    [Senate Hearing 115-192]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 115-192

         HIGH RISK, NO REWARD: GAO'S HIGH RISK LIST FOR INDIAN PROGRAMS

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

                                    HEARING

                                   before the

                          COMMITTEE ON INDIAN AFFAIRS
                              UNITED STATES SENATE

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 17, 2017

                                   __________

             Printed for the use of the Committee on Indian Affairs

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                          COMMITTEE ON INDIAN AFFAIRS

                      JOHN HOEVEN, North Dakota, Chairman
                      TOM UDALL, New Mexico, Vice Chairman
    JOHN BARRASSO, Wyoming               MARIA CANTWELL, Washington
    JOHN McCAIN, Arizona                 JON TESTER, Montana,
    LISA MURKOWSKI, Alaska               AL FRANKEN, Minnesota
    JAMES LANKFORD, Oklahoma             BRIAN SCHATZ, Hawaii
    STEVE DAINES, Montana                HEIDI HEITKAMP, North Dakota
    MIKE CRAPO, Idaho                    CATHERINE CORTEZ MASTO, Nevada
    JERRY MORAN, Kansas
         T. Michael Andrews, Majority Staff Director and Chief Counsel
           Jennifer Romero, Minority Staff Director and Chief Counsel

                                C O N T E N T S

                                  ----------
                                                                       Page
    Hearing held on May 17, 2017.....................................     1
    Statement of Senator Cortez Masto................................    56
    Statement of Senator Franken.....................................     4
    Statement of Senator Heitkamp....................................    58
    Statement of Senator Hoeven......................................     1
    Statement of Senator Udall.......................................     3

                                   Witnesses

    Black, Michael S., Acting Assistant Secretary, Indian Affairs,
      U.S. Department of the Interior................................    41
        Prepared statement...........................................    43
    Buchanan, Rear Admiral Chris, Acting Director, Indian Health
      Service, U.S. Department of Health and Human Services..........    47
        Prepared statement...........................................    48
    Dearman, Tony, Director, Bureau of Indian Education, U.S.
      Department of the Interior.....................................    51
        Prepared statement...........................................    52
    Emrey-Arras, Melissa, Director, Education, Workforce, and Income
      Security Issues, U.S. Government Accountability Office.........     5
        Prepared statement...........................................     8

                                    Appendix

    National Indian Education Association (NIEA), prepared statement.    71
    Response to written questions submitted by Hon. Catherine Cortez
      Masto to:
        Rear Admiral Chris Buchanan..................................    76
        Tony Dearman.................................................    90
        Melissa Emrey-Arras..........................................    75
    Response to written questions submitted by Hon. Steve Daines to:
        Tony Dearman.................................................    89
        Melissa Emrey-Arras..........................................    74
    Response to written questions submitted by Hon. Tom Udall to:
        Michael Black................................................    85
        Tony Dearman.................................................    90
        Rear Admiral Michael Weahkee.................................    77

         HIGH RISK, NO REWARD: GAO'S HIGH RISK LIST FOR INDIAN PROGRAMS

                                  ----------

                            WEDNESDAY, MAY 17, 2017

                                           U.S. Senate,
                                   Committee on Indian Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 2:30 p.m. in room
    628, Dirksen Senate Office Building, Hon. John Hoeven,
    Chairman of the Committee, presiding.

                OPENING STATEMENT OF HON. JOHN HOEVEN,
                     U.S. SENATOR FROM NORTH DAKOTA

        The Chairman. I call this hearing of the Indian Affairs
    Committee to order. This is an oversight hearing on High Risk,
    No Reward: GAO's High Risk List for Indian Programs.
        Before we get into today's hearing, I want to bring up last
    week's hearing that turned into a listening session. As the
    Committee is aware, we had witnesses travel from Arizona and
    Alaska to provide testimony on their respective bills, S. 825,
    the Southeast Alaska Regional Health Consortium Land Transfer
    Act of 2017 and S. 772, the Amber Alert Indian Country Act of
    2017.
        Since testimony and materials were received at last week's
    listening session, through no fault of their own, I would be
    wondering if there is any objection that all testimony and
    materials from last week's listening session be given the same
    weight as if the Committee held an actual legislative hearing?
    I am asking if there is any objection to that?
        Senator Udall. No objection.
        The Chairman. Good. Hearing no objection, all testimony and
    materials will be a part of the record and given the same
    weight as a legislative hearing. I thank you for that.
        Today, the Committee will examine the Government
    Accountability Office report on its High Risk List which now
    includes three Federal Indian programs.
        Every two years, at the start of a new Congress, the GAO
    compiles a list of at-risk Federal programs. These programs are
    considered high risk because they are vulnerable to fraud,
    waste, abuse or mismanagement.
        For the first time, three Indian issue areas were
    identified as high risk. These include Indian energy
    development, education and health care. In fact, the GAO tells
    us that these high risk areas have 39 open recommendations that
    have not been satisfied. These Federal programs are vitally
    important and affect many tribes and individuals across Indian
    Country.
        These programs affect the safety of school buildings and
    facilities, the quality of health care, education and the
    advancement of Indian energy development projects in Indian
    Country.
        Over the years, the GAO has done a tremendous job in
    examining and bringing to light numerous challenges facing
    these Federal Indian programs. Some of these problems are very
    troubling.
        For instance, in its 2014 report, the GAO noted that a
    single audit of a BIE school located in Arizona lost $1.7
    billion in unaccounted Federal funds. Upon further
    investigation, it was determined this money was illegally
    transferred to an offshore-bank account in Indonesia.
        The incident was referred to the Department of the
    Interior, Office of Inspector General in July 2014. The IG then
    asked for the assistance of the Federal Bureau of
    Investigation, the FBI.
        According the IG, certain bank accounts were hacked,
    enabling the unauthorized transfer of funds. How could this
    happen? Who was ultimately responsible for ensuring fraud like
    this does not happen to BIE-funded schools?
        At this point, I would ask for the first chart which
    illustrates various roles of the BIA, BIE and others in
    supporting and overseeing the BIE school facilities.
        The chart to my right shows how bureaucratic the BIE has
    become. For instance, the chart shows the multiple layers of
    offices that support and oversee BIE school facilities between
    the BIA, the Department, the Deputy Assistant Secretary for
    Management, and the BIE itself. The lack of oversight and cyber
    security is problematic but appears to be only a part of the
    problem.
        The GAO also issued a 2015 GAO report highlighting
    additional management challenges in education. Health care
    services also face significant issues. Since 2011, the
    Government Accountability Office has issued seven reports on
    the IHS, Indian Health Services. These reports related to
    improving oversight on the quality of care provided to Indian
    patients, improving the Purchased Referred Care Program,
    examining the enrollment of Indians in health care coverage
    expansion, and improving patient wait times at IHS facilities.
        One report found that Indian patients had waited six weeks
    for an initial visit with a family medicine physician. There
    appeared to be an even longer wait time of three to four months
    for an Indian patient to see an internal medicine physician.
        From data gathered from these seven reports, the GAO has
    made 14 recommendations to improve the Indian Health Services.
    These recommendations remain open. For one recommendation on
    staffing, the IHS disagreed and continues to not implement the
    GAO recommendation.
        Although the Indian Health Service has acted upon some
    recommendations, such as adopting Medicare-like rates for non-
    hospital services and improving data collection for the
    Purchase Preferred Care Program, more needs to be done.
        Finally, the GAO has confirmed what Indian tribes have
    experienced about lost opportunities when they wanted to
    develop their energy resources. These problems were outlined in
    the 2015 GAO report which highlighted poor management and
    oversight of energy resources and development at the Bureau of
    Indian Affairs.
        For instance, in 2016, the GAO found many BIA offices had
    high vacancy rates for key energy development positions.
    According to the GAO, some offices reported not having staff
    with key skills to review energy-related documents.
        Perhaps this is why one tribe said it took the BIA eight
    years to approve right-of-way agreements. This tribe said these
    delays cost an estimated $95 million in lost revenue.
        Our next charts illustrate the longer approval process for
    renewable and oil and gas Indian energy projects versus private
    lands. These charts show bureaucratic approval processes for an
    Indian tribe to develop their own energy resources. This needs
    to change.
        That is why I have introduced S. 245, the Indian Tribal
    Energy Development and Self Determination Act of 2017. This
    bill directs the Department of the Interior to provide Indian
    tribes with technical assistance in planning their energy
    resource development programs.
        The legislation cuts red tape and makes it easier for
    Indian tribes to develop their own resources. It also
    streamlines the process for approving tribal energy resource
    agreements and making this process more predictable for Indian
    tribes.
        Money made from developing Indian resources, whether coal,
    oil, natural gas, wind or solar, for example, can have a
    significant impact on tribal communities. These energy projects
    could create high-paying jobs and bring revenue to tribal
    governments.
        It is unacceptable that the trustee would inhibit and even
    prevent the tribes from engaging in healthy communities or
    economic development, whether it is energy or otherwise.
    Through misplaced, misguided policies, or mismanagement, these
    agencies should be ensuring that their tribes actually have
    opportunity and that they are thriving and prosperous and not
    continuing to suffer or miss opportunities. Indian communities
    deserve better than they are receiving right now.
        I want to welcome our witnesses today. I look forward to
    hearing from all of you on these important issues.
        Before I turn to our witnesses, I want to turn to Vice
    Chairman Udall for his opening statement.

                     STATEMENT OF HON. TOM UDALL,
                      U.S. SENATOR FROM NEW MEXICO

        Senator Udall. Thank you, Chairman Hoeven, for holding this
    very important oversight hearing on GAO's 2017 High Risk
    Report.
        The Federal Government has treaty and trust
    responsibilities to provide vital services, including health
    care and education, to Native American and Alaska Native
    tribes. Fulfillment of these responsibilities is both a moral
    and a legal obligation.
        As the Congress' oversight partner, the GAO plays an
    important role. It dedicates time and resources to thoroughly
    reviewing the delivery of Indian programs within the BIA, BIE
    and IHS. The review helps identify where we are falling short
    of meeting responsibilities.
        For years, GAO's work has provided evidence of something
    many tribal communities have long reported, that management
    challenges and funding barriers at these agencies reduce the
    effectiveness of tribal programs.
        Their findings shed light on the need for increased
    management oversight, infrastructure investment and workforce
    development. Their decision to include Indian programs on the
    High Risk List underscores the need to redouble this
    Committee's efforts to uncover the systemic challenges plaguing
    BIE schools, IHS facilities and the BIA's leasing program.
        When I met with Comptroller General Dodaro last week, he
    explained what the high designation means and the outcomes
    associated with such a designation. In my view, this
    designation presents the Committee with an opportunity. An
    opportunity to do better by not only recognizing the
    administrative challenges to effectively running these programs
    but also by committing resources and expertise tailored to
    address them.
        That will enable us to do our part to uphold the Federal
    Government's trust responsibilities to tribes. Budgets are a
    direct demonstration of our priorities, just as we have come
    here today to ask for more accountability from program
    administrators. Members of this Committee must join together to
    fight for more funding for schools, hospitals, teachers and
    nurses.
        I look forward to working with my colleagues on this
    Committee. Many of them, like Senator Murkowski and Chairman
    Hoeven, are fellow appropriators. That gives us multiple ways
    we can work to ensure that the Senate continues to pursue these
    important issues.
        I am hopeful that we can work together to ensure tribal
    programs achieve the success these communities deserve.
        Mr. Chairman, thank you again for holding this hearing. I
    look forward to the testimony. I thank the witnesses for being
    here today.
        The Chairman. Thank you, Vice Chairman Udall.
        I would ask if other members wish to make an opening
    statement at this point?

                     STATEMENT OF HON. AL FRANKEN,
                      U.S. SENATOR FROM MINNESOTA

        Senator Franken. Thank you, Mr. Chairman. I thank you both
    for calling this important hearing.
        Once I got to the Senate, I started harping on the Bug-O-
    Nay-Ge-Shig School on Leech Lake Reservation in Minnesota.
    Students at the Bug-O-Nay-Ge-Shig School had to face really
    horrendous conditions in their classrooms. This was a pole
    barn. If the wind was blowing more than 30 miles an hour, they
    had to leave the school. This could be in the dead of winter
    and they had to go outside in 30 to 40 degrees below weather.
    There were sewer problems; there were rodents; there was cold
    and dangerous wiring.
        A few years ago, I convinced then Interior Department
    Secretary Sally Jewell to visit the school. Once she saw it for
    herself, saw what the teachers and students went through, she
    saw the need and I am thrilled that we are able to finally get
    the funding to replace the school.
        This took a lot of work from lawmakers, from the tribe,
    from the community there, and from the Obama Administration.
    Construction is now underway. When school starts in the fall,
    they will have a new school.
        I know there are many, many Indian reservations across the
    country that are dealing with similar school buildings in poor
    condition. It is unjust to expect Indian students to succeed
    academically if we fail to provide them with the proper
    environment to achieve that success.
        Children in Indian schools must be able to learn in a
    modern environment with modern facilities like a lab. This
    school did not have a lab. They need an environment that says
    we care about you. This is one issue we are dealing with at
    today's BIE.
        That is why I work so hard to get the resources. The Vice
    Chairman talked about the appropriators. We, on this Committee,
    owe it to Indian Country and to the Native community to talk
    about the underfunding.
        We are talking about dysfunction in the organizations but
    some of this is circular. It is very hard to get doctors to
    come to practice in Indian Country if their spouses does not
    like the schools or housing.
        I applaud the Chairman for talking about energy
    development. I finally got some money from the Loan Guarantee
    Program, the guarantee part finally happened, and we got $9
    million that can be leveraged up to about $80 million of
    activity.
        Thank you for being here today. Let us make these agencies
    work more efficiently, but let us not pretend that inadequate
    funding does not affect the ability for these agencies to
    attract the kind of people they need and attract the kind of
    people on the ground they need in Indian Country.
        Thank you, Mr. Chairman.
        The Chairman. Are there other opening statements? If not, I
    would defer to the members for their questions. I am sorry, I
    am getting ahead of myself.
        Senator Franken. Mr. Chairman, I think we should go to the
    testimony first.
        [Laughter.]
        The Chairman. We are going to follow Senator Franken's
    recommendation.
        Senator Franken. Thank you.
        The Chairman. And go to the testimony first, that is a good
    idea.
        Again, I want to welcome all of you. Thank you for being
    here. I would ask that you hold your remarks to about five
    minutes. Obviously, your full written testimony will be made a
    part of the record.
        We will start with Ms. Emrey-Arras.

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

        Ms. Emrey-Arras. Thank you, Chairman Hoeven, Vice Chairman
    Udall, and members of the Committee.
        Thank you for inviting me here today to discuss a new area
    we have added to our High Risk List this year: improving
    Federal management of programs that serve tribes and their
    members.
        We added this area to our High Risk List this past February
    in response to serious problems in Federal management and
    oversight of Indian education, energy resources and health care
    programs, which were highlighted in several of our prior
    reports. Overall, our High Risk Program has served to identify
    and help resolve serious weaknesses in areas that involve
    substantial resources and provide critical services to the
    public.
        We added this new area to our High Risk List because we
    found that Interior and HHS have ineffectively managed Indian
    education, energy resources and health care programs in the
    following broad areas: one, oversight of Federal activities;
    two, collaboration and communication; three, Federal workforce
    planning; four, equipment, technology and infrastructure; and
    five, Federal agency data.
        Of the recommendations we have made to Interior and HHS on
    these issues, nearly 40 have not been implemented.
        In terms of Indian education, we found serious weaknesses
    in BIE's oversight of school spending and identified unsafe
    school conditions. For example, in a 2014 report, we found BIE
    did not have procedures and risk criteria to ensure that
    schools use Federal funds to educate students. Further, we
    found that BIE staff lacked expertise and training to
    effectively oversee school spending.
        As a result, we found several instances of misuse of funds,
    including as the Chairman noted, for one school, over $1
    million that was improperly transferred to offshore accounts.
        In 2016, we also reported that deteriorating facilities and
    equipment contributed to unsafe conditions at BIE schools. At
    one school, we found seven boilers that failed inspection
    because of safety hazards such as elevated levels of carbon
    monoxide and a natural gas leak. You can actually see the
    failed inspection tag on the poster over there.
        Turning to Indian energy issues, we found that BIA had
    inefficiently managed Indian energy resources and the energy
    development process. For example, in a June 2015 report, we
    found that although BIA's review and approval are required
    before Indian energy resources can be developed, BIA does not
    have a process or the data needed to track its review and
    response times.
        As the Chairman noted, a tribal official told us that BIA's
    review of energy-related documents took as long as eight years
    in some cases and during that time, the tribe estimates it lost
    more than $95 million in revenue.
        Moving on to Indian health care services, we have a poster
    that shows the IHS structure that will be put up momentarily.
    We found that IHS provides inadequate oversight of its
    federally-operated health care facilities and of its Purchased
    Referred Care Program.
        For example, in 2016 and 2017, we reported that IHS
    provided limited and inconsistent oversight of the timeliness
    and quality of care provided in its federally-operated
    facilities. As a result, it could not ensure that patients
    received timely quality care.
        We reported that according to IHS officials, access to
    timely primary care at some facilities was hindered by outdated
    medical and telecommunications equipment, such as analog
    mammography machines and telephones with an insufficient number
    of lines for scheduling patient appointments, as well as an
    insufficient workforce.
        We plan to continue monitoring the agency's efforts to
    address these issues and our nearly 40 open recommendations. In
    order for this area to be removed from our High Risk List,
    Interior and HHS need to show improvement on five key elements:
    leadership commitment, the capacity to resolve the risk; having
    an action plan; monitoring; and demonstrating progress. We have
    a star here that demonstrates the areas in which they need to
    show improvement to be removed from our High Risk List.
        We look forward to continuing our work with this Committee.
    My colleagues and I would be pleased to respond to any
    questions you may have. Thank you.
        [The prepared statement of Ms. Emrey-Arras follows:]

        Prepared Statement of Melissa Emrey-Arras, Director, Education,
     Workforce, and Income Security Issues, U.S. Government Accountability
                                     Office

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        The Chairman. Thank you.
        We will now turn to Acting Secretary Black.

            STATEMENT OF MICHAEL S. BLACK, ACTING ASSISTANT
           SECRETARY, INDIAN AFFAIRS, U.S. DEPARTMENT OF THE
                                INTERIOR

        Mr. Black. Chairman Hoeven, Vice Chairman Udall and members
    of the Committee, my name is Michael Black. I am the Acting
    Assistant Secretary for Indian Affairs at the Department of the
    Interior.
        Thank you for the opportunity to present testimony on
    behalf of the Department regarding Indian Affairs' role in the
    development of Indian energy and its recent high risk
    designation in the GAO High Risk Report issued in February.
        Let me begin by stating that the President and the
    Secretary have made a clear commitment to advancing America's
    energy independence through responsible resource development.
    Tribes play a critical role in this conversation, as energy
    development ranging from clean coal to oil and gas to wind
    creates good-paying jobs and bolsters tribal economies.
        The development of energy resources offers tribes
    opportunities that otherwise do not exist, particularly in
    rural areas. Strong tribal economies strengthen the exercise of
    tribal sovereignty and the Department continues to promote
    tribal energy development. However, as previous GAO reports
    have explained, there are many opportunities for us to improve.
        To avoid any confusion, let me be clear that the Department
    agrees with GAO's recommendations and we are dedicated to
    implementing widespread reform to help foster energy
    independence among tribes interested in developing their
    resources.
        As a former Director of BIA and current Acting Assistant
    Secretary, I know these issues well and acknowledge that we
    have a significant amount of work to do. My written testimony
    addresses GAO's recommendations and highlights our current
    progress toward implementation.
        GAO made 14 recommendations that will help Indian Affairs
    to promote energy development in Indian Country, including
    better utilization of GIS mapping tools and improved data
    collection and tracking systems.
        We are currently working to address the recommendations. As
    an example, BIA is working to utilize an off-the-shelf mapping
    tool with our Trust Asset and Accounting Management System,
    TAAMS, in order to integrate data viewing and our map creation
    capabilities into the TAAMS at the desktop level.
        The GIS Map Viewer will be based on verified legal
    descriptions and ownership data available in TAAMS with base
    reference data for mapping. Recently, the GIS Map Viewer was
    successfully tested with TAAMS and is now being reviewed for
    compliance with DOI and Indian Affairs information technology
    and electronic security policies and procedures.
        We are also working to address recommendations related to
    tracking systems and data collection by pulling together a
    group of subject matter experts in oil and gas processing to
    identify key identifiers and data fields need to track and
    monitor review and response times for oil and gas leases.
        We will utilize the information gathered during this
    process to make necessary modifications to TAAMS in order to
    improve efficiencies and timeliness in processing workloads.
        Indian Affairs is also in the process of standing up the
    Indian Energy Service Center which is the result of a concept
    paper produced by a multiagency team formed by the Indian
    Energy Minerals Steering Committee. The multiagency team held a
    tribal listening session, met individually with oil and gas
    tribes and the Coalition of Large Land-Based Tribes and also
    received written comments in an effort to gather input from
    relevant stakeholders.
        One of the recommendations was to include other regulatory
    agencies in the service center such as Fish and Wildlife
    Service, the Environmental Protection Agency and the Army Corps
    of Engineers so that the service center can act as a single
    point of contact or a lead agency to coordinate and navigate
    the regulatory process.
        Recognizing the importance of these stakeholders, the
    service center is developing streamlined and standardized
    programmatic coordination with these agencies to the greatest
    extent possible.
        This includes memoranda of understanding with the
    appropriate department bureaus and other Federal agencies
    involved in the development of Indian energy and mineral
    resources. In addition, the BIA, through the Indian Energy
    Minerals Steering Committee, has also established Federal
    partner groups, where needed, which include BIA, the Bureau of
    Land Management, the Office of Natural Resource Revenue, the
    Corps of Engineers, Fish and Wildlife and EPA.
        These groups provide field knowledge on energy and mineral
    issues and serve to facilitate and focus and assume the point
    of contact desired by the respective parties regarding the
    processing of energy development for each region.
        The Department is also working to implement GAO's
    recommendation that DOI provide additional energy development-
    specific guidance on provisions of the Tribal Energy Resource
    Agreement or TERA regulations the tribes have identified to the
    Department as being unclear.
        The Department believes that clarity can be best achieved
    by amending the Indian Minerals Development Act of 1982 to
    insert tribal self-determination language similar to that found
    in the Helping Expedite and Advance Responsible Tribal
    Homeownership, the HEARTH Act of 2012.
        The HEARTH Act permits tribes to lease surface trust lands
    for renewable energy purposes absent approval by the Department
    by implementing their own leasing regulations. In prior
    testimony to this Committee, the Department recommended
    Congress consider a HEARTH-like fix in the conventional energy
    arena by amending the law to match the HEARTH Act provisions.
    We would be willing to work with the members of this Committee
    on such an amendment.
        Thank you for the opportunity to present testimony today.
    The Department is committed to upholding the trust
    responsibility to tribes and implementing GAO's
    recommendations. I look forward to answering any questions you
    may have.
        Thank you.
        [The prepared statement of Mr. Black follows:]

