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[Senate Report 107-250]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 560
107th Congress                                                   Report
                                 SENATE
 2d Session                                                     107-250

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

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

                                _______
                                

               September 3, 2002.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 210]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 210) to authorize the integration and consolidation of 
alcohol and substance abuse programs and services provided by 
Indian tribal governments, and for other purposes having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill (as amended) do pass.

                                PURPOSE

    The primary purposes of the Native American Alcohol and 
Substance Abuse Program Consolidation Act of 2002 (S. 210) are 
twofold: to enable Indian tribes to consolidate and integrate 
alcohol, substance abuse, and mental health treatment services 
into one program to improve administrative, management, 
accounting effectiveness, and in the process create a simpler 
and more efficient service delivery system; and to recognize 
that tribal governments, as the local entities directly 
responsible for the well-being of their populations, can best 
determine the most appropriate policy goals and methods for 
achieving these goals in their communities.

                               BACKGROUND

    Native American communities continue to be plagued by 
alcohol and substance abuse at staggering rates and this abuse 
and concomitant social pathologies are wreaking havoc on Native 
people across the United States. The incidence of alcohol and 
substance abuse among American Indian and Alaskan Native adults 
is far greater than that of the general population. Alcoholism 
occurs among American Indian and Alaskan Natives at a rate that 
is 579% greater than the general population. Deaths due to 
alcoholism occur at a rate that is 440% higher than that of the 
general population.
    Similarly, alcohol continues to be an important risk factor 
associated with the top three killers of American Indian and 
Alaskan Native youth--accidents, suicide, and homicide. Based 
on 1993 data, the rate of mortality due to alcoholism among 
American Indian and Alaskan Native youth ages 15 to 24 was 5.2 
per 100,000 which is 17 times the rate for whites of the same 
age.
    Native Americans have higher rates of alcohol and drug use 
than any other racial or ethnic group in America. Despite 
previous treatment and preventive efforts, alcoholism and 
substance abuse continue to be prevalent among Native youth: 
82% of Native adolescents admit to having used alcohol, 
compared with 66% of non-Native youth. In a 1994 school-based 
study, 39% of Native high school seniors reported having 
``gotten drunk'' and 39% of Native children acknowledged using 
marijuana.
    Alcohol and substance abuse also contribute to other health 
and social problems including sexually transmitted diseases, 
child and spousal abuse, poor school achievement and dropout 
rates, drunk-driving related deaths, mental health problems, 
general feelings of hopelessness and, too commonly, suicide.
    In order to deal with the devastating affects of alcoholism 
and substance abuse in all communities, Congress has authorized 
and appropriated funds to many Federal agencies to address 
these problems. An informal survey made by committee staff 
identified approximately twenty (20) programs in seven Federal 
departments which tribes may access for the prevention and 
treatment of alcohol and other substance abuse.
    Many of these programs and services are available to 
tribes, but even where tribes secure access to program funding 
from several different sources, the amounts are generally so 
low, and the auditing and reporting requirements so onerous, 
that it is simply not cost effective for a tribe to attempt to 
participate in the programs.
    The Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2002 addresses both the service needs of 
the Native population and the inefficiencies of the current 
programs by authorizing Indian tribes (hereinafter ``Indian 
tribes'' or ``tribes'' and shall refer to Indian tribes, tribal 
organizations, and/or tribal consortia) to develop and submit a 
single plan to a single Federal agency to consolidate the 
servicers currently available in an effort to discipline the 
distribution of program services.
    The provisions of S. 210 mirror those of the highly 
successful Indian Employment, Training and Related Services 
Demonstration act of 1992, as amended, Pub. L. 102-477, which 
authorizes the integration of Federal job training and 
employment-related activities into one consolidated program.
    Commonly referred to as the ``477 program'', Public Law 
102-477 is widely recognized as one of the most successful 
employment training and economic development programs enacted 
for the benefit of Indian tribes. Based on the success of the 
original ``477'' experience, the Committee considers it viable 
to extend the program to other areas such as alcohol, substance 
abuse, and mental health services. Equally important, under 
``477'' program authority, tribes have the ability to tailor a 
program to address the specific needs of their communities, 
which increases effectiveness and satisfaction.
    As enacted, the ``477 program'' was designed to provide 
Indian tribes with a mechanism to better leverage the wide 
variety of employment training programs, while minimizing 
administrative time, cost and expense, and reducing the burden 
of Federal paperwork requirements. By all accounts, the ``477'' 
program has been successful in achieving these objectives.\1\
---------------------------------------------------------------------------
    \1\ In 2000, Congress recognized the success of the ``477 program'' 
and expanded its scope to include actual economic development 
activities as an adjunct to its core mission of employment training. 
See Title XI, Pub. L. 106-568.
---------------------------------------------------------------------------
    S. 210 expands upon the ``477'' concepts and would 
authorize the integration of Federally-funded alcohol, 
substance abuse, and mental health services and programs which 
are well-suited for integration because it is common for these 
program funds to be awarded in small sums. In fact, it is not 
unusual for a tribe to receive a variety of Federal grants and 
program dollars, each involving different audit, reporting and 
management requirements.

