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29–354 PDF 2018

S. HRG. 115–192 

HIGH RISK, NO REWARD: GAO’S HIGH RISK 

LIST FOR INDIAN PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MAY 17, 2017 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

JOHN HOEVEN, North Dakota, Chairman 

TOM UDALL, New Mexico, Vice Chairman 

JOHN BARRASSO, Wyoming 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JAMES LANKFORD, Oklahoma 

STEVE DAINES, Montana 

MIKE CRAPO, Idaho 

JERRY MORAN, Kansas 

MARIA CANTWELL, Washington 

JON TESTER, Montana, 

AL FRANKEN, Minnesota 

BRIAN SCHATZ, Hawaii 

HEIDI HEITKAMP, North Dakota 

CATHERINE CORTEZ MASTO, Nevada 

T. MICHAEL ANDREWS, Majority Staff Director and Chief Counsel 

JENNIFER ROMERO, Minority Staff Director and Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on May 17, 2017 ............................................................................... 1 

Statement of Senator Cortez Masto ....................................................................... 56 

Statement of Senator Franken ............................................................................... 4 

Statement of Senator Heitkamp ............................................................................. 58 

Statement of Senator Hoeven ................................................................................. 1 

Statement of Senator Udall .................................................................................... 3 

WITNESSES

Black, Michael S., Acting Assistant Secretary, Indian Affairs, U.S. Department of the Interior ............................................................................................. 41 

Prepared statement .......................................................................................... 43 

Buchanan, Rear Admiral Chris, Acting Director, Indian Health Service, U.S. 

Department of Health and Human Services ...................................................... 47 

Prepared statement .......................................................................................... 48 

Dearman, Tony, Director, Bureau of Indian Education, U.S. Department of 

the Interior ........................................................................................................... 51 

Prepared statement .......................................................................................... 52 

Emrey-Arras, Melissa, Director, Education, Workforce, and Income Security 

Issues, U.S. Government Accountability Office ................................................. 5 

Prepared statement .......................................................................................... 8 

APPENDIX

National Indian Education Association (NIEA), prepared statement ................. 71 

Response to written questions submitted by Hon. Catherine Cortez Masto 

to: 

Rear Admiral Chris Buchanan ........................................................................ 76 

Tony Dearman .................................................................................................. 90 

Melissa Emrey-Arras ........................................................................................ 75 

Response to written questions submitted by Hon. Steve Daines to: 

Tony Dearman .................................................................................................. 89 

Melissa Emrey-Arras ........................................................................................ 74 

Response to written questions submitted by Hon. Tom Udall to: 

Michael Black ................................................................................................... 85 

Tony Dearman .................................................................................................. 90 

Rear Admiral Michael Weahkee ...................................................................... 77 

(1) 

HIGH RISK, NO REWARD: GAO’S HIGH RISK 

LIST FOR INDIAN PROGRAMS 

WEDNESDAY, MAY 17, 2017 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:30 p.m. in room 

628, Dirksen Senate Office Building, Hon. John Hoeven, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JOHN HOEVEN, 

U.S. SENATOR FROM NORTH DAKOTA 

The CHAIRMAN. I call this hearing of the Indian Affairs Committee to order. This is an oversight hearing on High Risk, No Reward: GAO’s High Risk List for Indian Programs. 

Before we get into today’s hearing, I want to bring up last week’s 

hearing that turned into a listening session. As the Committee is 

aware, we had witnesses travel from Arizona and Alaska to provide 

testimony on their respective bills, S. 825, the Southeast Alaska 

Regional Health Consortium Land Transfer Act of 2017 and S. 772, 

the Amber Alert Indian Country Act of 2017. 

Since testimony and materials were received at last week’s listening session, through no fault of their own, I would be wondering 

if there is any objection that all testimony and materials from last 

week’s listening session be given the same weight as if the Committee held an actual legislative hearing? I am asking if there is 

any objection to that? 

Senator UDALL. No objection. 

The CHAIRMAN. Good. Hearing no objection, all testimony and 

materials will be a part of the record and given the same weight 

as a legislative hearing. I thank you for that. 

Today, the Committee will examine the Government Accountability Office report on its High Risk List which now includes three 

Federal Indian programs. 

Every two years, at the start of a new Congress, the GAO compiles a list of at-risk Federal programs. These programs are considered high risk because they are vulnerable to fraud, waste, abuse 

or mismanagement. 

For the first time, three Indian issue areas were identified as 

high risk. These include Indian energy development, education and 

health care. In fact, the GAO tells us that these high risk areas 

have 39 open recommendations that have not been satisfied. These 

2 

Federal programs are vitally important and affect many tribes and 

individuals across Indian Country. 

These programs affect the safety of school buildings and facilities, the quality of health care, education and the advancement of 

Indian energy development projects in Indian Country. 

Over the years, the GAO has done a tremendous job in examining and bringing to light numerous challenges facing these Federal Indian programs. Some of these problems are very troubling. 

For instance, in its 2014 report, the GAO noted that a single audit of a BIE school located in Arizona lost $1.7 billion in unaccounted Federal funds. Upon further investigation, it was determined this money was illegally transferred to an offshore-bank account in Indonesia. 

The incident was referred to the Department of the Interior, Office of Inspector General in July 2014. The IG then asked for the 

assistance of the Federal Bureau of Investigation, the FBI. 

According the IG, certain bank accounts were hacked, enabling 

the unauthorized transfer of funds. How could this happen? Who 

was ultimately responsible for ensuring fraud like this does not 

happen to BIE-funded schools? 

At this point, I would ask for the first chart which illustrates 

various roles of the BIA, BIE and others in supporting and overseeing the BIE school facilities. 

The chart to my right shows how bureaucratic the BIE has become. For instance, the chart shows the multiple layers of offices 

that support and oversee BIE school facilities between the BIA, the 

Department, the Deputy Assistant Secretary for Management, and 

the BIE itself. The lack of oversight and cyber security is problematic but appears to be only a part of the problem. 

The GAO also issued a 2015 GAO report highlighting additional 

management challenges in education. Health care services also face 

significant issues. Since 2011, the Government Accountability Office has issued seven reports on the IHS, Indian Health Services. 

These reports related to improving oversight on the quality of care 

provided to Indian patients, improving the Purchased Referred 

Care Program, examining the enrollment of Indians in health care 

coverage expansion, and improving patient wait times at IHS facilities. 

One report found that Indian patients had waited six weeks for 

an initial visit with a family medicine physician. There appeared 

to be an even longer wait time of three to four months for an Indian patient to see an internal medicine physician. 

From data gathered from these seven reports, the GAO has made 

14 recommendations to improve the Indian Health Services. These 

recommendations remain open. For one recommendation on staffing, the IHS disagreed and continues to not implement the GAO 

recommendation. 

Although the Indian Health Service has acted upon some recommendations, such as adopting Medicare-like rates for non-hospital services and improving data collection for the Purchase Preferred Care Program, more needs to be done. 

Finally, the GAO has confirmed what Indian tribes have experienced about lost opportunities when they wanted to develop their 

energy resources. These problems were outlined in the 2015 GAO 

3 

report which highlighted poor management and oversight of energy 

resources and development at the Bureau of Indian Affairs. 

For instance, in 2016, the GAO found many BIA offices had high 

vacancy rates for key energy development positions. According to 

the GAO, some offices reported not having staff with key skills to 

review energy-related documents. 

Perhaps this is why one tribe said it took the BIA eight years 

to approve right-of-way agreements. This tribe said these delays 

cost an estimated $95 million in lost revenue. 

Our next charts illustrate the longer approval process for renewable and oil and gas Indian energy projects versus private lands. 

These charts show bureaucratic approval processes for an Indian 

tribe to develop their own energy resources. This needs to change. 

That is why I have introduced S. 245, the Indian Tribal Energy 

Development and Self Determination Act of 2017. This bill directs 

the Department of the Interior to provide Indian tribes with technical assistance in planning their energy resource development programs. 

The legislation cuts red tape and makes it easier for Indian 

tribes to develop their own resources. It also streamlines the process for approving tribal energy resource agreements and making 

this process more predictable for Indian tribes. 

Money made from developing Indian resources, whether coal, oil, 

natural gas, wind or solar, for example, can have a significant impact on tribal communities. These energy projects could create 

high-paying jobs and bring revenue to tribal governments. 

It is unacceptable that the trustee would inhibit and even prevent the tribes from engaging in healthy communities or economic 

development, whether it is energy or otherwise. Through misplaced, misguided policies, or mismanagement, these agencies 

should be ensuring that their tribes actually have opportunity and 

that they are thriving and prosperous and not continuing to suffer 

or miss opportunities. Indian communities deserve better than they 

are receiving right now. 

I want to welcome our witnesses today. I look forward to hearing 

from all of you on these important issues. 

Before I turn to our witnesses, I want to turn to Vice Chairman 

Udall for his opening statement. 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you, Chairman Hoeven, for holding this 

very important oversight hearing on GAO’s 2017 High Risk Report. 

The Federal Government has treaty and trust responsibilities to 

provide vital services, including health care and education, to Native American and Alaska Native tribes. Fulfillment of these responsibilities is both a moral and a legal obligation. 

As the Congress’ oversight partner, the GAO plays an important 

role. It dedicates time and resources to thoroughly reviewing the 

delivery of Indian programs within the BIA, BIE and IHS. The review helps identify where we are falling short of meeting responsibilities. 

For years, GAO’s work has provided evidence of something many 

tribal communities have long reported, that management chalVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\DOCS\29354.TXT JACK
4 

lenges and funding barriers at these agencies reduce the effectiveness of tribal programs. 

Their findings shed light on the need for increased management 

oversight, infrastructure investment and workforce development. 

Their decision to include Indian programs on the High Risk List 

underscores the need to redouble this Committee’s efforts to uncover the systemic challenges plaguing BIE schools, IHS facilities 

and the BIA’s leasing program. 

When I met with Comptroller General Dodaro last week, he explained what the high designation means and the outcomes associated with such a designation. In my view, this designation presents 

the Committee with an opportunity. An opportunity to do better by 

not only recognizing the administrative challenges to effectively 

running these programs but also by committing resources and expertise tailored to address them. 

That will enable us to do our part to uphold the Federal Government’s trust responsibilities to tribes. Budgets are a direct demonstration of our priorities, just as we have come here today to ask 

for more accountability from program administrators. Members of 

this Committee must join together to fight for more funding for 

schools, hospitals, teachers and nurses. 

I look forward to working with my colleagues on this Committee. 

Many of them, like Senator Murkowski and Chairman Hoeven, are 

fellow appropriators. That gives us multiple ways we can work to 

ensure that the Senate continues to pursue these important issues. 

I am hopeful that we can work together to ensure tribal programs achieve the success these communities deserve. 

Mr. Chairman, thank you again for holding this hearing. I look 

forward to the testimony. I thank the witnesses for being here 

today. 

The CHAIRMAN. Thank you, Vice Chairman Udall. 

I would ask if other members wish to make an opening statement at this point? 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Thank you, Mr. Chairman. I thank you both 

for calling this important hearing. 

Once I got to the Senate, I started harping on the Bug-O-NayGe-Shig School on Leech Lake Reservation in Minnesota. Students 

at the Bug-O-Nay-Ge-Shig School had to face really horrendous 

conditions in their classrooms. This was a pole barn. If the wind 

was blowing more than 30 miles an hour, they had to leave the 

school. This could be in the dead of winter and they had to go outside in 30 to 40 degrees below weather. There were sewer problems; there were rodents; there was cold and dangerous wiring. 

A few years ago, I convinced then Interior Department Secretary 

Sally Jewell to visit the school. Once she saw it for herself, saw 

what the teachers and students went through, she saw the need 

and I am thrilled that we are able to finally get the funding to replace the school. 

This took a lot of work from lawmakers, from the tribe, from the 

community there, and from the Obama Administration. ConstrucVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 S:\DOCS\29354.TXT JACK
5 

tion is now underway. When school starts in the fall, they will have 

a new school. 

I know there are many, many Indian reservations across the 

country that are dealing with similar school buildings in poor condition. It is unjust to expect Indian students to succeed academically if we fail to provide them with the proper environment to 

achieve that success. 

Children in Indian schools must be able to learn in a modern environment with modern facilities like a lab. This school did not 

have a lab. They need an environment that says we care about you. 

This is one issue we are dealing with at today’s BIE. 

That is why I work so hard to get the resources. The Vice Chairman talked about the appropriators. We, on this Committee, owe 

it to Indian Country and to the Native community to talk about the 

underfunding. 

We are talking about dysfunction in the organizations but some 

of this is circular. It is very hard to get doctors to come to practice 

in Indian Country if their spouses does not like the schools or housing. 

I applaud the Chairman for talking about energy development. 

I finally got some money from the Loan Guarantee Program, the 

guarantee part finally happened, and we got $9 million that can be 

leveraged up to about $80 million of activity. 

Thank you for being here today. Let us make these agencies 

work more efficiently, but let us not pretend that inadequate funding does not affect the ability for these agencies to attract the kind 

of people they need and attract the kind of people on the ground 

they need in Indian Country. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Are there other opening statements? If not, I 

would defer to the members for their questions. I am sorry, I am 

getting ahead of myself. 

Senator FRANKEN. Mr. Chairman, I think we should go to the 

testimony first. 

[Laughter.] 

The CHAIRMAN. We are going to follow Senator Franken’s recommendation. 

Senator FRANKEN. Thank you. 

The CHAIRMAN. And go to the testimony first, that is a good idea. 

Again, I want to welcome all of you. Thank you for being here. 

I would ask that you hold your remarks to about five minutes. Obviously, your full written testimony will be made a part of the 

record. 

We will start with Ms. Emrey-Arras. 

STATEMENT OF MELISSA EMREY–ARRAS, DIRECTOR, 

EDUCATION, WORKFORCE, AND INCOME SECURITY ISSUES, 

U.S. GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. EMREY-ARRAS. Thank you, Chairman Hoeven, Vice Chairman Udall, and members of the Committee. 

Thank you for inviting me here today to discuss a new area we 

have added to our High Risk List this year: improving Federal 

management of programs that serve tribes and their members. 

6 

We added this area to our High Risk List this past February in 

response to serious problems in Federal management and oversight 

of Indian education, energy resources and health care programs, 

which were highlighted in several of our prior reports. Overall, our 

High Risk Program has served to identify and help resolve serious 

weaknesses in areas that involve substantial resources and provide 

critical services to the public. 

We added this new area to our High Risk List because we found 

that Interior and HHS have ineffectively managed Indian education, energy resources and health care programs in the following 

broad areas: one, oversight of Federal activities; two, collaboration 

and communication; three, Federal workforce planning; four, equipment, technology and infrastructure; and five, Federal agency data. 

Of the recommendations we have made to Interior and HHS on 

these issues, nearly 40 have not been implemented. 

In terms of Indian education, we found serious weaknesses in 

BIE’s oversight of school spending and identified unsafe school conditions. For example, in a 2014 report, we found BIE did not have 

procedures and risk criteria to ensure that schools use Federal 

funds to educate students. Further, we found that BIE staff lacked 

expertise and training to effectively oversee school spending. 

As a result, we found several instances of misuse of funds, including as the Chairman noted, for one school, over $1 million that 

was improperly transferred to offshore accounts. 

In 2016, we also reported that deteriorating facilities and equipment contributed to unsafe conditions at BIE schools. At one 

school, we found seven boilers that failed inspection because of 

safety hazards such as elevated levels of carbon monoxide and a 

natural gas leak. You can actually see the failed inspection tag on 

the poster over there. 

Turning to Indian energy issues, we found that BIA had inefficiently managed Indian energy resources and the energy development process. For example, in a June 2015 report, we found that 

although BIA’s review and approval are required before Indian energy resources can be developed, BIA does not have a process or 

the data needed to track its review and response times. 

As the Chairman noted, a tribal official told us that BIA’s review 

of energy-related documents took as long as eight years in some 

cases and during that time, the tribe estimates it lost more than 

$95 million in revenue. 

Moving on to Indian health care services, we have a poster that 

shows the IHS structure that will be put up momentarily. We 

found that IHS provides inadequate oversight of its federally-operated health care facilities and of its Purchased Referred Care Program. 

For example, in 2016 and 2017, we reported that IHS provided 

limited and inconsistent oversight of the timeliness and quality of 

care provided in its federally-operated facilities. As a result, it 

could not ensure that patients received timely quality care. 

We reported that according to IHS officials, access to timely primary care at some facilities was hindered by outdated medical and 

telecommunications equipment, such as analog mammography machines and telephones with an insufficient number of lines for 

7 

scheduling patient appointments, as well as an insufficient workforce. 

We plan to continue monitoring the agency’s efforts to address 

these issues and our nearly 40 open recommendations. In order for 

this area to be removed from our High Risk List, Interior and HHS 

need to show improvement on five key elements: leadership commitment, the capacity to resolve the risk; having an action plan; 

monitoring; and demonstrating progress. We have a star here that 

demonstrates the areas in which they need to show improvement 

to be removed from our High Risk List. 

We look forward to continuing our work with this Committee. My 

colleagues and I would be pleased to respond to any questions you 

may have. Thank you. 

[The prepared statement of Ms. Emrey-Arras follows:] 

8 

PREPARED STATEMENT OF MELISSA EMREY-ARRAS, DIRECTOR, EDUCATION, WORKFORCE, AND INCOME SECURITY ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE


517a1.eps
9 


517a2.eps

Chairman Hoeven, Vice Chairman Udall, and Members of the Committee: 

I am pleased to be here today to discuss a new area we added to our 

High Risk List this year-Improving Federal Management of Programs 

that Serve Tribes and Their Members. 

We added this high-risk area in February 2017 in response to serious 

problems in federal management and oversight of Indian education, 

health care programs, and energy resources, which were highlighted in 

several of our prior reports, along with reports and testimony from 

Inspectors General, tribal nations, special commissions, and others. In 

particular, we have found numerous weaknesses in how the Department 

of the Interior's (Interior) Bureau of Indian Education (BIE) and Bureau of 

Indian Affairs (BIA)-under the Office of the Assistant Secretary for Indian 

Affairs (Indian Affairs)-and the Department of Health and Human 

Services' (HHS) Indian Health Service (IHS) have administered education 

and health care services, which has put the health and safety of American 

Indians served by these programs at risk. These weaknesses included 

poor conditions at BIE school facilities that endangered studt:mts, and 

inadequate oversight of health care that hindered IHS's ability to ensure 

quality care to Indian communities. In addition, we have reported that BIA 

has mismanaged Indian energy resources held in trust and thereby 

limited opportunities for tribes and their members to use those resources 

to create economic benefits and improve the well-being of their 

communities. 

In 2016, Congress found in the Indian Trust Asset Reform Act that 

"through treaties, statutes, and historical relations with Indian tribes, the 

United States has undertaken a unique trust responsibility to protect and 

support Indian tribes and lndians."1 As further stated in that act, the 

fiduciary responsibilities of the United States to Indians arise in part from 

commitments made In treaties and agreements, in exchange for which 

Indians surrendered claims to vast tracts of land, and this history of 

federal-tribal relations and understandings has benefitted the people of 

the United States and established ~enduring and enforceable [fjederal 

obUgatlons to which the national honor has been committed." Through 

improvements to federal management of programs that serve tribes and 

their members, agencies can improve the efficiency of federal programs 

under which services are provided to tribes and their members. This 

1Pub. L. No. 114-178, § 101 (2016)(codir!ed at 25 U.S.C. § 5601). 
10 


517a3.eps

would be consistent with the expressed view of Congress as to the 

federal government's trust responsibilitfes, and strengthen confidence in 

the performance and accountability of our federal government. In light of 

this unique trust responsibility and concerns about the federal 

government ineffectively administering Indian education and health care 

programs and mismanaging Indian energy resources, we added these 

programs as a high-risk area because they uniquely affect tribal nations 

and their members. 

In this context, my testimony today will discuss the findings and 

recommendallons from our prior reports on the federal management and 

oversight of Indian education, health care, and energy resource 

development, which are summarized in our February 2017 High-Risk 

report.2 In particular, I will highlight key actions that Interior and HHS can 

take to help overcome challenges associated with federal management 

and oversight of programs in these areas. 

This testimony draws on findings from multiple reports we have issued in 

recent years, as well as updates we have received from Interior and HHS 

on our prior recommendations. To conduct our prior Issued work. we 

reviewed relevant federallews, regulations, and policies; reviewed and 

analyzed federal data; and interviewed tribal, federal, and industry 

officials, among others. More detailed information on our scope and 

methodology can be found in each of the cited reports. 3 

This testimony also draws on preliminary findings from our 1\vo ongoing 

reviews of oversight and accountability for BIE school safety and school 

construction projects. To conduct our work on BIE school safety, we 

reviewed Interior's safety program evaluations; a nongenerallzable 

sample of 50 randomly selected fiscal year 2016 BIE school inspection 

reports; BIA regional documentation of employee appraisals; and 

performance management practices in four BIA regions selected for 

geographic diversity and a range of safety inspection results. To conduct 

our work on BIE school construction, we assessed agency data on the 

cost and timenness of 49 school replacement projects completed from 

fiscal years 2003 to 2016 and reviewed contract and grant files for 10 

recently completed or ongoing projects. We also assessed Indian Affairs' 

2

GAO, High-Risk Series: Progress on Many Hlgh·Risk Aroas, \IW!ife Subslanliaf Efforts 

Needed on Others, GA0-17~17 (\Nashington, D.C .. Feb. 15, 2017). 

3

For a Ust of related reports, see GA0-17·J17. 
11 


517a4.eps

Background 

The High--Risk Proaram 

pnor.(l~es against its policies, de>JI~n standards, and federaii~WS and 

mgulations. 

Wu o<m<:luet<>d tha wru); '"'which this lsstimony Is ba~e<i In >lccordance 

with ~nar.a::y a<:c;epted g~·~rm""'lt au~1ng sla~dan:ls. Thooa standards 

r<;:q\l!rtlll1<rt we plan a!ld pal'l\xm lha aooit ltJ oC!ain suf.ic.en~ 2pp!<1ptiale 

evidence lo ~~Ide a rca=tle bos's for our findings and ccnclUsicl\S 

bawri on our audit obj!lol,'ves. Wo. bellevet'lat the evidenceobt~ir,ed 

prQvides a reasonable basis for our findings and <:nMiuslons. 

In 1990, GAO bagan a ~mgram to report on govemm.;ntop~ratl<lns that 

we kl~1ed as "hlgl1 r;s~: S'nce I hen, generolly ccin~iding with the stmt 

ot each """' Congre,.,, ws h~W> reporterl on the statL<S of progross 

add;ssoir.g previouslv fden~fted 111glh1sk area& and howe upd~!ed the 

High-Risk Ll$1 \o <!rid newhi!;ll-riiA<: areas. Ourmostrecenth\gll-llsk 

upcbte in February 2017 identifll3d 34 high-risk areas.' 

Ovemll, our hlgh-~s~ program has sGrved to identify and help rewl~e 

serious weakness"" In area$ that Involve substantial resourc~~ and 

~rovid~ crmoal services to !he public. Since the program began, the 

federal gcwemment has taken higiNi>;k problems seriously and has made 

long-needed progress toward correcting them. !n a number ofc~ses, 

pmg:ess has m>en suffi~lcnlll:>l U$ k> ffiffirn:e the h;g~-;isk diaignatio.'l.. 

7 c determine whlcll ladera! government progrn!<1s and funcllons slmu!d 

be d~ignilleci high ris~. we u~~ ourgu;d""ce do<l!Jmm>t, f:h;Wrmlning 

f'l.>rtorm~nce BndAcc~:~untaMfly Chall&nges and Hlgfl Risks.' In making 

this determination, we consider whether the program or funcli<ln 1s oF 

naliunal slgnlficance or is key to the p~rfurmance and accountability of 

thEI federal government 

Futiller. we consider qualitative factors, such as whet'1er the risk tnvot.les 

puhl!<:o h..aHh or sa!et~. rerv1t;G <Jdlvert. nat;<>nal se~urity. natrona! 

"GAO. fl-3~r 

'GAO, Vo161m!ni.'g ""'~'"'"" •miAo:>:IWl!aM)y Cha""'nges and Hf<;n i'llslto. G~·1'0~SP rN••hin~ton. D.C .. Novoml>or2000J. 
12 


517a5.eps

defense, economic growth, privacy or citizens' rights, or could result in 

significantly impaired service, program failure, injury or loss of life, or 

significantly reduced economy, efficiency, or effectiveness. In addition, we 

consider the exposure to loss in monetary or other quantitative terms, 

including financial risk in areas such as the value of major assets being 

impaired: revenue sources not being realized; major agency assets being 

lost, stolen, damaged, wasted, or underutilized; potential for, or evidence 

of improper payments; and the presence of contingencies or potential 

liabilities. Before making a high-risk designation, we also consider 

corrective measures planned or under way to resolve weaknesses and 

the status and effectiveness of these actions. 

Our experience has shown that the key elements needed to make 

progress in high-risk areas are top-level attention by the administration 

and agency leaders grounded in the five criteria for removal from the 

High-Risk List, .as well as any needed congressional action.!; The five 

criteria for removal that we identified in November 2000 are as follows: 

• Leadership Commlbnent, Demonstrated strong commitment and top 

leadership support 

• Capacity. The agency has the capacity (i.e,, people and resources) to 

resolve the risk(s). 

• Action Plan. A corrective action plan exists that defines the root 

cause, solutions. and provides for substantially completing corrective 

measures, including steps necessary to implement solutions we 

recommended. 

• Monitoring. A program has been instituted to monitor and 

Independently va11date the effectiveness and sustalnabllity of 

corrective measures. 

• Demonstrated Progress. Ability to demonstrate progress in 

implementing corrective measures and in resolving the high-risk area. 

The five criteria form a road map far efforts to improve and ultimately 

address high-risk issues. Addressing some of the criteria leads to 

progress, while satisfying all of the criteria is central to removal from the 

list. 

8GA0-01-159SP. 
13 


517a6.eps

Indian Education 

In each of our high-risk updates, for more !han a decade, wr; have 

assessed progress to address the five criteria for removing a hlgh-rlsk 

area from the list. In our 2015 update, we added clarity and specificity to 

our assessments by rating each high-risk area's progress on lhe triteria 

and used the following definitions: 

Met. Actions have been taken that meet the criterion. There are no 

significant amions that need to be taken to further address this 

crlterton. 

Partially Met. Some, but not all, actions necessary l<l meet the 

criterion have been taken. 

N"t Mel Few, if any, aclions toward meeting the criterion have been 

taken. 

Figure t shows a vioual representetion of varying degrees of progress In 

each of the five criteria for a high-risk area. 

NoO'iterlonilovoO"'""'" 

0"" <I"""'" P"~'d 

""" '"'"'""' """""""' 

NOOe: E'en polntorlr.o Sloe roptoso.>l• '"" orin• ''' """"" ''' ''"""' "<01 "" H~<>Jl~· Ll>l0<'0 .. "' dno r.orese11~ or.o oltho Uuoo ooslll"""""'· not mOl. p•CJ•I~ "'''· a met. An""'"'"'' p~m 

Ol""' """'"""" Ong "'''"" lballne """"""h.,""' boen mel, oR'"'~~""""''""'"'"'"'" middle nr.g "'""' ll'Ol lho cOietlo" ""boon P"'""~ mOl.""" o [~~ •hoded '""lOllllo '""'""'" nng 

"'''"" tballllo ""''""" ""' "'"' mel. 

Indian Affairs, thmugh BIE, is responsible fur providing quality educ:ation 

opportunities to Indian studenll> and oversees 165 elementary and 

secondary schools that serve approximately 41,000 students on or nsar 

Indian reservations in 23 states, often in rural areas and small towns (see 

fig.2). 
14 


517a7.eps

Flgum 2: Bumau of Indian Eduoation (!!IE) Soboolo and DormitO~O$ ~y Bur""" o! !nd!an Affairs Region 

.. 

.. 

• """'="'"'"......,...-J,e~"""""' 

J.Ooo<•rr~••"'E"'"""''""J""'""~'-' 

.. ., ,;u •• ~'"'"" 

""'"" 

. .. 

About two-thirds of BIE schools ere operated by tnbes, primarily through 

federal grants, and abolll one-lhlrd are operated directly by BIE. BIE's 

Indian eduostion programs origin ale from the iederal governmenfs trust 

msponsibnity to Indian l~bes, It Is the policy of the United Slates to fulfill 

this trust responsibility fur e<lucating Indian ohrldren by working with tribes 

1o ensure that education programs are of the highest quality and that 

children are provided a safe and healthy environment in which to learn. 

Students attendln.g BIE schools generally must be members of federally 

recognize<l ln<lian tribes, or descendants of members of such tribe~. and 

reside on or nearfederallndian reservaUons. An BIE schools-both 

trlbally- and BIE-opereted-receive alma~t all of their operational funding 

from federal sources, namely, lnterlor af\d the Department of Education, 
15 


517a8.eps

Indian Energy Resources 

totaling about $1.2 billio~ in 2016 Indian Affairs considers many BIE 

schools !o be in poor condition. 

BIE is primanl1 responsible for its schools' educatTonal func~ons, wltils 

their administrati~e functions-such as safety. facilities. and property 

management-are diVIded mainly between two other Indian Affa1rs" 

offices, BIA and the Office of the Deputy Assistant Secretary of 

Management However, w~ have identilied long-standing personnel 

issues. such as frequent turnover of leadership in these ofiioos that have 

hampered efforts to improve Indian education over the years. For 

example, In September 2013. we reported that from 2000 through 2013 

!here were repeated cltanges in the tenure ofact1ng and permanent 

aasi•tant~e~r,;taries of Indian Affairs. will1 the tenure ranging from 16 

days to 3 years.' During !his period, Ulerewas also frequent turnover in 

acting and permanent directors of BIE. Since that time, leadership 

turnover has continued In tllese offices_ For example. in March 2016 

Interior's lns)J<'dor General found th~t the BIE director had violated 

federal hiring practices. and he was removed lrorn his position.• 

Considerable energy resources. including domes\1~ mineral resources 

su~h as 011. gas, and coal. and resources with si<JnWmm\ polen~al for 

renewable energy development lnoludlng wind. solar, hydroeleotrio 

power, geothermal, and biomass, e~islthroughout Indian country. Tribal 

nations may seek opportunities to use these rnsources as an option to 

create economic benefits that provide revenue for government operalions 

and social service programs. cre!M htgh-quaiTty jobs. end offset power 

costs by Increasing access to reliable and affordable energyfortrtbal 

building• and individual home.; Wnile tribe• and their members 

determine how to use their enerM resources. If the resources are held In 

trustor rnslricted status. BIA-through its 12 regional offices. 85 agency 

offices, and other supporting offices-generally must review and approve 

7GAO, lnr!ian Alfai,;. ~urwu olln<ltan Eo'ttoo!ron Nee~• to /m~''"" o..,.,g.ru of Scl>ooJ Sp<>fi(/JJ>~. GA0-15-121 (Wa<lllngton, 0 ~-= Nov_ 13, 2014)_ 

'U.S. ~~mont oltho lntoMor. omc. ollnspoolor General.lmmsh!l"ll•m Roporl of 

lmpropor Hiring ollh<> Bufl'OU of Inrflan l"d!mallon. (Washington. 0 ~-= Morch 30. 2{1161 
16 


517a9.eps

leases, permits, and other documents required lor development (see fig. 

