Indian

18 health that affect the agencies of the Public Health

19 Service;

20 (3) advise each Assistant Secretary of the De21 partment concerning matters of Indian health with

22 respect to which that Assistant Secretary has au23 thority and responsibility;

24 (4) advise the heads of other agencies and pro25 grams of the Department concerning matters of In-
32

4

•S 558 IS

1 dian health with respect to which those heads have

2 authority and responsibility;

3 (5) coordinate the activities of the Department

4 concerning matters of Indian health; and

5 (6) perform such other functions as the Sec6 retary may designate.

7 (d) RATE OF PAY.—

8 (1) POSITIONS AT LEVEL IV.—Section 5315 of

9 title 5, United States Code, is amended by striking

10 ‘‘Assistant Secretaries of Health and Human Serv11 ices (6).’’ and inserting ‘‘Assistant Secretaries of

12 Health and Human Services (7).’’.

13 (2) POSITIONS AT LEVEL V.—Section 5316 of

14 title 5, United States Code, is amended by striking

15 ‘‘Director, Indian Health Service, Department of

16 Health and Human Services.’’.

17 (e) DUTIES OF ASSISTANT SECRETARY FOR INDIAN

18 HEALTH.—Section 601 of the Indian Health Care Im19 provement Act (25 U.S.C. 1661) is amended by striking

20 the section heading and all that follows through subsection

21 (a) and inserting the following:

22 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV23 ICE AS AN AGENCY OF THE PUBLIC HEALTH

24 SERVICE.

25 ‘‘(a) ESTABLISHMENT.—
33

5

•S 558 IS

1 ‘‘(1) IN GENERAL.—In order to more effectively

2 and efficiently carry out the responsibilities, authori3 ties, and functions of the United States to provide

4 health care services to Indians and Indian tribes,

5 there is established within the Public Health Service

6 of the Department of Health and Human Services

7 the Indian Health Service.

8 ‘‘(2) ADMINISTRATION.—The Indian Health

9 Service shall be administered by the Assistant Sec10 retary for Indian Health.

11 ‘‘(3) DUTIES.—In carrying out paragraph (2),

12 the Assistant Secretary shall—

13 ‘‘(A) report directly to the Secretary con14 cerning all policy- and budget-related matters

15 affecting Indian health;

16 ‘‘(B) collaborate with the Assistant Sec17 retary for Health concerning appropriate mat18 ters of Indian health that affect the agencies of

19 the Public Health Service;

20 ‘‘(C) advise each Assistant Secretary of the

21 Department of Health and Human Services

22 concerning matters of Indian health with re23 spect to which that Assistant Secretary has au24 thority and responsibility;
34

6

•S 558 IS

1 ‘‘(D) advise the heads of other agencies

2 and programs of the Department of Health and

3 Human Services concerning matters of Indian

4 health with respect to which those heads have

5 authority and responsibility;

6 ‘‘(E) coordinate the activities of the De7 partment of Health and Human Services con8 cerning matters of Indian health; and

9 ‘‘(F) perform such other functions as the

10 Secretary may designate.’’.

11 (f) CONFORMING AMENDMENTS.—

12 (1) AMENDMENTS TO INDIAN HEALTH CARE IM13 PROVEMENT ACT.—The Indian Health Care Im14 provement Act is amended—

15 (A) in section 601 (25 U.S.C. 1661)—

16 (i) in subsection (c), by striking ‘‘Di17 rector of the Indian Health Service’’ each

18 place it appears and inserting ‘‘Assistant

19 Secretary for Indian Health’’; and

20 (ii) in subsection (d)(1), by striking

21 ‘‘Director of the Indian Health Service’’

22 and inserting ‘‘Assistant Secretary for In23 dian Health’’; and

24 (B) in section 816(c)(1) (25 U.S.C.

25 1680f(c)(1)), by striking ‘‘Director of the In-
35

7

•S 558 IS

1 dian Health Service’’ and inserting ‘‘Assistant

2 Secretary for Indian Health’’.

3 (2) AMENDMENTS TO OTHER PROVISIONS OF

4 LAW.—

5 (A) Section 3307(b)(1)(C) of the Chil6 dren’s Health Act of 2000 (25 U.S.C. 1671

7 note; Public Law 106–310) is amended by

8 striking ‘‘Director of the Indian Health Serv9 ice’’ and inserting ‘‘Assistant Secretary for In10 dian Health’’.

11 (B) The Indian Lands Open Dump Clean12 up Act of 1994 is amended—

13 (i) in section 3 (25 U.S.C. 3902)—

14 (I) by striking paragraph (2);

15 (II) by redesignating paragraphs

16 (1), (3), (4), (5), and (6) as para17 graphs (4), (5), (2), (6), and (1), re18 spectively, and moving those para19 graphs so as to appear in numerical

20 order; and

21 (III) by inserting before para22 graph (4) (as redesignated by sub23 clause (II)) the following:
36

8

•S 558 IS

1 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As2 sistant Secretary’ means the Assistant Secretary for

3 Indian Health.’’;

4 (ii) in section 5 (25 U.S.C. 3904), by

5 striking the section heading and inserting

6 the following:

7 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN8 DIAN HEALTH.’’;

9 (iii) in section 6(a) (25 U.S.C.

10 3905(a)), in the subsection heading, by

11 striking ‘‘DIRECTOR’’ and inserting ‘‘AS12 SISTANT SECRETARY’’;

13 (iv) in section 9(a) (25 U.S.C.

14 3908(a)), in the subsection heading, by

15 striking ‘‘DIRECTOR’’ and inserting ‘‘AS16 SISTANT SECRETARY’’; and

17 (v) by striking ‘‘Director’’ each place

18 it appears and inserting ‘‘Assistant Sec19 retary’’.