                      SUMMARY OF MAJOR PROVISIONS

1. Overview and lead agency status

    Operationally, the Native American Alcohol and Substance 
Abuse Program Consolidation act of 2002 largely tracks the 
framework of Pub. L. 102-477. S. 210 authorizes the Secretary 
of the Department of Health and Human Services (DHHS) to be the 
lead agent for purposes of coordinating alcohol, substance 
abuse, and mental health programs at the Federal level. The 
Secretary is the logical candidate to lead this effort as the 
Secretary is responsible for administering the great majority 
of Indian health programs through the Indian Health Service 
(IHS).
    Because the Secretary also has considerable experience 
implementing the provisions of the Indian Self Determination 
and Education Assistance Act, as amended, the activities 
envisioned by S. 210 also logically fall under the Secretary's 
purview.
    Last, the Secretary oversees the operation of key agencies 
within the DHHS which provide funding in the area of alcohol, 
substance abuse and mental health treatment, making it an ideal 
point of coordination for the consolidation program.
    Though a representative of the Bureau of Indian Affairs 
testified at the Committee's October, 1999 hearing in favor of 
the Indian Health Service (IHS) assuming the role of lead 
agency for purposes of program integration, recently the Bureau 
of Indian Affairs (BIA) appears to be rethinking its position 
on the basis of its operation of the Indian Alcohol and 
Substance Abuse Program (ASAP). While ASAP plays an important 
role in addressing alcohol and substance abuse, the Committee 
believes that the BIA does not have institutional expertise in 
the area of mental health problems and, consequently, because a 
considerable number of the programs identified as important to 
Indian behavioral health care program services are located 
within the DHHS, the Committee believes that IHS should be the 
lead agency for implementation of S. 210.

2. Definitions

    A definition of ``substance abuse'' is included in the bill 
as amended in response to concerns expressed by Committee 
members that program monies consolidated under the bill could 
not be used to treat inhalant abuse, which is a growing problem 
among American Indian and Alaskan Native youth. It is the 
intent of the committee that funds used under this legislation 
be used to treat inhalant abuse where a tribe or tribal 
consortia determines such uses to be necessary.
    Definitions of ``automated clinical information system'' 
and ``Indian behavioral healthcare program'' are also included 
in the bill as amended. The term automated clinical information 
systems refers to computer software and/or hardware 
specifically designed for use in a clinical health care 
setting. The term Indian behavioral health care program is 
defined to express the intent of the committee to include 
within the purview of this act all Federal programs and, 
necessarily, related Federal funding, for alcohol, substance 
abuse prevention, diagnosis and treatment and mental health 
analysis, counseling, treatment, support and related programs 
for Indians and Indian tribes.