      Prepared Statement of Michael S. Black, Acting Assistant Secretary,
                Indian Affairs, U.S. Department of the Interior
        Chairman Hoeven, Vice Chairman Udall, and Members of the Committee,
    my name is Michael Black and I am the Acting Assistant Secretary for
    Indian Affairs at the Department of the Interior. Thank you for the
    opportunity to present testimony on behalf of the Department of the
    Interior (Department or DOI) regarding Indian Affairs' role in the
    development of Indian energy and its recent high risk designation in
    the Government Accountability Office (GAO) High Risk Report (GAO-17-317
    High Risk Series).
        The President and the Secretary have made a clear commitment to
    advancing America's energy independence through responsible resource
    development. Tribes play a critical role in this conversation, as
    energy development ranging from clean coal to oil and gas to wind
    creates good-paying jobs and bolsters tribal and local economies. In
    many instances, the development of energy resources offers Tribes
    opportunities that otherwise would not exist, particularly in rural
    areas.
        Strong tribal economies strengthen the exercise of tribal
    sovereignty, and the Department continues to promote tribal energy
    development. However, as previous GAO reports have explained, there are
    many opportunities for us to improve our support for tribal energy
    development. The Department agrees with GAO's recommendations and we
    are dedicated to implementing widespread reform to help foster energy
    independence among Tribes who are interested in developing their
    resources.
        As the High Risk report notes, GAO has made fourteen
    recommendations to the Bureau of Indian Affairs (BIA), via three
    reports, all of which currently remain open. As the former Director of
    BIA and current Acting Assistant Secretary, I know these issues well
    and acknowledge that we have a significant amount of work to do. My
    testimony today will address GAO's recommendations and highlight our
    current progress towards implementation.
    GAO 15-502
    Recommendation 1: To ensure it can verify ownership in a timely manner
            and identify resources available for development, BIA should
            take steps to complete its GIS mapping module in TAAMS.
        Indian Affairs agrees that promoting energy development in Indian
    Country requires timely verification of ownership and identification of
    resources available for development. The Department understands that
    GIS mapping of Indian lands is exceedingly important and we are working
    toward utilizing a GIS mapping tool for Indian lands and developing a
    GIS policy. However, the Trust Asset and Accounting Management System
    (TAAMS) was not designed as a geospatial mapping system, but simply to
    reflect legal descriptions as they appear on documents recorded as
    required by federal law.
        Thus, the BIA is not building out the GIS mapping module in TAAMS.
    Instead, the BIA will utilize commercially available, off-the-shelf
    mapping technology to integrate data viewing and map creation
    capabilities into TAAMS at the desktop. The GIS Map Viewer will be
    based upon verified legal land descriptions and ownership data
    available in TAAMS with base reference data for mapping. Recently, the
    GIS Map Viewer was successfully tested with TAAMS and is now being
    reviewed for compliance with DOI and Indian Affairs Information
    Technology (IAIT) electronic security policies and procedures for
    TAAMS. IAIT Change Advisory Board (CAB) and Architectural Review
    Committee (ARC) are expected to grant a preliminary Authority to
    Operate (ATO) within 180 days of review of the GIS Map Viewer security
    application for TAAMS. The GIS Map Viewer is scheduled for deployment
    by September 1, 2017.
    Recommendation 2: To ensure it can verify ownership in a timely manner
            and identify resources available for development, BIA should
            work with BLM to identify cadastral survey needs.
        A survey is an important step in developing a full inventory of
    trust resources, yet in more than a century since the establishment of
    Indian reservations, the federal government has not yet fully surveyed
    all Indian reservation lands. As in years past, the BIA and the BLM, in
    a coordinated and focused effort, have prepared a Reimbursable Service
    Agreement between the two agencies to identify and deliver the much
    needed survey-related products and services. Cadastral survey
    inventories are being evaluated and FY17 survey requests have been
    approved for funding and completion by BLM.
    Recommendation 3: To improve the efficiency and transparency of its
            review process, BIA should develop a documented process to
            track its review and response times.
        The GAO recommended the BIA develop a process to track BIA review
    and response times. A group of BIA subject matter experts in oil and
    gas processing have been working to modify TAAMS, incorporating the key
    identifiers and data fields needed to track and monitor review and
    response times for oil and gas leases and agreements. BIA is also in
    the process of evaluating and reviewing the current realty tracking
    system and TAAMS in order to improve efficiencies and timeliness in
    processing workloads. Due to the fact that modifications to data
    systems must be reviewed by multiple entities within the Department, a
    request for an extension of time will be submitted to the GAO within
    this quarter.
    Recommendation 4: To improve the efficiency and transparency of its
            review process, BIA should enhance data collection efforts to
            ensure it has data needed to track its review and response
            times.
        BIA is in the process of evaluating the data collection efforts
    used by various systems. Efforts are underway with subject matter
    experts to analyze and develop recommendations for improving data
    collection, tracking and business processes.
    Recommendation 5: Provide additional energy development-specific
            guidance on provisions of Tribal Energy Resource Agreement
            (TERA) regulations that tribes have identified to Interior as
            unclear.
        The Department is working to implement GAO's recommendation that
    DOI provide additional energy development-specific guidance on
    provisions of TERA regulations that tribes have identified to the
    Department as unclear. The Office of Indian Energy and Economic
    Development (IEED) continues to perform training and technical
    assistance on the TERA regulations, and will issue guidance on those
    provisions of TERA that have been identified as unclear.
        The Department believes that clarity can be best achieved by
    amending the Indian Minerals Development Act of 1982 to insert tribal
    self-determination language similar to that found in the Helping
    Expedite and Advance Responsible Tribal Homeownership (HEARTH) Act of
    2012. The HEARTH Act permits tribes to lease surface trust lands for
    renewable energy purposes absent approval by the Department by
    implementing their own leasing regulations. In prior testimony to this
    Committee, the Department recommended Congress consider a HEARTH-like
    fix in the conventional energy arena by amending the law to match the
    HEARTH Act provisions. We would be willing to work with the members of
    this committee on such an amendment.
    GAO 16-553
    Recommendation 6: Establish required timeframes for the review and
            approval of Indian Communitization Agreements (CAs) to ensure a
            more timely CA process.
        The Department is working to ensure CA processes are timely. A
    National Policy Memorandum has been developed that establishes
    timeframes for review and approval of Indian CAs. Such timeframes will
    also be incorporated into the BIA Fluid Mineral Estate Procedural
    Handbook and the Onshore Energy and Mineral Lease Management
    Interagency Standard Operating Procedures. The Memorandum is currently
    undergoing review and approval within the Department. On April 27,
    2017, the Department received notice than an extension was granted by
    GAO to extend the target date to the end of FY18.
    Recommendation 7: Develop a systematic mechanism for tracking Indian
            CAs through the review and approval process to determine, among
            other things, whether the revised CA process meets newly
            established timeframes.
        The BIA is developing a systematic mechanism to track Indian CAs
    through the review and approval process. As part of this effort, a
    group of BIA subject matter experts who meet regularly are working to
    implement identified enhancements to TAAMS. Until TAAMS can be modified
    to incorporate the key identifiers and data fields, the BIA is
    utilizing a centralized tracking spreadsheet on the Google platform.
    BIA leads the development and deployment of this tracking spreadsheet
    in consultation and coordination with BLM. We have received an
    extension from GAO to complete this recommendation by the end of FY18.
    Recommendation 8: Assess whether the revised CA process is achieving
            its objective to improve the timeliness of the review and
            approval of Indian CAs, and if not, make changes as
            appropriate.
        BIA and BLM will continue to use the tracking spreadsheet mentioned
    above, and, upon completion, the enhanced TAAMS, to monitor and assess
    the results of the efforts to streamline the Indian CA review and
    approval process. The bureaus will coordinate to establish a process
    for review of the collected data, which will assist in identifying and
    implementing any necessary process modifications.
    GAO 17-43
    Recommendation 9: Include the other regulatory agencies in the Service
            Center, such as Fish and Wildlife Services, the Environmental
            Protection Agency, and the Army Corps of Engineers, so that the
            Service Center can act as a single point of contact or a lead
            agency to coordinate and navigate the regulatory process.
        The Indian Energy Service Center (IESC) is working to implement
    Memoranda of Understanding (MOU) with appropriate Department bureaus
    and other Federal agencies involved in the development of Indian energy
    and mineral resources and to define roles and responsibilities
    regarding the development of those resources on trust lands. MOUs are
    being developed with the Fish and Wildlife Service (FWS), Environmental
    Protection Agency (EPA), Army Corps of Engineers (Corps), as well as
    IEED and Department of Energy (DOE).
        The BIA, through the Indian Energy Minerals Steering Committee
    (IEMSC), has also established Federal Partners Groups, where needed,
    which include: BIA, BLM, Office of Natural Resource Revenue (ONRR),
    Corps, FWS, and EPA. These groups provide field knowledge on energy and
    mineral issues and serve to facilitate and focus the single point of
    contact desired by the respective parties regarding the processing of
    energy development for each region.
        Currently, Federal Partner Groups are being established for the
    Navajo Region and the Rocky Mountain Region. Federal Partner Groups for
    the Great Plains Region, the Eastern Oklahoma/Southern Plains Regions,
    and the Western Region are currently meeting on a regular basis.
    Recommendation 10: Direct the Bureau of Indian Affairs to establish
            formal agreements with IEED and DOE that identify, at a
            minimum, the advisory or support role of each office.
        BIA recognizes that in addition to the identification of potential
    energy resources, there must be organized coordination between agencies
    to fully develop and/or protect Indian energy and mineral resources.
        In an effort to improve communication between the two offices, an
    MOU was recently signed between IEED and DOE outlining a partnership
    going forward. Currently, the IESC is reviewing this MOU with the
    intent of entering into the existing agreement. The IESC expects to
    meet with IEED and DOE in the near future to help finalize the
    agreement.
    Recommendation 11: Direct Bureau of Indian Affairs to establish a
            documented process for seeking and obtaining input from key
            stakeholders, such as BIA employees, on the Service Center
            activities.
        Currently, the IESC is developing a process that allows key
    agencies to provide input and requests for service received on behalf
    of tribes from the IESC. The process will also include guidance on the
    prioritization of task orders. The Executive Management Group of the
    IESC, comprised of the directors of the BIA, BLM, ONRR, and Office of
    the Special Trustee for American Indians (OST), are engaged in this
    work. The IESC is currently drafting intake forms, which will be
    distributed to obtain input regularly from stakeholders.
    Recommendation 12: Direct the Bureau of Indian Affairs to document the
            rationale for key decisions related to the establishment of the
            Service Center, such as alternatives and tribal requests that
            were considered.
        The development of the IESC was the result of a concept paper
    produced by a multi-agency team formed by the IEMSC. The multi-agency
    team held a tribal listening session, received written comments, and
    conducted conference calls in an effort to gather input from relevant
    stakeholders. The final version of the concept paper also included an
    organization chart which set forth the IESC chain-of-command. The IEMSC
    accepted and approved the concept paper as presented by the multi-
    agency team. At this point, the BIA believes this recommendation is
    complete.
    Recommendation 13: Direct the Bureau of Indian Affairs to incorporate
            effective workforce planning standards by assessing critical
            skills and competencies needed to fulfill BIA's
            responsibilities related to energy development and by
            identifying potential gaps.
        The BIA is in the process of identifying and implementing a
    workforce plan regarding positions associated with the development of
    Indian energy and minerals. First, the IESC will collect data directly
    from BIA, BLM, ONRR, and OST employees in an effort to identify
    workload and necessary technical competencies. Then, the IESC will work
    with partner bureaus to assess skills and competencies needed for
    energy and mineral workforce standards. This recommendation is expected
    to be completed by the end of 2017.
    Recommendation 14: Direct the Bureau of Indian Affairs to establish a
            documented process for assessing BIA's workforce composition at
            agency offices taking into account BIA's mission, goals, and
            tribal priorities.
        The BIA plans to assess the BIA Indian energy and mineral workforce
    composition using the same process as described in Recommendation 13.
    This includes collecting data directly from BIA, BLM, ONRR, and OST
    employees
    Conclusion
        Thank you for the opportunity to present testimony today. The
    Department is committed to upholding the trust responsibility to tribes
    and implementing GAO's recommendations. I would be glad to answer any
    questions the Committee may have.

        The Chairman. Thank you, Secretary Black.
        Rear Admiral Buchanan.

      STATEMENT OF REAR ADMIRAL CHRIS BUCHANAN, ACTING DIRECTOR,
      INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN
                                SERVICES

        Mr. Buchanan. Good afternoon, Chairman Hoeven, Vice
    Chairman Udall and members of the Committee.
        I am Chris Buchanan, an enrolled member of the Seminole
    Nation of Oklahoma, and the Acting Director of the Indian
    Health Service. I am pleased to have the opportunity to testify
    before the Committee on the GAO's February 2017 High Risk
    Report.
        I would like to thank you, Chairman Hoeven, Vice-Chairman
    Udall, and members of the Committee for elevating the
    importance of delivering quality care throughout IHS. The
    mission of the IHS, in partnership with American Indian and
    Alaska Native people, is to raise the physical, mental, and
    spiritual health of American Indian and Alaska Natives to the
    highest level. Providing quality health care is our highest
    priority.
        We share the urgency of overcoming the longstanding,
    systemic problems highlight by the GAO. We are addressing these
    challenges.
        Our goal is to make improvements in all program areas
    identified in the GAO High Risk Report. In addition, we are
    intensifying our efforts to close out open Office of Inspector
    General recommendations. In April 2017, IHS successfully closed
    three longstanding OIG open recommendations.
        IHS has strengthened its Enterprise Risk Management
    Program. The GAO High Risk Report recommendations were directly
    incorporated into this program work for 2017. Additionally, all
    our senior executives in IHS are directly involved in the
    national risk assessment discussions.
        Improving patient access to care through our outreach,
    education and enrollment activities remains a top priority.
    From fiscal year 2012 to fiscal year 2016, we saw a 21 percent
    increase in total Medicaid reimbursements and a 28 percent
    increase in total collections from private insurers.
        IHS is exploring ways to realign performance accountability
    to strengthen both field operations and headquarters oversight
    responsibilities by setting clear senior executive expectations
    and establishing clear lines of authority and accountability.
        In partnership with HHS, IHS developed a strong quality
    framework that is being implemented to assure that all
    hospitals and clinics have quality-focused compliance programs.
    We established the position of the Deputy Director of Quality
    Health Care as part of the agency's senior leadership team to
    provide a national focus for advising the IHS Director,
    providing leadership and guidance to the field and all aspects
    of assuring quality health care.
        This includes oversight of critical quality improvement
    strategies related to accreditation, certification, patient
    safety and quality care.
        We have made great progress in the past few months in
    regard to quality improvement initiatives. On April 28, IHS
    finalized a contract to purchase software for a national
    provider credentialing system. We plan to roll out the system
    in four pilot IHS areas in July of 2017 and to implement across
    the IHS areas by the end of 2017.
        A request for proposals for a single accrediting
    organization for IHS hospitals will be released by July 2017.
    To help hospitals maintain accreditation, IHS established a
    formal partnership with our sister agency, CMS through a
    contract to support best health care practices and other
    organizational improvements for IHS federally-operated
    hospitals that participate in the Medicare program.
        In addition, IHS is developing performance accountability
    metrics to support headquarters' oversight and monitoring
    functions. Earlier this month, we began pilot testing a system
    to collect standardized information on patient health care
    experience. Effective medical equipment is vital to patient
    safety and quality care.
        In July 2016, IHS established a new policy to ensure
    critical medical equipment used at IHS facilities is properly
    maintained and reliable. We mandated the use of computerized
    systems in all Federal health facilities to inventory medical
    equipment and provide information, longevity and reliability.
        We are implementing strategies to increase recruitment and
    retention to address longstanding workforce challenges. To
    share a few examples, IHS implemented a senior executive search
    committee process for recruiting highly qualified executives.
        Also, under the IHS-HRSA partnership, we made offers of
    National Health Service Corps scholarships and loan repayment
    incentives to recruit and retain primary care providers. As of
    April 2017, 472 National Health Service Corps scholarships and
    loan repayment scholars have entered our workforce in IHS and
    tribal facilities. These examples demonstrate that IHS is
    taking its challenges seriously and is continuing to take
    assertive and proactive steps to address them.
        Thank you for your commitment to improving quality, safety
    and access to care for American Indians and Alaska Natives.
        I would be happy to answer any questions the Committee has.
        [The prepared statement of Admiral Buchanan follows:]

      Prepared Statement of Rear Admiral Chris Buchanan, Acting Director,
      Indian Health Service, U.S. Department of Health and Human Services
        Chairman and Members of the Committee:
        Good afternoon, Chairman Hoeven, Vice-Chairman Udall, and Members
    of the Committee. I am Chris Buchanan, an enrolled member of the
    Seminole Nation of Oklahoma and Acting Director of the Indian Health
    Service (IHS). I am pleased to have the opportunity to testify before
    the Senate Committee on Indian Affairs on the Government Accountability
    Office (GAO) 2017 High Risk Report. I would like to thank you, Chairman
    Hoeven, Vice-Chairman Udall, and members of the Committee for elevating
    the importance of delivering quality care through the IHS.
        The IHS plays a unique role in the Department of Health and Human
    Services (HHS) because it was established to carry out the
    responsibilities, authorities, and functions of the United States to
    provide health care services to American Indians and Alaska Natives.
    The mission of the IHS, in partnership with American Indian and Alaska
    Native people, is to raise the physical, mental, social, and spiritual
    health of American Indian and Alaska Natives to the highest level. The
    IHS provides comprehensive health care delivery to approximately 2.2
    million American Indian and Alaska Natives through 26 hospitals, 59
    health centers, 32 health stations, and nine school health centers.
    Tribes also provide healthcare access through an additional 19
    hospitals, 284 health centers, 163 Alaska Village Clinics, 79 health
    stations, and eight school health centers.
        Providing quality healthcare is our highest priority. We share the
    urgency of addressing longstanding systemic problems highlighted in the
    February 2017 GAO High Risk Report. I would like to describe for you
    how we are addressing these challenges and highlight examples of recent
    progress.
    Enterprise Risk Management Program
        IHS has strengthened its Enterprise Risk Management (ERM) Program,
    which closely aligns our Risk Profile to our activities under the
    Federal Manager's Financial Integrity Act (FMFIA). A key element of the
    FMFIA, in addition to maintaining financial integrity, is providing
    annual assurance to the Secretary and the Congress that programs are
    effective and meet their objectives. The GAO High Risk Report
    recommendations have been directly incorporated into our ERM work for
    2017. All senior executives in IHS have been directly involved in
    national risk assessment discussions with a focus on effective risk
    mitigation planned for all executives and managers in 2017.
        IHS has dedicated sufficient resources to ensure that we have the
    needed expertise in IHS Headquarters to lead and oversee a successful
    risk management approach to improvement in all program areas on the GAO
    High Risk Report. In concert with closer attention to unimplemented
    recommendations from GAO, we are also intensifying our efforts to close
    out open Office of Inspector General (OIG) recommendations. In April
    2017, IHS successfully closed three long-standing OIG open
    recommendations, related to improvements needed in the IHS Behavioral
    Health Program. IHS has made progress in establishing and increasing
    partnerships within the agency, improved collaborations with other
    federal agencies and tribal organizations, and extensive training for
    program staff to ensure sustainability.
        IHS has increased senior management attention and priority on prior
    GAO recommendations related to management oversight of Indian health
    care and is implementing many positive changes. We are using the GAO
    findings and recommendations to inform our strategic and tactical
    planning efforts.
    Third Party Revenue
        IHS has diligently worked to improve access to care for our
    beneficiaries through outreach, education and enrollment activities
    that has resulted in higher total third party collections. We saw a 21
    percent increase in total Medicaid reimbursements and a 28 percent
    increase in total collections from private insurers from FY 2012 to FY
    2016. Another result of enrollment activities is to increase patient
    access to care by having third party payers cover care provided outside
    of the Indian health system for eligible beneficiaries. Also, in all
    IHS areas, we have programs that are able to purchase health care
    beyond the medical priority I.
    Realignment and Reorganization
        IHS is exploring ways to realign performance accountability to
    strengthen both field operations and headquarters oversight
    responsibilities by setting clear senior executive expectations, and
    establishing clearer lines of accountability. We also want to
    strengthen executive leadership accountability for accomplishing the
    objectives of the priorities of IHS that will result in improvement of
    the quality of health care provided.
    Quality Framework
        IHS is strongly committed to assuring that all its hospitals and
    clinics have quality-focused compliance programs. In partnership with
    the HHS Executive Council on Quality Health Care, IHS developed a
    strong Quality Framework (QF) that is now being implemented. We
    developed the QF by assessing current IHS quality policies, practices,
    and programs, incorporating standards from national experts, consulting
    with tribal leaders, and including best practices and expertise from
    across the IHS system of care, as well as leveraging quality
    specialists across HHS. The core elements are:

        Strengthening Organizational Capacity to Improve Quality of
            Care and Systems,

        Meeting and Maintaining Accreditation for IHS Direct
            Service Facilities,

        Aligning Service Delivery Processes to Improve Patient
            Experience,

        Ensuring Patient Safety, and

        Improving Transparency and Communication Regarding Patient
            Safety and Quality to IHS Stakeholders.

        We established the position of Deputy Director for Quality Health
    Care as part of the agency's senior leadership team to provide a
    national focus for advising the IHS director and providing leadership
    and guidance to the field on all aspects of assuring quality health
    care. Continuing the implementation of the strategic QF at all levels
    of IHS and in partnership with Tribal/Urban Indian organization
    partners is a key priority of this position. This includes oversight of
    critical quality improvement strategies related to accreditation/
    certification, patient safety, and quality care.
    Quality Improvement Initiatives
        We have made great progress in the past few months. On April 28th,
    IHS finalized a contract to purchase software for a National Provider
    Credentialing System, with a plan to roll out the system in four pilot
    IHS areas in July 2017 and a plan to implement across the other IHS
    areas by the end of 2017. The credentialing policy has been updated,
    and is the final stages of clearance. IHS plans to release a request
    for proposals for a single accrediting organization for IHS hospitals
    by July 2017. To help hospitals maintain accreditation, IHS established
    a formal partnership with our sister agency, the Centers for Medicare &
    Medicaid Services (CMS), through a contract to support best health care
    practices and other organizational improvements for IHS federally-
    operated hospitals that participate in the Medicare program.
        IHS hospitals can partner with CMS, which is supporting a Quality
    Innovation Network--Quality Improvement Organization to support, build,
    and redesign, if needed, their hospital operating infrastructure in
    order to provide high quality health care services. Under this
    partnership, IHS hospitals are able to focus on improving leadership
    and staff development, data acquisition and analytics, clinical
    standards of care, and quality of care related to the Medicare program.
        In addition, IHS is developing a performance accountability
    dashboard and related metrics to support Headquarters' oversight and
    monitoring functions. Earlier this month, pilot testing began for a
    system to collect standardized information on patient experience with
    care, using tablet devices. Workgroups are also finalizing standard
    setting for patient wait times and their measurement, and minimum
    standards for hospital Governing Board meetings. Beginning with the
    Great Plains Area, IHS is pilot testing a leadership coaching and
    mentoring program to strengthen organizational capacity to improve
    quality and governance.
        Effective medical equipment is vital to patient safety and quality
    care. In June 2016, IHS established a new policy to ensure critical
    medical equipment used at IHS facilities is properly maintained and
    reliable. Additionally, we mandated the use of a computerized system in
    all Federal health facilities to inventory medical equipment and
    provide other information about longevity and reliability. As
    implementation continues, we expect to see improved management of our
    medical equipment inventory to ensure outdated and non-functioning
    equipment is replaced in a timely manner.
    Workforce Development
        One of the most difficult challenges for IHS remains recruiting and
    retaining highly skilled administrators and physicians in rural and
    remote areas. To make a career in IHS more attractive to modern health
    care practitioners and health care administrators, IHS is implementing
    various strategies to increase recruitment and retention. To share a
    few examples, IHS has implemented a senior executive search committee
    process for recruiting highly qualified executives. Search committees
    are made up of IHS leadership and tribal partners who are charged with
    candidate outreach, assessment, and vetting. Through this new process,
    the IHS is more widely advertising vacancies through Federal, State,
    and non-profit partners, and is actively seeking additional venues to
    attract a diverse applicant pool of qualified candidates.
        IHS also has partnered closely with the Office of the Surgeon
    General to increase the recruitment of Commissioned Corps officers to
    provide management and clinical services throughout the IHS. The
    Commissioned Corps is offering expedited commissioning to applicants
    who commit to service in an IHS facility with critical staffing needs.
    In addition, the IHS and the Health Resources and Services
    Administration continue to work together to make the National Health
    Service Corps (NHSC) more accessible to fill health professional
    vacancies. This allows IHS facilities to recruit and retain primary
    care providers by using NHSC scholarship and loan repayment incentives.
    As of April 2017, 472 NHSC loan repayment and 21 NHSC scholars have
    entered our workforce in IHS and tribal facilities.
        These examples demonstrate that IHS is taking its challenges
    seriously, and is continuing to take assertive and proactive steps to
    address them. Thank you for your commitment to improving quality,
    safety, and access to health care for American Indians and Alaska
    Natives. I will be happy to answer any questions the Committee may
    have.

        The Chairman. Thank you, Admiral Buchanan.
        I will turn now to Director Dearman.

