U.S. GOVERNMENT PUBLISHING OFFICE

30–089 PDF WASHINGTON : 2018

S. HRG. 115–235 

HIGH RISK INDIAN PROGRAMS: PROGRESS AND 

EFFORTS IN ADDRESSING GAO’S 

RECOMMENDATIONS 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 13, 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 September 13, 2017 ..................................................................... 1 

Statement of Senator Cortez Masto ....................................................................... 69 

Statement of Senator Franken ............................................................................... 67 

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

Statement of Senator Udall .................................................................................... 2 

WITNESSES

Black, Michael S., Acting Assistant Secretary, Indian Affairs, U.S. Department of the Interior ............................................................................................. 46 

Prepared statement .......................................................................................... 47 

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

the Interior ........................................................................................................... 56 

Prepared statement .......................................................................................... 58 

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

Issues, U.S. Government Accountability Office ................................................. 4 

Prepared statement .......................................................................................... 6 

Weahkee, Rear Admiral Michael D., Acting Director, Indian Health Service, 

U.S. Department of Health and Human Services ............................................. 51 

Prepared statement .......................................................................................... 53 

APPENDIX

Floyd, Hon, James R., Principal Chief, Muscogee (Creek) Nation, prepared 

statement .............................................................................................................. 79 

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

Emrey-Arras ......................................................................................................... 80 

Response to written questions submitted by Hon. John McCain to RADM 

Michael D. Weahkee ............................................................................................ 88 

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

Michael S. Black ............................................................................................... 84 

Tony Dearman .................................................................................................. 81 

RADM Michael D. Weahkee ............................................................................ 86 

(1) 

HIGH RISK INDIAN PROGRAMS: PROGRESS 

AND EFFORTS IN ADDRESSING GAO’S 

RECOMMENDATIONS 

WEDNESDAY, SEPTEMBER 13, 2017 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:59 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. Today, the Committee is holding an important 

hearing on follow up to our May 17, 2017 hearing on the Government Accountability Office, GAO, and their High Risk List, which 

included for the first time, three Indian programs. 

In this hearing, we will examine the progress of the Bureau of 

Indian Affairs, the Bureau of Indian Education, and the Indian 

Health Service in addressing the GAO’s open recommendations for 

these agencies programs. We want all of these programs to be successful. 

I want to thank the GAO for bringing forward their recommendations and the numerous challenges facing these Federal Indian programs, not just identifying the problem but also providing recommendations. 

We want to work with the agencies in finding a path forward on 

these issues. Any further guidance from the GAO is welcome. That 

is why we appreciate having you here today. I also want to thank 

the witnesses for getting their testimony in on time. 

On February 15, 2017, the GAO issued its biannual High Risk 

List, which included Indian energy, Indian education, and Indian 

health care. These programs were considered high risk because 

they were vulnerable to fraud, waste, abuse and mismanagement. 

These programs are vitally important to Native Americans. They 

affect the safety of school buildings and facilities, the quality of 

health care, education, and the advancement of Indian energy development projects. 

These high risk programs put the health and safety of Native 

Americans at risk. By implementing the GAO recommendations, 

the risks identified should be diminished. Likewise, the affected 

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agencies can be strengthened in delivering programs and services 

to Native Americans. 

According to the GAO, there are 23 open recommendations for 

Indian education, 14 open recommendations for Indian health and 

13 open recommendations for Indian energy. The GAO stated in its 

previous testimony that it uses five criteria to determine if a program should be removed from the High Risk List. 

To be removed from this list, the agency must demonstrate leadership commitment, agency capacity and resources, an action plan, 

monitoring and, of course, progress. 

We will continue to closely monitor the progress and commitment 

of these agencies as they work with the GAO in efficiently closing 

out the open recommendations. I also expect any future recommendations by the GAO will be taken seriously and implemented by the agencies. 

I know there is still more work to be done by the agencies; however, I am encouraged by recent updates by the GAO that these 

agencies are making progress in satisfying the open recommendations, especially at BIE and IHS. 

I am still concerned that there are open recommendations and 

also am concerned about progress in regard to Indian energy. 

Again, I welcome our witnesses today and look forward to hearing what progress we have made and also how we can make more 

progress. Rest assured, this will not be the last hearing on this 

subject. 

With that, I will turn to Vice Chairman Udall. 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you, Chairman Hoeven. 

Here at the beginning, I would like to recognize now the Navajo 

Nation Council delegate, Walter Phelps from Arizona, who is attending this hearing today. 

This hearing starts where we left off after our first hearing on 

the GAO High Risk Report in May. Thank you for calling GAO, the 

BIE and the IHS back here so the agencies can update the Committee on their progress towards addressing GAO’s open recommendations so that we can examine how and whether they have 

been adequately focusing resources and expertise to improve their 

Indian programs. 

Before I get into discussing the high risk designation, I want to 

share a bit of information. The Santa Fe Indian School has a graduation rate of 96 percent; 88 percent of their students go on to attend a post secondary institution. 

At the Kiawah Public Health Corporation, a longer 30-minute 

visit standard is making visits meaningful for patients and providers. In the Albuquerque service area, providers are tracking patient wait times electronically and deploying customer satisfaction 

surveys to ensure they are meeting the needs of their patients. 

A team of pre-engineering students at the Southwestern Indian 

Polytechnic Institute recently competed against 20 colleges from 

across the Country winning a national NASA robotics competition. 

These success stories show the persistence and tenacity of tribal 

communities. They underscore the need for better sharing of best 

3 

practices within Federal Indian programs and most of all, they 

should remind this Committee that tribal communities can and do 

succeed despite the agency level administrative shortcomings they 

face. 

I would ask my colleagues here today to imagine how much more 

could be accomplished if their Federal partners were offering them 

needed support instead of getting in their way. For years, GAO’s 

work has provided evidence of something many tribal communities 

have long reported, that bureaucratic barriers at agencies like the 

BIA, the BIE and the IHS reduce the effectiveness of Indian programs across the Federal Government. 

BIE schools have reported that agency hiring directives continue 

to prevent them from filling key staff positions. IHS facilities in the 

Great Plains are still in CMS certification limbo as Native patients 

face uncertainty. 

The lack of necessary modern IT infrastructure affects everything from education to energy, grinding some tribal communities 

to a bureaucratically-induced halt. Unfortunately, these agencies 

have not taken a proactive approach to responding to tribal concerns. This high risk designation proves they were not committing 

themselves to resolving GAO’s findings. 

I read the GAO’s testimony today and was pleased to learn that 

BIA, BIE and IHS programs have benefited from the additional 

scrutiny put on them since they have been labeled high risk. It appears progress can only be made when Congress keeps the pressure 

on. Mr. Chairman, I appreciate you doing that. That is why I appreciate the Chairman’s follow through on this topic. 

The members of this Committee must do all we can to address 

the Federal Government’s shortcomings to improve its accountability and administration of Indian programs. I am looking forward to hearing what progress has been made to address GAO’s 

recommendations. I thank the Federal witnesses for being here 

today. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Vice Chairman Udall. 

Are there other opening statements? 

[No audible response.] 

The CHAIRMAN. Then we will turn to our witnesses. 

Our witnesses today are: Ms. Melissa Emrey-Arras, Director, 

U.S. Government Accountability Office, Washington, D.C.; Mr. Michael S. Black, Acting Assistant Secretary, Indian Affairs, U.S. Department of the Interior; Rear Admiral Michael D. Weahkee, Acting Director, Indian Health Service, U.S. Department of Health 

and Human Services, Rockville, Maryland; and Mr. Tony Dearman, 

Director, Bureau of Indian Education, U.S. Department of the Interior. 

Ms. EMREY-ARRAS. we will turn to you. 

4 

STATEMENT OF MELISSA EMREY–ARRAS, DIRECTOR, 

EDUCATION, WORKFORCE, AND INCOME SECURITY ISSUES, 

U.S. GOVERNMENT ACCOUNTABILITY OFFICE; 

ACCOMPANIED BY FRANK RUSCO, DIRECTOR, NATURAL 

RESOURCES AND ENVIRONMENT TEAM; AND KATHY KING, 

DIRECTOR, HEALTH CARE 

Ms. EMREY-ARRAS. Thank you for inviting me 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 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 prior reports. 

Overall, our High Risk Program has served to identify and help 

resolve serious weaknesses in areas involving substantial resources 

and providing critical services to the public. Today, I will focus on 

Interior and HHS’s efforts to address our recommendations. 

In our High Risk Report, we cited nearly 40 recommendations 

that were not implemented. Since then we have made an additional 

12 recommendations in two new reports on BIE school safety and 

construction, published in May of this year. While Interior and 

HHS have taken some steps to address these recommendations, 

only one has been fully implemented. 

We are happy to report that we just closed a recommendation we 

made to HHS to develop specific agency-wide standards for patient 

wait times. HHS developed these standards and published them on 

the IHS Indian Health Manual website just last month. This recommendation is now closed as fully implemented. The other recommendations, however, remain open. 

In some cases, the agencies have made plans or taken preliminary steps to address the recommendations, but have not fully implemented them. For example, in the area of Indian education, we 

recommended in 2014 that Interior develop procedures to oversee 

school spending for major programs. In May, the BIE director 

noted that the agency planned to complete this recommendation by 

the middle of 2019. Last month, officials reported to us that they 

had drafted procedures but further review and revision were needed before the procedures could be finalized and implemented. 

Also, in some cases, the agencies have yet to provide us supporting documentation that they have fully implemented our recommendations. Such documentation is needed for us to verify that 

the agency actions have occurred. 

For example, in the area of Indian energy, we recommended that 

BIA take steps to complete its GIS mapping module in its database 

to identify who owns and uses resources. On August 31, BIA officials told us that they had added this mapping capability to the 

database but the officials did not provide us with the supporting 

documentation to enable us to determine if the GIS capability addresses our recommendation. We are now working with BIA to obtain this needed documentation to determine if this function will 

comply with our recommendation. 

In other cases, however, an agency may not have taken any action on our recommendations. For example, in the area of Indian 

health care, IHS had agreed with two of our recommendations to 

5 

make the allocation of Purchased/Referred Care (PRC) funds more 

equitable but has not yet taken action to implement them. 

Our experience has shown that among the key elements needed 

to make progress in high risk areas is top level attention by the 

Administration and agency leaders. As the Chairman mentioned, 

we have five key elements we look at to decide whether or not an 

area should be removed from our High Risk List. These are: leadership commitment; capacity, which is having the people and resources to resolve the risk; having a corrective action plan; monitoring; and demonstrating progress. 

If the agencies can demonstrate significant improvement in these 

areas, they can be taken off the High Risk List. Likewise, individual issues can be removed if sufficient progress is made. For example, if sufficient progress is made in Federal management of Indian energy programs, Indian energy issues can be removed from 

the list, even if Indian education and health care issues remain on 

the list. 

We plan to continue monitoring the agencies’ efforts to address 

the approximately 50 recommendations that remain open. We look 

forward to continuing our work with this Committee in overseeing 

Interior and HHS to improve services to tribes and their members. 

My colleagues and I would be happy to answer any questions you 

may have. 

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

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


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The CHAIRMAN. Thank you. 

Next is Acting Assistant Secretary Black. 


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46 

STATEMENT OF MICHAEL S. BLACK, ACTING ASSISTANT 

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

INTERIOR 

Mr. BLACK. Good afternoon, Chairman Hoeven, Vice Chairman, 

and members of the Committee. 

Thank you for the opportunity to come back and present an update on behalf of the Department of Interior regarding Indian Affairs’ role in the development of Indian energy and our continued 

commitment to address the high risk designation in the Government Accountability Office High Risk Report. 

As we stated in my testimony in May, the Department agreed 

with GAO’s recommendations and we continue to address the recommendations in order to help foster energy independence among 

tribes who are developing their resources. 

As the High Risk Report notes, GAO made 14 recommendations 

to the Bureau of Indian Affairs via three reports. I am happy to 

note that we have made some progress on a number of those recommendations and plan to submit closure packages for those recommendations in the near future. 

I acknowledge that we have a significant amount of work to do. 

My testimony today will update the Committee on our progress towards implementation of the various recommendations. 

GAO recommended the development and implementation of a 

GIS mapping module that could be included in our Trust Asset Accounting Management System or TAAMS. In response, we have developed a GIS Map Viewer to work along with our TAAMS system. 

The Viewer was successfully tested and deployed on August 31, 

2017. A closure package for this recommendation has been signed 

and is in the process of being submitted for consideration of closure. 

In addition, we will be providing a demonstration of that system 

to GAO tomorrow in order to better demonstrate the capabilities of 

the system. 

GAO has also recommended that we provide additional guidance 

related to the Tribal Energy Resource or TERA Agreements. As a 

result, the Office of Indian Energy and Economic Development has 

reviewed the tribal comments it has received and found that the 

inherently Federal functions is one of the number one issues that 

tribes have identified in need of clarity. 

In consultation with Department’s Office of Solicitor, it was determined that the term can only truly be defined on a case-by-case 

basis when tribes have made a request to take over a specific Federal program, function, service or activity. 

In order to provide additional guidance, IEED, our Indian Energy 

and Economic Development Office, has placed on its website additional guidance related to TERA for those tribes interested in assuming energy-related functions. 

In addition, I have talked to my staff in the Indian Energy and 

Economic Development Program about the possibility of developing 

a primer or some type of guidance on conducting additional training opportunities for tribes interested in pursuing TERA. 

In order to respond to the GAO’s recommendation to include 

other Federal agencies in the activities of the Indian Energy and 

Economic Development Program or IESC Service Center, we have 

47 

been working to implement memoranda of understanding or MOUs 

with the appropriate department bureaus and other Federal agencies involved in 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 Fish and Wildlife, the Environmental Protection Agency and the Army Corps of Engineers. In addition, not too long ago, we signed a MOU between the Division of 

Energy and Mineral Development and the Department of Energy. 

Included in that, we are trying to look at the Indian Energy Service 

Center as becoming a participatory party to that MOU. 

IESC has prepared an addendum to the MOU with IEED and 

DOE in order to finalize the agreement. The addendum is currently 

the review process. We do need to make sure the MOU clearly 

identifies the roles of the different offices in relation to executing 

the Indian Energy Program. 

GAO has also identified the need to establish a documented process for seeking input from key stakeholders. In response, the IESC 

has developed a process including intake forms that allow key 

agencies to provide input and requests for service received on behalf of tribes and other agencies. 

This information will allow the service center to prioritize work 

tasks based on a standard set of criteria contained in the IESC referral priority assessment. The priority assessment considers the 

potential work items’ relative benefit to expediting an Indian energy project. The IESC began utilizing intake forms in August to 

obtain input regularly from stakeholders. 

In addition, the BIA is continuing the process of identifying and 

implementing the workforce plan regarding positions associated 

with the development of Indian energy and minerals. 

As I testified in May before the Committee, the IESC will collect 

data directly from BIA, BLM, ONRR and OST employees in an effort to identify workload and necessary technical competencies. 

The IEMSC will work with the partner bureaus to assess skills 

and competencies needed for energy and mineral workforce standards as well as identifying any existing gaps that may exist out 

there. An initial survey was distributed in August 2017 to key employees across the bureaus to identify workload and necessary technical competencies. The results are currently being analyzed. The 

BIA is on target and expects to complete this recommendation by 

the end of 2017. 

Thank you for the opportunity to present an update on our 

progress. I look forward to answering any questions. 

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 come back and 

present an update on behalf of the Department of the Interior (Department or DOI) 

regarding Indian Affairs’ role in the development of Indian energy and our continued commitment to address the high risk designation in the Government Accountability Office (GAO) High Risk Report (GAO–17–317 High Risk Series). 

48 

As we stated in our testimony in May, the Department agreed with GAO’s recommendations and we continue to address the recommendations by implementing 

widespread reform to help foster energy independence among Tribes who are interested in developing their resources. 

As the High Risk report notes, GAO made fourteen recommendations to the Bureau of Indian Affairs (BIA), via three reports. I am happy to note that we’ve made 

progress on a number of the recommendations and plan to submit closure packages 

for those recommendations in the near future. 