3),' 

Flsuro J: E!ureau of ln~lan Aff•lrs {BIA) R~~lons and Nuonb<tr of A~onoy orne" 

""""" ...... ,!Jiountoin --?loln•- Roglon __ ,,, 

E»le'" 

OMaho""' 

' -~· ·' EaaLom ~·~oon 

:.~"! .. __ 

~·~Jon f5)- N""~" cl 

... '"''""'"' 

BIA's management of Indian energy resources and oversight of 

de\lelopment 1s to be conducted pursuant to federal law, 1n e manner that 

1s consiStent wilh the federal governmenfs ftdudary trust responsibility to 

federally rec:ognr~ed lndran tribes and therr membeJs. In additron to BIA, 

the de~~elopment of Indian energy resources can be a complex process 

involving a range of additional stakeholders, including federal, tribal, and 

'Tru>t msaurcos on:o ~.o!d oy 1ha U.S. gm•ammont fartha banofiolol in1orest af tho 1nbe or 

• member, MO rosMclo~ fflaoureos "" m'""" by 1~0 1~00 oro mom~er out sul:jeotta re>lrir:tJons en !Oe~ sole or ~onster Truot onO """'oled resources ganeraEiy cannot be 

Joasoo wr:ncut apprcvSI of tno secreiOI)' of 1M lnten". ""'' "'" ~orally "''09'"" ws •ulhanly lo BIA_ 

state agencies, For example, the Bureau oi Land Management issues 

drilling permits to operators developing Indian oil and gas resou.-.:es after 

receiving BIA concurrence to approve the permits. The Environmental 

Protection Agency issues permits for air emissions that may bs required 

for some oil and gas dmelopment Interior's Fish and Wildlife Service 

ISSUes perm1ts for incidental deaths of certain Wildlife species, whmh may 

be affected by certain wind projects_ If energy development affects 

naVIgable waters, the U.S. Army Corp:o of Engineers may need to issue a 

permit. The specific role of federal agencies can vary on the basis of 

multiple factors, such as the type of resource, location of dmelopment, 

scale of development, ownership of the resource, and Indian t~be 

involved. Figure4 shows various roles federal agencies may have in the 

development of Indian energy resources. 

517a10.eps

" 0 " " "'<0 :::!; " 

iii>aill""'S"'"-.,. 

"'""'"' "' " 

["'"j"n.roo -·" 1: "' 3 " 

!i,ff 

0 :;>" ro 5" 0:: ID 

§"'"'Jl"'""'O' 

i.3 

" )> '<:: =r " 

'"""""'"'""" § §'."'."'&'3ga "" fJ- 8' <' !!: " ;;· ii;:;:g':il6--

. 

I 

I 

i 

I I '- 1 !nm 

r ! 

" .. !it • i" ··:l' .. 

.... , . ., 

i·;ii'! H 

"' !! 

' 

I 

@ 

(:%: \I 
18 


517a11.eps

Indian Health Care The Indian Health Service (IHS). an agencyvAihin HHS. is charged with 

providing health care to approximately 2.2 million Indians. IHS ovarsees 

its health care facilities lhrougl1 a decentralized system of area offices. 

which are led by area directors and located in 12 geogrsphi~ areas. (See 

Jig. 5 for a U.S. map showing the IHS patient population by arsa). Nine ol 

these 12 IHS areas have federelly opereted IHS lacilities-Albuquerque, 

Bemidji, Billings, Great Plains, Nashville, Navajo, Oklahoma City, 

Phoenix. and Portland." 

Figure 5: Indian Heolth Service (IHS) Potion! Popvl•llon by Ar<>>. Caiond" "foor 2014 

''Th• Ata•ka. D>l•lom"'. and Tuc"n aroao do not haV& any lodentlly op<l'atl!d tHS 

lao~i;ies. 
19 


517a12.eps

In fisoal year 2015, IHS allocated about $1.9 billion forheallh services 

provided by federally and triballv operated hospitals, heslth centers, and 

health stations. Federally operated facilities provide mostly primary and 

emergency care. in addition to some ancillary or specially serviees, The 

federally operakld system consists of26 hospitals, 56 health centers, and 

32 health staflons, IHS hospitals range in size from 4 to 133 beds. 

Ae<:ordlng to IHS, the headquarters office Is responsible for setting health 

care policy, ensuring the delivery of quality comprehensive health 

services, and advocating for the health needs and C<~ncems of Indians_ 

The IHS area offices are responsible for distributing fUnds to the facllltTes 

in their areas, monitoring their operation, and providing guidance and 

t~hnical assfstance. (See fig. 6). 

FljJure "' Health Care Re5ponsibililios of Indian Health Servloo (IHS) H"Oquarlers, Arw O[ficoo, and Fo<ler.lly Oporo,.d FaoiUIIos 

• Scllin~ o~onq.,;oo hoo1h .. .., pol"! 

• 5o•ui1<>:J <!iiiV.f'/ ''""''"'!' "'"'F'""""''""' '"'"'"' . "'""''"'" ,,, """'"' ,,,,," '"""" 

o Pro~"'"" «<e 10 "'i"''" • Fro~<0n9 ""'" .,,..,._ .uoh •• ""''Lh '"' """'"'"' """'"'"" ... d publ o heoW• ""'.,"'-' 

o W~nllo'ln; fooollly"P""'oo"' 

When servlc~s are not available at federally operated or tribolly operated 

faciliTies, IHS may, in some ca5eo, pav for services provided through 

external providers through its Purchased/Referred Care (PRC) program. 

IHS facilities and their associated PRC programs are located in 12 

geographic areas, ""ch overseen by on IHS office led by an area director. 

The PRC program Is funded through annual approprta\1ons ami must 

operate within the limits of available appropriated funds_ To be eligible for 

PRC services. recipients must generally meet several oriter~a, Including 

being a member or descendant of a federally recognized tribe or having 

close social and economic tios with the tribe, and living wi\h\n a Tribal 

Contract Heall/1 Services Area. Although funding available lor !he PRC 

program has recently increased, we have reported th~t the program is 
20 


517a13.eps

unable to pay for all eligible services, and that these gaps in services 

sometimes delay diagnoses and treatments, which can exacerbate the 

severity of a patient's condition and necessitate more Intensive 

treatment11 

The Patient Protection and Affordable Care Act (PPACA) expanded or 

created new health care coverage options that may benefit Indians, 

including a state option to expand Medicaid eligibility to individuals with 

im;omas at or below 138 percent of the federal poverty level (FPL). 

federal premium tax credits for individuals obtaining insurance through 

heatlh insurance exchanges with incomes bet\veen 100 and 400 percent 

of the FPL, and cost sharing exemptions for Indians who are members of 

federally recognized tribes with incomes at or below 300 percent of the 

FPL who purchase Insurance through the exchanges.12 In September 

2013, we estimated that PPACA's new coverage options may allow 

hundreds of thousands of Indians to obtain health care benefits for which 

they were not previously eligible, assuming all states expanded their 

Medicaid programs. u We reported that, if Indians enroll in one of these 

options and choose to receive care through IHS. increased revenue from 

third party payers such as Medicaid could free up IHS resources and help 

alleviate pressure on IHS's budget. 

11 GAO. Indian Hoa/111 scrvico: Health C<!ro SoNicos Are Not Arways Avoifallts to Nawe 

Amel1cans, GAO-Q5-789 (wasning1on, D.C.: Aug. 31, 2005). 

17See Pul:l. L No. 111-148, 124 SiaL 119 (Mar. 23, 2010), as amended byU\e Hesltll 

Care and Education Reconcilia1ion Act of2010, Pub. L. Na. 111-152, 124 Stat. 1029 (Mar. 

30, 2010). 

13GAO.Indian Health Service: Most American Indians and Alaska Natives Potsn/taRy 

Eligible fer Expended Health Coverage, but Action Needed to Increase Enrollment, 

GA0-13-553 (Washington, D.C.: Sep. 5, 2013), 
21 


517a14.eps

Serious Weaknesses 

with Federal 

Agencies' 

Management and 

Oversight of 

Programs Sellling 

Tribes and Their 

Members 

Indian Education 

Inadequate oversight of federal 

aotivities 

We have found that Interior end HHS have inelfsctivaly administered and 

Implemented Indian eduoat1on and health care pmHrams and 

mismanaged Indian energy resources in the following broad areas: (1) 

oversight of federal activities; (2) collaboration and oommuni<>ation: (3) 

federal workforce planning: (4) ,;quipment, technology, and infrastructure; 

and (5) federal ag,;nci""' data. Although the agencies have taken some 

actions to address the 41 recommendations we have made related to 

Indian programs. as of our Februmy 2017 High-Risk update. there are 

currently 39 that have yet to be fully addressed. 

We have ldenttned weaknesses in how India~ Affairs oversees school 

saf..ty and oons1ruction end 1n how 11 monitors the way schools use 

fedsral funds. In a March 2016 report we found that Indian Affair5 had 

not taken actions to ensure that Its BIA regional offices annually inspeol 

tlw safety and health of all BIE aohool campuses. as requ1red, or that the 

!nfurmatian it collected through ins,.ections was complete and accurate, 

and we recommended that n take such actions." Spedfioally, we fuund 

thaltndlan Affairs did not conduct annual inspections at about 1m3 BIE 

schools from fiscal years 2012 through 2015. Furth~r, 4 aut of 10 regions 

did not conduct any inspections during lh1s period. We also found that 

Indian Affairs did not systematlcally evaluate the thoroughness of the 

school safety lnspe<>tions it conducted or monnor the extent to which 

in•IJ"'clion procedures varied w1lh1n and across regions. We concluded 

thalli did not monltorwhe!IJer saiety inspectors in ea~h of ,J, regions are 

consistent~ followi~ appropriate procedures and guidance. inspections 

in different regions may continue to vary in completeness and miss 

important safely and health deficlencles at schools that could pose 

dang~rs to students and stall. 

In response to our findings and recommendations In September 2016, 

Indian Affairs provided documBntation that it had conducted fiscal year 

2016 annual safely Inspections at all BIE schools. In 2016. agency 

officials also reported on changes they had made to managing the 

"GAO, lrKiion AII•fm. Key AcliOil' Nli#lao~ ra Enwm S!Jiaty oadHoo/lh allmlra" S"olooOI 

fuc,frioo. GJ\{)..16-315 {Washington. D.C. Mar. 10. <016). 
22 


517a15.eps

perforrmmce of personnel responsible for overseeing and conducting 

school safety inspections. However, as of April2017, the agency had not 

provided documentation that the inspection information that its safety 

personnel collect and report to BlE schools is complete and accurate. In 

addition, our preliminary findings from ongoing work. since February 2017 

point to continued problems with Indian Affairs' oversight of safety 

inspections at BIE schools. In particular, we have found that BIA 

employees responsible for providing safety inspection reports to schools 

were not held accountable for late reports despite the agency's 

requirement and a new employee performance standard on submitting all 

reports within 30 days of an Inspection. We found that some reports were 

submitted more than 4 months after an inspection. We will conlinue to 

monitor the agency's efforts in this area. 

In February 2015, we i3lso testined that Indian Affairs did not consistenUy 

oversee some BIE school construction projects. ~ For example, we found 

that at one BIE school Indian Affairs managed a $3.5 million project to 

replace roofs, but the new roofs had leaked continually since they were 

installed, causing mold and ceiling damage in classrooms, according to 

agency documents. At another school, Indian Affairs funded construction 

of a $1.5 million building for school bus maintenance and bus storage, but 

the size of the building did not allow a large school bus to fit on the lift 

when the exterior door was closed (see fig. 7).1G 

15GAO, Indian Affairs: Preliminary Results Show Continued Challengrts to thrt Ovr~rsig!Jt 

and Support of Education Facllitirts, OA0·15.389T (\Nashington, D.C .. Frtb. 27, 2015). 

16As a result, staff at the scl'iool were required to m~lntain or rep~lr a large l:lus With the 

door open. which Is not practical in the cold South Dakota Wil'lters. 
23 


517a17.eps

Ffgur~ 7: E>,.dor~nd lnto,ior <>I Re"nUy-Con•btJoh>d School llu• M•ln!On•noo Building Whon> Door Does Not Clo•e When a Larye Schoolllusls On Kydraullc Ult 

Further, preliminarytin<lings from our ongoing work indicate that Indian 

Afl<lir-\ has not consistently used <Jcoount<lbility measures or ~onducted 

sufficlont overelght to ensure that BIE school construction projects were 

completed on tlme, w~hln budget, and met schools' ne~ds_ For instance, 

of the 49 school construction projects we rev tawed that had been 

completed from iiscal years 2003 lo 2016, 16 were 3 or more yeare 

behind sclledule and 1 was nearly !Oyears behind schedui"(S<>e fig_ 8). 

Flguro 8: Tim•llnoss of Indian Allalrs' School Roplacomont P"'joot. Complot<d, 

Fiso'l feare 2ij(l;)- <!01 6 

"'"" =·~ ... ~,.,.,.,~.·-- .... ~, ............ "_' ,....,_,....,, No'•- _,,.do oot ""' ro tOO '""'"'""• to nnmd~oIn a November2014 report, we also ldenllfted serious weakresses in 

Indian Affair5' o~ersight of sohool expenditures." For <>J<amp e, we 

reported that BIE does not have written oversight procedure• and risk 
24 


517a16.eps

Limited federal workforce 

planning 

criteria for ensuring schools use funds pr011ided by Interior fur their 

intended purpooe of providing BIE sludeflts a quality eduC<llion. As a 

result of Indian Affairs' lack of rwersight, we ldentlfled several instances of 

funds being misused, including $1.7 million for a school !hat were 

improP"rly transferred to an off"shore account. Our report contained 

several recommendations the~ if implemented, could help BTE acnurately 

track ~nd oversee BIE school eKpendltures to ensure that federal funds 

are being used fur their intended purposes. Specifically, we 

reoommended that lnterlordev~top both wrill~n proo=dur=• ~nd ~ riol<-

bo:>ed appro~ch to monitor school expenditures. In response to our 

recommendations In May 2016, Indian Affairs' officials said ~hey were in 

the prccess of establishing a new Office of Financial Accountability within 

BIE that, among other duties, would 011ersee school expenditures. They 

noted lhey were planning to hire auditors and grants management 

specialists who would be responsible fur developing written procedures to 

oversee school expenditures. Ill April 2017, agency oftidals also reported 

that they had ~lied the BIE Deputy Director for School Operaijons 

posmon. In addition, \hey nole<f thai newly hired personnel "'ere being 

trained In risk assessment and fraud prevention policy. However. the 

agency did not provide dmrumentation that it had developed and 

Implemented written procedures and risk criteria to ensure Eccountabil~y 

ofBIE school eJ~penditures as we recommended. Further, It reported that 

the target date fur fully implementing our recommendations 1vas October 

1, 2018. Therefore, we will continue to monitor the agency's efforts to 

Implement these recommendations. 

We ha·;e found limited workioroo planning in several key areas related to 

BIE sC:1ools. Spectncally, In a February 2015 testimony, we noted that the 

capaci:y of Indian Affair~ and BIE o~hool o\aff to ad<ltc$$ oo'oool f~o1l1ty 

needs Is limited due to gaps in expertise, steady declines in staffing 

levels,and limited lrtS\tlulional knowledge," 

In November 2014we reported thattlle lack of financtall!l<pertlse and 

training, among other things, hindered BIE administrator~· effectiveness in 

overseeing sohoci expendttures_'' For example, ahhough BIE line office 

administrators made key decisions about sohools' slngt" audit report 

findings-such as whether funds are being spent appropriately-they 

were nat auditors or accountants_ Addition atty. the administrators 

18 GI\G.15.-3B~T10GA0-15.-t2t. 
25 


517a18.eps

Outdated and deteriorating 

equipment, techno)O!Jy, and 

infrastructure 

responsible for the three BtE offices we visited said they did not have the 

financial expertlaeto understand the content of single audits. We 

re<:ammended that the agency develop a comprehen5ive workforce plan 

to ensure that BIE has an adequate number of staffwitl1the requls~e 

knowledge and sl:itts to effectively oversee BIE school expenditures. 

Interior agreed to implement this re~ommendation, but as of Apr" 2017, it 

had not provided documentation that It had done so. 

In September 2013, we reported that Indian Affairs C<'lUid not ensure that 

staffing levels at Indian Affairs' regional offices were ~djusffid to meet the 

needs ot BIE schools in regions with varying numbers of schoolsranging from 2 to 65-because it had not updated its strategic workforce 

plan." We recommended that Indian Affairs revi5e ~~strategic woriJ"or~e 

plan to enoum that its ~mployees who provide administrative support ro BIE ere placed in the appropriate o!IJces to ensure that regions with a large number of schools have sufficient support. Indian Affairs agreed to 

implement this recommendation In September 2016, Interior provided us 

with a revised wor~faroo plan for Indian Affairs. However, this plan did not 

include information about the workforce needs oflha Indian Affairs offices 

that provide administrative support to BIE and ils schools and therefore 

did not address our recommendation. N; of April 2017, we had not 

received any further updates from Indian Affairs. We will G<Jntinueto 

monHor Its efforts in this area. 

Aging BIE school facilffies and equipment have contributed ro degraded 

and unsafe conditions for stud en~ and staff. In a March 2016 report, we 

found one school with 7 lwilers thet failed Inspection llecause of multiple 

high-risk safety deficiencies, including elevated I ovals of carbon monoxide 

and a natural gas leak (see fig_ 9)_ 

"GAO, !nOla~ Allairo: Soffer Mamgomo"r ami Aorounla!llldy ~'ooriori ralmpro'm '"'""" Ed"oolioo, GAO. 1!-n4 (Washmgton, O.C.o S•pC :14, W1 Jl. 
26 


517a19.eps

Figure 9: Fa!led Baller Inspectlan Tag in a 8ureau of Indian Ed~catlon (BIE) Sehoc 

Classroom B~!lding 

Thos ~letT ol t•quopmPnl on<:p.ir.tod by 

th" U.S. 8111""" at lnd•~" Allmrs 1'!45 

lalled lnspeclo011 Out' 10 

----- -· -- -~~-~~-

__ -:; 

Four of the boilers were located in a student dormitory, and three were 

located in classroom buildings. All but one of the boilers were about 50 

years old. Although the poor condition of the boilers posed an imminent 

danger to the safety of students and staff, most of the boilers were not 

repaired until about B months after failing their inspection, prolonging 

safety risks to students and staff. 
27 


517a20.eps

Incomplete and inaccurate 

data 

Open Recommendations on 

Indian Education 

In February 2015, we also testified that BIE scllOJOJts faced a ~arie\y of 

challenges associated with their facilities, su~h as aging buildings and 

problems that result from years of deferred maintenance." For,.xample, 

at one school built in 1959 we observed e;.;tens1ve cracks in concrete 

blookwalls and supports. which a BIA official said had resulted from a 

sh1fting foundation. 

A tack of internal controls and ather weaknesses hinder Indian Affairs' 

ability to collect complete and accurate Information on the physical 

conditions of BIE schools. In addition to our March 2016 findings on 

Indian Affairs' lack of sound safety inspecUon information on BIE school 

facilities, as discussed above, in February 2015 we also testified on 

problems wi\11 the quality ofd~ta on overall BIE school condittons. These 

Issues Included Inconsistent data entry by schoo~ and insufficient quality 

controls, whicll made it difficult to determine the actual number of schools 

In poor condition and undermined Indian Affeirs· ability to effectfvely trook 

and address problems at school fildl~ies." 

When we ioou<Xl our February 2017 Higll,Risk update, we had made 13 

recommendations to Indian Affairs regarding improvements needed in the 

management of BIE schools, ofwhicll11 recommendations remain 

unaddressed. Spaci~cally, 

To help ensure that BIE schools provide sefe and healthy facilities for 

students and slafl, we made 4 recommendations, including that Indian 

Affairs ensure the inspection information It collects on BIE schools is 

complete and accurate; develop a plan to build schools' capacity to 

promptly address safety and health deficiencies; and consisten~y 

monitor whether BIE schools have established required saiety 

commiUees, 

To help ensure lllat BIE conducts more effective oversight of school 

spending, we made 4 recommendations, Including that Indian Affairs 

develop a worl\force plan to ensure that BIE has the staff to effectively 

owr;ee school spending: put in place written procedures and a riskbased approach to guidB BIE in overseeing school spending; and 

improve information shoring to support the oversigl1t of BIE school 

spending. 

21GAQ.15--JaST. 

"'GAO-t5--Ja9T. 
28 


517a21.eps

Indian Energy Resources 

Inadequate oversight offedeml 

activities 

To help ensure that Indian Affairs improves how it manages Indian 

edt. cation. we made 5 re<:ommendatlons of which 3 remain open. 

Including that Indian Affairs develop a strategic plan far BE that 

Includes goals and performance measures far how Its omces are 

fuililing their responsibilities to provide BIE with support; revise Indian 

Affairs' strategic workfurce plan to ensure that BIA regional offices 

ha11e an appropnate number of staff with the nght s~ills to support BIE 

sci>ools in their regions: and develop and implement deciSion·ma~ing 

pro:edures for BIE to improve acrountability for BIE schools. 

We reported in June 2015 that BIA's review and approval is required to develop Indian energy resources, Including the approval of leases, nghtof-way(ROW) agreements, and appraisals." However, BIA does not 

have a documenb:Jd prooe5s mths data needed to track its rEIIiew and 

response times-such as data on the date documents ere received, the 

date the review Is conetdered complete by the agency, and the dale 

documents are approved or denied. 

Slake holders we interviewed and lilerature we re~iewed suggested that 

BiA's review and approval can baa lengthy process and increase 

development costs and project de~e]opment times, resultlnQ 11 ml~sed 

development opportunities, lost revenue, and jeopardi~ed viability of 

projects." For example, in 2014, the Acting Chairman for the Southern 

Ute Indian Tribe reported that BIA's review of some of ns energy-related 

documents b:Jok as long as 8 years. SpeclHcally, as of Aprll30, 2014, the 

tribe h~d been waiting for at le<Jsl5 years for BIA to review 61 pipeline 

ROW agreements----1 1 of these 81 ROW agreements had been under 

review for 8 years. According to the tribal official. had these ROW 

agreements been approved in a timely manner, the tribe wouk::l have 

received revenue through ~arious sources, including tribal permitting fees, 

"GAO. JrJCom En•rw Ow!>~!- Pcct M•n•gem•n! by IJIA Has Hurc/oJe<! En•rgr 

D•v•twm"'! on kld!an t..ond4, GAO·l&-502 {IJ\/a&lrmgton. D.C .. June 8. 201~). 

"see, Jcr example, Hea<in~ on U.e Indian Tnbal Ene1g~ and S.ll·Delennin•lton Act Amendment• (S. 2132), 1 t3U. Cong. Mo<il 30, 2014). Statement of the Hororable Jame• M. Olguin. Acting Chairman, SouiMm Ute lnd1an T<i~al Couocil on behalf or U.e South01n Uto I mil"' Trib,, ond P1epa<ed otatement of Hon. Nathan Small. Cha11man. fo~ Hall Bu•inoSl! CoullC~. Shosh:mo-Bonnool< Tnbeo. S~er>;llllon1ng Sell-llumcion~ 0.-.1comin;p Bam or. lo Economic Do\'elopment'" Na~.-. Commun1tioo. F~d H@&lin;p B•fo1o tho Committee on lnd<Bn AffoiiS, United stat~• Son ale 11~111 Gong W """ {loug_ 17. 2011) 
29 


517a22.eps

oil and gas severance taxes, and royalties. The tribal official noted that, 

during the period of delay, prices for natural gas rose to an historic high 

but had since declined. Therefore, the official reported that much of the 

estimated $95 million In lost revenue would never be recovered by the 

tribe. 

In another example from our June 2015 report, one lease for a proposed 

utility-scale wind project took BIA more than 3 years to review and 

approve and according to a tribal official, the lease was only reviewed and 

approved after multiple calls and letters from the tribe to 81A 

headquarters. According to a tribal official. the long review time 

contributed to uncertainty about the continued viability of the project 

because data used to support the economic feasibility and environmental 

impact of the project became too old to accurately reflect current 

conditions. 

In our June 2015 report, we recommended that Interior direct BIA to 

develop a documented process to track its review and response times. In 

response, Interior stated it has taken initial steps to develop a 

documented process to track its review and response times for oil and 

gas leases and estimates it will have a fully documented process by 

September 30, 2018. However, it did not indicate whether it intends to 

track and monitor the review of other energy-related documents that must 

be approved before development can occur. Without comprehensively 

tracking and monitoring its review process, BIA cannot ensure that 

documents are moving forward In a timely manner, and lengthy review 

times may continue to contribute to lost revenue and missed development 

opportunities for Indian tribes. 

Moreover, in a June 2016 report, we found that BlA took steps to improve 

its process for reviewing revenue-sharing agreements, but it still had not 

established a systematic mechanism for monitoring or tracking. ~ With 

respect to revenue sharing agreaments, we recommended, among other 

things, that BIA develop a systematic mechanism for tracking these 

agreements through the review and approval process. Interior concurred 

with this recommendation and stated that BIA will develop such a 

mechanism, however in the meantime it would use a centralized tracking 

spreadsheet. 

25Gil0, lndJan Energy Developmr;mt: Interior Could Do More to lmpro'lrJ Its ProcGss for 

Approving Reven(le-$/JE!ring Agieememt, GA0-16.55S (Washington, D.C .. June 13, 2016). 
30 


517a23.eps

Ineffective collaboration and 

limited communication 

In June 2015, we reported that the added ~omplexill' of the Federal 

regulatory process, which can Include multiple regulatory a~;encies, 

prevents many developers from pursuing Indian energy resources for 

development." Subsequently, in November 2016 we reported that Interim 

had reo:ognized the need for collaboration in the regulatory process and 

described the creation of the Service Center as a center point of 

collaboration for permltling that will break down barriers between federal 

agencios."' We found that BIA had taken steps to form a Service Center 

that was intended to, among other things. help expedite the permitting 

process aosociall>d with Indian energy development. We reported that the 

Ser;Jce Center had the potential to increase collaboration between BIA 

and BLM on some permitting requirements associated with oil and gas 

development However, we found that BIA did not coordinate with other 

key regulatory agencies, Including Interior's Fish and Wildlife Ser;ice, the 

U.S. Amy Corps of Engineers, and the Em~ironmental Protection Agency. 

As a result, the Service Center was neither functioning ~s tte centr~l 

point for collaborating with all federal regulatory partners ge1erally 

involv.;d in energy development, nor did it serve as a single point of 

contact for permiHing requirements. Without serving in these capacities, 

we concluded that the Ser;ir.:e Center was ITmited in its ablll:y to Improve 

efficiencies in the federal rngulalory process. We also Foun~ that in 

forming the Service Center, BIA did not involve key stakeh(jdam, such as 

the Department of Energy (DOE)-an agency with significant enef!Jll 

expertise-and BIA employees from agency offices_ By not involving k<ly 

slaketJJlders, BIA was misoing an opportunity to Incorporate their 

expertise Into Its efforts. 

In our ~ovember2af6 report, we recommended that BIA include other 

regulatory agencies in the Service Center so that It can aot as a single 

point afcontaot or a lead agency to coordinate and navigate lhe 

regutalory process. We alao recommended that BIA establi•h formal 

agreenentswilh key stakeholders, such as DOE, t11at ldentfy the role of 

each stakeholder, and establish a process for seeking ~nd obtaining Input 

from key stakeholders, 3Ucll as BIAemployees, on the Ssp,ir.:e Canter's 

activities. Interior agreed with our recommendations and sl•ted it will 

implement Memoranda of Understanding to include the Cofls, FVVS, and 

'"'GA0-15-500. 

riGAO,II!dlon Enorgy D<!•ro/llJlmonr: ~rfrli/rom!l Ao!ioos Oy Fedemr Agom/os Aro Noodod to OvorwmoFoo1DISHitlO\rlin.g OW<li<lpmonl, GA0-17---'I~(WashinQion,D.C- Nov_ 10. 

2016~ 
31 


517a24.eps

limited federal workforce 

planning 

EPA that defines roles and respon.sibilities of eacl1 agency by December 

~1. 2017. 

In 2005, Congress pr<l11tded an option for tribes to enter into an 

agreement with the Secretery or the Interior that allowstri!J.es, at their 

dlscre!lon, to enter Into leases, business agreements, and rights-of-way 

agreements for energy resource development on tribal lands without 

ravlew and approval by the Secretary. However, in a June :mt5 report 

'""found that uncertainties about Interior's regula lions for implementing 

this option had contributed to deterring tribes fmm pursuing such 

agreements, We therefore recommended that Interior provide clarifying 

guidance." In response to our recommendal1on, Interior stated 11 wm 

provide additional energy development-specific guidance on provisions of 

tribal energy resource agreement regulations tribes have identified as 

unclear by September 30, 2018. 

In our June 201ti report. we found that BIA's long-standing w.:>rkforce 

challenges, such as inadequate staff resourc~s and staff at some offices 

without the s~llls needed to elfecli~ely re~iew energy-related documents. 

were factors hindering Indian energy devslopment" Further, in 

November:2015, we found BIA had Migh vacancy rates at some agency 

olflces and that the agency had not condud~d kByworkforce planning 

activities. such as identifying the key workforce skills needed to achie~e 

agency goals and assessing any skill gaps."'We concluded that these 

W<Jrkforce issue,<; contributed to BlA's management shortcomings that 

have hindered Indian energy development: and until BIA undertakes 

necessary workforce planning activities, it cannot ensure that it has a 

world'oroo vrith the right skills, appropriately aligned to meet the agency's 

goals and tribal prloriUes. We recommended that BIA assess cfltical skills 

and competencies needed to fulfill its responsibilities related to energy 

development and identify potential gaps. Wa also recommended BIA 

establish a documented process ror assessing BIA's wmld'orce 

composmon at agency offices laking into ae<;ount B!A'~ mi.,ion. >loals, 

and tribal pr.arities.lnterjar agreed with our recommendations and stated 

it is taking steps to implement them by Se[lhlmber 30, 2017. 

"t~I<0.15-5D2. 

"GA0-15-.51)2. 

00GAQ..17-43. 
32 


517a25.eps

Outdated and deteriorating 

equipment. te~hnology, and 

infrastructure 

Incomplete and inaoourate 

data 

Open Recommsndations on 

Indian Energy Development 

In Jure 2015, we found that BIA does not have the neoossary geographl~ 

information system {GIS) mapping data for Identifying who owns and uses 

resou-ces, such as exlsting leases. lntenor guid~nce states that efflo1ent 

manaJement of oil and gas resources relies, in part, on GIS mapping 

techmlogy b<!oause it allow.; managers to easily Tdenti!Y resources 

available for leasa and where leases are in effect." According to a BIA 

officia, wiThout GIS data, the proc..ss of identifying transacbons, such as 

leases and access agreements for Indian land and resources, can take 

slgni!i::ant time and staff resources to search paper records stored in 

mul\i~le locations. We recommended 81A should take steps!<> Improve its 

GIS capabilities to ensure it can verily ownership in a timely manner. In 

response, Interior staled It will enhanc~ mapping cepebilitles by 

developing a national dataset oomposed of all Indian land tracts snd 

boundaries in the next 4 years. 

In June 2015, we found that BIA did not have the data it needs to verily 

who cwns some Indian oil and gas rnsources or identifY where teases are 

in effect." In some cases, BIA cannotver11y ownership because federal 

cada!tral surveys-the means by which land is defined, divided, traced, 

and recordsd----Gannol be found or are outdated. We concluded that the 

ability to account for Indian resources would assist BIA in fulfilling its 

federal trust responsi~illty, and determining ownership was a necessary 

stepflr BIA to approve leases and other energy-related documents. We 

mcommended that Interior direct BIA to Identify land survey needs_ In 

response, Interior alated it will develop a data collection too! to IdentiFy the 

exten: of Its survey needs In IT seal year 2016_ As of April 20t7, Interior 

had not provided information on the status of i\5 efforts to develop a data 

collection tooL 

When we issued our February 2017 High-Risk update, we had made 14 

recommendations to BIA regarding 6ct1ons needed to help develop Indian 

energy resources. All14 recommendations remain open. Specifically, 

To help ensure BIA can veriFy ownership in a timely manner and 

id•ntify resouroos available for development, we made 2 

rocommendaUons, Including that Interior tak"' otepo to mopwve II> 

g•ographlc Information system mepping capabilities. 

"GA0-15-502. 

"'GA0-15-502. 
33 


517a26.eps

Indian Health Care 

Inadequate oversight offederal 

activities 

To help ensure BIA's review process is efficient and transparent, we 

made 2 recommendations, including that lnteriortak~ steos to 

develop a documented process to !reck review end response times for 

energy-related documents lllat must be approved l>elore tribes can 

de"•lop energy resources. 