         STATEMENT OF TONY DEARMAN, DIRECTOR, BUREAU OF INDIAN
               EDUCATION, U.S. DEPARTMENT OF THE INTERIOR

        Mr. Dearman. Good afternoon, Chairman Hoeven, Vice Chairman
    Udall, and members of the Committee.
        Thank you for the invitation to appear today to provide a
    statement on behalf of the Bureau of Indian Education and its
    recent designation on the Government Accountability Office High
    Risk Report.
        I am Tony Dearman, an enrolled member of the Cherokee
    Nation, and the BIE Director. Prior to becoming the BIE
    Director in November 2016, I served as Associate Deputy
    Director for Bureau-operated schools, Education Line Officer,
    Superintendent of Riverside Indian School, a principal and
    Science teacher at Sequoyah High School.
        Sequoyah High School has had more than 60 students receive
    the Gates Millennium scholarship over the past 15 years. At
    Riverside Indian School, where my daughter attends, we
    effectively built cross-agency and local partnerships to
    address the varying needs of our students.
        The successes my schools achieve require transparency,
    collaboration and dedication by everyone. In my short time as
    Director, I, alongside my leadership team, have been working to
    bring the same focus to BIE.
        In February, the GAO released its High Risk Report
    designating BIE as a high risk agency. In three separate
    reports dating back to 2013, the GAO provided 13
    recommendations to improve the Indian Affairs management of BIE
    schools.
        As of 2017, we have implemented three recommendations. We
    should have addressed these issues when they were first
    recommended by the GAO and I realize this lapse. I take full
    responsibility for these outstanding items on behalf of the
    agency.
        I am working with our senior leadership team within BIE as
    well as Indian Affairs, the Secretary's office and the GAO to
    ensure we address the outstanding recommendations. Our goal is
    not simply to close out the GAO recommendations but to utilize
    GAO reports as a road map for BIE to establish and maintain
    comprehensive policies and procedures that ensure
    accountability and provide long term organizational stability.
        Regarding GAO 13-774, we have implemented recommendations
    two, three and five which includes developing a communications
    strategy, appointing members to the BIE Department of Education
    Committee and revising a strategic workforce plan.
        We are continuing to assess the previous work while also
    working to implement recommendations one and four which are to
    develop documented decision-making procedures and a strategic
    plan. We plan to implement the remaining recommendations by the
    close of 2018.
        Regarding GAO-15-121, our work addressing these
    recommendations has been insufficient to date. We are moving
    forward to implement the report's four outstanding
    recommendations, including the creation of a comprehensive
    workforce plan, information sharing and financial oversight
    policies, as well as a risk-based monitoring system. To that
    end, we plan to complete the work on Recommendations 1 and 2 no
    later than the close of 2018 and Recommendations 3 and 4 by the
    middle of 2019.
        Regarding GAO-16-313, for Recommendations 1 and 2, we
    worked with the Bureau of Indian Affairs to implement a safe
    schools audit that was completed at all BIE-funded schools in
    2016. We must ensure the focus on completion does not detract
    from the quality of inspections.
        In addition, coordination and training is still needed to
    ensure sufficient work and follow up to which we are committed.
        With regard to Recommendations 3 and 4, we are conducting
    ongoing staff training, as well as working with Indian Affairs
    to provide support for school safety committees. Our agencies
    are working to produce formal policies and procedures to
    address shortcomings identified by a recently-formed
    interagency workgroup.
        Members of the Committee, thank you for the opportunity to
    present testimony today. While the designation as a high risk
    agency is a difficult matter to address, please know that I am
    not naive when I say the GAO's recommendations provide a
    concrete map toward sustained improvement.
        I appreciate the oversight this Committee is providing, as
    well as the expertise from GAO to help BIE address longstanding
    issues to better support Indian students. The GAO has laid out
    the tools for improvement. Now it is incumbent upon me and the
    rest of us at BIE to implement their guidance which will make
    us stronger, effective and accountable.
        There are great employees bureau-wide who wake up excited
    every day to improve a child's life, a child who, like my
    daughter, has all the potential to succeed given the right
    tools.
        Thank you for your time and I would be honored to answer
    any of your questions.
        [The prepared statement of Mr. Dearman follows:]

        Prepared Statement of Tony Dearman, Director, Bureau of Indian
                   Education, U.S. Department of the Interior
        Good afternoon Chairman Hoeven, Vice Chairman Udall, and Members of
    the Committee. Thank you for the invitation to appear today to provide
    a statement on behalf of the Bureau of Indian Education (BIE) and its
    recent high risk designation on the Government Accountability Office
    (GAO) High Risk Report (GAO-17-317 High Risk Series).
        I am Tony Dearman, a member of the Cherokee Nation, and the BIE
    Director. Prior to becoming the BIE Director in November 2016, I served
    as Associate Deputy Director for Bureau-operated schools, overseeing 17
    schools, four off-reservation boarding schools, and one dormitory.
    Before that, I served as superintendent of Riverside Indian School
    located in Anadarko, Oklahoma, and principal of Sequoyah High School in
    Tahlequah, Oklahoma. During my service at the school level, my
    leadership team worked to ensure our students not only received a
    quality education but also had the opportunity to receive holistic
    support.
        Today, Sequoyah High School is a first preference among Native
    students. In fact, more than 60 students who attended have gone on to
    receive Gates Millennium scholarships over the past 15 years. The
    competitive scholarship is based on a minimum 3.5 grade point average,
    community service hours, leadership experience, and written essays. At
    Riverside Indian School, we effectively worked with 75 different Indian
    tribes representing approximately 500 students from 23 states. To
    address the varying needs of our students, such as behavioral and
    mental health support services, we built partnerships with the Indian
    Health Service, local emergency medical services, and law enforcement
    to make sure students and staff were in a safe school environment.
        My passion has always been supporting our students at the local
    level, and I am honored to serve them in this new capacity, utilizing
    my knowledge of how our schools function, the issues students face, and
    the support they need from BIE to create success system-wide. The
    successes my schools achieved required transparency, collaboration, and
    dedication by everyone. In my short time as Director, I have been
    working to bring that same focus to BIE and have worked with the senior
    leadership team to expand the culture that served us so well at the
    school level.
        However, as highlighted in the GAO reports, much work remains. We
    have prioritized the GAO recommendations and are addressing these
    issues head on. The BIE team views the GAO's reports as a constructive
    tool to improve our agency and help the students for whom we are
    committed to serve. As such, I will provide you an update detailing the
    following areas:

            1. GAO High Risk Status for BIE

            2. GAO Recommendations

            3. GAO Recommendations Status & BIE Next Steps

    Bureau of Indian Education
        BIE supports education programs and residential facilities for
    Indian students from federally recognized tribes at 183 elementary and
    secondary schools and dormitories. Currently, the BIE directly operates
    53 schools and dormitories and tribes or tribal school boards operate
    the remaining 130 schools and dormitories through grants or contracts.
    In total, BIE-funded schools serve approximately 48,000 K-12 American
    Indian and Alaska Native students and residential boarders.
    Approximately 3,400 teachers, professional staff, principals, and
    school administrators work to support BIE-operated schools.
        BIE faces unique and urgent challenges in providing a high-quality
    education. As highlighted by GAO, a lack of consistent leadership--
    evidenced by the BIE's more than 35 directors since 1979--and the
    absence of regular and consistent strategic planning have limited the
    BIE's ability to improve its services.
    GAO High Risk Status for BIE
        In February, the GAO released its High Risk Report (GAO-17-317 High
    Risk Series) designating BIE as a high risk agency. The GAO highlighted
    the following persistent weaknesses noted in prior reports that inhibit
    the agency from fulfilling its mission to effectively serve Indian
    students:

        Indian Affairs' oversight of school safety and
            construction, as well as how BIE monitors the way schools use
            Interior funds;

        The impact of limited workforce planning in several key
            areas related to BIE schools affects service delivery;

        The effects of aging BIE school facilities and equipment
            and how such facilities contribute to degraded and unsafe
            conditions for students and staff; and

        How the lack of internal controls and other weaknesses
            hinder Indian Affairs' ability to collect complete and accurate
            information on the physical conditions of BIE schools.

        In three separate reports dating back to 2013, the GAO provided 13
    recommendations to improve Indian Affairs' management of BIE schools.
    As of 2017, eleven of GAO's recommendations remain open. As the BIE
    Director, I am committed to addressing these outstanding items. To that
    end, I am working with our senior leadership team within BIE as well as
    with Indian Affairs, the Secretary's office, and our colleagues at the
    GAO to ensure that BIE systematically and comprehensively addresses
    each outstanding recommendation as expeditiously and effectively as
    possible.
        My goal is not simply to address and close out GAO recommendations,
    but to utilize the outlined recommendations as a roadmap for BIE to
    establish and maintain comprehensive internal policies and procedures
    that support service delivery, ensure accountability, and provide
    organizational stability no matter who is leading the agency.
    GAO Recommendations: Status & BIE Next Steps
        In the past few years, BIE planned, consulted on, designed, and
    implemented a complex, multifaceted, bureau-wide reorganization. In
    February 2016, the Department of the Interior directed BIE to move
    forward with Phase I of its reorganization, with the agency committing
    considerable time, energy, and resources to carry out the directive.
    Simultaneously, considerable turnover within BIE senior leadership
    reduced capacity and focused BIE's attention on day-to-day service
    delivery rather than addressing critical, long-term organizational
    improvement strategies highlighted in GAO reports. BIE has now
    prioritized resources and critical personnel to refocus efforts to
    address the longstanding issues outlined in GAO reports that will,
    ultimately, improve our service delivery to Indian students.
        In November 2016, the BIE filled several key positions that have
    been tasked with serving on an internal working group focused on
    evaluating all outstanding GAO recommendations as well as BIE's past
    GAO closure submissions. The team completed its analysis in early 2017
    and reported its findings and recommendations to BIE leadership in mid-
    March. Based on the information received, BIE leadership is not
    satisfied with the quality and timeliness of the work to date, and
    recognizes the shortcomings and the need for each GAO recommendation to
    be reexamined and properly addressed.
        As described below, the BIE is currently working to complete the
    actions recommended in each of these three GAO reports. BIE leadership
    has identified and tasked specific staff to address each outstanding
    recommendation in a holistic and inclusive manner that creates buy-in
    and collaboration throughout the BIE and with staff across Indian
    Affairs. Further, BIE senior leadership looks forward to coordinating
    with GAO as the agency works to implement the recommendations outlined
    in this report.
    GAO Recommendations
        GAO-13-774-INDIAN AFFAIRS: Better Management and Accountability
    Needed to Improve Indian Education (September, 2013).

        GAO made five recommendations:

            I.) Develop and implement decisionmaking procedures which are
            documented in management directives, administrative policies,
            or operating manuals;

            II.) Develop a communication strategy;

            III.) Appoint permanent members to the BIE-Education committee
            and meet on a quarterly basis;

            IV.) Draft and implement a strategic plan with stakeholder
            input; and

            V.) Revise the BIE strategic workforce plan.

        BIE has completed implementation of recommendations two, three, and
    five, which includes development of a communications strategy,
    increased collaboration with the Department of Education through
    several mechanisms, including a BIE-ED Committee that meets every other
    week (rather than just quarterly) and that has proven to be even more
    responsive and effective than the quarterly one addressed in the
    original GAO recommendation, and revision of a strategic workforce
    plan, respectively. BIE will assess the effectiveness of its
    implementation of GAO's recommendations in an effort to continually
    improve BIE's operations. Currently, BIE is working to implement
    recommendations one and four, which are to develop documented
    decisionmaking procedures and a strategic plan, respectively, and
    partnering with GAO to clear them. BIE plans to implement fully the
    remaining recommendations contained in GAO-13-774 by 2018.
        Recommendation I--BIE, working cooperatively with leadership within
    Indian Affairs and pertinent stakeholders, has tasked an internal
    working group with evaluating the GAO recommendations. That working
    group will draft a formal, written decisionmaking policy and
    procedures, to be completed by the end of 2018.
        Recommendation IV--BIE, working cooperatively with leadership
    within Indian Affairs and pertinent stakeholders, has reviewed the
    strategic plan submitted to GAO in September 2016 and has determined
    the quality of work as unsatisfactory, both for the purposes of closing
    recommendation four and for working as a functional tool intended to
    guide the organization in achieving its mission. At the close of this
    review, BIE immediately began the process of planning and drafting a
    revised strategic plan. On March 8, 2017, BIE conducted a senior leader
    strategic planning exercise and followed that with an April 11, 2017
    all-leaders strategic planning conference convening local, regional,
    and central office leadership to determine paths forward. BIE revised
    its mission and vision statement as well as its strategic goals
    identified at the end April 2017 and will hold follow-up leadership
    meetings in late May and June.
        BIE has also partnered with external organizations such as the
    Council of Chief State School Officers--a nonpartisan, nationwide,
    nonprofit organizational leader that supports State Educational
    Agencies in serving their schools and students--to provide expertise
    and best practices in developing a sound strategic plan as well as
    creating a functional action plan for implementing an accurate system
    of progress measurement once the strategic plan is implemented. BIE
    expects to have the strategic plan completed, published publicly, and
    fully implemented by no later than the end of 2018.
        GAO-15-121-INDIAN AFFAIRS: Bureau of Indian Education Needs to
    Improve Oversight of School Spending (November, 2014).

        GAO made four recommendations:

            I.) Develop a comprehensive workforce plan;

            II.) Implement an information sharing procedure;

            III.) Draft a written procedure for making major program
            expenditures; and

            IV.) Create a risk-based approach in managing BIE school
            expenditures.

        In addition to GAO-13-774, BIE is continuing its work to implement
    GAO's four recommendations contained in GAO-15-121. To that end, the
    BIE plans to complete its work with respect to recommendations one and
    two no later than the close of 2018 and recommendations three and four
    by the middle of 2019.
        Recommendation I--BIE, working cooperatively with leadership within
    Indian Affairs and pertinent stakeholders, has tasked an internal
    working group with evaluating the GAO recommendations. That working
    group will draft a comprehensive workforce plan that is aligned with
    the BIE strategic plan, to be completed in 2018.
        Recommendation II--BIE, working cooperatively with leadership
    within Indian Affairs and pertinent stakeholders, has tasked an
    internal working group with evaluating GAO recommendations. That
    working group will also draft a comprehensive, interdepartmental
    coordination and information-sharing policy to ensure accountability
    and effectiveness in operations and service delivery.
        Recommendation III--BIE, working cooperatively with leadership
    within Indian Affairs and pertinent stakeholders, has started drafting
    and implementing a comprehensive financial oversight policy that
    establishes effective risk management procedures that will prevent,
    detect, and respond to fraud, including improper payments, based on
    GAO-established practices and OMB guidance. To accomplish this goal,
    the BIE will prioritize hiring staff with applicable experience and
    skills and we are already partnering with outside groups that can
    provide the much-needed technical assistance and expertise.
        Recommendation IV--BIE, working cooperatively with leadership
    within Indian Affairs and pertinent stakeholders, is drafting and
    implementing a risk-based monitoring methodology that is in compliance
    with the Fraud Reduction and Data Analytics Act of 2015 (Public Law
    114-186). BIE is currently seeking external working partnerships to
    provide much-needed technical assistance and expertise.
        GAO-16-313-INDIAN AFFAIRS: Key Actions Needed to Ensure Safety and
    Health at Indian School Facilities (March, 2016)

        GAO made recommendations:

            I.) Ensure that all BIE schools are inspected as well as
            implement a plan to mitigate challenges;

            II.) Prioritize inspections at schools where facility
            conditions may pose a greater risk to students;

            III.) Develop a plan to build schools' capacity to promptly
            address safety and health problems with facilities and improve
            the expertise of facility staff to maintain and repair school
            buildings; and

            IV.) Consistently monitor whether schools have established
            required safety committees.

        Finally, BIE is working to implement GAO's four recommendations
    contained in GAO-16-313.
        Recommendations I and II--BIE has worked with the Bureau of Indian
    Affairs (BIA) to address the first recommendation by implementing a
    Safe School Audit. In 2016, the audit was successfully completed at all
    BIE-funded schools and the agencies started the process of implementing
    corrective measures for identified deficiencies. However, we must
    ensure that the focus on completion does not detract from the quality
    of inspections, so additional coordination and training is still needed
    to ensure quality work, and most importantly, the necessary follow-up
    and technical assistance is provided.
        Recommendations III and IV--BIE is conducting ongoing staff and
    administrator training and is working with BIA to provide ongoing
    support for school safety committees through school inspections. We
    recognize that reporting for such activities is inadequate, so BIE is
    working with BIA to provide oversight of such inspections. The agencies
    are working to produce formal policies and procedures to address
    shortcomings through a recently formed inter-agency workgroup that is
    meeting throughout the summer to ensure coordination of activities as
    well as formalize long-term policies and procedures. The agencies, in
    coordination with other offices within Indian Affairs, are scheduled to
    meet in late May to coordinate activities to address these
    recommendations.
    Conclusion
        Chairman Hoeven, Vice Chairman Udall, and Members of the Committee,
    thank you for the opportunity to present testimony today. While the
    designation as a high risk agency is a difficult matter to address,
    please know that the BIE is committed to addressing GAO's
    recommendations in order to achieve sustained improvement.
        There are great employees Bureau-wide--from Central Office staff,
    to Education Resource Centers, to school teachers and cooks--who wake
    up excited every day to improve a child's life. But, there are also
    impediments to improvement and obstacles that hinder coordination and
    positive reform, as highlighted by GAO. Now, it is incumbent upon me,
    and all of us at BIE, to implement these recommendations.
        The BIE looks forward to working with the Members of this
    Committee, the GAO, and our partners across Interior as we address
    these recommendations. Thank you for your time, and I would be honored
    to answer any questions you may have.

        The Chairman. Thank you, Director Dearman.
        I would like to thank all of the witnesses again.
        At this time, I would like to turn to Senator Franken and
    ask if it would be okay if we do some questions?
        Senator Franken. I am sorry, Mr. Chairman. I was not
    listening.
        The Chairman. I was wondering since you objected to
    questions earlier, I am wondering if it is okay if we do some
    questions now?
        Senator Franken. No objection, Mr. Chairman.
        The Chairman. Thank you.
        We will start with Senator Cortez Masto.

               STATEMENT OF HON. CATHERINE CORTEZ MASTO,
                        U.S. SENATOR FROM NEVADA

        Senator Cortez Masto. Thank you, Mr. Chairman and Ranking
    Member, for this important discussion.
        My first question is for Melissa. Just so I have an
    understanding of this since I am new to the Committee. I am
    from Nevada and represent the great State of Nevada.
        This High Risk Report is put out because of the 41
    auditing, I do not know what you call it, violations or
    concerns that you have and the 39 that were not implemented, it
    is because these concerns were noted over two years ago or
    three years ago? How long has this been sitting out there
    before they are put in a High Risk Report like this?
        Ms. Emrey-Arras. That is an excellent question. It is more
    about the concerns we have identified than the number of
    recommendations that have yet to be implemented or how long it
    is taking them to be implemented. The concerns about public
    health and safety, critical services to tribes and their
    members, and the extent of the issues we found in these three
    areas led to our placing these three areas on the High Risk
    List.
        It does not mean that they have to complete each and every
    recommendation to get off the list but there needs to be
    demonstrated progress to show there is not significant concern
    for public safety, for example.
        Senator Cortez Masto. That is helpful because I just need
    to know, for the other members, were you just notified of this?
    How much time have you had to try to address these concerns? I
    am curious about your level of resources to address these
    concerns considering that there is a hiring freeze that is on
    and whether that has an impact on how you can or are able to
    address the contentions that are before you?
        Why don't we go down the line? I am curious to hear your
    thoughts on that.
        Mr. Black. A number of the reports, as Melissa mentioned
    earlier, date back a couple of years and we have been
    continually working on a number of those recommendations in
    both areas of BIE and Indian education, as well as Indian
    energy.
        Some of the stuff I identified in my testimony regarding
    Indian energy related to the service center, our refocusing the
    Indian Energy Mineral Steering Committee and some of those
    items that are efforts on our part.
        We have recognized a lot of those shortcomings. We are
    working hard to identify not only the shortcomings we have but
    methods, processes, procedures and streamlining that we can do
    to fully address GAO's recommendations.
        Senator Cortez Masto. Thank you. Because I have a short
    amount of time, I would like to hear from all of you but also a
    timeframe. Do you have a timeframe on when you intend to
    address these concerns?
        Mr. Black. Within our response to GAO, we identify
    timeframes for each and every one of the recommendations, yes.
        Mr. Buchanan. Thank you, Senator.
        We recognize how important the GAO recommendations are. I
    think we have been on it for about six years. We have had
    various recommendations that we have been providing. We take it
    seriously. We use the GAO recommendations as another
    opportunity to improve our health care service delivery.
        Thank you.
        Mr. Dearman. Thank you, Senator.
        Our GAOs actually go back to 2013. I have been on the job
    for six months. We have prioritized the GAO report and we are
    putting together workgroups to implement the recommendations
    from the GAO.
        Also, in doing this, we have created interagency workgroups
    because in our system, the BIE system, we have to have
    collaboration with Indian Affairs as well because there are so
    many parts of our schools where we do not have control.
        We are looking forward to working with Indian Affairs and
    implementing the recommendations.
        Senator Cortez Masto. I understand the Federal Government
    moves slowly but this is way too slow. It is unacceptable.
    These are serious contentions and it is impacting people in
    these communities.
        I would hope that you are seriously willing to work with us
    in Congress to address these concerns in a timely manner. I
    would ask that each one of you be willing to do so.
        I appreciate you coming here and being willing to come
    forward and talk about this but it needs to be addressed in a
    timely manner.
        Thank you for being here.
        The Chairman. Senator Heitkamp.