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 update the Committee on our progress towards implementation of the various GAO recommendations. 

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. 

Previously, Indian Affairs testified that the Trust Asset and Accounting Management System (TAAMS) was not designed as a geospatial mapping system, but is 

simply a system to reflect legal descriptions as they appear on documents recorded 

as required by federal law. 

In our previous testimony we also stated that the BIA would not be building out 

the GIS mapping module in TAAMS. Rather, the BIA would 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 is based upon 

verified legal land descriptions and ownership data available in TAAMS with base 

reference data for mapping. 

We are pleased to announce that the Indian Affairs Information Technology 

Change Advisory Board and Architectural Review Committee granted the Authority 

to Operate the GIS Map Viewer and that the GIS Map Viewer has been deployed, 

as of August 31, 2017. The GAO closure package is currently being prepared. 

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. 

The BIA and the BLM, in a coordinated and focused effort, prepared a Reimbursable Service Agreement between the two agencies to identify and deliver the much 

needed survey-related products and services. We are continuing to evaluate the cadastral survey inventories and our FY17 survey requests have been approved for 

funding and completion by BLM. 

An example of our progress is the Nevada Native Nations Land Act of 2016, 

passed by Congress last year, which transferred 71,137 acres of BLM and Forest 

Service lands to six different tribes; these lands are being surveyed now by BLM 

to establish tribal trust land descriptions and boundaries. 

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. 

We previously stated that the BIA was in the process of evaluating and reviewing 

the current realty review and approval process and information stored in TAAMS 

in order to improve efficiencies and timeliness in processing workloads. BIA subject 

matter experts have been developing requirements for tracking proposed mineral 

documents within TAAMS. Due to the fact that modifications to data systems must 

be reviewed by multiple entities within the Department, a request for an extension 

of time has been requested until the end of FY18. The BIA is waiting to hear whether this extension has been granted. 

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. 

The Indian Energy Service Center has been working closely with BIA, ONRR, and 

BLM IT personnel to navigate system and software access challenges. Currently, access testing is ongoing but preliminary results indicate the IESC experiences significant efficiency gains as the office gains access to systems and software. For example, 

IESC ONRR staff has access to the BIA TAAMS system allowing for greater efficiency and transparency for each of the offices in the processing of Indian oil and 

gas projects. 

49 

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. 

After the previous hearing, the Office of Indian Energy and Economic Development (IEED) reviewed Tribal comments regarding the term, ‘‘inherently federal 

functions.’’ We noticed that the term ‘‘inherently federal functions’’ is the only provision of the TERA regulations that Tribes have described to IEED as unclear. IEED 

consulted with the Department’s Office of the Solicitor (SOL), which determined 

that this term can only be defined on a case-by-case basis when tribes have made 

a request to take over a specific federal program, function, service and activity 

(PFSAs). On August 31, 2017, IEED placed on its web site guidance to tribes with 

an approved TERA or which seek to assume energy-related administrative functions 

under Public Law 93–638. The GAO closure package is currently being prepared. 

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 continuing its work to ensure CA processes are timely. A National Policy Memorandum (Memorandum) was issued that establishes a tracking 

mechanism to monitor the existing timeframes for review and approval of Indian 

CAs. This tracking mechanism will provide the data which will be used to establish 

standard and reasonable timeframes for CA review and approval. The 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 as updates to this document occur. On April 27, 2017, the Department received notice than an extension was granted by OIEA 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 still developing a systematic mechanism to track Indian CAs through 

the review and approval process. 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 received an extension from GAO to complete this recommendation by the end of FY18 and are on 

track to meet our target. 

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 capabilities, to monitor and assess the 

results of the efforts to streamline the Indian CA review and approval process. The 

bureaus will continue to coordinate to establish a process for review of the collected 

data, which will assist in identifying and implementing any necessary process modifications. 

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 the 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/IESC, 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, 

the Southwest Region, and the Rocky Mountain Region. Federal Partner Groups for 

50 

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. The 

IESC reviewed this MOU with the intent of also entering into the existing agreement. The IESC prepared an addendum to the MOU with IEED and DOE to finalize 

the agreement. The addendum is currently in the surname process. 

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. 

The IESC developed a process that allows key agencies to provide input and requests for service received on behalf of tribes from the IESC. The process includes 

guidance on the prioritization of task orders. The Executive Management Group of 

the IESC, is comprised of the directors of the BIA, BLM, ONRR, and Office of the 

Special Trustee for American Indians (OST), are engaged in this effort. The IESC 

began utilizing the intake forms in August, to obtain input regularly from stakeholders, and currently has no data to report. 

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 

and the GAO closure package is currently being prepared 

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 continuing the process of identifying and implementing a workforce 

plan regarding positions associated with the development of Indian energy and minerals. As we testified in May before the Committee, 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. The initial survey was distributed in August 2017 to key employees 

across BLM, ONRR, OST and BIA; results are being analyzed. The BIA is on target 

and expects to complete this recommendation by the end of 2017. 

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 is assessing 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. The BIA is on target to 

complete this assessment by December 31, 2017. 

Conclusion 

Thank you for the opportunity to present an update on our progress in addressing 

the GAO recommendations from past reports and the GAO High Risk Report (GAO– 

17–317 High Risk Series). I would be glad to answer any questions the Committee 

may have. 

The CHAIRMAN. Thank you, Assistant Secretary Black. 

I will now turn to Rear Admiral Michael Weahkee. 

51 

STATEMENT OF REAR ADMIRAL MICHAEL D. WEAHKEE, 

ACTING DIRECTOR, INDIAN HEALTH SERVICE, U.S. 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Mr. WEAHKEE. Good afternoon, Chairman Hoeven, Vice Chairman Udall and members of the Committee. 

I am pleased to provide testimony before the Committee today 

and would like to thank you for elevating the importance of delivering quality health care throughout the IHS. The IHS is committed to overcoming the longstanding, systemic problems hindering our efforts to provide quality health care for American Indians and Alaska Natives. 

I am proud to report that our concerted efforts are producing results. As of September 1, the Rosebud Indian Health Service Hospital is no longer under a Systems Improvement Agreement. We 

are striving to achieve a similar result for the Pine Ridge and 

Omaha Winnebago hospitals. 

Also in August, I signed the Official Patient Wait Times Policy 

and GAO has agreed to close that recommendation. 

The GAO identified a number of challenges facing the IHS in administering our health care programs. To overcome these challenges, we developed a Quality Framework and have worked diligently to refine and operationalize it. 

In less than a year, we have updated governing board bylaws, acquired a credentialing software system, developed a standard patient experience of care survey, developed patient wait time standards, and developed a performance accountability dashboard. 

We are on course to address the four key GAO recommendations 

on improvement of agency oversight of quality health care. In December 2016, IHS developed contingency and succession plans for 

the replacement of key personnel, including our area director positions. These succession plans are currently being updated and will 

be updated on a semi-annual basis. We will provide GAO with the 

copy they need as evidence of completion. We have requested closure of this recommendation. 

The second and third recommendations I would like to address 

concern patient wait times for appointments. The official patient 

wait times policy is now in effect. This policy finalizes the interim 

standards initially established in July of this year. 

The fourth quality-related recommendation is the agency-wide 

oversight of quality. We developed a performance accountability 

dashboard and acquired a practitioner credentialing software system. Dashboard metrics will allow oversight and management of 

compliance with policy and regulatory requirements that ensure 

quality and safety of care. The system-wide dashboard will be in 

full operation in the fall of 2017. 

The national provider credentialing and privileging system 

standardizes and streamlines the credentialing process across the 

IHS. We are implementing it in four IHS areas with plans to expand it to the rest of the agency by the end of 2017. 

I am also happy to report that the agency has made progress in 

addressing the ten key GAO recommendations on the improvement 

of our Purchased and Referred Care Program. To address the first 

of these three recommendations, IHS modified the data system that 

52 

tracks PRC referrals and emergency self referrals. We will report 

baseline data for calendar year 2017. 

IHS is also researching industry standards and will develop separate payment timeframe targets for these two referral types. We 

will request closure of this recommendation when that work is completed. 

GAO’s second recommendation was for PRC funds to be used to 

pay for program staff. Historically, IHS’ internal policy was to use 

PRC funds solely for the purchase of health care services. Any 

change in the current use of PRC should be balanced with the continuing need to assure access to services we cannot provide in our 

facilities. 

In response to the third recommendation, we provide patients 

with current information regarding opportunities for new coverage 

options. While we agree with the premise of the GAO’s recommendation, we have reservations about the specifics and would 

like to discuss this further with the GAO. The agency has requested closure of these two recommendations. 

The recommendation to cap payment rates has been implemented. Since capping PRC payment rates for non-hospital services, the IHS and participating tribes have realized a savings of 

more than $178 million so far in this calendar year. The additional 

savings realized enabled IHS and tribes to increase access to more 

health care services. 

IHS also developed an online PRC rate provider tracking tool to 

monitor patient access to care. We look forward to demonstrating 

that tool for the GAO. IHS has requested closure of this recommendation. 

I would like to address GAO’s three recommendations on the allocation of PRC program resources by describing the Federal-tribal 

administration of PRC funds. Approximately 60 percent of the PRC 

funds are distributed through Indian Self-Determination awards 

and are protected from unilateral reductions or reallocation by the 

agency. 

Any future changes in the PRC allocation methods, such as the 

two recommended by the GAO, will require tribal consultation. IHS 

has requested closure of these recommendations. 

We are also taking steps to address the third recommendation related to development of written PRC allocation policies and procedures. To assure transparency, IHS routinely directs area directors 

through official PRC allocation of funds distribution memos. 

These memos are official policy guidance and become part of the 

PRC policy chapter of the Indian Health Manual. The revised chapter is currently under final agency review. The agency has requested closure of this recommendation. 

We continue to address the remaining recommendations not discussed above: one related to the enrollment processes improvement 

and two focused on oversight for estimating need. Closure of these 

recommendations will be requested when we complete the steps 

necessary to document the changes and improvements we have 

made since 2011. 

I am very proud of the dedication and commitment of our IHS 

staff, at all levels of the agency, who have accomplished these objectives in the past year. I want to thank you again for your comVerDate Mar 15 2010 07:35 May 22, 2018 Jkt 030089 PO 00000 Frm 00056 Fmt 6633 Sfmt 6601 S:\DOCS\30089.TXT JACK
53 

mitment to improving quality, safety and access to health care for 

American Indians and Alaska Natives. 

I am happy to answer any questions the Committee may have. 

Thank you, sir. 

[The prepared statement of Admiral Weahkee follows:] 

PREPARED STATEMENT OF REAR ADMIRAL MICHAEL D. WEAHKEE, 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 RADM Michael D. Weahkee, Acting Director of the Indian Health 

Service (IHS). I am pleased to provide testimony before the Senate Committee on 

Indian Affairs on ‘‘High Risk Indian Programs: Progress and Efforts in Addressing 

GAO’s Recommendations’’. I would like to thank you, Chairman Hoeven, Vice-Chairman Udall, and Members of the Committee for elevating the importance of delivering quality care through the IHS. 

I am an enrolled member of the Zuni Tribe. Most recently, I served as the Chief 

Executive Officer (CEO) of the Phoenix Indian Medical Center, leading the largest 

federally-operated IHS hospital in the nation. I have previously served at IHS headquarters in a variety of posts. Before that, I served in leadership roles on behalf 

of the California Rural Indian Health Board. I am honored to be a veteran of the 

United States Air Force, where I served as a Public Health Specialist. I am also 

proud of the fact that I was born at the IHS hospital in Shiprock, New Mexico, and 

grew up as an active user of the IHS health care system. Essentially, Indian health 

care and public health have been my lifelong pursuits and are my passion. 

IHS is a distinctive agency in the Department of Health and Human Services 

(HHS), established to carry out the responsibilities, authorities, and functions of the 

United States to provide health care services to American Indians and Alaska Natives. It is the only HHS agency whose primary function is direct delivery of health 

care. The mission of IHS, in partnership with American Indian and Alaska Native 

people, is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. The IHS system consists of 12 Area 

offices, which oversee 170 Service Units that provide care at the local level. Health 

services are provided through facilities managed by IHS, by Tribes and tribal organizations under authorities of the Indian Self-Determination and Education Assistance Act (ISDEAA), and through contracts and grants awarded to urban Indian organizations authorized by the Indian Health Care Improvement Act. 

IHS is steadfastly committed to overcoming the longstanding systemic problems 

that have hindered our efforts to provide quality health care to American Indians 

and Alaska Natives, and I am proud to report that our concerted efforts are producing results. As of September 1, the Rosebud IHS Hospital is no longer under a 

Centers for Medicare & Medicaid Services (CMS) Systems Improvement Agreement. 

CMS determined that the hospital had substantially met all of the Medicare Conditions of Participation. We are striving to achieve a similar result for Pine Ridge and 

Omaha Winnebago IHS Hospitals. 

IHS is also committed to doing all that is necessary to be removed from GAO’s 

High Risk list. The GAO’s High Risk Report cited 14 recommendations that focus 

on IHS, derived from seven reports issued over a period of six years (2011 to 2017). 

Although all 14 recommendations remain open at this time, we have made substantial progress and are continuing to press forward. In July, IHS provided an update 

to GAO and requested closure of seven recommendations. GAO requested additional 

documentation concerning those requests that we are currently providing, and we 

will continue to submit additional responses to address the remaining GAO recommendations. I will describe the actions we are taking to address the recommendations and strengthen the IHS’ ability to ensure quality health care. 

Ensuring Quality Care 

GAO identified a number of challenges facing IHS in administering Indian health 

care programs that have hindered our ability to ensure quality of care to Indian 

communities. To overcome these challenges, IHS developed a Quality Framework— 

a plan to develop, implement and sustain quality-focused compliance programs at 

all of our hospitals and clinics. The Framework incorporates quality standards from 

national experts, including best practices and expertise from across the IHS system 

of care. Core elements of the Framework focus on strengthening our organizational 

capacity to improve quality of care and systems, meeting and maintaining accreditation for IHS Direct Service Facilities, aligning our service delivery processes to imVerDate Mar 15 2010 07:35 May 22, 2018 Jkt 030089 PO 00000 Frm 00057 Fmt 6633 Sfmt 6621 S:\DOCS\30089.TXT JACK
54 

prove patient experience, ensuring patient safety, and improving transparency and 

communication about patient safety and quality to IHS stakeholders. 

IHS has worked diligently to refine and operationalize the Quality Framework. 

In less than a year, we have updated Governing Board Bylaws, acquired a 

credentialing software system, developed a standard patient experience of care survey and an implementation strategy using electronic tablets, developed patient wait 

time standards for the primary care setting, developed a quality assurance accountability dashboard (the data reporting tool is currently undergoing functional testing), and are nearing award of a master contract for accreditation of hospitals. The 

Deputy Director for Quality Health Care provides senior leadership oversight of critical quality improvement strategies related to accreditation/certification, patient 

safety, and quality care. 

IHS has made remarkable progress and will continue to pursue implementation 

of the Quality Framework at all levels of IHS and in partnership with Tribal/Urban 

Indian organization partners as a key priority. Our leadership team is focused on 

ensuring quality in all that we do as an agency, and I expect this perspective and 

commitment will continue to produce results. 

We are strengthening the agency’s use of standards by developing new policies 

that define the standards and implementing system level reporting and oversight 

through Agency-wide improvements. We are on course to address the four key GAO 

recommendations on improvement of agency oversight of quality of care, and requested closure of one of these four recommendations in July. 

The first recommendation I would like to address concerns succession planning for 

key leadership personnel. 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 continue to 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, the IHS 

Leadership Training program is designed to prepare selected IHS individuals to 

serve in leadership positions at the Service Unit, Area, and Headquarters levels. In 

addition, staff rotations through IHS Headquarters provide additional training for 

senior level positions, and a mentoring initiative for those who have recently been 

promoted to key leadership positions has been implemented. We have requested closure of this recommendation. 

