[Senate Hearing 115-308]
[From the U.S. Government Publishing Office]
S. Hrg. 115-308
GAO HIGH RISK LIST: TURNING AROUND VULNERABLE INDIAN PROGRAMS
=======================================================================
HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
JUNE 13, 2018
__________
Printed for the use of the Committee on Indian Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. GOVERNMENT PUBLISHING OFFICE
31-222 PDF WASHINGTON : 2018
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 BRIAN SCHATZ, Hawaii
JAMES LANKFORD, Oklahoma HEIDI HEITKAMP, North Dakota
STEVE DAINES, Montana CATHERINE CORTEZ MASTO, Nevada
MIKE CRAPO, Idaho TINA SMITH, Minnesota
JERRY MORAN, Kansas
T. Michael Andrews, Majority Staff Director and Chief Counsel
Jennifer Romero, Minority Staff Director and Chief Counsel
C O N T E N T S
----------
Page
Hearing held on June 13, 2018.................................... 1
Statement of Senator Hoeven...................................... 1
Statement of Senator Murkowski................................... 3
Statement of Senator Udall....................................... 2
Witnesses
Dearman, Tony, Director, Bureau of Indian Education, U.S.
Department of the Interior..................................... 14
Prepared statement........................................... 15
LaCounte, Darryl, Acting Director, Bureau of Indian Affairs, U.S.
Department of the Interior..................................... 18
Prepared statement........................................... 19
Rusco, Frank, Director, Natural Resources and Environmental
Issues, U.S. Government Accountability Office.................. 4
Prepared statement........................................... 6
Weahkee, Rear Admiral Michael D., Acting Director, Indian Health
Service, U.S. Department of Health and Human Services.......... 23
Prepared statement........................................... 24
Appendix
Response to written questions submitted by Hon. Tom Udall to RADM
Michael D. Weahkee............................................. 35
GAO HIGH RISK LIST: TURNING AROUND VULNERABLE INDIAN PROGRAMS
----------
WEDNESDAY, JUNE 13, 2018
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:32 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. Good afternoon.
I hereby call this oversight hearing to order.
Just over a year ago, the Committee began examining the
Government Accountability Office's High Risk List. For the
first time, three Federal Indian programs, Indian Energy,
Education and Health Care were included on the list due to
their vulnerability to mismanagement, waste, fraud and abuse.
These Federal programs are vitally important to Native
American communities. They affect the safety of school
buildings, the quality of health care and education and the
advancement of Indian energy development.
This is the Committee's third hearing focusing on
evaluating efforts to address the GAO recommendations for
tribal health, education and energy programs. Based on some
recent information from the agency, there has been some
progress from the Bureau of Indian Education and the Indian
Health Service including recommendations and improving
services.
Over the past year, we have seen very little progress in
implementing Indian energy. Only one out of the 14 GAO
recommendations has been addressed by the Department of the
Interior regarding Indian energy development.
The Department of the Interior is supposed to facilitate
tribal resource development. However, for many tribes, the
agency has only delayed such activity. Our past hearings, as
well as the GAO reports, have confirmed that the Indian Energy
Program at DOI has cost tribes millions of dollars in delayed
or missed opportunities for economic development.
In my home State of North Dakota, the Mandan, Hidatsa and
Arikara Nation, also known as the Three Affiliated Tribes, has
been an industry leader in oil production. In fact, if the
Three Affiliated Tribes were their own State, they would be the
seventh leading oil export producer in the United States. Just
that one reservation, by itself, would be the seventh largest
oil producing State if it were a State.
It is of critical importance that the trustee does not
inhibit or prevent tribes such as the Three Affiliated Tribes
from engaging in activities that promote economic development
in Indian Country. Many tribes have invested in energy
development. These tribes have communicated to this Committee
their disappointment with the prioritization of energy
development at the Department of the Interior.
Some tribal leaders have even suggested moving the Indian
energy portfolio from the Department of the Interior into the
Department of Energy. Because of this feedback, this Congress I
introduced S. 245, the Indian Tribal Energy Development and
Self Determination Act of 2017 along with Senators Barrasso,
Enzi, Gardner, Heitkamp, Lankford, McCain, and Moran.
This bill was developed in consultation with the energy-
producing Indian tribes to correct burdensome agency
regulations. Most notably, the bill directs the Department of
the Interior to provide Indian tribes with technical assistance
in planning their energy resource development programs, cuts
red tape and makes it easier for Indian tribes to develop their
own resources, and streamlines the process for approving tribal
energy resource agreements.
Once again, Congress must step in to ensure the agency
prioritizes and corrects critical and failing programs. Moving
forward, we will continue to work to ensure the Department is
giving the appropriate attention to these matters.
I want to welcome all the witnesses today. I look forward
to hearing about the work being done to turnaround these
programs. Additionally, I look forward to discussing the GAO
recommendations that have been closed and a specific timeline
for closing outstanding recommendations.
More importantly, I want to know how these solutions have
benefitted Indians and tribal communities.
Before we hear from our witnesses, I want turn 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.
As you mentioned, this is our third hearing on the GAO High
Risk Report for Indian programs. I appreciate your follow-
through on this topic.
As this Committee is well aware, the Federal Government has
trust and treaty obligations to provide vital services to
American Indian and Alaska Native tribes. GAO's review of
Indian programs helps ensure our government is living up to and
respecting those obligations.
However, including Indian programs on the GAO High Risk
list confirms what many in Indian Country have reported to this
Committee; we must do better. Year after year, tribal
communities report gaps in Federal programs. In response, our
Federal partners point to workforce turnover and lack of
resources as the source of programs' ineffectiveness.
The Gallup Indian Medical Center, in my home state of New
Mexico, is a ``case in point,'' just one of the most recent
examples showing how much more we have to do. GIMC is located
in a 59 year old facility with a 19 percent vacancy rate.
Recent deficiencies at GIMC uncovered by the Centers for
Medicare and Medicaid Services mean the facility is at risk of
losing its accreditation, just like several hospitals in the
Great Plains and, as of last week, the IHS facility in the
Billings Service Area.
It is true that the root cause of many of GIMC's
deficiencies can be traced to the facility's age and its
struggle to recruit and retain staff, but these barriers to
quality care are not impossible to overcome. IHS leadership
must prioritize deficiencies by requesting the resources they
need to fully address the accreditation crisis in the Great
Plains, Billings and Navajo Service Areas. If IHS really wants
to prevent this crisis from spreading even further, leadership
must commit to realizing meaningful improvements in the way the
Service is managed.
The real goal of the High Risk List, and this Committee's
focus on it, is to make sure BIA, BIE, and IHS are working
toward meaningful institutional change. We need to see evidence
of cultural shifts within all three agencies that will lead to
proactive improvements in Federal Indian program delivery.
My questions for the panel today will focus on a central
theme: Is institutional change actually happening or are folks
merely ``checking boxes''? I am concerned that agency
leadership is too focused on counting the number of GAO
recommendations that have been closed.
As GAO points out in today's testimony, leadership should
instead focus on addressing ``systemic management weaknesses.''
The road map to improving Indian program delivery requires
leadership commitment, capacity building, planning, and careful
monitoring.
The members of this Committee must do all we can to address
the Federal Government's shortcomings to improve accountability
and administration of Indian Country programs. I look forward
to today's testimony from our witnesses and I hope we can have
a frank discussion about the real impacts each agency's efforts
are having on improvement.
Thank you, Mr. Chairman.
The Chairman. Are there other opening statements? Senator
Murkowski.
STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
Senator Murkowski. Very briefly, Mr. Chairman, I want to
thank you and the Vice Chairman for this hearing as a follow up
to the two previous hearings about the GAO and its High Risk
List.
I thank the GAO for identifying the numerous challenges
that face our Federal Indian programs in providing many of the
recommendations. I certainly hope that all our taking these
recommendations very seriously and using them as a path
forward.
We know the criticality of these programs to Alaska Natives
and Native Americans and making sure we do right by these
programs is really what we are all about.
As part of their testimony, the GAO stated there is a list
of criteria that an agency must meet in order to be removed
from the GAO's High Risk List. One of those criteria is
leadership commitment, not only that but permanent leadership
commitment.
Both the Assistant Secretary for Indian Affairs, the BIA
Director and the IHS Director are not confirmed at this point
in time. I think that's a problem for us, Mr. Chairman. As
stated in the GAO testimony, the lack of leadership makes it
incredibly difficult to follow through with previously-
identified plans and time frames for completing some of the
activities identified by the GAO. It seems as though we are in
a situation where you have the agency starting over and over in
the process to identify or perhaps implement corrective
actions.
I know this Committee worked expeditiously to move the
nominees that came before this Committee. We worked hard to see
that Tara Sweeney, nominated to be the Assistant Secretary for
BIA, would be moved out and be before the full Senate. She is
there.
She is keyed up and ready to go. She plans to spend her
initial days listening to tribal leaders, listening to members
of the congressional committees and other agencies, like the
GAO, to hear about the top priorities and how she can establish
this clear, comprehensive action plan going forward.
This is exactly the type of leadership that we need that
will help us get agencies, like the BIA and the BIE, off this
High Risk List. I only add this, Mr. Chairman, because I think
it is imperative that, as we move nominees through the
Committee, we work aggressively to get them through the full
process so that they can get to work, doing the work that
definitely needs to be addressed, as the GAO report clearly
points out.
Thank you for that, Mr. Chairman.
The Chairman. Thank you, Senator Murkowski.
We will now hear from our witnesses: Mr. Frank Rusco,
Director of Natural Resources and Environmental Issues,
Government Accountability Office; Mr. Tony Dearman, Director,
Bureau of Indian Education, U.S. Department of the Interior;
Mr. Darryl LaCounte, Acting Director, Bureau of Indian Affairs,
Department of the Interior; and Rear Admiral Michael Weahkee,
Acting Director, Indian Health Service, U.S. Department of
Health and Human Services.