To hBip improve c:larity of tribal energy resouroe sgreemtnt 

regulations, we recommended BIA provide additional guidance to 

tril>es on provisions that tribes have identified to Interior ss unclear. 

To help ensure that BIA's effort to streamline the review and approval 

process far revenue-sharing agreements achieves its objectives, we 

made 3 recommendation~. inchli"l!lh~t lniPrinr ~st~bli.•h tim" 

fr;;mes for \he review and ~pproval of Indian revanue-sha~ng 

agrnementsfor oil and gas, and e<ltablish a system tortr~oklng and 

monitoring the review and approval process to detennlne whether 

time frames are met. 

To help Improve efficiencies In the federal regulalol)l protess, we 

made 4 recommendations, induding that BIA take sreps to ~oordinaW 

with otherregulatmy agencies so the Indian Energy Service Center 

can serve as a single point of oontactor lead agency to navigate the 

regulato(\1 process. 

To help ensure that it has a vmrkforcewilh the right skills \hat are 

appropriately aligned to meet the agency's goals and tribal prtorities. 

we made 2 recommendations, including that BIA establish a 

documented pro~~•• for a.,.e.,;ing BIA's workforce com~osilion at 

agEncy omces. 

IHS provides inadequate oversight of lrealth care, both allis federally 

operated facilities and through the PRC program. In January2017, we 

reported that IHS provided limited and lnoonslstent oversight of the quality 

of care provided In It~ federallY operated facilities." As a res\.11, the 

agency cannot ensure that patients receive quality care_ IHS hes recently 

finalize:l a quality framework de~igned to address these deficiencies and 

improve Its oversight We recomm .. nded that, as part of Implementing the 

quality FramBWOrk, IHS ensum that agency-wide standards !or the quality 

of care provided in its feder;;lly operated faoil~ies are developed, and \hal 

"GAO, lrl<lia~ Hoallh S•rvioe: A<"i'ion• Neerle<i la lmJJf<Jve Ovemig!rl of O<.o/ily Care, 

GA0-17·1B1)Wash'"gton, D.C J•n Q,2017)_ 
34 


517a27.eps

facility performance in meeting these standards is systematically 

monitored over time. HHS agreed with our recommendation and cited 

steps it already has underway to improvs the quality of care in IHS's 

federally-operated facilities. HHS described the development of the IHS 

Quality Framework and Implementation Plan released in November 2016. 

However, as of April2017, IHS had not developed agency-wide 

standards for the quality of care provided in its federally operated 

facilities. 

In March 2016, we reported that IHS had not set any agency-wide 

standards for patient wait times at IHS federally operated facilities, 

Including how long It should take to schedule an sppointment and 

complete an office vlslt.34 According to tribal representatives, pslients 

reported difficulty scheduling primary care visits because of extended wait 

times. For example, one facility reported that new patients may wait 6 

weeks for an initial exam with a family medicine physician, and new 

patients in internal mEdicine may wait 3 to 4 months for an initial exam. 

We found that IHS has delegated this responsibility to its area offices and 

has not conducted any systematic, agency-wide oversight of the 

timeliness of primary care. We concluded that, without tllese standards, 

IHS cannot know whether It Is providing sufficient primary care to meet 

the needs of its patients. We recommended that IHS develop and 

communicate specific agency-wide standards for patient walt times In 

federally operated facilities, monitor patient walt times, and take 

corrective actions when standards are not met. HHS stated that it agreed 

with the need to improve patient wait times at IHS federally-operated 

facilities to ensure that primary care is available and accessible to 

Indians. In response to our recommendation, HHS described its plan to 

establish an Office of Quality Healtll Care at IHS Headquarters to provide 

for national policy and oversight of critical quality improvement strategies 

and ensure their success and accountability. As of April 2017, IHS has 

not established the Office of Quality Health Care and has not developed 

agency-wide standards for patient wait times in federally operated 

facilities. 

In June 2012, we found that IHS had taken few steps to evaluate 

variations in the funds it allocates for the Contract Health Services 

34GAO, Indian Hrm/111 SeiVice: Ac/iOIJS Needed to Improve Oversight of Patient Wait 

Timos, GA0-16-JJ3jWashlngton, D.C.: Mar. 29, 2016). 
35 


517a28.eps

Ineffective collaboration and 

limited communication 

progr~m (now called PRC), whlcll varied from $299 to SB01 par capita 

across the 12 IHS geographic areas in ~seal year 2010." IHS did not 

know the origin of the base funding formula, which, according to IHS 

officials, had existed since the 1930s and accounted for 82 percent or the 

funds •llo<>ated to the araa offices in fiscal year 2010. Annual adjustments 

for population growth and inftation were made as a percent<ge of base 

Iundin~ and are t11e same across all areas. Additional program increases 

were not large enough to alter funding variations because ttese 

additional increases had been a relatively small proportion cf PRC funds 

that area offices received, Because IHS continued to use this 

m~thoo!ology, w~ condud~d that it could not equitably allocate funds to 

mesl:lhe health care needs of Indians. In order to ensure IKS equitably 

allocates PRC funds, we recommended that Congress con:!k!er requiring 

IHS tode~elop and use a new method to allocate funds to account for 

~a notions across oreas. Legislation introduced in the House and reported 

out of committee In 2018 would have addressed this issue by requiring 

the agency to establish regulations to develop and implement a revised 

PRC cistribution fonnula taking Into account cenetn faclors that may vary 

aero.,; areas. Also, a House Report partially addressed this issue by 

directilg the agency to allocate an Increased funding increment resulting 

from Interiors 2017 regular appropriation, H.R. 5538, pursuant to a 

specifed allocation formula that may vary across areas. However, ne~her 

bill became law. 

In a June 2012 report, we found that IHS does net require its area offices 

to info111 IHS heodquarters If they dlstrtbute program increase funds to 

l<>o~l PRC ~r<>grame uelng dlffar~nt orlt~rl~ th~n !he PRC alb=lion 

formula suggested by headquarters." As a result, we concluded that IHS 

may b= unaware of additional funding variation across ara ... We 

recorm~ended that IHS devetopwrllten policies and procedures to require 

area offices to notify IHS when they diverge from the formula for 

allocating funds to PRC programs. HHS concurred willl this 

recorrrnendallon and noted that guidance requiring area offices to report 

these =hang as to IHS headquarters would be added to the PRC manual, 

but it did not spectry a dale for doing so, As ol April2017, It-S had not 

add&dthls guidance to tha manual. 

"'GAO.In<fi8n HeM~ SeMCO: ACMO ~'e<<!Od ~ E/l;tlo'O i!:qlllroblo All=ol/co af 

RMI1Lrt<e8 {()(lit" Contract Hoamt Sofl'ioos Progrnm, M0-12-4~5 (Wo~lirql<m, D.C.; 

June 1>, 2012) 

00 GA0-1~-<<9 
36 


517a29.eps

Limited federal workforce 

planning 

In a March 2016 report, we reported that according lo IHS ofiT~ials, an 

1nsuflio1entworkfarce was tile biggest Impediment to ensuring patients 

oouldaocass ~mely primary care." According to IHS's 2016 budget 

justification, there were O'lef 1,550 vacancies lor heallh care professionals throughout IHS's health care system Including: physicians, 

dentlots, nurses, pharmacists, physician assistants, and nurse 

practi·ioners_ According 1<> IHS officials, staffing vacancies rad created 

obsta-,les for facilities worklrtg to provide primary care. 

In January 2017, we found !hot inconsistencies in lHS's oversight of 

qualllr of care provided in its federally operated facnities w..-e 

exacerbated by significant turnover in area Jeadernhip_ '" Officials from 

iour of the nine area offices in our review reported that they had at lea$! 

three area directors in the pas\5 years, (See fig, 10), 

""GA0.11).~33 

'"GA0-17-181 
37 


517a30.eps

Flguro 10: 