The second and third recommendations I would like to address concern patient 

wait times for appointments. Wait times are an important measure of the patient 

experience and IHS federally-operated service units have been collecting and tracking this data to improve patient services. On August 25, I signed the official Patient 

Wait Times policy formalizing the IHS wait times standards for outpatient primary 

care visits in direct care IHS facilities. This policy finalizes the interim standards 

initially established in July of this year. Under these new standards, the mean wait 

time for a primary care appointment will be 28 days or less and for urgent appointments it will be 48 hours or less. These mean appointment wait times are the core 

measures that will be collected in all primary care settings. The data collected 

across IHS’ direct service sites will be used to continually improve patient wait 

times. In order to implement the agency-wide standards by December 31, 2017, the 

IHS Chief Medical Officer communicated the Patient Wait Time policy Circular to 

Area clinical leadership on September 1, 2017. As part of its implementation, IHS 

will monitor the outcome data and ensure corrective actions are taken if standards 

are not met. 

The fourth quality-related recommendation I will address is the Agency-wide oversight of quality. IHS has developed a performance accountability dashboard and acquired a practitioner credentialing software system. The accountability dashboard 

incorporates the five dimensions of health: patient safety, care effectiveness, patientcenteredness, timeliness, and care efficiency. Dashboard metrics will allow oversight 

and management of compliance with policy and regulatory requirements that ensure 

quality and safety of care. The measure definitions are complete, the data collection 

tool is in testing, and the dashboard for visualization is under development. The 

IHS will have the system-wide dashboard of performance accountability metrics in 

operation in the fall 2017. The dashboard is a powerful tool that 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. 

We are making other system-wide changes to ensure that quality improvements 

made by the federally-operated facilities are supported and sustained over time. IHS 

is modernizing the way provider credentialing and privileging, and facility accreditation preparedness is carried out within the federally-operated hospitals and clinics. 

55 

Also, we strengthened the governance and oversight of the hospitals by implementing standard Hospital Governing Board requirements. 

To facilitate the hiring of qualified providers and ensure patient safety, the IHS 

is implementing a national provider credentialing and privileging system. The system is being implemented first in four IHS Areas and then will be expanded to the 

remaining IHS Areas by the end of 2017. The national credentialing system standardizes and streamlines the credentialing process across the IHS. Privileging and 

performance evaluations of IHS practitioners will be key aspects tracked in the new 

system that help address quality and patient safety. The IHS credentialing and 

privileging policy is being updated to support the new system. 

Additionally, IHS expects to award a contract to a single accrediting organization 

for IHS hospitals later this month. IHS’ use of one accreditation body will support 

the Agency-wide approach to quality improvement in the IHS facilities to help maintain accreditation. IHS’ existing partnership with CMS further supports best health 

care practices and other organizational improvements for IHS federally-operated 

hospitals that participate in the Medicare program. 

Lastly, since January 2017, IHS Hospital Governing Board (GB) Bylaws for inpatient acute care hospitals have been standardized across the Agency. We set minimum standards IHS-wide, while maintaining flexibility for the Areas and Service 

Units to accommodate needs specific to their locations and service populations. GB 

bylaws now specify minimum meeting frequency, agenda topics, and membership. 

Area Directors were instructed to immediately incorporate these changes into GB 

Bylaws for each hospital, communicate these new requirements to their Service 

Units and verify completion of these changes to IHS Headquarters (which was accomplished by February 2017). 

Purchased/Referred Care Improvements 

I can report that the agency has made progress in addressing the 10 key GAO 

recommendations on improvement of the Purchased/Referred Care (PRC) program. 

The IHS is improving and increasing access to care for our beneficiaries through 

outreach, education and enrollment activities, and requested closure of six recommendations in July. We are working to provide GAO with additional documentation of our progress. 

The first GAO recommendations on the PRC program that I can report progress 

on address opportunities for improving the administration of the program. IHS 

places a high priority on timely processing of purchase orders, private provider 

claims, and payments for those services that cannot be provided by our facilities directly. Improving the data reporting and measurement system is essential to assuring that PRC programs are efficient. To that end and to address the first of the 

three recommendations, IHS modified the data system that tracks PRC referrals 

and emergency self-referrals and expects to begin baseline reporting for calendar 

year (CY) 2017 that will be available in CY 2018. IHS is currently researching industry standards and expects to have separate payment timeframe targets for these 

two referral types. We will request closure of this recommendation when the work 

is completed on all the items. GAO’s second recommendation was for PRC funds to 

be used to pay for program staff. Historically, IHS’ internal policy was to use PRC 

funds solely for the purchase of health care services. Any change in the current use 

of PRC should be balanced with the continuing need to assure access to services we 

cannot provide in our facilities. As for the third recommendation, we provide patients with current information regarding opportunities for new coverage options 

and ability to access care without obtaining a PRC referral. The Agency has requested closure of these two recommendations. 

I can report that the recommendation to cap payment rates for non-hospital services has been addressed. IHS issued a final rule with comment, which amended the 

IHS regulations at 42 CFR part 136 to add a new Subpart I. The new Subpart I 

applies Medicare payment methodologies to physician and other non-hospital services or items purchased through the PRC program. The additional savings realized 

enables IHS and Tribal providers to increase access to more health care services. 

After capping PRC payment rates for non-hospital services, IHS and Tribes that use 

the IHS fiscal intermediary for the processing of PRC claims have realized a savings 

of more than $178 million so far this calendar year. All IHS PRC programs participate in the PRC payment rates; Tribes are not required to participate, but may opt 

in. To date, six Tribes have opted in to participate. IHS also developed an online 

PRC Rates Provider Tracking tool to monitor the access to physician and other nonhospital 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 on use of the tool to the Area PRC officers at a face-to-face meeting in DeVerDate Mar 15 2010 07:35 May 22, 2018 Jkt 030089 PO 00000 Frm 00059 Fmt 6633 Sfmt 6621 S:\DOCS\30089.TXT JACK
56 

cember 2016. The tool went live in January 2017. IHS has requested closure of this 

recommendation. 

I would like to address GAO’s three recommendations on the allocation of PRC 

program resources by describing the federal-tribal administration of PRC funds and 

its implications for our response to the first and second recommendations. Approximately sixty percent of the PRC funds are distributed through Indian Self-Determination awards and are protected from unilateral reductions or reallocation by the 

agency, absent one of the 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. Any future changes in PRC allocation methods, such as the two 

recommended by GAO, will undergo tribal consultation. The tribal-federal 

workgroup on improving PRC met in June of this year and recommended not changing the fund allocation methodology at a time when there is uncertainty in the future of federal health care financing and policy. IHS has requested closure of these 

two recommendations. 

I would also like to report on actions we are taking to address the third recommendation related to the development of written PRC allocation policies and procedures. To assure transparency, IHS distributed guidance on PRC allocation of 

funds to Area Directors and PRC officers in CY 2016. IHS routinely 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 chapter is under final agency review. The Agency 

has requested closure of this recommendation. 

We continue our work addressing the remaining recommendations not discussed 

above: one addressing improvement in the enrollment processes and two focused on 

oversight for estimating need. We expect to request closure for these three open recommendations when we complete all the steps necessary to document the changes 

and improvements the Agency has adopted since 2011. 

IHS is committed to addressing all risks impacting our ability to carry out our 

Agency mission. We have incorporated the GAO’s High Risk Report recommendations into the IHS risk management work plan for 2017. IHS has entrusted leadership at all levels of the organization to identify current controls and will review 

their effectiveness in our annual internal management assessments. Where controls 

are deemed insufficient, actions to strengthen them will be taken. This special focus 

on identifying and mapping internal controls will help to inform strategic planning 

and identify appropriate areas for resource allocation. 

I am very proud of the dedication and commitment of IHS staff at all levels of 

the agency who have accomplished these objectives in the past year. And I think 

you will agree with me that these actions 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. 

Mr. Dearman. 

STATEMENT OF TONY DEARMAN, DIRECTOR, BUREAU OF 

INDIAN EDUCATION, U.S. DEPARTMENT OF THE INTERIOR 

Mr. DEARMAN. Good afternoon, Chairman Hoeven and members 

of the Committee. 

Thank you for the invitation to appear again on behalf of the Bureau of Indian Education in regard to our recent work addressing 

BIE’s High Risk designation. 

As highlighted in the GAO reports, much work remains, but I am 

glad to report progress since the last time we met. Since the last 

hearing, we continue to prioritize the GAO recommendations and 

view their reports as a constructive tool to improve the agency and 

help the students we are committed to serve. 

In three separate reports dating back to 2013, GAO provided 13 

recommendations to improve the management of BIE schools. Currently, 11 of the GAO’s recommendations remain open but progress 

is being made on these outstanding recommendations. 

57 

GAO issued three additional reports in May of 2017 since the 

last Committee hearing. The three additional GAO reports include 

several new recommendations, ten of which directly involve the 

BIE while the others require coordination with other bureaus within Indian Affairs. 

As director, 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 comprehensively addresses each outstanding recommendation. 

We appreciate the assistance and collaboration offered by GAO. 

In recent months, the BIE, through the support of the department, 

has increased its direct communication with GAO, which has enhanced BIE’s ability to more effectively address outstanding recommendations. 

Through in-person meetings and follow-up teleconferences, GAO 

has provided BIE comments and suggestions for closing the outstanding recommendations. 

Regarding GAO–13–774, BIE has completed implementation of 

recommendations two and three, which includes development of a 

communications strategy and increased collaboration with the Department of Education. 

Recommendation five, revision of a strategic workforce plan, was 

previously considered closed by the department, but not GAO. After 

a thorough review of the recommendation five closure package with 

GAO, BIE and the department have chosen to list the recommendation as open and are working to submit a new closure 

package. 

Further, BIE is currently working to implement recommendations one, four, and five, which are to develop documented decisionmaking procedures, a strategic plan, and a comprehensive workforce plan. BIE plans to fully implement the remaining recommendations contained in GAO–13–774 by 2018. 

Regarding GAO–15–121, BIE continues to implement GAO’s four 

recommendations and 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. 

Regarding GAO–16–313 and GAO–17–421, Indian Affairs has 

formed an interagency workgroup to address all safety-related GAO 

recommendations. The workgroup consists of staff from BIE, BIA, 

and pertinent partners across Indian Affairs. The group’s first 

meeting was held on May 31 through June 1, 2017, with a second 

meeting held on August 15–16, 2017. 

Working with BIA, BIE is currently crafting and implementing 

comprehensive safety inspection policies and procedures to ensure 

that high quality inspections and reports are carried out. 

Regarding GAO–17–423, not all recommendations are directly 

under BIE’s purview. However, BIE tentatively concurs with recommendation seven and is examining the feasibility and cost of implementation. 

With regard to Recommendation 8, BIE non-concurs with GAO 

regarding this recommendation. While altering the transportation 

formula could be beneficial, it would require a formally-negotiated 

rulemaking. To consider such rulemaking, BIE would need to have 

support of its tribal partners. 

58 

Regarding GAO–17–447, BIE is working cooperatively with partners across Indian Affairs to address GAO’s recommendations. As 

this is a new report, these items are not outstanding but will nonetheless be addressed as expeditiously as possible. 

Members of the Committee, thank you for the opportunity to 

present testimony today and provide the Committee an update regarding our GAO work. BIE is excited about our recent progress 

and remains committed to sustained improvement. The BIE looks 

forward to working with you and appreciates your time and attention in this important matter. 

I would be honored to answer any questions you may have. 

[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 again on behalf of the Bureau 

of Indian Education (BIE) to discuss our ongoing work to address the high risk designation from the Government Accountability Office (GAO) in the High Risk Report 

(GAO–17–317 High Risk Series). 

As highlighted in the GAO reports, much work remains, but I am glad to update 

this Committee on progress made since I last testified in May. A priority as BIE 

Director includes addressing the GAO recommendations and the issues highlighted 

head on. As I previously testified, the BIE team views the GAO’s reports as a constructive tool to improve our agency and help the students we are committed to 

serve. As such, I will update you on headway made in the following areas: 

1. GAO High Risk Status for BIE 

2. GAO Recommendations 

3. GAO Recommendations Status & BIE Next Steps 

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 previous reports that inhibit the agency from efficiently 

executing its mission to serve Indian students: 

• Indian Affairs’ (IA) 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; 

• 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 IA’s 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 thirteen recommendations to improve IA’s management of BIE schools. Currently, eleven of 

GAO’s recommendations remain open. However, progress is being made to address 

BIE’s outstanding recommendations. GAO issued three additional reports in May 

2017 since the last Committee hearing on this subject. These new GAO reports include several new recommendations, ten of which would require a response solely 

from BIE. BIE tentatively concurred with one of the ten new recommendations and 

disagreed with one other new recommendation. The remaining recommendations, 

due to agency authority, are directed to other entities within IA, or a combination 

of agencies within IA. 

As Director, I am committed to addressing these outstanding items. To that end, 

I am working with our senior leadership team within BIE as well as with the Bureau of Indian Affairs (BIA), the Office of the Assistant Secretary for Indian Affairs, 

the Secretary’s Office, and our colleagues at GAO to ensure BIE comprehensively 

addresses each outstanding recommendation as expeditiously and effectively as possible. We are appreciative of the assistance and collaboration offered by GAO. In recent months, the BIE, through the support of the Department, has increased its diVerDate Mar 15 2010 07:35 May 22, 2018 Jkt 030089 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 S:\DOCS\30089.TXT JACK
59 

rect communication with GAO, which has enhanced BIE’s ability to efficiently address outstanding recommendations. Through in-person meetings and follow-up teleconferences, GAO has provided BIE comments and suggestions for closing recommendations in a timely manner. 

GAO recommendations are a roadmap for BIE to establish and maintain comprehensive internal policies and procedures that support service delivery, ensure accountability, and provide organizational stability. We look forward to continuing our 

work with GAO and this Committee. 

GAO Recommendations: Status and 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 services rather 

than addressing critical, long-term organizational improvement strategies highlighted in the 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 ability to serve 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 need for each GAO recommendation to be reexamined and addressed. BIE is currently working to complete the actions recommended in each of 

these three GAO reports. 

OUTSTANDING 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 and three, which includes development of a communications strategy and increased collaboration with 

the Department of Education (ED) through several mechanisms, including a BIE– 

ED Committee that meets every other week (rather than just quarterly). Recommendation five, revision of a strategic workforce plan, was previously considered 

closed by the Department, but not GAO. After reviewing the previous work submitted by BIE regarding recommendation five, and after closely collaborating with 

GAO regarding the work product, BIE and the Department relisted the recommendation as open and will continue to work collaboratively with GAO until fully 

implemented. Additionally, BIE will assess the effectiveness of its implementation 

of GAO’s closed recommendations in an effort to continually improve BIE’s operations. BIE is currently working to implement recommendations one, four, and five, 

which are to develop documented decisionmaking procedures, a strategic plan, and 

a comprehensive workforce plan. BIE plans to fully implement the remaining recommendations contained in GAO–13–774 by 2018. 

Recommendation I—In June 2017, the BIE workgroup convened staff from across 

the Bureau for a two-day workshop. During the workshop, the workgroup solicited 

inter-departmental input regarding a formal strategic decisionmaking policy. A draft 

strategic decisionmaking procedure was produced by the workgroup shortly thereafter. On July 14, 2017, the BIE workgroup provided a copy of the draft strategic 

decisionmaking procedure to all BIE senior leaders for a one-week review and input 

period. Following the one week review, the workgroup incorporated all feedback and 

submitted the draft procedure to the IA’s Office of Regulatory Affairs and Collaborative Action (RACA) on July 28, 2017. 

60 

RACA is the office responsible for reviewing, and ultimately publishing, the document in the Indian Affairs Manual (IAM), which is a reference for all agencies and 

offices within IA. On August 18, 2017, RACA provided BIE edits and input for review. On August 21, 2017, BIE completed its review of RACA’s feedback and resubmitted the draft decisionmaking procedure for publication into the IAM. BIE is 

awaiting final publication of the strategic decisionmaking procedure by RACA. Upon 

final publication, BIE will schedule a training event for all appropriate personnel 

regarding the use of the newly drafted strategic decisionmaking policy as well as 

work to provide a closure package to GAO. 