I want to remind the witnesses that your full testimony
will be made a part of the official hearing record so please
keep your statements to five minutes so that we have time for
questions.
With that, Mr. Rusco, if you would proceed.
STATEMENT OF FRANK RUSCO, DIRECTOR, NATURAL
RESOURCES AND ENVIRONMENTAL ISSUES, U.S.
GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Rusco. Thank you. Chairman Hoeven, Vice Chairman Udall
and members of the Committee, thank you for the opportunity to
provide an update on progress made to resolve the underlying
issues that led GAO to put programs that serve tribes and their
members on GAO's High Risk List.
GAO has made about 50 recommendations to improve management
weaknesses at some Interior and Health and Human Services
agencies. To date, a little more than a third of those
recommendations have been closed and they are primarily the
result of agency actions to implement the recommendations.
In addition, GAO has found agency leadership to be
receptive to ongoing discussions to identify and address the
underlying management problems that resulted in these specific
recommendations.
For these reasons, GAO sees significant progress made by
the agencies relative to the management weaknesses identified
in the High Risk Report. However, GAO will continue to audit
these programs and if additional weaknesses are identified,
there will be additional recommendations.
This is why to get off the High Risk Group List, closing
recommendations is not enough. Agencies need to identify the
root causes of management weaknesses and address those root
causes.
Specifically, GAO has five criteria agencies must meet:
first is demonstrated leadership commitment; second is the
capacity and other resources needed to identify and address
root causes; third is an action plan to address root causes;
fourth is a monitoring plan that identifies measures of program
success and regularly evaluates those measures; and fifth is
demonstrated progress in addressing root causes.
In regular meetings between GAO teams and agency
leadership, we have identified some progress toward meeting
most, if not all, of these criteria. Still, additional progress
is required in all areas, particularly in the areas of
leadership commitment and the capacity and resources needed to
identify and address root causes.
With regard to leadership commitment, Indian Affairs, IHS,
BIA and BIE have each taken some actions to partially meet this
criterion. For example, leadership of all agencies has been
receptive to meeting with GAO teams regularly and working to
develop a better understanding of what needs to be done to get
off the High Risk List. However, fully meeting the leadership
commitment criterion would require that accountability be
assigned to specific leaders and teams in each agency to
identify and resolve root causes.
These assignments need to be a part of the job descriptions
for those leaders and teams. Also, the teams and leaders need
to be given the authority to identify root causes and the
resources to address them. Lastly, these assignments need to
continue to function even in the face of leadership changes.
In order to identify and address root causes, agencies need
to build capacity. Indian Affairs, IHS, BIA and BIE have each
made some progress toward partially meeting this criterion.
For example, BIE has been able to hire school safety
officers and other personnel. BIA conducted a survey to
identify workforce needs for the Indian Energy Service Center.
IHS officials have said the agency is expanding the role of
internal audit staff to complement GAO and IG audits.
However, all of the agencies have vacancies in key offices.
For example, BIA has said it does not have sufficient staff to
do comprehensive workforce planning. Such a plan would need to
include not just headquarters staff and leadership, but also
workforce at the regional and agency office level to ensure the
right people with the right skills are in the right places to
meet program responsibilities.
Ultimately, to meet fully the capacity criterion, Interior
and IHS must prioritize the High Risk Program serving tribes
and their members and provide Indian Affairs, IHS, BIA and BIE
with enough capacity and other resources to identify and
address root causes of management weaknesses.
Thank you. This ends my oral remarks. My colleagues and I
will be happy to answer any questions you may have.
[The prepared statement of Mr. Rusco follows:]
Prepared Statement of Frank Rusco, Director, Natural Resources and
Environmental Issues, U.S. Government Accountability Office
high risk--agencies need to continue efforts to address management
weaknesses of federal programs serving indian tribes
Chairman Hoeven, Vice Chairman Udall, and Members of the Committee:
I am pleased to be here today to discuss the status of actions by
the Departments of the Interior (Interior) and Health and Human
Services (HHS) to address issues that led to the high-risk designation
we made related to the federal management of programs that serve tribes
and their members. We added this area to our High Risk List in February
2017 because of our concern about the ability of agencies within these
departments to manage (1) education and health care programs that serve
tribes and their members and (2) Indian energy resources. \1\ In
particular, we found numerous weaknesses in how Interior's Bureau of
Indian Education (BIE) and Bureau of Indian Affairs (BIA)--under the
office of the Assistant Secretary, Indian Affairs (Indian Affairs)--
managed education and energy resources and how HHS's Indian Health
Service (IHS) managed health care services. We reported that these
management weaknesses jeopardized the health and safety of American
Indians served by these programs and limited opportunities for tribes
and their members to use energy resources to create economic benefits
and improve the well-being of their communities. This testimony
provides examples of actions taken and progress made by these agencies
to address the five criteria we use for determining whether to remove a
high-risk designation (leadership commitment, capacity, action plan,
monitoring, and demonstrated progress).
---------------------------------------------------------------------------
\2\ 1GAO, High-Risk Series: Progress on Many High-Risk Areas, While
Substantial Efforts Needed on Others, GAO-17-317 (Washington, D.C.:
Feb. 15, 2017).
---------------------------------------------------------------------------
In 2016, Congress found in the Indian Trust Asset Reform Act that
``through treaties, statutes, and historical relations with Indian
tribes, the United States has undertaken a unique trust responsibility
to protect and support Indian tribes and Indians.'' \2\ As further
stated in that act, the fiduciary responsibilities of the United States
to Indians arise in part from commitments made in treaties and
agreements, in exchange for which Indians surrendered claims to vast
tracts of land. The act notes that this history of federal-tribal
relations and understandings has benefitted the people of the United
States and established ``enduring and enforceable [f]ederal obligations
to which the national honor has been committed.'' Through improvements
to federal management of programs that serve tribes and their members,
agencies can improve the efficiency of federal programs under which
services are provided to tribes and their members. Such improvements
would be consistent with the expressed view of Congress as to the
federal government's trust responsibilities and would strengthen
confidence in the performance and accountability of the federal
government. In light of this unique trust responsibility and concerns
about the federal government's management of Indian education and
health care programs and Indian energy resources and because these
issues uniquely affect tribal nations and their members, we added the
federal management of programs serving tribes and their members as a
high-risk area in February 2017. \3\
---------------------------------------------------------------------------
\2\ Pub. L. No. 114-178, 101 (2016)(codified at 25 U.S.C.
5601).
\3\ GAO-17-317.
---------------------------------------------------------------------------
The focus of this high-risk area is on management weaknesses within
federal agencies that administer programs that serve tribes and their
members. However, not all federal programs are administered by federal
agencies. In accordance with federal Indian policy that recognizes the
right of Indian tribes to self-government and that supports tribal
self-determination, a number of tribes have elected to take over the
administration of certain federal programs and services from BIA, BIE,
and IHS. Our recommendations identified in the high-risk area are
neither reflective of the performance of programs administered by
tribes nor directed at any tribally operated programs and activities.
We have ongoing work reviewing tribes' use of selected legal
mechanisms to take over the administration of federal programs from BIA
and to assume control and decisionmaking authority over surface leasing
of their lands. In addition, we have ongoing work related to health
care programs that serve tribes and their members. Specifically, we are
reviewing: (1) provider vacancies in IHS; (2) the use of advance
appropriation authority for federal health programs and any
applications to IHS; (3) how IHS compares with the Veterans Health
Administration, Medicare, and Medicaid in terms of overall structure,
user characteristics and service utilization, and funding levels; and
(4) access to care for American Indian veterans. The results of these
reviews will help inform future updates to the High Risk List.
For this statement, we drew on findings from our reports issued
from September 2011 through September 2017 and updated that work by
reviewing agency documentation and interviewing agency officials. To
conduct our previously issued work, on which this testimony draws, we
reviewed relevant federal laws, regulations, and policies; reviewed
agency documentation; and interviewed tribal, federal, and industry
officials, among others. More detailed information on the scope and
methodology of our work can be found in each of the reports cited in
our High-Risk Series report. \4\ We conducted the work on which this
statement is based in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform
the audit to obtain sufficient, appropriate evidence to provide a
reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
---------------------------------------------------------------------------
\4\ GAO-17-317.
---------------------------------------------------------------------------
Background
Since 1990, generally every 2 years at the start of a new Congress,
we call attention to agencies and program areas that are high risk due
to their vulnerability to mismanagement or that are most in need of
transformation. \5\ Our high-risk program is intended to help inform
the congressional oversight agenda and to improve government
performance. Since 1990, a total of 61 different areas have appeared on
the High-Risk List. Of these, 24 areas have been removed, and 2 areas
have been consolidated. On average, the high-risk areas that were
removed from the list had been on it for 9 years after they were
initially added.
---------------------------------------------------------------------------
\5\ In our High-Risk List, we also call attention to agencies and
program areas that are high risk due to fraud, waste, and abuse, but we
do not include such areas in this report.
---------------------------------------------------------------------------
Our experience with the High-Risk List over the past 25 years has
shown that the key elements needed to make progress in high-risk areas
are top-level attention by the administration and agency leaders
grounded in the five criteria for removing high-risk designations,
which we reported on in November 2000. \6\ We found that when
legislative and agency actions, including those in response to our
recommendations, result in significant progress toward resolving a
high-risk problem, we will remove the high-risk designation. However,
implementing our recommendations alone will not result in the removal
of the designation, because the condition that led to the
recommendations is symptomatic of systemic management weaknesses. In
cases in which we remove the high-risk designation, we continue to
closely monitor the areas. If significant problems again arise, we will
consider reapplying the high-risk designation. The five criteria for
removing high-risk designations are:
---------------------------------------------------------------------------
\6\ GAO, Determining Performance and Accountability Challenges and
High Risks, GAO-01-159SP (Washington, D.C.: November 2001).
Leadership commitment. Demonstrated strong commitment and
---------------------------------------------------------------------------
top leadership support to address the risks.
Capacity. Agency has the capacity (i.e., people and other
resources) to resolve the risk(s).