20 (C) Section 5504(d)(2) of the Augustus F.

21 Hawkins–Robert T. Stafford Elementary and

22 Secondary School Improvement Amendments of

23 1988 (25 U.S.C. 2001 note; Public Law 100–

24 297) is amended by striking ‘‘Director of the
37

9

•S 558 IS

1 Indian Health Service’’ and inserting ‘‘Assist2 ant Secretary for Indian Health’’.

3 (D) Section 203(a)(1) of the Rehabilitation

4 Act of 1973 (29 U.S.C. 763(a)(1)) is amended

5 by striking ‘‘Director of the Indian Health

6 Service’’ and inserting ‘‘Assistant Secretary for

7 Indian Health’’.

8 (E) Subsections (b) and (e) of section 518

9 of the Federal Water Pollution Control Act (33

10 U.S.C. 1377) are amended by striking ‘‘Direc11 tor of the Indian Health Service’’ each place it

12 appears and inserting ‘‘Assistant Secretary for

13 Indian Health’’.

14 (F) Section 317M(b) of the Public Health

15 Service Act (42 U.S.C. 247b–14(b)) is

16 amended—

17 (i) by striking ‘‘Director of the Indian

18 Health Service’’ each place it appears and

19 inserting ‘‘Assistant Secretary for Indian

20 Health’’; and

21 (ii) in paragraph (2)(A), by striking

22 ‘‘the Directors referred to in such para23 graph’’ and inserting ‘‘the Director of the

24 Centers for Disease Control and Preven-
38

10

•S 558 IS

1 tion and the Assistant Secretary for Indian

2 Health’’.

3 (G) Section 417C(b) of the Public Health

4 Service Act (42 U.S.C. 285–9(b)) is amended

5 by striking ‘‘Director of the Indian Health

6 Service’’ and inserting ‘‘Assistant Secretary for

7 Indian Health’’.

8 (H) Section 1452(i) of the Safe Drinking

9 Water Act (42 U.S.C. 300j–12(i)) is amended

10 by striking ‘‘Director of the Indian Health

11 Service’’ each place it appears and inserting

12 ‘‘Assistant Secretary for Indian Health’’.

13 (I) Section 803B(d)(1) of the Native

14 American Programs Act of 1974 (42 U.S.C.

15 2991b–2(d)(1)) is amended in the last sentence

16 by striking ‘‘Director of the Indian Health

17 Service’’ and inserting ‘‘Assistant Secretary for

18 Indian Health’’.

19 (J) Section 203(b) of the Michigan Indian

20 Land Claims Settlement Act (Public Law 105–

21 143; 111 Stat. 2666) is amended by striking

22 ‘‘Director of the Indian Health Service’’ and in23 serting ‘‘Assistant Secretary for Indian

24 Health’’.
39

11

•S 558 IS

1 (g) REFERENCES.—Any reference to the Director of

2 the Indian Health Service in any other Federal law, Exec3 utive order, rule, regulation, or delegation of authority, or

4 in any document of or relating to the Director of the In5 dian Health Service, shall be deemed to refer to the Assist6 ant Secretary.

Æ
40

The CHAIRMAN. I am somewhat disappointed with the past opposition from the Department of Health and Human Services to this

type of legislation. I hope that we will be able to work out our differences. The Department has expended a good deal of energy promoting its One-HHS proposal, which would restructure and consolidate functions within the Department of Health and Human Services to be more citizen-centered and results-oriented. That is the

very concept that I think is the foundation of S. 285, yet the Department of Health and Human Services has neither supported

past versions of the bill or has offered helpful suggestions as to

how we could improve it so that they could support it.

Senator Inouye and I and other members have worked very hard

to increase the resources for Indian health, and it is simply unacceptable to me that the inconvenience of the DHHS has not given

them the impetus they need to support it or help us move this bill

forward.

We will start with our first panel, which is only Dr. William

Raub, the acting assistant secretary for Planning and Evaluation

for the Department of Health and Human Services. He will be accompanied by Michel Lincoln and Rich Kopanda.

If you would just go ahead and set up there, Dr. Raub, we will

start with you. Your complete testimony will be included in the

record. If you would like to abbreviate, please feel free to do so.

Thank you for appearing.

STATEMENT OF WILLIAM RAUB, ACTING ASSISTANT SECRETARY FOR PLANNING AND EVALUATION, DEPARTMENT

OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY

MICHEL LINCOLN, DEPUTY DIRECTOR, INDIAN HEALTH

SERVICE; RICHARD KOPANDA, EXECUTIVE DIRECTOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, ROCKVILLE, MD

Mr. RAUB. Thank you, Mr. Chairman. I appreciate the opportunity to appear before you this morning. Mr. Kopanda is with me.

We have learned that Mr. Lincoln is en route, caught in one of

Washington’s infamous traffic jams. With your permission, I will

have him join us as he arrives.

The CHAIRMAN. Absolutely. Sure.

Mr. RAUB. I will submit my full statement for the record and just

make some brief comments now, as you have suggested, Mr. Chairman.

The CHAIRMAN. That will be fine.

Mr. RAUB. First, with respect to S. 285, S. 285 would permit an

Indian tribe to carryout a demonstration project according to a plan

approved by the Secretary to consolidate grants for substance

abuse and mental health programs into a single comprehensive

program for purposes of providing improved services, facilitating

implementation of an automated clinical information system, encouraging technology-based quality assurance activities, and facilitating evaluation of these programs. The Department supports the

principle that Indian tribes know best how to meet the needs of

their members. We have no objection to allowing tribes to consolidate programs addressing substance abuse and mental health prob-
41

lems where appropriate, consistent with the purposes of the underlying programs and in order to achieve administrative efficiencies.