Recommendation IV—BIE, working cooperatively with leadership within IA 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. On 

April 11, 2017 BIE held a follow-up strategic planning session, convening local, regional, and central office personnel to determine paths forward. By the end of April 

2017, BIE began revising its mission and vision statement and identified draft 

goals. On June 14, 2017 and July 18—20, 2017, BIE held additional strategic planning sessions to identify strategies aligned to goals and established a communications plan for sharing the draft plan with internal and external stakeholders to solicit feedback as well as developing a timeframe for formal consultation with Indian 

tribes. In addition, BIE identified dates for additional organization-wide planning 

meetings on August 29–30, 2017 and September 26–28, 2017. 

To ensure that the strategic planning process is effective and results in a high 

quality and useful work product, the BIE has partnered with external subject matter expert organizations, such as the Council of Chief State School Officers 

(CCSSO), the South Central Comprehensive Center (SC3), and the Building State 

Capacity and Productivity Center (BSCPC). These organizations have provided BIE 

with technical expertise and shared best practices in developing an effective, longterm strategic plan as well as creating a functional action plan for implementing 

a measurement system to track progress once the strategic plan is implemented. 

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. 

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—During the early stages of the current BIE reform, IA contracted a workforce study. However, following BIE’s meetings with GAO on June 17, 

2017 and August 16, 2017, GAO provided clarification regarding work product expectations identifying skills gap, prioritization of vacancies, and the need for plans 

contingent on varying outcomes, such as available funding and hiring constraints. 

BIE plans to revisit the work done by IA in the prior study and reexamine its workforce planning efforts in light of GAO’s feedback. 

Recommendation II—BIE staff is working to ensure that necessary financial oversight information is shared across the agency. In the short term, BIE has developed 

a share point system and ensured all key staff members, such as those involved 

with calculating the 2017–2018 school risk matrix, have access to audit reports. Additionally, BIE now has access to the IA Division of Internal Evaluation and Assessment (DIEA) Audit Report Tracking Tool (ARTT) system that provides a real-time 

status of Audit report findings, recommendations and questioned costs. 

In June 2017, the BIE working group convened staff from across the BIE for a 

two-day workshop to develop a permanent, comprehensive, interdepartmental policy 

and procedure for sharing information across the Bureau. In addition, BIE is currently working with its Information Technology support staff to examine the feasibility of implementing an electronic tool that would provide all internal divisions 

within BIE fiscal monitoring access to upload and share documents and information. 

61 

Recommendation III—As part of its work, BIE leadership has given all staff with 

fiscal monitoring responsibilities the directive that all school monitoring events will 

be made in a single, coordinated manner. This will ensure that staff from the Division of Performance and Accountability, School Operations, Education Resource 

Center, and Associate Deputy Director offices will conduct single, coordinated visits 

to all schools identified as high risk through the utilization of the BIE High-Risk 

Matrix. 

In addition, the BIE workgroup convened a two-day workshop in June 2017 concentrated solely on addressing all outstanding recommendations related to BIE’s fiscal monitoring activities. During the workshop, the workgroup solicited inter-departmental input regarding a uniform, comprehensive, interdepartmental fiscal monitoring policy and procedure. A draft fiscal monitoring policy and procedure is in 

draft form but still requires further input and editing, which will be completed in 

the coming months. Following the workgroup’s final drafting efforts, BIE plans to 

submit the fiscal monitoring policy and procedure to all BIE senior leaders for a review and input period, after which BIE will submit the proposed policy and procedure to RACA for review and publishing into the IAM. 

Finally, on August 14, 2017, the BIE received Departmental approval to advertise 

and fill three key fiscal monitoring related positions. These positions are newly established under the reform and were specifically designed to provide BIE with increased human capital needed to effectively conduct fiscal monitoring. These positions include a Program Manager for Budget and Finance and two auditor positions. 

Recommendation IV—In June 2017, members of the BIE working group met to 

begin drafting a comprehensive risk-based monitoring methodology to ensure compliance with the Fraud Reduction and Data Analytics Act of 2015 (Public Law 114– 

186). During the workshop, the workgroup solicited inter-departmental input regarding a comprehensive risk assessment methodology. The workgroup has completed its work implementing the 2017–2018 risk assessment based on the comprehensive methodology. 

The workgroup is also drafting a risk assessment policy and procedure to ensure 

the methodology is used annually in a standardized and uniform manner. However, 

the policy and procedure requires further input and editing, which will take place 

in coming months. Following the workgroup’s final drafting efforts, BIE plans to 

submit the risk assessment policy and procedure to all BIE senior leaders for a review and input period, after which BIE will submit the proposed policy and procedure to RACA for review and publishing into the IAM. 

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. 

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. 

BIA completed safety inspections at all BIE-funded schools for the first time in 

2016. BIE and BIA are currently on time in completing all school inspections in 

2017 as well. However, BIE understands the need to ensure focus on completion 

does not detract from the quality of inspections. To that end, BIA has formed an 

inter-agency workgroup to address all safety-related GAO recommendations. The 

workgroup consists of staff from across IA, including the BIE, BIA, DIEA, the Deputy Assistant Secretary—Management (DAS–M), and Division of Facilities Management and Construction (DFMC). The workgroup’s first meeting was held on May 31 

through June 1, 2017, with a follow-up meeting held August 15–16, 2017. 

As a contingency plan, the workgroup has also drafted an inspection mitigation 

and prioritization plan based on risk should it be unable to complete 100 percent 

of inspections in future years. BIE plans to submit its mitigation and prioritization 

plan to its IA partners for review and input no later than September 2017. 

62 

Recommendations III and IV—BIE is conducting ongoing staff and administrator 

training and is working with BIA to provide long-term support of 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, through the workgroup members described in GAO 16–313 Recommendations I and II, are working to produce formal policies and procedures to 

address shortcomings through a recently formed inter-agency workgroup that met 

throughout the summer coordinate activities to ensure such committees are formed 

and trained in a timely and consistent manner. 

2017 GAO RECOMMENDATIONS

GAO–17–421—INDIAN AFFAIRS: Further Actions Needed to Improve Oversight 

and Accountability for School Safety Inspections (May, 2017) 

GAO made six recommendations, five of which apply to BIE in conjunction with 

IA and BIA: 

I.) Develop and take corrective actions to address BIA safety program weaknesses identified in prior Interior evaluations; 

II.) Develop and implement a plan to assess employees’ safety training needs 

and monitor compliance with IA’s safety training requirements; 

III.) Ensure employee performance standards on inspections are consistently incorporated into the appraisal plans of all personnel with safety program responsibilities; 

IV.) Develop performance and quality standards and establish a process for routinely monitoring the quality of inspection reports; 

V.) Develop a system which routinely monitors and require inspectors to submit 

completed safety reports to schools within a 30-day timeframe; and 

VI.) Use timelines information to assess employee performance for personnel 

with safety program responsibilities. 

IA has formed an inter-agency workgroup to address all safety related GAO recommendations. The workgroup consists of staff from BIE, BIA, IA, DIEA, and 

DFMC. The group’s first meeting was held on May 31 through June 1, 2017, with 

a second follow-up meeting held on August 15–16, 2017. Working with BIA, BIE is 

currently crafting and implementing comprehensive safety inspection policies and 

procedure to ensure that inspections and reports are carried out in a timely manner 

and are of sufficient quality. 

GAO–17–423—INDIAN AFFAIRS: Better Data Could Improve Road Management 

and Inform Indian Student Attendance Strategies (May, 2017) 

GAO made eight recommendations, two of which apply to BIE: 

VII.) Provide guidance to BIE schools to collect data on student absences related 

to road and weather conditions; and 

VIII.) Review the BIE Transportation Formula and determine, with BIA and 

tribal stakeholders, what adjustments are needed to better reflect transportation costs for schools. 

Recommendation VII—BIE tentatively concurs with this recommendation and is 

currently examining feasibility and costs of tracking absences due to road conditions, among other important data points, within its Native American Student Information System (NASIS) system. 

Recommendation VIII—BIE non-concurs with GAO regarding this recommendation. While this could be beneficial, altering the transportation formula would require formal negotiated rulemaking. The BIE would only consider undergoing such 

rulemaking with the support of its tribal partners. To date, BIE has not received 

any such communication. 

GAO 17–447—INDIAN AFFAIRS: Actions Needed to Better Manage Indian 

School Construction Projects (May, 2017) 

GAO made six recommendations, two of which apply to BIE: 

V.) Improve oversight and technical assistance to tribal organizations to enhance tribal capacity to manage major constructions projects; and 

VI.) Develop and implement guidance for maintaining complete contract and 

grant files for all BIE school construction projects. 

Recommendation V—BIE will work cooperatively with IA Office of Facilities, 

Property and Safety Management (OFPSM) and DFMC to draft an engagement plan 

63 

and high risk project tracking system on time to GAO. As this is a new report, these 

items are not outstanding but will be addressed as expeditiously as possible. 

Recommendation VI—BIE will work cooperatively with OFPSM and DFMC to 

draft guidance regarding how official contract and grant files are required to be held 

by the contracting officer or awarding official and any requirements for retention 

and location of such files. BIE will coordinate activities to ensure on time delivery 

to GAO. As this is a new report, these items are not outstanding but will be addressed as expeditiously as possible. 

Conclusion 

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

you for the opportunity to present testimony today and provide the Committee an 

update regarding our work with GAO. BIE is excited about our recent progress and 

remains committed to addressing all of GAO’s recommendations in order to achieve 

sustained improvement. The BIE looks forward to working with you and our partners as we address the recommendations. Thank you for your time, and I would be 

honored to answer any questions you may have. 

The CHAIRMAN. Thank you, Mr. Dearman. 

We will start with five-minute rounds of questioning. 

I would like to direct my opening question to Ms. Emrey-Arras. 

According to GAO, there are 23 open recommendations for Indian 

education; 14 open recommendations for Indian health; and 13 

open for Indian energy. 

Talk to me about how we make progress to close out all of those. 

What is the best way in terms of oversight and follow up to make 

sure these are tracked and closed out in a way that both you and 

the agency come to agreement that it is resolved or we are back 

here talking about it? 

Ms. EMREY-ARRAS. I think within the education area, we have 

been doing a lot of additional communication. As Director Dearman 

noted, we have done a lot more in-person meetings, and a lot of additional phone meetings to provide suggestions on how to implement recommendations and provide direct and immediate feedback 

on their ideas. 

I think that kind of interaction is very constructive in terms of 

moving towards implementation. I do think within the education 

area, there has been a lot of movement since we put them on the 

High Risk List and since we last testified. Plans have been put in 

place for all the education recommendations and steps are being 

laid out to accomplish implementation. 

At this point, we are not able to close any of those, but we would 

like to see continued progress in those areas. 

The CHAIRMAN. What is a realistic timeframe for getting them 

closed and being back here reporting, not that we would have them 

all closed but a realistic timeline to do a follow up on progress? 

Ms. EMREY-ARRAS. I think another six months. I think that 

would be an excellent time to see where we stand. Certainly, there 

are recommendations across these three areas of energy, education 

and health care that are more intensive, that require, for example, 

more collaboration and consultation and the like. 

On the other hand, there are some low hanging fruit recommendations shall we say, some easy fixes that could be put in 

place for some of them. For example, I think we would say that it 

should not take four and a half years to develop procedures to oversee school spending. We know right now there are, in fact, draft 

procedures they mentioned they have. 

64 

Instead of waiting until the middle of 2019 to finalize and implement those, our hope would be within the next six months, if possible, those could be rolled out so we would have more oversight 

of school spending. 

The CHAIRMAN. Are there provisions in regard to any of these 

recommendations where you hit impasse? 

Ms. EMREY-ARRAS. I would not say within the education area. 

Let me defer to my other colleagues in energy and health care and 

see on their ends. 

Ms. KING. Senator, I am Kathleen King from the healthcare 

team. Thank you for having us here. 

I would say in the health care arena, we have some disagreements with the agency over the PRC program. In 2012, we actually 

made a matter to Congress in terms of directing IHS to develop a 

new formula for the PRC program because we found there was a 

great disparity in spending per capita ranging from a low of $300 

to a high of $800. 

We knew at that time the agency would not agree with that so 

we made that a matter for Congress. 

We also made some recommendations to the agency at that time 

about how they count PRC users and how they calculate the availability of hospital services. That was in 2012. At that time, the 

agency agreed with us. Most recently, the agency has said that is 

a matter for tribal consultation and indicated today the Tribal Consultation Group had said they are not in favor of any changes at 

this time. 

The CHAIRMAN. Are there other areas of disagreement within 

IHS and with the GAO recommendations? 

Ms. KING. I think the only other outstanding disagreement has 

to do with their use of PRC funds for staff. In our view, we thought 

there is such a shortage of staff to process enrollments and help 

people figure out whether they are eligible for Medicaid or other 

things that some of the PRC funds should be allocated for that purpose. The agency disagreed with that. 

The CHAIRMAN. Anything else in regard to IHS? 

Ms. KING. One more thing and this is not really a recommendation but we would be interested in seeing what the agency’s thirdparty reimbursements have been over the last several years after 

the implementation of the Affordable Care Act. That is not work 

we have conducted or have underway. 

The CHAIRMAN. Thank you. 

In regard to energy? 

Mr. RUSCO. Thank you. I am Frank Rusco. 

I would not characterize it exactly as an impasse but more of we 

are not exactly on the same page in one particular area. That 

would be in oversight and monitoring practices at the Bureau agency level. 

BIA has been working on documents to set standards and also 

to identify problems. What we have not seen yet is plans to roll out 

those and get those plans and guidance to the agency level and 

then to follow up with monitoring and measurement. Until we see 

that, it will not happen on the ground. 

65 

I could give you some more specifics but I think it is better that 

we work directly with BIA and talk with them to try to sort out 

that sort of disconnect. 

The CHAIRMAN. Is there disagreement or has it just not been figured out? 

Mr. RUSCO. I am not sure, because we have not had the conversation, whether it is something that they’re missing about what 

we expect but what we see them doing is not clearly what we want 

them to do. I think we are going to have a round of conversation 

shortly about that. 

The CHAIRMAN. We will ask that question as well. 

Thank you. 

Mr. RUSCO. Thank you. 

The CHAIRMAN. Now I will turn to the Vice Chairman. 

Senator UDALL. Thank you, Chairman Hoeven. 

I very much appreciate Senator Franken pitch hitting. He is always very good at that. 

I would like to talk about the efforts to reduce BIA’s workforce. 

We have heard news reports about personnel moves affecting dozens of high level SES employees and yet the Administration left 

Congress in the dark about Interior’s plans. 

The proposed personnel moves are uprooting employees who 

have formed deep and lasting relationships with the surrounding 

communities, including individuals with the Office of the Assistant 

Secretary for Indian Affairs and the Bureau of Indian Affairs. 

The GAO noted repeatedly in its High Risk Reports that an 

under staffed and ill equipped workforce is already an issue that 

hinders Indian energy development. For Mike Black, I am concerned that Interior’s personnel moves will only exacerbate the 

issues identified by the GAO. 

I sent two letters to the Department of the Interior about these 

recent personnel moves, one on July 11 and another on August 21, 

neither of which has received a response. 

Can you commit to me today I will have a response to all of my 

questions and my colleagues’ questions by this Friday, September 

15? 

Mr. BLACK. I will certainly take back that message to the Administration that you are requesting that. 

Senator UDALL. Thank you. 

I know these letters were above your pay grade but just want 

you to take back to Secretary Zinke, the Deputy Secretary and others that he committed to answering these both talking to me privately and publicly. We expect answers when all of us put in letters of this nature. 