Action plan. A corrective action plan that defines the root
causes, identifies effective solutions, and provides for
substantially completing corrective measures in the near term,
including steps necessary to implement solutions we
recommended.
Monitoring. A program has been instituted to monitor and
independently validate the effectiveness and sustainability of
corrective measures.
Demonstrated progress. Ability to demonstrate progress in
implementing corrective measures and in resolving the high-risk
area.
These five criteria form a road map for efforts to improve and
ultimately address high-risk issues. Addressing some of the criteria
leads to progress, and satisfying all of the criteria is central to
removal from the list. Figure 1 shows the five criteria for removal for
a designated high-risk area and examples of agency actions leading to
progress toward removal.
Figure 1: Criteria Agencies Must Meet Before High-Risk
Designations Can Be Removed and Examples of Actions Leading to
Progress toward Removal
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Importantly, the actions listed are not ``stand alone'' efforts
taken in isolation of other actions to address high-risk issues. That
is, actions taken under one criterion may be important to meeting other
criteria as well. For example, top leadership can demonstrate its
commitment by establishing a corrective action plan, including long-
term priorities and goals to address the high-risk issue and by using
data to gauge progress--actions that are also vital to addressing the
action plan and monitoring criteria. When an agency meets all five of
these criteria, we can remove the agency from the High Risk List. We
rate agency progress on the criteria using the following definitions:
Met. Actions have been taken that meet the criterion. There
are no significant actions that need to be taken to further
address this criterion.
Partially Met. Some, but not all, actions necessary to meet
the criterion have been taken.
Not Met. Few, if any, actions toward meeting the criterion
have been taken.
Agencies Made Some Progress Addressing the Management Weaknesses That
Led to the 2017 High Risk Designation
Officials from Indian Affairs, BIE, BIA, and IHS expressed their
commitment to addressing the issues that led to the high-risk
designation for federal management of programs that serve tribes and
their members. Since we last testified before this committee on
September 13, 2017, we met with agency leaders and worked with each
agency to identify actions the agencies took or plan to take to address
the concerns that contributed to the designation. \7\ We determined
that Indian Affairs, BIE, BIA, and IHS demonstrated varying levels of
progress to partially meet most or all of the criteria for removing a
high-risk designation. However, additional progress is needed for the
agencies to fully address the criteria and related management
weaknesses, particularly in the areas of leadership commitment and
capacity.
---------------------------------------------------------------------------
\7\ 7GAO, High Risk: Status of Prior Recommendations on Federal
Management of Programs Serving Indian Tribes, GAO-17-790T (Washington,
D.C.: Sept. 13, 2017).
---------------------------------------------------------------------------
Leadership Commitment
To meet the leadership commitment criterion for removal of a high-
risk designation, an agency needs to have demonstrated strong
commitment and top leadership support to address management weaknesses.
The following examples show actions Indian Affairs, BIE, BIA, and IHS
took to partially meet the leadership commitment criterion.
Education. Indian Affairs' leaders have demonstrated
commitment to addressing key weaknesses in the management of
BIE schools in several ways. For example, the BIE Director
formed an internal working group, convened meetings with other
senior leaders within Indian Affairs, and publicly stated that
his agency is committed to ensuring implementation of our
recommendations on Indian education. In addition, the BIE
Director and other Indian Affairs leaders and senior managers
have met with us frequently to discuss outstanding
recommendations, actions they have taken to address these
recommendations, and additional actions they could take. In
particular, the BIE Director met with us on nine occasions over
the past year to discuss our recommendations and instructed his
staff to provide us draft policies and procedures related to
our recommendations. However, it is important that Indian
Affairs leaders be able to sustain this level of commitment to
solving problems in Indian education. Since 2012, there have
been six Assistant-Secretaries of Indian Affairs and five BIE
Directors. There has also been leadership turnover in other key
offices responsible for implementing our recommendations on
Indian education. We have previously reported that leadership
turnover hampered Indian Affairs' efforts to make improvements
to Indian education. \8\ We believe that ensuring stable
leadership and a sustained focus on needed changes is vital to
the successful management of BIE schools.
---------------------------------------------------------------------------
\8\ GAO, Indian Affairs: Better Management and Accountability
Needed to Improve Indian Education, GAO-13-774 (Washington, D.C.: Sept
24, 2013).
Energy. BIA officials demonstrated leadership commitment by,
for example, issuing a memorandum requiring all regions and
their agency offices \9\ to use a centralized data management
system to track requests for land title status reports. \10\
Using this type of centralized approach for tracking such
requests may improve BIA's ability to provide needed oversight
of federal actions associated with energy development and
ensure documents needed for the development of energy resources
are provided in a timely manner. In addition, BIA officials
frequently met with us over the last 9 months to discuss the
bureau's progress in addressing recommendations related to
Indian energy. However, Indian Affairs does not have a
permanent Assistant Secretary. BIA does not have a permanent
Director, and BIA's Office of Trust Service--which has
significant responsibility over Indian energy activities--does
not have a permanent Director or Deputy Director. We have seen
turnover in these leadership positions as officials have been
brought in to temporarily fill these roles. As officials are
brought in temporarily, previously identified plans and
timeframes for completing some activities have changed, and BIA
has found itself starting over on the process to identify or
implement corrective actions.
---------------------------------------------------------------------------
\9\ 9BIA, through its 12 regions, more than 80 agency offices, and
headquarters office, generally has primary authority for managing
Indian energy resources and the development process.
\10\ A land title status report is required before leasing land and
minerals held in trust or obtaining a right-of-way to traverse land
held in trust.
Health Care. IHS officials demonstrated leadership
commitment by regularly meeting with us to discuss the agency's
progress in addressing our recommendations. IHS has continued
to implement its Quality Framework by acquiring a software
system to centralize the credentialing of clinical providers,
developing a patient experience of care survey, and developing
standards for limiting patient wait time. However, IHS still
does not have permanent leadership--including a Director of
IHS--which is necessary for the agency to demonstrate its
commitment to improvement. Since 2012, there have been five IHS
Acting Directors, and there has been leadership turnover in
other key positions, such as area directors. \11\ For example,
in January 2017 we reported that officials from four of the
nine area offices in our review reported that they had at least
three area directors over the prior 5 years. \12\ We also
reported that inconsistent area office and health care facility
leadership is detrimental to the oversight of facility
---------------------------------------------------------------------------
operations and the supervision of personnel.
\11\ IHS oversees its health care facilities through a
decentralized system of area offices, which are led by area directors.
\12\ GAO, Indian Health Service: Actions Needed to Improve
Oversight of Quality of Care, GAO-17-181 (Washington, D.C.: Jan. 9,
2017).
---------------------------------------------------------------------------
To fully meet the leadership commitment criterion, all agencies
will need, among other things, stable, permanent leadership that has
assigned the tasks needed to address weaknesses and that holds those
assigned accountable for progress. For a timeline of senior leadership
turnover in Indian Affairs, BIE, BIA, and IHS from 2012 through 2018,
see Figure 2.
Figure 2: Senior Leadership in Agencies Responsible for
Education, Energy, and Health Care Programs Serving Tribes
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Capacity
To meet the capacity criterion, an agency needs to demonstrate that
it has the capacity (i.e., people and other resources) to resolve its
management weaknesses. Indian Affairs, BIE, BIA, and IHS each made some
progress in identifying capacity and resources to implement some of our
recommendations, but BIA and IHS officials reported to us that the
agencies do not have the people and resources needed to fully implement
other recommendations. The following examples show actions Indian
Affairs, BIE, BIA, and IHS took to partially meet the capacity
criterion.
Education. BIE and other Indian Affairs offices that support
BIE schools have made some progress in demonstrating capacity
to address risks to Indian education. For example, BIE hired a
full-time program analyst to coordinate its working group and
help oversee the implementation of our recommendations on
Indian education. This official has played a key role in
coordinating the agency's implementation efforts and has
provided us with regular updates on the status of these
efforts. BIE has also conducted hiring in various offices in
recent years as part of a 2014 Secretarial Order to reorganize
the bureau. \13\ For example, it has hired school safety
officers and personnel in offices supporting the oversight of
school spending. However, about 50 percent of all BIE positions
have not been filled, including new positions that have been
added as a result of the agency's restructuring, according to a
BIE official. Moreover, agency officials told us that vacancies
remain in several key positions, including the Chief Academic
Officer and the Associate Deputy Director for Bureau Operated
Schools. Furthermore, BIE and other Indian Affairs offices that
support BIE schools have not developed a workforce plan to
address staffing and training gaps with key staff, which we
previously recommended. Such a plan is important to allow BIE
and other Indian Affairs offices to better understand workforce
needs and leverage resources to meet them. BIE officials told
us they have held workforce planning sessions and anticipate
completing work on our recommendation to develop a workforce
plan at the end of 2018.
---------------------------------------------------------------------------
\13\ 13U.S. Department of the Interior, Secretarial Order 3334:
Restructuring the Bureau of Indian Education. (Washington, D.C.: June
16, 2014).
Energy. In November 2016, we recommended that BIA establish
a documented process for assessing the workforce at its agency
offices. \14\ BIA has taken a number of actions, such as
conducting an internal survey to identify general workforce
needs related to oil and gas development. This survey
information supported staffing decisions for the recently
created Indian Energy Service Center. However, BIA officials
told us the bureau does not have the staff or resources to
implement a comprehensive workforce planning system that would
be needed to ensure it has staff in place to meet its
organizational needs.
---------------------------------------------------------------------------
\14\ 14GAO, Indian Energy Development: Additional Actions by
Federal Agencies Needed to Overcome Factors Hindering Development, GAO-
17-43 (Washington, D.C.: Nov. 17, 2016).
Health Care. IHS has made some progress in demonstrating it
has the capacity and resources necessary to address the program
risks we identified in our reports. For example, IHS officials
stated that the agency is expanding the role of internal audit
staff within its enterprise risk management program to augment
internal audits and complement audits by the HHS Inspector
General and GAO. However, according to IHS, there are still
vacancies in several key positions, including the Director of
the Office of Resource Access and Partnerships, and the Office
---------------------------------------------------------------------------
of Finance and Accounting.