I II II II II II II I II 

[[ [[ 

II II II II II II II II 

I II II I II II 

1111 

I '"'"""•"'~'" 

~~~.:! '""-''""""'-" '''""""""" 

''"'~ =~.-,....~"'""""""'"'"""""""" '""'""""'" NOlo: Til's r...,ro r<loeio lhe number of oo~~'"' ""'~foe • ;.,~,.to~ Umo """' Onolnd''"'"'' ooul:< be ""''«d ""''<l•'"""' '' ""'"''"''""' ~>olo 00111 ooUn~ >nd pormanen1 oosl~on5 lor ollrorel'lt """"'f.l"'"' "''" """"''· In"''" ,.,.-eu,..,..,o., c,.,., Plain<,~'""'~' "" Portrentl-en '""'g '''"""'"""'."''"too oormonm """'"'"· In""""''""""'·~~"""''"' 1t;• 

"""' "'' '''""''· 'Anloofl",jals repono< ~formolloo "'""''" Jul)o2016. 
38 


517a31.eps

Outdated and deteriorating 

equipment, technology, and 

infroatruoturc 

In September 2013, we found that IHS did not have an effective plan to 

ensure that sufficient staff would be in place to assist with Increased 

enrolment and thinl party billing undere><panded Medicaid or \he 

exchonges beginning in Z014 under PPACA." We concluded thatwitlmut 

a plan. IHS may not be able to ensure that a sufficient number of staff 

were available to ~ssistwilh enrollment and to process increased ltlird· 

party payments. We recommended that IHS realign nurrentresourc:e5 

~nd personnel to in.,..ease capacity to assist with these efforts. HHS 

neither agreed nor disagreed with our recommendation, and as of April 

2017 IHS had not implemented IL 

In Dac:smber 2013, we reported tha~ according to loo:at PRC program 

offidals, insuflident staffing for ths PRC program affected their ability to 

lssve timely pvr~hase orders for health oare services appro'/Bd by the 

program." IHS's staffing standards model established a staffing ratio 

base~ on the annual number of purchase orders euthorized lor health 

aerJlces at a fadlity. and some PRC program officials notec that their 

number of staff was below these standards. contrlbu~ng to delays in 

detennlnlng eligibility lor the program and processing payments to 

providers. We recommended lhatlHS use avallable PRC funds to pay lor 

PRCprogram staff. HHS disagreed with !his recommendation. stating Its 

Intent to use PRC funds to pay only fur services. not staff. since PRC 

funding was not sufficient to pay for ell needed services. We 

acknowledged the difficult challenges ~nd choices faced byPRC 

programs when program funds are not available to pay for all needed 

serJices_ However. we maintained that without using funds to pay for 

staff, some PRC programs would continue to have staffing tovels below 

IHS"s staffing standards model, which ocntrlbutes to delays In 

administering the program. As oi April2017. IHS had not irrplemenlad 

this recommendation. 

In M<rch Z016, we reported that, according to IHS officials, accees to 

time~!' primary care at some health care facililias serving Indian 

communitle~ i~ hindered by ~ut<!al<!d me<lieal and t~lecommunication~ 

"GAO·l!.-553. 

"GJ>.o. Ill~IOn HO<>IIn SOIVIOO>' OppotWnlrroo Moy Exlsl To lm(JWVO Tho Con/mot HoB/IIr 

Sorvl<ns Progrom, GA0-1•-S7 IW<'5nlnBI<>n, O.C.- Oeo. t t. ;!01'). 
39 


517a32.eps

Incomplete and in~ccur~te 

d~ta 

Open Recommendations on 

Indian Heallh Cera 

equipment, suoh as analog mammography machines and telephones with 

an insufficient number of lines for sche<luling patient appoirllments." 

In~ June 2012 report, we found that IHS officjaJs do not beie"e that its 

PRC program data are complete or that areas C<Jilect these data 1n the 

s~memanner." We concluded lh~t, without ~ccurate data. IHS cannot 

know if the proportion of actual PRC users is consistent a<:ross areas. We 

made three recommendations to Improve the accuracy oftte PRC data 

forfutum allocationo. including using ~dual oountt; ofPRC users. using 

wriation in le~els of aV<lilable hospital services in the fundlrg formula. 

and. as mentioned above. requiring area offices to notify hsadquarters 

when they diverge from U1e formule for ~lloc~ljng funds !() PRC pragrams. 

HHS did notconourwith our recommendation to use a~tualcounts of 

PRC users, rather than aiiiHS users, in any formula for allcx;oting PRC 

funds that relfes on the numberot active users, stating that IHS"s 

C<Jmbined C<Junt of all users is intended to re-flect the health care needs of 

PRC users. HHS concurred with our reC<Jmmendation that IHS use 

variations in levels of available hospital se!Vices to allocate PRC funds. 

As of April2017, IHS had not implemented these reC<Jmmendatlons. 

In D<lcember 2013, we reported that one of the measures fHS uses to 

asse!'ll the time it !ekes Ia approve end process payments to providers in 

the PRC program did not provide a clear picture otlime11ness because it 

C<Jmbines data for two different types of PRC services." Wa 

recommended that IHS take steps to improve its ability to rr.easure 

timeliness by modifying its claims date system to distingui•h between two 

types of referrals and establish separate timeframe targets for each type. 

HHS ooncurmdwlth this recomm<!nda.tion. buta.s Aprll2017. IHS had not 

impl<!mented it. 

When we issued our February 2017 High-Rlsk update. we had made 14 

reoommendalions to HHS reg~rding Improvements needed in the 

management oftHS facilities. all14 of which remain unaddressed. 

Although IHS has taken sl!lleral actions in response to our 

recommendations. such as improving the date collected for the PRC 

"GA0.11>-~!3 

"GA0-'2 ... 6 

"GA0.1o.i;1 
40 


517a33.eps

program and adopting Medicare-like rates for non-hospital services, 

additional steps are needed. Specifically, 

• To help ensure that Indian people receive quality health care, we 

recommended that the Secretary of HHS direct the Director of IHS to 

take the following two actions: (i) as part of implementing IHS's 

quality framework, ensure that agency-wide standards for the quality 

of care provided in its federally operated facilities are developed and 

systematically monitor facility performance in meeting these standards 

over time; and (2) develop contingency and succession plans for 

replacing key personnel, including area directors. 

• To help ensure that timely primary ca-e is available and accessible to 

Indians, we recommended that IHS: (1) develop and communicate 

specific agencywwide standards for wait times in federallywoperated 

facilities, and (2) monitor patient wait times in federallywoperated 

facilities and ensure that corrective a~tions are taken when standards 

are not met. 

• To help ensure that IHS has meaningful information on the timeliness 

with which it issues purchase orders authorizing payment under the 

PRC program, and to improve the timeliness of payments to 

providers, we recommended that IHS: (1) modify its claims payment 

system to separately track IHS referrals and self-referrals. revise the 

Government Performance and Results Act measures for the PRC 

program so that it distinguishes between these two types of referrals, 

and establish separate timeframe targets for these referral types; and 

(2) better align PRC staffing levels and workloads by revising Its 

current pmctices, where available, used to pay for PRC program staff. 

In addition, as HHS and IHS monitor the effect that new coverage 

options available under PPACA have on PRC funds, we 

recommended that IHS concurrently develop potential options to 

streamline requirements for program eligibility. 

• To help ensure successful outreach efforts regarding PPACA 

coverage expansions, we recommended that IHS realign current 

resources and personnel to increase capacity to deal with enrollment 

in Medicaid and the exchanges and prepare for increased billing to 

these payers. 

• If payments for physician and ot11er nanhospital services are capped, 

we recommended that JHS monitor patient access to these services. 

• To help ensure a more equitable allot:atlon of funds per capita across 

areas, we recommended that Congress consider requiring IHS to 

develop and use a new method for allocating PRC funds. To make 
41 

The CHAIRMAN. Thank you. 

We will now turn to Acting Secretary Black. 

STATEMENT OF MICHAEL S. BLACK, ACTING ASSISTANT 

SECRETARY, INDIAN AFFAIRS, U.S. DEPARTMENT OF THE 

INTERIOR 

Mr. BLACK. Chairman Hoeven, Vice Chairman Udall and members of the Committee, my name is Michael Black. I am the Acting 


517a34.eps
42 

Assistant Secretary for Indian Affairs at the Department of the Interior. 

Thank you for the opportunity to present testimony on behalf of 

the Department regarding Indian Affairs’ role in the development 

of Indian energy and its recent high risk designation in the GAO 

High Risk Report issued in February. 

Let me begin by stating that the President and the Secretary 

have made a clear commitment to advancing America’s energy 

independence through responsible resource development. Tribes 

play a critical role in this conversation, as energy development 

ranging from clean coal to oil and gas to wind creates good-paying 

jobs and bolsters tribal economies. 

The development of energy resources offers tribes opportunities 

that otherwise do not exist, particularly in rural areas. Strong tribal economies strengthen the exercise of tribal sovereignty and the 

Department continues to promote tribal energy development. However, as previous GAO reports have explained, there are many opportunities for us to improve. 

To avoid any confusion, let me be clear that the Department 

agrees with GAO’s recommendations and we are dedicated to implementing widespread reform to help foster energy independence 

among tribes interested in developing their resources. 

As a former Director of BIA and current Acting Assistant Secretary, I know these issues well and acknowledge that we have a 

significant amount of work to do. My written testimony addresses 

GAO’s recommendations and highlights our current progress toward implementation. 

GAO made 14 recommendations that will help Indian Affairs to 

promote energy development in Indian Country, including better 

utilization of GIS mapping tools and improved data collection and 

tracking systems. 

We are currently working to address the recommendations. As an 

example, BIA is working to utilize an off-the-shelf mapping tool 

with our Trust Asset and Accounting Management System, 

TAAMS, in order to integrate data viewing and our map creation 

capabilities into the TAAMS at the desktop level. 

The GIS Map Viewer will be based on verified legal descriptions 

and ownership data available in TAAMS with base reference data 

for mapping. Recently, the GIS Map Viewer was successfully tested 

with TAAMS and is now being reviewed for compliance with DOI 

and Indian Affairs information technology and electronic security 

policies and procedures. 

We are also working to address recommendations related to 

tracking systems and data collection by pulling together a group of 

subject matter experts in oil and gas processing to identify key 

identifiers and data fields need to track and monitor review and response times for oil and gas leases. 

We will utilize the information gathered during this process to 

make necessary modifications to TAAMS in order to improve efficiencies and timeliness in processing workloads. 

Indian Affairs is also in the process of standing up the Indian 

Energy Service Center which is the result of a concept paper produced by a multiagency team formed by the Indian Energy Minerals Steering Committee. The multiagency team held a tribal lisVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00046 Fmt 6633 Sfmt 6601 S:\DOCS\29354.TXT JACK
43 

tening session, met individually with oil and gas tribes and the Coalition of Large Land-Based Tribes and also received written comments in an effort to gather input from relevant stakeholders. 

One of the recommendations was to include other regulatory 

agencies in the service center such as Fish and Wildlife Service, 

the Environmental Protection Agency and the Army Corps of Engineers so that the service center can act as a single point of contact 

or a lead agency to coordinate and navigate the regulatory process. 

Recognizing the importance of these stakeholders, the service 

center is developing streamlined and standardized programmatic 

coordination with these agencies to the greatest extent possible. 

This includes memoranda of understanding with the appropriate 

department bureaus and other Federal agencies involved in the development of Indian energy and mineral resources. In addition, the 

BIA, through the Indian Energy Minerals Steering Committee, has 

also established Federal partner groups, where needed, which include BIA, the Bureau of Land Management, the Office of Natural 

Resource Revenue, the Corps of Engineers, Fish and Wildlife and 

EPA. 

These groups provide field knowledge on energy and mineral 

issues and serve to facilitate and focus and assume the point of 

contact desired by the respective parties regarding the processing 

of energy development for each region. 

The Department is also working to implement GAO’s recommendation that DOI provide additional energy development-specific guidance on provisions of the Tribal Energy Resource Agreement or TERA regulations the tribes have identified to the Department as being unclear. 

The Department believes that clarity can be best achieved by 

amending the Indian Minerals Development Act of 1982 to insert 

tribal self-determination language similar to that found in the 

Helping Expedite and Advance Responsible Tribal Homeownership, 

the HEARTH Act of 2012. 

The HEARTH Act permits tribes to lease surface trust lands for 

renewable energy purposes absent approval by the Department by 

implementing their own leasing regulations. In prior testimony to 

this Committee, the Department recommended Congress consider a 

HEARTH-like fix in the conventional energy arena by amending 

the law to match the HEARTH Act provisions. We would be willing 

to work with the members of this Committee on such an amendment. 

Thank you for the opportunity to present testimony today. The 

Department is committed to upholding the trust responsibility to 

tribes and implementing GAO’s recommendations. I look forward to 

answering any questions you may have. 

Thank you. 

[The prepared statement of Mr. Black follows:] 

PREPARED STATEMENT OF MICHAEL S. BLACK, ACTING ASSISTANT SECRETARY, INDIAN

AFFAIRS, U.S. DEPARTMENT OF THE INTERIOR

Chairman Hoeven, Vice Chairman Udall, and Members of the Committee, my 

name is Michael Black and I am the Acting Assistant Secretary for Indian Affairs 

at the Department of the Interior. Thank you for the opportunity to present testimony on behalf of the Department of the Interior (Department or DOI) regarding 

Indian Affairs’ role in the development of Indian energy and its recent high risk desVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00047 Fmt 6633 Sfmt 6621 S:\DOCS\29354.TXT JACK
44 

ignation in the Government Accountability Office (GAO) High Risk Report (GAO– 

17–317 High Risk Series). 

The President and the Secretary have made a clear commitment to advancing 

America’s energy independence through responsible resource development. Tribes 

play a critical role in this conversation, as energy development ranging from clean 

coal to oil and gas to wind creates good-paying jobs and bolsters tribal and local 

economies. In many instances, the development of energy resources offers Tribes opportunities that otherwise would not exist, particularly in rural areas. 

Strong tribal economies strengthen the exercise of tribal sovereignty, and the Department continues to promote tribal energy development. However, as previous 

GAO reports have explained, there are many opportunities for us to improve our 

support for tribal energy development. The Department agrees with GAO’s recommendations and we are dedicated to implementing widespread reform to help foster energy independence among Tribes who are interested in developing their resources. As the High Risk report notes, GAO has made fourteen recommendations to the 

Bureau of Indian Affairs (BIA), via three reports, all of which currently remain 

open. As the former Director of BIA and current Acting Assistant Secretary, I know 

these issues well and acknowledge that we have a significant amount of work to do. 

My testimony today will address GAO’s recommendations and highlight our current 

progress towards implementation. 

GAO 15–502 

Recommendation 1: To ensure it can verify ownership in a timely manner and identify resources available for development, BIA should take steps to complete its 

GIS mapping module in TAAMS. 

Indian Affairs agrees that promoting energy development in Indian Country requires timely verification of ownership and identification of resources available for 

development. The Department understands that GIS mapping of Indian lands is exceedingly important and we are working toward utilizing a GIS mapping tool for 

Indian lands and developing a GIS policy. However, the Trust Asset and Accounting 

Management System (TAAMS) was not designed as a geospatial mapping system, 

but simply to reflect legal descriptions as they appear on documents recorded as required by federal law. 

Thus, the BIA is not building out the GIS mapping module in TAAMS. Instead, 

the BIA will utilize commercially available, off-the-shelf mapping technology to integrate data viewing and map creation capabilities into TAAMS at the desktop. The 

GIS Map Viewer will be based upon verified legal land descriptions and ownership 

data available in TAAMS with base reference data for mapping. Recently, the GIS 

Map Viewer was successfully tested with TAAMS and is now being reviewed for 

compliance with DOI and Indian Affairs Information Technology (IAIT) electronic 

security policies and procedures for TAAMS. IAIT Change Advisory Board (CAB) 

and Architectural Review Committee (ARC) are expected to grant a preliminary Authority to Operate (ATO) within 180 days of review of the GIS Map Viewer security 

application for TAAMS. The GIS Map Viewer is scheduled for deployment by September 1, 2017. 

Recommendation 2: To ensure it can verify ownership in a timely manner and identify resources available for development, BIA should work with BLM to identify 

cadastral survey needs. 

A survey is an important step in developing a full inventory of trust resources, 

yet in more than a century since the establishment of Indian reservations, the federal government has not yet fully surveyed all Indian reservation lands. As in years 

past, the BIA and the BLM, in a coordinated and focused effort, have prepared a 

Reimbursable Service Agreement between the two agencies to identify and deliver 

the much needed survey-related products and services. Cadastral survey inventories 

are being evaluated and FY17 survey requests have been approved for funding and 

completion by BLM. 

Recommendation 3: To improve the efficiency and transparency of its review process, 

BIA should develop a documented process to track its review and response times. 

The GAO recommended the BIA develop a process to track BIA review and response times. A group of BIA subject matter experts in oil and gas processing have 

been working to modify TAAMS, incorporating the key identifiers and data fields 

needed to track and monitor review and response times for oil and gas leases and 

agreements. BIA is also in the process of evaluating and reviewing the current realty tracking system and TAAMS in order to improve efficiencies and timeliness in 

processing workloads. Due to the fact that modifications to data systems must be 

45 

reviewed by multiple entities within the Department, a request for an extension of 

time will be submitted to the GAO within this quarter. 

Recommendation 4: To improve the efficiency and transparency of its review process, 

BIA should enhance data collection efforts to ensure it has data needed to track 

its review and response times. 

BIA is in the process of evaluating the data collection efforts used by various systems. Efforts are underway with subject matter experts to analyze and develop recommendations for improving data collection, tracking and business processes. 

Recommendation 5: Provide additional energy development-specific guidance on provisions of Tribal Energy Resource Agreement (TERA) regulations that tribes have 

identified to Interior as unclear. 

The Department is working to implement GAO’s recommendation that DOI provide additional energy development-specific guidance on provisions of TERA regulations that tribes have identified to the Department as unclear. The Office of Indian 

Energy and Economic Development (IEED) continues to perform training and technical assistance on the TERA regulations, and will issue guidance on those provisions of TERA that have been identified as unclear. 

The Department believes that clarity can be best achieved by amending the Indian Minerals Development Act of 1982 to insert tribal self-determination language 

similar to that found in the Helping Expedite and Advance Responsible Tribal 

Homeownership (HEARTH) Act of 2012. The HEARTH Act permits tribes to lease 

surface trust lands for renewable energy purposes absent approval by the Department by implementing their own leasing regulations. In prior testimony to this 

Committee, the Department recommended Congress consider a HEARTH-like fix in 

the conventional energy arena by amending the law to match the HEARTH Act provisions. We would be willing to work with the members of this committee on such 

an amendment. 

GAO 16–553 

Recommendation 6: Establish required timeframes for the review and approval of Indian Communitization Agreements (CAs) to ensure a more timely CA process. 

The Department is working to ensure CA processes are timely. A National Policy 

Memorandum has been developed that establishes timeframes for review and approval of Indian CAs. Such timeframes will also be incorporated into the BIA Fluid 

Mineral Estate Procedural Handbook and the Onshore Energy and Mineral Lease 

Management Interagency Standard Operating Procedures. The Memorandum is currently undergoing review and approval within the Department. On April 27, 2017, 

the Department received notice than an extension was granted by GAO to extend 

the target date to the end of FY18. 

Recommendation 7: Develop a systematic mechanism for tracking Indian CAs 

through the review and approval process to determine, among other things, 

whether the revised CA process meets newly established timeframes. 

The BIA is developing a systematic mechanism to track Indian CAs through the 

review and approval process. As part of this effort, a group of BIA subject matter 

experts who meet regularly are working to implement identified enhancements to 

TAAMS. Until TAAMS can be modified to incorporate the key identifiers and data 

fields, the BIA is utilizing a centralized tracking spreadsheet on the Google platform. BIA leads the development and deployment of this tracking spreadsheet in 

consultation and coordination with BLM. We have received an extension from GAO 

to complete this recommendation by the end of FY18. 

Recommendation 8: Assess whether the revised CA process is achieving its objective 

to improve the timeliness of the review and approval of Indian CAs, and if not, 

make changes as appropriate. 

BIA and BLM will continue to use the tracking spreadsheet mentioned above, 

and, upon completion, the enhanced TAAMS, to monitor and assess the results of 

the efforts to streamline the Indian CA review and approval process. The bureaus 

will coordinate to establish a process for review of the collected data, which will assist in identifying and implementing any necessary process modifications. 

46 

GAO 17–43 

Recommendation 9: Include the other regulatory agencies in the Service Center, such 

as Fish and Wildlife Services, the Environmental Protection Agency, and the 

Army Corps of Engineers, so that the Service Center can act as a single point 

of contact or a lead agency to coordinate and navigate the regulatory process. 

The Indian Energy Service Center (IESC) is working to implement Memoranda 

of Understanding (MOU) with appropriate Department bureaus and other Federal 

agencies involved in the development of Indian energy and mineral resources and 

to define roles and responsibilities regarding the development of those resources on 

trust lands. MOUs are being developed with the Fish and Wildlife Service (FWS), 

Environmental Protection Agency (EPA), Army Corps of Engineers (Corps), as well 

as IEED and Department of Energy (DOE). 

The BIA, through the Indian Energy Minerals Steering Committee (IEMSC), has 

also established Federal Partners Groups, where needed, which include: BIA, BLM, 

Office of Natural Resource Revenue (ONRR), Corps, FWS, and EPA. These groups 

provide field knowledge on energy and mineral issues and serve to facilitate and 

focus the single point of contact desired by the respective parties regarding the processing of energy development for each region. 

Currently, Federal Partner Groups are being established for the Navajo Region 

and the Rocky Mountain Region. Federal Partner Groups for the Great Plains Region, the Eastern Oklahoma/Southern Plains Regions, and the Western Region are 

currently meeting on a regular basis. 

Recommendation 10: Direct the Bureau of Indian Affairs to establish formal agreements with IEED and DOE that identify, at a minimum, the advisory or support 

role of each office. 

BIA recognizes that in addition to the identification of potential energy resources, 

there must be organized coordination between agencies to fully develop and/or protect Indian energy and mineral resources. 

In an effort to improve communication between the two offices, an MOU was recently signed between IEED and DOE outlining a partnership going forward. Currently, the IESC is reviewing this MOU with the intent of entering into the existing 

agreement. The IESC expects to meet with IEED and DOE in the near future to 

help finalize the agreement. 

Recommendation 11: Direct Bureau of Indian Affairs to establish a documented process for seeking and obtaining input from key stakeholders, such as BIA employees, on the Service Center activities. 

Currently, the IESC is developing a process that allows key agencies to provide 

input and requests for service received on behalf of tribes from the IESC. The process will also include guidance on the prioritization of task orders. The Executive 

Management Group of the IESC, comprised of the directors of the BIA, BLM, 

ONRR, and Office of the Special Trustee for American Indians (OST), are engaged 

in this work. The IESC is currently drafting intake forms, which will be distributed 

to obtain input regularly from stakeholders. 

Recommendation 12: Direct the Bureau of Indian Affairs to document the rationale 

for key decisions related to the establishment of the Service Center, such as alternatives and tribal requests that were considered. 

The development of the IESC was the result of a concept paper produced by a 

multi-agency team formed by the IEMSC. The multi-agency team held a tribal listening session, received written comments, and conducted conference calls in an effort to gather input from relevant stakeholders. The final version of the concept 

paper also included an organization chart which set forth the IESC chain-of-command. The IEMSC accepted and approved the concept paper as presented by the 

multi-agency team. At this point, the BIA believes this recommendation is complete. 

Recommendation 13: Direct the Bureau of Indian Affairs to incorporate effective 

workforce planning standards by assessing critical skills and competencies needed to fulfill BIA’s responsibilities related to energy development and by identifying potential gaps. 

The BIA is in the process of identifying and implementing a workforce plan regarding positions associated with the development of Indian energy and minerals. 

First, the IESC will collect data directly from BIA, BLM, ONRR, and OST employees in an effort to identify workload and necessary technical competencies. Then, the 

IESC will work with partner bureaus to assess skills and competencies needed for 

energy and mineral workforce standards. This recommendation is expected to be 

completed by the end of 2017. 

47 

Recommendation 14: Direct the Bureau of Indian Affairs to establish a documented 

process for assessing BIA’s workforce composition at agency offices taking into 

account BIA’s mission, goals, and tribal priorities. 

The BIA plans to assess the BIA Indian energy and mineral workforce composition using the same process as described in Recommendation 13. This includes collecting data directly from BIA, BLM, ONRR, and OST employees 

Conclusion 

Thank you for the opportunity to present testimony today. The Department is 

committed to upholding the trust responsibility to tribes and implementing GAO’s 

recommendations. I would be glad to answer any questions the Committee may 

have. 

The CHAIRMAN. Thank you, Secretary Black. 

Rear Admiral Buchanan. 

STATEMENT OF REAR ADMIRAL CHRIS BUCHANAN, ACTING 

DIRECTOR, INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. BUCHANAN. Good afternoon, Chairman Hoeven, Vice Chairman Udall and members of the Committee. 

I am Chris Buchanan, an enrolled member of the Seminole Nation of Oklahoma, and the Acting Director of the Indian Health 

Service. I am pleased to have the opportunity to testify before the 

Committee on the GAO’s February 2017 High Risk Report. 

I would like to thank you, Chairman Hoeven, Vice-Chairman 

Udall, and members of the Committee for elevating the importance 

of delivering quality care throughout IHS. The mission of the IHS, 

in partnership with American Indian and Alaska Native people, is 

to raise the physical, mental, and spiritual health of American Indian and Alaska Natives to the highest level. Providing quality 

health care is our highest priority. 

We share the urgency of overcoming the longstanding, systemic 

problems highlight by the GAO. We are addressing these challenges. 

Our goal is to make improvements in all program areas identified in the GAO High Risk Report. In addition, we are intensifying 

our efforts to close out open Office of Inspector General recommendations. In April 2017, IHS successfully closed three longstanding OIG open recommendations. 

IHS has strengthened its Enterprise Risk Management Program. 

The GAO High Risk Report recommendations were directly incorporated into this program work for 2017. Additionally, all our senior executives in IHS are directly involved in the national risk assessment discussions. 

Improving patient access to care through our outreach, education 

and enrollment activities remains a top priority. From fiscal year 

2012 to fiscal year 2016, we saw a 21 percent increase in total 

Medicaid reimbursements and a 28 percent increase in total collections from private insurers. 

IHS is exploring ways to realign performance accountability to 

strengthen both field operations and headquarters oversight responsibilities by setting clear senior executive expectations and establishing clear lines of authority and accountability. 

In partnership with HHS, IHS developed a strong quality framework that is being implemented to assure that all hospitals and 

clinics have quality-focused compliance programs. We established 

48 

the position of the Deputy Director of Quality Health Care as part 

of the agency’s senior leadership team to provide a national focus 

for advising the IHS Director, providing leadership and guidance to 

the field and all aspects of assuring quality health care. 

This includes oversight of critical quality improvement strategies 

related to accreditation, certification, patient safety and quality 

care. 

We have made great progress in the past few months in regard 

to quality improvement initiatives. On April 28, IHS finalized a 

contract to purchase software for a national provider credentialing 

system. We plan to roll out the system in four pilot IHS areas in 

July of 2017 and to implement across the IHS areas by the end of 

2017. 

A request for proposals for a single accrediting organization for 

IHS hospitals will be released by July 2017. To help hospitals 

maintain accreditation, IHS established a formal partnership with 

our sister agency, CMS through a contract to support best health 

care practices and other organizational improvements for IHS federally-operated hospitals that participate in the Medicare program. 

In addition, IHS is developing performance accountability 

metrics to support headquarters’ oversight and monitoring functions. Earlier this month, we began pilot testing a system to collect 

standardized information on patient health care experience. Effective medical equipment is vital to patient safety and quality care. 

In July 2016, IHS established a new policy to ensure critical 

medical equipment used at IHS facilities is properly maintained 

and reliable. We mandated the use of computerized systems in all 

Federal health facilities to inventory medical equipment and provide information, longevity and reliability. 

We are implementing strategies to increase recruitment and retention to address longstanding workforce challenges. To share a 

few examples, IHS implemented a senior executive search committee process for recruiting highly qualified executives. 

Also, under the IHS–HRSA partnership, we made offers of National Health Service Corps scholarships and loan repayment incentives to recruit and retain primary care providers. As of April 

2017, 472 National Health Service Corps scholarships and loan repayment scholars have entered our workforce in IHS and tribal facilities. These examples demonstrate that IHS is taking its challenges seriously and is continuing to take assertive and proactive 

steps to address them. 

Thank you for your commitment to improving quality, safety and 

access to care for American Indians and Alaska Natives. 

I would be happy to answer any questions the Committee has. 

[The prepared statement of Admiral Buchanan follows:] 

PREPARED STATEMENT OF REAR ADMIRAL CHRIS BUCHANAN, ACTING DIRECTOR, 

INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Chairman and Members of the Committee: 

Good afternoon, Chairman Hoeven, Vice-Chairman Udall, and Members of the 

Committee. I am Chris Buchanan, an enrolled member of the Seminole Nation of 

Oklahoma and Acting Director of the Indian Health Service (IHS). I am pleased to 

have the opportunity to testify before the Senate Committee on Indian Affairs on 

the Government Accountability Office (GAO) 2017 High Risk Report. I would like 

49 

to thank you, Chairman Hoeven, Vice-Chairman Udall, and members of the Committee for elevating the importance of delivering quality care through the IHS. 

The IHS plays a unique role in the Department of Health and Human Services 

(HHS) because it was established to carry out the responsibilities, authorities, and 

functions of the United States to provide health care services to American Indians 

and Alaska Natives. The mission of the IHS, in partnership with American Indian 

and Alaska Native people, is to raise the physical, mental, social, and spiritual 

health of American Indian and Alaska Natives to the highest level. The IHS provides comprehensive health care delivery to approximately 2.2 million American Indian and Alaska Natives through 26 hospitals, 59 health centers, 32 health stations, 

and nine school health centers. Tribes also provide healthcare access through an additional 19 hospitals, 284 health centers, 163 Alaska Village Clinics, 79 health stations, and eight school health centers. 

Providing quality healthcare is our highest priority. We share the urgency of addressing longstanding systemic problems highlighted in the February 2017 GAO 

High Risk Report. I would like to describe for you how we are addressing these challenges and highlight examples of recent progress. 

Enterprise Risk Management Program 

IHS has strengthened its Enterprise Risk Management (ERM) Program, which 

closely aligns our Risk Profile to our activities under the Federal Manager’s Financial Integrity Act (FMFIA). A key element of the FMFIA, in addition to maintaining 

financial integrity, is providing annual assurance to the Secretary and the Congress 

that programs are effective and meet their objectives. The GAO High Risk Report 

recommendations have been directly incorporated into our ERM work for 2017. All 

senior executives in IHS have been directly involved in national risk assessment discussions with a focus on effective risk mitigation planned for all executives and 

managers in 2017. 

IHS has dedicated sufficient resources to ensure that we have the needed expertise in IHS Headquarters to lead and oversee a successful risk management approach to improvement in all program areas on the GAO High Risk Report. In concert with closer attention to unimplemented recommendations from GAO, we are 

also intensifying our efforts to close out open Office of Inspector General (OIG) recommendations. In April 2017, IHS successfully closed three long-standing OIG open 

recommendations, related to improvements needed in the IHS Behavioral Health 

Program. IHS has made progress in establishing and increasing partnerships within 

the agency, improved collaborations with other federal agencies and tribal organizations, and extensive training for program staff to ensure sustainability. 

IHS has increased senior management attention and priority on prior GAO recommendations related to management oversight of Indian health care and is implementing many positive changes. We are using the GAO findings and recommendations to inform our strategic and tactical planning efforts. 

Third Party Revenue 

IHS has diligently worked to improve access to care for our beneficiaries through 

outreach, education and enrollment activities that has resulted in higher total third 

party collections. We saw a 21 percent increase in total Medicaid reimbursements 

and a 28 percent increase in total collections from private insurers from FY 2012 

to FY 2016. Another result of enrollment activities is to increase patient access to 

care by having third party payers cover care provided outside of the Indian health 

system for eligible beneficiaries. Also, in all IHS areas, we have programs that are 

able to purchase health care beyond the medical priority I. 

Realignment and Reorganization 

IHS is exploring ways to realign performance accountability to strengthen both 

field operations and headquarters oversight responsibilities by setting clear senior 

executive expectations, and establishing clearer lines of accountability. We also 

want to strengthen executive leadership accountability for accomplishing the objectives of the priorities of IHS that will result in improvement of the quality of health 

care provided. 

Quality Framework 

IHS is strongly committed to assuring that all its hospitals and clinics have quality-focused compliance programs. In partnership with the HHS Executive Council on 

Quality Health Care, IHS developed a strong Quality Framework (QF) that is now 

being implemented. We developed the QF by assessing current IHS quality policies, 

practices, and programs, incorporating standards from national experts, consulting 

with tribal leaders, and including best practices and expertise from across the IHS 

50 

system of care, as well as leveraging quality specialists across HHS. The core elements are: 

• Strengthening Organizational Capacity to Improve Quality of Care and Systems, 

• Meeting and Maintaining Accreditation for IHS Direct Service Facilities, 

• Aligning Service Delivery Processes to Improve Patient Experience, 

• Ensuring Patient Safety, and 

• Improving Transparency and Communication Regarding Patient Safety and 

Quality to IHS Stakeholders. 

We established the position of Deputy Director for Quality Health Care as part 

of the agency’s senior leadership team to provide a national focus for advising the 

IHS director and providing leadership and guidance to the field on all aspects of assuring quality health care. Continuing the implementation of the strategic QF at all 

levels of IHS and in partnership with Tribal/Urban Indian organization partners is 

a key priority of this position. This includes oversight of critical quality improvement strategies related to accreditation/certification, patient safety, and quality 

care. 

Quality Improvement Initiatives 

We have made great progress in the past few months. On April 28th, IHS finalized a contract to purchase software for a National Provider Credentialing System, 

with a plan to roll out the system in four pilot IHS areas in July 2017 and a plan 

to implement across the other IHS areas by the end of 2017. The credentialing policy has been updated, and is the final stages of clearance. IHS plans to release a 

request for proposals for a single accrediting organization for IHS hospitals by July 

2017. To help hospitals maintain accreditation, IHS established a formal partnership with our sister agency, the Centers for Medicare & Medicaid Services (CMS), 

through a contract to support best health care practices and other organizational 

improvements for IHS federally-operated hospitals that participate in the Medicare 

program. 

IHS hospitals can partner with CMS, which is supporting a Quality Innovation 

Network—Quality Improvement Organization to support, build, and redesign, if 

needed, their hospital operating infrastructure in order to provide high quality 

health care services. Under this partnership, IHS hospitals are able to focus on improving leadership and staff development, data acquisition and analytics, clinical 

standards of care, and quality of care related to the Medicare program. 

In addition, IHS is developing a performance accountability dashboard and related metrics to support Headquarters’ oversight and monitoring functions. Earlier 

this month, pilot testing began for a system to collect standardized information on 

patient experience with care, using tablet devices. Workgroups are also finalizing 

standard setting for patient wait times and their measurement, and minimum 

standards for hospital Governing Board meetings. Beginning with the Great Plains 

Area, IHS is pilot testing a leadership coaching and mentoring program to strengthen organizational capacity to improve quality and governance. 

Effective medical equipment is vital to patient safety and quality care. In June 

2016, IHS established a new policy to ensure critical medical equipment used at 

IHS facilities is properly maintained and reliable. Additionally, we mandated the 

use of a computerized system in all Federal health facilities to inventory medical 

equipment and provide other information about longevity and reliability. As implementation continues, we expect to see improved management of our medical equipment inventory to ensure outdated and non-functioning equipment is replaced in a 

timely manner. 

Workforce Development 

One of the most difficult challenges for IHS remains recruiting and retaining 

highly skilled administrators and physicians in rural and remote areas. To make a 

career in IHS more attractive to modern health care practitioners and health care 

administrators, IHS is implementing various strategies to increase recruitment and 

retention. To share a few examples, IHS has implemented a senior executive search 

committee process for recruiting highly qualified executives. Search committees are 

made up of IHS leadership and tribal partners who are charged with candidate outreach, assessment, and vetting. Through this new process, the IHS is more widely 

advertising vacancies through Federal, State, and non-profit partners, and is actively seeking additional venues to attract a diverse applicant pool of qualified candidates. 

51 

IHS also has partnered closely with the Office of the Surgeon General to increase 

the recruitment of Commissioned Corps officers to provide management and clinical 

services throughout the IHS. The Commissioned Corps is offering expedited commissioning to applicants who commit to service in an IHS facility with critical staffing 

needs. In addition, the IHS and the Health Resources and Services Administration 

continue to work together to make the National Health Service Corps (NHSC) more 

accessible to fill health professional vacancies. This allows IHS facilities to recruit 

and retain primary care providers by using NHSC scholarship and loan repayment 

incentives. As of April 2017, 472 NHSC loan repayment and 21 NHSC scholars have 

entered our workforce in IHS and tribal facilities. 

These examples demonstrate that IHS is taking its challenges seriously, and is 

continuing to take assertive and proactive steps to address them. Thank you for 

your commitment to improving quality, safety, and access to health care for American Indians and Alaska Natives. I will be happy to answer any questions the Committee may have. 

The CHAIRMAN. Thank you, Admiral Buchanan. 

I will turn now to Director Dearman. 

STATEMENT OF TONY DEARMAN, DIRECTOR, BUREAU OF 

INDIAN EDUCATION, U.S. DEPARTMENT OF THE INTERIOR 