3. Types of programs that are eligible for consolidation

    Section 5 of the bill as amended addresses the different 
types of programs which may be included in plans for 
consolidation under this legislation. The predecessor bill 
authorized only those programs which are formula-funded. In the 
106th Congress, the Committee was made aware that formula 
funding is rarely used to fund alcohol and substance abuse 
programs, and that the majority of funds used for these 
programs are provided through competitive grant or other 
programs. Accordingly, the Committee has amended the 
authorization in S. 210 to include grant programs and other 
types of funding that may be distributed for the treatment of 
alcohol, substance abuse or mental health treatment. The 
Committee intends that tribes have significant latitude in 
securing funding sources for inclusion in a consolidated plan.
    Testimony from the IHS and BIA in the 106th congress 
indicated that both agencies were concerned with the provisions 
regarding the availability of grant funding and how tribes and 
tribal consortia might utilize the consolidation program. In 
October 1999, both agencies pledged to present a report to the 
Committee not later than February, 2000, which would address 
this issue and identify viable alternatives to the language of 
S. 1507, as introduced.
    While a report was never submitted to the Committee, a 
feasibility study mandated by Title VI of Pub. L. 106-260 was 
provided to the committee in draft form which indicated that 
several programs that fall within the purview of Indian 
behavioral health care programs could be consolidated into a 
demonstration project. Such programs would therefore be 
candidates for consolidation under this legislation.
    The Department has expressed concerns that certain program 
funding sources, such as the Substance Abuse and Mental Health 
Services Administration's (SAMHSA) Community Mental Health 
Block Grant and the Substance Abuse Prevention and Treatment 
Block Grant, might need statutory amendments to work 
effectively with the S. 210 consolidation program.
    The Native American Alcohol and Substance Abuse Program 
Consolidation Act of 2002 has been amended from prior versions 
to allow for inclusion of grant funding, as noted below, such 
as that which tribes receive from the SAMHSA.
    In drafting Section 5, considerable thought was given to 
the provision which allows grant funds to be consolidated. The 
committee recognizes that without the inclusion of grant monies 
this program authority would be ineffective because the 
majority of monies available to tribes for the treatment of 
alcohol and substance abuse problems are distributed through 
grants.
    The Committee does not intend that the enactment of S. 210 
provide justification for the denial of grant applications 
submitted by tribes because the DHHS prefers that the funds not 
be consolidated. At the same time, the Committee desires to 
protect the integrity of the grant process. Accordingly, a 
tribe must still apply for and secure a competitive grant 
before it can include the grant funding in a consolidation 
plan.
    Section 5 also accommodates the granting agency by allowing 
a consolidation where the plan to include grant funds is 
essentially the same as the requirements of the grant program. 
This allows some flexibility for the tribe but still requires 
conformity to the requirements of the grant program.

4. Initiation of program

    Under the Native American Alcohol and Substance Abuse 
Program Consolidation Act of 2002, the Secretary is obligated 
to develop and implement the Interdepartmental Memorandum of 
Agreement (MOA) at the Cabinet level. This MOA will provide the 
framework for the implementation and operation of the 
consolidation program among relevant Federal agencies. The 
Committee does not anticipate that there will be any problem 
drafting and adopting this MOA as there is an existing model 
readily available.
    Initially, the Committee expects that the departments of 
Health and Human Services, Interior, Justice and Education will 
cooperate in the development of the MOA. Eventually, each 
Federal department or agency which funds alcohol, substance 
abuse and mental health programs can be expected to be 
signatories to the MOA and to participate in a meaningful way.
    The Committee expects that, similar to the MOA developed to 
implement Congress' mandate in Pub. L. 102-477, the MOA 
required by the Native American Alcohol and Substances Abuse 
Program Consolidation Act of 2002 will address the following 
issues:
    1. Advising tribal governments regarding their eligibility 
to integrate programs and how they may develop and implement a 
tribal for consolidation of funds.
    2. Procedures for the review and approval of plans, 
including time lines for their review and approval.
    3. The agreement which will be used by tribes and Federal 
departments or agencies to govern their relationships under the 
program. It is anticipated that the agreement that is currently 
being used will provide guidance to the Secretaries who enter 
into the Memorandum of Agreement.
    4. An expedited process for the review of waiver 
applications from tribes participating in this program. 
Additionally, it is anticipated that appeals from a denial will 
also be accelerated.
    5. An agreement and procedure for the timely payment of 
funds to tribes participating in the program.
    The Committee expects that the opportunity to access this 
program will be extended to all tribes that express a desire to 
participate.