To fully meet the capacity criterion, all of the agencies need to
assess tradeoffs between these and other administration priorities in
terms of people and resources, and the agencies should provide to
decision makers key information on resources needed to address
management weaknesses.
Action Plan
To meet the action plan criterion, an agency needs to have a
corrective action plan that defines the root causes, identifies
effective solutions, and provides for substantially completing
corrective measures in the near term, including steps necessary to
implement the solutions we recommended. Indian Affairs, BIE, BIA, and
IHS have shown progress in identifying actions to address many of our
recommendations-leading us to believe they can partially meet the
action plan criterion before our next update of the High Risk List. For
example:
Education. BIE has taken several steps to develop action
plans to address management weaknesses. For example, BIE
implemented a new policy for overseeing BIE school spending,
including developing written procedures and risk criteria for
monitoring school expenditures. BIE also developed a strategic
plan, which we recommended in September 2013. \15\ The plan
provides the agency with goals and strategies for improving its
management and oversight of Indian education, and establishes
detailed actions and milestones for the implementation. BIE has
notified us that it has completed the plan and expects to
publish it on June 11, 2018, and will begin implementation
starting in July 2018. We will review the strategic plan once
it has been published. In addition, Indian Affairs' Office of
Facilities, Property & Safety Management has developed and
implemented revised comprehensive guidelines that addressed
several of our findings on weaknesses with BIE school safety
identified in our March 2016 report. \16\ However, Indian
Affairs has not provided us with evidence that it has developed
and put in place action plans on other important issues, such
as a comprehensive, long-term capital asset plan to inform its
allocation of school construction funds, which we recommended
in May 2017. \17\
---------------------------------------------------------------------------
\15\ GAO, Indian Affairs: Better Management and Accountability
Needed to Improve Indian Education, GAO-13-774 (Washington, D.C.: Sept.
24, 2013).
\16\ GAO, Indian Affairs: Key Actions Needed to Ensure Safety and
Health at Indian School Facilities, GAO-16-313 (Washington, D.C.: Mar.
10, 2016).
\17\ GAO, Indian Affairs: Actions Needed to Better Manage Indian
School Construction Projects, GAO-17-447 (Washington, D.C.: May 24,
2017).
Energy. BIA officials met with us several times over the
past few months to discuss planned actions for addressing
management weaknesses related to Indian energy resources, and
they identified actions they have taken to help implement some
of our recommendations. For instance, BIA officials told us
they have proposed several modifications to the bureau's land
records data management system that will enable increased
tracking and monitoring of key documents that BIA must review
prior to the development of Indian energy resources. BIA
officials we met with have demonstrated an understanding that
addressing long-standing management weaknesses is not
accomplished through a single action but through comprehensive
planning and continued movement toward a goal. However, the
agency does not have a comprehensive plan to address the root
---------------------------------------------------------------------------
causes of all identified management shortcomings.
Health Care. Senior leaders in IHS have prioritized
addressing our recommendations by meeting with us frequently
and implementing four recommendations we highlighted in our
February 2017 update to the High Risk List. \18\ IHS
incorporated our recommendations into its risk management work
plan starting in 2017, and according to IHS officials, they
will annually review the effectiveness of the agency's internal
controls, and where controls are deemed insufficient, take
actions to strengthen them. IHS officials we met with have
demonstrated an understanding that addressing long-standing
management weaknesses requires that they develop a corrective
action plan that defines root causes, identifies solutions, and
provides for substantially completing corrective measures.
However, agency officials have not yet developed a corrective
action plan.
---------------------------------------------------------------------------
\18\ GAO-17-317.
To fully meet the action plan criterion, a comprehensive plan that
identifies actions to address the root causes of its management
shortcomings would have to come from top leadership with a commitment
to provide sufficient capacity and resources to take the necessary
actions to address management shortcomings and risks.
Monitoring
To meet the monitoring criterion, an agency needs to demonstrate
that a program has been instituted to monitor and independently
validate the effectiveness and sustainability of corrective measures.
For example, agencies can demonstrate that they have a systematic way
to track performance measures and progress against goals identified in
their action plans. We have been working with the agencies to help
clarify the need to establish a framework for monitoring progress that
includes goals and performance measures to track their efforts and
ultimately verify the effectiveness of their efforts. BIA and IHS made
progress in holding frequent review meetings to assess the status of
implementing our recommendations but have not yet taken needed steps to
monitor their progress in addressing the root causes of their
management weaknesses. In addition, Indian Affairs has made some
progress in meeting the monitoring criterion on Indian education. For
example, the agency has implemented a plan to monitor the effectiveness
of corrective measures to address school safety program weaknesses.
However, the agency has not yet demonstrated that it is monitoring
other areas, such as showing that it is using safety program outcomes
to evaluate and manage the performance of regional safety inspectors.
To fully meet the monitoring criterion, the agencies need to set up
goals and performance measures as they develop action plans and take
further actions to monitor the effectiveness of actions to address root
causes of identified management shortcomings.
Demonstrated Progress
To meet the demonstrated progress criterion, an agency needs to
demonstrate progress in implementing corrective measures and in
resolving the high-risk area. We made 50 recommendations to improve
management weaknesses at Indian Affairs, BIE, BIA, and IHS, of which 34
are still open. Since our testimony in September 2017, we found that
Indian Affairs has made significant progress in implementing corrective
actions in education as demonstrated by our closure of nearly a third
of our recommendations directed to Indian Affairs related to education
programs. \19\ We found that BIA and IHS also made some progress in
implementing corrective actions related to the management of energy
resources and healthcare programs. Specifically, since our testimony in
September 2017, BIA took actions resulting in the implementation of 2
of 14 recommendations, and IHS took actions that resulted in the
implementation of four recommendations. The following examples show
actions Indian Affairs, BIA, and IHS took to partially meet the
demonstrated progress criterion.
---------------------------------------------------------------------------
\19\ GAO-17-790T.
Education. As of early June 2018, Indian Affairs had fully
addressed 8 of the 23 outstanding education recommendations we
identified in our September 2017 testimony, and we have closed
them. \20\ BIE implemented half of the closed recommendations,
including 2 on oversight of BIE school spending identified as
high priority in a March 2018 letter from the Comptroller
General to the Secretary of the Interior. The rest of the
recommendations we closed were implemented by personnel in
Indian Affairs' Office of Facilities, Property & Safety
Management and related to oversight of school safety and
construction. Overall, Indian Affairs' efforts since we issued
our High Risk List update in February 2017 represent a
significant increase in activity implementing our
recommendations. \21\ Substantial work, however, remains to
address our outstanding recommendations in several key areas,
such as in accountability for BIE school safety and school
construction projects. For example, BIA has reported taking
some actions to address recommendations in our May 2017 report
on improving accountability of its safety employees who inspect
BIE schools. \22\ However, it has not provided us with
documentation of these actions.
---------------------------------------------------------------------------
\20\ GAO-17-790T.
\21\ GAO-17-317.
\22\ GAO, Indian Affairs: Further Actions Needed to Improve
Oversight and Accountability for School Safety Inspections, GAO-17-421
(Washington, D.C.: May 24, 2017).
Energy. In June 2015, we recommended that BIA take steps to
improve its geographic information system (GIS) capabilities to
ensure it can verify ownership in a timely manner. \23\ Since
our last update in September 2017, BIA has made significant
progress in enhancing its GIS capabilities by integrating map-
viewing technology and capabilities into its land management
data system. In addition, we recommended that BIA take steps to
identify cadastral survey needs. \24\ BIA's enhanced map-
viewing technology also allows the bureau to identify land
boundary discrepancies, which can then be researched and
corrected. Further, BIA identified unmet survey needs that were
contained within the defunct cadastral request system and
developed a new mechanism for its regions and agency offices to
make survey requests. We believe these actions show significant
progress in addressing management weaknesses associated with
data limitations and outdated technology.
---------------------------------------------------------------------------
\23\ GAO, Indian Energy Development: Poor Management by BIA Has
Hindered Energy Development on Indian Lands, GAO-15-502 (Washington,
D.C.: June 15, 2015).
\24\ A cadastral survey is, in effect, the public record of the
extent, value, and ownership of land.
Health Care. In April 2013, we recommended that IHS monitor
patient access to physician and other nonhospital care to
assess how capped payment rates may benefit or impede the
availability of care. \25\ In response to our recommendation,
IHS developed an online tracking tool that enables the agency
to document providers that refuse to contract for lower rates.
In October 2017, IHS officials met in person with us and
provided a demonstration of the tracking tool.
---------------------------------------------------------------------------
\25\ GAO, Indian Health Service: Capping Payment Rates for
Nonhospital Services Could Save Millions of Dollars for Contract Health
Services, GAO-13-272 (Washington, D.C.: April 11, 2013).
To fully meet the demonstrating progress criterion, agencies need
to continue taking actions to ensure sustained progress and show that
management shortcomings are being effectively managed and root causes
are being addressed.
In conclusion, we see some progress in all of the criteria,
including leadership commitment, at all agencies, especially related to
education programs. However, permanent leadership that provides
continuing oversight and accountability is needed. We also see varying
levels of progress at all of the agencies in understanding what they
need to do to be removed from the High Risk List by identifying steps
that can be incorporated into corrective action plans to address most
recommendations. We look forward to working with the agencies to track
their progress in implementing a framework for monitoring and
validating the effectiveness of planned corrective actions. In
addition, the agencies all have made progress in implementing some key
recommendations, for demonstrated progress in resolving the high-risk
area. Perhaps the biggest challenge for the agencies will be achieving
the capacity and identifying the resources required to address the
deficiencies in their programs and activities. This challenge cannot be
overcome by the agencies without a commitment from the administration
to prioritize fixing management weaknesses in programs and activities
that serve tribes and their members.