One issue the GAO High Risk Report highlights is the lack of 

interagency coordination for Indian programs. That certainly is no 

surprise to this Committee. One school in my home State of New 

Mexico, the Dz School on the Navajo Nation has recently suffered 

from this lack of coordination. 

Because of some unforeseen issues with the campus sewage system and the location of the school’s gym, their school camp’s replacement has stalled. BIE, BIA, DOI leadership and IHS all need 

to come to the table before these issues will be resolved. 

66 

Mr. Dearman, you were at a meeting my staff had at the Dz 

School recently so I know you heard about these unique issues 

firsthand. Has your office made any progress on these issues since 

that meeting last month? 

Mr. DEARMAN. Yes, Senator, we have. We actually reached out 

to the Division of Facilities Management and Construction and 

started talking about the issues raise during our school visit. 

You are exactly right. We have to have other departments of Indian Affairs at the table. BIA and BIE, including the tribe, will 

need to be at the table to discuss the issues that were brought up. 

Senator UDALL. Also, the Indian Health Service. I want to ask 

Admiral Weahkee, was your office aware that the IHS clinic near 

the school uses the school’s sewage system? 

Mr. WEAHKEE. Sir, the issue just came to our attention at the national level recently but our engineers and sanitarians in the Navajo area have been working closely with Indian education in Dz. 

Yes, sir, we do have folks addressing the issue there. 

Senator UDALL. Can I get your commitment that you will have 

your team work with Mr. Dearman and the Navajo Nation and the 

Dz school board to get this sewage issue resolved in a timely manner? 

Mr. WEAHKEE. Yes, sir. 

Senator UDALL. Mr. Black, was your office aware of the Dz gym 

sitting on BIA-held land? 

Mr. BLACK. Yes, sir. Mr. Dearman made me aware of that issue 

as well. 

Senator UDALL. Can I get your commitment to see if the Bureau 

can resolve this issue internally to follow up with my staff and the 

school if congressional action is needed? 

Mr. BLACK. Yes, sir, certainly. 

Senator UDALL. For the panel as a whole, the Dz School example 

illustrates this larger coordination issue perfectly. How will each of 

your offices do a better job of interagency coordination moving forward? Why don’t we start with you, Mr. Black? 

Mr. BLACK. I think quite honestly, sir, that is something we all 

have to address between all the different bureaus and agencies, especially when we are dealing with multijurisdictional issues such 

as this. 

Coming from the region, I have had some experience where we 

have to make sure and sometimes just incorporating regular meetings between Indian Health Service, BIA and BIE, it really starts 

at the local level and works its way up versus top down. We need 

to get that message out to our staff. 

Senator UDALL. Admiral Weahkee? 

Mr. WEAHKEE. Yes, sir, I would reiterate the structural issues of 

covering vast geography. We do have great leaders on the ground 

to elevate issues to their area leadership. We need to be more 

transparent and communicative with those area directors on issues 

such as these that cross barriers and boundaries. 

Senator UDALL. Thank you. 

Mr. Dearman, briefly. 

Mr. DEARMAN. Vice Chairman, not only the Senate Committee on 

Indian Affairs is holding us accountable, so is Secretary Zinke. We 

are working with all the departments within Indian Affairs that 

67 

have their hand in our schools, meaning BIA, DASM, Deputy Assistant Secretary of Management, and IHS to help take care of our 

kids. 

We have really collaborated with agencies that have a hand in 

running our schools. We have gotten a lot of support from the Administration and the departments I have been working with to 

make sure our kids and schools are taken care of. 

Senator UDALL. Thank you. 

Thank you, Mr. Chairman. 

The CHAIRMAN. I would now like to turn to our other Vice Chairman, Senator Al Franken. 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. We might as well just have three, Senator 

Cortez Masto as well. 

I just have a question concerning the extent to which Mike Black 

and Secretary Zinke have gotten involved with this GAO report 

and how hands-on they are in addressing this issue. Does anyone 

have any comment on that? Ms. Emrey-Arras? 

Ms. EMREY-ARRAS. I would say that Mr. Black has certainly been 

involved in our meetings. I would defer to the agency officials regarding the Secretary’s involvement. 

Mr. BLACK. Since long before I became the Acting Assistant Secretary, I have been involved in a lot of these efforts related to the 

GAO on the energy side of it. Since becoming Acting Assistant Secretary, I have had regular interaction with Tony to make sure I 

have updates to find out where they are in the process, what they 

are doing, and making sure they are getting the support they need 

from my office. 

The Administration and the Secretary’s office on down has been 

very supportive of all of the activities we are doing and encouraging us. Indian energy and education are two of the Secretary’s 

priorities and things he wants us to carry forward. We are getting 

the full support of his office as well. 

Senator FRANKEN. His office. Do you see him much? 

Mr. BLACK. I don’t interact that often with the Secretary himself, 

but he has been busy trying to catch up on a lot of things, the first 

part of the transition, but he is aware of the issues going on. We 

are making sure he is being updated as well. 

Senator FRANKEN. I want to talk about a crisis that is going on 

not just in Indian Country but especially in Indian Country, something that has been declared a crisis by the Administration. That 

is the opioid epidemic. 

Indian reservations are the front lines. In my State, Indian babies are now over ten times more likely to be diagnosed with Neonatal Abstinence Syndrome or opioid withdrawal symptoms than 

other babies in our State’s Medicaid program. Earlier this year on 

the Red Lake Reservation from February to July, nearly three 

dozen people overdosed, including ten overdoses in July alone. 

At one point the crisis was so bad, the local hospital ran out of 

narcan which blocks the effects of opioids and helps reverse an 

overdose. 

68 

I met with a number of tribal leaders. It was clear from these 

meetings that we need a multi-pronged approach to address the 

opioid crisis in Indian Country. We need more research, lower prescribing rates, greater resources for prevention, and better access 

to treatment. 

We also need to consider integrating traditional ceremonies, culturally sensitive recovery and those kinds of activities into evidence-based treatment and recovery programs. The White Earth 

Reservation in the northwest part of my State has a successful 

MOMS Program. 

Again, the President’s Commission on Combating Drug Addiction 

and the opioid crisis has declared this a crisis. Led by Chris 

Christie from New Jersey, they recently posted the interim report 

of recommendations to address the opioid crisis. 

The primary recommendation was to declare the opioid epidemic 

a national emergency in order to permit the use of Federal disaster 

funds in fighting outbreak, to encourage swift action by Federal 

agencies to address the crisis and to raise public awareness and 

prompt congressional action. 

While the Administration is evaluating the legal implications of 

such a declaration, the Commission is working on a final report 

which is expected in October. Several tribes in Minnesota have also 

issued similar public emergencies. 

Admiral Weahkee, what recommendations did you make to Chris 

Christie and the Commission on how to address the opioid epidemic in Indian Country? 

Mr. WEAHKEE. Thank you, Senator Franken, for bringing up this 

issue of the opioid epidemic. We know it is a national issue. It definitely has had a dramatic impact in Indian Country. 

I believe that some of the efforts that have been made across our 

agencies to ensure the availability of naloxone are a great start 

within the IHS. We have also been training our providers ensuring 

that they are properly certified for medication assisted treatments. 

You already mentioned the culturally appropriate and community 

specific modalities. 

I believe tribes need to be at the table in helping to define what 

is going to work best for their communities. I think number one is 

bringing the tribes to the table to be engaged in the conversation. 

Senator FRANKEN. Bringing the tribe to the table? 

Mr. WEAHKEE. Yes, sir. 

Senator FRANKEN. I know my time has run out. I just feel this 

is such a crisis that we are seeing, such devastation. I just would 

like to see resources. I think that is why you declare an emergency, 

you can use resources to get people treatment and medication therapy, and get them some proper medication to substitute that does 

not cause you to get high. 

It just feels like an all hands on deck emergency all over the 

Country but especially in Indian Country, especially in Minnesota. 

I think we need to understand this is something that can be treated and needs to be treated. 

I would urge you especially to be in contact or Indian Health to 

be in contact with the Commission. Okay? 

Mr. WEAHKEE. Thank you, sir. 

Senator FRANKEN. Thank you. 

69 

The CHAIRMAN. Vice Chairman Cortez Masto. 

STATEMENT OF HON. CATHERINE CORTEZ MASTO, 

U.S. SENATOR FROM NEVADA 

Senator CORTEZ MASTO. Thank you, Mr. Chairman. 

Let me follow up on that conversation, Admiral, because we all 

know opioids are a crisis across the Country. I want to understand. 

You are not just now bringing tribes to the table; this is a conversation we have already been having with these tribes, is that 

correct? 

Mr. WEAHKEE. Yes, ma’am. My response was in regard to what 

would I tell Governor Chris Christie. Tribes have definitely been 

heavily engaged with us in developing programs that work for their 

communities. 

Another example of something we have done within our agency 

is the development of what we call the HOPE Committee which focuses on heroin, opioids and pain efforts. Getting tribes involved in 

conversations about what is going to work, culturally what is going 

to work within their communities, looking at the available resources and filling in those gaps is imperative. 

Senator CORTEZ MASTO. Thank you. 

First of all, let me say thank you for what you have done to implement some of the recommendations. I know one of the recommendations you looked at was to address the patient wait time 

and having a tracking system in place. 

Something has come to my attention, and I just want to verify 

this. The medical records system that IHS uses was developed by 

Veterans Affairs but the VA is going to discontinue support of this 

system within the next few years. Your new patient wait time 

tracking program is attached to that system. 

Is that true and what do you intend to do if the VA is no longer 

supporting your RPMS system? 

Mr. WEAHKEE. Thank you for the question. 

First, the VA has announced they are moving away from their 

VISTA Electronic Health Record. We have historically relied on the 

VA for programming support of our own Resource and Patient 

Management System, RPMS. 

Fortunately, in this case, with regard to the tool that we developed for patient wait times, we developed that separate from the 

EHR and in a way that it can be used with any electronic health 

record, business intelligence software that is not necessarily a part 

of RPMS, so they are separate systems. 

Senator CORTEZ MASTO. It is not going to have an impact at all 

on your patient tracking? 

Mr. WEAHKEE. It will have an impact on patient tracking but in 

regard to how we are going to monitor it with our new tracking 

tool, no. 

Senator CORTEZ MASTO. Is VA discontinuing support of the system going to impact you in any way whatsoever? 

Mr. WEAHKEE. The discontinuation of their program support will 

definitely have an impact on the Indian Health Service. We have 

initiated robust conversations not only with the VA but we have 

held tribal listening sessions, initiated conversations with DOD, 

70 

the Coast Guard, all of which are going through or have gone 

through similar conversions. 

We are at a point where we are information gathering to really 

assess what our options will be moving forward. 

Senator CORTEZ MASTO. Then putting a plan together to come up 

with any gap to address the changes that need to take place and 

any resources that need to be associated with it? 

Mr. WEAHKEE. Yes, ma’am. 

Senator CORTEZ MASTO. Is that going to happen this budget cycle 

if you need resources? 

Mr. WEAHKEE. We have initiated conversations internally. As 

you mentioned, the VA’s plan is to transition off over several years. 

We know at least in the next several budget cycles. We are more 

in an information gathering and planning phase. When we start to 

need the resources to purchase consultants or hardware, those asks 

will come should we make the decision to convert the EHR. 

Senator CORTEZ MASTO. Thank you. 

First of all, thank you gentlemen for being here as well as GAO. 

It is very, very important and we appreciate you coming back here 

and talking about the changes and recommendations that are necessary. 

Mr. Dearman, we talked in the past, the last time you were here. 

One of the things we talked about was the school accountability 

data and the lack of up-to-date information that was necessary on 

the websites. 

Correct me if I am wrong, did I hear that you are any closer to 

having real time data or up-to-date data that is available? 

Mr. DEARMAN. We are getting closer, Senator, to gathering that 

data and having that where we can actually start distributing that 

data. We are not quite there yet. 

Senator CORTEZ MASTO. What is the timeframe, you think, for 

that? 

Mr. DEARMAN. I can get back to you on the timeframe. We are 

working collaboratively with the Department of Education on this 

task. I can get back to you with the timeframe. 

Senator CORTEZ MASTO. That would be very helpful. 

You have a lot on your plate. The other question I have is, is it 

a resource issue or a staffing issue to help address some of these 

changes that are going to be necessary? 

Mr. DEARMAN. It is just the lack of gathering and collecting data 

over the past three years. We are playing catch up to catch up with 

all the data we haven’t collected. That is the reason we are behind. 

Senator CORTEZ MASTO. With the Chairman’s indulgence, because I know my time is up, we heard from GAO some of their concerns that there may be some impasse still. I did not hear your response to that, the concerns they brought up. Do you have any response to that? 

Mr. BLACK. Let me go ahead, Senator, if you don’t mind. 

Especially like for BIA on the energy stuff, it wasn’t necessarily 

an impasse. I think we need to do a better job of communicating 

and working directly with the GAO folks on our BIA energy. Similar to what our BIE folks have been doing with school education, 

they have been working closely with them. We just need to do a 

better job. 

71 

It is not that we are not taking proactive steps. We need to make 

sure we are communicating better with GAO. 

Senator CORTEZ MASTO. Thank you. 

Anything else to add? 

Mr. WEAHKEE. Yes, ma’am. With regard to the Indian Health 

Service items specific to our Purchase and Referred Care Program, 

I agree also that robust discussion with Ms. King and her team is 

going to be needed to come up with a final determination. 

Our tribes, in consultation, have told us some of the items they 

are absolutely opposed to. Bringing all partners together and doing 

what is best for our patients and the communities is key. When it 

comes down to it, that is what we are here for. We need to make 

those decisions in a patient-centered manner. 

Senator CORTEZ MASTO. Thank you. 

Thank you, Mr. Chairman, for letting me go over my time. I appreciate it. 

The CHAIRMAN. Absolutely, Senator. 

Admiral, let us go to you and talk about the PRC Program. The 

question I had for Ms. Emrey-Arras was where is there some disagreement in resolving the outstanding recommendations? We will 

meet again in six months just like we are today and we want to 

see what we are down to. We are going to just work through these. 

That is why I was asking where there is disagreement. It sounds 

like there is some disagreement on the PRC Program. Would you 

address that for me? 

Mr. WEAHKEE. Yes, sir. 

I will start with the first one being the allocation methodology. 

The CHAIRMAN. The second was shifting money to staffing. 

Mr. WEAHKEE. Yes, sir. 

With the allocation methodology, we currently use, as part of our 

formula, the number of active users of our facilities. The GAO has 

asked us to look at using the historical number or the actual number of PRC users which is a subset of the active user count. 

By doing that, we actually will run into some problems because 

the use of the PRC Program changes from year to year. 

They also asked that we develop a defined benefits package. 

Without this funding coming through a mandatory source, it is difficult to define the minimum package. 

I believe a third recommendation that was made was that we 

give all of our PRC-eligible patients a card to identify that they are 

eligible for PRC. That is also a problem because something as simple as a member moving off reservation out of the CHSDA would 

no longer make them eligible for the PRC. 

These are just some examples of the more robust conversations 

I think we need to have with the GAO around some of those issues. 

With regard to the use of PRC funding for staff or other administration of the program, I think we are open to having more conversation in that regard. I think there is variation across our agency and that we should be giving our sites more tools than further 

restricting their choice and ability to manage the program in the 

way they see fit. I think there is more to be said in that regard. 

The CHAIRMAN. That would make sense in two respects, both because I want you to work with GAO because we are going to meet 

again in six months and I want to encourage you to work together 

72 

so that when we come back it is something that we have agreement 

on. Also, it is going to relate to another question I will ask here 

in a minute. 

The other area was on energy for you, Mike. The question that 

came up was oversight monitoring but basically getting guidance, 

measurement and standards down to the offices and some kind of 

follow up for making sure they meet them. Do you follow me? 

We are getting stories, for example, that in Colorado if you want 

to site a well or something like that, it is taking three months off 

the reservation but 31 months on the reservation for energy development. That is one example. I think it goes to what you talked 

about and why it needs to be addressed. 