5. Review and approval of tribal plans

    Central to the success of this program is a well-though 
out, comprehensive plan to develop and implement programs in a 
consolidated manner. It is the belief of the Committee that 
Tribes can best determine where scarce resources will be used 
most economically and what type of services are most 
appropriate to serve their members. Accordingly, the Federal 
agencies that administer program funds which are authorized to 
be consolidated under this legislation are expected to give 
deference to tribal allocations of resources and program 
design.
    The Secretaries are expected to allow tribes a great deal 
of flexibility in designing the plan which will be submitted 
pursuant to this legislation. Creativity in the use of multi-
year plans, mix of services and innovative approaches to 
treatment should not be stifled. The primary objective of the 
Native American Alcohol and Substance Abuse Program 
Consolidated Act of 2002 is the reduction of the incidence of 
alcohol and substance abuse suffered by American Indians and 
Alaskan Natives.
    It is clear that ``mainstream'' treatment approaches to 
treating these problems have not been effective and that tribal 
involvement in developing new and culturally appropriate 
services is needed. It is expected that the Secretary will keep 
this in mind when reviewing plans under the act. The Secretary 
should focus on the following when reviewing such plans:
    1. Does the plan effectively address the purposes of the 
program, how those purposes meet Tribal goals to address the 
existing problems, and what is the projected effect the program 
is expected to have on individuals served?
    2. Does the plan lay out an overall strategy for dealing 
with alcohol and substance abuse and mental health problems 
within the tribe's service area?
    3. Does the plan integrate other available resources?
    Where tribes or tribal consortia have integrated or have an 
intent to consolidate competitive grant programs, it is 
expected that Federal agencies will provide maximum flexibility 
program participants who are attempting to match grant 
requirements to tribal needs. The character of a grant program 
is, of course, relevant but, unless there is a statutory 
mandate, serious consideration should be given to allowing a 
Tribe whose plan does not match with the requirements of a 
grant to consolidate funds.

6. Waiver authority

    As a part of the plan submission and review process, the 
bill provides that the tribe and Federal government review the 
plan and identify any rules, regulations, policies, procedures 
or underlying statutory provisions which need to be waived in 
order to successfully implement the plan.
    One of the purposes of this bill is to simplify Federal 
requirements pertaining to the operation of Federal programs. 
The Committee expects that unless a Federal requirement is 
central to the nature of the program involved, it should be 
considered an appropriate requirement to be waived under the 
authority provided.

7. Amendments made to S. 210 as introduced

    During the business meeting at which S. 210 was approved, 
several amendments to the bill were made by the Committee.
    Section 4 language regarding use of program funds for 
acquisition of technology by lease, license or purchase, or for 
training to use such technology, is intended to clarify that, 
in developing a consolidation program, tribes and tribal 
consortia are authorized and encouraged to utilize modern 
technological advances in computer hardware and software, 
communications and other electronic devices.
    In the private health care industry, such advances have 
proven to greatly improve efficiencies in clinical practices, 
as well as in third party and Medicare/Medicaid billing. It is 
the intent of the Committee that S. 210 be interpreted to give 
tribal health facilities the widest latitude in adopting 
industry best practices, for the purpose of providing the 
highest quality health care to Indian people possible given the 
limited budgets on which most such facilities operate.
    Similarly, Section 6 language regarding technology site 
assessments and plan descriptions of technology use and 
implementation are intended to encourage tribal health 
facilities to utilize, where appropriate, industry best 
practices for computer hardware and software communications and 
other electronic devices. It is the intent of the Committee for 
tribal health facilities and Federal agencies to, where 
appropriate, utilize the authorization granted under this 
legislation to develop modern, reliable and valid systems to 
improve the accountability, quality and continuity of the 
mental health and substance abuse programs serving Indian 
people, while at the same time more efficiently utilizing the 
funding received and the ability to bill third party providers 
and access Medicaid/Medicare system.