Chairman Hoeven, Vice Chairman Udall, and Members of the Committee,
this completes my prepared statement. I would be pleased to respond to
any questions that you may have.
The Chairman. Mr. Dearman.
STATEMENT OF TONY DEARMAN, DIRECTOR, BUREAU OF
INDIAN EDUCATION, U.S. DEPARTMENT OF THE INTERIOR; ACCOMPANIED
BY MELISSA EMARY ARONSON, EDUCATION DIRECTOR
Mr. Dearman. Good afternoon, Chairman Hoeven, Vice Chairman
Udall and members of the Committee.
I am Tony Dearman, Director of the Bureau of Indian
Education. On behalf of the BIE and the Department, thank you
for the invitation to appear again.
In February 2017, GAO released its High Risk Report
designating BIE as a high risk agency. As in past hearings, I
acknowledge that BIE neglected GAO reports for too long. Work
remains but I am glad to update this Committee on significant
progress regarding BIE's outstanding recommendations.
As of today, GAO has formally closed eight of our
outstanding recommendations. We expect to submit for closure in
the coming days GAO Report 13-774, Recommendation No. 4, a
strategic plan and anticipate implementation of the other four
outstanding recommendations by year's end. This puts BIE in a
good position to address the challenge provided by members of
the Committee at prior hearings
Regarding GAO Report 13-774, BIE implemented Recommendation
Nos. 1, 2 and 3, development of a decision-making procedure;
communications strategy; and increased collaboration with the
Department of Education.
With regard to Recommendation No. 4, over the past year,
all levels of BIE contributed to the creation of a draft
strategic plan. We then held three listening sessions and five
regional tribal consultations in late 2017.
After incorporation of relevant consultation comments, BIE
developed its formal strategic plan and consultation report to
provide transparency regarding inclusion of tribal comments. I
am happy to report that last week, departmental leadership
completed its review and approved the strategic plan. Upon
implementation and through our communications strategy, we
anticipate GAO will close our ninth outstanding recommendation
in the coming weeks.
The Department previously considered Recommendation No. 5,
revision of a strategic workforce plan closed. However, GAO did
not concur. After review of the previous work, BIE and the
Department relisted the recommendation as open.
Importantly, we prioritized the implementation of the
strategic plan before the workforce plan. It made little sense
to implement the formal workforce plan prior to executing a
strategic plan that set the direction of the organization.
To ensure our employees and stakeholders benefit from a
high quality workforce plan, we continue to work with
comprehensive and content-centered experts funded through the
Department of Education. We are now on target to address this
recommendation by year's end, which will address both GAO
Report 13-774, Recommendation No. 5 and GAO Report 15-121,
Recommendation No. 1.
Since the last hearing, we also developed and implemented a
comprehensive fiscal monitoring policy and procedure. This
coordinates monitoring efforts and improves technical
assistance to schools. As of May, GAO formally closed
Recommendation Nos. 2, 3 and 4 which are addressed in this
comprehensive policy.
Regarding GAO Report 16-313, Indian Affairs, in
coordination with BIE, successfully implemented Recommendation
Nos. 2 and 4 in recent months. As of June 1, GAO closed
Recommendation No. 2 regarding safety guidance for school
inspections.
As part of this work, Indian Affairs revised its inspection
guidance and tools to ensure they are comprehensive and up-to-
date. Further, GAO closed Recommendation No. 4 in early 2018
regarding the requirement of school safety committees at the
local level. Two recommendations in GAO Report 16-313 remain
open, Recommendation No. 1 regarding mitigation of challenges
for school inspection and Recommendation No. 3 concerning
increasing school capacity to address safety issues. Indian
Affairs is coordinating across bureaus to address these
remaining recommendations as quickly as possible.
Through its recommendations, GAO provided a road map to
improve service delivery to our schools. BIE, as well as Indian
Affairs and the Department, took Congress' charge to address
these as quickly and effectively as possible. Implementing
GAO's guidance will work to make us better at addressing the
needs of our students, students like my daughter who attend a
BIE school.
Thank you for your time. I would be honored to answer any
questions you may have.
[The prepared statement of Mr. Dearman follows:]
Prepared Statement of Tony Dearman, Director, Bureau of Indian
Education, U.S. Department of the Interior
Good afternoon Chairman Hoeven, Vice Chairman Udall, and Members of
the Committee. Thank you for the invitation to appear again on behalf
of the Bureau of Indian Education (BIE) to discuss our ongoing work to
address the high-risk designation from the Government Accountability
Office (GAO) in the High Risk Report (GAO-17-317 High Risk Series).
As highlighted in the GAO reports, much work remains, but I am glad
to update this Committee on progress made regarding the outstanding
recommendations since I last testified in September. GAO has conveyed
that addressing the outstanding recommendations will help them work
toward removing BIE from the high-risk designation. While the BIE is
working to address all GAO recommendations, including those in
subsequent reports issued in 2017, this testimony will provide an
update on progress regarding outstanding GAO recommendations in
relation to the high-risk designation--now having closed seven
recommendations. BIE appreciates GAO's continued support and assistance
in improving BIE services to our students. The BIE is now well
positioned to address all outstanding recommendations by year's end--a
challenge provided by Members of this Committee at the last hearing.
As I previously testified, the BIE team views the GAO's reports as
a constructive tool to improve our agency and help the students we are
committed to serve. As such, I will update you on headway made in the
following areas:
1. GAO High Risk Status for BIE
2. GAO Recommendations
3. GAO Recommendations Status & BIE Next Steps
GAO High Risk Status for BIE
In February 2017, the GAO released its High Risk Report (GAO-17-317
High Risk Series) designating BIE as a high-risk agency. The GAO
highlighted the following persistent weaknesses noted in previous
reports that inhibit the agency from efficiently executing its mission
to serve Indian students:
Indian Affairs' (IA) oversight of school safety and
construction, as well as how BIE monitors the way schools use
Interior funds;
The impact of limited workforce planning in several key
areas related to BIE schools;
The effects of aging BIE school facilities and equipment and
how such facilities contribute to degraded and unsafe
conditions for students and staff; and
How the lack of internal controls and other weaknesses
hinder IA's ability to collect complete and accurate
information on the physical conditions of BIE schools.
In three separate reports dating back to 2013, the GAO provided
thirteen recommendations to improve IA's management of BIE schools. BIE
has now closed seven GAO recommendations. BIE has additionally made
significant progress in addressing its remaining outstanding
recommendations.
As Director, I am committed to addressing these outstanding items.
To that end, I am working with our senior leadership team within BIE as
well as with IA, the Secretary's Office, and our colleagues at GAO to
ensure that BIE comprehensively addresses each outstanding
recommendation as expeditiously and effectively as possible. Throughout
the past year, the BIE, through the support of the Department of the
Interior (Department), regularly and directly communicated with GAO,
which enhanced BIE's ability to address outstanding recommendations.
Through in-person meetings and teleconferences, GAO provided BIE
comments and suggestions for effectively closing recommendations in a
timely manner.
GAO recommendations are a roadmap for BIE to establish and maintain
comprehensive internal policies and procedures that support service
delivery, ensure accountability, and provide organizational stability.
We appreciate the assistance and collaboration offered by GAO and look
forward to our continued partnership.
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 directed BIE to move forward with Phase I
of its reorganization, with the agency committing considerable time,
energy, and resources to carry out the directive. Simultaneously,
considerable turnover within BIE senior leadership reduced capacity and
focused BIE's attention on day-to-day services rather than addressing
critical, long-term organizational improvement strategies highlighted
in the GAO reports. Since becoming Director, I directed BIE to
prioritize resources and critical personnel to refocus our efforts in
addressing the longstanding, systemic issues outlined in GAO reports
that will ultimately improve our ability to serve Indian students.
In November 2016, the BIE filled several key positions 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 was not satisfied with the
quality and timeliness of the Bureau's response in addressing GAO's
outstanding recommendations. Since then, BIE consistently worked to
complete the actions recommended to improve service delivery and
accountability.
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 completed implementation of recommendations one, two and three,
which includes development of a decisionmaking procedure,
communications strategy and increased collaboration with the Department
of Education (ED). The Department previously considered recommendation
five--revision of a strategic workforce plan--closed. However, GAO did
not concur. After reviewing the previous work submitted by BIE
regarding recommendation five, and after closely collaborating with GAO
regarding the work product, BIE and the Department relisted the
recommendation as open. The Department will continue to work with GAO
until recommendation five is fully implemented. Additionally, BIE will
assess the effectiveness of its long-term implementation of GAO's
closed recommendations in an effort to continually improve BIE
operations. BIE is currently working to implement recommendations four
and five, which are to develop a strategic plan, as well as a
comprehensive workforce plan. BIE plans to implement the remaining
recommendations contained in GAO-13-774 by the end of 2018.
Recommendation IV--BIE, working with leadership within IA and
pertinent stakeholders, reviewed the strategic plan submitted to GAO in
September 2016 and determined that the quality of work as
unsatisfactory, both for the purposes of closing recommendation four as
well as 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 to initiate work. On April 11, 2017, BIE held a follow-up
strategic planning session, convening local, regional, and central
office personnel to determine paths forward. By the end of April 2017,
BIE began revising its mission and vision statement and identified
draft goals. On June 14, 2017 and July 18-20, 2017, BIE held additional
strategic planning sessions to identify strategies aligned to goals and
established a communications plan for sharing the Draft Strategic Plan
Proposal with internal and external stakeholders to solicit feedback as
well as developing a timeframe for formal consultation with Indian
tribes. BIE then held additional organization-wide planning meetings on
August 29-30, 2017 and September 26-28, 2017.