Mr. DEARMAN. Good afternoon, Chairman Hoeven, Vice Chairman Udall, and members of the Committee. 

Thank you for the invitation to appear today to provide a statement on behalf of the Bureau of Indian Education and its recent 

designation on the Government Accountability Office High Risk Report. 

I am Tony Dearman, an enrolled member of the Cherokee Nation, and the BIE Director. Prior to becoming the BIE Director in 

November 2016, I served as Associate Deputy Director for Bureauoperated schools, Education Line Officer, Superintendent of Riverside Indian School, a principal and Science teacher at Sequoyah 

High School. 

Sequoyah High School has had more than 60 students receive 

the Gates Millennium scholarship over the past 15 years. At Riverside Indian School, where my daughter attends, we effectively built 

cross-agency and local partnerships to address the varying needs of 

our students. 

The successes my schools achieve require transparency, collaboration and dedication by everyone. In my short time as Director, 

I, alongside my leadership team, have been working to bring the 

same focus to BIE. 

In February, the GAO released its High Risk Report designating 

BIE as a high risk agency. In three separate reports dating back 

to 2013, the GAO provided 13 recommendations to improve the Indian Affairs management of BIE schools. 

As of 2017, we have implemented three recommendations. We 

should have addressed these issues when they were first recommended by the GAO and I realize this lapse. I take full responsibility for these outstanding items on behalf of the agency. 

I am working with our senior leadership team within BIE as well 

as Indian Affairs, the Secretary’s office and the GAO to ensure we 

address the outstanding recommendations. Our goal is not simply 

to close out the GAO recommendations but to utilize GAO reports 

as a road map for BIE to establish and maintain comprehensive 

policies and procedures that ensure accountability and provide long 

term organizational stability. 

52 

Regarding GAO 13–774, we have implemented recommendations 

two, three and five which includes developing a communications 

strategy, appointing members to the BIE Department of Education 

Committee and revising a strategic workforce plan. 

We are continuing to assess the previous work while also working to implement recommendations one and four which are to develop documented decision-making procedures and a strategic plan. 

We plan to implement the remaining recommendations by the close 

of 2018. 

Regarding GAO–15–121, our work addressing these recommendations has been insufficient to date. We are moving forward to implement the report’s four outstanding recommendations, 

including the creation of a comprehensive workforce plan, information sharing and financial oversight policies, as well as a risk-based 

monitoring system. To that end, we plan to complete the work on 

Recommendations 1 and 2 no later than the close of 2018 and Recommendations 3 and 4 by the middle of 2019. 

Regarding GAO–16–313, for Recommendations 1 and 2, we 

worked with the Bureau of Indian Affairs to implement a safe 

schools audit that was completed at all BIE-funded schools in 2016. 

We must ensure the focus on completion does not detract from the 

quality of inspections. 

In addition, coordination and training is still needed to ensure 

sufficient work and follow up to which we are committed. 

With regard to Recommendations 3 and 4, we are conducting ongoing staff training, as well as working with Indian Affairs to provide support for school safety committees. Our agencies are working to produce formal policies and procedures to address shortcomings identified by a recently-formed interagency workgroup. 

Members of the Committee, thank you for the opportunity to 

present testimony today. While the designation as a high risk agency is a difficult matter to address, please know that I am not naı ̈ve 

when I say the GAO’s recommendations provide a concrete map toward sustained improvement. 

I appreciate the oversight this Committee is providing, as well as 

the expertise from GAO to help BIE address longstanding issues to 

better support Indian students. The GAO has laid out the tools for 

improvement. Now it is incumbent upon me and the rest of us at 

BIE to implement their guidance which will make us stronger, effective and accountable. 

There are great employees bureau-wide who wake up excited 

every day to improve a child’s life, a child who, like my daughter, 

has all the potential to succeed given the right tools. 

Thank you for your time and I would be honored to answer any 

of your questions. 

[The prepared statement of Mr. Dearman follows:] 

PREPARED STATEMENT OF TONY DEARMAN, DIRECTOR, BUREAU OF INDIAN

EDUCATION, U.S. DEPARTMENT OF THE INTERIOR

Good afternoon Chairman Hoeven, Vice Chairman Udall, and Members of the 

Committee. Thank you for the invitation to appear today to provide a statement on 

behalf of the Bureau of Indian Education (BIE) and its recent high risk designation 

on the Government Accountability Office (GAO) High Risk Report (GAO–17–317 

High Risk Series). 

53 

I am Tony Dearman, a member of the Cherokee Nation, and the BIE Director. 

Prior to becoming the BIE Director in November 2016, I served as Associate Deputy 

Director for Bureau-operated schools, overseeing 17 schools, four off-reservation 

boarding schools, and one dormitory. Before that, I served as superintendent of Riverside Indian School located in Anadarko, Oklahoma, and principal of Sequoyah 

High School in Tahlequah, Oklahoma. During my service at the school level, my 

leadership team worked to ensure our students not only received a quality education 

but also had the opportunity to receive holistic support. 

Today, Sequoyah High School is a first preference among Native students. In fact, 

more than 60 students who attended have gone on to receive Gates Millennium 

scholarships over the past 15 years. The competitive scholarship is based on a minimum 3.5 grade point average, community service hours, leadership experience, and 

written essays. At Riverside Indian School, we effectively worked with 75 different 

Indian tribes representing approximately 500 students from 23 states. To address 

the varying needs of our students, such as behavioral and mental health support 

services, we built partnerships with the Indian Health Service, local emergency 

medical services, and law enforcement to make sure students and staff were in a 

safe school environment. 

My passion has always been supporting our students at the local level, and I am 

honored to serve them in this new capacity, utilizing my knowledge of how our 

schools function, the issues students face, and the support they need from BIE to 

create success system-wide. The successes my schools achieved required transparency, collaboration, and dedication by everyone. In my short time as Director, I 

have been working to bring that same focus to BIE and have worked with the senior 

leadership team to expand the culture that served us so well at the school level. 

However, as highlighted in the GAO reports, much work remains. We have 

prioritized the GAO recommendations and are addressing these issues head on. The 

BIE team views the GAO’s reports as a constructive tool to improve our agency and 

help the students for whom we are committed to serve. As such, I will provide you 

an update detailing the following areas: 

1. GAO High Risk Status for BIE 

2. GAO Recommendations 

3. GAO Recommendations Status & BIE Next Steps 

Bureau of Indian Education 

BIE supports education programs and residential facilities for Indian students 

from federally recognized tribes at 183 elementary and secondary schools and dormitories. Currently, the BIE directly operates 53 schools and dormitories and tribes 

or tribal school boards operate the remaining 130 schools and dormitories through 

grants or contracts. In total, BIE-funded schools serve approximately 48,000 K–12 

American Indian and Alaska Native students and residential boarders. Approximately 3,400 teachers, professional staff, principals, and school administrators work 

to support BIE-operated schools. 

BIE faces unique and urgent challenges in providing a high-quality education. As 

highlighted by GAO, a lack of consistent leadership—evidenced by the BIE’s more 

than 35 directors since 1979—and the absence of regular and consistent strategic 

planning have limited the BIE’s ability to improve its services. 

GAO High Risk Status for BIE 

In February, the GAO released its High Risk Report (GAO–17–317 High Risk Series) designating BIE as a high risk agency. The GAO highlighted the following persistent weaknesses noted in prior reports that inhibit the agency from fulfilling its 

mission to effectively serve Indian students: 

• Indian Affairs’ oversight of school safety and construction, as well as how BIE 

monitors the way schools use Interior funds; 

• The impact of limited workforce planning in several key areas related to BIE 

schools affects service delivery; 

• The effects of aging BIE school facilities and equipment and how such facilities 

contribute to degraded and unsafe conditions for students and staff; and 

• How the lack of internal controls and other weaknesses hinder Indian Affairs’ 

ability to collect complete and accurate information on the physical conditions 

of BIE schools. 

In three separate reports dating back to 2013, the GAO provided 13 recommendations to improve Indian Affairs’ management of BIE schools. As of 2017, eleven of 

GAO’s recommendations remain open. As the BIE Director, I am committed to adVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00057 Fmt 6633 Sfmt 6621 S:\DOCS\29354.TXT JACK
54 

dressing these outstanding items. To that end, I am working with our senior leadership team within BIE as well as with Indian Affairs, the Secretary’s office, and our 

colleagues at the GAO to ensure that BIE systematically and comprehensively addresses each outstanding recommendation as expeditiously and effectively as possible. 

My goal is not simply to address and close out GAO recommendations, but to utilize the outlined recommendations as a roadmap for BIE to establish and maintain 

comprehensive internal policies and procedures that support service delivery, ensure 

accountability, and provide organizational stability no matter who is leading the 

agency. 

GAO Recommendations: Status & BIE Next Steps 

In the past few years, BIE planned, consulted on, designed, and implemented a 

complex, multifaceted, bureau-wide reorganization. In February 2016, the Department of the Interior directed BIE to move forward with Phase I of its reorganization, with the agency committing considerable time, energy, and resources to carry 

out the directive. Simultaneously, considerable turnover within BIE senior leadership reduced capacity and focused BIE’s attention on day-to-day service delivery 

rather than addressing critical, long-term organizational improvement strategies 

highlighted in GAO reports. BIE has now prioritized resources and critical personnel to refocus efforts to address the longstanding issues outlined in GAO reports 

that will, ultimately, improve our service delivery to Indian students. 

In November 2016, the BIE filled several key positions that have been tasked 

with serving on an internal working group focused on evaluating all outstanding 

GAO recommendations as well as BIE’s past GAO closure submissions. The team 

completed its analysis in early 2017 and reported its findings and recommendations 

to BIE leadership in mid-March. Based on the information received, BIE leadership 

is not satisfied with the quality and timeliness of the work to date, and recognizes 

the shortcomings and the need for each GAO recommendation to be reexamined and 

properly addressed. 

As described below, the BIE is currently working to complete the actions recommended in each of these three GAO reports. BIE leadership has identified and 

tasked specific staff to address each outstanding recommendation in a holistic and 

inclusive manner that creates buy-in and collaboration throughout the BIE and with 

staff across Indian Affairs. Further, BIE senior leadership looks forward to coordinating with GAO as the agency works to implement the recommendations outlined 

in this report. 

GAO Recommendations 

GAO–13–774–INDIAN AFFAIRS: Better Management and Accountability Needed 

to Improve Indian Education (September, 2013). 

GAO made five recommendations: 

I.) Develop and implement decisionmaking procedures which are documented in 

management directives, administrative policies, or operating manuals; 

II.) Develop a communication strategy; 

III.) Appoint permanent members to the BIE-Education committee and meet on 

a quarterly basis; 

IV.) Draft and implement a strategic plan with stakeholder input; and 

V.) Revise the BIE strategic workforce plan. 

BIE has completed implementation of recommendations two, three, and five, 

which includes development of a communications strategy, increased collaboration 

with the Department of Education through several mechanisms, including a BIE– 

ED Committee that meets every other week (rather than just quarterly) and that 

has proven to be even more responsive and effective than the quarterly one addressed in the original GAO recommendation, and revision of a strategic workforce 

plan, respectively. BIE will assess the effectiveness of its implementation of GAO’s 

recommendations in an effort to continually improve BIE’s operations. Currently, 

BIE is working to implement recommendations one and four, which are to develop 

documented decisionmaking procedures and a strategic plan, respectively, and 

partnering with GAO to clear them. BIE plans to implement fully the remaining 

recommendations contained in GAO–13–774 by 2018. 

Recommendation I—BIE, working cooperatively with leadership within Indian Affairs and pertinent stakeholders, has tasked an internal working group with evaluating the GAO recommendations. That working group will draft a formal, written 

decisionmaking policy and procedures, to be completed by the end of 2018. 

55 

Recommendation IV—BIE, working cooperatively with leadership within Indian 

Affairs and pertinent stakeholders, has reviewed the strategic plan submitted to 

GAO in September 2016 and has determined the quality of work as unsatisfactory, 

both for the purposes of closing recommendation four and for working as a functional tool intended to guide the organization in achieving its mission. At the close 

of this review, BIE immediately began the process of planning and drafting a revised strategic plan. On March 8, 2017, BIE conducted a senior leader strategic 

planning exercise and followed that with an April 11, 2017 all-leaders strategic 

planning conference convening local, regional, and central office leadership to determine paths forward. BIE revised its mission and vision statement as well as its 

strategic goals identified at the end April 2017 and will hold follow-up leadership 

meetings in late May and June. 

BIE has also partnered with external organizations such as the Council of Chief 

State School Officers—a nonpartisan, nationwide, nonprofit organizational leader 

that supports State Educational Agencies in serving their schools and students—to 

provide expertise and best practices in developing a sound strategic plan as well as 

creating a functional action plan for implementing an accurate system of progress 

measurement once the strategic plan is implemented. BIE expects to have the strategic plan completed, published publicly, and fully implemented by no later than the 

end of 2018. 

GAO–15–121–INDIAN AFFAIRS: Bureau of Indian Education Needs to Improve 

Oversight of School Spending (November, 2014). 

GAO made four recommendations: 

I.) Develop a comprehensive workforce plan; 

II.) Implement an information sharing procedure; 

III.) Draft a written procedure for making major program expenditures; and 

IV.) Create a risk-based approach in managing BIE school expenditures. 

In addition to GAO–13–774, BIE is continuing its work to implement GAO’s four 

recommendations contained in GAO–15–121. To that end, the BIE plans to complete 

its work with respect to recommendations one and two no later than the close of 

2018 and recommendations three and four by the middle of 2019. 

Recommendation I—BIE, working cooperatively with leadership within Indian Affairs and pertinent stakeholders, has tasked an internal working group with evaluating the GAO recommendations. That working group will draft a comprehensive 

workforce plan that is aligned with the BIE strategic plan, to be completed in 2018. 

Recommendation II—BIE, working cooperatively with leadership within Indian 

Affairs and pertinent stakeholders, has tasked an internal working group with evaluating GAO recommendations. That working group will also draft a comprehensive, 

interdepartmental coordination and information-sharing policy to ensure accountability and effectiveness in operations and service delivery. 

Recommendation III—BIE, working cooperatively with leadership within Indian 

Affairs and pertinent stakeholders, has started drafting and implementing a comprehensive financial oversight policy that establishes effective risk management procedures that will prevent, detect, and respond to fraud, including improper payments, based on GAO-established practices and OMB guidance. To accomplish this 

goal, the BIE will prioritize hiring staff with applicable experience and skills and 

we are already partnering with outside groups that can provide the much-needed 

technical assistance and expertise. 

Recommendation IV—BIE, working cooperatively with leadership within Indian 

Affairs and pertinent stakeholders, is drafting and implementing a risk-based monitoring methodology that is in compliance with the Fraud Reduction and Data Analytics Act of 2015 (Public Law 114–186). BIE is currently seeking external working 

partnerships to provide much-needed technical assistance and expertise. 

GAO–16–313–INDIAN AFFAIRS: Key Actions Needed to Ensure Safety and 

Health at Indian School Facilities (March, 2016) 

GAO made recommendations: 

I.) Ensure that all BIE schools are inspected as well as implement a plan to 

mitigate challenges; 

II.) Prioritize inspections at schools where facility conditions may pose a greater 

risk to students; 

III.) Develop a plan to build schools’ capacity to promptly address safety and 

health problems with facilities and improve the expertise of facility staff to 

maintain and repair school buildings; and 

IV.) Consistently monitor whether schools have established required safety committees. 

56 

Finally, BIE is working to implement GAO’s four recommendations contained in 

GAO–16–313. 

Recommendations I and II—BIE has worked with the Bureau of Indian Affairs 

(BIA) to address the first recommendation by implementing a Safe School Audit. In 

2016, the audit was successfully completed at all BIE-funded schools and the agencies started the process of implementing corrective measures for identified deficiencies. However, we must ensure that the focus on completion does not detract 

from the quality of inspections, so additional coordination and training is still needed to ensure quality work, and most importantly, the necessary follow-up and technical assistance is provided. 

Recommendations III and IV—BIE is conducting ongoing staff and administrator 

training and is working with BIA to provide ongoing support for school safety committees through school inspections. We recognize that reporting for such activities 

is inadequate, so BIE is working with BIA to provide oversight of such inspections. 

The agencies are working to produce formal policies and procedures to address 

shortcomings through a recently formed inter-agency workgroup that is meeting 

throughout the summer to ensure coordination of activities as well as formalize 

long-term policies and procedures. The agencies, in coordination with other offices 

within Indian Affairs, are scheduled to meet in late May to coordinate activities to 

address these recommendations. 

Conclusion 

Chairman Hoeven, Vice Chairman Udall, and Members of the Committee, thank 

you for the opportunity to present testimony today. While the designation as a high 

risk agency is a difficult matter to address, please know that the BIE is committed 

to addressing GAO’s recommendations in order to achieve sustained improvement. 

There are great employees Bureau-wide—from Central Office staff, to Education 

Resource Centers, to school teachers and cooks—who wake up excited every day to 

improve a child’s life. But, there are also impediments to improvement and obstacles 

that hinder coordination and positive reform, as highlighted by GAO. Now, it is incumbent upon me, and all of us at BIE, to implement these recommendations. 

The BIE looks forward to working with the Members of this Committee, the GAO, 

and our partners across Interior as we address these recommendations. Thank you 

for your time, and I would be honored to answer any questions you may have. 

The CHAIRMAN. Thank you, Director Dearman. 

I would like to thank all of the witnesses again. 

At this time, I would like to turn to Senator Franken and ask 

if it would be okay if we do some questions? 

Senator FRANKEN. I am sorry, Mr. Chairman. I was not listening. 

The CHAIRMAN. I was wondering since you objected to questions 

earlier, I am wondering if it is okay if we do some questions now? 

Senator FRANKEN. No objection, Mr. Chairman. 

The CHAIRMAN. Thank you. 

We will start with Senator Cortez Masto. 

STATEMENT OF HON. CATHERINE CORTEZ MASTO, 

U.S. SENATOR FROM NEVADA 

Senator CORTEZ MASTO. Thank you, Mr. Chairman and Ranking 

Member, for this important discussion. 

My first question is for Melissa. Just so I have an understanding 

of this since I am new to the Committee. I am from Nevada and 

represent the great State of Nevada. 

This High Risk Report is put out because of the 41 auditing, I 

do not know what you call it, violations or concerns that you have 

and the 39 that were not implemented, it is because these concerns 

were noted over two years ago or three years ago? How long has 

this been sitting out there before they are put in a High Risk Report like this? 

Ms. EMREY-ARRAS. That is an excellent question. It is more about 

the concerns we have identified than the number of recommendaVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00060 Fmt 6633 Sfmt 6601 S:\DOCS\29354.TXT JACK
57 

tions that have yet to be implemented or how long it is taking 

them to be implemented. The concerns about public health and 

safety, critical services to tribes and their members, and the extent 

of the issues we found in these three areas led to our placing these 

three areas on the High Risk List. 

It does not mean that they have to complete each and every recommendation to get off the list but there needs to be demonstrated 

progress to show there is not significant concern for public safety, 

for example. 

Senator CORTEZ MASTO. That is helpful because I just need to 

know, for the other members, were you just notified of this? How 

much time have you had to try to address these concerns? I am curious about your level of resources to address these concerns considering that there is a hiring freeze that is on and whether that 

has an impact on how you can or are able to address the contentions that are before you? 

Why don’t we go down the line? I am curious to hear your 

thoughts on that. 

Mr. BLACK. A number of the reports, as Melissa mentioned earlier, date back a couple of years and we have been continually 

working on a number of those recommendations in both areas of 

BIE and Indian education, as well as Indian energy. 

Some of the stuff I identified in my testimony regarding Indian 

energy related to the service center, our refocusing the Indian Energy Mineral Steering Committee and some of those items that are 

efforts on our part. 

We have recognized a lot of those shortcomings. We are working 

hard to identify not only the shortcomings we have but methods, 

processes, procedures and streamlining that we can do to fully address GAO’s recommendations. 

Senator CORTEZ MASTO. Thank you. Because I have a short 

amount of time, I would like to hear from all of you but also a 

timeframe. Do you have a timeframe on when you intend to address these concerns? 

Mr. BLACK. Within our response to GAO, we identify timeframes 

for each and every one of the recommendations, yes. 

Mr. BUCHANAN. Thank you, Senator. 

We recognize how important the GAO recommendations are. I 

think we have been on it for about six years. We have had various 

recommendations that we have been providing. We take it seriously. We use the GAO recommendations as another opportunity to 

improve our health care service delivery. 

Thank you. 

Mr. DEARMAN. Thank you, Senator. 

Our GAOs actually go back to 2013. I have been on the job for 

six months. We have prioritized the GAO report and we are putting 

together workgroups to implement the recommendations from the 

GAO. 

Also, in doing this, we have created interagency workgroups because in our system, the BIE system, we have to have collaboration 

with Indian Affairs as well because there are so many parts of our 

schools where we do not have control. 

We are looking forward to working with Indian Affairs and implementing the recommendations. 

58 

Senator CORTEZ MASTO. I understand the Federal Government 

moves slowly but this is way too slow. It is unacceptable. These are 

serious contentions and it is impacting people in these communities. 

I would hope that you are seriously willing to work with us in 

Congress to address these concerns in a timely manner. I would 

ask that each one of you be willing to do so. 

I appreciate you coming here and being willing to come forward 

and talk about this but it needs to be addressed in a timely manner. 

Thank you for being here. 

The CHAIRMAN. Senator Heitkamp. 

STATEMENT OF HON. HEIDI HEITKAMP, 

U.S. SENATOR FROM NORTH DAKOTA 

Senator HEITKAMP. Mr. Chairman and Vice Chairman, thanks so 

much for calling this meeting. 

I am going to pick up where Senator Cortez Masto left off. We 

are struggling every day in Indian Country in this country with 

poor schools, poor health care, poor law enforcement, and lack of 

housing. We cannot afford not to be absolutely the best at what we 

do. We cannot afford to wait six years to address the issues that 

GAO has set forth. 

We need to do a better job on this dais, I think, holding you all 

accountable and knowing that this matters. This work matters that 

you do. It is a matter, in some cases, of life and death. It certainly 

is a matter of the future of children living in Indian Country. 

I am not going to go maybe beyond that but I want you to know 

that we intend to take this very seriously. We want to see better 

results. I think anyone who has sat through these hearings in the 

last Congress knows we are particularly concerned about the quality and the response at Indian Health. It needs to be better. 

All of this, as we work through these programs, it is hard to fight 

for additional funding when there appears to be a lack of accountability for the funding you already get. I spend a lot of time reviewing GAO reports in our role on the Homeland Security and Government Affairs Committee. I think in many cases, we do not take 

these reports as seriously as we should but it is particularly concerning to me in Indian Country. 

Rather than go through a series of questions about when and if, 

just know we are going to call on you to give us reports. It is not 

going to wait until the next hearing. We are going to be on this. 

If you need more resources, if that is a problem, then you need 

to say it. You cannot just keep doing what you are doing and expect the same result. We have the lowest rates of high school graduation in Indian Country, the highest rates of infant mortality, and 

the highest rates of diabetes. We could go on and on and on. That 

is not a formula for success going forward. 

You have an obligation not only to the taxpayers and people of 

this country. You have a treaty obligation to meet these standards 

under treaty obligations. Just know I know we are turning page, 

we have a new Administration coming in, but we are going to be 

looking for a much higher level of accountability. We are going to 

59 

be asking our friends at GAO to continue to participate to change 

the outcomes. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Heitkamp. 

Ms. Emrey-Arras, you found as far as wait times at IHS facilities, patients could wait six weeks for an initial exam with a family 

medicine physician and up to three to four months for an initial 

exam by an internal medicine physician. 

Why is it taking so long? Why isn’t it getting fixed? 

Ms. EMREY-ARRAS. For that question, I will defer to my colleague, Ms. Kathy King who is the director for that work. 

Ms. KING. Good afternoon, Senator. 

I think one of the key problems is that IHS headquarters delegates responsibility for all of these matters to the area offices and 

then they do not have proper oversight, so there is not feedback 

coming from the area offices back to headquarters about what is 

going on. 

The CHAIRMAN. Admiral Buchanan, how are you going to fix that 

and when? 

Mr. BUCHANAN. We acknowledge the challenges and the frustration of the Committee. We can do better and will do better. We 

have implemented what we have been referencing as the quality 

framework going forward. I mentioned in my testimony the Enterprise Risk Management System providing metrics. 

Specifically related to our quality framework, we have identified 

five priority areas, one of those being wait times and making sure 

that our patients and patient safety is top priority. That is what 

we are looking for in the Indian Health Service. 

Timelines, we have timelines specifically related to our Enterprise Risk Management System. The next step is, we have identified all our high risk areas within the agency by bringing in all our 

office directors and area directors and having them participate in 

this risk management system and identifying those risks. 

The next step is to develop action plans going forward. I look to 

have those action plans completed by July 2017. 

The CHAIRMAN. Meaning, you have the standards and have them 

implemented by when? 

Mr. BUCHANAN. I am sorry. Let me clarify. 

The CHAIRMAN. You have established the standards and then you 

have to implement them. You have established the standards and 

when do you expect to have them established? If you have not, then 

when do you expect to have them implemented? 

Mr. BUCHANAN. Specifically, for the wait times, we are looking 

at all of our best practices that we have been utilizing across the 

agency. We are doing measurements to see what those standards 

should be. 

Then once we hit those standards, we will do some pilot testing 

to move that out. I cannot give you a specific date on when that 

will roll out. 

The CHAIRMAN. You need to. This has gone on too long already. 

We need to know when you are going to have your standards, when 

you are going to have them in place, and how are you are going 

to follow up to make sure they are adhered to because then we 

need to have the GAO go back and make sure it is getting done. 

60 

I think this goes to what both Senator Cortez Masto, Senator 

Heitkamp, and I am sure the Vice Chairman will ask you about it, 

as well as other members of this Committee. We need to be setting 

some timelines here to get it done, we need to track the progress, 

and we need to have you back in front of us to know it is getting 

done. 

We cannot continue to have this not get done. That is what we 

are looking at here. That is why you are in the high risk category 

because it is not getting done. We are going to agree to get it done, 

we are going to agree on some timelines, and agree to some follow 

up so that we know this stuff is getting done. 

If you do not have those timelines, I want you to come back. I 

would ask that you come back to the Committee with those 

timelines. I would ask that the GAO come back as well and we will 

set it up for follow up. We are going to track this. 

Mr. BUCHANAN. Yes, sir, we are definitely willing to track it. We 

have implemented some metrics to start the tracking process once 

these items and these workgroups establish the timeframes we 

want to monitor. 

That is not only at the local level, but we are bringing it from 

the headquarters to area, all the way through the service units. We 

will have timelines. 

The CHAIRMAN. By when do you suppose you could get back to 

us with an indication of when you will have the timelines and 

when you are going to have them implemented? You tell me how 

soon you can get back to the Committee on that? 

Mr. BUCHANAN. By the end of fiscal year 2017. 

The CHAIRMAN. That is too long. It needs to be before then. 

Mr. BUCHANAN. July 2017. 

The CHAIRMAN. That is the soonest you think you could do it? 

Mr. BUCHANAN. If I can get it done sooner, I will get it done 

sooner. 

The CHAIRMAN. All right. 

Mr. BUCHANAN. You have my commitment on that. 

The CHAIRMAN. Mr. Vice Chairman. 

Senator UDALL. Thank you, Chairman Hoeven. 

Senator Cortez Masto asked a question and I do not think I 

heard an answer from some of you. That was on the issue of the 

hiring freeze. Along with several of my colleagues on this Committee, I signed a letter to President Trump urging him to exempt 

Indian programs from the February hiring freeze. Now, these same 

programs might feel the effects of the reduction in force planned 

by the President. 

I will come back to Melissa, but my question to each of you is 

did the hiring freeze exacerbate your agency staffing issues identified by the GAO? 

Mr. BLACK. Thank you for the question, Senator. 

The hiring freeze has been lifted at this point in time. 

Senator UDALL. I do not want to interrupt you but my understanding is you are still bound up in the hiring freeze. We have 

gone out of the time period but are you hiring right now? 

Mr. BLACK. Yes, we are, sir. 

Senator UDALL. You are hiring all across the board? 

Mr. BLACK. Yes. 

61 

Senator UDALL. Bureau of Indian Affairs, BIE, IHS, all across 

the board? 

Mr. BLACK. I cannot speak for IHS, but for BIA and BIE, yes, 

sir, we are able to hire. We are going through a process to ensure 

that we are hiring our highest priorities at this time and working 

through that process. 

Senator UDALL. When you say highest priorities, it sounds like 

you are slowing it down some because that is some of the stuff I 

have been hearing within the agencies, that the hiring freeze is 

still impacting hiring. Is it still impacting hiring? 

Mr. BLACK. Like I said, it is not really a hiring freeze at this 

point. We do have some specific instructions as to how we go about 

hiring. Most of our field locations are able to move forward with 

positions at GS–11 and below. We are identifying those other positions to ensure that we are filling the most critical positions and 

that positions are being filled at the right locations for the right 

needs. 

Senator UDALL. Thank you. Admiral Buchanan? 

Mr. BUCHANAN. Thank you. 

We have been recruiting and hiring, so it has not impeded our 

ability to hire at the local level and our service units where we are 

providing patient care. 

Senator UDALL. You are up and running now and the hiring 

freeze is not impacting you? 

Mr. BUCHANAN. Yes, sir. 

Senator UDALL. Tony. 

Mr. DEARMAN. Thank you, Senator. 

The hiring freeze has been lifted as we discussed. We are moving 

forward at the contract education level and our school levels. As far 

as the GAO, with that, we have some very resilient staff in our offices and schools. We have been able to take the time and actually 

get arms around the GAO and plan to get those implemented. 

Senator UDALL. Chairman Hoeven, I think you would join me in 

this. We know, on a bipartisan basis, both in the Bush and Obama 

Administrations, by this point, we usually have senior staff in 

these areas. We do not have them. I do not want to put you on the 

spot in any way. 

Melissa, I really believe it has to do with putting accountable 

people in place at the top, who are there, and will be in front of 

the Committee on a regular basis. They will give us the deadlines, 

the implementation and how they are going to get that done. Melissa, could you speak to that, both the hiring freeze and having 

senior staff in place in all of the positions? All the people we have 

in front of us are acting people. 

Ms. EMREY-ARRAS. We have not looked at the hiring freeze for 

this particular work, but I would say the point about turnover and 

stability is really critical. This is something we have pointed out 

previously, that there has been extensive turnover in leadership positions which has led, we believe, to management challenges, especially at BIE. 

In terms of the hiring, we think it would be helpful to guide the 

hiring with a workforce plan. We have two outstanding recommendations to do workforce planning so you know what you are 

62 

hiring for, so you know how many people you need, and you need 

to know what skills they need to have. 

We found BIE folks who were doing reviews of single audits who 

told us they were not accountants, and they did not know what 

they were looking at. Yet they were responsible for overseeing 

school spending. You need to have a workforce plan to guide the 

hiring going forward. 

Senator UDALL. Thank you very much. 

I can tell you that constituents of mine who visit Washington 

and have meetings within all of these agencies do not feel, at the 

senior level, there is guidance because folks are in an acting position rather than having people in the position who are running the 

departments and doing the things that you, the GAO and this 

Committee wants them to do. 

Mr. Chairman, thank you for your courtesies in allowing me to 

go over a little. 

The CHAIRMAN. Senator Cortez Masto. 

Senator CORTEZ MASTO. Thank you. I have one more question if 

that is all right. 

I have heard from my constituents as well. I work very closely 

with them. This extra question comes from a Chairman I just had 

the opportunity to sit down and talk with. It addresses Indian 

Health Service. 

I understand that the Indian Health Service made a mistake in 

overestimating the amount required in Fiscal Year 2017 to fully 

fund contract support cost payments due tribes under self determination contracts and self governance compacts. 

I am kind of curious as to what explains this error. How much 

is needed in Fiscal Year 2018 and what assurance can you give the 

Committee that, going forward, your estimates are going to be accurate? 

Mr. BUCHANAN. I do not have that information in front of me. I 

would be happy to submit that for the record. 

Senator CORTEZ MASTO. Thank you. I appreciate that. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator. 

This is for Ms. Emrey-Arras. Are IHS, BIA and BIE able to attract the qualified professionals they need? If not, what can they 

do? 

Ms. EMREY-ARRAS. Let me check with my colleagues to see if 

they have covered that in their areas. It looks like we have in the 

health care area. 

Ms. KING. Senator, in the health care area, we have noted longstanding vacancies. For example, in the last several years, at least 

four of the area offices said they had several acting area directors. 

This kind of turnover causes problems for the agency. 

We have some ongoing work where we are drilling down on staffing issues. We hope to be able to have some constructive suggestions for the agency. 

The CHAIRMAN. Are there any concrete recommendations you 

would have for getting qualified people in key positions? Obviously, 

it starts at the top, as the Vice Chairman said. He is right about 

that. If there other recommendations for getting key people into 

key positions, I think that would be very helpful. 

63 

Ms. KING. Thank you. 

The CHAIRMAN. Secretary Black, the GAO highlights in its report 

on Indian energy that the BIA did not track and review response 

times for energy development documents from tribes. That is necessary, of course, if you are going to understand what your turnaround time is and whether or not you are being responsive. 

My question is, what are you doing to address that? How are you 

setting up some type of process to make sure you are tracking 

those times and giving timely and quality service? 

Mr. BLACK. Thank you for the question, Senator Hoeven. 

Through our Indian Energy Minerals Steering Committee, we 

have brought together a group of experts in the field to identify 

identifiers in the key fields that we need to be able to track to better identify where we are in processing energy-related documents, 

whether they be rights-of-way, communitization agreements, or applications for a permit to drill. 

We also are working with our partners over at BLM, who have 

the responsibility for APDs to ensure we are coordinating with 

them and identifying any roadblocks in that process that are hindering us. 

For the communitization agreements, we recently issued a national policy memorandum that identifies key timeframes and stuff 

in there. We are also developing right now a Google platform tracking system for all of the CAs that we are processing out there in 

Indian Country. 

That allows us to identify not only where we are in the process 

and how many we have backlogged, but any areas where we are 

seeing some major holdups or anything like that so we can better 

address those as we move forward. We will be doing that with all 

of our different things. 

Leases, we are going to work with our TAAMS system to incorporate different fields in there that could be as simple as knowing 

when the lease comes into our office, when it gets processed, and 

when the NEPA activities are completed, so we can track them all 

the way through the process and identify any areas where we see 

holdups or roadblocks. 

The CHAIRMAN. What is your timeline for getting those things in 

place? 

Mr. BLACK. I cannot remember exactly. I want to say we are 

working toward those for either the close of 2017 or sometime after 

that, but I will get back to you on that. 

The CHAIRMAN. You will provide us with the timelines, because 

we are going to invite you back as well to talk about it probably 

no later than the end of July. 

Mr. BLACK. Okay. 

The CHAIRMAN. If you turn your head to your left and gaze up, 

you will see a very nice blanket that was presented to us at 

Cankdeska Cikana Tribal College in North Dakota. I think it looks 

nice there, don’t you? 

Mr. BLACK. It looks great up there, sir. 

The CHAIRMAN. They showed us wonderful hospitality at our 

field hearing. I want to commend the president of the tribal college 

and all of her people for the fine job they did and express my appreciation to them. 

64 

Mr. BLACK. Yes, very much so. 

The CHAIRMAN. I want to thank you for being there and also for 

your willingness to help on some of the issues we talked about. 

Mr. BLACK. Certainly. 

The CHAIRMAN. I would ask Admiral Buchanan, there was one 

recommendation I think IHS disagreed with relative to staffing. Of 

the other recommendations, about 14 recommendations, are there 

any other recommendations the GAO made that you do not agree 

with? 

Mr. BUCHANAN. We agree with the recommendations and are actively working to correct those. 

The CHAIRMAN. Thank you. Vice Chairman Udall? 

Senator UDALL. Thank you, Mr. Chairman. 

Admiral Buchanan, in your written testimony, you said IHS 

Medicaid reimbursements increased 21 percent since 2012. Then 

you note, ‘‘In all IHS areas, we have programs that are able to purchase health care beyond the medical priority 1.’’ 

We all know beyond medical priority 1. When you have medical 

1, you are really talking about life and limb, so going beyond that 

is something really good for the community. Exactly how many 

purchased referred care programs are able to recover requests beyond the medical priority 1? 

Mr. BUCHANAN. We are actively providing guidance to our PRC 

programs to make sure patient safety is a premium for us. I do not 

have the exact number in front of me to give you but I would be 

happy to submit that to the record. 

Senator UDALL. That would be great. 

Is the 21 percent increase in Medicaid reimbursements responsible for the expansion of coverage under purchased referred care? 

Mr. BUCHANAN. The increase? 

Senator UDALL. Yes, the 21 percent increase in Medicaid reimbursements I quoted that you mentioned in your testimony, are 

those Medicaid reimbursements responsible for the expansion of 

coverage under purchased referred care, PRC? 

Mr. BUCHANAN. Yes, with that additional savings, we are able to 

increase our PRC access to care and provide more services to our 