Mr. BLACK. Certainly, sir. I think we are trying to take those 

steps to get there. Part of that is being able to collect the data and 

have the necessary information to number one, confirm those types 

of reports. I cannot really confirm that it takes 31 months on the 

reservation versus three months off. We need to be able to collect 

that data and in the entire process, be able to verify that. 

The CHAIRMAN. Mr. Secretary, it is. I am hearing from tribal 

chairmen and others that it is. What I am more concerned about 

is that you are getting standards down. I get that you are working 

to put that in place, but also, in the meantime, people are waiting 

to execute that lease. That is a lot of opportunity cost for the tribe. 

How can you address that more expeditiously both interim and 

on a permanent basis is what I am getting at. 

Mr. BLACK. In the process of trying to collect data, I hope you 

did not get me wrong, it is not like we are trying to stop everything 

else to get data so that we can move forward. We are trying to continue with that process utilizing the Indian Energy Service Center 

and the other resources that we have available to us to be able to 

address APDs, leases and right-of-ways at all of our different offices. 

We are using our Division of Energy and Mineral Developments 

and some of their programs to provide some assistance. We are 

using our regional offices to supplement and help the agency offices 

to get activities done. 

We are identifying through the process I mentioned a bit earlier 

through different intakes from the field as far as what is the work 

out there that needs to be done, what resources do we need to put 

out there to make this happen. 

The CHAIRMAN. I would encourage you to get input from the 

field, talk to the States too. Maybe they can give you some resources to help leverage your efforts but you really have to look 

both in terms of the solution you want to put in place but some interim steps to help this along while you are doing that. 

Mr. BLACK. I totally agree, sir. 

The CHAIRMAN. Okay. For the BIE staffing, clearly staffing is a 

problem, Mr. Dearman. What are you doing to address the staffing 

issue? I know it is not easy but it is clearly really important. 

Mr. DEARMAN. Mr. Chairman, we have received 77 waivers as 

was mentioned in our written testimony. Currently, at the school 

level, we have 90 teacher vacancies and 871 positions filled. 

One of the things we have done is we had to address the immediate problem right now with losing our teachers. In talking to our 

73 

schools, one problem causing us to lose our teachers was because 

it took so long to go through the application process. 

One of the things our HR was having to do because of our process was having to go through every class that a teacher candidate 

had in their college transcripts. Just recently we put in place that 

BIE will recognize State certification of the States our schools reside in. Therefore, when we get a teacher application, if that certification is attached, there will not be two weeks of going through 

transcripts. 

We are really trying to address the immediate problem of why 

we are losing our teachers. That is what we are doing at that level. 

We are currently in the process of advertising the 77 waivers 

that we have received and moving forward with filling the positions. 

The CHAIRMAN. That is maybe one of the best answers we have 

heard today. That is exactly what you should be doing, working 

with the State, leveraging your resources, if they have those approvals and you can rely on them, that helps you get people faster. 

That is a great example. It doesn’t cost you more money but enables you to get the job done more expeditiously. 

I appreciate that. That is the kind of solutions we are looking for 

because we are always in a resource-constrained environment. Any 

leveraging like that you can do, I commend you on that solution. 

Admiral Weahkee, yesterday morning, we heard from tribal leaders from Arizona. The White House had a lot of the tribal chairmen 

in and we met with them. Dr. Price, the Secretary of HHS, met 

with them. 

Specifically, we heard leaders from the Gila River Indian Community and the Quechan Tribe that IHS is in the process of constructing two IHS health care facilities. There are others going on 

too. For example, in my home State of North Dakota, three affiliated tribes and Chairman Fox is also working on a facility. 

The staffing is the concern. The tribe is building facilities but 

they need IHS either staffing or funding, if they go through the 638 

Program. I want to make sure you are asking for those funds 

through the budgeting process and you are doing everything you 

can. 

Again, this is a leveraging effort between the tribe building the 

facility and the Federal Government providing the staffing or the 

funding for 638 staffing. Can you address that? How do we make 

sure that happens that as they build these facilities, they have the 

staff there because this is progress in providing quality health care 

on the reservation? That is what we are after. 

Mr. WEAHKEE. Yes, sir. Thank you for the question. 

We have a series of six to seven different facilities. Some of them 

are brand new facilities; some of them are replacement facilities; 

and some are joint venture projects where we partnered with the 

tribes. They provided the funding for the construction and we have 

agreed to provide the staffing and operations support. 

In the case of Gila River, which will be opening the Red Tail 

Hawk or what we refer to also as the Southeast Ambulatory Care 

Center and the Quechan Tribe in Fort Yuma, this is one of those 

situations where the first to complete the facility, we fund the facilities as they are completed using the date of occupancy as the 

74 

key date. The tribes are working hard to get their facilities built 

ahead of time. 

In the most recent budget cycle, we had to make a tough decision 

about what could be funded. The decisions were to allocate the 

funds or ask for the funds for those positions or those sites that 

were going to be opened first. We know these two facilities will be 

coming online in 2018. 

We are appreciative of the recent markups that we have seen in 

the budgeting process. We really appreciate that. 

The CHAIRMAN. I would really emphasize again, given the leverage and joint nature of these programs, that we do everything we 

can to fund them. I will work on that from the appropriations side 

with you but we need to make sure they are funded. 

Mr. WEAHKEE. Thank you, sir. 

I am also meeting with Representative O’Halleran from Arizona 

later this week on the same topic. 

The CHAIRMAN. I believe that needs to be a part of the request 

and that we need to do everything we can to make sure it is appropriated funding for these facilities. I think it has to be a priority. 

Mr. WEAHKEE. Absolutely, expansion and access to care for all of 

these new facilities. 

The CHAIRMAN. When the tribes take the initiative to build the 

facility and pay for it, we just have to find a way to fund it, particularly for something like health care on the reservation. It is a 

huge priority. 

I will wrap up there. Again, I appreciate the progress that you 

have made. As I say, we will be doing this again in six months. 

I will now turn to the Vice Chairman. 

Senator UDALL. Thank you, Mr. Chairman. 

BIE has only existed as a standalone bureau since 2006. It was 

previously a part of BIA and that legacy can still be seen in the 

way the many administrative tasks are divided between the two 

agencies. In fact, many of GAO’s recommendations to improve Indian education will require BIA to work hand in hand with BIE. 

Yet, Mr. Black, I noticed your testimony here today and in May 

only focused on Indian energy. How engaged has BIA leadership 

been with the review of GAO’s Indian education recommendations? 

Mr. BLACK. I think Mr. Dearman can confirm for me or with me 

that the Bureau of Indian Affairs has been engaged and working 

with them in those areas where we do have cross responsibilities 

and safety is a good example. 

We are working very closely with our Bureau of Indian Education and the BIA safety individuals to ensure that we are having 

regular meetings and developing the necessary standards and policies to be able to address the safety inspections. That is just one 

example. 

Then in the area of facility management, we are working with 

the Deputy Assistant Secretary for Management’s office as well and 

our facility management operations, working real close with Tony 

and his staff to make sure we are addressing their needs as well. 

Senator UDALL. Mr. Dearman, do you believe that BIA has taken 

the issue surrounding Indian education outlined in the High Risk 

Report seriously or could they be doing more? 

75 

Mr. DEARMAN. Vice Chairman, yes, I do believe they are taking 

it seriously. They have been at the table with us at all of our meetings and have been actively engaged in improving our system 

based on GAO’s recommendations. 

Mr. Black touched on a lot of different areas but even in the contract area, the contract area for purchasing books and things like 

that, we have to work with BIA as well. BIA has really been involved. 

Senator UDALL. The same question to Ms. Emrey-Arras, do you 

believe BIA has taken the issues surrounding Indian education outlined in the High Risk Report seriously or could they be doing 

more? 

Ms. EMREY-ARRAS. Yes, we do, and we think that their focus on 

school safety is particularly important given the health hazards we 

have identified in schools in the past. We think that continued collaboration is essential to resolving those recommendations and ensuring safe schools for these children. 

Senator UDALL. One coordination issue between BIE, BIA and 

DOI I have heard about recently relates to SIPI, one of the two federally-operated tribal colleges that happens to be located in my 

home State of New Mexico. 

They have faced many issues getting timely BIA and DOI signoff 

on contract procurement and staff hiring approvals. Now I have 

learned these delays could cost the school its accreditation and potential grant funding. 

Mr. Black, was your office aware of these delays and how do they 

impact the SIPI school community? 

Mr. BLACK. Mr. Dearman has made me aware that there have 

been some issues at SIPI that we have been trying to address, 

working, again, between BIA and the department, particularly on 

the hiring situation. We have had approval to do the hiring at SIPI 

and that is currently in the recruitment process. 

Anything further related to that, I would have to pass off to 

Tony. 

Senator UDALL. What can be done on your end to resolve these 

pending approvals in a timely manner? What can your office do to 

make sure these types of delays do not happen again? 

Mr. BLACK. Part of that is I can always go back to communication, Senator, to make sure we have the proper protocols in place 

to make sure we are communicating these issues and the right people are getting the right information. 

Senator UDALL. Mike, as you know, tribal energy sovereignty is 

a goal that we need to strive for. Consider these numbers. While 

reservations account for 2 percent of the Nation’s land mass, they 

hold 5 percent of the Nation’s potential renewable energy resources. 

The Department of Energy estimates that wind power from tribal 

lands could satisfy 32 percent of the total U.S. electricity demand. 

GAO issues a number of reports on this topic over the years, yet 

the same problems continue to arise, BIA’s failure to coordinate, inadequate workforce numbers and training, and outdated technology. 

We heard from GAO that BIA is addressing its recommendations 

but only for conventional energy production. Why is that and what 

76 

is BIA doing to assist tribes with the development of renewable energy? 

Mr. BLACK. The impetus of some of the reports has been more 

on the conventional but we are not ignoring the renewable energy 

or the wind side as well. As more and more tribes become interested in bringing those things to our attention and our table, we 

are working with them closely. 

The HEARTH Act is a good example that allows tribes to utilize 

some of the leasing tools in order for the development of renewable 

resources. We are working to make sure that our staff is aware. 

That is going to become another function of the Indian Energy 

Service Center. As more and more of the renewable energy programs become active, we will be utilizing the service center to provide training, resources and applicability. 

Senator UDALL. Good. I hope you keep pushing on both sides 

there. 

Mr. Chairman, I have one more question. 

Admiral Weahkee, last month, you issued Circular 17–11 to set 

national patient appointment wait time standards for IHS facilities. These standards focus on how long it takes to secure an appointment but I did not see any reference to wait times or how long 

it takes a patient to be seen once they arrive at an IHS facility. 

I know several service units within the IHS Albuquerque service 

area already have patient wait time tracking systems in place. In 

fact, I believe many service units report patients being able to complete their full appointment from the sign-in to the doctor’s visit to 

pharmacy pickup in under an hour. 

Melissa, has the GAO evaluated these efforts to address patient 

wait times? If so, does GAO believe they will resolve the issues uncovered in the 2016 report? 

Ms. EMREY-ARRAS. I will defer to my colleague, the Director in 

the health care area, Kathy King. 

Senator UDALL. Thank you, Kathy. 

Ms. KING. We have not had a chance to evaluate them yet since 

they just went into effect. It would take some time for us to see 

how they are implemented. Then we would have a chance to evaluate. 

Senator UDALL. Okay. Focusing now on Admiral Weahkee, how 

will the new standards in Circular 17–11 and the new wait times 

tracking software related to it interact with local service units who 

already have metrics in place? 

Mr. WEAHKEE. We see these metrics as trigger points for those 

sites that already have systems in place and may even have better 

metrics than those that have been identified as the benchmarks. 

We definitely do not want to impact negatively on those benchmarks. 

We also see these as preliminary metrics. As you have identified, 

through the emergency department or other primary care visits 

there are other parameters that we should be measuring like dental visits and behavioral health visits. 

In terms of how it impacts those sites that are already using a 

system, there will be no impact but if they go beyond that 28 day 

or 48 hour trigger, they will be getting questions about what is 

77 

going on and what help they need to make sure we are meeting 

those thresholds. 

Senator UDALL. Good. This potential disconnect between service 

units, service areas and national IHS efforts on the issue of patient 

wait times is not unique. GAO identified inconsistent policies between levels of IHS leadership as an overarching issue with the 

service. 

Admiral Weahkee, what is IHS doing to make sure that innovations and best practices at the local level, particularly in triballyoperated facilities, are shared with the larger system and not stifled? 

Mr. WEAHKEE. Thank you for the question, Senator. 

One of the tools we are using is what we call our improving patient care collaborative, an opportunity for sites to share in an 

email format what is going well. Somebody may ask for a policy on 

a given topic and get that response from another site. 

I definitely agree that sometimes the best innovation and more 

often than not, the innovation happens at the front lines by the 

staff doing the work. In that regard, the IPC collaborative is one 

good example of that information being shared across the system. 

The other thing we are doing is reaching out to our tribal partners and hearing what they have. We made a recent visit to Alaska 

to look at the Nuka Institute. We will be making a visit out to 

Oklahoma next week and have the opportunity to hear from Cherokee Nation about some of the innovative work they are doing in 

program planning around recruitment and retention and developing their own home grown training programs for medical providers. 

We are really excited about some of the innovation that is coming 

out of our Indian partners. 

Senator UDALL. Thank you. That is very encouraging. 

As I sum up, Mr. Chairman, let me say I fully support your effort 

to have the parties, the agencies and agency heads return here in 

six months to see how they have done on the recommendations and 

see which things we are closing out and what kind of progress we 

are making. 

Thank you very much, Mr. Chairman. 

The CHAIRMAN. Thank you, Vice Chairman Udall. 

Again, thank you to our witnesses for being here today. We will 

have you back in six months and again review the progress on all 

of these important issues. I do appreciate the work that has been 

done while recognizing there is a lot more to do and that it is very 

important for Indian Country. Thanks to all of you. 

For members of the Committee, if they have additional questions, 

they can submit them for the record over the next two weeks. 

Again, thank you. With that, this hearing is adjourned. 

[Whereupon, at 4:18 p.m., the Committee was adjourned.] 

(79) 

A P P E N D I X 

PREPARED STATEMENT OF HON, JAMES R. FLOYD, PRINCIPAL CHIEF, MUSCOGEE

(CREEK) NATION

The Muscogee (Creek) Nation is the fourth largest tribe in the United States with 

more than 85,000 citizens across the United States and has jurisdiction over more 

than eight counties. Under the Indian Self-Determination and Education Assistance 

Act (ISDEAA), the Nation has assumed authority to provide health care, social and 

realty services, public safety, natural resources management, infrastructure development and repair and economic development. Additionally, MCN operates the 

Eufaula Dormitory, a peripheral dormitory, through a Bureau of Indian Affairs 

(BIA) grant. As such, the Nation was very concerned when the Government Accountability Office (GAO) included the BIA, Bureau of Indian Education (BIE), and 

Indian Health Service (IHS) programs in their 2017 High Risk Report. On behalf of the Nation, I write to express my appreciation for the oversight that 

Senators and the Senate Committee on Indian Affairs have provided while seeking 

solutions and closure of the GAO recommendations. The Committee’s partnership 

and persistence is critical while the three agencies work to correct concerns highlighted by Senators and tribes. I have also provided a few comments on the updates 

provided during the September 13th oversight hearing that are of interest to MCN. 

The Trust Asset and Accounting Management System (TAAMS) does not include 

functions necessary to adequately track and record issues related to restricted land. 

MCN utilizes the TAAMS to preform various realty functions, including land title 

and record services. T AAMS has been instrumental in improving record keeping 

and modernizing realty functions and the GAO recommendations would continue to 

increase the helpfulness of the system overall. However, when the BIA initially developed TAAMS it did not include functions to adequately document restricted land 

ownership and the unique situations which rise from restricted land status. As a 

result, MCN’s Realty Office utilizes electronic and hard copy record keeping practices in order to properly track ownership, leases and other land use agreements on 

behalf of the Nation’s restricted land owners. MCN would recommend that the Committee continue to monitor the BIA’s progress in expanding the functionality of the 

TAAMS. 