Following these internal planning sessions, the BIE produced a
Draft Strategic Plan Proposal for review by Tribes and key
stakeholders. On October 17, 2017, early in the planning process, BIE
initiated a series of meaningful and substantive Tribal consultation
and listening sessions regarding the Draft Strategic Plan Proposal. The
consultation sessions achieved the BIE's goal to engage and work with
Tribes, school boards, and other stakeholders to obtain input for
meeting the needs of BIE students and Indian Country. Upon conclusion
of five regional Tribal consultation sessions and three listening
sessions, the BIE began a substantive review and analysis of all
feedback and made significant edits and changes in light of the
contribution of its Tribal partners. In April 2018, the BIE submitted
its final Strategic Direction to Department leadership for formal
review and approval. Upon receiving approval, the BIE will publish and
implement the Strategic Direction.
Recommendation V--BIE purposefully delayed implementation of
recommendation five until finalizing its Strategic Direction. The BIE
will create and implement the workforce plan based on the goals
outlined in the Strategic Direction. To ensure that implementation is
effective, the BIE is working with external subject-matter expert
organizations, such as the WestED comprehensive center, the Academic
Development Institute, and the Building State Capacity and Productivity
Center (BSCPC) to establish work strands and monitoring to ensure
increased accountability in service delivery. These organizations will
collaborate with BIE to provide technical expertise and best practices
in developing an effective, long-term action plan for implementing a
measurement system to track progress once implementation of the
Strategic Direction begins. BIE's goal is to complete the strategic
workforce plan by the close 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.
BIE continues to implement GAO's four recommendations contained in
GAO-15-121. As of May, the BIE developed and implemented a
comprehensive fiscal monitoring policy and procedure, which coordinates
efforts and technical assistance across the Bureau. As a result, GAO
permanently closed recommendations two, three, and four. The BIE is now
focusing its efforts on completing a comprehensive workforce plan,
which addresses recommendation one as well as recommendation five in
GAO-13-774--implementation of a strategic workforce plan.
Recommendation I--During the early stages of the current BIE
reform, IA contracted a workforce study. However, following BIE's
meetings with GAO on June 17, 2017 and August 16, 2017, GAO provided
clarification regarding expectations by identifying skills gap,
prioritization of vacancies, and the need for plans contingent on
varying outcomes, such as available funding and hiring constraints. BIE
plans to revisit the work completed by IA in the prior study and
reexamine its workforce planning efforts in light of GAO's feedback.
Additionally, during the strategic planning process the BIE held two
initial workforce-planning exercises to begin planning. BIE's goal is
to complete the comprehensive workforce plan by the close of 2018.
GAO-16-313--INDIAN AFFAIRS: Key Actions Needed to Ensure Safety and
Health at Indian School Facilities (March 2016)
GAO made recommendations:
I.) Ensure that all BIE schools are inspected as well as
implement a plan to mitigate challenges;
II.) Prioritize inspections at schools where facility
conditions may pose a greater risk to students;
III.) Develop a plan to build schools' capacity to promptly
address safety and health problems with facilities and improve
the expertise of facility staff to maintain and repair school
buildings; and
IV.) Consistently monitor whether schools have established
required safety committees.
BIE successfully implemented recommendation two and four, and GAO
permanently closed the recommendations in early 2018. BIE and its IA
partners continue work implementing GAO's two remaining recommendations
contained in GAO-16-313.
Recommendations I and III--BIE is collaborating with partners from
across IA to address its remaining safety-related GAO recommendations.
The BIE is committed to working with IA, the Secretary's office, and
our colleagues at the GAO to ensure that the BIE systematically and
comprehensively addresses each recommendation for improving services
and safety at BIE schools. Specifically, through an IA collaborative
working group to address outstanding safety issues, BIE and IA
administered safe school audits with a 100 percent completion rate in
both 2016 and 2017. We are on track to complete 100 percent of
inspections in 2018 and are monitoring whether schools have established
required safety committees.
We are also working to ensure that employee performance standards
regarding inspections are consistently incorporated into the appraisal
plans of personnel with safety program responsibilities. Personnel are
on schedule to formally require safety inspectors to document when
inspection reports are sent to schools as well as establish a process
to routinely monitor the timeliness of such reports. Further, BIE staff
and its IA partners drafted and recently implemented the ``Indian
Affairs Safety Health and Accessibility Inspection/Evaluation
Guidelines'', which will comprehensively address many of GAO's safety-
related recommendations outlined in subsequent GAO reports released in
2017.
Conclusion
Chairman Hoeven, Vice Chairman Udall, and Members of the Committee,
thank you for the opportunity to present testimony today and provide
the Committee an update regarding our work with GAO. Much work remains,
but BIE is excited about our recent progress and is committed to
addressing all GAO recommendations in order to achieve sustained
improvement for our students. Thank you for your time, and I would be
honored to answer any questions you may have.
The Chairman. Mr. LaCounte.
STATEMENT OF DARRYL LACOUNTE, ACTING DIRECTOR,
BUREAU OF INDIAN AFFAIRS, U.S. DEPARTMENT OF THE
INTERIOR
Mr. LaCounte. Thank you.
Good afternoon, Chairman Hoeven, Vice Chairman Udall and
members of the Committee.
My name is Darryl LaCounte. I am the Acting Director for
the Bureau of Indian Affairs at the Department of the Interior.
I transitioned into this role from the Acting Deputy Director
for Trust Services. My permanent role is Regional Director for
the Rocky Mountain Region. As the Regional Director, I am
responsible for all programs, services and costs provided to
uphold the Trust with the tribes and individual Indians in the
region.
Prior to Federal service, I worked extensively in
agriculture in eastern Montana and western North Dakota and
also in the oil and gas exploration field in Montana, North
Dakota, Wyoming, Colorado and Nebraska.
Thank you for the opportunity to present an update on
behalf of the Department regarding the Indian Affairs role in
development of Indian energy and our continued commitment to
address the high risk designation in the Government
Accountability Office High Risk Report, 17-317, High Risk
Series.
Since February of this year, I and my staff have worked
diligently to reestablish and improve communication with GAO. I
feel we have been very successful in developing a productive
relationship.
The Department is committed to working in collaboration to
assure that we meet the five criteria GAO uses for determining
whether to remove a high risk designation, leadership
commitment, capacity, action plan, monitoring and demonstrated
progress. We have made progress in these areas.
The Department understands that removal from the High Risk
List is not directly linked to implementation of the
recommendations. However, our progress in implementing these
recommendations clearly demonstrates a commitment to widespread
reform.
As the Committee is aware, the Department agreed with GAO's
recommendations and we continues to address the recommendations
by implementing widespread reform to help foster energy
independence among tribes who are interested in developing
their resources.
As the High Risk Report notes, GAO made 14 recommendations
to the Bureau of Indian Affairs via three reports. We are
pleased to report that we have made progress in all 14
recommendations.
We are pleased to update the Committee that Recommendation
Nos. 1 and 5 have been closed. Since coming onboard as the
Acting Director a month and a half ago, I have prioritized and
aggressively closed out as many of the GAO recommendations as
possible.
There are some I believe we can close by the end of
September 2018 such as Recommendation Nos. 2, 3, 4 and 6. There
are some GAO recommendations that have major components in the
activity. Those recommendations are Nos. 7, 8, 9, 13 and 14.
Our goal is to close out these five recommendations by the end
of this year.
As for the remaining GAO recommendations, Nos. 10, 11 and
12, we have made significant progress in these and are
optimistic we will be able to close out these recommendations
by the end of the calendar year as well.
Again, thank you for the opportunity to provide an update
on our progress in addressing the GAO recommendations from past
reports and the GAO High Risk Report, 17-317, High Risk Series.
I would be glad to answer any questions the Committee may
have.
[The prepared statement of Mr. LaCounte follows:]
Prepared Statement of Darryl LaCounte, Acting Director, Bureau of
Indian Affairs, U.S. Department of the Interior
Chairman Hoeven, Vice Chairman Udall, and Members of the Committee,
my name is Darryl LaCounte and I am the Acting Director for the Bureau
of Indian Affairs at the Department of the Interior (Department). Thank
you for the opportunity to present an update on behalf of the
Department regarding Indian Affairs' role in the development of Indian
energy and our continued commitment to address the high risk
designation in the Government Accountability Office (GAO) High Risk
Report (GAO-17-317 High Risk Series).
As the Committee is aware, the Department agreed with GAO's
recommendations and we continue to address the recommendations by
implementing widespread reform to help foster energy independence among
Tribes who are interested in developing their resources. As the High
Risk report notes, GAO made fourteen recommendations to the Bureau of
Indian Affairs (BIA), via three reports. We are pleased to report that
we've made progress on a number of the recommendations, some have been
closed, and we plan to submit closure packages for other
recommendations in the near future.
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.
We are pleased to announce that the Indian Affairs GIS Map Viewer
has been deployed, as of August 31, 2017. As of February 22, 2018, BIA
addressed the requirements for this Recommendation, and demonstrated
the system with ample evidence to close this recommendation.
Recommendation 2: To ensure it can verify ownership in a timely
manner and identify resources available for development, BIA should
work with BLM to identify cadastral survey needs.
The BIA and the BLM, in a coordinated and focused effort, prepared
a Reimbursable Service Agreement between the two agencies to identify
and deliver the much needed survey-related products and services. We
are continuing to evaluate the cadastral survey requests that have been
approved for funding for completion by BLM.
BLM and BIA reviewed and established a database that contains the
information necessary to identify ownership. An intake mechanism was
developed by the Indian Energy Service Center for making new survey
requests. The BIA drafted instructions and will provide guidance on how
to make requests and how to track the progress of incoming requests
from BIA Regional offices. Implementation and full deployment of the
cadastral survey process is scheduled no later than September, 2018.
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.
Previously we stated that the BIA was in the process of evaluating
and reviewing the approval process and information stored in TAAMS in
order to improve efficiencies and timeliness in processing workloads.
Since then, the BIA subject matter experts provided modifications to
enhance TAAMS to incorporate a tracking mechanism for proposed mineral
related transactions. A Change Request for the system was presented to
the TAAMS Change Management Board in January, 2018. In February, the
Board vetted and approved the system enhancements.