However, the Department has concerns with several provisions of

S. 285 and thus cannot support it as currently drafted. I will summarize these concerns now. My prepared statement contains more

extensive comments.

No. 1, the bill does not delineate clearly the programs that would

be subject to consolidation under the proposed authority. Nor does

the bill delineate the permissible uses of the consolidated funds.

No. 2, the bill is ambiguous with respect to how the grant consolidation authority applies to competitive grant programs.

No. 3, the bill does not require that its authorized waivers of

statutory or regulatory provisions be consistent with the statutory

objectives of the grants proposed for consolidation. Prudent stewardship demands that such consistency be considered when assessing the appropriateness of a waiver.

No. 4, the 90-day timetable for review of proposed grant consolidations is likely to be insufficient in most cases, given that a consolidation plan could involve up to seven separate Cabinet-level

agencies and multiple components of several of them.

No. 5, responsibility for leading the implementation of this Act

should be vested in the Secretary of Health and Human Services,

not the Director of the Indian Health Service.

No. 6, the bill does not limit the amount of grant funds that

could be used for administrative overhead and information technology.

No. 7, the bill is not sufficiently specific as to the extent to which

consolidated funds may be used for an automated clinical information system that serves not only the behavioral health program, as

defined in the bill, but also the entire Indian health care delivery

system.

No. 8, the bill creates an unfunded mandate by shifting responsibilities for oversight of all consolidated programs to the Department, without making provision for transferring the corresponding

administrative resources from the affected agencies.

Notwithstanding these comments, Mr. Chairman, we endorse the

concept behind S. 285 and are prepared to work with the committee to address our concerns.

With respect to S. 558, we note that it elevates the director of

the Indian Health Service to assistant secretary for Indian Health.

We believe this action is unnecessary. The director of the Indian

Health Service enjoys direct access to the secretary on all health

services issues impacting tribes and tribal organizations. Moreover,

the director serves as vice chair of the secretary’s Intra-departmental Council for Native American Affairs and thus has a leadership role toward ensuring that Native American policy is implemented across all agencies and offices of the Department including

human services programs.

With respect to S. 555, we note that the bill authorizes the Secretary of Health and Human Services to establish a foundation

through which private sector partnerships with the Federal Government could work to improve the health status of American Indians and Alaska Natives. This legislation is under review within the

executive branch.
42

Thank you for the opportunity to appear today, Mr. Chairman.

I will be pleased to respond as best I can to your questions.

[Prepared statement of Dr. Raub appears in appendix.]

The CHAIRMAN. Okay. Thank you, Dr. Raub.

First of all, you listed about eight reasons that you do not like

the bill. I did not hear one, except a very general kind of a concept,

about what you do like about it. So what I want you to do is not

tell the committee so much about what is wrong with it. I want you

to tell us how to fix it. I want you to submit some language that

you think the Department can live with that we can try and integrate with the existing language.

Mr. RAUB. We would be pleased to do that, sir. As you have indicated, there have been successes in a comparable activity under the

477 authority. The problem and the opportunity for consolidation

is often a general issue, not only with the Indian tribes, but with

many entities of local government. So it is a concept of interest to

the Department, and one of particular interest to the Secretary. So

we would be pleased to work with the staff in addressing the aspects of the bill that cause concern.

The CHAIRMAN. I appreciate that.

You stated the strong objection to the IHS as the lead agency.

You object, as I understand it, to the bill to elevate the IHS Director in S. 558 on the grounds that the IHS is already the principal

point within the DHHS for Indian health. But at the same time,

you object to the IHS as the lead agency for the purposes of alcohol

and drug integration because, in your view, the Secretary and

SAMHSA are the main agencies for substance abuse. Is there some

disparity in your belief between those two?

Mr. RAUB. I do not believe so, sir. I think what we are saying

is the Secretary, as the responsible official for the management of

the Department, would wish to have vested in him the overall authorities. He would use those authorities to involve systematically

not only the Administrator of SAMHSA but also the Director of the

Indian Health Service and other agency heads as appropriate in

addressing issues related to American Indians and Alaska Natives.

The CHAIRMAN. I see.

And also, as I understand your testimony, although I did not

hear you say it specifically, but as I understand your testimony,

you ‘‘expect that the States will address’’ mental health and substance abuse needs for Indians and Native Alaskans living within

the borders of States. It has been my experience that they do not;

that an awful lot of Indian people simply fall through the cracks.

They do not get their needs addressed. Do you have some statistics

that you can provide for the committee that indicates the States

are providing this service?

Mr. RAUB. We would be glad to follow up on that question, Mr.

Chairman. The reference in the statement was to the statutory provisions on those programs in SAMHSA that focus the awards at

the State and look to the State to involve the tribes in funding and

their integration with the State programs, but we can followup for

the record.

The CHAIRMAN. Well, they should. Sometimes what happens,

though is that when Indians go to a general health clinic, they are

told that they need to go to their reservation and get it through the
43

Indian Health Service, which is sometimes 1,000 miles away. That

is a little difficult to do. So sometimes they just sort of give up and

stay sick and do not have their needs met.

So it seems to me that sometimes there might be some kind of

a disparity with what you are saying and what is actually happening out there. So if you could—if there is any indication that you

have that is solid, black and white information that we do not

know that they are providing it, I would like to have that and I

am sure the other committee members would, too.

On the elevation bill, I think Secretary Thompson, who I have

known ever since he was a Governor, and he is a very, very fine

man, and doing his very best, but sometimes the intentions of one

Secretary cannot determine what the intentions of a future Secretary are going to be. I worry that we will end up—sometime in

the future we may see the IHS Director relegated back to a secondtier position. I know that Senator McCain is concerned about that.

