99–010

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 

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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, drunkdriving 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 

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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. 

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

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. 

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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 

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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. 

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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 

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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 

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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 is limited. 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 

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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. 

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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:

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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. 

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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 selfgovernance. 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. 

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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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