                   STATEMENT OF HON. HEIDI HEITKAMP,
                     U.S. SENATOR FROM NORTH DAKOTA

        Senator Heitkamp. Mr. Chairman and Vice Chairman, thanks so
    much for calling this meeting.
        I am going to pick up where Senator Cortez Masto left off.
    We are struggling every day in Indian Country in this country
    with poor schools, poor health care, poor law enforcement, and
    lack of housing. We cannot afford not to be absolutely the best
    at what we do. We cannot afford to wait six years to address
    the issues that GAO has set forth.
        We need to do a better job on this dais, I think, holding
    you all accountable and knowing that this matters. This work
    matters that you do. It is a matter, in some cases, of life and
    death. It certainly is a matter of the future of children
    living in Indian Country.
        I am not going to go maybe beyond that but I want you to
    know that we intend to take this very seriously. We want to see
    better results. I think anyone who has sat through these
    hearings in the last Congress knows we are particularly
    concerned about the quality and the response at Indian Health.
    It needs to be better.
        All of this, as we work through these programs, it is hard
    to fight for additional funding when there appears to be a lack
    of accountability for the funding you already get. I spend a
    lot of time reviewing GAO reports in our role on the Homeland
    Security and Government Affairs Committee. I think in many
    cases, we do not take these reports as seriously as we should
    but it is particularly concerning to me in Indian Country.
        Rather than go through a series of questions about when and
    if, just know we are going to call on you to give us reports.
    It is not going to wait until the next hearing. We are going to
    be on this.
        If you need more resources, if that is a problem, then you
    need to say it. You cannot just keep doing what you are doing
    and expect the same result. We have the lowest rates of high
    school graduation in Indian Country, the highest rates of
    infant mortality, and the highest rates of diabetes. We could
    go on and on and on. That is not a formula for success going
    forward.
        You have an obligation not only to the taxpayers and people
    of this country. You have a treaty obligation to meet these
    standards under treaty obligations. Just know I know we are
    turning page, we have a new Administration coming in, but we
    are going to be looking for a much higher level of
    accountability. We are going to be asking our friends at GAO to
    continue to participate to change the outcomes.
        Thank you, Mr. Chairman.
        The Chairman. Thank you, Senator Heitkamp.
        Ms. Emrey-Arras, you found as far as wait times at IHS
    facilities, patients could wait six weeks for an initial exam
    with a family medicine physician and up to three to four months
    for an initial exam by an internal medicine physician.
        Why is it taking so long? Why isn't it getting fixed?
        Ms. Emrey-Arras. For that question, I will defer to my
    colleague, Ms. Kathy King who is the director for that work.
        Ms. King. Good afternoon, Senator.
        I think one of the key problems is that IHS headquarters
    delegates responsibility for all of these matters to the area
    offices and then they do not have proper oversight, so there is
    not feedback coming from the area offices back to headquarters
    about what is going on.
        The Chairman. Admiral Buchanan, how are you going to fix
    that and when?
        Mr. Buchanan. We acknowledge the challenges and the
    frustration of the Committee. We can do better and will do
    better. We have implemented what we have been referencing as
    the quality framework going forward. I mentioned in my
    testimony the Enterprise Risk Management System providing
    metrics.
        Specifically related to our quality framework, we have
    identified five priority areas, one of those being wait times
    and making sure that our patients and patient safety is top
    priority. That is what we are looking for in the Indian Health
    Service.
        Timelines, we have timelines specifically related to our
    Enterprise Risk Management System. The next step is, we have
    identified all our high risk areas within the agency by
    bringing in all our office directors and area directors and
    having them participate in this risk management system and
    identifying those risks.
        The next step is to develop action plans going forward. I
    look to have those action plans completed by July 2017.
        The Chairman. Meaning, you have the standards and have them
    implemented by when?
        Mr. Buchanan. I am sorry. Let me clarify.
        The Chairman. You have established the standards and then
    you have to implement them. You have established the standards
    and when do you expect to have them established? If you have
    not, then when do you expect to have them implemented?
        Mr. Buchanan. Specifically, for the wait times, we are
    looking at all of our best practices that we have been
    utilizing across the agency. We are doing measurements to see
    what those standards should be.
        Then once we hit those standards, we will do some pilot
    testing to move that out. I cannot give you a specific date on
    when that will roll out.
        The Chairman. You need to. This has gone on too long
    already. We need to know when you are going to have your
    standards, when you are going to have them in place, and how
    are you are going to follow up to make sure they are adhered to
    because then we need to have the GAO go back and make sure it
    is getting done.
        I think this goes to what both Senator Cortez Masto,
    Senator Heitkamp, and I am sure the Vice Chairman will ask you
    about it, as well as other members of this Committee. We need
    to be setting some timelines here to get it done, we need to
    track the progress, and we need to have you back in front of us
    to know it is getting done.
        We cannot continue to have this not get done. That is what
    we are looking at here. That is why you are in the high risk
    category because it is not getting done. We are going to agree
    to get it done, we are going to agree on some timelines, and
    agree to some follow up so that we know this stuff is getting
    done.
        If you do not have those timelines, I want you to come
    back. I would ask that you come back to the Committee with
    those timelines. I would ask that the GAO come back as well and
    we will set it up for follow up. We are going to track this.
        Mr. Buchanan. Yes, sir, we are definitely willing to track
    it. We have implemented some metrics to start the tracking
    process once these items and these workgroups establish the
    timeframes we want to monitor.
        That is not only at the local level, but we are bringing it
    from the headquarters to area, all the way through the service
    units. We will have timelines.
        The Chairman. By when do you suppose you could get back to
    us with an indication of when you will have the timelines and
    when you are going to have them implemented? You tell me how
    soon you can get back to the Committee on that?
        Mr. Buchanan. By the end of fiscal year 2017.
        The Chairman. That is too long. It needs to be before then.
        Mr. Buchanan. July 2017.
        The Chairman. That is the soonest you think you could do
    it?
        Mr. Buchanan. If I can get it done sooner, I will get it
    done sooner.
        The Chairman. All right.
        Mr. Buchanan. You have my commitment on that.
        The Chairman. Mr. Vice Chairman.
        Senator Udall. Thank you, Chairman Hoeven.
        Senator Cortez Masto asked a question and I do not think I
    heard an answer from some of you. That was on the issue of the
    hiring freeze. Along with several of my colleagues on this
    Committee, I signed a letter to President Trump urging him to
    exempt Indian programs from the February hiring freeze. Now,
    these same programs might feel the effects of the reduction in
    force planned by the President.
        I will come back to Melissa, but my question to each of you
    is did the hiring freeze exacerbate your agency staffing issues
    identified by the GAO?
        Mr. Black. Thank you for the question, Senator.
        The hiring freeze has been lifted at this point in time.
        Senator Udall. I do not want to interrupt you but my
    understanding is you are still bound up in the hiring freeze.
    We have gone out of the time period but are you hiring right
    now?
        Mr. Black. Yes, we are, sir.
        Senator Udall. You are hiring all across the board?
        Mr. Black. Yes.
        Senator Udall. Bureau of Indian Affairs, BIE, IHS, all
    across the board?
        Mr. Black. I cannot speak for IHS, but for BIA and BIE,
    yes, sir, we are able to hire. We are going through a process
    to ensure that we are hiring our highest priorities at this
    time and working through that process.
        Senator Udall. When you say highest priorities, it sounds
    like you are slowing it down some because that is some of the
    stuff I have been hearing within the agencies, that the hiring
    freeze is still impacting hiring. Is it still impacting hiring?
        Mr. Black. Like I said, it is not really a hiring freeze at
    this point. We do have some specific instructions as to how we
    go about hiring. Most of our field locations are able to move
    forward with positions at GS-11 and below. We are identifying
    those other positions to ensure that we are filling the most
    critical positions and that positions are being filled at the
    right locations for the right needs.
        Senator Udall. Thank you. Admiral Buchanan?
        Mr. Buchanan. Thank you.
        We have been recruiting and hiring, so it has not impeded
    our ability to hire at the local level and our service units
    where we are providing patient care.
        Senator Udall. You are up and running now and the hiring
    freeze is not impacting you?
        Mr. Buchanan. Yes, sir.
        Senator Udall. Tony.
        Mr. Dearman. Thank you, Senator.
        The hiring freeze has been lifted as we discussed. We are
    moving forward at the contract education level and our school
    levels. As far as the GAO, with that, we have some very
    resilient staff in our offices and schools. We have been able
    to take the time and actually get arms around the GAO and plan
    to get those implemented.
        Senator Udall. Chairman Hoeven, I think you would join me
    in this. We know, on a bipartisan basis, both in the Bush and
    Obama Administrations, by this point, we usually have senior
    staff in these areas. We do not have them. I do not want to put
    you on the spot in any way.
        Melissa, I really believe it has to do with putting
    accountable people in place at the top, who are there, and will
    be in front of the Committee on a regular basis. They will give
    us the deadlines, the implementation and how they are going to
    get that done. Melissa, could you speak to that, both the
    hiring freeze and having senior staff in place in all of the
    positions? All the people we have in front of us are acting
    people.
        Ms. Emrey-Arras. We have not looked at the hiring freeze
    for this particular work, but I would say the point about
    turnover and stability is really critical. This is something we
    have pointed out previously, that there has been extensive
    turnover in leadership positions which has led, we believe, to
    management challenges, especially at BIE.
        In terms of the hiring, we think it would be helpful to
    guide the hiring with a workforce plan. We have two outstanding
    recommendations to do workforce planning so you know what you
    are hiring for, so you know how many people you need, and you
    need to know what skills they need to have.
        We found BIE folks who were doing reviews of single audits
    who told us they were not accountants, and they did not know
    what they were looking at. Yet they were responsible for
    overseeing school spending. You need to have a workforce plan
    to guide the hiring going forward.
        Senator Udall. Thank you very much.
        I can tell you that constituents of mine who visit
    Washington and have meetings within all of these agencies do
    not feel, at the senior level, there is guidance because folks
    are in an acting position rather than having people in the
    position who are running the departments and doing the things
    that you, the GAO and this Committee wants them to do.
        Mr. Chairman, thank you for your courtesies in allowing me
    to go over a little.
        The Chairman. Senator Cortez Masto.
        Senator Cortez Masto. Thank you. I have one more question
    if that is all right.
        I have heard from my constituents as well. I work very
    closely with them. This extra question comes from a Chairman I
    just had the opportunity to sit down and talk with. It
    addresses Indian Health Service.
        I understand that the Indian Health Service made a mistake
    in overestimating the amount required in Fiscal Year 2017 to
    fully fund contract support cost payments due tribes under self
    determination contracts and self governance compacts.
        I am kind of curious as to what explains this error. How
    much is needed in Fiscal Year 2018 and what assurance can you
    give the Committee that, going forward, your estimates are
    going to be accurate?
        Mr. Buchanan. I do not have that information in front of
    me. I would be happy to submit that for the record.
        Senator Cortez Masto. Thank you. I appreciate that.
        Thank you, Mr. Chairman.
        The Chairman. Thank you, Senator.
        This is for Ms. Emrey-Arras. Are IHS, BIA and BIE able to
    attract the qualified professionals they need? If not, what can
    they do?
        Ms. Emrey-Arras. Let me check with my colleagues to see if
    they have covered that in their areas. It looks like we have in
    the health care area.
        Ms. King. Senator, in the health care area, we have noted
    longstanding vacancies. For example, in the last several years,
    at least four of the area offices said they had several acting
    area directors. This kind of turnover causes problems for the
    agency.
        We have some ongoing work where we are drilling down on
    staffing issues. We hope to be able to have some constructive
    suggestions for the agency.
        The Chairman. Are there any concrete recommendations you
    would have for getting qualified people in key positions?
    Obviously, it starts at the top, as the Vice Chairman said. He
    is right about that. If there other recommendations for getting
    key people into key positions, I think that would be very
    helpful.
        Ms. King. Thank you.
        The Chairman. Secretary Black, the GAO highlights in its
    report on Indian energy that the BIA did not track and review
    response times for energy development documents from tribes.
    That is necessary, of course, if you are going to understand
    what your turnaround time is and whether or not you are being
    responsive.
        My question is, what are you doing to address that? How are
    you setting up some type of process to make sure you are
    tracking those times and giving timely and quality service?
        Mr. Black. Thank you for the question, Senator Hoeven.
        Through our Indian Energy Minerals Steering Committee, we
    have brought together a group of experts in the field to
    identify identifiers in the key fields that we need to be able
    to track to better identify where we are in processing energy-
    related documents, whether they be rights-of-way,
    communitization agreements, or applications for a permit to
    drill.
        We also are working with our partners over at BLM, who have
    the responsibility for APDs to ensure we are coordinating with
    them and identifying any roadblocks in that process that are
    hindering us.
        For the communitization agreements, we recently issued a
    national policy memorandum that identifies key timeframes and
    stuff in there. We are also developing right now a Google
    platform tracking system for all of the CAs that we are
    processing out there in Indian Country.
        That allows us to identify not only where we are in the
    process and how many we have backlogged, but any areas where we
    are seeing some major holdups or anything like that so we can
    better address those as we move forward. We will be doing that
    with all of our different things.
        Leases, we are going to work with our TAAMS system to
    incorporate different fields in there that could be as simple
    as knowing when the lease comes into our office, when it gets
    processed, and when the NEPA activities are completed, so we
    can track them all the way through the process and identify any
    areas where we see holdups or roadblocks.
        The Chairman. What is your timeline for getting those
    things in place?
        Mr. Black. I cannot remember exactly. I want to say we are
    working toward those for either the close of 2017 or sometime
    after that, but I will get back to you on that.
        The Chairman. You will provide us with the timelines,
    because we are going to invite you back as well to talk about
    it probably no later than the end of July.
        Mr. Black. Okay.
        The Chairman. If you turn your head to your left and gaze
    up, you will see a very nice blanket that was presented to us
    at Cankdeska Cikana Tribal College in North Dakota. I think it
    looks nice there, don't you?
        Mr. Black. It looks great up there, sir.
        The Chairman. They showed us wonderful hospitality at our
    field hearing. I want to commend the president of the tribal
    college and all of her people for the fine job they did and
    express my appreciation to them.
        Mr. Black. Yes, very much so.
        The Chairman. I want to thank you for being there and also
    for your willingness to help on some of the issues we talked
    about.
        Mr. Black. Certainly.
        The Chairman. I would ask Admiral Buchanan, there was one
    recommendation I think IHS disagreed with relative to staffing.
    Of the other recommendations, about 14 recommendations, are
    there any other recommendations the GAO made that you do not
    agree with?
        Mr. Buchanan. We agree with the recommendations and are
    actively working to correct those.
        The Chairman. Thank you. Vice Chairman Udall?
        Senator Udall. Thank you, Mr. Chairman.
        Admiral Buchanan, in your written testimony, you said IHS
    Medicaid reimbursements increased 21 percent since 2012. Then
    you note, ``In all IHS areas, we have programs that are able to
    purchase health care beyond the medical priority 1.''
        We all know beyond medical priority 1. When you have
    medical 1, you are really talking about life and limb, so going
    beyond that is something really good for the community. Exactly
    how many purchased referred care programs are able to recover
    requests beyond the medical priority 1?
        Mr. Buchanan. We are actively providing guidance to our PRC
    programs to make sure patient safety is a premium for us. I do
    not have the exact number in front of me to give you but I
    would be happy to submit that to the record.
        Senator Udall. That would be great.
        Is the 21 percent increase in Medicaid reimbursements
    responsible for the expansion of coverage under purchased
    referred care?
        Mr. Buchanan. The increase?
        Senator Udall. Yes, the 21 percent increase in Medicaid
    reimbursements I quoted that you mentioned in your testimony,
    are those Medicaid reimbursements responsible for the expansion
    of coverage under purchased referred care, PRC?
        Mr. Buchanan. Yes, with that additional savings, we are
    able to increase our PRC access to care and provide more
    services to our patients.
        Senator Udall. Given the numbers in the statements you just
    made, how would rolling back Medicaid expansion impact IHS
    service delivery?
        Mr. Buchanan. I do not have those figures in front of me.
        Senator Udall. You have obviously seen a significant influx
    as a result of Medicaid. If you take that Medicaid money, you
    are going to end up rolling back a lot of the achievements you
    have made, isn't that true?
        Mr. Buchanan. Being a former CEO, we place a premium on
    those third party collections, Medicaid, Medicare and private
    insurance. We also saw some increases in private insurance
    during that time. Focusing on third party collections allows us
    to increase services for our patients.
        Senator Udall. Thank you very much.
        Melissa, what sort of oversight benefits or additional
    management resources usually result from the inclusion in the
    high risk category?
        Ms. Emrey-Arras. When an agency or program area is put on
    the high risk list, we really focus on it. This is something we
    give a lot of attention to. We do a lot of additional work on
    these areas and really try to hold the agencies' feet to the
    fire on making progress.
        Senator Udall. Thank you.
        I also wanted to focus on workforce. Given the high levels
    of leadership turnover at BIE and IHS, one of GAO's
    recommendations for both agencies is to develop contingency and
    succession planning for key positions.
        This question is for BIE and IHS. I apologize, Mr. Dearman,
    you are not acting, so I said that earlier. It is just that the
    two folks here, Mike and Admiral Buchanan, are.
        Mr. Dearman and Admiral Buchanan, how are your agencies
    working to ensure all administrative duties are fulfilled in
    the face of frequent turnover?
        Mr. Dearman. With us being able to go out and hire
    positions, looking at GAO's recommendations, we are moving
    forward in working with our interagency Indian Affairs
    workgroups because there are some functions that we have to
    rely on other agencies through BIA.
        As we transition some of the workforce to us, we have to
    make sure of our staff. An example would be school safety. As
    we inherit school safety, our staff will be trained so there
    will be a transition period.
        We are addressing first and foremost as a priority, the GAO
    recommendations to make sure that we have the personnel and the
    workforce to address the recommendations that have been put in
    place.
        Senator Udall. Admiral Buchanan.
        Mr. Buchanan. We have developed succession plans at
    headquarters and office director level, so we have those in
    place. We are working on creating leadership training academies
    for our senior leaders. We are rotating folks through our
    headquarters office to provide additional training, to mentor,
    coach and make sure they are adequately trained to accept those
    senior level positions.
        Senator Udall. Thank you very much.
        Thank you, Mr. Chairman.
        The Chairman. Senator Franken.
        Senator Franken. Thank you, Mr. Chairman.
        May I suggest that once we finish with our questions that
    the witnesses could repeat their testimony?
        The Chairman. We will take that under advisement.
        [Laughter.]
        Senator Franken. Okay. Thank you.
        Thank you all for your testimony.
        You brought up sort of a follow up, Ms. Emrey-Arras. I am
    curious about this for our oversight as a committee. How does
    this work? We are now saying these are at high risk, energy,
    education and health care. How can we not allow this to go a
    long time and come back with another report like this? How do
    we, as a committee, do our oversight? How does GAO do it? How
    can we best stay on top of you?
        Ms. Emrey-Arras. Thank you for the question.
        I think, as demonstrated so far in this hearing, the idea
    of having agencies provide frequent progress reports to this
    Committee would be an excellent idea; to talk to the agencies
    and have the agencies come up and say, this is where we are in
    implementing these recommendations, these are our dates.
        Some things are just taking far longer than they should.
    For example, having basic written procedures to oversee school
    spending is not something that should take multiple years. Yet,
    that is taking multiple years to have basic instructions on how
    to oversee school spending.
        I would say any kind of additional pressure from this
    Committee to expedite processes would be very much welcomed.
        Senator Franken. Mr. Dearman, would that be welcomed?
        Mr. Dearman. Absolutely. We have taken the GAO
    recommendations and made them a priority, Senator. We are going
    to move forward in getting them implemented.
        Senator Franken. Admiral, I know some people who worked at
    HHS under the Obama Administration who have left since the new
    Administration came in. Some of them might need jobs. They are
    pretty good administrators is what I am saying.
        Right now, IHS has a 20 percent vacancy rate for health
    care professionals, including physicians and nurses. Some of
    the challenges that contribute to the lack of qualified staff
    at IHS facilities include difficulty providing competitive
    salaries, lack of training facilities, lack of suitable
    housing, schools and community resources for health care
    professionals and their families.
        I think you experience the same thing in education. I
    mentioned this in my opening statement. To recruit a doctor or
    a teacher, their spouse is going to be saying, what school are
    my kids going to go to, what health care are my kids going to
    get? There is a sort of continuing cycle.
        Ms. Emrey-Arras, what do you think needs to happen both
    inside and outside of IHS to make IHS facilities places where
    qualified health professionals want to work and live in that
    area? I think the Chairman may have asked that of you a bit
    earlier or something like that.
        Ms. Emrey-Arras. I will defer to my colleague, Kathy King,
    the Director of Health Care Services.
        Senator Franken. Thank you. It is good to see you. Welcome.
        Ms. King. Thank you.
        Senator, we have current work underway looking at that. We
    have heard that the VA has better hiring authorities than IHS.
    That is something we are examining in the course of our current
    work.
        We agree there are some difficulties common in rural areas,
    especially remote rural areas. We are hoping to look at that
    and see if we can find some best practices elsewhere that might
    be applicable to IHS.
        Senator Franken. How much of Indian Country is in remote
    and rural areas?
        Ms. King. I do not have a number right of the top but it is
    a fair amount. Some are also located adjacent to more
    metropolitan areas.
        Senator Franken. Admiral?
        Mr. Buchanan. There are a lot of rural areas. As she said,
    it is hard to recruit in those rural areas. As you referenced,
    it takes a comprehensive approach to bring in those physicians.
    Schools and housing is one of the challenges, definitely in
    trying to put the physician into a location that the next
    shopping area is two and a half hours away. Just to get food is
    a challenge.
        It is hard to recruit. Other facilities or private
    facilities have those same challenges in a rural setting.
        Senator Franken. Can I ask the Admiral a little bit about
    the opioid crisis in Indian Country? How does the IHS
    collaborate with local, State and regional stakeholders to
    create interventions to combat the opioid epidemic?
        Mr. Buchanan. It truly is a challenging situation. It is
    going to take State, IHS and all our partners working together
    to fight this epidemic that is happening. We have been
    educating tribal leaders on what IHS is doing. We are working
    with our partners in BIA to provide certain medications to
    assist with combating the opioid issues. We are looking to all
    partners to address the issue.
        Senator Franken. I hope you will partner with tribes and
    the Indian community to develop effective culturally-based
    interventions.
        Mr. Buchanan. Definitely, sir. We have actually established
    what we are calling the HOPE Charter Committee where we look at
    all these types of issues and come up with recommendations. We
    will definitely be working with tribes going forward.
        Senator Franken. Thank you.
        I am running over my time. Thank you, Mr. Chairman, for
    your indulgence. Thank you for calling this hearing. I hope we
    can do frequent oversight.
        The Chairman. One of the things we talked about is we will
    have them all back probably by the end of July. We did ask for
    some timeframes on responses both in terms of what those
    responses are and implementation. I anticipate that we will
    have all of the witnesses and the GAO back by the end of July
    for a progress report.
        Director Dearman, I brought up one case, a cyber attack,
    where money was taken from one the BIE schools, $1.7 million.
    There was $8 million in the account, so they could have gotten
    even more. Half a million was recovered, so the loss was $1.2
    million. What is being done to prevent that kind of thing
    happening in the future?
        Mr. Dearman. Thank you, Senator.
        We have actually initiated some training. We have to get
    down to the school level. I say we are going back to old
    school. We are going to actually start implementing training
    from the school level up. In the past, central office has
    controlled so much that we have not gotten down into the
    schools.
        It was actually our Performance and Accountability Division
    monitoring program that actually discovered the funds. We have
    implemented a monitoring system that goes in and does
    monitoring from our schools. As we add positions to our
    organizational chart, we will build that even stronger, not
    actually add positions, but hire positions into our
    organization. This will strengthen our ability to go out and
    monitor our expenditures.
        The Chairman. In 2014, the BIE Study Group report
    discovered that approximately 80 tribally-operated BIE schools
    retained approximately a total of $125 million in unspent
    funds. The report cites a unique provision in the tribally-
    controlled schools Act that encourages schools to not spend
    funding they receive from the BIE and the Department of
    Education. What is going on? Why would they not be utilizing
    those funds? Can you explain that and what is being done about
    it?
        Mr. Dearman. What will be done about that, sir, is as we
    increase our organization, when we start bringing on the
    positions within our organization, we are going to provide
    technical assistance with our tribally-controlled schools and
    their tribes to make sure that money is actually spent where it
    needs to go. That is what we can do moving forward.
        The Chairman. Do you have an update on the current amount
    of unspent funds?
        Mr. Dearman. No, I do not, sir.
        The Chairman. You could get back to us with that?
        Mr. Dearman. Yes, we will get back to you.
        The Chairman. And a progress report in terms of what you
    are doing about it?
        Mr. Dearman. Yes.
        The Chairman. That completes my questions for right now.
        Vice Chairman?
        Senator Udall. Thank you, Mr. Chairman.
        Last year, the IHS began an agency-wide systems improvement
    effort now known as the Quality Improvement Framework. Admiral
    Buchanan, what kind of tribal input did the IHS seek when
    designating the framework?
        Mr. Buchanan. Thank you for the question.
        We went through tribal consultation before the framework
    was released in November of 2016.
        Senator Udall. How were the GAO's recommendations accounted
    for in its design?
        Mr. Buchanan. They were taken into account for sure. Some
    of the priorities can be highlighted in those areas. I know the
    Committee is looking for organizational capacity and
    accountability. That is one of the main priorities within the
    framework.
        Senator Udall. Admiral, I know you are in an acting
    position until the IHS director is confirmed. Until then, I am
    concerned that the framework will stall and much needed
    improvements will fail to be implemented.
        Is IHS currently implementing the Quality Improvement
    Framework?
        Mr. Buchanan. IHS is currently implementing the Quality
    Framework but I want to assure you that even though I am in an
    acting capacity, I take that first piece of acting as act and
    do something. That is what we are doing. We are not waiting for
    a person to be confirmed. We are moving forward because we
    cannot wait because it is patients we are seeing. That is the
    focus of everything that we do.
        Senator Udall. How is it working, the Quality Improvement
    Framework?
        Mr. Buchanan. As mentioned earlier, the wait time issue
    brought up earlier, we are addressing that. That is part of the
    Quality Framework, one of the priorities within the framework.
        In my testimony, there were some credentialing initiatives
    that we have undertaken. We made that award and that will be
    rolling out very, very soon. We are using some pilot sites to
    roll that out.
        We are also making sure accreditation of our facilities,
    another piece of the Quality Framework, is being addressed. We
    are specifically working with one organization to accredit our
    hospitals throughout IHS.
        Senator Udall. Admiral, would you recommend to the new
    leadership that the framework continue?
        Mr. Buchanan. Yes, sir, I would. It is a framework that can
    modify and morph over time specific to the needs, a living
    document, but with five priorities in place, it is a good
    framework.
        I want to leave whoever is the confirmed IHS Director a
    working document, a working health care delivery system going
    forward that they can take and move forward with the GAO's and
    OIG's recommendations.
        Senator Udall. Thank you.
        Thank you, Mr. Chairman. Mr. Chairman, are you doing one
    more round?
        The Chairman. No, I am finished.
        Senator Udall. Okay. I just want to do one more question
    with Tony Dearman.
        BIE is in the middle of an administrative reorganization
    set in motion during Secretary Jewell's tenure. Mr. Dearman, as
    I am sure you are aware, Indian Country has concerns with how
    this reorganization is being implemented.
        Would you recommend the reorganization continue as mandated
    or are there changes in the works?
        Mr. Dearman. Thank you, Senator. We are moving forward with
    the reorganization that is in place. We have tried to get out
    and visit with the tribes. I have actually been visiting with
    some of the Lieutenant Governors and Governors of some of the
    Pueblos.
        If there are concerns, we would ask, please contact us and
    we will sit down with people and explain and answer any
    questions. If there are any changes that come along with the
    reorganization, it will be through consultation.
        Senator Udall. How will you engage with tribal stakeholders
    and the GAO to improve BIE's reorganization efforts and
    increase transparency?
        Mr. Dearman. A very good question. As you are aware, not
    one size fits all in our tribal capacities and even in our
    schools. In rolling this out and developing GAO-15-121, we will
    actually be talking to the tribes and looking at different
    situations because it is not just going to cover our BIE-
    operated schools; it has to cover and support our tribally-
    controlled schools as well. It has to cover a wide range of
    different schools, settings and tribes.
        Senator Udall. Melissa, what improvements would GAO make to
    BIE's reorganization efforts?
        Ms. Emrey-Arras. We do not have any particular position
    regarding BIE's reorganization but we think at the end of the
    day, children need to be in safe facilities. However way that
    is accomplished, we would be delighted. At this point in time,
    that is not the case.
        Senator Udall. Thank you.
        Mr. Chairman, this is not a question but I would just like
    to emphasize that from many of the Senators who showed up today
    you hear a frustration and wanting things to operate a lot
    better in Indian Country, whether education, health care,
    energy or all the various areas.
        I just want to say the GAO listing this as a high risk
    opportunity is a chance for us to work together to work with
    the new people that come in the next Administration and say, we
    are going to get this done and move this forward.
        I hope you get the signal from us, not only is there
    criticism, but we are going to do everything we can in our
    roles to try to encourage everyone to set goals, implement, get
    things done, and improve this situation.
        Thank you very much.
        The Chairman. I think that is right, Vice Chairman Udall.
        For all three of you, we are going to have you back in
    approximately several months, say by the end of July. We will
    look for specific progress on the items brought up today. We
    will also ask the GAO to come because we are going to want you
    to work with us as we track this on, I would say, a relatively
    frequent progress report basis. I would say at our next
    hearing, we will decide how that is working and the next steps.
        Ms. Emrey-Arras?
        Ms. Emrey-Arras. To that end, I would also like to let the
    Committee know we have two additional reports related to school
    safety issues coming out next week. We would also be happy to
    share additional information on that new work with all of you.
        The Chairman. Good. We will look forward to that and
    obviously make that a part of our process here.
        If there are other recommendations on how to proceed, as
    the Vice Chairman and other Senators said, we want to make sure
    we are making progress and tracking progress.
        With that, if there are no more questions, members may
    submit follow-up questions for the record. The hearing record
    will be open for two weeks.
        Again, I want to thank all of you for being here today. We
    look forward to working more with you to make progress on these
    very important issues.
        With that, we are adjourned. Thank you.
        [Whereupon, at 4:25 p.m., the Committee was adjourned.]