That is why he introduced that elevation bill. Would you like to

give us your profound wisdom on that?

Mr. RAUB. I doubt that I have profound wisdom about either the

present or the future, Mr. Chairman, but I would say that the Secretary, as you indicated, is strongly committed to involving all the

components of the Department with respect to Indian Affairs activities. He believes with his own leadership, that of the Deputy

Secretary, the creation of the Intradepartmental Council, and the

leadership involvement of the Director of the Indian Health Service

in that, that he has actually gone beyond that which is implied by

a title change with respect to the Director of the Indian Health

Service.

On the other hand, I am sure the Secretary will be attentive to

the strong feelings of the members of the Congress with respect to

that issue. He is always amenable to considering that.

The CHAIRMAN. You may not want to answer this, but have you

noticed any of what can commonly be described as ‘‘turf problems’’

with other agencies not wanting it to encroach on their areas of

substance abuse?

Mr. RAUB. Sir, I have not.

Richard.

The CHAIRMAN. Yes; identify yourself for the record before you

speak.

Mr. KOPANDA. Richard Kopanda from SAMHSA, Executive Officer.

We have not noticed that either in SAMHSA.

The CHAIRMAN. Would you like to tell Senator McCain that this

is probably not a necessary bill? [Laughter.]

I should not even ask you that. I know Senator McCain really

well—a very determined man. I thought I would just pass that on

to you.

We have some additional questions for you and for IHS, too. I

think those I will probably submit in writing to you, Dr. Raub, if

that is all right with you. I am not sure if anyone else will be showing up. As you might guess, it is pretty hectic around here. Many

of us are trying to cover two committees at the same time.
44

With that, I do appreciate your being here, and when you get

questions in the record from Senator Inouye or other members, if

you would answer them in writing, I would certainly appreciate it.

Mr. RAUB. Thank you, sir. We will.

The CHAIRMAN. Thank you.

We will now go to the second panel, which would be Julia DavisWheeler from the National Indian Health Board; and Hoskie

Benally, the CEO of Our Youth, Our Future, Incorporated in Farmington.

We will go ahead, Ms. Davis-Wheeler. Nice to see you here again.

What—twice now in 2 weeks or 3 weeks?

Ms. DAVIS-WHEELER. Yes; 2 weeks.

The CHAIRMAN. Very happy to see you here. Go ahead.

STATEMENT OF JULIA DAVIS-WHEELER, CHAIR, NATIONAL

INDIAN HEALTH BOARD

Ms. DAVIS-WHEELER. Good morning everyone. It is a pleasure to

be here. As stated for the record, my name is Julia Davis-Wheeler

and I am chairperson of the National Indian Health Board. I also

serve as Secretary for the Nez Perce Tribe Council in Idaho. On behalf of the National Indian Health Board, it is a great pleasure to

be here to offer testimony regarding this health-related legislation.

At NIHB, we serve all the Federal-recognized American Indians

and Alaska Natives tribal governments in advocating for health

care delivery to all of our people at home. We strive to advance the

level of health care and the adequacy of funding for health services

that are operated by Indian Health Service programs, operated directly by tribal governments and other programs.

We have Board members that represent the 12 areas of IHS and

are elected at-large by their respective tribal government officials

within their region. We continue to work diligently to address the

health disparities that continue to plague Indian country. There

are several legislative items that have been introduced during the

108th Congress that would help us improve the health status of

American Indians and Alaska Natives.

The first one I would like to speak about is the Indian Health

Service Director elevation to Assistant Secretary of Indian Health.

Before I begin discussing S. 558, I would like to say a few words

about the Secretary of Health and Human Services, Tommy G.

Thompson. As a tribal leader, I feel very comfortable in saying that

Secretary Thompson has been the most accessible Cabinet secretary in this Administration. He and his immediate staff have

been available at every possible opportunity to visit with tribal

leaders and to see first-hand the health needs of our people. It is

good to see visits to Indian country by the President’s Cabinet

members. I myself was at Tacoma, Washington when Deputy Secretary Claude Allen attended a coastal meeting there with Northwest leaders. It was very well received.

Also, the National Indian Health Board is aware that the committee will consider the nomination of Dr. Charles Grim as Director of the Indian Health Service. As I mentioned in my testimony

last week, we support this nomination. We support his nomination

and we appreciate his willingness to take on this hard, significant

role. Resolutions were passed by Affiliated Tribes of Northwest In-
45

dians, the National Congress of American Indians, the National Indian Health Board, and tribal leaders have pushed since 1995– 1996 to elevate the status of the Indian Health Director as means

to recognize the importance of the Federal Government’s functions

in carrying out its trust responsibility.

I would like to give you an example of why tribal leaders feel this

elevation is important. One example is in 1996 when President

Clinton had a tribal government meeting at the White House, the

Director of Indian Health Service at that time was not allowed to

sit with the Cabinet members at this meeting. It proved to be not

embarrassing, but a little hard for us as tribal leaders to see the

Director of Indian Health Service set to the side, while all the other

Cabinet members were brought up forward to meet with tribal

leaders and the President.

We have been asking for another meeting with the President.

The tribal leaders wish to meet with the President and that has

not come about. So I just wanted to mention that to you.

The intent of S. 558 is quite appropriate, as it does just that in

a manner consistent with the government-to-government relationship between the United States and the tribal governments that

have signed their treaties. As we advance this legislation, we want

to take adequate steps to ensure that we build on the improvements that have been made within the Department of HHS over

the last few years in addressing tribal issues, and further that the

Indian Health Service continues to be a part of this effort. We feel

that this can be accomplished with revisions to S. 558, and I have

prepared specific recommendations on the language for S. 558. I

would like to submit them for the record.