                          LEGISLATIVE HISTORY

    S. 210 was introduced on January 30, 2001, by Senator 
Campbell for himself and for Senator Inouye, and was referred 
to the Committee on Indian Affairs. Senator Johnson was added 
as a cosponsor on February 13, 2001. On July 10, 2002, the 
Committee, in open business session, voted unanimously to 
favorably report S. 210 to the full Senate.
    A predecessor bill to S. 210 (S. 1507) was introduced by 
Senator Campbell in the 106th Congress. The bill was reported 
out of Committee and in June 2000, passed the Senate. However 
that bill was never taken up by the House of Representatives.
    When originally introduced in the 106th Congress as S. 
1507, the bill designated the Bureau of Indian Affairs (BIA) as 
the lead agency for coordination and implementation. This 
initial designation was based on BIA operation of the Indian 
Alcohol and Substance Abuse Program. However, all witnesses who 
appeared at a hearing held on S. 1507 in October 1999, 
recommended that the Indian Health Service be designated the 
appropriate, lead agency in which the coordination of this 
program should be housed. Therefore, when reintroduced as S. 
210, the bill designated the Indian Health Service rather than 
the Bureau of Indian Affairs as the lead agency for 
coordination and implementation of the Native American Alcohol 
and Substance Abuse Program Consolidation Act of 2002.
    Also, when originally introduced, S. 1507 provided only for 
consolidation of alcohol and substance abuse programs. However, 
testimony received at the October, 1999, hearing, as well as 
substantial submissions of written testimony and information 
brought to the Committee emphasized the need to expand the 
scope of the bill beyond merely alcohol and substance abuse.
    Quite often, alcohol and substance abuse problems are 
symptomatic of or are triggered by other mental health 
problems. Without treating the mental health problem at the 
same time as the alcohol or substance abuse problem, the effect 
of treatment islimited. Accordingly, the Committee amended the 
bill to provide for the inclusion of mental health programs.
    When reintroduced as S. 210, the bill provided for the 
expanded scope of programs eligible for consolidation, to 
include programs for the treatment of mental health problems as 
candidates for consolidation.

                      SECTION-BY-SECTION ANALYSIS

Section 1. Short title

    The Act may be cited as the Native American Alcohol and 
Substance Abuse Program Consolidation Act of 2002.

Section 2. Statement of purpose

    The primary purposes of this Act are to enable Indian 
Tribes to consolidate and integrate alcohol and other substance 
abuse programs, and mental health and related programs, and to 
recognize that Indian tribes can best determine the goals and 
methods for establishing and implementing mental health and 
alcohol and substance abuse programs for their communities.

Section 3. Definitions

    This section contains definitions for Automated Clinical 
Information System, Indian Behavorial Healthcare Programs, 
Federal Agency, Indian Tribe, Indian, Secretary and Substance 
abuse.

Section 4. Integration of services authorized

    The Secretary of Health and Human Services, in cooperation 
with the other appropriate heads of departments and agencies 
shall, upon the receipt of an acceptable plan from a tribe, 
authorize the tribe to consolidate Federally-funded Indian 
behavioral health care programs into a single, coordinated, 
comprehensive program. This will include utilizing, where 
appropriate, and automated clinical information system to 
better manage services, costs and reporting requirements. 
Additionally, Indian Tribes are authorized to use funds from a 
consolidated program to purchase, lease or license, or provide 
training, for technology for an automated clinical information 
system.

Section 5. Programs affected

    The programs that may be integrated include Indian 
behavioral health care programs under which Indian tribes are 
eligible for receipt of funds under a statutory or 
administrative formula, competitive or other grant program, or 
any other funding scheme. In the case of grant funding, a tribe 
must obtain permission to consolidate programs from the agency 
that is awarding the grant or, in the alternative, tailor its 
reporting structure closely to the reporting required by the 
grant program.

Section 6. Plan requirements

    The requirements for an applicant tribe under this Act are 
to: identify the programs to be integrated, consistent with the 
purposes of this Act; describe a comprehensive program 
strategy, including identifying programs available on and near 
the relevant tribe's service area and technology assessments; 
how the services are to be integrated, delivered and budgeted, 
including the implementation of an automated clinical 
information system, if used; develop a consolidated budget; 
identify the agencies involved in integrating the programs; 
identify any statutory provisions, regulations, policies or 
procedures that the tribe believes need to be waived; and be 
approved by the appropriate tribal governing body.

Section 7. Plan review

    In reviewing the plan the Secretary is to consult with the 
other Federal agencies providing funding and with the tribe. 
The parties shall identify any waivers necessary to enable 
implementation of the plan. Affected agencies shall have the 
authority to provide waivers, unless the affected agency 
determines that such a waiver is inconsistent with the purposes 
of this Act.