patients. 

Senator UDALL. Given the numbers in the statements you just 

made, how would rolling back Medicaid expansion impact IHS 

service delivery? 

Mr. BUCHANAN. I do not have those figures in front of me. 

Senator UDALL. You have obviously seen a significant influx as 

a result of Medicaid. If you take that Medicaid money, you are 

going to end up rolling back a lot of the achievements you have 

made, isn’t that true? 

Mr. BUCHANAN. Being a former CEO, we place a premium on 

those third party collections, Medicaid, Medicare and private insurance. We also saw some increases in private insurance during that 

time. Focusing on third party collections allows us to increase services for our patients. 

Senator UDALL. Thank you very much. 

Melissa, what sort of oversight benefits or additional management resources usually result from the inclusion in the high risk 

category? 

65 

Ms. EMREY-ARRAS. When an agency or program area is put on 

the high risk list, we really focus on it. This is something we give 

a lot of attention to. We do a lot of additional work on these areas 

and really try to hold the agencies’ feet to the fire on making 

progress. 

Senator UDALL. Thank you. 

I also wanted to focus on workforce. Given the high levels of 

leadership turnover at BIE and IHS, one of GAO’s recommendations for both agencies is to develop contingency and succession 

planning for key positions. 

This question is for BIE and IHS. I apologize, Mr. Dearman, you 

are not acting, so I said that earlier. It is just that the two folks 

here, Mike and Admiral Buchanan, are. 

Mr. Dearman and Admiral Buchanan, how are your agencies 

working to ensure all administrative duties are fulfilled in the face 

of frequent turnover? 

Mr. DEARMAN. With us being able to go out and hire positions, 

looking at GAO’s recommendations, we are moving forward in 

working with our interagency Indian Affairs workgroups because 

there are some functions that we have to rely on other agencies 

through BIA. 

As we transition some of the workforce to us, we have to make 

sure of our staff. An example would be school safety. As we inherit 

school safety, our staff will be trained so there will be a transition 

period. 

We are addressing first and foremost as a priority, the GAO recommendations to make sure that we have the personnel and the 

workforce to address the recommendations that have been put in 

place. 

Senator UDALL. Admiral Buchanan. 

Mr. BUCHANAN. We have developed succession plans at headquarters and office director level, so we have those in place. We are 

working on creating leadership training academies for our senior 

leaders. We are rotating folks through our headquarters office to 

provide additional training, to mentor, coach and make sure they 

are adequately trained to accept those senior level positions. 

Senator UDALL. Thank you very much. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Senator Franken. 

Senator FRANKEN. Thank you, Mr. Chairman. 

May I suggest that once we finish with our questions that the 

witnesses could repeat their testimony? 

The CHAIRMAN. We will take that under advisement. 

[Laughter.] 

Senator FRANKEN. Okay. Thank you. 

Thank you all for your testimony. 

You brought up sort of a follow up, Ms. Emrey-Arras. I am curious about this for our oversight as a committee. How does this 

work? We are now saying these are at high risk, energy, education 

and health care. How can we not allow this to go a long time and 

come back with another report like this? How do we, as a committee, do our oversight? How does GAO do it? How can we best 

stay on top of you? 

Ms. EMREY-ARRAS. Thank you for the question. 

66 

I think, as demonstrated so far in this hearing, the idea of having agencies provide frequent progress reports to this Committee 

would be an excellent idea; to talk to the agencies and have the 

agencies come up and say, this is where we are in implementing 

these recommendations, these are our dates. 

Some things are just taking far longer than they should. For example, having basic written procedures to oversee school spending 

is not something that should take multiple years. Yet, that is taking multiple years to have basic instructions on how to oversee 

school spending. 

I would say any kind of additional pressure from this Committee 

to expedite processes would be very much welcomed. 

Senator FRANKEN. Mr. Dearman, would that be welcomed? 

Mr. DEARMAN. Absolutely. We have taken the GAO recommendations and made them a priority, Senator. We are going to move forward in getting them implemented. 

Senator FRANKEN. Admiral, I know some people who worked at 

HHS under the Obama Administration who have left since the new 

Administration came in. Some of them might need jobs. They are 

pretty good administrators is what I am saying. 

Right now, IHS has a 20 percent vacancy rate for health care 

professionals, including physicians and nurses. Some of the challenges that contribute to the lack of qualified staff at IHS facilities 

include difficulty providing competitive salaries, lack of training facilities, lack of suitable housing, schools and community resources 

for health care professionals and their families. 

I think you experience the same thing in education. I mentioned 

this in my opening statement. To recruit a doctor or a teacher, 

their spouse is going to be saying, what school are my kids going 

to go to, what health care are my kids going to get? There is a sort 

of continuing cycle. 

Ms. Emrey-Arras, what do you think needs to happen both inside 

and outside of IHS to make IHS facilities places where qualified 

health professionals want to work and live in that area? I think the 

Chairman may have asked that of you a bit earlier or something 

like that. 

Ms. EMREY-ARRAS. I will defer to my colleague, Kathy King, the 

Director of Health Care Services. 

Senator FRANKEN. Thank you. It is good to see you. Welcome. 

Ms. KING. Thank you. 

Senator, we have current work underway looking at that. We 

have heard that the VA has better hiring authorities than IHS. 

That is something we are examining in the course of our current 

work. 

We agree there are some difficulties common in rural areas, especially remote rural areas. We are hoping to look at that and see 

if we can find some best practices elsewhere that might be applicable to IHS. 

Senator FRANKEN. How much of Indian Country is in remote and 

rural areas? 

Ms. KING. I do not have a number right of the top but it is a fair 

amount. Some are also located adjacent to more metropolitan 

areas. 

Senator FRANKEN. Admiral? 

67 

Mr. BUCHANAN. There are a lot of rural areas. As she said, it is 

hard to recruit in those rural areas. As you referenced, it takes a 

comprehensive approach to bring in those physicians. Schools and 

housing is one of the challenges, definitely in trying to put the physician into a location that the next shopping area is two and a half 

hours away. Just to get food is a challenge. 

It is hard to recruit. Other facilities or private facilities have 

those same challenges in a rural setting. 

Senator FRANKEN. Can I ask the Admiral a little bit about the 

opioid crisis in Indian Country? How does the IHS collaborate with 

local, State and regional stakeholders to create interventions to 

combat the opioid epidemic? 

Mr. BUCHANAN. It truly is a challenging situation. It is going to 

take State, IHS and all our partners working together to fight this 

epidemic that is happening. We have been educating tribal leaders 

on what IHS is doing. We are working with our partners in BIA 

to provide certain medications to assist with combating the opioid 

issues. We are looking to all partners to address the issue. 

Senator FRANKEN. I hope you will partner with tribes and the Indian community to develop effective culturally-based interventions. 

Mr. BUCHANAN. Definitely, sir. We have actually established 

what we are calling the HOPE Charter Committee where we look 

at all these types of issues and come up with recommendations. We 

will definitely be working with tribes going forward. 

Senator FRANKEN. Thank you. 

I am running over my time. Thank you, Mr. Chairman, for your 

indulgence. Thank you for calling this hearing. I hope we can do 

frequent oversight. 

The CHAIRMAN. One of the things we talked about is we will 

have them all back probably by the end of July. We did ask for 

some timeframes on responses both in terms of what those responses are and implementation. I anticipate that we will have all 

of the witnesses and the GAO back by the end of July for a 

progress report. 

Director Dearman, I brought up one case, a cyber attack, where 

money was taken from one the BIE schools, $1.7 million. There 

was $8 million in the account, so they could have gotten even more. 

Half a million was recovered, so the loss was $1.2 million. What 

is being done to prevent that kind of thing happening in the future? 

Mr. DEARMAN. Thank you, Senator. 

We have actually initiated some training. We have to get down 

to the school level. I say we are going back to old school. We are 

going to actually start implementing training from the school level 

up. In the past, central office has controlled so much that we have 

not gotten down into the schools. 

It was actually our Performance and Accountability Division 

monitoring program that actually discovered the funds. We have 

implemented a monitoring system that goes in and does monitoring 

from our schools. As we add positions to our organizational chart, 

we will build that even stronger, not actually add positions, but 

hire positions into our organization. This will strengthen our ability 

to go out and monitor our expenditures. 

68 

The CHAIRMAN. In 2014, the BIE Study Group report discovered 

that approximately 80 tribally-operated BIE schools retained approximately a total of $125 million in unspent funds. The report 

cites a unique provision in the tribally-controlled schools Act that 

encourages schools to not spend funding they receive from the BIE 

and the Department of Education. What is going on? Why would 

they not be utilizing those funds? Can you explain that and what 

is being done about it? 

Mr. DEARMAN. What will be done about that, sir, is as we increase our organization, when we start bringing on the positions 

within our organization, we are going to provide technical assistance with our tribally-controlled schools and their tribes to make 

sure that money is actually spent where it needs to go. That is 

what we can do moving forward. 

The CHAIRMAN. Do you have an update on the current amount 

of unspent funds? 

Mr. DEARMAN. No, I do not, sir. 

The CHAIRMAN. You could get back to us with that? 

Mr. DEARMAN. Yes, we will get back to you. 

The CHAIRMAN. And a progress report in terms of what you are 

doing about it? 

Mr. DEARMAN. Yes. 

The CHAIRMAN. That completes my questions for right now. 

Vice Chairman? 

Senator UDALL. Thank you, Mr. Chairman. 

Last year, the IHS began an agency-wide systems improvement 

effort now known as the Quality Improvement Framework. Admiral Buchanan, what kind of tribal input did the IHS seek when 

designating the framework? 

Mr. BUCHANAN. Thank you for the question. 

We went through tribal consultation before the framework was 

released in November of 2016. 

Senator UDALL. How were the GAO’s recommendations accounted for in its design? 

Mr. BUCHANAN. They were taken into account for sure. Some of 

the priorities can be highlighted in those areas. I know the Committee is looking for organizational capacity and accountability. 

That is one of the main priorities within the framework. 

Senator UDALL. Admiral, I know you are in an acting position 

until the IHS director is confirmed. Until then, I am concerned that 

the framework will stall and much needed improvements will fail 

to be implemented. 

Is IHS currently implementing the Quality Improvement Framework? 

Mr. BUCHANAN. IHS is currently implementing the Quality 

Framework but I want to assure you that even though I am in an 

acting capacity, I take that first piece of acting as act and do something. That is what we are doing. We are not waiting for a person 

to be confirmed. We are moving forward because we cannot wait 

because it is patients we are seeing. That is the focus of everything 

that we do. 

Senator UDALL. How is it working, the Quality Improvement 

Framework? 

69 

Mr. BUCHANAN. As mentioned earlier, the wait time issue 

brought up earlier, we are addressing that. That is part of the 

Quality Framework, one of the priorities within the framework. 

In my testimony, there were some credentialing initiatives that 

we have undertaken. We made that award and that will be rolling 

out very, very soon. We are using some pilot sites to roll that out. 

We are also making sure accreditation of our facilities, another 

piece of the Quality Framework, is being addressed. We are specifically working with one organization to accredit our hospitals 

throughout IHS. 

Senator UDALL. Admiral, would you recommend to the new leadership that the framework continue? 

Mr. BUCHANAN. Yes, sir, I would. It is a framework that can 

modify and morph over time specific to the needs, a living document, but with five priorities in place, it is a good framework. 

I want to leave whoever is the confirmed IHS Director a working 

document, a working health care delivery system going forward 

that they can take and move forward with the GAO’s and OIG’s 

recommendations. 

Senator UDALL. Thank you. 

Thank you, Mr. Chairman. Mr. Chairman, are you doing one 

more round? 

The CHAIRMAN. No, I am finished. 

Senator UDALL. Okay. I just want to do one more question with 

Tony Dearman. 

BIE is in the middle of an administrative reorganization set in 

motion during Secretary Jewell’s tenure. Mr. Dearman, as I am 

sure you are aware, Indian Country has concerns with how this reorganization is being implemented. 

Would you recommend the reorganization continue as mandated 

or are there changes in the works? 

Mr. DEARMAN. Thank you, Senator. We are moving forward with 

the reorganization that is in place. We have tried to get out and 

visit with the tribes. I have actually been visiting with some of the 

Lieutenant Governors and Governors of some of the Pueblos. 

If there are concerns, we would ask, please contact us and we 

will sit down with people and explain and answer any questions. 

If there are any changes that come along with the reorganization, 

it will be through consultation. 

Senator UDALL. How will you engage with tribal stakeholders 

and the GAO to improve BIE’s reorganization efforts and increase 

transparency? 

Mr. DEARMAN. A very good question. As you are aware, not one 

size fits all in our tribal capacities and even in our schools. In rolling this out and developing GAO–15–121, we will actually be talking to the tribes and looking at different situations because it is not 

just going to cover our BIE-operated schools; it has to cover and 

support our tribally-controlled schools as well. It has to cover a 

wide range of different schools, settings and tribes. 

Senator UDALL. Melissa, what improvements would GAO make 

to BIE’s reorganization efforts? 

Ms. EMREY-ARRAS. We do not have any particular position regarding BIE’s reorganization but we think at the end of the day, 

children need to be in safe facilities. However way that is accomVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00073 Fmt 6633 Sfmt 6601 S:\DOCS\29354.TXT JACK
70 

plished, we would be delighted. At this point in time, that is not 

the case. 

Senator UDALL. Thank you. 

Mr. Chairman, this is not a question but I would just like to emphasize that from many of the Senators who showed up today you 

hear a frustration and wanting things to operate a lot better in Indian Country, whether education, health care, energy or all the 

various areas. 

I just want to say the GAO listing this as a high risk opportunity 

is a chance for us to work together to work with the new people 

that come in the next Administration and say, we are going to get 

this done and move this forward. 

I hope you get the signal from us, not only is there criticism, but 

we are going to do everything we can in our roles to try to encourage everyone to set goals, implement, get things done, and improve 

this situation. 

Thank you very much. 

The CHAIRMAN. I think that is right, Vice Chairman Udall. 

For all three of you, we are going to have you back in approximately several months, say by the end of July. We will look for specific progress on the items brought up today. We will also ask the 

GAO to come because we are going to want you to work with us 

as we track this on, I would say, a relatively frequent progress report basis. I would say at our next hearing, we will decide how that 

is working and the next steps. 

Ms. Emrey-Arras? 

Ms. EMREY-ARRAS. To that end, I would also like to let the Committee know we have two additional reports related to school safety 

issues coming out next week. We would also be happy to share additional information on that new work with all of you. 

The CHAIRMAN. Good. We will look forward to that and obviously 

make that a part of our process here. 

If there are other recommendations on how to proceed, as the 

Vice Chairman and other Senators said, we want to make sure we 

are making progress and tracking progress. 

With that, if there are no more questions, members may submit 

follow-up questions for the record. The hearing record will be open 

for two weeks. 

Again, I want to thank all of you for being here today. We look 

forward to working more with you to make progress on these very 

important issues. 

With that, we are adjourned. Thank you. 

[Whereupon, at 4:25 p.m., the Committee was adjourned.] 

(71) 

1See GAO, High Risk Series: Progress on Many High-Risk Areas, While Substantial Efforts 

Needed on Others, GAO–17–317 (Feb. 2017) 2See GAO, Indian Affairs: Better Management and Accountability Needed to Improve Indian 

Education, GAO–13–744 (Sept. 2013). 3See e.g., GAO, Bureau of Indian Education Needs to Improve Oversight of School Spending, 

GAO–15–121 (Nov. 2014). 

A P P E N D I X 

PREPARED STATEMENT OF THE NATIONAL INDIAN EDUCATION ASSOCIATION (NIEA) 

Introduction 

Thank you for this opportunity to submit testimony regarding the Committee’s 

May 17, 2017 hearing on the Government Accounting Office High Risk Report 

(GAO–17–317 High Risk Series). Founded in 1969, the National Indian Education 

Association (NIEA) represents Native students, educators, families, communities, 

and tribes, advocating for improved educational opportunities that enable Native 

students to thrive in the classroom and beyond. 

The Problems Did Not Develop—and Cannot Be Fixed—Overnight 

First and foremost, we all must acknowledge that the problems identified in the 

Government Accounting Office High Risk Report (Report) and discussed at the hearing were not created overnight and they will not be solved overnight. Generations 

of neglect have resulted in Bureau of Indian (BIE) school systems that exists today. 

The systems for construction and maintenance of BIE schools, operations, and staffing are just a few of the ongoing areas that need significant improvement. 

A number of the areas that the GAO identified as needing reform are areas that 

involve the BIE responsibilities, operations, and staff. 1 Some BIE schools have 

never been adequately built. Others have often not received the maintenance funding they need, and have become dilapidated as a result. BIE schools also face enormous challenges regarding staffing and operations. 2 Employees are often not placed 

in positions for which they have the necessary skills. BIE lacks staff with the expertise required to oversee school expenditures. 3 Other challenges for paying expenses 

and operations can be attributed to the fact that BIE must coordinate with the Bureau of Indian Affairs, which operates on a different fiscal year and with different 

reporting systems for audits, for example. 

Solutions to address the problems created from long standing neglect will not be 

found in quick fixes. Long term tribal engagement will be necessary. Sustained, 

meaningful community engagement will be necessary for Native communities to 

trust schools that have previously excluded Native caregivers from engaging with 

BIE schools. The Reform that is currently underway represents this—developed 

from direct tribal input, the current reorganization is an effort to address the longterm problems in a systemic way. These efforts must be supported and continued 

through to completion. 

The Trust Responsibility for Native Education as it Relates to BIE Reform 

Established through treaties, federal law, and U.S. Supreme Court decisions, the 

federal government’s trust responsibility to tribes includes the obligation to provide 

parity in access and equal resources to all American Indian and Alaska Native students, regardless of where they attend school. The federal government’s trust responsibility in the field of Native education is a shared responsibility between the 

Administration and Congress for federally recognized Indian tribes. 

With respect to BIE Reform, the trust responsibility requires schools that enable 

Native students to succeed. That means no leaking roofs, open floors, air and heating systems that do not work. It means that Reform must be completed and it must 

be supported by Congress to make sure BIE serves Native students well. 

72 

The Status of Reform and the Resources Necessary 

Over the last five years, the GAO has found numerous challenges to the administration of BIE, staffing, and school construction. The BIE Reform was undertaken 

in 2014 to address these problems. Today, BIE is still struggling with numerous 

issues. Staffing continues to be a problem. Numerous vacancies in the BIE have 

been delayed, leading to vacancy rates of up to 9 percent in 2017. NIEA is concerned 

that the BIE must have the authority and resources to fill vacancies. 

In addition to staffing, school construction continues to be a challenge for the BIE. 

Over 60 BIE schools are still currently rated in ‘‘poor’’ condition, and construction 

issues continue to put Native students at an educational disadvantage. With respect 

to the specific discussions at the May 17th Senate Committee on Indian Affairs 

hearing, we agree with the urgent need for a long-term school replacement plan that 

would set out priorities for school construction and replacement over the next 40– 

60 years and that would include a plan for adequate maintenance funding. We 

would note, however, that Congress must partner with BIE and the tribes to get 

the plan done, and then to implement it. 

Accountability 

NIEA also knows that accountability, in addition to funding, is required to ensure 

that BIE’s funding is used to effectively and efficiently improve the educational opportunities of Native students. We respectfully would like to urge that increased 

oversight over BIE by Congress is a necessary part of shared accountability. The 

accountability that the GAO reports and this Senate Committee on Indian Affairs 

brought has helped reveal problems and spurred BIE forward. NIEA asks the Committee to continue that critical, active oversight role. 

Accountability also extends to fairness with respect to Native schools receiving the 

resources that Department of Defense schools receive. There are only two educational systems for which the federal government is directly responsible: Department of Defense (DOD) schools and federally operated and federally funded tribal 

schools. BIE schools, however, lag far behind DOD schools in funding, school construction, and student achievement. While DOD schools are being renovated and remodeled, schools within the BIE system are woefully outdated and, in some cases, 

dangerous for students and staff. As America’s most vulnerable population, Native 

students should have equal access to resources and opportunities. Congress should 

fulfill its responsibility to Native students by remedying the disparities between 

these two federally operated school systems. 

Next Steps to Achieve Results 

NIEA continues to be generally supportive of BIE Reform. We agree with the 

GAO’s insights and support Director Tony Dearman’s testimony at the hearing. We 

see incremental progress and believe the Committee should recognize progress as 

well. 

At the same time, we urge transparency in the design and execution of the Reform in order to include tribal participation, facilitate congressional oversight, and 

ensure that reform fulfills the federal government’s trust responsibility regarding 

delivery of trust- and treaty-based educational rights. See NIEA Resolution # 2016– 

E02 and #2014–11 atttached. 

We have three recommendations regarding how Reform can be undertaken in a 

way that honors the Federal Government’s responsibilities, respects the government-to-government relationship between tribes and the United States, and 

achieves much-needed progress regarding our Native students’ education. 

Keep the BIE within the Department of the Interior 

Although reform is needed, it continues to be essential that Native education remain the purview of the BIE and that BIE remains housed within the Department 

of Interior, which has extensive experience carrying out the United States’ trust responsibility. Tribal leaders have repeatedly stated that the BIE should stay within 

the Department of Interior. NIEA joins tribes in strongly opposing any effort to 

move Native education to the Department of Education. However, we look forward 

to follow-up hearings to determine what the BIE and the Department of Education 

are doing to work together to address the needs of Native students. 

Follow-up with Hearings with Both BIA and BIE Officials 

As stated, over 60 BIE schools currently rated in ‘‘poor’’ condition. Native children 

are learning in buildings that are crumbling around them. We appreciate the attention that has been paid to the dilapidated Bug-O-Nay-Ge-Shig school. This school 

is, unfortunately, representative of the significant problems facing schools that linger on the BIE’s school construction list. Additional funds for facilities and maintenance are desperately needed so that the BIE can reduce the construction and reVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00076 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK
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pair backlog, addressing schools in the order they appear on the BIE construction 

list so that schools that have long awaited facilities funding will not continue to be 

neglected. We also urge the completion of the long-term school replacement plan and 

increased oversight over school construction funds to ensure the effective administration of federal funds. 

Continue Oversight of Reform 

As NIEA has previously stated, and has expressed in Resolution # 2014–11 and 

more recently in #2016–E02, continued congressional oversight over the BIE reform 

process is necessary. As the reform moves forward to completion, details of the reform should continue to be made public, tribal input should be prioritized, and congressional oversight should continue. 

Conclusion 

We thank the Committee for holding this oversight hearing. It is precisely hearings and oversight like this that has and will help address the concerns included 

in this. We urge Congress and the Administration to use this opportunity to work 

closely with tribes, who must be central to better serving students attending BIE 

schools. Finally, we firmly believe that self-governance in education is the answer 

to the current crisis in the Native education system: Tribes have demonstrated time 

and time again that we are better equipped to address the needs of our own peoples. 

Working together, with mutual commitment and bipartisan support from Congress, we continue to believe that the best way forward is to both hold BIE accountable and invest resources to further tribal self-determination in education and deliver Native students the education they need to succeed. 

Attachments 

NIEA RESOLUTION 2016–E–02 

RELATING TO LEGAL AND POLICY ISSUES CONCERNING THE REORGANIZATION OF THE

BUREAU OF INDIAN EDUCATION (BIE) TO PORTIONS OF ITS IMPLEMENTATION

WHEREAS, the National Indian Education Association (NIEA) was established 

in 1970 for the purpose of advocating, planning, and promoting the unique and special educational needs of American Indians, Alaska Natives, and Native Hawaiians, 

and provides a forum to discuss and act upon issues affecting the education of Indian and Native people; and 

WHEREAS, the BIE is currently in the process of reorganizing its structure in 

such a way that violates various provisions of the governing statute, namely the organizational and operational provisions of PL 95–561; and 

WHEREAS, in spite of numerous efforts from members of this organization directly involved with BIE education programs at the local and tribal level, the BIE 

is going forward with its reorganization without responding to the concerns of the 

tribal entities in violation of the consultation requirements of 25 USC 2011; and 

WHEREAS, the organization changes proposed by the BIE undermines the role 

of local and agency school boards and confuses the lines of authority within BIE, 

and BIE ignores specific GAO reports that have made specific recommendations concerning the organizational deficiencies of BIE, such recommendations have been endorsed by the Congressional appropriations committees; and 

WHEREAS, the instructional improvement oriented policies embedded in the reorganization could have easily been implemented with a major restructuring that 

does not violate the law. 

THEREFORE BE IT RESOLVED, that the National Indian Education Association passed resolution 2014–11 on BIE implementation in 2014 and seeks to make 

sure BIE is accountable and serves Native students optimally through its organizational structure; and 

BE IT FURTHER RESOLVED that on behalf of its member constituents, NIEA 

renews our requests for a thorough legal and policy review of the BIE reorganization prior to any further implementation; and 

BE IT FURTHER RESOLVED that within the next two weeks, NIEA take action to implement this resolution; and 

BE IT FINALLY RESOLVED that this resolution shall be the policy of NIEA 

until it is withdrawn or modified by subsequent resolution. 

C E R T I F I C A T I O N 

I do hereby certify that the following resolution was dully considered and passed 

by the National Indian Education Association on October 7th, 2016 at which a 

quorum of the membership was present. 

74 

Patricia Whitefoot, President 

NIEA RESOLUTION 2014–11 

TITLE: SUPPORT FOR CONGRESSIONAL OVERSIGHT CONCERNING THE BUREAU OF INDIAN

EDUCATION RESTRUCTURING AND BLUE PRINT FOR REFORM

WHEREAS, the National Indian Education Association (NIEA) was established 

in 1970 for the purpose of advocating, planning, and promoting the unique and special educational needs of American Indians, Alaska Natives, and Native Hawaiians; 

and 

WHEREAS, NIEA, as the largest national Indian organization of American Indian, Alaska Native, and Native Hawaiian educators, administrators, parents, and 

students in the United States, provides a forum to discuss and act upon issues affecting the education of Indian and Native people; and 

WHEREAS, through its unique relationship with Indian nations and tribes, the 

federal government has established programs and resources to meet the educational 

needs of American Indians, Alaska Natives, and Native Hawaiians, residing on and 

off their reserved or non-reserved homelands; and 

WHEREAS, the Obama Administration has asserted broad executive authority in 

implementing the U.S. Department of the Interior Secretarial Order to Transform 

the Bureau of Indian Education (BIE) as based on recommendations of the American Indian Education Study Group’s Blueprint for Reform; and 

WHEREAS, there is broad based concern throughout Indian country, and with 

treaty tribes in particular, that the BIE realignment is creating statutory conflicts 

and being implemented without a congressional authorization and without congressional oversight; and 

WHEREAS, The Secretary of the Interior Sally Jewell has not appeared before 

the Senate Committee on Indian Affairs to provide details concerning the BIE restructuring, nor has the Secretary provided congressional appropriations committees 

with a detailed budget request to pay for the restructuring; and 

WHEREAS, Administration officials have erroneously testified to the Senate 

Committee on Indian Affairs that there is no opposition from Indian country concerning the Blueprint for Reform; and 

WHEREAS, to meet the Federal Government’s continuing trust responsibility 

and assess measurable trust standards in the field of Indian education including the 

entire trust corpus for treaty-based educational rights delivered through the BIE, 

it is essential that committees of jurisdiction in both the U.S. House of Representatives and U. S. Senate provide congressional oversight on executive actions concerning the BIE; 

NOW THEREFORE BE IT RESOLVED, that the National Indian Education 

Association directs the Board and Executive Director to request a congressional investigation into the Bureau of Indian Education restructuring and Blueprint for Reform to ascertain if the Secretarial Order creates a statutory conflict and to document Department of the Interior proposed offsets to pay for the restructuring; and 

BE IT FURTHER RESOLVED, that the National Indian Education Association 

directs the Board and Executive Director to request oversight hearings by the Senate Committee on Indian Affairs and House Education and Workforce Committee 

and House Committee on Natural Resources and other appropriate congressional 

committees regarding the Bureau of Indian Education restructuring and Blueprint 

for Reform. 

C E R T I F I C A T I O N 

I do hereby certify that the following resolution was dully considered and passed 

by the National Indian Education Association on October 18, 2014 at which a 

quorum of the membership was present. 

Melvin Monette, President 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. STEVE DAINES TO

MELISSA EMREY-ARRAS

Question 1. The findings from the Government Accountability Office we’re exploring today come as no surprise but are still damning. As Ms. Emery-Arras testifies, 

‘‘Interior and HHS have ineffectively administered and implemented Indian education and health care programs and mismanaged Indian energy resources’’ in a 

handful of important areas. By most estimations, this is a failing grade. Ms. EmeryArras, exactly how many recommendations has GAO made to the respective agenVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00078 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK
75 

cies represented here on the witness panel- BIE, BIA, and IHS-that have not yet 

been implemented? 

Answer. 

Education 

We have made 23 recommendations to Indian Affairs that remain open, including 

12 recommendations in 2 reports on Indian school safety and construction issued on 

May 24, 2017. 

Energy 

We made 14 recommendations to BIA that have not yet been implemented. 

Health care 

We have made 13 recommendations to IHS that have not yet been implemented. 

We have also made one Matter for Congressional Consideration that remains 

unaddressed. 

Question 2. And how long has it been since these recommendations were made? 

Answer. 

Education 

Of the 23 recommendations on Indian education that remain open, 3 were made 

in 2013, 4 were made in 2014, 4 were made in 2016, and 12 were made in 2017. 

Energy 

The 14 recommendations were made in 3 reports issued between June 2015 and 

November 2016. 

Health care 

Of the IHS recommendations that remain open, 2 were made in 2011, 3 were 

made in 2012, 4 were made in 2013, 2 were made in 2016, and 2 were made in 

2017. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. CATHERINE CORTEZ MASTO

TO MELISSA EMREY-ARRAS

Question 1a. The report discussed the importance of appropriate and level staffing, particularly the need to efficiently replace key personnel as vacancies become 

apparent. Currently, there are over 1,550 job vacancies across the IHS system. 

Staffing is an issue that needs to be seriously addressed by Congress and the Department. While the IHS did get an exemption from the Trump administration’s federal hiring freeze to hire medical staff, the IHS is still restricted from hiring other 

critical hospital administration personnel. 

As the department moves forward with identifying service gaps, does the GAO 

plan to analyze and report on the negative effect the Executive Order has on patient 

care in Indian country? 

Answer. We are conducting ongoing work on the staffing vacancies at IHS. Within 

the scope of this work, we plan to take the hiring freeze into consideration when 

we analyze the information and draft our findings. 

Question 1b. How did the GAO take into account the hiring freeze at the Department of Health and Human Services before making any of its recommendations? 

Was this information intentionally omitted? If so, why? 

Answer. GAO’s high risk report was based on findings and recommendations from 

reports on IHS that predate the hiring freeze. We are conducting ongoing work on 

the staffing vacancies at IHS. Within the scope of this work, we plan to take the 

hiring freeze into consideration when we analyze the information and draft our findings. 

Question 2. When CMS or the department has found violations of patient care 

at the IHS operated facilities, how has the GAO investigated these findings? What 

action have you suggested and followed up on? 

Answer. GAO does not follow-up on individual findings reported by CMS or HHS. 

For our report on IHS’s oversight of quality of care (GAO–17–181), we reviewed evidence of IHS quality oversight, including findings from interim IHS audits, which 

we include in our report. For example, one such audit found defective lead aprons 

at an IHS medical facility, but IHS officials stated these deficiencies had been corrected. We also found that IHS did not have agency-wide measures for the quality 

of care in its facilities, and that IHS’s oversight of quality was limited and inconsistent. We recommended that IHS ensure that agency-wide standards for the quality of care provided in its federally operated facilities are developed, that facility 

76 

performance in meeting these standards is systematically monitored over time, and 

that enhancements are made to its adverse event reporting system. 

Question 3. Outside of Las Vegas and Reno, Nevada is a very rural state. Many 

of our tribes and rural communities are hundreds of miles away from large urban 

areas. As the Tribal Chairman from the Shoshone-Paiute Tribes of Duck Valley told 

me in a meeting yesterday, their reservation is 100 miles in any direction to a nonIHS medical facility. If anyone, whether a tribal member or not, needs immediate 

medical care, often their only option is an IHS facility. That puts an incredible 

strain on the system. How does the GAO report take into account outlier situations 

like this? If not, why? 

Answer. We have not come across this issue during the course of our IHS work. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. CATHERINE CORTEZ MASTO

TO REAR ADMIRAL CHRIS BUCHANAN

Question 1. Many of the challenges experienced by IHS are a direct result of the 

poor funding status of Indian Tribes. How do your offices work regionally in identifying the needs in different states and regions? 

Answer. The Indian Health Service (IHS) has a unique government-to-government 

relationship with American Indian and Alaska Native tribal governments and is 

committed to regular and meaningful consultation and collaboration with these 

Tribes. Consultation is considered an essential element for a sound and productive 

relationship with Tribes. It is IHS policy that consultation occurs when there is a 

critical event that may impact Tribes, new or revised policies or programs are proposed, or the IHS budget request and annual performance plan are being developed. 

This process is especially critical during the tribal budget formulation/consultation 

process. 

The IHS manages multiple fiscal-year budgets on a regular basis. The IHS budget 

formulation process is comprised of annual forums for Indian Tribes to interact with 

the IHS to provide program priorities, policies, and budget recommendations. In 

order to ensure Tribes are able to provide meaningful input for the IHS budget request, the IHS follows a timeframe that coincides with the Department of Health 

and Human Services’ budget schedule: (1) October—December: Each of the 12 IHS 

Areas hold budget formulation work sessions to provide technical assistance, identify local and/or regional health priorities; (2) February—March: IHS conducts a national IHS budget formulation work session that consolidates the work conducted 

at the Area level; (3) May—Tribes present national priorities and recommendations 

at the National HHS Tribal Budget Formulation and Consultation Session. The annual budget formulation and consultation process ensures the priorities and budget 

recommendations of IHS, tribal, and urban stakeholders are discussed and reviewed. In addition, IHS uses advisory committees to provide leadership, advocacy, 

and guidance to the Director on policy and program matters. 

Question 2. In understanding best practices by IHS and self-governance Tribes, 

it has been pointed out to me that the health care system is often is working well 

for some of these communities. How is the IHS regional administration sharing best 

practices among Regional Directors? 

Answer. The 2016–2017 IHS Quality Framework encourages regular, ongoing 

communications to share information about best practices across IHS. IHS has numerous mechanisms by which best practices are shared among different IHS Areas. 

The IHS National Councils, comprised of different professional specialties, meet and 

communicate regularly about challenges and best practices. Examples of these 

Councils include the National Councils of Chief Medical Officers, Nurse Leadership, 

Clinical Directors, Chief Executive Officers, Chief Clinical Consultants, Behavioral 

Health, Oral Health, Pharmacy, and Laboratory. Cross Council communication happens as needed and may be facilitated by and/or include Area and/or Headquarters 

leadership and staff. Councils meet in person annually at a National Combined 

Council meeting. In addition, Inter-Council Workgroups are formed to address crosscutting issues such as Opioids, Suicide, or Workforce recruitment and retention. 

Another mechanism through which IHS shares best practices throughout the system is through the IHS Clinical Support Center and the Telebehavioral Health Center of Excellence. This free education enables providers to learn and master new 

skills especially from rural and remote sites through a platform that easily connects 

with providers in low bandwidth areas and via mobile devices. Topics are wide-ranging such as Fetal Alcohol Spectrum Disorder, Trauma Informed Care, Utilizing Data 

with Dashboards, Leadership Training, Medication-Assisted Treatment for Chronic 

Opioid Use and many more. 

77 

1 Rear Admiral Chris Buchanan served as the Acting Director of the Indian Health Service 

at the time of this hearing. Since then, Michael D. Weahkee assumed duties as Acting Director 

and is currently serving in this capacity. 2 U.S. Gov’t Accountability Office, GAO–17–317, High Risk Series: Progress on Many High 

Risk Areas, While Substantial Efforts Needed on Others, at 202 (2017). 

IHS also collaborates with HealthInsight, which is a Quality Improvement Organization (QIO), and our hospitals to improve the health of American Indian and 

Alaska Native people by implementing and sharing best practices through the Partnership to Advance Tribal Health (PATH). The aim of PATH is to continuously improve the quality of care by implementing best health care practices and identifying 

other operational improvement needs. This three year initiative is being funded by 

the Center for Standards and Quality at the Centers for Medicare & Medicaid Services (CMS). 

IHS continues to share best practices through the Improving Patient Care (IPC) 

Initiative. The Indian Health Service (IHS) launched the Improving Patient Care 

(IPC) program in 2008 to improve the quality of health care and to provide greater 

access to care for American Indians and Alaska Natives using the Patient Centered 

Medical Home (PCMH) model. Now, nine years after the launch, the IPC Program 

continues to provide training and technical assistance, supporting Indian health facilities to achieve success in improving patient access to care, implementing clinical 

quality enhancements and promoting patient satisfaction. You can learn more about 