Our recommendations would be to place the Indian health director at the level of the assistant secretary of Indian Health, but do

it in a manner which does not diminish the secretary’s responsibility to carry out the Federal Government’s trust responsibility.

As I mentioned previously, over the past several years Americans

Indians and Alaska Natives have slowly crept into the mind set of

nearly all areas of DHHS. There are three facts that I would like

to bring forward: No. 1, informed personnel and the elevation of

tribal issues with the Office of the Secretary. No. 2, the hard work

of the Indian Health Service officials to advance issues internally.

No. 3, and most importantly, the persistence of tribal governments

to ensure that the purpose and intent of the Executive order mandating tribal consultation is properly carried out.

One of the more significant examples of the increased awareness

and acknowledgement of the importance of Indian issues within the

Department is the revival of the Secretary’s Intradepartmental

Council on Native American Affairs, which is cochaired by the Indian Health Service Director. Because of the many critical issues

that need to be addressed within the Department of HHS, we feel

that any changes to the structure of the Department must be done

in a manner that does not isolate Indian health issues, but instead

makes those issues a common thread among all Department areas.

The integration and consolidation of alcohol and substance

abuse—all of the purposes expressed in S. 285, the Native American Alcohol and Substance Abuse Program Consolidation Act of

2003, serve to improve the delivery of alcohol and substance abuse.
46

As a tribal leader, I commend the Senator for introducing this bill.

American Indians and Alaska Native tribal governments are consistently searching for ways to develop more effective and efficient

programs to better serve tribal members, and are extremely interested in providing such services, utilizing the best practices available.

While we are certainly supportive of legislation that seeks to coordinate and improve the delivery of alcohol and substance abuse

throughout Indian Country, tribal leaders have expressed their

concern with certain provisions of this legislation. Many of the concerns are due to the language establishing a lead agency. The National Indian Health Board feels the IHS is an appropriate and capable agency to administer such duties. Also, we feel it is equally

important to engage all applicable agencies to the greatest extent

possible, to ensure that IHS carries out the functions of this collaborative effort in an appropriate manner.

As an advocate for the alcohol and substance abuse, we as tribal

leaders need to do all we can to not allow the younger generation

to fall to the devastating disease of alcohol and substance abuse.

Perhaps this could be achieved by utilizing a committee consisting

of the involved agencies, chaired by the Indian Health Service. All

activities of the lead agency under this proposed Act would be carried out according to the decisions made by the committee, with

input from tribal governments. Further consultation should be included to provide for tribal involvement for all measures that

would affect the provision of alcohol and substance abuse treatment in Indian country.

Establishing the Native American Health and Wellness Foundation, the intent and purpose of S. 555, to create this Wellness

Foundation, is absolutely appropriate, and mirrors much of what

occurs in the private sector delivery of health services. It would

serve as a valuable mechanism to maintain a single organization

to allow for the Indian Health Service to receive charitable support.

Such an entity has not existed previously, which has deterred the

donation of such support. The National Indian Health Board urges

that the Foundation’s activities do not have a negative impact on

the Indian Health Service budget, but rather serves to boost the Indian Health Service funding.

I would also like to mention that the National Indian Health

Board would be a capable umbrella organization under which the

proposed Foundation could operate. As of March 3 of this year, the

NIHB fully operates out of the Washington, DC area and is governed by Board members from across Indian country. Many of the

activities that would be provided by the Foundation, such as activities furthering the health and wellness of American Indians and

Alaska Natives, and participating with and assisting Federal,

State, and tribal governments, are already provided by the National Indian Health Board. We would be willing and supportive to

discussing this with the committee. We feel this bill should be a

part of the consultation process.

In conclusion, I would like to thank the committee for its consideration of our testimony and for your interest in the improvement

of the health of American Indians and Alaska Native people. We

are certainly pleased that this is the third hearing to take place so
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far this year on Indian Health, and we trust that our issues will

continue to be a priority for the 108th Congress.

Thank you.

[Prepared statement of Ms. Davis-Wheeler appears in appendix.]

The CHAIRMAN. Thank you, Julia.

Why don’t you go ahead, Mr. Benally, and then I will ask a couple of questions of each of you.

STATEMENT OF HOSKIE BENALLY, JR., CHIEF EXECUTIVE

OFFICER, OUR YOUTH, OUR FUTURE, INC.

Mr. BENALLY. Thank you.

I come from more of a direct service perspective with regard to

this bill, S. 285. I just want to discuss the importance of the management information system. We have run a treatment program for

13 years for Native American adolescents down in New Mexico,

and serve not only Navajos, but other tribes in that area. One of

the things that we found was that a sound management information system is very helpful in determining the needs of clients, as

well as determining the needs of staff members.

Some of the statistics that we got out were very helpful to us—

such stats as what kind of drugs are we seeing in our youth? We

specialize in adolescent youth treatment, and it would be surprising to see some of the things that we thought were still in the cities

coming onto the reservation. So in identifying those types of drugs,

such as methamphetamines; ours is a high-traffic for that drug. We

were able to again gear up our staff and provide training in that

area to help them deal with this drug. But if we did not have this

management information system to give us that kind of information, we would not have been able to identify those treatment

needs and the client needs in those areas.

But I think the one thing is that in Navajo country or Indian

country as a whole (we also provide consultation services to other

Indian tribes) is that we really do not have a handle on where we

are in the battle against drugs and alcohol, complicated by the addition of the mental issues that go along with that. We know that

research shows that a high percentage, I think in the general public 64 percent have a mental health disorder that is driving the

substance abuse. In this area, we have been able to train our staff

with help from a Ph.D-level clinical psychologist and master’s level

people to be able to help the youth in this area.