Section 8. Plan approval

    The Secretary shall have 90 days after the receipt of a 
tribe's plan to approve or disapprove the plan. If the plan is 
disapproved, the tribal government shall be informed, in 
writing, of the reasons for the disapproval and shall be given 
an opportunity to amend its plan or petition for a 
reconsideration of the Secretary's decision.

Section 9. Federal responsibilities

    Paragraph (a) provides that within 180 days following the 
date of enactment of this Act, the appropriate Secretaries 
shall enter into an interdepartmental Memorandum of Agreement 
providing for the implementation of the plans authorized under 
this Act. The lead agency under this Act is the Indian Health 
Service. The responsibilities of the IHS will include: the 
development of a single report format to be used by a tribe to 
report on the activities undertaken by the plan and on all plan 
expenditures, and the development of a single system of Federal 
oversight for the plan, including the provision of technical 
assistance to tribes and convening of a meeting not less than 
two times during each fiscal year between the affected Federal 
agencies and tribes and tribal organizations.
    Paragraph (b) provides that the single report format shall 
be developed by the Secretary of HHS and should contain 
information that will allow a determination that the tribe has 
compiled with the requirements incorporated in its approved 
plan.

Section 10. No reduction in amounts

    In no case shall the amount of Federal funds available to a 
participating tribe involved in any project be reduced as a 
result of the enactment of this Act.

Section 11. Interagency fund transfers authorized

    The appropriate Secretaries are authorized to take such 
action as necessary to provide for interagency transfer of 
funds otherwise available to a tribe.

Section 12. Administration of funds and overage

    Program funds shall be administered to allow for a 
determination that funds from specific programs are spent on 
allowable activities; however, tribes are not required to 
maintain separate records tracing any services or activities 
conducted under approved plans to the individual programs under 
which funds were authorized. All administrative costs may be 
commingled and participating tribes shall be entitled to the 
full amount of such costs.

Section 13. Fiscal accountability

    Nothing in this Act shall be construed to interfere with 
the ability of the Secretary to fulfill his responsibilities 
for the safeguarding of Federal funds.

Section 14. Report on statutory and other barriers to integration

    Within two years after the date of enactment of this Act, 
the Secretary shall submit a report to the Committee on Indian 
Affairs of the Senate and the Committee on Resources of the 
House of Representatives on the implementation of this program. 
Within five years after the date of the enactment of this Act, 
the Secretary shall submit a report to the Committee on Indian 
Affairs of the Senate and the Committee on Resources of the 
House of Representatives on the results of the implementation 
of the program, which identifies statutory barriers to the 
ability of tribes to more effectively integrate their mental 
health programs and services.

Section 15. Assignment of Federal personnel to State Indian alcohol and 
        drug treatment programs

    Any State with an alcohol and substance abuse program 
targeted to Indian tribes shall be eligible to receive, at no 
cost to the State, such Federal personnel assignments deemed 
appropriate to help insure the success of such program.

                   COST AND BUDGETARY CONSIDERATIONS

    The cost estimate for S. 210 as calculated by the 
Congressional Budget Office, is set forth below:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 30, 2002.
Hon. Daniel K. Inouye,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 210, the Native 
American Alcohol and Substance Abuse Program Consolidation Act 
of 2002.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Eric Rollins.
            Sincerely,
                                          Barry B. Anderson
                                    (For Dan L. Crippen, Director).
    Enclosure.

S. 210--Native American Alcohol and Substance Abuse Program 
        Consolidation Act of 2002

    CBO estimates that implementing S. 210 would cost about 
$600,000 in 2003 and less than $500,000 annually after that, 
assuming appropriation of the necessary funds. The bill would 
permit Indian tribes to consolidate alcohol and substance abuse 
programs that are currently funded through a number of federal 
agencies.
    Under S. 210, tribes would submit plans to the Department 
of Health and Human Services (HHS) for approval. HHS would 
approve or reject plans after consulting with the federal 
agencies that would be affected. During this approval process, 
these agencies would be able to waive statutory and other 
requirements to enable tribes to implement their plans. CBO 
estimates that the costs of approving plans, monitoring their 
implementation, and providing technical assistance would cost 
about $600,000 in 2003 and $350,000 annually in later years.
    S. 210 also would require HHS to submit reports on the 
bill's implementation within two and five years of enactment. 
CBO estimates that these reports would each cost less than 
$100,000. The additional costs of S. 210 would be borne by the 
Indian Health Service, the lead agency for the bill's 
implementation.
    Enacting S. 210 would not affect direct spending or 
receipts; therefore, pay-as-you-go procedures would not apply. 
This bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. By 
allowing tribes to consolidate programs for behavioral health 
care, including substance abuse, the bill would provide tribes 
with greater programmatic flexibility.
    The CBO staff contact for this estimate is Eric Rollins. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