                                A P P E N D I X

     Prepared Statement of the National Indian Education Association (NIEA)
    Introduction
        Thank you for this opportunity to submit testimony regarding the
    Committee's May 17, 2017 hearing on the Government Accounting Office
    High Risk Report (GAO-17-317 High Risk Series). Founded in 1969, the
    National Indian Education Association (NIEA) represents Native
    students, educators, families, communities, and tribes, advocating for
    improved educational opportunities that enable Native students to
    thrive in the classroom and beyond.
    The Problems Did Not Develop--and Cannot Be Fixed--Overnight
        First and foremost, we all must acknowledge that the problems
    identified in the Government Accounting Office High Risk Report
    (Report) and discussed at the hearing were not created overnight and
    they will not be solved overnight. Generations of neglect have resulted
    in Bureau of Indian (BIE) school systems that exists today. The systems
    for construction and maintenance of BIE schools, operations, and
    staffing are just a few of the ongoing areas that need significant
    improvement.
        A number of the areas that the GAO identified as needing reform are
    areas that involve the BIE responsibilities, operations, and staff. \1\
    Some BIE schools have never been adequately built. Others have often
    not received the maintenance funding they need, and have become
    dilapidated as a result. BIE schools also face enormous challenges
    regarding staffing and operations. \2\ Employees are often not placed
    in positions for which they have the necessary skills. BIE lacks staff
    with the expertise required to oversee school expenditures. \3\ Other
    challenges for paying expenses and operations can be attributed to the
    fact that BIE must coordinate with the Bureau of Indian Affairs, which
    operates on a different fiscal year and with different reporting
    systems for audits, for example.
    ---------------------------------------------------------------------------
        \1\ See GAO, High Risk Series: Progress on Many High-Risk Areas,
    While Substantial Efforts Needed on Others, GAO-17-317 (Feb. 2017)
        \2\ See GAO, Indian Affairs: Better Management and Accountability
    Needed to Improve Indian Education, GAO-13-744 (Sept. 2013).
        \3\ See e.g., GAO, Bureau of Indian Education Needs to Improve
    Oversight of School Spending, GAO-15-121 (Nov. 2014).
    ---------------------------------------------------------------------------
        Solutions to address the problems created from long standing
    neglect will not be found in quick fixes. Long term tribal engagement
    will be necessary. Sustained, meaningful community engagement will be
    necessary for Native communities to trust schools that have previously
    excluded Native caregivers from engaging with BIE schools. The Reform
    that is currently underway represents this--developed from direct
    tribal input, the current reorganization is an effort to address the
    long-term problems in a systemic way. These efforts must be supported
    and continued through to completion.
    The Trust Responsibility for Native Education as it Relates to BIE
            Reform
        Established through treaties, federal law, and U.S. Supreme Court
    decisions, the federal government's trust responsibility to tribes
    includes the obligation to provide parity in access and equal resources
    to all American Indian and Alaska Native students, regardless of where
    they attend school. The federal government's trust responsibility in
    the field of Native education is a shared responsibility between the
    Administration and Congress for federally recognized Indian tribes.
        With respect to BIE Reform, the trust responsibility requires
    schools that enable Native students to succeed. That means no leaking
    roofs, open floors, air and heating systems that do not work. It means
    that Reform must be completed and it must be supported by Congress to
    make sure BIE serves Native students well.
    The Status of Reform and the Resources Necessary
        Over the last five years, the GAO has found numerous challenges to
    the administration of BIE, staffing, and school construction. The BIE
    Reform was undertaken in 2014 to address these problems. Today, BIE is
    still struggling with numerous issues. Staffing continues to be a
    problem. Numerous vacancies in the BIE have been delayed, leading to
    vacancy rates of up to 9 percent in 2017. NIEA is concerned that the
    BIE must have the authority and resources to fill vacancies.
        In addition to staffing, school construction continues to be a
    challenge for the BIE. Over 60 BIE schools are still currently rated in
    ``poor'' condition, and construction issues continue to put Native
    students at an educational disadvantage. With respect to the specific
    discussions at the May 17th Senate Committee on Indian Affairs hearing,
    we agree with the urgent need for a long-term school replacement plan
    that would set out priorities for school construction and replacement
    over the next 40-60 years and that would include a plan for adequate
    maintenance funding. We would note, however, that Congress must partner
    with BIE and the tribes to get the plan done, and then to implement it.
    Accountability
        NIEA also knows that accountability, in addition to funding, is
    required to ensure that BIE's funding is used to effectively and
    efficiently improve the educational opportunities of Native students.
    We respectfully would like to urge that increased oversight over BIE by
    Congress is a necessary part of shared accountability. The
    accountability that the GAO reports and this Senate Committee on Indian
    Affairs brought has helped reveal problems and spurred BIE forward.
    NIEA asks the Committee to continue that critical, active oversight
    role.
        Accountability also extends to fairness with respect to Native
    schools receiving the resources that Department of Defense schools
    receive. There are only two educational systems for which the federal
    government is directly responsible: Department of Defense (DOD) schools
    and federally operated and federally funded tribal schools. BIE
    schools, however, lag far behind DOD schools in funding, school
    construction, and student achievement. While DOD schools are being
    renovated and remodeled, schools within the BIE system are woefully
    outdated and, in some cases, dangerous for students and staff. As
    America's most vulnerable population, Native students should have equal
    access to resources and opportunities. Congress should fulfill its
    responsibility to Native students by remedying the disparities between
    these two federally operated school systems.
    Next Steps to Achieve Results
        NIEA continues to be generally supportive of BIE Reform. We agree
    with the GAO's insights and support Director Tony Dearman's testimony
    at the hearing. We see incremental progress and believe the Committee
    should recognize progress as well.
        At the same time, we urge transparency in the design and execution
    of the Reform in order to include tribal participation, facilitate
    congressional oversight, and ensure that reform fulfills the federal
    government's trust responsibility regarding delivery of trust- and
    treaty-based educational rights. See NIEA Resolution # 2016-E02 and
    #2014-11 atttached.
        We have three recommendations regarding how Reform can be
    undertaken in a way that honors the Federal Government's
    responsibilities, respects the government-to-government relationship
    between tribes and the United States, and achieves much-needed progress
    regarding our Native students' education.
    Keep the BIE within the Department of the Interior
        Although reform is needed, it continues to be essential that Native
    education remain the purview of the BIE and that BIE remains housed
    within the Department of Interior, which has extensive experience
    carrying out the United States' trust responsibility. Tribal leaders
    have repeatedly stated that the BIE should stay within the Department
    of Interior. NIEA joins tribes in strongly opposing any effort to move
    Native education to the Department of Education. However, we look
    forward to follow-up hearings to determine what the BIE and the
    Department of Education are doing to work together to address the needs
    of Native students.
    Follow-up with Hearings with Both BIA and BIE Officials
        As stated, over 60 BIE schools currently rated in ``poor''
    condition. Native children are learning in buildings that are crumbling
    around them. We appreciate the attention that has been paid to the
    dilapidated Bug-O-Nay-Ge-Shig school. This school is, unfortunately,
    representative of the significant problems facing schools that linger
    on the BIE's school construction list. Additional funds for facilities
    and maintenance are desperately needed so that the BIE can reduce the
    construction and repair backlog, addressing schools in the order they
    appear on the BIE construction list so that schools that have long
    awaited facilities funding will not continue to be neglected. We also
    urge the completion of the long-term school replacement plan and
    increased oversight over school construction funds to ensure the
    effective administration of federal funds.
    Continue Oversight of Reform
        As NIEA has previously stated, and has expressed in Resolution #
    2014-11 and more recently in #2016-E02, continued congressional
    oversight over the BIE reform process is necessary. As the reform moves
    forward to completion, details of the reform should continue to be made
    public, tribal input should be prioritized, and congressional oversight
    should continue.
    Conclusion
        We thank the Committee for holding this oversight hearing. It is
    precisely hearings and oversight like this that has and will help
    address the concerns included in this. We urge Congress and the
    Administration to use this opportunity to work closely with tribes, who
    must be central to better serving students attending BIE schools.
    Finally, we firmly believe that self-governance in education is the
    answer to the current crisis in the Native education system: Tribes
    have demonstrated time and time again that we are better equipped to
    address the needs of our own peoples.
        Working together, with mutual commitment and bipartisan support
    from Congress, we continue to believe that the best way forward is to
    both hold BIE accountable and invest resources to further tribal self-
    determination in education and deliver Native students the education
    they need to succeed.

        Attachments

                           NIEA Resolution 2016-E-02
     relating to legal and policy issues concerning the reorganization of
     the bureau of indian education (bie) to portions of its implementation
        WHEREAS, the National Indian Education Association (NIEA) was
    established in 1970 for the purpose of advocating, planning, and
    promoting the unique and special educational needs of American Indians,
    Alaska Natives, and Native Hawaiians, and provides a forum to discuss
    and act upon issues affecting the education of Indian and Native
    people; and
        WHEREAS, the BIE is currently in the process of reorganizing its
    structure in such a way that violates various provisions of the
    governing statute, namely the organizational and operational provisions
    of PL 95-561; and
        WHEREAS, in spite of numerous efforts from members of this
    organization directly involved with BIE education programs at the local
    and tribal level, the BIE is going forward with its reorganization
    without responding to the concerns of the tribal entities in violation
    of the consultation requirements of 25 USC 2011; and
        WHEREAS, the organization changes proposed by the BIE undermines
    the role of local and agency school boards and confuses the lines of
    authority within BIE, and BIE ignores specific GAO reports that have
    made specific recommendations concerning the organizational
    deficiencies of BIE, such recommendations have been endorsed by the
    Congressional appropriations committees; and
        WHEREAS, the instructional improvement oriented policies embedded
    in the reorganization could have easily been implemented with a major
    restructuring that does not violate the law.
        THEREFORE BE IT RESOLVED, that the National Indian Education
    Association passed resolution 2014-11 on BIE implementation in 2014 and
    seeks to make sure BIE is accountable and serves Native students
    optimally through its organizational structure; and
        BE IT FURTHER RESOLVED that on behalf of its member constituents,
    NIEA renews our requests for a thorough legal and policy review of the
    BIE reorganization prior to any further implementation; and
        BE IT FURTHER RESOLVED that within the next two weeks, NIEA take
    action to implement this resolution; and
        BE IT FINALLY RESOLVED that this resolution shall be the policy of
    NIEA until it is withdrawn or modified by subsequent resolution.
    C E R T I F I C A T I O N
        I do hereby certify that the following resolution was dully
    considered and passed by the National Indian Education Association on
    October 7th, 2016 at which a quorum of the membership was present.
            Patricia Whitefoot, President

                            NIEA Resolution 2014-11
      title: support for congressional oversight concerning the bureau of
            indian education restructuring and blue print for reform
        WHEREAS, the National Indian Education Association (NIEA) was
    established in 1970 for the purpose of advocating, planning, and
    promoting the unique and special educational needs of American Indians,
    Alaska Natives, and Native Hawaiians; and
        WHEREAS, NIEA, as the largest national Indian organization of
    American Indian, Alaska Native, and Native Hawaiian educators,
    administrators, parents, and students in the United States, provides a
    forum to discuss and act upon issues affecting the education of Indian
    and Native people; and
        WHEREAS, through its unique relationship with Indian nations and
    tribes, the federal government has established programs and resources
    to meet the educational needs of American Indians, Alaska Natives, and
    Native Hawaiians, residing on and off their reserved or non-reserved
    homelands; and
        WHEREAS, the Obama Administration has asserted broad executive
    authority in implementing the U.S. Department of the Interior
    Secretarial Order to Transform the Bureau of Indian Education (BIE) as
    based on recommendations of the American Indian Education Study Group's
    Blueprint for Reform; and
        WHEREAS, there is broad based concern throughout Indian country,
    and with treaty tribes in particular, that the BIE realignment is
    creating statutory conflicts and being implemented without a
    congressional authorization and without congressional oversight; and
        WHEREAS, The Secretary of the Interior Sally Jewell has not
    appeared before the Senate Committee on Indian Affairs to provide
    details concerning the BIE restructuring, nor has the Secretary
    provided congressional appropriations committees with a detailed budget
    request to pay for the restructuring; and
        WHEREAS, Administration officials have erroneously testified to the
    Senate Committee on Indian Affairs that there is no opposition from
    Indian country concerning the Blueprint for Reform; and
        WHEREAS, to meet the Federal Government's continuing trust
    responsibility and assess measurable trust standards in the field of
    Indian education including the entire trust corpus for treaty-based
    educational rights delivered through the BIE, it is essential that
    committees of jurisdiction in both the U.S. House of Representatives
    and U. S. Senate provide congressional oversight on executive actions
    concerning the BIE;
        NOW THEREFORE BE IT RESOLVED, that the National Indian Education
    Association directs the Board and Executive Director to request a
    congressional investigation into the Bureau of Indian Education
    restructuring and Blueprint for Reform to ascertain if the Secretarial
    Order creates a statutory conflict and to document Department of the
    Interior proposed offsets to pay for the restructuring; and
        BE IT FURTHER RESOLVED, that the National Indian Education
    Association directs the Board and Executive Director to request
    oversight hearings by the Senate Committee on Indian Affairs and House
    Education and Workforce Committee and House Committee on Natural
    Resources and other appropriate congressional committees regarding the
    Bureau of Indian Education restructuring and Blueprint for Reform.
    C E R T I F I C A T I O N
        I do hereby certify that the following resolution was dully
    considered and passed by the National Indian Education Association on
    October 18, 2014 at which a quorum of the membership was present.
            Melvin Monette, President
                                     ______

        Response to Written Questions Submitted by Hon. Steve Daines to
                              Melissa Emrey-Arras
        Question 1. The findings from the Government Accountability Office
    we're exploring today come as no surprise but are still damning. As Ms.
    Emery-Arras testifies, ``Interior and HHS have ineffectively
    administered and implemented Indian education and health care programs
    and mismanaged Indian energy resources'' in a handful of important
    areas. By most estimations, this is a failing grade. Ms. Emery-Arras,
    exactly how many recommendations has GAO made to the respective
    agencies represented here on the witness panel- BIE, BIA, and IHS-that
    have not yet been implemented?

        Answer.

        Education

        We have made 23 recommendations to Indian Affairs that remain open,
    including 12 recommendations in 2 reports on Indian school safety and
    construction issued on May 24, 2017.

        Energy

        We made 14 recommendations to BIA that have not yet been
    implemented.

        Health care

        We have made 13 recommendations to IHS that have not yet been
    implemented. We have also made one Matter for Congressional
    Consideration that remains unaddressed.

        Question 2. And how long has it been since these recommendations
    were made?

        Answer.

        Education

        Of the 23 recommendations on Indian education that remain open, 3
    were made in 2013, 4 were made in 2014, 4 were made in 2016, and 12
    were made in 2017.

        Energy

        The 14 recommendations were made in 3 reports issued between June
    2015 and November 2016.

        Health care

        Of the IHS recommendations that remain open, 2 were made in 2011, 3
    were made in 2012, 4 were made in 2013, 2 were made in 2016, and 2 were
    made in 2017.
                                     ______

    Response to Written Questions Submitted by Hon. Catherine Cortez Masto
                             to Melissa Emrey-Arras
        Question 1a. The report discussed the importance of appropriate and
    level staffing, particularly the need to efficiently replace key
    personnel as vacancies become apparent. Currently, there are over 1,550
    job vacancies across the IHS system. Staffing is an issue that needs to
    be seriously addressed by Congress and the Department. While the IHS
    did get an exemption from the Trump administration's federal hiring
    freeze to hire medical staff, the IHS is still restricted from hiring
    other critical hospital administration personnel.
        As the department moves forward with identifying service gaps, does
    the GAO plan to analyze and report on the negative effect the Executive
    Order has on patient care in Indian country?
        Answer. We are conducting ongoing work on the staffing vacancies at
    IHS. Within the scope of this work, we plan to take the hiring freeze
    into consideration when we analyze the information and draft our
    findings.

        Question 1b. How did the GAO take into account the hiring freeze at
    the Department of Health and Human Services before making any of its
    recommendations? Was this information intentionally omitted? If so,
    why?
        Answer. GAO's high risk report was based on findings and
    recommendations from reports on IHS that predate the hiring freeze. We
    are conducting ongoing work on the staffing vacancies at IHS. Within
    the scope of this work, we plan to take the hiring freeze into
    consideration when we analyze the information and draft our findings.

        Question 2. When CMS or the department has found violations of
    patient care at the IHS operated facilities, how has the GAO
    investigated these findings? What action have you suggested and
    followed up on?
        Answer. GAO does not follow-up on individual findings reported by
    CMS or HHS. For our report on IHS's oversight of quality of care (GAO-
    17-181), we reviewed evidence of IHS quality oversight, including
    findings from interim IHS audits, which we include in our report. For
    example, one such audit found defective lead aprons at an IHS medical
    facility, but IHS officials stated these deficiencies had been
    corrected. We also found that IHS did not have agency-wide measures for
    the quality of care in its facilities, and that IHS's oversight of
    quality was limited and inconsistent. We recommended that IHS ensure
    that agency-wide standards for the quality of care provided in its
    federally operated facilities are developed, that facility performance
    in meeting these standards is systematically monitored over time, and
    that enhancements are made to its adverse event reporting system.

        Question 3. Outside of Las Vegas and Reno, Nevada is a very rural
    state. Many of our tribes and rural communities are hundreds of miles
    away from large urban areas. As the Tribal Chairman from the Shoshone-
    Paiute Tribes of Duck Valley told me in a meeting yesterday, their
    reservation is 100 miles in any direction to a non-IHS medical
    facility. If anyone, whether a tribal member or not, needs immediate
    medical care, often their only option is an IHS facility. That puts an
    incredible strain on the system. How does the GAO report take into
    account outlier situations like this? If not, why?
        Answer. We have not come across this issue during the course of our
    IHS work.
                                     ______

    Response to Written Questions Submitted by Hon. Catherine Cortez Masto
                         to Rear Admiral Chris Buchanan
        Question 1. Many of the challenges experienced by IHS are a direct
    result of the poor funding status of Indian Tribes. How do your offices
    work regionally in identifying the needs in different states and
    regions?
        Answer. The Indian Health Service (IHS) has a unique government-to-
    government relationship with American Indian and Alaska Native tribal
    governments and is committed to regular and meaningful consultation and
    collaboration with these Tribes. Consultation is considered an
    essential element for a sound and productive relationship with Tribes.
    It is IHS policy that consultation occurs when there is a critical
    event that may impact Tribes, new or revised policies or programs are
    proposed, or the IHS budget request and annual performance plan are
    being developed. This process is especially critical during the tribal
    budget formulation/consultation process.
        The IHS manages multiple fiscal-year budgets on a regular basis.
    The IHS budget formulation process is comprised of annual forums for
    Indian Tribes to interact with the IHS to provide program priorities,
    policies, and budget recommendations. In order to ensure Tribes are
    able to provide meaningful input for the IHS budget request, the IHS
    follows a timeframe that coincides with the Department of Health and
    Human Services' budget schedule: (1) October--December: Each of the 12
    IHS Areas hold budget formulation work sessions to provide technical
    assistance, identify local and/or regional health priorities; (2)
    February--March: IHS conducts a national IHS budget formulation work
    session that consolidates the work conducted at the Area level; (3)
    May--Tribes present national priorities and recommendations at the
    National HHS Tribal Budget Formulation and Consultation Session. The
    annual budget formulation and consultation process ensures the
    priorities and budget recommendations of IHS, tribal, and urban
    stakeholders are discussed and reviewed. In addition, IHS uses advisory
    committees to provide leadership, advocacy, and guidance to the
    Director on policy and program matters.

        Question 2. In understanding best practices by IHS and self-
    governance Tribes, it has been pointed out to me that the health care
    system is often is working well for some of these communities. How is
    the IHS regional administration sharing best practices among Regional
    Directors?
        Answer. The 2016-2017 IHS Quality Framework encourages regular,
    ongoing communications to share information about best practices across
    IHS. IHS has numerous mechanisms by which best practices are shared
    among different IHS Areas. The IHS National Councils, comprised of
    different professional specialties, meet and communicate regularly
    about challenges and best practices. Examples of these Councils include
    the National Councils of Chief Medical Officers, Nurse Leadership,
    Clinical Directors, Chief Executive Officers, Chief Clinical
    Consultants, Behavioral Health, Oral Health, Pharmacy, and Laboratory.
    Cross Council communication happens as needed and may be facilitated by
    and/or include Area and/or Headquarters leadership and staff. Councils
    meet in person annually at a National Combined Council meeting. In
    addition, Inter-Council Workgroups are formed to address cross-cutting
    issues such as Opioids, Suicide, or Workforce recruitment and
    retention.
        Another mechanism through which IHS shares best practices
    throughout the system is through the IHS Clinical Support Center and
    the Telebehavioral Health Center of Excellence. This free education
    enables providers to learn and master new skills especially from rural
    and remote sites through a platform that easily connects with providers
    in low bandwidth areas and via mobile devices. Topics are wide-ranging
    such as Fetal Alcohol Spectrum Disorder, Trauma Informed Care,
    Utilizing Data with Dashboards, Leadership Training, Medication-
    Assisted Treatment for Chronic Opioid Use and many more.
        IHS also collaborates with HealthInsight, which is a Quality
    Improvement Organization (QIO), and our hospitals to improve the health
    of American Indian and Alaska Native people by implementing and sharing
    best practices through the Partnership to Advance Tribal Health (PATH).
    The aim of PATH is to continuously improve the quality of care by
    implementing best health care practices and identifying other
    operational improvement needs. This three year initiative is being
    funded by the Center for Standards and Quality at the Centers for
    Medicare & Medicaid Services (CMS).
        IHS continues to share best practices through the Improving Patient
    Care (IPC) Initiative. The Indian Health Service (IHS) launched the
    Improving Patient Care (IPC) program in 2008 to improve the quality of
    health care and to provide greater access to care for American Indians
    and Alaska Natives using the Patient Centered Medical Home (PCMH)
    model. Now, nine years after the launch, the IPC Program continues to
    provide training and technical assistance, supporting Indian health
    facilities to achieve success in improving patient access to care,
    implementing clinical quality enhancements and promoting patient
    satisfaction. You can learn more about IPC at https://www.ihs.gov/ipc.
        Each year, the Department of Health and Human Services (HHS), IHS
    and Department of the Interior (DOI) Bureau of Indian Affairs (BIA) and
    Tribes host an annual Tribal Self-Governance Consultation Conference to
    share best practices, discuss policy issues, and conduct communication,
    education and outreach activities. The IHS Tribal Self-Governance
    Advisory Committee meets four times a year to share best practices and
    to advise the IHS Director on policy issues related to implementation
    of Title V of the ISDEAA. IHS partners with the Tribal Self-Governance
    Communication and Education Tribal Consortium which publishes a
    newsletter, Sovereign Nations, highlighting best practices. Lastly, the
    IHS Office of Tribal Self-Governance hosts a series of ISDEAA Title V
    trainings each year across the IHS Areas.