Tribes consistently provide feedback to IHS regarding the Purchased/Referred 

Care (PRC) Funding Allocation Methodology. 

Along with many other tribes and tribal organizations, MCN provides regular 

feedback regarding the PRC program implementation and funding allocation methodology. In fact, shortly after the passage of the Patient Protection and Affordable 

Care Act (ACA), tribes weighed whether the PRC allocation should be updated to 

reflect new factors that changed as a result of health care reform. However, tribal 

leadership did not believe the impact of the legislation would be measurable in Indian Country for quite some time. Since those initial discussions, tribes have regularly reviewed the allocation methodology and data regarding implementation of the 

law across the country. Rear Admiral Weahkee was correct in his statement that, 

nationally, there is tribal consensus that the methodology should not be changed. 

As such, MCN was startled when GAO claimed that IHS had not worked cooperatively toward implementing their PRC recommendations. 

Though the system is imperfect, the failure is not entirely IHS’s to bear. Failure 

to adequately fund the Indian health system has resulted in the need to ration care 

that cannot be provided by Indian, tribal or urban health programs. PRC is the 

funding methodology and medical priority system that IHS utilizes to ration that 

care. Tribes have worked collaboratively with IHS to develop this methodology using 

several data points. The current-methodology includes data and a system of 

weighting data that consider the care available to Indians across all IHS areas. 

GAO’s scope of work and recommendations, though thoughtful, do not apply the 

same level of expertise tribes have developed regarding the allocation of the entire 

IHS budget. Additionally, the GAO’s recommendations do not accurately capture or 

80 

consider the various other streams of funding that are distributed using other data 

points. MCN would be happy to provide additional information and insight regarding the methodology development and agrees with the national consensus that the 

PRC methodology does not have to be altered at this point in time. 

The Nation remains committed to providing the best possible services under its 

ISDEAA agreements and looks forward to working with the Committee members, 

Administration leadership, and others to implement solutions that improve access 

to and quality of those services. I appreciate the opportunity to provide the comments above and your continued efforts to oversee the trust responsibility relationship. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. STEVE DAINES TO

MELISSA EMREY-ARRAS

Question 1. Ms. Emery-Arras, exactly how many recommendations to the Indian 

Health Service were open when the Government Accountability Office added the 

agency to the high risk list? 

Answer. When we issued our 2017 High Risk report, there were 13 recommendations to HHS that were unimplemented. 

Question 2. And how many have been fully implemented? 

Answer. Since our 2017 High Risk report was issued, IHS has implemented three 

of these recommendations. 

• In response to a recommendation in GAO–13–272, to monitor the Purchased/ 

Referred Care (PRC) program access to physician and other nonhospital care, 

and to assess how the PRC payment rates may impede the availability of care, 

IHS developed an online PRC Rates Provider Tracking tool. The use of this tool 

enables PRC programs to document providers that refuse to contract for their 

most favored customer rate or accept the PRC. On October 3, 2017 IHS officials 

met in-person with GAO and provided a demonstration of the PRC Rates Provider Tracking Tool. 

• In response to a recommendation in GAO–16–333, IHS developed specific standards for patient wait times and published them to the IHS Indian Health Manual website in August 2017. 

• In response to a recommendation in GAO–17–181, in December 2016, the 

former IHS Principal Deputy Director, issued a directive for all HQ and Area 

Offices to develop succession and contingency plans to identify potential leaders 

or senior managers to fill critical positions in the short- or the long-term, and 

identify individuals available immediately for unexpected absences or departures. The IHS Office of Human Resources issued guidance, instructions, and 

a template for identifying key leadership positions in the HQ Offices, Area Offices, and Service Units. The instructions also included a requirement to conduct a skills-gap analysis to assess any identified employee’s current competencies against those needed for the target leadership position. 

Question 3. And how long has it been since the earliest of these recommendations 

were made to IHS? 

Answer. In our February 2017 High Risk report, we cited 2 recommendations 

from a fiscal year 2011 report on the accuracy of data used for estimating PRC 

needs, with which HHS agreed. These recommendations remain unimplemented. 

Question 4. Would you say that period of time is enough to have implemented 

these recommendations? 

Answer. GAO tracks and publicly reports annually on the percentage of recommendations made 4 years ago that have since been implemented. We use a 4- 

year reporting window because it generally takes 4 full years to implement some 

of our recommendations. In fiscal year 2015, we reported that 79 percent of recommendations made in fiscal year 2011 had been implemented. We believe the recommendations that we have made to IHS could have been implemented within this 

timeframe and we will continue to monitor IHS’s efforts to implement our recommendations in a timely manner. 

Question 5. I understand that responsiveness to GAO from IHS on the status of 

the recommendations has been an issue. Could you describe what those challenges 

have been? 

Answer. While IHS’s responsiveness to our recommendations has been an issue 

in the past, since we added the agency to our High Risk list, agency officials have 

become more responsive. For example, in October 2017, GAO and IHS officials met 

in person to discuss all unimplemented recommendations to determine possible imVerDate Mar 15 2010 07:35 May 22, 2018 Jkt 030089 PO 00000 Frm 00084 Fmt 6601 Sfmt 6621 S:\DOCS\30089.TXT JACK
81 

plementation solutions. After this meeting, we were able to close one recommendation as implemented. In addition, we have received several e-mails in the past few 

months providing information documenting steps that IHS officials have taken to 

implement our recommendations. We hope to continue this collaborative relationship as the agency moves forward with implementing other recommendations. 

Question 6. I also understand that in multiple instances, when IHS stated that 

they’ve implemented various recommendations, the documentation has been subpar. 

Can you provide a couple examples of when that evidence was insufficient? 

Answer. In the past, IHS officials have requested that we close recommendations 

as implemented but provided no evidence. For example, IHS officials informed us 

that the agency developed a requirement for contingency and succession planning 

for key leadership positions at headquarters and area offices, but did not provide 

documentation of their efforts. 

In addition, officials have sometimes provided documentation of their efforts to 

implement recommendations, but the documentation was insufficient to determine 

what steps had been taken. For example, when attempting to document the development and use of the PRC Rates Provider Tracking tool, officials provided a link to 

a secure area of the IHS website that was not available to GAO staff. When informed of this, IHS officials sent a screenshot of the webpage that showed the button for the tool in the lower left hand corner of the site. This was not sufficient to 

determine what the agency had done to implement the recommendations. 

However, IHS officials have since sent sufficient documentation of their contingency and succession planning efforts, as well as the PRC Rates Provider Tracking 

tool. The inperson meeting in October was particularly helpful and allowed us to 

explain the level of documentation that we need in order to consider a recommendation implemented. During this meeting, IHS staff demonstrated the tracking tool, 

and showed us a user guide, the data entry page, and an example of a provider refusals report. 

Question 7. I understand there was one instance in particular—and it’s particularly mindboggling—where IHS actually sent a screenshot of a corner of a website 

as documentation of their having implemented the recommendation. Could you 

share what happened there? 

Answer. See answer to question 6 above. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

TONY DEARMAN

BIE Student Outcomes Data 

Question 1. The most recent school and Bureau accountability data provided on 

the BIE website 

dates to SY2012–2013. 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. 

Please provide a copy of all statutorily required school accountability data for 

SY2013–2014, SY2014–2015, and SY2015–2016. If this information is not currently 

available, please provide a firm timeline of when such information can be made 

available to the Chairman and the Vice Chairman. 

Answer. Available data has been reported to the U.S. Department of Education’s 

(ED) EDFacts data collection system. The Bureau is working to update and post 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 of 2018, the Bureau has hired an Accountability and Assessment Supervisor as well as several Education Research Analysts and has filled six Native American School Information Specialists (NASIS) positions. These personnel are specifically focused on data by expanding technical assistance to schools as well as improving the Bureau’s collection and use of key data 

metrics critical to supporting the needs of students attending BIE-funded schools. 

Question 2. Title I of the Every 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. 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. Yet, as on the date of 

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this hearing, the BIE’s webpage on the Bureau’s ESSA State Plan is completely 

blank. 

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. To meet its obligations under the Elementary and Secondary Education 

Act of 1966, as amended by the Every Student Succeeds Act (ESEA) and develop 

a State Plan, the BIE will amend its existing standards, assessments, and accountability regulations through Negotiated Rulemaking (NRM); and solicit stakeholder 

and tribal input through consultation regarding the BIE State Plan. At a December 

8, 2016 meeting between BIE and ED, Education officials expressed a view that the 

State Plan under ESEA was optional for the BIB. BIE Director Dearman announced 

the BIB would move forward with developing a State Plan, as approved through 

rulemaking, as a means to facilitate a transition to ESEA and ensure the development of a coherent federal education system across the twenty-three (23) states in 

which BIE facilities operate. The BIE notified ED via email on January 7, 2017 that 

it would submit a State Plan. 

To meet its ESEA obligations and develop a State Plan, the BIE will: (1) amend 

its existing standards, assessments, and accountability regulations through Negotiated Rulemaking (NRM), and (2) solicit stakeholder and tribal input through consultation regarding the BEE State Plan. On November 9, 2015, the BIE published 

a notice of intent (80 FR 69161) requesting comments and nominations for tribal 

representatives for the NRM. Upon transition between Administrations, the initial 

formulation of the NRM was postponed in order to provide incoming Department 

staff adequate time to review prior work. As of 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. 

The negotiated rulemaking committee was re-advertised in Federal Register notice (82 FR 43199) soliciting nominations on September 14, 2017, with a deadline 

for submission of nominations by October 16, 2017. The nominations received were 

reviewed by Department and BIE officials and selected members will be announced 

through a notice in the Federal Register, which will be available for public review 

and comment. After such time, a subsequent Federal Register Notice will announce 

the final NRM members and initial meeting dates. 

Ultimately, the NRM will recommend revisions to existing regulations (25 CFR 

Part 30), replace the No Child Left Behind Act (NCLB) Adequate Yearly Progress 

regulatory language, and implement the Secretary’s statutory responsibility to define the standards, assessments, and accountability system, consistent with the 

ESEA The BIE and ED consult and work together on a range of Indian education 

related issues, through the departments’ interagency work group that meets biweekly and through direct communication. 

Question 2a. 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 BEE has elected to adopt a State Plan that will work to improve the 

BLE’s support of Bureau-funded schools. Through tribal consultation and solicitation of stakeholder feedback, the BIE will ensure ESEA requirements are met. 

Ultimately, the BIE will carry out its obligations under the ESEA through rules 

and regulations determined under the NRM, which 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 the 

ESEA. 

Question 3. The Navajo Nation reports to my Office that the BIE is currently not 

efficiently transferring student data required under a signed memorandum of understanding between the Tribe and the Bureau. Is BIE working with the Navajo Nation 

to ensure the spirit and letter of the MOU are followed? 

Answer. BIE has and continues to work with the Navajo Nation tribal government 

as well as Department of Dine Education (DODE) on an ongoing basis as the tribe 

and its education agency work to clarify their preference for outreach with the BIE,. 

For instance, BIE Associate Deputy Director (ADD) of Navajo Schools has worked 

to share Partnership for Assessment of Readiness for College and Careers (PARCC) 

data for SY 2014–2015 (NM only Navajo schools), 2015–2016 and 2016–2017. The 

Navajo ADD offices have continued to support the Navajo Nation with ongoing 

83 

NASIS data training with meetings held as recently as October 2017. The Navajo 

Nation is now in the process of amending their Data Agreement to include Personally Identifiable Information (PII) assurance documentation, which was shared with 

the President of the Navajo Nation at the NIEA convention held in early October 

2017. 

Question 3a. How is BIE ensuring that tribes with members enrolled in BIE-funded schools have timely access to information necessary to track student outcomes? 

Answer. The BIE is provided with short-cycle assessment data by Northwest Evaluation Association (NWEA) after each testing window which informs instructional 

practices and student outcomes. Such data are accessible at school sites by instructors and school leadership. The test results are normally sent to each school site 

by the vendor, Measured Progress/Smarter Balance, in late June. 

In regards to summative data, the BIE has access to state assessment data 

through schools that receive such information directly; the BIE does not have direct 

access to all state assessment data and often must request the data from individual 

schools. Although BIE has Memoranda of Agreement in place for sharing state assessment data for many schools this is not the case for all states in which the BIF., 

operates. As noted in a previous response, the BIE is currently in the process of establishing a Negotiated Rulemaking Committee that will, among other things, determine if the BIE should establish its own unique accountability system under the 

ESEA, which could improve the BIE’s data disaggregation and dissemination capabilities through a uniform system, or continue to operate and serve schools based 

on the 23 states in which the schools are located. 

Question 3b. What mechanisms within BIE are in place to lift tribal accountability 

to the level of the federally-mandated accountability plans referenced in question (2) 

above? 

Answer. Indian Tribes may seek waivers from the BIE’s standards, assessment 

and accountability system requirements, under ESEA section 8204(c). BIE continues 

to partner with ED to facilitate such waiver requests and provide technical assistance and support to ensure successful transition of such authority to a Tribe. As 

of 2018, the Navajo Nation and Miccosukee Tribe have waivers approved by the two 

agencies, which supports local control of education and provides Tribes the flexibility to better meet their local needs. For example, Navajo Nation’s agreement includes an alternative system of accountability for schools that allows BIE-funded 

schools that serve the Tribe but are located in three different states to operate 

under a uniform system. Currently, BIE Education Resource Center staff provides 

ongoing technical assistance to tribes with such waivers. 

Question 3c. Does BIE have any other student outcome related data (for example—graduation rate trends, or absenteeism trends in BIE schools) that it can 

share? 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. 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. 

IT Infrastructure Challenges 

Question 4. One issue BIE school-level leadership has repeatedly raised involves 

challenges meeting the Bureau’s data reporting requests. For example, the administration team at Southwestern Indian Polytechnic Institute (SIPI) never received the 

credentials they needed to access BIE reporting software. Several folks from the 

school reached out to regional BIE and BIA staff—who are located in an office right 

down the road in Albuquerque—but they never received a response. Can you commit 

to working with SIPI to resolve this systems access issue? 

Answer. Yes. 

Question 4a. How is your office working to make sure BIE schools have sufficient 

technical assistance to fully utilize reporting software like Maximo? 

Answer. BIE has offered technical assistance and training opportunities to BIE 

schools regarding the use of the Maximo system via five four-day sessions held in 

Albuquerque, NM as well as across the country at regional training. 

Question 4b. How is your office working to make sure data reporting requirements 

aren’t duplicative or unnecessarily burdensome for tribes and schools staff? 

84 

Answer. BIE leadership does not want such reporting requirements to impede 

school-level functions or create unnecessary burdens on local staff. As such, BIB 

leadership is working to ensure compliance and technical assistance teams visit 

schools in a coordinated manner to increase efficiency in compliance monitoring 

while decreasing the number of site visits held each year. 

Question 5. GAO has found that BIE’s student attendance system had no way to 

note that an absence was caused by transportation issues. BIE is working to update 

the data system related to this issue; but this is just one small piece of a larger 

data and IT issue facing BIE. When will the transportation-related absentee tracking issue identified by GAO in May be fully implemented? 

Answer. BIE tentatively agreed to GA0–17–423: Tribal Transportation recommendation 7. The BIE is currently exploring the addition of a field within NASIS 

to capture whether an individual student’s absence is due to inclement weather or 

road conditions. The BIE will consult with the NASIS vendor to discuss the feasibility and cost involved for this additional requirement and consider implementation 

of recommendation 7 based on this information and available resources. 

Question 5a. Please list and explain other data and IT issues that BIE is currently 

working to improve. 