               REGULATORY AND PAPERWORK IMPACT STATEMENT

    Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires that each report accompanying a bill to 
evaluate the regulatory and paperwork impact that would be 
incurred in carrying out the bill. The Committee has concluded 
that S. 210 will reduce regulatory or paperwork requirements 
and impacts.

                        EXECUTIVE COMMUNICATIONS

    A copy of a letter from the Department of Health and Human 
Services (DHHS) dated October 18, 2001, is set out below.

                The Secretary of Health and Human Services,
                                  Washington, DC, October 18, 2001.
Hon. Daniel K. Inouye,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: This is in response to your request for 
the views of the Department of Health and Human Services (HHS) 
on S. 210, the ``Native American Alcohol and Substance Abuse 
Program Consolidation Act of 2001'', and S. 214, the bill to 
elevate the position of Director of the Indian Health Service 
within HHS to Assistant Secretary for Indian Health.

S. 210, the ``Native American Alcohol and Substance Abuse Program 
        Consolidation Act of 2001''

    S. 210 would permit Indian tribes to consolidate substance 
abuse prevention and treatment and mental health funds that 
they are eligible for under formula and competitive grants and 
other programs, according to a plan approved by the Secretary. 
It would not provide for consolidation of programs providing 
specific guaranteed packages of health care benefits to 
identifiable individual beneficiaries, such as Medicare, 
Medicaid, and the State Children's Health Insurance Program 
(SCHIP).
    In general, the Department supports the principle that 
Indian tribes best know how to meet the needs of their members 
through alcohol and substance abuse prevention programs. We 
also have no objection in principle to allowing tribes to 
consolidate programs addressing substance abuse and mental 
health problems where appropriate, consistent with program 
intent and for the purposes of achieving administrative 
efficiencies. However, we have some concerns about provisions 
of S. 210 which we would need to work with the Committee to 
resolve. For example, we are concerned about how the 
distribution of funds authorized and appropriated under 
existing competitive or formula grant authority could be 
affected.
    The Department is currently preparing, in compliance with 
recent amendments to the Indian Self-Determination and 
Education Act, a feasibility study for possible demonstration 
projects on self-governance. The study will address tribes' 
operation of substance abuse prevention and treatment 
activities, including consolidation of funds awarded under 
separate programs. Completion of the feasibility study 
(currently projected to be by February 2002) will provide us 
with information that will better enable us to identify 
possible changes needed to S. 210 to prevent problems and 
disagreements that could arise in implementing the contemplated 
consolidation program. The Department, therefore, would prefer 
that the committee delay action on S. 210 until we have 
completed work on the study. At that time, the Department will 
provide its views and looks forward to working with the 
Committee to address any substantive concerns with S. 210.

S. 214, to elevate the position of IHS Director to Assistant Secretary

    S. 214 would elevate the position of Director of the Indian 
Health Service within HHS to Assistant Secretary for Indian 
Health. The Department is currently in the process of 
reorganizing and has not finalized its restructuring. We 
therefore have no position on this bill at this time.
    Thank you for the opportunity to provide the Committee with 
the Department's views on these bills. We look forward to 
working closely with your Committee on these important issues.
    We are advised by the Office of Management and Budget that 
there is no objection to the transmittal of this report from 
the standpoint of the Administration's program.
            Sincerely,
                                                 Tommy G. Thompson.

                        CHANGES IN EXISTING LAW

    In compliance with subsection 12 of rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the bill are required to be set out in that accompanying 
Committee report. The Committee finds that enactment of S. 210 
will not result in any changes in existing law.

                                
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