[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
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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
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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