Answer. The BIE has formed a bureau-wide working group to improve its data 

collection, management, and reporting. The working group was formed in early 2017 

and was initially tasked with bringing outdated EdFacts data up-to-date. The working group is now performing a bureau-wide data audit and is in the early stages 

of creating policies and procedures designed to improve the Bureau’s collection, 

management, and reporting of data. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

MICHAEL S. BLACK

Inter-Agency Coordination: Impact of Zinke Reorganization on the Indian 

Energy Service Center 

Question 1. The GAO reported that the BIA continues to fail in coordinating with 

other agencies that play a role in the development of Indian energy, like Fish and 

Wildlife Service, the Army Corps of Engineers, and the Environmental Protection 

Agency. As a result, the Service Center does not serve as the central point of collaboration/coordination as originally envisioned. Potentially compounding matters, 

Secretary Zinke floated a proposal at a House Appropriations hearing to reorganize 

the Department into a system modeled on the military’s joint command model that 

would shift employees from D.C. and regional headquarters offices to field locations. 

There are concerns that Secretary Zinke’s proposed reorganization of Interior’s subagencies will further complicate or delay attempts to better coordinate within Interior the permitting and approval of Indian energy projects. In addition, tribes have 

reported that Interior’s consultation with them on these moves is limited, if it happens at all. How will the proposed reorganization of the Department of the Interior 

affect ongoing efforts to make sure agencies are coordinating with the Service Center? 

Answer. The Indian Energy Service Center (IESC) is a multi-agency office comprising Bureau of Indian Affairs (BIA), the Office of Natural Resource Revenue 

(ONRR), and the Bureau of Land Management (BLM) staff components that provide 

support of Indian energy development on Indian lands. The Department will continue efforts to improve coordination among bureaus in support of tribal management of energy resources. 

Question 1a. The Indian Energy Service Center was a result of robust collaboration between Interior and tribes. To the extent the proposed reorganization impacts 

the Service Center, will the BIA consult with tribes to limit adverse impacts to coordination? 

Answer. The Department does not anticipate any adverse impacts to coordination 

and services resulting from the proposed reorganization. The BIA has initiated discussions with Indian Country and will continue with formal tribal consultations regarding any proposed adjustments to the regional field organizations serving the 

BIA and BIE. 

IT Infrastructure: Energy Lease Review and Response 

Question 2. In its 2015 report, GAO found that BIA did not have a clear system 

for or the data needed to track its review and response times for the approval of 

leases, rights-of-way, and appraisals for energy development on Indian lands. The 

BIA must be able to track its review and response times to ensure the approval 

85 

process is efficient, transparent, and meets the needs of tribes that seek to utilize 

their natural resources. 

It is absolutely essential that the process for tracking review and response times 

is comprehensive. Can you confirm that the process will include all documents that 

need to be approved before and after resource development can occur? 

Answer. We have made progress on this issue, and tracking some data from 

leases, rights-of-way, and mineral-related agreements (Communitization agreements 

and Unit agreements) is in place for BIA. This remains an ongoing process. 

IT Infrastructure: GIS Mapping of Indian Energy 

Question 3. GAO identified issues with outdated and deteriorating equipment, 

technology, and infrastructure at BIA, which has led to the inefficient management 

of Indian energy resources. One recurring problem for the BIA, and one that has 

existed for years, is inadequate information about ownership over surface and mineral rights. The BIA has stated its intent to develop a national dataset of all Indian 

land tracts and boundaries, but has not provided a timeline-or even what resources 

are necessary-to complete this survey. GAO found, for example, that some tribes 

couldn’t pursue development opportunities because BIA did not have an inventory 

of the tribe’s energy assets available. GAO recommended that Interior incorporate 

mapping technology that would greatly increase the agency’s efficiency. Can you describe how Interior has updated its mapping technology? 

Answer. In response to the Government Accountability Office’s May 2017 Report, 

BIA has taken steps to integrate geographic information system (GIS) technology 

into the Trust Asset and Accounting Management System (TAAMS). 

Version 1.0 of TAAMS ‘‘Map Viewer’’ was placed into production and is currently 

available for use as of August 31, 2017. A demonstration of the capabilities of the 

Map Viewer was performed on September 14, 2017, for GAO program auditors. On 

September 13, 2017, the Assistant Secretary reported to the Senate Committee on 

Indian Affairs on this accomplishment and submission of the closure package to the 

GAO on this recommendation. 

Program level staff and tribes are now able to view and print maps from TAAMS 

that can be shared with landowners and enable managers to make informed decisions regarding energy resources in a timely manner. 

The Map Viewer, in conjunction with the TAAMS ownership and encumbrance reports, provide program level managers with the information regarding title and restrictions for making timely energy resource decisions. There are 193,487 Indian 

land tracts that are viewable through the Map Viewer and 21,280 tracts which must 

be converted into a spatial representation as resources permit. Please refer to the 

table below for statistics by Region. 

BIA Region 

Tracts Visable in 

TAAMS Viewer 

8/30/2017 

Tracts Remaining 

that Require Spatial 

Conversion to be 

visable in Viewer 

8/30/21017 

Eastern (LAC 0–99) 141 200 

Northwest (LAC 100–199) 26,410 5,577 

Rocky Mountain (LAC 200–299) 46.804 3,951 

Great Plains (LAC 300–399) 61.063 2,437 

Midwest (LAC 400–499) 7,844 3,111 

Pacific (LAC 500–599) 2,878 844 

Western (LAC 600–699) 12.664 859 

Southwest/Navajo (LAC 700–799) 7.228 1,330 

Southern Plains (LAC 800–899) 9,818 862 

Eastern Oklahoma/Alaska (LAC 900–999) 18.637 2,109 

Totals 193,487 21,280 

Additionally, new land area boundary representations (Reservation, Rancheria, 

Public Domain Allotment, etc.) are under development and are made viewable in the 

Map viewer as they are completed. Nationally, boundary data for the current 333 

federally recognized tribal land areas, referenced in the following table, are expected 

to be completed by Spring of FY18. 

Region Total Land Area 

Boundaries by Region 

Rocky Mountain 7 

Midwest 37 

86 

Region Total Land Area 

Boundaries by Region 

Northwest 45 

Great Plains 16 

Pacific 105 

Eastern 30 

Eastern Oklahoma 2 

Southern Plains 6 

Southwest 26 

Western 56 

Navajo 3 

Total 333 

The procedure for developing the data is described in the Indian Land Tract and 

Land Area Boundary Mapping Training Guide. The BIA plans to continue to advance the Map Viewer to include other nationally stewarded and standardized 

geospatial datasets to support energy development. 

Question 3a. How do initiatives like updating IT infrastructure and creating new 

planning processes impact the resources you have available for providing services 

to tribes? 

Answer. Initiatives for updating IT infrastructure are important and required to 

address limited and aged IT network infrastructure, which impact the BIA resources for providing timely services to tribes. TAAMS services, for example, are 

often delayed due to high usage, limited data line capacity, remote locations and restricted access. Further, planning processes such as developing national geospatial 

databases with rigorous standards are needed but are resource intensive and require expertise in GIS. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

RADM MICHAEL WEAHKEE

Inter-Agency Coordination 

Question 1. In 2015, the Centers for Medicare & Medicaid Services (CMS) withdrew its accreditation of the Omaha-Winnebago IHS Hospital in Nebraska. At the 

GAO High Risk hearing in June, IHS Deputy Director Buchanan testified that the 

hospital would be reaccredited within a matter of months. The loss of CMS certification is both a safety concern and a funding issue. What is the current CMS accreditation status of the Omaha-Winnebago IHS Hospital? 

Answer. One of the Indian Health Service (IHS) priorities is to bring the OmahaWinnebago Hospital (OWH) into full compliance with the Centers for Medicare & 

Medicaid Services (CMS) standards. The hospital is not currently CMS-certified. 

Filling critical hospital leadership positions is essential to achieving and sustaining 

CMS accreditation. We hired a Clinical Director, Chief Nurse Officer, and Quality 

Manager for OWH in recent months. We want to ensure the OWH is fully prepared 

before requesting CMS return for a re-survey, and we continue to assess progress 

on an on-going basis. 

Question 1a. Are you working with CMS to address the cited deficiencies? 

Answer. The IHS Omaha-Winnebago Hospital continues to work diligently on 

quality improvement and patient safety, supported by technical assistance from 

Joint Commission Resources, to address quality improvement and patient safety requirements of CMS. The OWH will be going through a Joint Commission Resources 

unannounced survey in the coming weeks. Once successfully completed and OWH 

is determined to be fully prepared for a CMS survey, a re-certification application 

will be submitted. 

Inter-Agency Coordination 

Question 2. During a series of site visits over the last year, the Albuquerque IHS 

Service Area reported to my staff that all Albuquerque-area Service Units are deploying patient satisfaction surveys. Are other IHS Service Areas currently utilizing 

the same or similar patient satisfaction surveys? 

Answer. The Quality Framework Steering Committee established the Patient Experience of Care Survey working group to develop a standardized patient experience 

survey for IHS. In their pre-development phase of work, the working group surveyed 

IHS facilities on the use of Improving Patient Care (IPC) survey instruments. Fifty 

percent (50 percent) of 34 responding facilities reported use of the IPC survey. The 

87 

remaining respondents indicated use of Agency for Healthcare Research & Quality 

Consumer Assessment of Healthcare Providers & Systems (AHRQ CAHPS), Net 

Promoter, and Care and Health Outcomes (ECHO). A pilot of implementing the new 

Patient Experience Survey using electronic tablets was completed at four facilities 

in four IHS Areas in June 2017 and achieved excellent results for patient acceptability, usability, immediate access to survey results (locally actionable data), and 

staff workload (collecting and analyzing results). While IHS implements the new Patient Experience of Care Survey tool more broadly throughout the system, IHS continues to support Service Units’ use of the IHS IPC Patient Satisfaction Survey tool 

to monitor patient perceptions of care. 

Question 2a. What is IHS doing to share and implement best practices, e.g., patient experience surveys, between Areas? 

Answer. The IHS shares information with participating Service Units via the IPC 

Program Portal and the Quality Framework Steering Committee hosts monthly 

webinars with all Area and Service Unit Quality Managers. In partnership with 

CMS, all IHS hospitals also participate in the Partnership to Advance Tribal Health 

(PATH), a single Quality Improvement Network (QIN)-Quality Improvement Organization (QIO) entity dedicated to improving quality of care by implementing best 

practices and identifying opportunities for operational improvement across IHS hospitals. 

Question 2b. Are you aware of any agencies (HRSA, HHS) that have expertise in 

developing key processes and policies aimed at improving patient experience? Are 

you working with those agencies to further develop IHS policies? 

Answer. IHS consulted with the SouthCentral Foundation (tribal health program) 

and the Agency for Healthcare Research and Quality (AHRQ), Office of the National 

Coordinator (ONC), Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), 

and the Assistant Secretary for Planning and Evaluation (ASPE) to develop its 

standardized patient experience survey. IHS is aware of the HRSA Health Center 

Patient Survey (HCPS) and is also consulting with the Veterans Health Administration Patient Experience Office on strategies to optimize survey use. 

IT and Data Infrastructure: 

Question 3. IHS uses a medical records system originally developed by the Veterans Affairs Department called the Resource and Patient Management System 

(‘‘RPMS’’). The VA will discontinue support of this system within the next few years, 

and tribes are concerned the IHS will have no structure or resources in place to implement or purchase a new system. It does not appear that IHS has a replacement 

plan to address this issue. What is IHS’s plan to replace RPMS and will the Service 

need any additional budgetary resources to implement it? 

Answer. The IHS is undertaking a thorough and comprehensive analysis of alternatives that includes federal, tribal, and urban stakeholder input to consider all options for our Electronic Health Record (EHR) strategy. While commercial EHR solutions offer out-of-the-box capabilities, the Department of Veterans Affairs (VA) and 

IHS systems are designed specifically to meet the unique needs of the agencies 

through customized medical applications, which can be more complex with a greater 

focus on longitudinal care over time than commercial EHR systems. 

As part of our engagement with tribal programs, the Muscogee-Creek Nation provided an in-depth briefing demonstrating implementation of their two commercial 

EHR systems. The Cherokee Nation briefed the IHS Chief Medical Officer on their 

commercial EHR system and we have been engaged in dialogue with tribal health 

programs from Alaska on this issue. We have been engaged with other tribal health 

programs or tribal health committees as well. 

Under the current arrangement, the IHS was able to adapt the VA software for 

use in our EHR system without having to expend funds on the development. The 

loss of the VA as a source of software code will likely have a budgetary impact on 

the IHS as we plan for the future. 

Question 3a. Could you please provide an outline of this plan and an estimate of 

IHS’s IT needs over the next several years? 

Answer. The timing for IHS must remain largely in synchronization with the 

plans and the timeline of the VA. The VA’s plans and timelines are still under development, but early indications point to a 7–8 year project timeline. With that in 

mind, the VA will need to continue its support for VistA for years, which means that 

the IHS will continue to have support for RPMS for years. The VA will still be releasing new patches for a while, but it will begin shifting away from new development to add functionality and start focusing narrowly on patches that address patient safety, and get the system ready for data sharing and archive. 

88 

The IHS is currently developing a timeline that recognizes the end of support for 

the current EHR system and considers potential replacement. We estimate that a 

replacement would be a multi-year project. During the first year, the IHS would be 

heavily involved with exploration, comparison, and decisional activities. The second 

year would entail acquisition activities. Additional years would focus on rolling implementation at clinics and hospitals. The funding required will be determined in 

large part by the EHR system(s) chosen. 

Question 4. IHS also recently announced a new patient wait-time tracking addition to RPMS. They believe this expansion of RPMS will address one of GAO’s unresolved recommendations from 2016. However, IHS told staff this new ‘‘fix’’ to track 

patient wait times might become obsolete as soon as the RPMS system goes out of 

use. How will the eventual replacement of RPMS impact the ability of IHS headquarters to monitor patient wait-times? 

Answer. IHS has focused on the use of business intelligence (BI) software to work 

alongside the Resource and Patient Management System Electronic Health Record 

(RPMS EHR) in order to systematically measure and track wait times. Business intelligence software can be utilized with any EHR. Any EHR transition would require 

updates in the linkages between the BI software and the EHR. IHS will include 

wait times metrics as a requirement for health information systems. 

Question 5. Several Service Units within the IHS-Albuquerque Service Area utilize a patient appointment program known as CQueque to electronically monitor patient wait times once an individual arrives for their appointment. These Units report to my staff that this program helps them self-audit staff performance and departmental progress towards patient experience goals. 

Do any Service Units or Areas outside of Albuquerque utilize similar ‘‘sign-in’’ 

software to track the efficiency of patient flows within IHS facilities or between difference departments within one facility? 

Answer. Yes. Efficiency and patient flow are important metrics in the Improving 

Patient Care (IPC) program. RPMS includes the ability to track appointment checkin, and data from RPMS can be utilized with or without business intelligence software to augment the measuring and tracking capabilities. Not all patient flow data 

is captured in the EHR, so IHS facilities use data both from within and external 

to the EHR to track efficiency and patient flow. 

Question 5a. Is IHS exploring a way to include tracking of similar wait-time information in its efforts to address patient experience and wait time issues identified 

by GAO in the series of reports listed in the High Risk Report? 

Answer. The IHS Improving Patient Care (IPC) Program addresses measurement 

and improvement efforts to shorten cycle time (start to finish of an appointment). 

IHS continues to explore opportunities and options for improving its capacity to 

measure cycle time and other wait-time metrics as a component of the patient experience of care. We are looking to extend the use of wait time standards to other 

services we provide such as dental and behavioral health. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN MCCAIN TO

RADM MICHAEL D. WEAHKEE

Question. The Gila River Indian Community has contacted my office concerning 

budget shortfalls in the FY 2018 budget that could delay the 2018 opening of the 

newly constructed Red Tail Hawk Health Clinic. I understand that the Clinic has 

remained on budget for many years, and that IHS is aware of the 2018 opening 

date. What is the status of the facility for the next fiscal year? 

Answer. The funding of national priorities reflected in the FY 2018 President’s 

Budget required IHS to make choices between its programs and investments. The 

Indian Health Service (IHS) currently expects the Red Tail Hawk Health Center to 

be completed during January 2018. However, the FY 2018 request does not currently include staffing and operational funds for this new clinic. 

Æ