To support and demonstrate BIA's commitment to enhance and
streamline business processes, a National Policy Memorandum (NPM-TRUS-
34-A1) has been issued regarding the utilization of a Tracking sheet
for Communitization Agreements in addition to Rights-of-Way. Once
developed, this tracking system will include permanent tracking in
TAAMS by September 30, 2018.
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.
Data tracking is under development for TAAMS enhancements to
capture review and response times. The enhancements will be reviewed by
regional offices with active oil and gas transactions to improve
business transactions.
The Fluid Minerals Handbook updates will include the new process,
timeframes, and reporting requirements. Our target completion date is
September 30, 2018.
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.
On August 31, 2017, after reviewing tribal comments, our
Department's Office of Indian Energy and Economic Development (IEED)
placed on its web site guidance to tribes seeking an approved TERA or
which seek to assume energy-related administrative functions under
Public Law 93-638. As a result, the GAO closed Recommendation 5 on
March 8, 2018.
In addition, IEED plans to prepare and place on its web site by the
end of this calendar year a downloadable primer on how a tribe can
apply for a TERA. This task was not required by Recommendation 5 but
IEED believes it will enhance tribal understanding of the TERA approval
process.
GAO 16-553
Recommendation 6: Establish required timeframes for the review and
approval of Indian Communitization Agreements (CAs) to ensure a more
timely CA process.
The Department is continuing its work to ensure CA processes for
review and approval are timely. As noted previously, a National Policy
Memorandum (Memorandum) was issued that establishes a tracking
mechanism to monitor the existing timeframes for review and approval of
Indian CAs. As mentioned previously, the procedure to modify TAAMS is
in development.
The process will be outlined in the Standard Operating Procedure
(SOP) supported by the intent of the Interagency Agreement. The
Interagency Agreement is signed by BIA, BLM, OST, ONRR and IEED to
process federal Indian energy transactions. Each Agency has a role and
responsibility to support resource development including training. SOP
training specific to Indian Oil and Gas Leasing Activities is June 12-
13, 2018 at the National Indian Training Center in Albuquerque NM.
We are pleased to announce that BIA can close out this
Recommendation. BIA has made the necessary enhancements to TAAMS which
establish processing steps and required data entry. The timeframes and
process established through this recommendation will be utilized as the
business rules for the development of the CA tracker that will be added
to TAAMS in the near future that will address recommendation number 7.
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 developed a systematic mechanism to track Indian CAs
through the review and approval process. Until TAAMS can be modified to
incorporate the key identifiers and data fields, the BIA, in the
meantime, is utilizing a centralized tracking spreadsheet. BIA leads
the development and deployment of this tracking spreadsheet in
consultation and coordination with BLM. BIA received an extension from
GAO to complete this recommendation by the end of FY 2018. We are on
target to meet this timeframe to complete and close out this
recommendation.
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.
Effective coordination to identify areas of improvements to key
data fields have been progressive to assure TAAMS capabilities capture
all aspects of the CA process. The bureaus will continue to coordinate
to collect data, which will assist in identifying and implementing any
necessary process modifications. It is important to know that this
Recommendation falls in line with other TAAMS system enhancements
already underway. It is expected that training will be provided to
personnel to use these system enhancements by the end of this fiscal
year 2018. The system enhancements scheduled for training are the GIS
Mapping (Complete February, 2018), Title Status Reports (TSR), and
Acquisition & Disposal modules. Once the CA module is complete, follow
up to the SOP training will be coordinated and implemented.
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 IESC is committed to establishing formal Memorandums of
Understanding (MOUs) for each of the recommended agencies. On January
10, 2018, the United States Army Corps of Engineers (USACE) signed the
MOU with IESC. On June 1, 2018, the U.S. Fish and Wildlife Service's
Principal Deputy Director also signed the MOU with IESC. The remaining
draft MOU is in the review and signature approval process with the
Environmental Protection Agency (EPA). We anticipate all MOUs to be
signed before the end of 2018.
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.
In an effort to improve communication between the two offices, an
MOU was signed between IEED and the Department of Energy (DOE)
outlining a partnership going forward. The IESC prepared an addendum to
the MOU with IEED and DOE to finalize the agreement. The addendum is
currently in the surname process within the Department.
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's
activities.
The IESC developed a process that allows key agencies to provide
input and requests for service received on behalf of tribes from the
IESC. The process includes guidance on the prioritization of task
orders. The Executive Management Group of the IESC is comprised of the
directors of the BIA, BLM, ONRR, and Office of the Special Trustee for
American Indians (OST). The IESC began utilizing the intake forms in
August 2017 to obtain input regularly from stakeholders. IESC is on
target to close this recommendation.
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 Department created the Indian Energy & Minerals Steering
Committee (IEMSC), which is a group that helps to ensure that the
Department meets its trust responsibility to federally recognized
Indian tribes and the individual Indian mineral owners. The IEMSC is an
inter-agency forum for Indian energy and mineral resource development,
royalty management coordination, and information exchange. This
committee is comprised of senior representatives from the BIA, BLM,
ONRR, OST, and the Solicitor's Office. On February 6, 2018, the IEMSC
addressed energy issues and opportunities in Indian Country. The recent
major accomplishments of the IEMSC include:
Ensuring consistent answers across the Department to
questions in Indian country;
Working through issues involving underground injection;
Streamlining activities across agencies to avoid duplication
of effort; and
Created multi-agency policy for communitization agreements.
In addition, this committee sponsors three Federal Partners groups
that focus on Fort Berthold; Uintah and Ouray; and Oklahoma, Texas, and
Kansas.
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.
IESC identified energy and minerals workforce data collected from a
multi-agency survey to align with workforce needs for energy and
minerals management. The information gleaned from the survey confirmed
common needs across agencies in the areas of engineering, engineering
technicians and environmental science disciplines at the forefront of
identifying the availability of the resources for economic development.
Based on responses to the survey and current data, BIA attrition
over the past 5 years has resulted in a potential gap of 33 to 50
engineers, engineering technicians, and environmental scientists,
within the Trust functions across the BIA. Current retirement
statistics show that 59 percent of the employees who occupy these
positions are eligible for retirement now or within 5 years.
With the data collected from the survey and knowledge of the gaps
that need to be filled, the BIA will work with the IESC and partner
bureaus to develop effective workforce standards to address the need
for the skills and competencies needed for energy development. The
BIA's goal is to develop a draft energy and mineral workforce standards
by the end of FY 2018, but no later than the end of that calendar year.
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.
In previous testimony, BIA indicated it was assessing the BIA
Indian energy and mineral workforce composition using the same process
as described in Recommendation 13. The same data and results from the
survey conducted will provide a starting point for BIA to establish a
documented process that will allow BIA to assess its workforce
composition. The composition will, of course, take into consideration
BIA's mission and goals, and also tribal priorities.
Presently, Workforce planning is conducted by the Regional Division
managers working directly with the respective Deputy Directors with
respect to Regional priorities as identified for this Recommendation.
Once the workforce plan is finalized it is presented and reviewed with
the Regional Director for further analysis and final approval. Amended
organizational charts are reviewed and approved by the Regional
Director; and as appropriate by the Director of BIA. We expect the
workforce plan to include a documented assessment component for our
workforce composition. The BIA is on target to complete this documented
assessment by the end of FY 2018, but no later than the end of that
calendar year.
Conclusion
Thank you for the opportunity to present an update on our progress
in addressing the GAO recommendations from past reports and the GAO
High Risk Report (GAO-17-317 High Risk Series). I would be glad to
answer any questions the Committee may have.
The Chairman. Admiral Weahkee.
STATEMENT OF REAR ADMIRAL MICHAEL D. WEAHKEE,
ACTING DIRECTOR, INDIAN HEALTH SERVICE, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Weahkee. Good afternoon, Chairman Hoeven, Vice Chairman
Udall, and members of the Senate Committee on Indian Affairs.
I am Rear Admiral Michael Weahkee, Acting Director of the
Indian Health Service. I am pleased to provide testimony today
regarding IHS programs identified by the U.S. Government
Accountability Office High Risk Report.
Providing quality care is imperative to the IHS mission. I
want to thank you for bringing awareness to the important
issues and recommendations highlighted by the GAO.
IHS is a unique agency within the Department of Health and
Human Services as it is the only HHS agency whose primary
function is direct health care delivery. Our mission is to
raise the physical, mental, social and spiritual health of
American Indians and Alaska Natives to the highest level.
To that end, IHS is committed to making improvements and
ultimately to being removed from the GAO's High Risk List.
The GAO's High Risk List Report cited 14 recommendations
focusing on the Indian Health Service. Since publication of the
report in February 2017, the GAO has closed four
recommendations as implemented, two recommendations as
unimplemented, and the remaining eight recommendations are
progressing toward completion by IHS. One request for closure
is still under consideration by the GAO.
IHS leadership is committed to making substantial progress
in addressing GAO's recommendations and continues to press
forward in a working relationship with the GAO. Since last
September, I have met several times with key GAO officials to
describe action plans for closing out the remaining
recommendations.
IHS has taken a comprehensive and integrated approach
towards creating an oversight capability at the headquarters
level to improve the quality of care and patient safety. We
implemented corrective measures to mitigate high risk in areas
directly impacting health care. These measures include uniform
standards across all agency hospitals and clinics for
accreditation, credentialing, patient wait times and PRC
authorizations.
IHS finalized the National Accountability Dashboard for
Quality on February 20, 2018 and data for the first quarter of
fiscal year 2018 was published on the IHS website in early
April 2018. Data from the second quarter of fiscal year 2018 is
currently being collected and reported internally. This
dashboard is a valuable recording tool that will enable IHS
headquarters and our area offices to have a viewpoint on the
hospitals and health centers functioning across the system.
Moving forward, IHS is working with our Department of
Health and Human Services colleagues to establish an Office of
Quality at IHS headquarters. This office will be responsible
for providing oversight for quality across the IHS healthcare
system.
The Office of Quality will oversee, direct and evaluate
agency-wide activities to ensure quality health care.