        Question 3. Question on behalf of Chairman Ted Howard of the
    Shoshone-Paiute Tribe of the Duck Valley: ``I understand that the
    Indian Health Service made a mistake in overestimating the amount
    required in fiscal year 2017 to fully fund contract support cost
    payments due Tribes under self-determination contracts and self-
    governance compacts. What explains this error, how much is needed in FY
    2018, and what assurance can you give the Committee that going forward
    your estimates are accurate?''
        Answer. The contract support costs (CSC) amount included in the FY
    2017 budget was for a proposed reclassification of CSC to a mandatory
    appropriation at a specified funding level. Projecting future CSC
    funding need is dependent on several variables, including how many
    additional Tribes might choose to enter into ISDEAA agreements or to
    expand their current agreements. The intent was to estimate a level
    that was sufficient to cover any additional need arising from these
    unknown, variable factors. Moreover, the estimate of CSC need prior to
    the contract period often differs from the final, actual amount that
    will be negotiated after the end of the contract period; therefore, the
    final amount for FY 2017 cannot yet be determined. The IHS' request for
    FY 2017 was estimated to cover the full amount for each Tribe or tribal
    organization, which is not known until the end of their contract terms.
        In the President's FY 2018 Budget Request for IHS, the CSC need
    projection is $718 million and includes a proposal to maintain the
    indefinite, discretionary appropriation. This amount is based on
    continually updated data. The IHS remains dedicated to continually
    tracking and monitoring estimated and final CSC needs and working
    closely with Tribes to understand potential future needs.
                                     ______

         Response to Written Questions Submitted by Hon. Tom Udall to
                        Rear Admiral Michael Weahkee \1\
    ---------------------------------------------------------------------------
        \1\ Rear Admiral Chris Buchanan served as the Acting Director of
    the Indian Health Service at the time of this hearing. Since then,
    Michael D. Weahkee assumed duties as Acting Director and is currently
    serving in this capacity.
    ---------------------------------------------------------------------------
    GAO Reports and Recommendations
        Question 1. The Government Accountability Office (GAO)'s February
    2017 High Risk Report noted 14 unresolved recommendations for the
    Indian Health Service (IHS). \2\ Your testimony provided a broad
    overview of various improvement initiatives currently underway at the
    Service but did not provide a point-by-point response explaining how
    IHS is addressing each of these unresolved recommendations. Please
    provide a summary and timeline of the Services' plans to address each
    of these unresolved recommendations.
    ---------------------------------------------------------------------------
        \2\ U.S. Gov't Accountability Office, GAO-17-317, High Risk Series:
    Progress on Many High Risk Areas, While Substantial Efforts Needed on
    Others, at 202 (2017).
    ---------------------------------------------------------------------------
        Answer. IHS received fourteen recommendations from the GAO reports
    listed on the 2017 High Risk Report, which covered six years and seven
    reports. All recommendations remain open at this time. In early July
    and early August, IHS provided an update to GAO reflecting the current
    progress we are making for each recommendation and requested seven of
    the 14 recommendations be closed. As discussed with Committee staff
    during a formal briefing about the status of our work to address GAO
    recommendations on August 9, 2017, IHS has made significant progress
    and continues to work with GAO to close all recommendations.
        The following table provides a summary of the open recommendations
    for each GAO report and indicates how many for which we have requested
    closure. Details about how IHS is addressing each recommendation
    follow.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

    GAO-17-181: Actions Needed to Improve Oversight of Quality of Care
        Recommendation 1. Ensure agency-wide standards for the quality of
    care provided in federally-operated facilities are developed, monitored
    over time, and enhancements are made to the adverse event reporting
    system.
        Agency Progress: IHS named an Acting Deputy Director for Quality in
    2016 and is implementing a system-wide dashboard of performance
    accountability metrics. The accountability dashboard incorporates the
    six dimensions of health, as identified in IOM's report, ``Crossing the
    Quality Chasm: A New Health System for the 21st Century''--patient
    safety, care effectiveness, patient-centeredness, timeliness, care
    efficiency, and equity. IHS is also pilot testing a national Provider
    Credentialing System in four Areas, with the goal of fully implementing
    the system agency-wide by the end of CY 2017. The credentialing policy
    is being updated as well. IHS anticipates an award for a national
    hospital accreditation contract this year and best practices for an
    adverse event reporting system continue to be assessed by the agency.

        Recommendation 2. Develop contingency and succession plans for the
    replacement of key personnel, including Area Directors.
        Agency Progress: In December 2016, IHS developed contingency and
    succession plans, including skills gap analyses and appropriate
    developmental programs for the replacement of key personnel, including
    Area Directors. The December 2016 succession plans are currently being
    updated and will be updated on a semi-annual basis. In addition to the
    contingency and succession plans, IHS has developed leadership training
    academies for senior leaders. For example, staff rotations through IHS
    Headquarters provide additional training for senior level positions. A
    mentoring initiative for those who have recently been promoted to key
    leadership positions has been implemented. The agency has requested
    closure of this recommendation.
    GAO-16-333: Actions Needed to Improve Oversight of Patient Wait Times
        Recommendation 1. Develop and communicate specific agency-wide
    standards for patient wait times in federally-operated facilities and
    review experience with timeliness goals set as part of Improving
    Patient Care (IPC).
        Agency Progress: IHS patient wait time standards were established
    in July 2017. A supporting policy document is being developed. IHS is
    developing a communications plan to inform and address questions from
    internal and external stakeholders. An implementation plan is also
    being developed which includes education, data collection, resources,
    monitoring, and target timelines. If sites experience challenges in
    meeting the standards, technical assistance will be provided through
    the Improving Patient Care (IPC) program. Additionally, since IHS
    federally-operated facilities currently collect patient wait time data
    at the Service Unit level, the IPC program, in collaboration with the
    IHS Office of Information Technology, is developing a reporting system
    to support monitoring patient wait time measures and evaluating
    progress at the Area and national levels.

        Recommendation 2. Monitor patient wait times in federally-operated
    facilities and ensure corrective actions are taken when standards are
    not met.
        Agency Progress: IHS is targeting the full implementation of
    Agency-wide standards for wait times by later this year including
    monitoring of the outcome data. IHS is developing an implementation
    plan which includes education, data collection, resources, monitoring,
    and target timelines. If sites experience challenges in meeting the
    standards and/or the target timelines, technical assistance will be
    provided through the Improving Patient Care program. This is consistent
    with the overall IHS objective to promote the Patient Centered Medical
    Home (PCMH) model of care within IHS ambulatory care facilities and the
    IPC focus on building quality improvement skills and knowledge within
    the IHS health care system.
    GAO-14-57: Opportunities May Exist to Improve the CHS Program
        Recommendation 1. Modify the claims payment system to separately
    track IHS referrals and self-referrals, revise GPRA measures so they
    distinguish between the two types of referrals and establish separate
    targets.
        Agency Progress: IHS is modifying the data system to track
    separately IHS referrals and emergency self-referrals, where the
    notification requirement and all other requirements of the PRC
    regulations at 42 CFR 136 are met, and are subsequently authorized for
    PRC payment. We expect to be able to provide baseline reporting for CY
    2017. IHS is currently researching industry standards and expects to
    have separate payment timeframe targets for these two referral types.

        Recommendation 2. Improve the alignment between CHS staffing levels
    and workload by revising IHS current practices, where appropriate, to
    allow available funds to be used to pay for CHS program staff.
        Agency Progress: The IHS did not concur with this recommendation
    because historically, Agency policy has been to use Purchased/Referred
    Care (PRC), formerly known as Contract Health Services (CHS), funds
    solely for the purchase of health care services. The agency has
    requested closure of this recommendation.

        Recommendation 3. Proactively develop potential options to
    streamline program eligibility requirements.
        Agency Progress: IHS disseminated information to patients about
    their coverage and ability to access care without obtaining a PRC
    referral. IHS hospitals have worked with the respective States to
    implement presumptive eligibility. The agency has requested closure of
    this recommendation.
    GAO-13-272: Capping Payment Rates for Non-hospital Services Could Save
            Millions of Dollars for CHS
        Recommendation 1. Should Congress decide to cap payments for
    physician and other non-hospital services made through IHS's CHS
    program, IHS should monitor the CHS program patient access in order to
    assess how any new payment rates may benefit or impede the availability
    of care.
        Agency Progress: IHS developed an online PRC Rates Provider
    Tracking tool to monitor the access to physician and other non-hospital
    care. This tool enables PRC programs to document providers that refuse
    to contract for their most favored customer rate or accept the PRC
    rates.
        IHS provided training to the Area PRC officers at a face-to-face
    meeting in December 2016 on how to use the tool. The tool went live in
    January 2017.
        After capping PRC payment rates for non-hospital services, IHS and
    Tribes have realized a savings of more than $139.7 million so far this
    calendar year. PRC savings through June 2017 are listed in the table
    below. All IHS PRC programs participate in the PRC payment rates;
    however, Tribes are not required to participate but may opt-in as
    stated in 25 U.S.C. 45aaa16(e). The additional savings enables IHS and
    tribal providers to deliver more and increase access to health care
    services.
        IHS has requested closure of this recommendation.

                 Purchased and Referred Care Savings by Month--January--June, 2017--Federal and Tribal*
    ----------------------------------------------------------------------------------------------------------------
                        Month                         Federal           Tribal           Total             YTD
    ----------------------------------------------------------------------------------------------------------------
    JAN                                                $6,127,595         $120,168       $6,247,763       $6,247,763
    FEB                                                $9,328,068         $781,264      $10,109,332      $16,357,095
    MAR                                               $24,002,806       $2,890,466      $26,893,272      $43,250,367
    APR                                               $28,747,136         $554,038      $29,301,174      $72,551,541
    MAY                                               $31,357,518       $2,113,185      $33,470,703     $106,022,244
    JUNE                                              $28,840,636       $4,876,569      $33,717,205     $139,739,449
    YTD                                              $128,403,759      $11,335,690     $139,739,449
    ----------------------------------------------------------------------------------------------------------------
    This data includes six (6) tribal programs.

    GAO-13-553: Most AI/AN Potentially Eligible for Expanded Health
            Coverage, but Action Needed to Increase Enrollment
        Recommendation 1. Prepare for the increase in eligibility for
    expanded Medicaid and new coverage options and the need for enrollment
    assistance and billing capacity by realigning current resources and
    personnel to increase capacity.
        Agency Progress: In an effort to improve our enrollment efforts at
    the local level, IHS developed and disseminated a Business Plan
    Template and Template Description in 2013. IHS monitors use of the
    business plan through cascading performance elements in Area Directors'
    and CEOs' performance evaluations.
        IHS sponsored national IHS Partnership Conferences in 2013 and 2016
    that included patient registration and benefits coordination tracks
    that focused on outreach and education. The 2017 IHS Partnership
    Conference with IHS, tribal, and Urban Indian Organization Business
    Offices, PRC coordinators, health information management (HIM), and
    finance staff was held August 22-24. This hands-on training supports
    our front-line staff who are directly involved in the PRC, business
    office and HIM operations.
        IHS also entered into cooperative agreements with the National
    Indian Health Board and National Congress of American Indians to
    conduct consumer outreach, education, training and T/A for Tribes and
    Tribal organizations related to options, enrollment, and exemptions.
    IHS hosted a patient registration and benefits coordination training in
    April 2017 focusing on outreach, education and assistance to patients
    regarding coverage.
    GAO-12-446: Action needed to Ensure Equitable Allocation of Resources
            for the CHS Program
        Recommendation 1. Use variations in levels of available hospital
    services in a formula for allocating CHS funds.
        Agency Progress: Approximately half of the PRC funds are
    distributed through Indian Self-Determination awards and so are
    protected from unilateral reductions or reallocation by the agency,
    absent one of the other circumstances set forth in 25 U.S.C.
    5325(b)(2) or 25 U.S.C.  5388(d)(1)(C)(ii). IHS partners with tribal
    leaders in making PRC fund allocation decisions for directly-operated
    programs. The agency has requested closure of this recommendation.

        Recommendation 2. Use actual counts of CHS users rather than all
    IHS users in a formula for allocating CHS funds that relies on number
    of active users.
        Agency Progress: IHS partners with tribal leaders in making PRC
    fund allocation decisions for directly operated programs. Any future
    changes in allocation methods will undergo tribal consultation. The
    agency has requested closure of this recommendation.

        Recommendation 3. Develop written policies and procedures to
    require Area offices to notify IHS when changes are made to the
    allocations of funds to CHS programs.
        Agency Progress: IHS distributed guidance on PRC allocation of
    funds to Area directors and PRC officers in CY 2016. IHS directs Area
    directors through official PRC allocation of funds distribution memos.
    These memos are official procedural documents that become a part of the
    PRC policy chapter of the Indian Health Manual. The agency has
    requested closure of this recommendation.
    GAO-11-767: Increased Oversight Needed to Ensure Accuracy of Data Used
            for Estimating CHS Need
        Recommendation 1. Develop a written policy documenting how IHS
    evaluates need for the CHS program and disseminate it to Area offices
    and CHS programs.
        Agency Progress: IHS is developing the specific policy and
    procedural guidance, which will be incorporated into the Indian Health
    Manual.

        Recommendation 2. Provide written guidance to CHS programs on a
    process to use when funds are depleted and there is a continued need
    for services and monitor to ensure that appropriate actions are taken.
        Agency Progress: IHS plans to issue written policy and guidance to
    all IHS sites by September 30, 2017.

        Question 2. GAO's High Risk Report notes that many implementation
    decisions are left to individual Area Directors to decide (e.g.,
    allocation of Purchased-Referred Care funds among facilities, patient
    wait time standards, operation of IHS facility Governing Boards, etc.).
    \3\ How does IHS propose to improve quality of care across the entire
    system given the level of discretion left to Area offices?
    ---------------------------------------------------------------------------
        \3\ U.S. Gov't Accountability Office, GAO-17-317, High Risk Series:
    Progress on Many High Risk Areas, While Substantial Efforts Needed on
    Others, at 209-214 (2017).
    ---------------------------------------------------------------------------
        Answer. IHS is working to standardize policies and procedures
    across the system. Area Office and Service Unit representatives have
    been included as members of the Quality Framework Steering Committee
    (responsible for implementation of system level improvements identified
    in the IHS 2016-2017 Quality Framework). IHS continues working to
    establish the Office of Quality Health Care under the Deputy Director
    of Quality Health Care. This office will continue the work of system
    level quality improvement and patient safety enhancement, ensuring
    sustainment of Quality Framework implementation and providing oversight
    and coordination of information sharing for quality and safety. This
    office will work closely with the IHS Quality Consortium to identify
    best practices, unify processes, and prioritize quality and safety
    initiatives and resources across the IHS system of care.
        A Quality Accountability Dashboard Working Group was established by
    the Steering Committee to develop metrics that will allow oversight and
    management of compliance with policy and regulatory requirements that
    ensure quality and safety of care. IHS expects the measure definitions,
    data collection tool, and dashboard will be ready for use by August 31,
    2017. The dashboard will enable Headquarters and Area Offices to have
    real-time visibility across the IHS system. This will facilitate
    implementation and monitoring of quality measures throughout the system
    over time. The success of this dashboard has also led to efforts to
    develop similar dashboard tools related to three other agency
    priorities: People, Partnerships, and Resources.
        Additionally, a Patient Wait Times Working Group was established by
    the Steering Committee to develop standards for primary care patient
    wait times for appointments. The Working Group completed standard
    development in June 2017: 28 days or less for primary care, non-follow-
    up appointments and 48 hours for primary care urgent visit
    appointments. This standard was developed based on review of standards
    from Avera Health, Defense Health Agency, Veterans Health
    Administration, Institute for Healthcare Improvement, and a literature
    search from the National Library of Medicine (using Scopus) on April
    21, 2017, and has been incorporated into a measure for the Quality
    Accountability Dashboard so that it can be monitored routinely and
    improved.
        In early January 2017, hospital Governing Board (GB) Bylaws for
    inpatient acute care hospitals were standardized across IHS. The goal
    of this change was to ensure a baseline of standards IHS-wide, while
    maintaining flexibility for the Areas and service units to accommodate
    needs specific to their locations and service populations. Bylaws must
    now include the following:

       Frequency of formal governing board meetings: At least twice
            per year, but may meet more often if desired/necessary to meet
            the needs of the service unit.

       Membership of governing board: The minimum number of GB
            members is determined by the Chair (Area Director) and ensures
            adequate representation of disciplines to carry out the
            required activities. All GB members have a vote and the
            majority of voting members must represent the Area Office and
            may also include similar representation from Service Units.

        --Due to the inherent federal functions of governing federal
            facilities, members of the Governing Board must be IHS federal
            employees/officers.

        --Tribal consultation is encouraged through CEO communications with
            tribal leadership, and tribal representatives may be invited to
            open forums or town hall meetings in order to provide input.

       Meeting Agendas: At a minimum, Governing Board meeting
            agendas must include the following elements:
        --Quality of Care--including quality improvement and quality
            assurance/compliance
        --Patient Safety
        --Hospital/Facility Operations

        These three components were communicated to Area Directors for
    immediate incorporation into GB Bylaws for each hospital. Area Offices
    communicated these new requirements to their Service Units within their
    established channels and required verification of incorporation in
    respective GB Bylaws for reporting back to IHS Headquarters.

        Question 2a. Does IHS have a consistent way to capture innovation/
    best practices within one service area and share those with other
    service areas?
        Answer. The IHS Improving Patient Care (IPC) Program has been
    providing quality improvement support and guidance since 2008 for
    ambulatory care services. One of its primary goals is to assist IHS,
    Tribal and Urban Indian Health Programs with developing Patient-
    Centered Medical Homes. A component of the Program's process is to
    capture innovations and best practices for sharing with all
    participating locations.
        Beginning in 2016, IHS also established a number of forums (in
    addition to the IPC Program) for networking among quality assurance and
    quality improvement staff at all levels of the agency. Quarterly lunch
    time webinars for Service Unit leaders to share lessons learned and
    best practices related to quality and safety have been on-going since
    June 2016. A Quality Managers Listserv has been established to
    communicate and share information among Headquarters, Area Office, and
    Service Unit quality assurance and quality improvement staff.
    Additionally, a monthly webinar series for Area and Service Unit
    Quality Managers is hosted by Headquarters Quality Framework Steering
    Committee staff for real-time communications and information sharing.
    These communications platforms reach wide and varied audiences at all
    levels, support a network of geographically isolated employees, and
    build unity of practice and purpose for quality improvement and patient
    safety.
        IHS has continued its productive partnerships with the Premier Inc.
    Hospital Improvement and Innovation Network (HIIN) and HealthInsight
    New Mexico Quality Improvement Organization (QIO) with its Partnership
    to Advance Tribal Health (PATH). The Premier HIIN provides technical
    assistance and learning platforms to reduce Hospital Acquired
    Conditions and Readmissions. They coach hospital care teams and staff
    on best practices, lessons learned, and quality improvement activities
    aligned with these goals. The HealthInsight NM QIO and PATH are
    providing leadership development learning opportunities, care team
    effectiveness enhancement, patient safety resources, patient/family
    engagement technical assistance, and system level assessments.
    Engagement with both of these quality improvement entities is
    increasing opportunities to identify best practices and innovative
    solutions to improve quality and safety, and adds another layer of
    communication opportunities to share this information across IHS.

        Question 3. GAO testified that inclusion on the biennial High Risk
    report often result in agencies receiving additional management
    resources from Department leadership and the Office of Management and
    Budget (OMB). Has IHS seen increased engagement from the Department of
    Health and Human Services' (DOI's) Office of the Secretary or OMB since
    the High Risk designation? If so, please summarize any evidence of this
    increased engagement.
        Answer. The Office of the Secretary and OMB are actively engaged
    with IHS in addressing the challenges identified by GAO in the High
    Risk report. For example, the IHS resources were prioritized in the FY
    2018 budget request. Further, OMB and HHS have approved use of the Non-
    recurring Expenses Fund for IHS to meet key needs in facilities,
    Information Technology (IT) systems and medical equipment. Departmental
    and OMB staff have also toured field facilities, both IHS and tribally-
    run, engaging in discussions with tribal leaders, patients and other
    stakeholders about priorities and needs at the local health care
    delivery level. In addition, HHS has assigned personnel with specific
    expertise from other HHS operating divisions to assist IHS in
    addressing risk areas such as health services in the Great Plains Area
    (GPA).

        Question 4. GAO also testified that staff and leadership turnover
    is an overarching issue facing IHS. How is IHS working to ensure all
    administrative duties are fulfilled in the face of frequent turnover?
        Answer. At the local level, when employees provide notice of
    impending departure, IHS works to identify and designate staff to
    assume the duties until the position is filled. More globally, IHS uses
    position management data to identify and track vacancies across IHS to
    identify gaps in administrative functions and services and determine
    both immediate and long-term staffing and recruitment needs. In
    addition, the IHS Area and HQ offices have developed succession plans
    that will aid in identifying immediate, short-term, and long-term plans
    for ensuring staff develop the competencies to potentially serve in
    leadership positions on a temporary or permanent basis for when key
    leadership positions become vacant. IHS is also in the process of
    developing a staff transition planning tool for current leaders to
    provide key position information and institutional knowledge for
    incoming staff. Finally, IHS has developed a leadership training
    program to prepare high performing staff with leadership and
    administrative skills for their own developmental benefit, and also to
    provide IHS with a cadre of trained staff in the event of turnover.

        Question 4a. Given these staffing challenges, how is IHS ensuring
    federally-operated, tribally-operated, and urban-Indian IHS facilities
    receive full support with medical, legal, and financial compliance
    requirements?
        Answer. IHS continues to implement the Quality Framework launched
    in November 2016, which was developed to strengthen organizational
    capacity to improve quality of care, improve our ability to meet and
    maintain accreditation for IHS direct service facilities, align service
    delivery processes to improve the patient experience, ensure patient
    safety, and improve processes and strengthen communications for early
    identification of risks. Inherent in these objectives is ensuring
    compliance with medical, legal, and financial requirements.
        A specific action aimed at assuring accountability is development
    of a system-wide dashboard of performance accountability metrics that
    will demonstrate aspects of compliance with various requirements,
    standards, policy, and guidance. IHS is working with its Area Offices
    and local community facilities to enhance financial reports, and
    estimation capabilities; and is exploring additional IT tools which can
    improve financial reporting, reduce time/effort involved in routine
    financial staff work, and ease the burden on managers at the local,
    Area, and Headquarters levels in accessing financial information and
    identifying mission critical issues.
        Tribes that manage their health care programs under Indian Self-
    Determination and Education Assistance Act contracts and compacts are
    responsible for ensuring their programs' compliance with limited
    oversight by IHS. However, IHS provides technical assistance and offers
    some opportunities for tribal programs to participate in to assist them
    in addressing certain requirements. Urban Indian Organizations have
    responsibility for compliance for the programs included in their
    contracts and grants, and IHS has an oversight role to ensure they are
    carrying out the terms of the contracts and grants. In addition, Urban
    Indian Organizations are able to participate in some IHS activities to
    improve compliance such as training provided through the IHS
    Partnerships Conference.

        Question 4b. How is IHS ensuring the Service's staffing efforts
    address the technical skills gaps (e.g., health systems administration)
    identified by GAO?
        Answer. During the first quarter of FY 2017, the IHS conducted a
    skills gap analyses for key positions and developed appropriate level
    developmental programs for those positions. A leadership training
    program has been developed which includes Leadership Training Academies
    for senior level staff and individual development plans to improve the
    competencies and skills required for staff new to leadership roles,
    including rotating staff through Headquarters to provide additional
    training in preparation for future placement in senior level positions.
        An important part of the IHS leadership program includes succession
    planning for key positions and preparing staff to compete for
    leadership positions. Succession plans are updated semi-annually. In
    addition, IHS has initiated a mentoring initiative for those who have
    recently been promoted to key leadership positions. Best practices will
    be identified to expand these types of activities throughout IHS.
    School-based Health Clinics
        Question 5. According to your testimony, IHS supports nine direct-
    service and eight tribally-operated school-based health clinics. Where
    are these 17 clinics located, and what scope of medical services do
    they provide to the schools they serve?
        Answer. Of the 17 school-based health programs, one is located in
    Alaska; four are located in New Mexico within the Albuquerque Area; two
    are located in Minnesota within the Bemidji Area; two are located in
    the Nashville Area, specifically in Mississippi and North Carolina; one
    program is located in New Mexico within Navajo Area; one program is
    located in Oklahoma; one program is located in Arizona within Phoenix
    Area; and five are located in Arizona within the Tucson Area.
        The scope of health services provided at the schools varies and may
    include clinical services such as dental and pharmacy or behavioral
    health services or both types of services.

        Question 5a. Is IHS aware of any tribal interest in expanding the
    number of these clinics to other schools and communities in Indian
    Country?
        Answer. The IHS has provided school-based health services for many
    years. In general, both IHS and Tribes have been increasingly
    interested in expanding school-based health services and clinics to
    improve access to care for patients who may otherwise not have received
    services for a number of reasons (e.g., lack of transportation).
    Parents and school administrators have also been extremely supportive
    of these types of partnerships and collaborations.

        Question 5b. Is IHS aware of any barriers that might prevent the
    Service from working collaboratively with Bureau of Indian Education
    (BIE) and tribes to open these more of these clinics?
        Answer. In our experience working collaboratively with the BIE and
    Tribes, we have encountered challenges relating to obtaining parental
    consent forms, including those that must be signed by legal guardians,
    and obtaining space for the school-based health services.