The other thing I would like to say is that this management information system helped us, we are in New Mexico, to become accredited by the Joint Commission on Accreditation of Hospital Organizations, which is a national accreditation—very stringent accreditation that we sought and we received back in 1993. But along

with that, we were licensed with the Children, Youth and Families

Department of New Mexico. One thing that we are finding out

there, in talking to other tribes and also providing consultation

services, is that because of the lack of outcome data being produced

by treatment programs, they are having a hard time tapping into

Medicaid dollars, because Medicaid requires that you be able to

provide outcome data to show the effectiveness and quality of your

treatment. So we were able to do that, and in addition to receiving
48

other Federal dollars, we were able to receive Medicaid dollars to

supplement the operation of the organization.

Now, I would just like to say also that I think this bill here is

something that is long in coming and something that I think is

very useful, because we are finding out that tribes out there are

not conducting the assessments that are necessary in order to identify some of the mental health issues and some of the drug disorders that are out there. We are primarily focusing on alcohol

abuse. With this bill, that will improve that and provide quality

and effective services to our Indian people, I feel. It is more from

a direct service approach that we are seeing these things happen.

So we are real supportive of this bill here.

I would like to say thank you.

[Prepared statement of Mr. Benally appears in appendix.]

The CHAIRMAN. Thank you.

Julia, speaking of S. 285, I might tell you that I briefed your

written testimony and then tried to listen as well as I could to your

verbal testimony. It is a little bit different—or not maybe different,

but it seems to be a little milder than the comments in your written testimony.

I guess this is the third time we have dealt with this bill in hearings on it, and to my knowledge at our previous hearing, there has

been no tribal leader, no Indian health organization that has made

any objections about it at all. Has something changed since then,

or has it been the official position of the member tribes of the

NIHB—they just made the decision recently about this bill?

Ms. DAVIS-WHEELER. Senator Campbell, on the S. 285, it was a

big discussion at the National Congress of American Indians meeting that we had in San Diego last fall. From the discussion in the

Health Committee that I chair, through the human resources structure of NCAI, there was a lot of discussion at that meeting that

it needed to be looked at a little bit more.

The CHAIRMAN. Well, was part of that discussion your opposition

to having the IHS as the lead agency?

Ms. DAVIS-WHEELER. I did not hear any opposition to having Indian Health Services the lead agency, but I guess in the record

there might be a few that did have a little concern.

The CHAIRMAN. You spoke some of a committee of agencies. Do

you believe a committee or several agencies can do a better job

than having one agency responsible, on whose desk the buck stops?

Ms. DAVIS-WHEELER. The idea was to have someone from each

agency on the committee to bring about the awareness of the tribal

leaders or tribal governments’ needs, as stated by Mr. Benally. We

have a lot of drugs on the reservations that are brought in from

the cities, and having SAMHSA, the other agencies present where

they can hear that from the tribal leaders personally, I think it

would help. If anything, it would bring about more awareness to

all of the Federal agencies.

The CHAIRMAN. You mentioned the work that Secretary Thompson is doing, and I also said I think he is doing a terrific job. He

has been very sensitive, I think, to Indian issues. But he is only

going to be there about 6 more years. That is the way it works

around here. If the Administration changes, well, maybe less than

that, but the max would be 6 more years. Are you confident that
49

the next person that is going to be there is going to be as sensitive

as Secretary Thompson is, because that is one of the reasons I am

pushing this bill—to give it some continuity through different Administrations that support Indian programs and are less supportive

of Indian programs.

Ms. DAVIS-WHEELER. Senator Campbell, I think you have hit the

nail on the head with that one because we as the National Indian

Health Board and other national organizations see this Administration as being, I guess, an advocate for us in Indian country to

push legislation. It would be great to have Secretary Thompson

leave a legacy, in the event that in 6 years he has helped us elevate our health status, but leave a legacy with us as tribal leaders

to honor that administrative Cabinet position, and especially in the

area of Indian health, but also in the area of elevation of the Indian Health Service Director.

I heard from the testimony previously that the gentleman from

the DHHS does not feel that it is necessary. I would respectfully

disagree that as a tribal leader, we have been wanting to see this

position elevated for such a long time. It would make us, as tribal

governments, feel better to see the IHS Director position elevated.

He could really do something for us if he would support that.

The CHAIRMAN. I think so, too, but did I understand your testimony, you said that elevation should be in a way that does not diminish the Secretary’s responsibilities to tribal governments. Are

you worried about an erosion of trust responsibility if that position

was elevated?

Ms. DAVIS-WHEELER. No; not at all. I think that those two positions would go hand in hand. Secretary Thompson has been very

open and able, when he can, to meet with us. He has shook our

hands and talked with us. We really appreciate that. He has given

us more time on his agenda than anyone else.

The CHAIRMAN. Was somebody from his agency, or he, at San

Diego—at the National Congress of American Indians?

Ms. DAVIS-WHEELER. Yes; but because of the schedules, I cannot

remember the exact dates, but they had to just come in for a day

or two and then go right back out.

The CHAIRMAN. Mr. Benally, from listening to your testimony, it

sounds to me that your organization is doing a terrific job for Native youngsters who are obviously suffering from an increased problem with drugs and alcohol. You talked at length about the information technology. We have received some complaints about this

accounting system that is currently used by the IHS called the

RPMS—the Registered Patient Management System. Does your

member organizations and clinics use that kind of software?