IPC at https://www.ihs.gov/ipc. 

Each year, the Department of Health and Human Services (HHS), IHS and Department of the Interior (DOI) Bureau of Indian Affairs (BIA) and Tribes host an 

annual Tribal Self-Governance Consultation Conference to share best practices, discuss policy issues, and conduct communication, education and outreach activities. 

The IHS Tribal Self-Governance Advisory Committee meets four times a year to 

share best practices and to advise the IHS Director on policy issues related to implementation of Title V of the ISDEAA. IHS partners with the Tribal Self-Governance 

Communication and Education Tribal Consortium which publishes a newsletter, 

Sovereign Nations, highlighting best practices. Lastly, the IHS Office of Tribal SelfGovernance hosts a series of ISDEAA Title V trainings each year across the IHS 

Areas. 

Question 3. Question on behalf of Chairman Ted Howard of the Shoshone-Paiute 

Tribe of the Duck Valley: ‘‘I understand that the Indian Health Service made a mistake in overestimating the amount required in fiscal year 2017 to fully fund contract 

support cost payments due Tribes under self-determination contracts and self-governance compacts. What explains this error, how much is needed in FY 2018, and 

what assurance can you give the Committee that going forward your estimates are 

accurate?’’ 

Answer. The contract support costs (CSC) amount included in the FY 2017 budget 

was for a proposed reclassification of CSC to a mandatory appropriation at a specified funding level. Projecting future CSC funding need is dependent on several variables, including how many additional Tribes might choose to enter into ISDEAA 

agreements or to expand their current agreements. The intent was to estimate a 

level that was sufficient to cover any additional need arising from these unknown, 

variable factors. Moreover, the estimate of CSC need prior to the contract period 

often differs from the final, actual amount that will be negotiated after the end of 

the contract period; therefore, the final amount for FY 2017 cannot yet be determined. The IHS’ request for FY 2017 was estimated to cover the full amount for 

each Tribe or tribal organization, which is not known until the end of their contract 

terms. 

In the President’s FY 2018 Budget Request for IHS, the CSC need projection is 

$718 million and includes a proposal to maintain the indefinite, discretionary appropriation. This amount is based on continually updated data. The IHS remains dedicated to continually tracking and monitoring estimated and final CSC needs and 

working closely with Tribes to understand potential future needs. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

REAR ADMIRAL MICHAEL WEAHKEE 1

GAO Reports and Recommendations 

Question 1. The Government Accountability Office (GAO)’s February 2017 High 

Risk Report noted 14 unresolved recommendations for the Indian Health Service 

(IHS). 2 Your testimony provided a broad overview of various improvement initiaVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00081 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK
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tives currently underway at the Service but did not provide a point-by-point response explaining how IHS is addressing each of these unresolved recommendations. Please provide a summary and timeline of the Services’ plans to address each 

of these unresolved recommendations. 

Answer. IHS received fourteen recommendations from the GAO reports listed on 

the 2017 High Risk Report, which covered six years and seven reports. All recommendations remain open at this time. In early July and early August, IHS provided an update to GAO reflecting the current progress we are making for each recommendation and requested seven of the 14 recommendations be closed. As discussed with Committee staff during a formal briefing about the status of our work 

to address GAO recommendations on August 9, 2017, IHS has made significant 

progress and continues to work with GAO to close all recommendations. 

The following table provides a summary of the open recommendations for each 

GAO report and indicates how many for which we have requested closure. Details 

about how IHS is addressing each recommendation follow. 

GAO–17–181: Actions Needed to Improve Oversight of Quality of Care 

Recommendation 1. Ensure agency-wide standards for the quality of care provided 

in federally-operated facilities are developed, monitored over time, and enhancements are made to the adverse event reporting system. 

Agency Progress: IHS named an Acting Deputy Director for Quality in 2016 and 

is implementing a system-wide dashboard of performance accountability metrics. 

The accountability dashboard incorporates the six dimensions of health, as identiVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00082 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK

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fied in IOM’s report, ‘‘Crossing the Quality Chasm: A New Health System for the 

21st Century’’—patient safety, care effectiveness, patient-centeredness, timeliness, 

care efficiency, and equity. IHS is also pilot testing a national Provider 

Credentialing System in four Areas, with the goal of fully implementing the system 

agency-wide by the end of CY 2017. The credentialing policy is being updated as 

well. IHS anticipates an award for a national hospital accreditation contract this 

year and best practices for an adverse event reporting system continue to be assessed by the agency. 

Recommendation 2. Develop contingency and succession plans for the replacement 

of key personnel, including Area Directors. 

Agency Progress: In December 2016, IHS developed contingency and succession 

plans, including skills gap analyses and appropriate developmental programs for the 

replacement of key personnel, including Area Directors. The December 2016 succession plans are currently being updated and will be updated on a semi-annual basis. 

In addition to the contingency and succession plans, IHS has developed leadership 

training academies for senior leaders. For example, staff rotations through IHS 

Headquarters provide additional training for senior level positions. A mentoring initiative for those who have recently been promoted to key leadership positions has 

been implemented. The agency has requested closure of this recommendation. 

GAO–16–333: Actions Needed to Improve Oversight of Patient Wait Times 

Recommendation 1. Develop and communicate specific agency-wide standards for 

patient wait times in federally-operated facilities and review experience with timeliness goals set as part of Improving Patient Care (IPC). 

Agency Progress: IHS patient wait time standards were established in July 2017. 

A supporting policy document is being developed. IHS is developing a communications plan to inform and address questions from internal and external stakeholders. 

An implementation plan is also being developed which includes education, data collection, resources, monitoring, and target timelines. If sites experience challenges in 

meeting the standards, technical assistance will be provided through the Improving 

Patient Care (IPC) program. Additionally, since IHS federally-operated facilities currently collect patient wait time data at the Service Unit level, the IPC program, in 

collaboration with the IHS Office of Information Technology, is developing a reporting system to support monitoring patient wait time measures and evaluating 

progress at the Area and national levels. 

Recommendation 2. Monitor patient wait times in federally-operated facilities and 

ensure corrective actions are taken when standards are not met. 

Agency Progress: IHS is targeting the full implementation of Agency-wide standards for wait times by later this year including monitoring of the outcome data. IHS 

is developing an implementation plan which includes education, data collection, resources, monitoring, and target timelines. If sites experience challenges in meeting 

the standards and/or the target timelines, technical assistance will be provided 

through the Improving Patient Care program. This is consistent with the overall 

IHS objective to promote the Patient Centered Medical Home (PCMH) model of care 

within IHS ambulatory care facilities and the IPC focus on building quality improvement skills and knowledge within the IHS health care system. 

GAO–14–57: Opportunities May Exist to Improve the CHS Program 

Recommendation 1. Modify the claims payment system to separately track IHS referrals and self-referrals, revise GPRA measures so they distinguish between the 

two types of referrals and establish separate targets. 

Agency Progress: IHS is modifying the data system to track separately IHS referrals and emergency self-referrals, where the notification requirement and all other 

requirements of the PRC regulations at 42 CFR 136 are met, and are subsequently 

authorized for PRC payment. We expect to be able to provide baseline reporting for 

CY 2017. IHS is currently researching industry standards and expects to have separate payment timeframe targets for these two referral types. 

Recommendation 2. Improve the alignment between CHS staffing levels and workload by revising IHS current practices, where appropriate, to allow available funds 

to be used to pay for CHS program staff. 

Agency Progress: The IHS did not concur with this recommendation because historically, Agency policy has been to use Purchased/Referred Care (PRC), formerly 

known as Contract Health Services (CHS), funds solely for the purchase of health 

care services. The agency has requested closure of this recommendation. 

Recommendation 3. Proactively develop potential options to streamline program 

eligibility requirements. 

80 

Agency Progress: IHS disseminated information to patients about their coverage 

and ability to access care without obtaining a PRC referral. IHS hospitals have 

worked with the respective States to implement presumptive eligibility. The agency 

has requested closure of this recommendation. 

GAO–13–272: Capping Payment Rates for Non-hospital Services Could Save 

Millions of Dollars for CHS 

Recommendation 1. Should Congress decide to cap payments for physician and 

other non-hospital services made through IHS’s CHS program, IHS should monitor 

the CHS program patient access in order to assess how any new payment rates may 

benefit or impede the availability of care. 

Agency Progress: IHS developed an online PRC Rates Provider Tracking tool to 

monitor the access to physician and other non-hospital care. This tool enables PRC 

programs to document providers that refuse to contract for their most favored customer rate or accept the PRC rates. 

IHS provided training to the Area PRC officers at a face-to-face meeting in December 2016 on how to use the tool. The tool went live in January 2017. 

After capping PRC payment rates for non-hospital services, IHS and Tribes have realized a savings of more than $139.7 million so far this calendar year. PRC savings through June 2017 are listed in the table below. All IHS PRC programs participate in the PRC payment rates; however, Tribes are not required to participate but 

may opt-in as stated in 25 U.S.C. 45aaa16(e). The additional savings enables IHS 

and tribal providers to deliver more and increase access to health care services. 

IHS has requested closure of this recommendation. 

Purchased and Referred Care Savings by Month—January—June, 2017—Federal and 

Tribal* 

Month Federal Tribal Total YTD 

JAN $6,127,595 $120,168 $6,247,763 $6,247,763 

FEB $9,328,068 $781,264 $10,109,332 $16,357,095 

MAR $24,002,806 $2,890,466 $26,893,272 $43,250,367 

APR $28,747,136 $554,038 $29,301,174 $72,551,541 

MAY $31,357,518 $2,113,185 $33,470,703 $106,022,244 

JUNE $28,840,636 $4,876,569 $33,717,205 $139,739,449 

YTD $128,403,759 $11,335,690 $139,739,449 

This data includes six (6) tribal programs. 

GAO–13–553: Most AI/AN Potentially Eligible for Expanded Health Coverage, but Action Needed to Increase Enrollment 

Recommendation 1. Prepare for the increase in eligibility for expanded Medicaid 

and new coverage options and the need for enrollment assistance and billing capacity by realigning current resources and personnel to increase capacity. 

Agency Progress: In an effort to improve our enrollment efforts at the local level, 

IHS developed and disseminated a Business Plan Template and Template Description in 2013. IHS monitors use of the business plan through cascading performance 

elements in Area Directors’ and CEOs’ performance evaluations. 

IHS sponsored national IHS Partnership Conferences in 2013 and 2016 that included patient registration and benefits coordination tracks that focused on outreach 

and education. The 2017 IHS Partnership Conference with IHS, tribal, and Urban 

Indian Organization Business Offices, PRC coordinators, health information management (HIM), and finance staff was held August 22–24. This hands-on training 

supports our front-line staff who are directly involved in the PRC, business office 

and HIM operations. 

IHS also entered into cooperative agreements with the National Indian Health 

Board and National Congress of American Indians to conduct consumer outreach, 

education, training and T/A for Tribes and Tribal organizations related to options, 

enrollment, and exemptions. IHS hosted a patient registration and benefits coordination training in April 2017 focusing on outreach, education and assistance to patients regarding coverage. 

GAO–12–446: Action needed to Ensure Equitable Allocation of Resources for 

the CHS Program 

Recommendation 1. Use variations in levels of available hospital services in a formula for allocating CHS funds. 

Agency Progress: Approximately half of the PRC funds are distributed through Indian Self-Determination awards and so are protected from unilateral reductions or 

81 

3 U.S. Gov’t Accountability Office, GAO–17–317, High Risk Series: Progress on Many High 

Risk Areas, While Substantial Efforts Needed on Others, at 209–214 (2017). 

reallocation by the agency, absent one of the other circumstances set forth in 25 

U.S.C. § 5325(b)(2) or 25 U.S.C. § 5388(d)(1)(C)(ii). IHS partners with tribal leaders 

in making PRC fund allocation decisions for directly-operated programs. The agency 

has requested closure of this recommendation. 

Recommendation 2. Use actual counts of CHS users rather than all IHS users in 

a formula for allocating CHS funds that relies on number of active users. 

Agency Progress: IHS partners with tribal leaders in making PRC fund allocation 

decisions for directly operated programs. Any future changes in allocation methods 

will undergo tribal consultation. The agency has requested closure of this recommendation. 

Recommendation 3. Develop written policies and procedures to require Area offices to notify IHS when changes are made to the allocations of funds to CHS programs. 

Agency Progress: IHS distributed guidance on PRC allocation of funds to Area directors and PRC officers in CY 2016. IHS directs Area directors through official PRC 

allocation of funds distribution memos. These memos are official procedural documents that become a part of the PRC policy chapter of the Indian Health Manual. 

The agency has requested closure of this recommendation. 

GAO–11–767: Increased Oversight Needed to Ensure Accuracy of Data Used 

for Estimating CHS Need 

Recommendation 1. Develop a written policy documenting how IHS evaluates 

need for the CHS program and disseminate it to Area offices and CHS programs. 

Agency Progress: IHS is developing the specific policy and procedural guidance, 

which will be incorporated into the Indian Health Manual. 

Recommendation 2. Provide written guidance to CHS programs on a process to 

use when funds are depleted and there is a continued need for services and monitor 

to ensure that appropriate actions are taken. 

Agency Progress: IHS plans to issue written policy and guidance to all IHS sites 

by September 30, 2017. 

Question 2. GAO’s High Risk Report notes that many implementation decisions 

are left to individual Area Directors to decide (e.g., allocation of Purchased-Referred 

Care funds among facilities, patient wait time standards, operation of IHS facility 

Governing Boards, etc.). 3 How does IHS propose to improve quality of care across 

the entire system given the level of discretion left to Area offices? 

Answer. IHS is working to standardize policies and procedures across the system. 

Area Office and Service Unit representatives have been included as members of the 

Quality Framework Steering Committee (responsible for implementation of system 

level improvements identified in the IHS 2016–2017 Quality Framework). IHS continues working to establish the Office of Quality Health Care under the Deputy Director of Quality Health Care. This office will continue the work of system level 

quality improvement and patient safety enhancement, ensuring sustainment of 

Quality Framework implementation and providing oversight and coordination of information sharing for quality and safety. This office will work closely with the IHS 

Quality Consortium to identify best practices, unify processes, and prioritize quality 

and safety initiatives and resources across the IHS system of care. 

A Quality Accountability Dashboard Working Group was established by the Steering Committee to develop metrics that will allow oversight and management of compliance with policy and regulatory requirements that ensure quality and safety of 

care. IHS expects the measure definitions, data collection tool, and dashboard will 

be ready for use by August 31, 2017. The dashboard will enable Headquarters and 

Area Offices to have real-time visibility across the IHS system. This will facilitate 

implementation and monitoring of quality measures throughout the system over 

time. The success of this dashboard has also led to efforts to develop similar dashboard tools related to three other agency priorities: People, Partnerships, and Resources. Additionally, a Patient Wait Times Working Group was established by the Steering Committee to develop standards for primary care patient wait times for appointments. The Working Group completed standard development in June 2017: 28 days 

or less for primary care, non-follow-up appointments and 48 hours for primary care 

urgent visit appointments. This standard was developed based on review of standards from Avera Health, Defense Health Agency, Veterans Health Administration, 

Institute for Healthcare Improvement, and a literature search from the National Library of Medicine (using Scopus) on April 21, 2017, and has been incorporated into 

82 

a measure for the Quality Accountability Dashboard so that it can be monitored routinely and improved. 

In early January 2017, hospital Governing Board (GB) Bylaws for inpatient acute 

care hospitals were standardized across IHS. The goal of this change was to ensure 

a baseline of standards IHS-wide, while maintaining flexibility for the Areas and 

service units to accommodate needs specific to their locations and service populations. Bylaws must now include the following: 

• Frequency of formal governing board meetings: At least twice per year, but may 

meet more often if desired/necessary to meet the needs of the service unit. 

• Membership of governing board: The minimum number of GB members is determined by the Chair (Area Director) and ensures adequate representation of 

disciplines to carry out the required activities. All GB members have a vote and 

the majority of voting members must represent the Area Office and may also 

include similar representation from Service Units. 

—Due to the inherent federal functions of governing federal facilities, members 

of the Governing Board must be IHS federal employees/officers. 

—Tribal consultation is encouraged through CEO communications with tribal 

leadership, and tribal representatives may be invited to open forums or town 

hall meetings in order to provide input. 

• Meeting Agendas: At a minimum, Governing Board meeting agendas must include the following elements: 

—Quality of Care—including quality improvement and quality assurance/compliance 

—Patient Safety 

—Hospital/Facility Operations 

These three components were communicated to Area Directors for immediate incorporation into GB Bylaws for each hospital. Area Offices communicated these new 

requirements to their Service Units within their established channels and required 

verification of incorporation in respective GB Bylaws for reporting back to IHS 

Headquarters. 

Question 2a. Does IHS have a consistent way to capture innovation/best practices 

within one service area and share those with other service areas? 

Answer. The IHS Improving Patient Care (IPC) Program has been providing quality improvement support and guidance since 2008 for ambulatory care services. One 

of its primary goals is to assist IHS, Tribal and Urban Indian Health Programs with 

developing Patient-Centered Medical Homes. A component of the Program’s process 

is to capture innovations and best practices for sharing with all participating locations. 

Beginning in 2016, IHS also established a number of forums (in addition to the 

IPC Program) for networking among quality assurance and quality improvement 

staff at all levels of the agency. Quarterly lunch time webinars for Service Unit 

leaders to share lessons learned and best practices related to quality and safety 

have been on-going since June 2016. A Quality Managers Listserv has been established to communicate and share information among Headquarters, Area Office, and 

Service Unit quality assurance and quality improvement staff. Additionally, a 

monthly webinar series for Area and Service Unit Quality Managers is hosted by 

Headquarters Quality Framework Steering Committee staff for real-time communications and information sharing. These communications platforms reach wide and 

varied audiences at all levels, support a network of geographically isolated employees, and build unity of practice and purpose for quality improvement and patient 

safety. 

IHS has continued its productive partnerships with the Premier Inc. Hospital Improvement and Innovation Network (HIIN) and HealthInsight New Mexico Quality 

Improvement Organization (QIO) with its Partnership to Advance Tribal Health 

(PATH). The Premier HIIN provides technical assistance and learning platforms to 

reduce Hospital Acquired Conditions and Readmissions. They coach hospital care 

teams and staff on best practices, lessons learned, and quality improvement activities aligned with these goals. The HealthInsight NM QIO and PATH are providing 

leadership development learning opportunities, care team effectiveness enhancement, patient safety resources, patient/family engagement technical assistance, and 

system level assessments. Engagement with both of these quality improvement entities is increasing opportunities to identify best practices and innovative solutions to 

improve quality and safety, and adds another layer of communication opportunities 

to share this information across IHS. 

Question 3. GAO testified that inclusion on the biennial High Risk report often 

result in agencies receiving additional management resources from Department 

83 

leadership and the Office of Management and Budget (OMB). Has IHS seen increased engagement from the Department of Health and Human Services’ (DOI’s) 

Office of the Secretary or OMB since the High Risk designation? If so, please summarize any evidence of this increased engagement. 

Answer. The Office of the Secretary and OMB are actively engaged with IHS in 

addressing the challenges identified by GAO in the High Risk report. For example, 

the IHS resources were prioritized in the FY 2018 budget request. Further, OMB 

and HHS have approved use of the Non-recurring Expenses Fund for IHS to meet 

key needs in facilities, Information Technology (IT) systems and medical equipment. 

Departmental and OMB staff have also toured field facilities, both IHS and triballyrun, engaging in discussions with tribal leaders, patients and other stakeholders 

about priorities and needs at the local health care delivery level. In addition, HHS 

has assigned personnel with specific expertise from other HHS operating divisions 

to assist IHS in addressing risk areas such as health services in the Great Plains 

Area (GPA). 

Question 4. GAO also testified that staff and leadership turnover is an overarching issue facing IHS. How is IHS working to ensure all administrative duties 

are fulfilled in the face of frequent turnover? 

Answer. At the local level, when employees provide notice of impending departure, 

IHS works to identify and designate staff to assume the duties until the position 

is filled. More globally, IHS uses position management data to identify and track 

vacancies across IHS to identify gaps in administrative functions and services and 

determine both immediate and long-term staffing and recruitment needs. In addition, the IHS Area and HQ offices have developed succession plans that will aid in 

identifying immediate, short-term, and long-term plans for ensuring staff develop 

the competencies to potentially serve in leadership positions on a temporary or permanent basis for when key leadership positions become vacant. IHS is also in the 

process of developing a staff transition planning tool for current leaders to provide 

key position information and institutional knowledge for incoming staff. Finally, 

IHS has developed a leadership training program to prepare high performing staff 

with leadership and administrative skills for their own developmental benefit, and 

also to provide IHS with a cadre of trained staff in the event of turnover. 

Question 4a. Given these staffing challenges, how is IHS ensuring federally-operated, tribally-operated, and urban-Indian IHS facilities receive full support with 

medical, legal, and financial compliance requirements? 

Answer. IHS continues to implement the Quality Framework launched in November 2016, which was developed to strengthen organizational capacity to improve 

quality of care, improve our ability to meet and maintain accreditation for IHS direct service facilities, align service delivery processes to improve the patient experience, ensure patient safety, and improve processes and strengthen communications 

for early identification of risks. Inherent in these objectives is ensuring compliance 

with medical, legal, and financial requirements. 

A specific action aimed at assuring accountability is development of a system-wide 

dashboard of performance accountability metrics that will demonstrate aspects of 

compliance with various requirements, standards, policy, and guidance. IHS is 

working with its Area Offices and local community facilities to enhance financial reports, and estimation capabilities; and is exploring additional IT tools which can improve financial reporting, reduce time/effort involved in routine financial staff work, 

and ease the burden on managers at the local, Area, and Headquarters levels in accessing financial information and identifying mission critical issues. 

Tribes that manage their health care programs under Indian Self-Determination 

and Education Assistance Act contracts and compacts are responsible for ensuring 

their programs’ compliance with limited oversight by IHS. However, IHS provides 

technical assistance and offers some opportunities for tribal programs to participate 

in to assist them in addressing certain requirements. Urban Indian Organizations 

have responsibility for compliance for the programs included in their contracts and 

grants, and IHS has an oversight role to ensure they are carrying out the terms 

of the contracts and grants. In addition, Urban Indian Organizations are able to 

participate in some IHS activities to improve compliance such as training provided 

through the IHS Partnerships Conference. 

Question 4b. How is IHS ensuring the Service’s staffing efforts address the technical skills gaps (e.g., health systems administration) identified by GAO? 

Answer. During the first quarter of FY 2017, the IHS conducted a skills gap analyses for key positions and developed appropriate level developmental programs for 

those positions. A leadership training program has been developed which includes 

Leadership Training Academies for senior level staff and individual development 

plans to improve the competencies and skills required for staff new to leadership 

84 

4Letter from Chris Buchanan, Acting Director, Indian Health Service, to Tribal and Urban 

Indian Organization Leaders (Mar. 28, 2017) (on file with S. Comm. on Indian Affairs). 

roles, including rotating staff through Headquarters to provide additional training 

in preparation for future placement in senior level positions. 

An important part of the IHS leadership program includes succession planning for 

key positions and preparing staff to compete for leadership positions. Succession 

plans are updated semi-annually. In addition, IHS has initiated a mentoring initiative for those who have recently been promoted to key leadership positions. Best 

practices will be identified to expand these types of activities throughout IHS. 

School-based Health Clinics 

Question 5. According to your testimony, IHS supports nine direct-service and 

eight tribally-operated school-based health clinics. Where are these 17 clinics located, and what scope of medical services do they provide to the schools they serve? 

Answer. Of the 17 school-based health programs, one is located in Alaska; four 

are located in New Mexico within the Albuquerque Area; two are located in Minnesota within the Bemidji Area; two are located in the Nashville Area, specifically 

in Mississippi and North Carolina; one program is located in New Mexico within 

Navajo Area; one program is located in Oklahoma; one program is located in Arizona within Phoenix Area; and five are located in Arizona within the Tucson Area. 

The scope of health services provided at the schools varies and may include clinical services such as dental and pharmacy or behavioral health services or both 

types of services. 

Question 5a. Is IHS aware of any tribal interest in expanding the number of these 

clinics to other schools and communities in Indian Country? 

Answer. The IHS has provided school-based health services for many years. In 

general, both IHS and Tribes have been increasingly interested in expanding schoolbased health services and clinics to improve access to care for patients who may otherwise not have received services for a number of reasons (e.g., lack of transportation). Parents and school administrators have also been extremely supportive of 

these types of partnerships and collaborations. 

Question 5b. Is IHS aware of any barriers that might prevent the Service from 

working collaboratively with Bureau of Indian Education (BIE) and tribes to open 

these more of these clinics? 

Answer. In our experience working collaboratively with the BIE and Tribes, we 

have encountered challenges relating to obtaining parental consent forms, including 

those that must be signed by legal guardians, and obtaining space for the schoolbased health services. 

Question 6. What relationship does IHS have with the BIE regarding the provision of medical services to Native students attending BIE schools and students living in BIE dormitories? 

Answer. The Indian Health Service has had an on-going collaborative relationship 

with the Department of Interior’s Bureau of Indian Education (BIE). For example, 

the Navajo Area Office has entered into partnership agreements with the BIE to 

provide services to Native students attending BIE Schools and students residing in 

BIE dormitories. Currently, there are seventeen partnerships in place with State, 

tribal, private and BIE schools located in Arizona and New Mexico. We are working 

on collecting additional data regarding the scope of services at all school-based 

health programs where Indian Health Service funded services are being provided to 

Native students. 

Unused funds 

On March 28, 2017, IHS issued a ‘‘Dear Tribal Leader’’ letter addressing concerns 

of whether the Service returns ‘‘a significant amount of unused money to the United 

States Treasury each year.’’ 4

Question 6a. For which specific activities/authorized uses did IHS have unused 

funds in FY2011? Please include a description of any statutory limitations that govern the use or repurposing of these unused funds. 

Answer. Within the lump sum appropriation for the IHS Services account, $3.8 

million was returned to Treasury when the FY 2011 appropriated funds officially 

cancelled. Examples of activities included in the Services account include Hospitals 

and Health Clinics, Dental Health, Public Health Nursing, and other preventive and 

clinical services. This appropriation contained annual budget authority meaning 

that the budget authority was only available for new obligations during one fiscal 

year.—The default period of availability for appropriations, unless otherwise specified by Congress, is one year. Per OMB Circular A–11, annual budget authority can 

85 

be obligated for the expenses of one fiscal year, followed by a five year expired phase 

during which time the budget authority is no longer available for new obligations 

but can be used only for adjustments to obligations incurred prior to the expired 

phase. At the close of that six year total period, the funds are considered lapsed and 

returned to the U.S. Treasury. This is standard budget execution practice for similar 

accounts government-wide. 

Question 6b. How does the amount of IHS unused funds compare to the amount 

of unused funds returned by other agencies both within HHS and across the Federal 

Government as a whole? 

Answer. IHS has not performed a comprehensive review of other agencies. It is 

important to note that program administration varies by agency and appropriation, 

and the purpose of the appropriation can be a significant factor in an agency’s ability to expend the funds within the period of availability. For IHS, the service units/ 

health programs providing direct patient care have the greatest flexibility for fully 

expending appropriated funds. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

MICHAEL BLACK

GAO Reports and Recommendations 

Question 1. The Government Accountability Office (GA0)’s February 2017 HighRisk Report included several unresolved recommendations for the Bureau of Indian 

Affairs (BIA) to help ensure that Bureau of Indian Education (BIE) schools provide 

safe and healthy facilities for students and staff. GAO testified at this Oversight 

Hearing: 

‘‘As of April 2017, the agency had not provided documentation that the inspection 

information that its safety personnel collect and report to BIE schools is complete 

and accurate. In addition, our preliminary findings from ongoing work since February 2017 point to continued problems with Indian Affairs’ oversight of safety inspections at BIE schools.’’ 

Despite these remaining Indian Education-related recommendations for BIA, your 

testimony focused exclusively on addressing the remaining Indian Energy-related 

GAO recommendations. Please provide a summary and timeline of the Bureau’s 

plans to address each of these unresolved recommendations. 

Answer. On July 17, 2017, and August 16, 2017, Indian Affairs (IA) and the Department of the Interior’s Office of Financial Management provided GAO updates 

on progress on the BIE open recommendations. While none of the recommendations 

have been closed to date, GAO acknowledged the progress made and that some of 

the recommendations are close to full implementation. 

Indian Affairs has taken the following actions to address the GAO recommendations concerning school safety: 

• In FY 2016, 100 percent of the BIE schools were inspected, reports were issued 

and deficiencies were recorded for remediation. 

• Performance standards for SES Regional Directors and safety personnel were 

revised in FY 2016 and FY2017 that added specific performance elements and 

measures to ensure safety inspections are performed annually. 

• In FY 2017, Indian Affairs established a Safety Work Group to enhance the 

school safety program and engage all the stakeholders to ensure a successful 

Indian Affairs integrated safety program. 

• In FY 2017, policy guidance and handbooks were issued and disseminated to 

all Indian Affairs personnel responsible for school safety and remediation of the 

deficiencies. 

• Indian Affairs tracks monthly safety inspections performed and disseminates 

the progress to the BIE and BIA Director and Regional Directors. 

• Indian Affairs is currently developing a mandatory course curriculum for personnel responsible for performing safety inspections. 

• In FY 2017, BIE stood up their School Safety Office and is continuing to recruit 

for their vacant positions. 

Question 1a. Has BIA established a process to routinely monitor the quality and 

timeliness of all school inspection reports? If so, please provide an explanation of 

this process. 

Answer. The BIA will amend the 2017 safety performance standards for Safety 

Inspectors to comply with the standards in the recently updated Indian Affairs SafeVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00089 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK
86 

ty, Health and Accessibility Inspection/Evaluation Guidelines and the Indian Affairs 

Fire Systems Inspection, Testing and Maintenance Guidelines. 

In addition, the Division of Safety and Risk Management (DSRM), BIA, and BIE 

will develop and formally publish a comprehensive quality performance standard for 

inspection reports and develop a formal and uniform process of monitoring the quality of safety inspection reports. 

The BIE and BIA, in coordination with the DSRM, will develop and implement 

comprehensive and uniform Performance Appraisal Plans for all Indian Affairs safety personnel in FY 2017, to include a component addressing the timeliness of safety 

inspection reports submission. The first-line supervisors will then hold employees 

accountable based on the timeliness data collected by DSRM. 

Question 1b. What controls has BIA put in place to ensure that any high-risk safety and health deficiencies identified in school inspections are remedied in a timely 

manner? 

Answer. Office of Facilities, Property, and Safety Management (OFPSM through 

the Division of Facilities Management and Construction (DFMC) coordinates with 

DSRM, BIA and BIE to identify high risk items included in safety inspection reports. Once identified, DFMC/OFPSM has supplemental funding programs (major 

and minor Improvement & Repair, Emergency, Fire, Environmental) that provide 

funding for correction of high risk safety and health deficiencies. DFMC/OFPSM, in 

coordination with DSRM, BIA and BIE, also prioritizes safety, health and accessibility deferred maintenance deficiencies for annual Improvement and Repair funding provided to the Regions and Sites. DFMC/OFPSM has an established contract 

for Condition Assessments that also identifies safety and health deficiencies and 

completes any outstanding abatement plans during site visits. 

Question 1c. Please provide a summary of how BIA and BIE arc working to improve inter-Bureau coordination on safety inspections, health and safety issue remediation, and operations/maintenance activities. 

Answer. The BIE has worked closely across Indian Affairs, including with BIA, 

in recent months to address outstanding GAO recommendations and improve Bureau operations and service delivery in Bureau-funded schools. Upon GAO’s identification of BIE as a high-risk agency, the Bureau coordinated efforts with Indian 

Affairs to prioritize accountability and oversight in order to address GAO recommendations, which will increase efficiency and effectiveness. 

Indian Affairs is supportive of the BIE as the agency participates in joint work 

groups specifically created to address outstanding GAO recommendations, such as 

the Indian Affairs Safety Work Group that includes participants from BIA. The 

Work Group held two sessions this past summer as a means to increase coordination, develop policies and procedures, and address outstanding GAO recommendations. Through the Work Group, BIE and BIA staff, alongside DFMC and Indian 

Affairs, have worked together to ensure that safety inspections are 100 percent completed for the second year in a row as well as developing policies and procedures 

to make sure quality improves and that supports are in place to assist critical staff, 

such as safety inspectors. The work group will plan subsequent meetings for the fall 

to ensure progress continues to be made on coordinated work. Additionally, Indian 

Affairs has formed an initial work group to specifically address financial oversight 

across the agencies. This coordination will diminish bureaucratic inefficiencies and 

promote communication across Indian Affairs. 

Question 2. GAO additionally testified that inclusion on the biennial High Risk 

report often results in agencies receiving additional management resources from Department leadership and the Office of Management and Budget (OMB). Has BIA 

seen increased engagement from the Department of the Interior’s (DOI’s) Office of 

the Secretary or OMB since the High Risk designation? If so, please summarize any 

evidence of this increased engagement. 

Answer. Yes, as indicated in a previous response, the Department’s Office of Financial Management has been involved in the July and August meetings with GAO. 

Also, on a monthly and quarterly basis, DIEA provides and discusses the status of 

all GAO and OIG recommendations with the Office of Financial Management. Additionally, representatives from the Department’s Assistant Secretary for Policy, Management and Budget attended the July 17, 2017, meeting with GAO and IA senior 

leadership. 

Question 3. Shortly following the conclusion of the May 17th Oversight Hearing, 

GAO released three additional reports regarding BIE education-related functions 

‘‘Tribal Transportation: Better Data Could Improve Road Management and Inform 

Indian Student Attendance Strategies,’’ 2 ‘‘Indian Affairs: Actions Needed to Better 

Manage Indian School Construction Projects,’’ 3 and ‘‘Indian Affairs: Further Actions 

Needed to Improve Oversight and Accountability for School Safety inspections.’’ 4

87 

Within these three reports, the GAO provided a total of 20 new recommendations 

to improve the delivery of education to BIE students. Please provide a summary and 

timeline of the Bureau’s plans to address each of the 20 recommendations directed 

at BIA. 

Answer. BIA provided a 60-day report to GAO and members of Congress on August 9, 2017, describing how BIA will partner with stakeholders in implementing 

each of the recommendations and detailing the timelines (including dates and responsible persons) for addressing each of the recommendations. BIA is also coordinating with the Federal Highway Administration (FHWA) and Tribal Transportation Program Coordinating Committee (TTPCC) on the proposal for addressing 

recommendations and responses. 

Question 3a. Please provide a summary of the efforts BIA is undertaking to work 

with BIE, and DOI’s Office of the Secretary, and OMB to ensure the remaining recommendations from these three reports are addressed in a timely, effective manner. 

Answer. OFPSM is coordinating with DSRM, BIA and BIE to update policies, 

guidelines, performance plans and provide training for site personnel in Safety & 

Health, Accessibility, O&M services/activities, Improvement & Repair and other 

supplemental program funding guidelines and requirements. Training sessions have 

been posted on relevant websites for access by anyone needing training or for refresher training. 

Staff and Leadership Turnover 

Question 4. When asked about any continuing limitations placed on hiring by Administration leadership, you testified that the BIA and BIE are subject to certain 

hiring restrictions depending on vacancy grade-level and location. How many total 

vacancies does BIA currently have? And, what is the breakdown of these vacancies 

by type (location, grade level, and function)? 

Answer. The Office of Human Capital Management office has identified 1,003 vacancies BIA-wide, as of August 15, 2017 (see spreadsheet). 

Question 4a. What, if any, limitations put in place by the White House, OMB, or 

DOI’s Office of the Secretary exists regarding BIA’s ability to fill these vacancies? 

Answer. The Departmental Hiring Controls currently allow for the filling of vacancies at the GS–1 1 grade level and below located outside of the Washington, 

D.C., and Denver, Colorado, metropolitan areas. Hiring for all positions in the 

Washington, D.C., and Denver, Colorado, metropolitan areas is allowed with the 

granting of a waiver by the Secretary’s Office. 

Question 5. In its 2017 High RiskReport, GAO identified workforce planning- including frequent turnover and high vacancy rates- as an overarching issue facing 