        Question 6. What relationship does IHS have with the BIE regarding
    the provision of medical services to Native students attending BIE
    schools and students living in BIE dormitories?
        Answer. The Indian Health Service has had an on-going collaborative
    relationship with the Department of Interior's Bureau of Indian
    Education (BIE). For example, the Navajo Area Office has entered into
    partnership agreements with the BIE to provide services to Native
    students attending BIE Schools and students residing in BIE
    dormitories. Currently, there are seventeen partnerships in place with
    State, tribal, private and BIE schools located in Arizona and New
    Mexico. We are working on collecting additional data regarding the
    scope of services at all school-based health programs where Indian
    Health Service funded services are being provided to Native students.
    Unused funds
        On March 28, 2017, IHS issued a ``Dear Tribal Leader'' letter
    addressing concerns of whether the Service returns ``a significant
    amount of unused money to the United States Treasury each year.'' \4\
    ---------------------------------------------------------------------------
        \4\ Letter from Chris Buchanan, Acting Director, Indian Health
    Service, to Tribal and Urban Indian Organization Leaders (Mar. 28,
    2017) (on file with S. Comm. on Indian Affairs).
    ---------------------------------------------------------------------------
        Question 6a. For which specific activities/authorized uses did IHS
    have unused funds in FY2011? Please include a description of any
    statutory limitations that govern the use or repurposing of these
    unused funds.
        Answer. Within the lump sum appropriation for the IHS Services
    account, $3.8 million was returned to Treasury when the FY 2011
    appropriated funds officially cancelled. Examples of activities
    included in the Services account include Hospitals and Health Clinics,
    Dental Health, Public Health Nursing, and other preventive and clinical
    services. This appropriation contained annual budget authority meaning
    that the budget authority was only available for new obligations during
    one fiscal year.--The default period of availability for
    appropriations, unless otherwise specified by Congress, is one year.
    Per OMB Circular A-11, annual budget authority can be obligated for the
    expenses of one fiscal year, followed by a five year expired phase
    during which time the budget authority is no longer available for new
    obligations but can be used only for adjustments to obligations
    incurred prior to the expired phase. At the close of that six year
    total period, the funds are considered lapsed and returned to the U.S.
    Treasury. This is standard budget execution practice for similar
    accounts government-wide.

        Question 6b. How does the amount of IHS unused funds compare to the
    amount of unused funds returned by other agencies both within HHS and
    across the Federal Government as a whole?
        Answer. IHS has not performed a comprehensive review of other
    agencies. It is important to note that program administration varies by
    agency and appropriation, and the purpose of the appropriation can be a
    significant factor in an agency's ability to expend the funds within
    the period of availability. For IHS, the service units/health programs
    providing direct patient care have the greatest flexibility for fully
    expending appropriated funds.
                                     "_____

         Response to Written Questions Submitted by Hon. Tom Udall to
                                 Michael Black
    GAO Reports and Recommendations
        Question 1. The Government Accountability Office (GA0)'s February
    2017 High-Risk Report included several unresolved recommendations for
    the Bureau of Indian Affairs (BIA) to help ensure that Bureau of Indian
    Education (BIE) schools provide safe and healthy facilities for
    students and staff. GAO testified at this Oversight Hearing:
        ``As of April 2017, the agency had not provided documentation that
    the inspection information that its safety personnel collect and report
    to BIE schools is complete and accurate. In addition, our preliminary
    findings from ongoing work since February 2017 point to continued
    problems with Indian Affairs' oversight of safety inspections at BIE
    schools.''
        Despite these remaining Indian Education-related recommendations
    for BIA, your testimony focused exclusively on addressing the remaining
    Indian Energy-related GAO recommendations. Please provide a summary and
    timeline of the Bureau's plans to address each of these unresolved
    recommendations.
        Answer. On July 17, 2017, and August 16, 2017, Indian Affairs (IA)
    and the Department of the Interior's Office of Financial Management
    provided GAO updates on progress on the BIE open recommendations. While
    none of the recommendations have been closed to date, GAO acknowledged
    the progress made and that some of the recommendations are close to
    full implementation.
        Indian Affairs has taken the following actions to address the GAO
    recommendations concerning school safety:

       In FY 2016, 100 percent of the BIE schools were inspected,
            reports were issued and deficiencies were recorded for
            remediation.

       Performance standards for SES Regional Directors and safety
            personnel were revised in FY 2016 and FY2017 that added
            specific performance elements and measures to ensure safety
            inspections are performed annually.

       In FY 2017, Indian Affairs established a Safety Work Group
            to enhance the school safety program and engage all the
            stakeholders to ensure a successful Indian Affairs integrated
            safety program.

       In FY 2017, policy guidance and handbooks were issued and
            disseminated to all Indian Affairs personnel responsible for
            school safety and remediation of the deficiencies.

       Indian Affairs tracks monthly safety inspections performed
            and disseminates the progress to the BIE and BIA Director and
            Regional Directors.

       Indian Affairs is currently developing a mandatory course
            curriculum for personnel responsible for performing safety
            inspections.

       In FY 2017, BIE stood up their School Safety Office and is
            continuing to recruit for their vacant positions.

        Question 1a. Has BIA established a process to routinely monitor the
    quality and timeliness of all school inspection reports? If so, please
    provide an explanation of this process.
        Answer. The BIA will amend the 2017 safety performance standards
    for Safety Inspectors to comply with the standards in the recently
    updated Indian Affairs Safety, Health and Accessibility Inspection/
    Evaluation Guidelines and the Indian Affairs Fire Systems Inspection,
    Testing and Maintenance Guidelines.
        In addition, the Division of Safety and Risk Management (DSRM),
    BIA, and BIE will develop and formally publish a comprehensive quality
    performance standard for inspection reports and develop a formal and
    uniform process of monitoring the quality of safety inspection reports.
        The BIE and BIA, in coordination with the DSRM, will develop and
    implement comprehensive and uniform Performance Appraisal Plans for all
    Indian Affairs safety personnel in FY 2017, to include a component
    addressing the timeliness of safety inspection reports submission. The
    first-line supervisors will then hold employees accountable based on
    the timeliness data collected by DSRM.

        Question 1b. What controls has BIA put in place to ensure that any
    high-risk safety and health deficiencies identified in school
    inspections are remedied in a timely manner?
        Answer. Office of Facilities, Property, and Safety Management
    (OFPSM through the Division of Facilities Management and Construction
    (DFMC) coordinates with DSRM, BIA and BIE to identify high risk items
    included in safety inspection reports. Once identified, DFMC/OFPSM has
    supplemental funding programs (major and minor Improvement & Repair,
    Emergency, Fire, Environmental) that provide funding for correction of
    high risk safety and health deficiencies. DFMC/OFPSM, in coordination
    with DSRM, BIA and BIE, also prioritizes safety, health and
    accessibility deferred maintenance deficiencies for annual Improvement
    and Repair funding provided to the Regions and Sites. DFMC/OFPSM has an
    established contract for Condition Assessments that also identifies
    safety and health deficiencies and completes any outstanding abatement
    plans during site visits.

        Question 1c. Please provide a summary of how BIA and BIE arc
    working to improve inter-Bureau coordination on safety inspections,
    health and safety issue remediation, and operations/maintenance
    activities.
        Answer. The BIE has worked closely across Indian Affairs, including
    with BIA, in recent months to address outstanding GAO recommendations
    and improve Bureau operations and service delivery in Bureau-funded
    schools. Upon GAO's identification of BIE as a high-risk agency, the
    Bureau coordinated efforts with Indian Affairs to prioritize
    accountability and oversight in order to address GAO recommendations,
    which will increase efficiency and effectiveness.
        Indian Affairs is supportive of the BIE as the agency participates
    in joint work groups specifically created to address outstanding GAO
    recommendations, such as the Indian Affairs Safety Work Group that
    includes participants from BIA. The Work Group held two sessions this
    past summer as a means to increase coordination, develop policies and
    procedures, and address outstanding GAO recommendations. Through the
    Work Group, BIE and BIA staff, alongside DFMC and Indian Affairs, have
    worked together to ensure that safety inspections are 100 percent
    completed for the second year in a row as well as developing policies
    and procedures to make sure quality improves and that supports are in
    place to assist critical staff, such as safety inspectors. The work
    group will plan subsequent meetings for the fall to ensure progress
    continues to be made on coordinated work. Additionally, Indian Affairs
    has formed an initial work group to specifically address financial
    oversight across the agencies. This coordination will diminish
    bureaucratic inefficiencies and promote communication across Indian
    Affairs.

        Question 2. GAO additionally testified that inclusion on the
    biennial High Risk report often results in agencies receiving
    additional management resources from Department leadership and the
    Office of Management and Budget (OMB). Has BIA seen increased
    engagement from the Department of the Interior's (DOI's) Office of the
    Secretary or OMB since the High Risk designation? If so, please
    summarize any evidence of this increased engagement.
        Answer. Yes, as indicated in a previous response, the Department's
    Office of Financial Management has been involved in the July and August
    meetings with GAO. Also, on a monthly and quarterly basis, DIEA
    provides and discusses the status of all GAO and OIG recommendations
    with the Office of Financial Management. Additionally, representatives
    from the Department's Assistant Secretary for Policy, Management and
    Budget attended the July 17, 2017, meeting with GAO and IA senior
    leadership.

        Question 3. Shortly following the conclusion of the May 17th
    Oversight Hearing, GAO released three additional reports regarding BIE
    education-related functions ``Tribal Transportation: Better Data Could
    Improve Road Management and Inform Indian Student Attendance
    Strategies,'' \2\ ``Indian Affairs: Actions Needed to Better Manage
    Indian School Construction Projects,'' \3\ and ``Indian Affairs:
    Further Actions Needed to Improve Oversight and Accountability for
    School Safety inspections.'' \4\ Within these three reports, the GAO
    provided a total of 20 new recommendations to improve the delivery of
    education to BIE students. Please provide a summary and timeline of the
    Bureau's plans to address each of the 20 recommendations directed at
    BIA.
        Answer. BIA provided a 60-day report to GAO and members of Congress
    on August 9, 2017, describing how BIA will partner with stakeholders in
    implementing each of the recommendations and detailing the timelines
    (including dates and responsible persons) for addressing each of the
    recommendations. BIA is also coordinating with the Federal Highway
    Administration (FHWA) and Tribal Transportation Program Coordinating
    Committee (TTPCC) on the proposal for addressing recommendations and
    responses.

        Question 3a. Please provide a summary of the efforts BIA is
    undertaking to work with BIE, and DOI's Office of the Secretary, and
    OMB to ensure the remaining recommendations from these three reports
    are addressed in a timely, effective manner.
        Answer. OFPSM is coordinating with DSRM, BIA and BIE to update
    policies, guidelines, performance plans and provide training for site
    personnel in Safety & Health, Accessibility, O&M services/activities,
    Improvement & Repair and other supplemental program funding guidelines
    and requirements. Training sessions have been posted on relevant
    websites for access by anyone needing training or for refresher
    training.
    Staff and Leadership Turnover
        Question 4. When asked about any continuing limitations placed on
    hiring by Administration leadership, you testified that the BIA and BIE
    are subject to certain hiring restrictions depending on vacancy grade-
    level and location. How many total vacancies does BIA currently have?
    And, what is the breakdown of these vacancies by type (location, grade
    level, and function)?
        Answer. The Office of Human Capital Management office has
    identified 1,003 vacancies BIA-wide, as of August 15, 2017 (see
    spreadsheet).

        Question 4a. What, if any, limitations put in place by the White
    House, OMB, or DOI's Office of the Secretary exists regarding BIA's
    ability to fill these vacancies?
        Answer. The Departmental Hiring Controls currently allow for the
    filling of vacancies at the GS-1 1 grade level and below located
    outside of the Washington, D.C., and Denver, Colorado, metropolitan
    areas. Hiring for all positions in the Washington, D.C., and Denver,
    Colorado, metropolitan areas is allowed with the granting of a waiver
    by the Secretary's Office.

        Question 5. In its 2017 High RiskReport, GAO identified workforce
    planning- including frequent turnover and high vacancy rates- as an
    overarching issue facing Indian Affairs. For example, several tribally
    operated BIE schools have informally reported to this Committee that
    staffing turnover and vacancies at Education Resource Centers make it
    difficult to receive timely assistance with reporting and compliance
    questions. How is BIA working to ensure all administrative duties are
    fulfilled in the face of these workforce challenges?
        Answer. During workforce planning efforts to address administrative
    duties and technical skill gaps, the BIA conducted a wide-spread review
    of components on optimal human capital levels required in relation to
    the services provided; gaps in talent and performance requirements;
    critical skills, functions and occupations to retain; and positions
    that should/could be eliminated or restructured/re-staffed to meet
    BIA's incremental goals of downsizing and reducing unnecessary
    processes and overlapping and redundant authorities/controls. As a
    result of the review, the BIA identified a need to restructure the
    organization to achieve near-term workforce reductions and allocate the
    resources where the needs are greatest. The BIA plans to consolidate
    programs and functions; realign functions to improve efficiency by
    eliminating overlapping responsibilities from central offices and other
    units where appropriate; relocate or reassign personnel to different
    duty stations and program areas; streamline supervisory staff
    restructure positions to correct skill imbalances and/or develop
    leadership; eliminate positions and functions that are redundant and
    obsolete as a result of automation and changing job competency
    requirements; utilize career ladder positions to establish a balanced
    workforce; and reduce grade levels throughout all locations across all
    the organization. To implement some of these changes, the BIA is also
    requesting the authority to offer Voluntary Separation Incentive
    Payment (VSIP) and Voluntary Early Retirement Authority (VERA). These
    actions and use of these authorities will allow BIA to implement and
    transition to more efficient Regional Office operations along with
    facilitating the effective delivery of services to our customers. They
    will allow the agency to achieve more efficient alignment of mission
    related operations and more consistent management of services across
    the organization.

        Question 5a. How is BIA ensuring the Bureau's staffing plan address
    the technical skill gaps (e.g., real estate management) identified by
    GAO?
        Answer. The BIA conducted a wide-spread review of components on
    optimal human capital levels required in relation to the services
    provided; gaps in talent and performance requirements; critical skills,
    functions and occupations to retain; and positions that should/could be
    eliminated or restructured/re-staffed to meet BIA's incremental goals
    of downsizing and reducing unnecessary processes and overlapping and
    redundant authorities/controls. As a result of the review, the BIA
    identified a need to restructure the organization to achieve near-term
    workforce reductions and to focus resources where the needs are
    greatest. As a result, the BIA plans to consolidate programs and
    functions; realign functions to improves efficiency by eliminating
    overlapping responsibilities from central offices and other units where
    appropriate; relocate or reassign personnel to different duty stations
    and program areas; streamline supervisory staff; restructure positions
    to correct skill imbalances and/or develop leadership; eliminate
    positions and functions that are redundant and obsolete as a result of
    automation and changing job competency requirements; utilize career
    ladder positions to establish a balanced workforce; and reduce grade
    levels throughout all locations across all the organization. To
    implement some of these changes, the BIA is also requesting the
    authority to offer Voluntary Separation Incentive Payment (VSIP) and
    Voluntary Early Retirement Authority (VERA).
    Energy
        Question 6. While BIA acknowledged in its testimony that ``a survey
    is an important step in developing a full inventory of trust
    resources,'' it also conceded that the federal government has not yet
    fully surveyed all Indian reservation lands. The BIA stated that
    ``cadastral survey inventories are being evaluated and FYI7 survey
    requests have been approved for funding and completion by BLM.'' Has
    BIA identified the extent to which trust lands do not have accurate
    surveys?
        Answer. While there is no inventory of unsurveyed lands, we know
    that there are significant areas of Indian lands that have not been
    surveyed, such as the Navajo reservation and certain tribal lands
    within the Eastern Region's jurisdiction. We have an inventory of
    survey needs identified by the BIA Regions in coordination with BLM,
    that are the result of proposed real estate development projects,
    zoning, trespass issues (boundary establishment), litigation needs and
    legislative mandates.

        Question 6a. Does BIA know what resources are needed to complete
    these surveys?
        Answer. Funding for the line item that covers Real Estate Services
    (RES) projects, including cadastral surveys, is $2.7 million. Our
    inventory of survey needs includes surveys for approximately 5,000
    projects. Funding is also required to fulfill BIA's trust
    responsibility and Fiduciary Trust Model components: BLM Indian Land
    Surveyor program, Certified Federal Surveyor program, Enhance Public
    Lands Survey System in Indian Country, and development of a cadastral-
    based geographic information system.

        Question 6b. Please list and describe the FYI7 survey requests that
    have been approved for funding and completion by BLM.
        Answer. BLM has approved for funding and completion the surveys
    mandated by the Nevada Native Nations Land Act (NNNLA), which required
    the new trust lands (70,000 acres) for the tribes involved in the NNNLA
    to be surveyed in 18 months (i.e., by the end of FY18).

        Question 7. When asked about GAO's finding that BIA did not have a
    documented process or the data needed to track its review and response
    times, the BIA stated that its experts are working to modify TAAMS. BIA
    further explained that these modifications may incorporate ``the key
    identifiers and data fields needed to track and monitor review and
    response times for oil and gas leases and agreements.'' BIA mentioned
    taking steps to track and monitor oil and gas leases and agreements. Is
    the agency also taking steps to track and monitor other energy-related
    documents that must be reviewed by BIA, such as ROW agreements?
        Answer. Yes. Rights-of-way are being tracked and monitored, a
    process that was implemented on April 21, 2016, the effective date of
    the revised 25 CFR Part 169 regulations. The revised Part 169
    regulations impose deadlines for BIA action on requests for rights-of-
    way.

        Question 7a. Is the agency taking steps to track and monitor
    documents related to environmental reviews, like those associated with
    the National Environmental Policy Act, the Endangered Species Act, and
    the National Historic Preservation Act?
        Answer. The agency tracks environmental reviews under NEPA through
    the NEPA Tracker, a central repository for tracking NEPA Actions across
    the organization. The system standardizes the NEPA action tracking
    process, improves data call efficiency, makes the NEPA action process
    more transparent, improves NEPA Action data analytics, and minimizes
    impacts of data calls. NEPA Coordinators are required to enter all NEPA
    Actions into the NEPA Tracking System, effective September 1, 2012.

        Question 8. The BIA also stated that it is in the process of
    evaluating and reviewing the current realty tracking system and TAAMS
    to improve efficiencies and timeliness in processing workloads. Yet,
    because multiple entities within the Department must review
    modifications to data systems, BIA intends to ask GAO for an extension
    of time to address this recommendation. With what other entities must
    the Department coordinate when reviewing the proposed modifications?
        Answer. TAAMS enhancements are programmed and implemented after
    approval by the TAAMS Change Management Board. The Board has authority
    to approve the change. If, however, the enhancement is a major
    development, it must be approved by the Department's Chief Information
    Officer.

        Question 9. The GAO recommended that DOI provide additional energy
    development specific guidance on provisions of TERA regulations that
    tribes have identified to the Department as unclear. \6\ The BIA
    testified that the Department, through the Office of Indian Energy and
    Economic Development, will issue guidance on those provisions of TERA
    that tribes identified as unclear. Will the guidance include
    clarification for ``inherently federal functions''?
        Answer. The Office of Indian Energy and Economic Development (IEED)
    has placed on its web site for tribal review a description of the
    technical assistance it will furnish tribes that are interested in
    programs, functions, services and activities (PFSAs) associated with
    the TERA regulations that Tribes can contract for under the Indian
    Self-Determination and Education Assistance Act, and PFSAs associated
    with the TERA regulations that the Interior Secretary must perform:
    https://www.bia.gov/as-ia/ieed/division-energy-and-mineral-development/
    tribal-toolbox/demd-and-office-of-solicitor
        To further clarify the TERA approval process, IEED plans to
    collaborate with the Department's Office of the Solicitor during
    calendar year 2018 to publish as part of IEED's ongoing online series
    ``Tribal Economic Development Principles at a Glance,'' a primer on the
    TERA approval process.
        Past IEED primers can be accessed at; https://www.bia.gov/as-ia/
    ieed/online-primers-economic-development-glance.

        Question 9a. What other provisions does the Department intend to
    include in the proposed guidance?
        Answer. Because ``inherently federal functions'' can only be
    defined on a case-by-case basis, it is not possible to compile any kind
    of list of these functions or provide meaningful examples. IEED is
    inviting tribes to query the office on these issues as they arise from
    real-world circumstances. The GAO report also identifies as ``unclear''
    what happens when tribal regulations enacted pursuant to a TERA
    conflict with federal regulations. TEED would work with the Solicitor
    to provide a response based on the particular circumstances of each
    specific inquiry on this matter.

        ENDNOTES
            1 U.S. Gov't Accountability Office, GAO-1 7-317, High Risk
            Series: Progress on Many High-Risk Areas, While Substantial
            Efforts Needed on Others (2017).
            2 U.S. Gov't Accountability Office, GA0-17-423, Tribal
            Transportation; Better Data Could Improve Road Management and
            Inform Indian Student Attendance Strategies (2017).
            3 U.S. Gov't Accountability Office, GA0-17-447, Indian Affairs:
            Actions Needed to Better Manage Indian School Construction
            Projects (2017).
            4 U.S. Gov't Accountability Office, GA0-17-421, Indian Affairs:
            Further Actions Needed to Improve Oversight and Accountability
            for School Safety Inspections (2017).
            5 U.S. Gov't Accountability Office, GA0-17-317, at 216.
                                     ______

        Response to Written Questions Submitted by Hon. Steve Daines to
                                  Tony Dearman
        Question. Mr. Dearman, in your testimony, you set mid-2019 as a
    goal to implement two recommendations from a 2014 report, which is five
    years later. What is the holdup?
        Answer. These recommendations should have been addressed in a more
    timely fashion. Since taking leadership of the Bureau of Indian
    Education (BIE) in November 2016, 1 have assessed our Government
    Accountability Office-related work to date. BIE leadership has not been
    satisfied with either the quality or the timeliness of the work
    performed to analyze the GAO recommendations. As a result, I have
    directed BEE senior leadership to prioritize implementing all
    outstanding GAO recommendations as quickly as possible. While I
    understand the timeframe for comprehensively addressing BIE's
    outstanding GAO recommendations, including the recommendations you
    highlight, has been extended, I believe it is prudent that the bureau
    continue to work toward timely and effectively addressing GAO's
    recommendations and we are doing so, as discussed in my testimony for
    this hearing.
                                     ______

    Response to Written Questions Submitted by Hon. Catherine Cortez Masto
                                to Tony Dearman
        Question. As you may know, Nevada has two BIE schools: Duckwater
    Shoshone Elementary School and Pyramid Lake Junior/Senior High School.
    We are all very proud of all or our students, teachers, administrators,
    and parents. We want the very best for them, and they deserve the very
    best your department has to offer. Director Dearman, in your written
    testimony you mentioned that your office is diligently working to
    address the varying and developing needs of students, including
    behavioral and mental health support services. Can you please talk
    further about this partnership with Indian Health Service (IHS) and how
    you are planning to overcome some of the IHS limitations outlined in
    the report?--Can you elaborate on your strategic plan to collaborate
    with local emergency medical services and law enforcement to ensure the
    safety and wellbeing of students and staff in school?
        Answer. In December 2016, BIE, IHS, and Bureau of Indian Affairs
    (BIA), entered into an Inter-agency Agreement intended to increase
    access to mental and behavioral health services for students attending
    BIE schools and youth detained in Office of Justice Services (OJS)
    facilities. The Agreements allow each agency to establish local
    partnerships through a Memorandum of Agreement (MOA) between IHS
    federally-operated mental health programs, BIE-operated elementary and
    secondary schools, and BIA OJS-operated juvenile detention centers to
    provide mental health assessment and counseling services, which
    includes tele-behavioral health services.
        Under this 10-year partnership, behavioral health services will be
    offered at BIE schools and OJS facilities that are located near an
    available IHS facility. Key staff, including our Student Health Program
    Specialist, are partnering within the agencies under a National
    Implementation Team tasked with identifying key contacts to create
    Regional and Local Implementation Teams. This new collaboration is
    intended to ensure that the mental and behavioral health needs of our
    students are being met.
        BIE is also collaborating with OJS to provide comprehensive law
    enforcement oversight for schools. This includes strategic program
    direction, development of related policies, procedures, standards and
    guidelines, and program accountability and consistency. In January
    2017, BIE began working through the partnership to provide expert law
    enforcement guidance and direction to local law enforcement officials,
    school administrators, and tribal leaders in response to criminal
    matters or emergencies that occur on tribal school campuses or within
    the immediate vicinity of a tribal school.
                                     ______

         Response to Written Questions Submitted by Hon. Tom Udall to
                                  Tony Dearman
    GAO High-Risk Report and Recommendations
        Question 1. The Government Accountability Office (GAO) testified
    that inclusion on the biennial High Risk report often results in
    agencies receiving additional management resources from Department
    leadership and the Office of Management and Budget (OMB). Has the
    Bureau of Indian Education (BIE) seen increased engagement from the
    Department of the Interior's (DOI's) Office of the Secretary or OMB
    since the Bureau's High Risk designation? If so, please summarize any
    evidence of this increased engagement.
        Answer. Upon GAO's identification of BIE as a high-risk agency, the
    Department has worked closely with the Bureau as it prioritizes
    accountability and oversight in order to address GAO recommendations,
    which will increase efficiency and effectiveness.
        The Department is supportive of the BIE as it participates in work
    groups specifically created to address GAO recommendations, such as the
    Indian Affairs Safety Work Group (Safety Work Group) that includes
    participants from the Assistant Secretary-Indian Affairs (Indian
    Affairs) office, Bureau of Indian Affairs (BIA), and Division of
    Facilities Management and Construction (DFMC). The Safety Work Group
    has held two workgroup sessions this summer as a means to increase
    coordination, develop policies and procedures, and address outstanding
    GAO recommendations in reports GA0-16-313 and GA0-17-421.
        The Department has also provided BIE support as it works to
    increase its direct communication with GAO, which has enhanced BIE's
    ability to comprehensively address outstanding recommendations. It is
    the Department's goal that BIE is effective in addressing GAO
    recommendations as well as coordinating effectively across Federal
    agencies in order to improve BIE accountability and oversight. As such,
    the BIE has had consistent contact and works closely with senior
    leadership within the Department and the Secretary's office to ensure
    matters highlighted in GAO reports, particularly those critical to
    directly improving the wellness and safety of students in Bureau-funded
    schools, are properly addressed in a timely manner.