Mr. BENALLY. The program that we originally used—this was introduced by IHS—we are one of several regional adolescent treatment centers throughout the United States that were originally

funded by the omnibus drug bill of 1986. We became the third one

to open, but Orion (ph) Health Care, which is also called Accurate

Assessments and apparently had a contract with IHS back about

1998, I think it was somewhere about that time, to look into developing a management information system and offer it to the adolescent treatment centers. We took advantage of that and brought it

into our treatment center and found it to be very, very useful.
50

The other thing that we added onto that system was a cultural

assessment part that we developed with Accurate Assessments to

address at some of the cultural needs of our students. But what we

are finding out is that the old Cadmus system did not work, and

we are finding out now that perhaps IHS is looking at developing

another one. I guess my position is why develop another one when

you have one that is already working and proven to work, and

there is other software out there that can work? It is just going to

put us behind time-wise. This management information system

that we are using is also being used by 130 other Native American

programs in the United States. I think the States are beginning to

look at these programs with their tribes that reside within their

States. So we have been real happy with it.

The CHAIRMAN. That is a system you would advise the IHS to

use with all tribes?

Mr. BENALLY. Pardon?

The CHAIRMAN. Is that a system that you would advise the IHS

to use for all tribes?

Mr. BENALLY. Yes; I would very strongly recommend that because we have used it. We have also; in providing consultation to

other Indian tribes, found that it is something that is very—can be

used by other tribes; has proven to work for us, and we have

shared data with them. I think CSAT also—we have a CSAT grant,

and CSAT has recognized our program as an exemplary program

in using this software, because it helped to provide cost analysis

and also helped to provide an evidence-based treatment program.

In other words, we did research with this, and it brought a lot of

data forward that says that the program that we used, not only

with our adolescents but with the families, was very effective.

CSAT is now using us as their consultant out there to train others

in what they call the Accurate Assessment Addiction Severity

Index.

The CHAIRMAN. One of the goals of S. 285 is to try to make it

easier for a tribe to take part in grants and programs that might

otherwise have been too complicated to apply for, through all the

different bureaucratic requirements. Are there any grants or programs that your organization might be interested in that you have

found too difficult, too time consuming, or do not have the resources to be able to apply for those grants?

Mr. BENALLY. Yes; well, I am lucky. I have a Ph.D clinical psychologist who has been trained in grant writing, and a master level

social worker. But if I did not have those people, I would not be

able to apply for these grants at the level of sophistication the

grantors are asking for. Now, if the grants come out in accordance

to this bill in which that you are asking for a management system,

then I think a lot of tribes out there are going to have a tough time

with it because I do not think they have that infrastructure at this

point in time to realistically or with much knowledge respond to a

grant management information systems. I think some kind of transition period of technical assistance needs to be provided in that

area because I think these grants are going to require that component before receiving dollars.

The CHAIRMAN. What did you say your Ph.D was in?
51

Mr. BENALLY. No; I have a clinical psychologist who is a Ph.D

that is on my staff.

The CHAIRMAN. Oh, I see. Very good. Thank you.

I have no further questions, but Senator Inouye or other members may submit some for writing. As I told the first panel, I do

not want to hear just what is wrong with everything. What I want

to hear is how we make it better, how we try and move something

that is going to benefit Indian people. So any suggestions you have

for S. 285 or any other bills, the other two bills, I would appreciate

hearing from you

Yes, Julia?

Ms. DAVIS-WHEELER. Yes; thank you, Senator Campbell.

My oral comments were very different from the written comments that were submitted. For the record, I would like you to

know as the Chair of this committee that we will send a revised

set of testimony from NIHB.

The CHAIRMAN. Did you talk to somebody between the time you

sent in the written testimony and the time you—okay.

Ms. DAVIS-WHEELER. Okay. [Laughter.]

The CHAIRMAN. I have no problem with that. We do it, too.

Great. Alright, thank you for being here. I appreciate that.

Ms. DAVIS-WHEELER. Thank you.

The CHAIRMAN. I notice Mr. Lincoln came in. I understand you

were tied up in traffic. I have got a little time. Would you like to

make your statement for the record, Mr. Lincoln? Oh, you were

going to accompany Dr. Raub. I see.

Mr. LINCOLN. I was going to accompany Dr. Raub, and I do

apologize to the committee. I mean no disrespect ever to this committee.

The CHAIRMAN. I understand, yes.

Mr. LINCOLN. These bills are important.

The CHAIRMAN. Yes; particularly around the Capitol here with

the grounds all torn up and the new sensitivity to post-9–11 problems, it is a mess to try to get around.

But I would like to maybe ask you a question if I could, and that

deals with the elevation bill. Is it your view that the IHS Director

as the Vice Chairman of the Intradepartmental Council for Native

Americans currently enjoys an elevated status without actually

being elevated?

Mr. LINCOLN. It is my observation, Mr. Chairman, if I may reflect just briefly on the 11 years that I have been back here at

headquarters in the Indian Health Service as the Deputy Director,

that Dr. Grim, the Interim Director, indeed does enjoy more access

than I have ever seen with the Secretary.

The CHAIRMAN. You have been there 8 years. How many Directors have there been?

Mr. LINCOLN. I came when Dr. Everett Rhodes was the Director,

also with Dr. Michael Trujillo and now with Dr. Grim.

The CHAIRMAN. And I think if I am not mistaken Senator

McCain has introduced this bill about 8 years in a row or something—about 8 years in a row. It has never really gone anywhere

yet. Have you—well, I will not ask you that. It would be subjective.

I will not bother asking you.
52

Okay. Thank you. I appreciate your being here. I may submit additional questions to Dr. Raub or you, too, on behalf of the committee.

Mr. LINCOLN. Thank you, sir.