Indian Affairs. For example, several tribally operated BIE schools have informally 

reported to this Committee that staffing turnover and vacancies at Education Resource Centers make it difficult to receive timely assistance with reporting and compliance questions. How is BIA working to ensure all administrative duties are fulfilled in the face of these workforce challenges? 

Answer. During workforce planning efforts to address administrative duties and 

technical skill gaps, the BIA conducted a wide-spread review of components on optimal human capital levels required in relation to the services provided; gaps in talent and performance requirements; critical skills, functions and occupations to retain; and positions that should/could be eliminated or restructured/re-staffed to meet 

BIA’s incremental goals of downsizing and reducing unnecessary processes and overlapping and redundant authorities/controls. As a result of the review, the BIA identified a need to restructure the organization to achieve near-term workforce reductions and allocate the resources where the needs are greatest. The BIA plans to consolidate programs and functions; realign functions to improve efficiency by eliminating overlapping responsibilities from central offices and other units where appropriate; relocate or reassign personnel to different duty stations and program areas; 

streamline supervisory staff restructure positions to correct skill imbalances and/or 

develop leadership; eliminate positions and functions that are redundant and obsolete as a result of automation and changing job competency requirements; utilize career ladder positions to establish a balanced workforce; and reduce grade levels 

throughout all locations across all the organization. To implement some of these 

changes, the BIA is also requesting the authority to offer Voluntary Separation Incentive Payment (VSIP) and Voluntary Early Retirement Authority (VERA). These 

actions and use of these authorities will allow BIA to implement and transition to 

more efficient Regional Office operations along with facilitating the effective delivery 

of services to our customers. They will allow the agency to achieve more efficient 

alignment of mission related operations and more consistent management of services across the organization. 

88 

Question 5a. How is BIA ensuring the Bureau’s staffing plan address the technical 

skill gaps (e.g., real estate management) identified by GAO? 

Answer. The BIA conducted a wide-spread review of components on optimal 

human capital levels required in relation to the services provided; gaps in talent and 

performance requirements; critical skills, functions and occupations to retain; and 

positions that should/could be eliminated or restructured/re-staffed to meet BIA’s incremental goals of downsizing and reducing unnecessary processes and overlapping 

and redundant authorities/controls. As a result of the review, the BIA identified a 

need to restructure the organization to achieve near-term workforce reductions and 

to focus resources where the needs are greatest. As a result, the BIA plans to consolidate programs and functions; realign functions to improves efficiency by eliminating overlapping responsibilities from central offices and other units where appropriate; relocate or reassign personnel to different duty stations and program areas; 

streamline supervisory staff; restructure positions to correct skill imbalances and/ 

or develop leadership; eliminate positions and functions that are redundant and obsolete as a result of automation and changing job competency requirements; utilize 

career ladder positions to establish a balanced workforce; and reduce grade levels 

throughout all locations across all the organization. To implement some of these 

changes, the BIA is also requesting the authority to offer Voluntary Separation Incentive Payment (VSIP) and Voluntary Early Retirement Authority (VERA). 

Energy 

Question 6. While BIA acknowledged in its testimony that ‘‘a survey is an important step in developing a full inventory of trust resources,’’ it also conceded that the 

federal government has not yet fully surveyed all Indian reservation lands. The BIA 

stated that ‘‘cadastral survey inventories are being evaluated and FYI7 survey requests have been approved for funding and completion by BLM.’’ Has BIA identified 

the extent to which trust lands do not have accurate surveys? 

Answer. While there is no inventory of unsurveyed lands, we know that there are 

significant areas of Indian lands that have not been surveyed, such as the Navajo 

reservation and certain tribal lands within the Eastern Region’s jurisdiction. We 

have an inventory of survey needs identified by the BIA Regions in coordination 

with BLM, that are the result of proposed real estate development projects, zoning, 

trespass issues (boundary establishment), litigation needs and legislative mandates. 

Question 6a. Does BIA know what resources are needed to complete these surveys? 

Answer. Funding for the line item that covers Real Estate Services (RES) projects, 

including cadastral surveys, is $2.7 million. Our inventory of survey needs includes 

surveys for approximately 5,000 projects. Funding is also required to fulfill BIA’s 

trust responsibility and Fiduciary Trust Model components: BLM Indian Land Surveyor program, Certified Federal Surveyor program, Enhance Public Lands Survey 

System in Indian Country, and development of a cadastral-based geographic information system. 

Question 6b. Please list and describe the FYI7 survey requests that have been approved for funding and completion by BLM. 

Answer. BLM has approved for funding and completion the surveys mandated by 

the Nevada Native Nations Land Act (NNNLA), which required the new trust lands 

(70,000 acres) for the tribes involved in the NNNLA to be surveyed in 18 months 

(i.e., by the end of FY18). 

Question 7. When asked about GAO’s finding that BIA did not have a documented 

process or the data needed to track its review and response times, the BIA stated 

that its experts are working to modify TAAMS. BIA further explained that these 

modifications may incorporate ‘‘the key identifiers and data fields needed to track 

and monitor review and response times for oil and gas leases and agreements.’’ BIA 

mentioned taking steps to track and monitor oil and gas leases and agreements. Is 

the agency also taking steps to track and monitor other energy-related documents 

that must be reviewed by BIA, such as ROW agreements? 

Answer. Yes. Rights-of-way are being tracked and monitored, a process that was 

implemented on April 21, 2016, the effective date of the revised 25 CFR Part 169 

regulations. The revised Part 169 regulations impose deadlines for BIA action on requests for rights-of-way. 

Question 7a. Is the agency taking steps to track and monitor documents related 

to environmental reviews, like those associated with the National Environmental 

Policy Act, the Endangered Species Act, and the National Historic Preservation Act? 

Answer. The agency tracks environmental reviews under NEPA through the 

NEPA Tracker, a central repository for tracking NEPA Actions across the organization. The system standardizes the NEPA action tracking process, improves data call 

89 

efficiency, makes the NEPA action process more transparent, improves NEPA Action data analytics, and minimizes impacts of data calls. NEPA Coordinators are required to enter all NEPA Actions into the NEPA Tracking System, effective September 1, 2012. 

Question 8. The BIA also stated that it is in the process of evaluating and reviewing the current realty tracking system and TAAMS to improve efficiencies and timeliness in processing workloads. Yet, because multiple entities within the Department must review modifications to data systems, BIA intends to ask GAO for an 

extension of time to address this recommendation. With what other entities must 

the Department coordinate when reviewing the proposed modifications? 

Answer. TAAMS enhancements are programmed and implemented after approval 

by the TAAMS Change Management Board. The Board has authority to approve the 

change. If, however, the enhancement is a major development, it must be approved 

by the Department’s Chief Information Officer. 

Question 9. The GAO recommended that DOI provide additional energy development specific guidance on provisions of TERA regulations that tribes have identified 

to the Department as unclear. 6 The BIA testified that the Department, through the 

Office of Indian Energy and Economic Development, will issue guidance on those 

provisions of TERA that tribes identified as unclear. Will the guidance include clarification for ‘‘inherently federal functions’’? 

Answer. The Office of Indian Energy and Economic Development (IEED) has 

placed on its web site for tribal review a description of the technical assistance it 

will furnish tribes that are interested in programs, functions, services and activities 

(PFSAs) associated with the TERA regulations that Tribes can contract for under 

the Indian Self-Determination and Education Assistance Act, and PFSAs associated 

with the TERA regulations that the Interior Secretary must perform: https:// 

www.bia.gov/as-ia/ieed/division-energy-and-mineral-development/tribal-toolbox/ 

demd-and-office-of-solicitor 

To further clarify the TERA approval process, IEED plans to collaborate with the 

Department’s Office of the Solicitor during calendar year 2018 to publish as part 

of IEED’s ongoing online series ‘‘Tribal Economic Development Principles at a 

Glance,’’ a primer on the TERA approval process. 

Past IEED primers can be accessed at; https://www.bia.gov/as-ia/ieed/onlineprimers-economic-development-glance. 

Question 9a. What other provisions does the Department intend to include in the 

proposed guidance? 

Answer. Because ‘‘inherently federal functions’’ can only be defined on a case-bycase basis, it is not possible to compile any kind of list of these functions or provide 

meaningful examples. IEED is inviting tribes to query the office on these issues as 

they arise from real-world circumstances. The GAO report also identifies as ‘‘unclear’’ what happens when tribal regulations enacted pursuant to a TERA conflict 

with federal regulations. TEED would work with the Solicitor to provide a response 

based on the particular circumstances of each specific inquiry on this matter. 

ENDNOTES 

1 U.S. Gov’t Accountability Office, GAO–1 7–317, High Risk Series: Progress on 

Many High-Risk Areas, While Substantial Efforts Needed on Others (2017). 

2 U.S. Gov’t Accountability Office, GA0–17–423, Tribal Transportation; Better 

Data Could Improve Road Management and Inform Indian Student Attendance 

Strategies (2017). 

3 U.S. Gov’t Accountability Office, GA0–17–447, Indian Affairs: Actions Needed 

to Better Manage Indian School Construction Projects (2017). 

4 U.S. Gov’t Accountability Office, GA0–17–421, Indian Affairs: Further Actions 

Needed to Improve Oversight and Accountability for School Safety Inspections 

{2017). 

5 U.S. Gov’t Accountability Office, GA0–17–317, at 216. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. STEVE DAINES TO

TONY DEARMAN

Question. Mr. Dearman, in your testimony, you set mid-2019 as a goal to implement two recommendations from a 2014 report, which is five years later. What is 

the holdup? 

Answer. These recommendations should have been addressed in a more timely 

fashion. Since taking leadership of the Bureau of Indian Education (BIE) in November 2016, 1 have assessed our Government Accountability Office-related work to 

date. BIE leadership has not been satisfied with either the quality or the timeliness 

90 

of the work performed to analyze the GAO recommendations. As a result, I have 

directed BEE senior leadership to prioritize implementing all outstanding GAO recommendations as quickly as possible. While I understand the timeframe for comprehensively addressing BIE’s outstanding GAO recommendations, including the 

recommendations you highlight, has been extended, I believe it is prudent that the 

bureau continue to work toward timely and effectively addressing GAO’s recommendations and we are doing so, as discussed in my testimony for this hearing. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. CATHERINE CORTEZ MASTO

TO TONY DEARMAN

Question. As you may know, Nevada has two BIE schools: Duckwater Shoshone 

Elementary School and Pyramid Lake Junior/Senior High School. We are all very 

proud of all or our students, teachers, administrators, and parents. We want the 

very best for them, and they deserve the very best your department has to offer. 

Director Dearman, in your written testimony you mentioned that your office is diligently working to address the varying and developing needs of students, including 

behavioral and mental health support services. Can you please talk further about 

this partnership with Indian Health Service (IHS) and how you are planning to 

overcome some of the IHS limitations outlined in the report?—Can you elaborate 

on your strategic plan to collaborate with local emergency medical services and law 

enforcement to ensure the safety and wellbeing of students and staff in school? 

Answer. In December 2016, BIE, IHS, and Bureau of Indian Affairs (BIA), entered 

into an Inter-agency Agreement intended to increase access to mental and behavioral health services for students attending BIE schools and youth detained in Office 

of Justice Services (OJS) facilities. The Agreements allow each agency to establish 

local partnerships through a Memorandum of Agreement (MOA) between IHS federally-operated mental health programs, BIE-operated elementary and secondary 

schools, and BIA OJS-operated juvenile detention centers to provide mental health 

assessment and counseling services, which includes tele-behavioral health services. 

Under this 10-year partnership, behavioral health services will be offered at BIE 

schools and OJS facilities that are located near an available IHS facility. Key staff, 

including our Student Health Program Specialist, are partnering within the agencies under a National Implementation Team tasked with identifying key contacts to 

create Regional and Local Implementation Teams. This new collaboration is intended to ensure that the mental and behavioral health needs of our students are 

being met. 

BIE is also collaborating with OJS to provide comprehensive law enforcement 

oversight for schools. This includes strategic program direction, development of related policies, procedures, standards and guidelines, and program accountability and 

consistency. In January 2017, BIE began working through the partnership to provide expert law enforcement guidance and direction to local law enforcement officials, school administrators, and tribal leaders in response to criminal matters or 

emergencies that occur on tribal school campuses or within the immediate vicinity 

of a tribal school. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

TONY DEARMAN

GAO High-Risk Report and Recommendations 

Question 1. The Government Accountability Office (GAO) testified that inclusion 

on the biennial High Risk report often results in agencies receiving additional management resources from Department leadership and the Office of Management and 

Budget (OMB). Has the Bureau of Indian Education (BIE) seen increased engagement from the Department of the Interior’s (DOI’s) Office of the Secretary or OMB 

since the Bureau’s High Risk designation? If so, please summarize any evidence of 

this increased engagement. 

Answer. Upon GAO’s identification of BIE as a high-risk agency, the Department 

has worked closely with the Bureau as it prioritizes accountability and oversight in 

order to address GAO recommendations, which will increase efficiency and effectiveness. 

The Department is supportive of the BIE as it participates in work groups specifically created to address GAO recommendations, such as the Indian Affairs Safety 

Work Group (Safety Work Group) that includes participants from the Assistant Secretary-Indian Affairs (Indian Affairs) office, Bureau of Indian Affairs (BIA), and Division of Facilities Management and Construction (DFMC). The Safety Work Group 

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has held two workgroup sessions this summer as a means to increase coordination, 

develop policies and procedures, and address outstanding GAO recommendations in 

reports GA0–16–313 and GA0–17–421. 

The Department has also provided BIE support as it works to increase its direct 

communication with GAO, which has enhanced BIE’s ability to comprehensively address outstanding recommendations. It is the Department’s goal that BIE is effective in addressing GAO recommendations as well as coordinating effectively across 

Federal agencies in order to improve BIE accountability and oversight. As such, the 

BIE has had consistent contact and works closely with senior leadership within the 

Department and the Secretary’s office to ensure matters highlighted in GAO reports, particularly those critical to directly improving the wellness and safety of students in Bureau-funded schools, are properly addressed in a timely manner. 

Question 2. A number of the outstanding recommendations for improving Indian 

Education included in GAO’s February 2017 High-Risk Report require action by the 

Bureau of Indian Affairs (BIA) to fully resolve. 1 Your testimony provided an outline 

of BIE’s efforts to address these remaining recommendations that included references to ‘‘working cooperatively with the leadership within Indian Affairs.’’ Yet, 

Mr. Black’s testimony focused exclusively on addressing the remaining Indian Energy recommendations flagged by GAO in the 2017 High Risk Report. Has BIE seen 

increased engagement from BIA leadership regarding its role in resolving the remaining GAO recommendations regarding financial oversight and safety inspections? If so, please summarize any evidence of this increased engagement. 

Answer. The BIE has worked closely across Indian Affairs, including BIA, in recent months to address outstanding GAO recommendations and improve Bureau operations and service delivery in Bureau-funded schools. Upon GAO’s identification 

of BIB as a high-risk agency, the Bureau coordinated efforts with Indian Affairs to 

prioritize accountability and oversight in order to address GAO recommendations, 

which will increase efficiency and effectiveness. 

Indian Affairs is supportive of the BIE as it participates in joint work groups specifically created to address outstanding GAO recommendations, such as the Indian 

Affairs Safety Work Group (Safety Work Group) that includes participants from 

BIA. The Work Group held two workgroup sessions this past summer as a means 

to increase coordination, develop policies and procedures, and address outstanding 

GAO recommendations. Through the Safety Work Group, BIE and BIA staff, alongside DFMC and Indian Affairs, have worked together to ensure that safety inspections are 100 percent completed for the second year in a row as well as to develop 

policies and procedures to make sure quality improves and supports are in place to 

assist critical staff, such as safety inspectors. The Safety Work Group will plan subsequent meetings to progress coordinated work. Additionally, Indian Affairs has 

formed an initial work group specific to address financial oversight across the agencies. This coordination will diminish bureaucratic inefficiencies and promote communication across Indian Affairs. 

Question 3. Shortly following the conclusion of the May 176 Oversight Hearing, 

GAO released three additional reports regarding the BIE—‘‘Tribal Transportation: 

Better Data Could Improve Road Management and Inform Indian Student Attendance Strategies,’’ 2 ‘‘Indian Affairs: Actions Needed to Better Manage Indian School 

Construction Projects,’’ 3 and ‘‘Indian Affairs: Further Actions Needed to Improve 

Oversight and Accountability for School Safety Inspections.’’ 4 Within these three reports, the GAO provided a total of 20 new recommendations to improve the delivery 

of education to BIE students. Please provide a summary and timeline of the Bureau’s plans to address each of the 20 recommendations directed at BIE. 

Answer. The reports provide ten additional recommendations that BIE must address unilaterally. The other findings, due to agency authority, are directed to other 

entities within Indian Affairs, or must be addressed by a combination of these entities. BIE now has 21 total outstanding recommendations from past GAO reports as 

well as those issued in 2017 that it must address. 

In reference to the reports mentioned, BIE worked directly with Indian Affairs 

through the aforementioned work groups to provide formal updates to GAO on August 8, 2017, and August 16, 2017. The three enclosed letters (DOL 60–Day Letter 

to GAO Report 17–421 IA School Safety; DOI 60–Day Letter to GA0–17–423 Tribal 

Transport; and DOI 60 Day Letter to GAO Report 17–447 IA School Construction) 

provide responses to each new GAO recommendation as well as timelines and bureau authority for associated work to be completed. 

Question 3a. Please provide a summary of the efforts BIE is undertaking to work 

with BIA, and DOI’s Office of the Secretary, and OMB to ensure the remaining recommendations from these three reports are addressed in a timely, effective manner. 

92 

Answer. BIE worked directly with Indian Affairs to provide updates to GAO on 

August 8, 2017 and August 16, 2017. The three enclosed letters (DOI 60–Day Letter 

to GAO Report 17421 IA School Safety; DOI 60–Day Letter to GA0–17–423 Tribal 

Transport; and DOI 60 Day Letter to GAO Report 17–447 IA School Construction) 

provide responses to each new GAO recommendation as well as timelines and Bureau authority for associated work to be completed. 

Staff and Leadership Turnover 

Question 4. When asked about any continuing limitations placed on hiring by Administration leadership, you testified that the BIE is currently ‘‘hiring at all levels.’’ 

Yet, this response is at odds with statements made by DOI’s Office of Budget staff 

at a May 6, 2017 Committee Briefing and an April 12, 2017 memorandum issued 

by Associate Deputy Secretary James Cason. Please clarify your claim that BIE is 

‘‘hiring at all levels’’ in light of the previously noted May 6 statements and April 

12 memorandum. 

Answer. On April 14, 2017, a DOI memorandum provided Department guidance 

to agencies and bureaus regarding updated hiring controls, detailing that: 

• Bureaus and offices could proceed with lateral reassignments or details, except 

for Senior Executive Service positions. 

• Bureaus and offices could proceed with hiring for all positions, outside Washington, DC and Denver, Colorado, at the grade of GS–11 and below. 

• Bureaus and offices could proceed with hiring for positions above GS–11 and 

within Washington, DC and Denver, Colorado if provided a waiver based on 

how such positions will better support on-the-ground mission delivery. 

With regard to BIE hiring, the agency continues to hire at all levels consistent 

with the guidance provided by the Department. The Department-specific hiring controls also do not affect contract positions funded by the BIE, such as school level 

teachers. As such, students incur no major disruptions in access to instruction. After 

the initial hiring freeze, the Bureau has worked consistently and cooperatively with 

Department leadership in obtaining hiring waivers for filling critical, non-field positions at all levels. For example, the Department provided BIE clearance on August 

14, 2017 to hire, or clarify further the need to hire, 39 vacant positions above GS– 

1 1 as well as in various duty locations that are critical to improving service delivery. Clearance has been provided to hire additional positions since August. The Bureau continues to coordinate with Department leadership to acquire waivers for any 

remaining vacancies. 

Question 4a.a. How many total vacancies does BIE currently have? And, what is 

the breakdown of these vacancies by type (location, grade level, and function)? 

Answer. At the time of the hearing, the BIE was 42 percent fully staffed with 134 

positions filled out of a total of 316 positions (waivers pending), Bureau-wide. Such 

positions include those in the BIE Director’s Office (Central Office), School Operations Division, Division of Performance and Accountability, Associate Deputy Director—Tribally-Controlled Schools, Associate Deputy Director—Bureau-Operated 

Schools, and Associate Deputy Director—Navajo Schools. Since May 2017, the Bureau is nearly 46 percent fully staffed with hiring continuing to improve service delivery. 

Question 4b. What, if any, limitations put in place by the White House, OMB, or 

DOI’s Office of the Secretary exists regarding BIE’s ability to fill these vacancies? 

Answer. As noted in a previous response, the agency continues to hire at all levels 

consistent with the guidance provided by the Department. In addition, the Department-specific hiring controls did not affect contract positions funded by the BIE, 

such as school level teachers. As such, students incurred no major disruptions in 

classroom instruction. After the initial hiring freeze, the Bureau has worked consistently and cooperatively with Department leadership in obtaining hiring waivers for 

filling critical, non-field positions at all levels. 

Question 5. In its 2017 High Risk Report, GAO identified staffing turnover as an 

overarching issue facing Indian Education.’ For example, several tribally operated 

BIE schools have informally reported to this Committee that staffing turnover and 

vacancies at Education Resource Centers (ERCs) make it difficult to receive timely 

assistance with reporting and compliance questions. How is BIE working to ensure 

all administrative duties are fulfilled in the face of frequent turnover? 

Answer. A major goal of the BIE is to identify, recruit, develop, retain, and empower highly-effective employees at all levels. However, obstacles, such as limited 

access to housing as well as duty stations located in geographically isolated and impoverished communities continue to impact employee recruitment. While vacancies 

do persist, the BIE has not experienced exceedingly high turnover rates at its 

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ERCs—only one employee has separated (June 30, 2017) since January 1, 2016. 

However, as the Bureau continues to fill positions, the BIE is working to streamline 

hiring practices where possible to increase recruitment as well as ensure existing 

staff have the administrative support from Central Office to perform their duties effectively. 

BIE Central Office, as part of its GAO related work, is developing its comprehensive strategic planning effort to set agency priorities and focus energy and resources 

to ensure employees are working toward common goals. It is critical that BIE employees are focused on outcomes and results that will help the agency provide improved service delivery, technical assistance, and oversight regardless of staffing levels. Such strategic planning work will also assist the agency as it develops a comprehensive workforce plan that addresses such vacancies and focuses human capital 

where needed to ensure Bureau-funded schools’ needs are effectively addressed in 

a timely manner. Human capital capacity has historically been an issue for the BIE, 

so even as the agency works to hire positions to expand such capacity, the agency 

is working to formalize plans that will also address retention through professional 

development and standard appraisal metrics. 

Question 5a. How is BIE ensuring federally-operated and tribally-operated Bureau 

schools receive full support with legal and financial compliance requirements (e.g., 

completion of annual audits and Individuals with Disabilities Education Act compliance)? 

Answer. The BIE is working to ensure existing staff have the administrative support from Central Office to perform their duties effectively as well as ensure employee appraisal metrics increase employee accountability. BIE leadership has 

tasked management across the Bureau with improving the alignment of appraisal 

metrics with the services for which employees are tasked to provide, such as assisting in financial compliance, providing technical assistance, and assisting with completion of annual audits. These metrics are critical to reducing waste, fraud, and 

abuse and utilizing public tax dollars as efficiently and effectively as possible. 

In addition, BIE is hiring additional budget personnel and fiscal auditors to assist 

in compliance, and is developing a school visit coordination and information sharing 

policy that establishes formal procedures for fiscal monitoring and requiring coordination among BIE staff. This will improve technical assistance through regular, onsite audits based on risk elements for federal funding distribution and financial 

compliance. As part of any risk matrix, such policies and procedures will not alleviate or address all risk but will formalize a protocol for diminishing such risk 

through coordinated School Intervention Teams from Bureau ERCs and Division of 

Performance and Accountability staff who work with schools to address areas of 

greatest need. 

Question 5b. How is BIE ensuring the Bureau’s staffing plan addresses technical 

skills gaps (e.g., financial audit expertise) identified by GAO? 

Answer. As part of the BIE’s reorganization, the BIE is working to increase its 

capacity and narrow its technical skills gap for financial oversight and fiscal monitoring. Accordingly, the Bureau has prioritized hiring of fiscal monitors, such as 

auditors and budget personnel. The BIE has advertised such positions for hiring to 

increase capacity to address such gaps. Among other areas, another focus has been 

increasing data-driven decisionmaking across the Bureau through improved data 

collection. The Bureau is working to hire several Education Research Analysts and 

three Native American Student Information System (NASIS) positions that will improve the Bureau’s collection and use of key data metrics critical to informed decisionmaking that addresses areas of greatest need. 

BIE School Accountability 

Question 6. The most recent school and Bureau accountability data provided on 

the BIE website dates to SY2012–2013. 6 The Committee is unaware of any other 

locations where the Bureau might have published accountability data for the three 

school years completed sinceSY2012–2013 concluded and required under Section 

1111 of the Elementary and Secondary Education Act through August 1, 2016: 7

Please provide a copy of all statutorily required school accountability data for SY 

2013–2014, SY 2014–2015, and SY 2015–2016. 

Answer. The Bureau is working to update and post some of the additional, required public reporting on school accountability. However, most information has not 

yet been aggregated and remains partially incomplete. Recently, leadership has refocused attention to increasing data-driven decisionmaking across the Bureau 

through improved data collection. As mentioned previously, the Bureau is working 

to hire several Education Research Analysts and three NASIS positions specifically 

focusing on data that will improve the Bureau’s collection and use of key data 

metrics critical to supporting the needs of students attending BIE-funded schools. 

94 

Question 6a. Please provide an overview of how BIE ensures parents, tribes, and 

Congress has timely access to this information. 

Answer. The BIE has hired personnel to serve as the Communication Specialist 

to address and update communication outlets going forward. It is critical that the 

Bureau is transparent and efficient in delivering information, and this is a key component to achieving this goal. The BIE is working with an ED contractor, the Center 

for Standards and Assessment Implementation (CSAI), to develop procedures to ensure timely data collection and reporting take place, which will then be externally 

communicated to stakeholders. 

Question 6b. Does BIE have any other student outcome related data (e.g., graduation rate trends, absenteeism trends, etc.) that it can share with the Committee? 

If so, please provide it here or provide a firm timeline of when such information can 

be made available to the Chairman and the Vice Chairman. 

Answer. As noted in response to a previous question, the Bureau is working to 

bring recent data sets up to date. Currently, an analysis of longitudinal data trends 

is unavailable until such data strands are collected and verified. However, the Bureau has enclosed the following 2015 Bureau of Indian Education Report on Student 

Achievement and Growth from the Northwest Evaluation Association for the Committee’s review. Its results suggest that BIE students have shown some improvements over time in achievement and growth rates, most notably in mathematics and 

for students attending earlier grade levels. However, gaps persist and BIE remains 

committed to improving service delivery that will help narrow the gap for students 

attending Bureau-funded schools. 

Question 7. Title I of theEvery Student Succeeds Act (ESSA) requires states to 

design and implement an accountability system to measure school quality and performance in consultation with a variety of stakeholders. 8 The Department of Education (ED) indicates on its website that BIE, acting in its capacity as the State 

Education Agency (SEA) for BIE-funded schools, provided notice of intent to submit 

its state accountability plan to ED on September 18, 2017. 9 Yet, as on the date of 

this hearing, the BIE’s webpage on the Bureau’s ESSA State Plan is completely 

blank. 10 What is the status of the BIE state plan? Please provide a summary of any 

BIE’s coordination between BIE and ED on this issue and a description of all relevant consultations undertaken by BIE to date on development of a state accountability plan. 

Answer. While ED officials have expressed a view that the BIE is not required 

to submit a State Plan under ESSA, BIE Director Dearman announced that the BIE 

would develop a State Plan as a means to facilitate a transition to ESSA requirements and ensure the development of a coherent federal education system across 

the 23 states in which BIE facilities operate. The BIE notified ED via email on January 7, 2017 that it would submit a State Plan. However, many of the elements of 

the plan would relate to standards, assessments, and accountability, and BIE is required by the ESEA to conduct negotiated rulemaking to establish standards, assessments, and an accountability system that is consistent with the ESSA changes 

to the ESEA. 

As the Department works to establish the Negotiated Rulemaking Committee outlined below to negotiate and develop a proposed rule, in accordance the Negotiated 

Rulemaking Act, timelines have had to shift to provide adequate time for review by 

the Administration. Nevertheless, work on the State Plan continues as a means for 

addressing a key part of the BIE Strategic Plan for improving student outcomes and 

increasing coordination across BIE-funded schools. Once drafted, BIE will engage 

stakeholders, including tribal community members, school personnel, and parents, 

to provide input. Formal tribal consultation will take place following the stakeholder 

engagement phase to ensure tribes have a document for which to provide comments 

and have meaningful consultation. 

Additionally, BIE continues to have a close and consistent working relationship 

with ED through the interagency collaborative work group that meets bi-weekly. 

Through this coordination, BIE and ED have entered into an interim Memorandum 

of Understanding that ensures ED Title funding continues to support BIE students 

for SY 2017–18. 

Question 7a. Please provide an overview of BIE’s efforts to comply with ESSA as 

a whole and outline how the Bureau has worked with ED to ensure full compliance 

moving forward. 

Answer. To meet its obligations, the BIE will: (1) amend its existing standards, 

assessments, and accountability regulations through negotiated rulemaking, and (2) 

solicit stakeholder and tribal input through consultation regarding the BIE State 

Plan. The BIE has elected to adopt a State Plan that will work to improve the BIE’s 

95 

support of Bureau-funded schools. Through tribal consultation and solicitation of 

stakeholder feedback, the BIE will ensure ESSA requirements are met. 

Section 8204(c), as amended by the ESSA, directs the Secretary of the Interior, 

through negotiated rulemaking, to update the BIE standards, assessments, and accountability system. On November 9, 2015, the BIE published a notice of intent (80 

FR 69161) requesting comments and nominations for tribal representatives for the 

Negotiated Rulemaking Committee (Committee). During transition, the initial formulation of the Committee was postponed in order to provide incoming Department 

staff adequate time to review prior work. In August 2017, the BIE was provided 

clearance to move forward with re-initiating the Committee and working and consulting with stakeholders to determine membership and subsequent steps. More information is forthcoming regarding timing of the notice that will clarify consultation, membership, meeting dates, and other pertinent information. 

Ultimately, the Committee will recommend revisions to the existing regulations 

(25 CFR Part 30) to replace the NCLB Adequate Yearly Progress regulatory language and implement the Secretary’s statutory responsibility to define the standards, assessments, and accountability system, consistent with ESSA. BIE continues 

to have a close and consistent working relationship with ED through the interagency collaborative work group that meets bi-weekly to ensure full compliance with 

ESSA. The BIE and ED consult frequently on a range of topics and direct communication includes electronic and telephonic correspondence. 

School-based Health Clinics 

Question 8. RADM Chris Buchanan’s testified that IHS supports nine direct-service and eight tribally-operated, school-based health clinics. His testimony provides 

no details as to whether these clinics are located in schools operated by Local Education Agencies (LEAs) or by the BIE. Are any of these 17 health clinics located in 

131E schools? If so, please provide a list of those schools. 

Answer. The BIE Student Health Program Specialist conducted site visit assessments of BIE-funded schools in the fall of 2017 to determine what health and behavioral health services were being provided by the Indian Health Service (IHS). IHS 

has identified several 131E schools as pilot sites for school-based health clinics. BIE 

is excited to collaborate with IHS to establish school-based clinics so critical health 

and behavioral health services are provided to our students. 

In December 2016, the Indian Health Service (INS) and BIE entered into an 

inter-agency agreement intended to increase access to mental and behavioral health 

services for students attending BIE-funded schools. This 10-year partnership allows 

each agency to build up local partnerships through Memoranda of Agreement (MOA) 

among local IHS mental health programs and BIE-funded schools in order to provide on-site mental health assessment and counseling services to BIE students. For 

information regarding general school-based health clinics as well as the MOA work, 

BIE recommends the Committee work with IHS, the designated lead agency, for further clarification. 

Question 8a. Is BIE aware of any IHS-supported school-based health clinics previously operating on a BIE school or dormitory campus? 

Answer. The BIE defers to IHS, as lead agency, for further clarification and information regarding general school-based health clinics as well as the MOA work. 

Question 9. This Committee has heard from several tribes and BIE school community members from several different parts of Indian Country who are interested in 

opening IHSsupplemented school-based health clinics in a BIE-funded school or dormitory. However, representatives from these tribes and communities report that regional BIE leadership rejected the idea. Is BIE aware of any requests by tribes to 

open IHS-supported school-based health clinics within a BIE-funded school or dormitory? If so, please provide any pertinent information relating to such requests 

(e.g., date request was received, name of the BIE line office/resource center that received the request, and BIE’s response to the request). 

Answer. As IHS and BIE coordinate and work together under the MOA to better 

support onsite services to BIE students, BIE leadership has been supportive of such 

work and is unaware of the aforementioned outreach. The Bureau will work with 

its management team to determine if such requests were made and, if so, what actions were taken in response. We look forward retrieving more information and providing an update when possible. 

Question 9a. What barriers—if any—exist to BIE working collaboratively with 

tribes and IHS to open these clinics? For example, would BIE have concerns about 

liability or operations/maintenance expenses of the clinic space? 

Answer. There may be barriers, which vary by facility depending on the availability of local medical staff, space at the school facility, current state of local partVerDate Mar 15 2010 14:29 Mar 22, 2018 Jkt 029354 PO 00000 Frm 00099 Fmt 6601 Sfmt 6621 S:\DOCS\29354.TXT JACK
96 

nerships (BIE/IHS, tribe, and school), as well as unique issues faced by personnel, 

such as community support. Additional barriers include the dissemination/sharing 

of sensitive student/patient data and significant communications issues at the local 

site level. Despite these and future barriers that may develop, BIE is dedicated to 

ensuring that the health and behavioral health needs of our students are met. 

Question 9b. Can BIE provide any suggestions to overcoming those barriers identified above? 

Answer. BIE is committed to working with its partners, including IHS, to provide 

technical assistance and support to schools. This workgroup would also provide annual updates and progress reports as necessary. BIE will also conduct a comprehensive needs assessment and thorough investigation of the current state regarding 

school-based health clinics and associated barriers/solutions. In addition, BIE has 

established a new position to further assist with the coordination of student behavioral health and has hired a Student Health Program Specialist. 

Medicaid Funding in BIE Schools 

Question 10. In general, the Medicaid Program allows school districts to provide 

Early Periodic Screening Diagnosis and Treatment (EPSDT) services and allows the 

schools to directly bill the Program for medically necessary services related to Individual Education Plans (IEPs). Does BIE coordinate with states and/or the Center 

for Medicaid Services (CMS) to receive allowable reimbursements for delivery of 

these services? If so, please provide a summary of how BIE interacts with the Medicaid Program and an estimate of the level of Medicaid funding received by the Bureau. 

Answer. BIE is aware that while some Bureau-funded schools have worked 

through the process of directly billing Medicaid for services, the agency itself has 

not done an adequate job of providing professional development for such interaction 

with the Medicaid program. The process can be cumbersome and capacity at various 

schools differs. The Bureau will work as part of its strategic planning to include the 

development of a formal policy and associated procedure as a means for collecting 

data and improving the health and welfare of BIE-funded students. Because this 

currently takes place on a local level, the Bureau does not have adequate data to 

present at this time. 

ENDNOTES 

1 U.S. Gov’t Accountability Office, GA0–17–317, High Risk Series: Progress on 

Many High-Risk Areas, While Substantial Efforts Needed on Others (2017). 

2 U.S. Gov’t Accountability Office, GA0–17–423, Tribal Transportation: Better 

Data Could Improve Road Management and Inform Indian Student Attendance 

Strategies (2017). 

3 U.S. Gov’t Accountability Office, GA0–17–447, Indian Affairs: Actions Needed 

to Better Manage Indian School Construction Projects (2017). 

4 U.S. Gov’t Accountability Office, GA0–17–421, Indian Affairs: Further Actions 

Needed to Improve Oversight and Accountability for School Safety Inspections 

(2017). 

5 U.S. Gov’t Accountability Office, GA0–17–317, at 205. 

6 School Report Cards, BUREAU OF INDIANEDUCATION https:/bie.edu/ 

HowAreWeDoing/Scorecardsindexhtm (accessed on May 17, 2017) 

7 Every Student Succeeds Act, Pub. L. No. 1 14 -95, § 5(e) (1) (A), 129 Stat. 

1802, 1806 (20 15). 

8 Every Student Succeeds Act. Pub. L. No. 114–95. § 1000 et sec.. 129 Stat. 

1802, 1814–1913 (2015). 

9 ESSA State Plan Notice of Intent to Submit, U.S. DEP’TOFEDUCATION 

Æ