        Question 2. A number of the outstanding recommendations for
    improving Indian Education included in GAO's February 2017 High-Risk
    Report require action by the Bureau of Indian Affairs (BIA) to fully
    resolve. \1\ Your testimony provided an outline of BIE's efforts to
    address these remaining recommendations that included references to
    ``working cooperatively with the leadership within Indian Affairs.''
    Yet, Mr. Black's testimony focused exclusively on addressing the
    remaining Indian Energy recommendations flagged by GAO in the 2017 High
    Risk Report. Has BIE seen increased engagement from BIA leadership
    regarding its role in resolving the remaining GAO recommendations
    regarding financial oversight and safety inspections? If so, please
    summarize any evidence of this increased engagement.
        Answer. The BIE has worked closely across Indian Affairs, including
    BIA, in recent months to address outstanding GAO recommendations and
    improve Bureau operations and service delivery in Bureau-funded
    schools. Upon GAO's identification of BIB as a high-risk agency, the
    Bureau coordinated efforts with Indian Affairs to prioritize
    accountability and oversight in order to address GAO recommendations,
    which will increase efficiency and effectiveness.
        Indian Affairs is supportive of the BIE as it participates in joint
    work groups specifically created to address outstanding GAO
    recommendations, such as the Indian Affairs Safety Work Group (Safety
    Work Group) that includes participants from BIA. The Work Group held
    two workgroup sessions this past summer as a means to increase
    coordination, develop policies and procedures, and address outstanding
    GAO recommendations. Through the Safety Work Group, BIE and BIA staff,
    alongside DFMC and Indian Affairs, have worked together to ensure that
    safety inspections are 100 percent completed for the second year in a
    row as well as to develop policies and procedures to make sure quality
    improves and supports are in place to assist critical staff, such as
    safety inspectors. The Safety Work Group will plan subsequent meetings
    to progress coordinated work. Additionally, Indian Affairs has formed
    an initial work group specific to address financial oversight across
    the agencies. This coordination will diminish bureaucratic
    inefficiencies and promote communication across Indian Affairs.

        Question 3. Shortly following the conclusion of the May 176
    Oversight Hearing, GAO released three additional reports regarding the
    BIE--``Tribal Transportation: Better Data Could Improve Road Management
    and Inform Indian Student Attendance Strategies,'' \2\ ``Indian
    Affairs: Actions Needed to Better Manage Indian School Construction
    Projects,'' \3\ and ``Indian Affairs: Further Actions Needed to Improve
    Oversight and Accountability for School Safety Inspections.'' \4\
    Within these three reports, the GAO provided a total of 20 new
    recommendations to improve the delivery of education to BIE students.
    Please provide a summary and timeline of the Bureau's plans to address
    each of the 20 recommendations directed at BIE.
        Answer. The reports provide ten additional recommendations that BIE
    must address unilaterally. The other findings, due to agency authority,
    are directed to other entities within Indian Affairs, or must be
    addressed by a combination of these entities. BIE now has 21 total
    outstanding recommendations from past GAO reports as well as those
    issued in 2017 that it must address.
        In reference to the reports mentioned, BIE worked directly with
    Indian Affairs through the aforementioned work groups to provide formal
    updates to GAO on August 8, 2017, and August 16, 2017. The three
    enclosed letters (DOL 60-Day Letter to GAO Report 17-421 IA School
    Safety; DOI 60-Day Letter to GA0-17-423 Tribal Transport; and DOI 60
    Day Letter to GAO Report 17-447 IA School Construction) provide
    responses to each new GAO recommendation as well as timelines and
    bureau authority for associated work to be completed.

        Question 3a. Please provide a summary of the efforts BIE is
    undertaking to work with BIA, and DOI's Office of the Secretary, and
    OMB to ensure the remaining recommendations from these three reports
    are addressed in a timely, effective manner.
        Answer. BIE worked directly with Indian Affairs to provide updates
    to GAO on August 8, 2017 and August 16, 2017. The three enclosed
    letters (DOI 60-Day Letter to GAO Report 17421 IA School Safety; DOI
    60-Day Letter to GA0-17-423 Tribal Transport; and DOI 60 Day Letter to
    GAO Report 17-447 IA School Construction) provide responses to each new
    GAO recommendation as well as timelines and Bureau authority for
    associated work to be completed.
    Staff and Leadership Turnover
        Question 4. When asked about any continuing limitations placed on
    hiring by Administration leadership, you testified that the BIE is
    currently ``hiring at all levels.'' Yet, this response is at odds with
    statements made by DOI's Office of Budget staff at a May 6, 2017
    Committee Briefing and an April 12, 2017 memorandum issued by Associate
    Deputy Secretary James Cason. Please clarify your claim that BIE is
    ``hiring at all levels'' in light of the previously noted May 6
    statements and April 12 memorandum.
        Answer. On April 14, 2017, a DOI memorandum provided Department
    guidance to agencies and bureaus regarding updated hiring controls,
    detailing that:

       Bureaus and offices could proceed with lateral reassignments
            or details, except for Senior Executive Service positions.

       Bureaus and offices could proceed with hiring for all
            positions, outside Washington, DC and Denver, Colorado, at the
            grade of GS-11 and below.

       Bureaus and offices could proceed with hiring for positions
            above GS-11 and within Washington, DC and Denver, Colorado if
            provided a waiver based on how such positions will better
            support on-the-ground mission delivery.

        With regard to BIE hiring, the agency continues to hire at all
    levels consistent with the guidance provided by the Department. The
    Department-specific hiring controls also do not affect contract
    positions funded by the BIE, such as school level teachers. As such,
    students incur no major disruptions in access to instruction. After the
    initial hiring freeze, the Bureau has worked consistently and
    cooperatively with Department leadership in obtaining hiring waivers
    for filling critical, non-field positions at all levels. For example,
    the Department provided BIE clearance on August 14, 2017 to hire, or
    clarify further the need to hire, 39 vacant positions above GS-1 1 as
    well as in various duty locations that are critical to improving
    service delivery. Clearance has been provided to hire additional
    positions since August. The Bureau continues to coordinate with
    Department leadership to acquire waivers for any remaining vacancies.

        Question 4a.a. How many total vacancies does BIE currently have?
    And, what is the breakdown of these vacancies by type (location, grade
    level, and function)?
        Answer. At the time of the hearing, the BIE was 42 percent fully
    staffed with 134 positions filled out of a total of 316 positions
    (waivers pending), Bureau-wide. Such positions include those in the BIE
    Director's Office (Central Office), School Operations Division,
    Division of Performance and Accountability, Associate Deputy Director--
    Tribally-Controlled Schools, Associate Deputy Director--Bureau-Operated
    Schools, and Associate Deputy Director--Navajo Schools. Since May 2017,
    the Bureau is nearly 46 percent fully staffed with hiring continuing to
    improve service delivery.

        Question 4b. What, if any, limitations put in place by the White
    House, OMB, or DOI's Office of the Secretary exists regarding BIE's
    ability to fill these vacancies?
        Answer. As noted in a previous response, the agency continues to
    hire at all levels consistent with the guidance provided by the
    Department. In addition, the Department-specific hiring controls did
    not affect contract positions funded by the BIE, such as school level
    teachers. As such, students incurred no major disruptions in classroom
    instruction. After the initial hiring freeze, the Bureau has worked
    consistently and cooperatively with Department leadership in obtaining
    hiring waivers for filling critical, non-field positions at all levels.

        Question 5. In its 2017 High Risk Report, GAO identified staffing
    turnover as an overarching issue facing Indian Education.' For example,
    several tribally operated BIE schools have informally reported to this
    Committee that staffing turnover and vacancies at Education Resource
    Centers (ERCs) make it difficult to receive timely assistance with
    reporting and compliance questions. How is BIE working to ensure all
    administrative duties are fulfilled in the face of frequent turnover?
        Answer. A major goal of the BIE is to identify, recruit, develop,
    retain, and empower highly-effective employees at all levels. However,
    obstacles, such as limited access to housing as well as duty stations
    located in geographically isolated and impoverished communities
    continue to impact employee recruitment. While vacancies do persist,
    the BIE has not experienced exceedingly high turnover rates at its
    ERCs--only one employee has separated (June 30, 2017) since January 1,
    2016. However, as the Bureau continues to fill positions, the BIE is
    working to streamline hiring practices where possible to increase
    recruitment as well as ensure existing staff have the administrative
    support from Central Office to perform their duties effectively.
        BIE Central Office, as part of its GAO related work, is developing
    its comprehensive strategic planning effort to set agency priorities
    and focus energy and resources to ensure employees are working toward
    common goals. It is critical that BIE employees are focused on outcomes
    and results that will help the agency provide improved service
    delivery, technical assistance, and oversight regardless of staffing
    levels. Such strategic planning work will also assist the agency as it
    develops a comprehensive workforce plan that addresses such vacancies
    and focuses human capital where needed to ensure Bureau-funded schools'
    needs are effectively addressed in a timely manner. Human capital
    capacity has historically been an issue for the BIE, so even as the
    agency works to hire positions to expand such capacity, the agency is
    working to formalize plans that will also address retention through
    professional development and standard appraisal metrics.

        Question 5a. How is BIE ensuring federally-operated and tribally-
    operated Bureau schools receive full support with legal and financial
    compliance requirements (e.g., completion of annual audits and
    Individuals with Disabilities Education Act compliance)?
        Answer. The BIE is working to ensure existing staff have the
    administrative support from Central Office to perform their duties
    effectively as well as ensure employee appraisal metrics increase
    employee accountability. BIE leadership has tasked management across
    the Bureau with improving the alignment of appraisal metrics with the
    services for which employees are tasked to provide, such as assisting
    in financial compliance, providing technical assistance, and assisting
    with completion of annual audits. These metrics are critical to
    reducing waste, fraud, and abuse and utilizing public tax dollars as
    efficiently and effectively as possible.
        In addition, BIE is hiring additional budget personnel and fiscal
    auditors to assist in compliance, and is developing a school visit
    coordination and information sharing policy that establishes formal
    procedures for fiscal monitoring and requiring coordination among BIE
    staff. This will improve technical assistance through regular, on-site
    audits based on risk elements for federal funding distribution and
    financial compliance. As part of any risk matrix, such policies and
    procedures will not alleviate or address all risk but will formalize a
    protocol for diminishing such risk through coordinated School
    Intervention Teams from Bureau ERCs and Division of Performance and
    Accountability staff who work with schools to address areas of greatest
    need.

        Question 5b. How is BIE ensuring the Bureau's staffing plan
    addresses technical skills gaps (e.g., financial audit expertise)
    identified by GAO?
        Answer. As part of the BIE's reorganization, the BIE is working to
    increase its capacity and narrow its technical skills gap for financial
    oversight and fiscal monitoring. Accordingly, the Bureau has
    prioritized hiring of fiscal monitors, such as auditors and budget
    personnel. The BIE has advertised such positions for hiring to increase
    capacity to address such gaps. Among other areas, another focus has
    been increasing data-driven decisionmaking across the Bureau through
    improved data collection. The Bureau is working to hire several
    Education Research Analysts and three Native American Student
    Information System (NASIS) positions that will improve the Bureau's
    collection and use of key data metrics critical to informed
    decisionmaking that addresses areas of greatest need.
    BIE School Accountability
        Question 6. The most recent school and Bureau accountability data
    provided on the BIE website dates to SY2012-2013. \6\ The Committee is
    unaware of any other locations where the Bureau might have published
    accountability data for the three school years completed sinceSY2012-
    2013 concluded and required under Section 1111 of the Elementary and
    Secondary Education Act through August 1, 2016: \7\ Please provide a
    copy of all statutorily required school accountability data for SY
    2013-2014, SY 2014-2015, and SY 2015-2016.
        Answer. The Bureau is working to update and post some of the
    additional, required public reporting on school accountability.
    However, most information has not yet been aggregated and remains
    partially incomplete. Recently, leadership has refocused attention to
    increasing data-driven decisionmaking across the Bureau through
    improved data collection. As mentioned previously, the Bureau is
    working to hire several Education Research Analysts and three NASIS
    positions specifically focusing on data that will improve the Bureau's
    collection and use of key data metrics critical to supporting the needs
    of students attending BIE-funded schools.

        Question 6a. Please provide an overview of how BIE ensures parents,
    tribes, and Congress has timely access to this information.
        Answer. The BIE has hired personnel to serve as the Communication
    Specialist to address and update communication outlets going forward.
    It is critical that the Bureau is transparent and efficient in
    delivering information, and this is a key component to achieving this
    goal. The BIE is working with an ED contractor, the Center for
    Standards and Assessment Implementation (CSAI), to develop procedures
    to ensure timely data collection and reporting take place, which will
    then be externally communicated to stakeholders.

        Question 6b. Does BIE have any other student outcome related data
    (e.g., graduation rate trends, absenteeism trends, etc.) that it can
    share with the Committee? If so, please provide it here or provide a
    firm timeline of when such information can be made available to the
    Chairman and the Vice Chairman.
        Answer. As noted in response to a previous question, the Bureau is
    working to bring recent data sets up to date. Currently, an analysis of
    longitudinal data trends is unavailable until such data strands are
    collected and verified. However, the Bureau has enclosed the following
    2015 Bureau of Indian Education Report on Student Achievement and
    Growth from the Northwest Evaluation Association for the Committee's
    review. Its results suggest that BIE students have shown some
    improvements over time in achievement and growth rates, most notably in
    mathematics and for students attending earlier grade levels. However,
    gaps persist and BIE remains committed to improving service delivery
    that will help narrow the gap for students attending Bureau-funded
    schools.

        Question 7. Title I of theEvery Student Succeeds Act (ESSA)
    requires states to design and implement an accountability system to
    measure school quality and performance in consultation with a variety
    of stakeholders. \8\ The Department of Education (ED) indicates on its
    website that BIE, acting in its capacity as the State Education Agency
    (SEA) for BIE-funded schools, provided notice of intent to submit its
    state accountability plan to ED on September 18, 2017. \9\ Yet, as on
    the date of this hearing, the BIE's webpage on the Bureau's ESSA State
    Plan is completely blank. \10\ What is the status of the BIE state
    plan? Please provide a summary of any BIE's coordination between BIE
    and ED on this issue and a description of all relevant consultations
    undertaken by BIE to date on development of a state accountability
    plan.
        Answer. While ED officials have expressed a view that the BIE is
    not required to submit a State Plan under ESSA, BIE Director Dearman
    announced that the BIE would develop a State Plan as a means to
    facilitate a transition to ESSA requirements and ensure the development
    of a coherent federal education system across the 23 states in which
    BIE facilities operate. The BIE notified ED via email on January 7,
    2017 that it would submit a State Plan. However, many of the elements
    of the plan would relate to standards, assessments, and accountability,
    and BIE is required by the ESEA to conduct negotiated rulemaking to
    establish standards, assessments, and an accountability system that is
    consistent with the ESSA changes to the ESEA.
        As the Department works to establish the Negotiated Rulemaking
    Committee outlined below to negotiate and develop a proposed rule, in
    accordance the Negotiated Rulemaking Act, timelines have had to shift
    to provide adequate time for review by the Administration.
    Nevertheless, work on the State Plan continues as a means for
    addressing a key part of the BIE Strategic Plan for improving student
    outcomes and increasing coordination across BIE-funded schools. Once
    drafted, BIE will engage stakeholders, including tribal community
    members, school personnel, and parents, to provide input. Formal tribal
    consultation will take place following the stakeholder engagement phase
    to ensure tribes have a document for which to provide comments and have
    meaningful consultation.
        Additionally, BIE continues to have a close and consistent working
    relationship with ED through the interagency collaborative work group
    that meets bi-weekly. Through this coordination, BIE and ED have
    entered into an interim Memorandum of Understanding that ensures ED
    Title funding continues to support BIE students for SY 2017-18.

        Question 7a. Please provide an overview of BIE's efforts to comply
    with ESSA as a whole and outline how the Bureau has worked with ED to
    ensure full compliance moving forward.
        Answer. To meet its obligations, the BIE will: (1) amend its
    existing standards, assessments, and accountability regulations through
    negotiated rulemaking, and (2) solicit stakeholder and tribal input
    through consultation regarding the BIE State Plan. The BIE has elected
    to adopt a State Plan that will work to improve the BIE's support of
    Bureau-funded schools. Through tribal consultation and solicitation of
    stakeholder feedback, the BIE will ensure ESSA requirements are met.
        Section 8204(c), as amended by the ESSA, directs the Secretary of
    the Interior, through negotiated rulemaking, to update the BIE
    standards, assessments, and accountability system. On November 9, 2015,
    the BIE published a notice of intent (80 FR 69161) requesting comments
    and nominations for tribal representatives for the Negotiated
    Rulemaking Committee (Committee). During transition, the initial
    formulation of the Committee was postponed in order to provide incoming
    Department staff adequate time to review prior work. In August 2017,
    the BIE was provided clearance to move forward with re-initiating the
    Committee and working and consulting with stakeholders to determine
    membership and subsequent steps. More information is forthcoming
    regarding timing of the notice that will clarify consultation,
    membership, meeting dates, and other pertinent information.
        Ultimately, the Committee will recommend revisions to the existing
    regulations (25 CFR Part 30) to replace the NCLB Adequate Yearly
    Progress regulatory language and implement the Secretary's statutory
    responsibility to define the standards, assessments, and accountability
    system, consistent with ESSA. BIE continues to have a close and
    consistent working relationship with ED through the interagency
    collaborative work group that meets bi-weekly to ensure full compliance
    with ESSA. The BIE and ED consult frequently on a range of topics and
    direct communication includes electronic and telephonic correspondence.
    School-based Health Clinics
        Question 8. RADM Chris Buchanan's testified that IHS supports nine
    direct-service and eight tribally-operated, school-based health
    clinics. His testimony provides no details as to whether these clinics
    are located in schools operated by Local Education Agencies (LEAs) or
    by the BIE. Are any of these 17 health clinics located in 131E schools?
    If so, please provide a list of those schools.
        Answer. The BIE Student Health Program Specialist conducted site
    visit assessments of BIE-funded schools in the fall of 2017 to
    determine what health and behavioral health services were being
    provided by the Indian Health Service (IHS). IHS has identified several
    131E schools as pilot sites for school-based health clinics. BIE is
    excited to collaborate with IHS to establish school-based clinics so
    critical health and behavioral health services are provided to our
    students.
        In December 2016, the Indian Health Service (INS) and BIE entered
    into an inter-agency agreement intended to increase access to mental
    and behavioral health services for students attending BIE-funded
    schools. This 10-year partnership allows each agency to build up local
    partnerships through Memoranda of Agreement (MOA) among local IHS
    mental health programs and BIE-funded schools in order to provide on-
    site mental health assessment and counseling services to BIE students.
    For information regarding general school-based health clinics as well
    as the MOA work, BIE recommends the Committee work with IHS, the
    designated lead agency, for further clarification.

        Question 8a. Is BIE aware of any IHS-supported school-based health
    clinics previously operating on a BIE school or dormitory campus?
        Answer. The BIE defers to IHS, as lead agency, for further
    clarification and information regarding general school-based health
    clinics as well as the MOA work.

        Question 9. This Committee has heard from several tribes and BIE
    school community members from several different parts of Indian Country
    who are interested in opening IHSsupplemented school-based health
    clinics in a BIE-funded school or dormitory. However, representatives
    from these tribes and communities report that regional BIE leadership
    rejected the idea. Is BIE aware of any requests by tribes to open IHS-
    supported school-based health clinics within a BIE-funded school or
    dormitory? If so, please provide any pertinent information relating to
    such requests (e.g., date request was received, name of the BIE line
    office/resource center that received the request, and BIE's response to
    the request).
        Answer. As IHS and BIE coordinate and work together under the MOA
    to better support onsite services to BIE students, BIE leadership has
    been supportive of such work and is unaware of the aforementioned
    outreach. The Bureau will work with its management team to determine if
    such requests were made and, if so, what actions were taken in
    response. We look forward retrieving more information and providing an
    update when possible.

        Question 9a. What barriers--if any--exist to BIE working
    collaboratively with tribes and IHS to open these clinics? For example,
    would BIE have concerns about liability or operations/maintenance
    expenses of the clinic space?
        Answer. There may be barriers, which vary by facility depending on
    the availability of local medical staff, space at the school facility,
    current state of local partnerships (BIE/IHS, tribe, and school), as
    well as unique issues faced by personnel, such as community support.
    Additional barriers include the dissemination/sharing of sensitive
    student/patient data and significant communications issues at the local
    site level. Despite these and future barriers that may develop, BIE is
    dedicated to ensuring that the health and behavioral health needs of
    our students are met.

        Question 9b. Can BIE provide any suggestions to overcoming those
    barriers identified above?
        Answer. BIE is committed to working with its partners, including
    IHS, to provide technical assistance and support to schools. This
    workgroup would also provide annual updates and progress reports as
    necessary. BIE will also conduct a comprehensive needs assessment and
    thorough investigation of the current state regarding school-based
    health clinics and associated barriers/solutions. In addition, BIE has
    established a new position to further assist with the coordination of
    student behavioral health and has hired a Student Health Program
    Specialist.
    Medicaid Funding in BIE Schools
        Question 10. In general, the Medicaid Program allows school
    districts to provide Early Periodic Screening Diagnosis and Treatment
    (EPSDT) services and allows the schools to directly bill the Program
    for medically necessary services related to Individual Education Plans
    (IEPs). Does BIE coordinate with states and/or the Center for Medicaid
    Services (CMS) to receive allowable reimbursements for delivery of
    these services? If so, please provide a summary of how BIE interacts
    with the Medicaid Program and an estimate of the level of Medicaid
    funding received by the Bureau.
        Answer. BIE is aware that while some Bureau-funded schools have
    worked through the process of directly billing Medicaid for services,
    the agency itself has not done an adequate job of providing
    professional development for such interaction with the Medicaid
    program. The process can be cumbersome and capacity at various schools
    differs. The Bureau will work as part of its strategic planning to
    include the development of a formal policy and associated procedure as
    a means for collecting data and improving the health and welfare of
    BIE-funded students. Because this currently takes place on a local
    level, the Bureau does not have adequate data to present at this time.

        ENDNOTES
            1 U.S. Gov't Accountability Office, GA0-17-317, High Risk
            Series: Progress on Many High-Risk Areas, While Substantial
            Efforts Needed on Others (2017).
            2 U.S. Gov't Accountability Office, GA0-17-423, Tribal
            Transportation: Better Data Could Improve Road Management and
            Inform Indian Student Attendance Strategies (2017).
            3 U.S. Gov't Accountability Office, GA0-17-447, Indian Affairs:
            Actions Needed to Better Manage Indian School Construction
            Projects (2017).
            4 U.S. Gov't Accountability Office, GA0-17-421, Indian Affairs:
            Further Actions Needed to Improve Oversight and Accountability
            for School Safety Inspections (2017).
            5 U.S. Gov't Accountability Office, GA0-17-317, at 205.
            6 School Report Cards, BUREAU OF INDIANEDUCATION https:/
            bie.edu/HowAreWeDoing/Scorecardsindexhtm (accessed on May 17,
            2017)
            7 Every Student Succeeds Act, Pub. L. No. 1 14 -95,  5(e) (1)
            (A), 129 Stat. 1802, 1806 (20 15).
            8 Every Student Succeeds Act. Pub. L. No. 114-95.  1000 et
            sec.. 129 Stat. 1802, 1814-1913 (2015).
            9 ESSA State Plan Notice of Intent to Submit, U.S.
            DEP'TOFEDUCATION