The CHAIRMAN. I have no further comments or questions. We will

keep the record open for two weeks for any additional comments

from the audience in general or from the people who testified.

With that, the hearing is adjourned. Thank you for appearing.

[Whereupon, at 10:45 a.m., the committee was adjourned, to reconvene at the call of the Chair.]
(53)

APPENDIX

ADDITIONAL MATERIAL SUBMITTED FOR THE RECORD

PREPARED STATEMENT OF HOSKIE BENALLY, JR., MEMBER, NAVAJO NATION, SHIPROCK, NM

My name is Hoskie Benally, Jr. I am a member of the Navajo Nation of Shiprock,

NM. For the past 14 years, I have been the Chief Executive Officer of a private nonprofit American Indian owned organization, Our Youth, Our Future, Inc. (OYOF).

OYOF has operated a residential treatment center on the Navajo reservation and

a community health center in Farmington, NM. A majority of our funding came

from the Indian Health Services (IHS) and the collection of Medicaid dollars.

Currently we serve as advocates for American Indian adolescents and families in

the area of alcohol and other drug treatment along with mental health disorders.

We conduct outcome base research on our programs and disseminate information in

order to improve the lives of our adolescents in need of treatment. Through these

endeavors, OYOF has developed the Multi-systemic Cultural Treatment Model for

American Indian adolescents and their families. This treatment model uses a multimodal assessment strategy to measure symptom changes and pro-social functioning

at intake, termination, 6, and 12 months following termination. This is one of the

few if not the only manualized treatment model for American Indian adolescents

that includes a treatment outcome design. In addition, it has a quality assurance

system developed for American Indian programs. OYOF has responded to the call

of future substance abuse treatment to be guided by a blend of best practice clinical

treatment and innovative high-tech computer technologies. This approach is to facilitate alcohol and other drug and mental health treatment that is high-quality,

timesaving, consistent, evidence-based and cost-effective. OYOF secured a Center for

Substance Abuse Treatment (CSAT) 3-year grant to conduct a program evaluation

and a cost analysis of the residential treatment program. Critical information was

gleaned from the data that provided pertinent information to improve treatment of

our adolescents. Without this vital information our program may not have achieved

the success we have experienced.

It is important to realize that a majority of our success was due to the implementation of a user friendly management information system (MIS). The following are

some of the tasks that the MIS completed:

Manages clinical service hours (prescribed v. actual received services).

Tracks clinician’s billable hours for Medicaid and Managed-Care services.

Tracks client’s response to treatment and the need of additional services.

All clinical documentation is automated allowing for close supervision of treatment.

This system generates reporting requirements and supports outcome base treatment. The above tasks improve the overall quality assurance of the program and

allows for a structured and consistent treatment to be implemented.

This system allowed us to meet all of our JCAHO accreditations, Children, Youth,

and Families Department, State of New Mexico and Medicaid regulations. In addition, we had Government Performance Regulation Act (GPRA) indicators and also

the monthly, quarterly, and annual tribal government reports. Many of these re-
54

ports overlapped and when we were collecting this data on a manual basis was almost impossible to accomplish. Upon implementing a MIS clinical documentation

system, our ability to collect and collate the data was improved substantially. However, it is important to note that the overlap continued and we spent many hours

disseminating this information for the different governing entities. We created innovative ways to meet these standards by developing a computerized report that met

majority of the data reporting requirements. It is important to realize that majority

of American Indian treatment programs do not have this capability or the skilled

staff to meet this level of reporting. The initial step of implementing a MIS can be

costly if an analysis is not conducted to determine the actual need in hardware, software, and staffing. There are many for-profit organizations that have developed

such MIS and are being used in Indian country. Accurate Assessments has worked

with IHS since 1998 customizing software to meet the specialized needs of the treatment programs. They are currently serving over 130 American Indian treatment

programs. This is the MIS that OYOF has used since 1998 and was instrumental

in collecting data that secured our CSAT grant.

Recently, IHS has made the decision to write and develop their own MIS for substance abuse. Even though there are excellent programs that exist in the field for

possibly half the cost. Therefore, it may not be the most cost effective approach for

IHS. We have been waiting for more than 3 years for IHS to respond to the need

of treatment programs to have ‘‘real time’’ data that they can access simply by sitting at their computer. In addition, many treatment programs do not collect their

GPRA data and the area offices have difficulty meeting their data requirements.

This lack of quality data collection is a result of the lack of communication with the

field and IHS. The following are some of the reasons why agencies do not receive

quality data:

No. 1. Lacks of compliance due to no initial buy in from the field in what to collect

and the importance of such data.

No. 2. Trusting IHS to analyze and interpret the data in a culturally appropriate

manner.

No. 3. Providing ‘‘real time’’ data reports and/or feedback.

No. 4. Lacks of a user friendly system that can accommodate the many challenges

of rural programs.

No. 5. Lacks of ongoing support and training to make the data have practical application to the field.

No. 6. Finally, many of the programs do not have properly trained staff to complete the tasks.

Finally, how do we decrease the ‘‘redtape’’ of securing the funding from the government to the tribes and/or treatment programs? This is not an easy question to

answer. It is very complex and has much to do with the lack of standards that are

required for tribal treatment programs to meet. Many of the programs do not have

evidence-based treatment that requires a data collection component let alone the expertise to collect such data that would be require to write a grant. It will be vital

that this committee look at the whole system and take this opportunity to develop

a system that not only wants to fund programs, but will demand accountability from

any program that secures such funding. However, the most important issue is that

my people receive the best treatment possible and that we begin to make gains in

keeping our young people from a life of alcohol and drugs, trauma, poverty, and the

loss of hope.

I thank you for the valuable opportunity to submit written testimony and to provide oral testimony to this committee.
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