Furthermore, the office will ensure that quality is integrated
into all agency programs in a collaborative and organized
manner.
IHS continues to improve and increase access to care for
our beneficiaries through outreach, education and enrollment
activities. The National PRC Program is setting targets for
local programs and monitoring compliance to ensure IHS is able
to provide access for patients in the most cost effective
manner.
Since implementation of the PRC rates regulations in
October 2016, the PRC Program has realized a $553 million
savings. The savings have allowed PRC programs to pay for
additional services and fund more medical priority levels than
ever before which improves access to care for our patients.
I am very proud of the dedication and commitment of IHS
staff at all levels of the agency. We focused on and
accomplished the objectives of the action plan during this past
year. These actions demonstrate that IHS takes its challenges
seriously and continues to take proactive steps to address
them.
I want to thank you for your commitment to improving
quality, safety and access to health care for American Indians
and Alaska Natives. I am happy to answer any questions you
might have. Thank you.
[The prepared statement of Admiral Weahkee follows:]
Prepared Statement of Rear Admiral Michael D. Weahkee, Acting Director,
Indian Health Service, U.S. Department of Health and Human Services
Good afternoon, Chairman Hoeven, Vice-Chairman Udall, and Members
of the Senate Committee on Indian Affairs. I am RADM Michael D.
Weahkee, Acting Director of the Indian Health Service (IHS). I am
pleased to provide testimony today regarding IHS programs identified by
the U.S. Government Accountability Office High Risk Report. Providing
quality care is imperative to the IHS mission and I want to thank you
for bringing awareness to the important issues and recommendations
highlighted by GAO.
IHS is a unique agency within the Department of Health and Human
Services (HHS). It is the only HHS agency whose primary function is
direct health care delivery. IHS was established to carry out the
responsibilities, authorities, and functions of the United States in
providing health care services to American Indians and Alaska Natives.
The mission, in partnership with American Indian and Alaska Native
people, is to raise the physical, mental, social, and spiritual health
of American Indians and Alaska Natives to the highest level. The IHS
system consists of 12 area offices, which oversee 168 service units
that provide care at the local level. Health services are provided
through facilities managed by IHS, by tribes and tribal organizations
under authorities of the Indian Self-Determination and Education
Assistance Act, and through contracts and grants awarded to urban
Indian organizations authorized by the Indian Health Care Improvement
Act.
Demonstrated Progress
IHS is committed to make improvements and ultimately be removed
from the GAO's High Risk list. The GAO's High Risk Report cited 14
recommendations focusing on IHS, based on seven reports issued over a
period of six years. Since the report's publication on February 15,
2017, GAO has closed four recommendations as implemented and two
recommendations as unimplemented. One request for closure is still
under consideration, and eight recommendations are progressing toward
completion by IHS.
Leadership Commitment
IHS leadership is committed to making substantial progress on
addressing GAO's recommendations and continues to press forward in
working partnership with GAO. Since last September, I have met several
times with key GAO officials to describe action plans for closing-out
the recommendations. IHS is focused on implementing change across the
agency to strengthen our ability to ensure quality health care.
Progress on Improvements in Quality Care
IHS has taken a comprehensive and integrated approach towards
creating an oversight capability at headquarters to improve the quality
of care and patient safety. We implemented corrective measures to
mitigate high-risk in areas directly impacting patient care, including
uniform standards across all agency hospitals and clinics for
accreditation, credentialing, patient wait times, and Purchased/
Referred Care (PRC) authorizations to improve quality and
accountability across the system of care.
Reducing patient wait times continues to be a priority for the
agency. Wait times are an important measure of the patient experience
and IHS federally-operated service units have been collecting and
tracking this data to improve patient services. Through IHS Circular
Number 17-11, IHS established in 2017 wait time standards for
outpatient primary and urgent care visits to direct care IHS
facilities, and we are currently monitoring and collecting data. In
addition, patient wait time metrics for emergency care were made
available through the Centers for Medicare & Medicaid Services (CMS)
and are now under agency review. A workgroup was established to
finalize patient wait times on primary care non-urgent visits as well.
IHS is working toward automated data collection and aggregation
capabilities to improve monitoring.
Monitoring
IHS finalized the National Accountability Dashboard for Quality on
February 20, 2018. Data for the first quarter of fiscal year (FY) 2018
was published on the IHS website in early April 2018 and data from the
second quarter of FY 2018 is currently being collected and reported
internally through the reporting tool. The dashboard is a valuable
reporting tool that will enable IHS headquarters and area offices to
have a near real-time view of health care hospitals and health centers
functioning across the system. Over time, this will facilitate
implementation and monitoring of quality care measures. As IHS
continues to implement the National Accountability Dashboard for
Quality, we anticipate the results will demonstrate sustained
improvements in the nine key metrics tracked in the dashboard including
accreditation and an active quality improvement program.
Organizational Capacity
Moving forward, IHS is working with our HHS colleagues to establish
an Office of Quality (OQ) that will be responsible for providing
oversight for quality across the IHS health care system. The OQ will
oversee, direct, and evaluate agency-wide activities to ensure quality
health care. Moreover, the OQ will support IHS hospitals and health
centers by providing a system of quality assurance to attain and
maintain compliance with CMS Conditions of Participation and
accreditation standards. The office will collaborate with the IHS
Office of Information Technology to ensure that the agency has
effective systems in place to promote patient care, encourage data
collection and reporting, provide secure credentialing and privileging,
and prepare for the reporting and evaluation of adverse events. The OQ
will also focus on building a quality improvement capability and
encouraging innovations that promote safe, effective, and efficient
care delivery.
IHS is committed to addressing any and all risks to our mission.
Enterprise risk management and compliance are important components of
the quality process. We believe the most efficient and effective
approach for coordinating national risk management and compliance
activities is by consolidating related functions in the OQ. The OQ will
ensure that quality is integrated into all agency programs in a
collaborative and organized manner.
Purchased/Referred Care Improvements
IHS continues to improve and increase access to care for our
beneficiaries through outreach, education, and enrollment activities.
The national PRC program is setting targets for local programs and
monitoring compliance to ensure that IHS is able to provide access to
our patients in the most cost effective manner. IHS monitors the online
PRC Rates Provider Tracking tool to assess and take action if there is
an impediment to available care. This tool enables PRC programs to
document providers that refuse to contract for their most favored
customer rate or accept the PRC rate. Since implementation of the PRC
rates regulations in October 2016, the PRC program has realized a $553
million savings according to the fiscal intermediary. These savings
have allowed PRC programs to pay for additional services and fund more
medical priority levels than before, which improves access to care for
our patients.
IHS continues to work closely with tribal leaders in making
decisions about PRC fund allocation. Any future changes in PRC
allocation methods will undergo tribal consultation. As recently as
October 2017, the Director's Workgroup on Improving PRC recommended
maintaining the existing PRC formula without change. We were pleased to
have GAO staff participate in two PRC Workgroup meetings where they
engaged in discussions with tribal leaders about their recommendations.
After discussion with the Workgroup, GAO acknowledged IHS's limited
ability to make any changes to the PRC formula that could potentially
result in the reduction of funds to any tribe. GAO subsequently made
the decision to close two recommendations concerning the PRC formula
allocation as not implemented. In addition, IHS is updating its PRC
policy chapter in the Indian Health Manual and is conducting tribal
consultation before finalizing the chapter.
I am very proud of the dedication and commitment of IHS staff at
all levels of the agency who have focused on and accomplished the
objectives of the action plan during this past year. These actions
demonstrate that IHS is taking its challenges seriously, and is
continuing to take assertive and proactive steps to address them. Thank
you for your commitment to improving quality, safety, and access to
health care for American Indians and Alaska Natives. I am happy to
answer your questions.
The Chairman. I would like to thank the witnesses. We will
proceed with questions.
First, Mr. Rusco, how does the GAO continue to monitor
problem areas after recommendations have been closed out?
Mr. Rusco. At the very least, every calendar year, we
review every open recommendation. We go to the agency to see
what progress has been made. In the case of working with the
BIA, we have been doing that much more frequently.
We have found the working relationship to be generally very
good. They have been making progress in almost all of the
recommendations we have made. As of today, there are two that
have been closed, one yesterday, and we got some more
information.
I would like to say the one key recommendation they were
able to close is to implement a good, solid GIS system for
identifying property lines. This will enable BIA to more easily
identify landownership.
In the event of someone wanting to develop a piece of land
for energy or any other economic development, having that
ownership data right at hand in the GIS system will make a big
impact. That is one recommendation they have managed to close.
The Chairman. Mr. Dearman, the GAO stated in its written
testimony about 50 percent of all BIE positions have not been
filled. These vacancies obviously impact educational services
and basic operations. What are your barriers to getting these
positions filled?
Mr. Dearman. Thank you, Senator.
First off, if you know anyone who wants a challenge, a very
rewarding job, send them to BIE.
The Chairman. Vice Chairman Udall always likes a challenge.
Mr. Dearman. We have had many. As we discussed in previous
hearings, isolation and the location of our schools and also
the location of our physicians has been an issue in the past.
We have really worked with the Department to actually move some
of the positions out of D.C. because we have heard from tribal
leadership that we need to have positions in tribal
communities.
An example of what has happened is moving the positions to
where the tribes are. We have a chief academic officer
position, a SES position critical in our organization. We have
advertised that position in Washington, D.C. and received five
applicants. We moved it to where the tribes are and when I
checked last week, we received 139 applicants.
We are anticipating that by relocating the positions, the
locations, we are going to recruit and be able to hire some
tribal members that know our tribal communities and our
schools.
The Chairman. That sounds like a good idea.
Mr. LaCounte, obviously if you go through the number of
recommendations outstanding and how you will start closing out
some of those on energy, with your background and experience
and where you have been geographically, it seems to me you
should have some pretty good insight and ability to work in
this area.
We really have to get going on some of these issues the GAO
brought forward on energy because it is a real opportunity in
Indian Country for jobs, revenue and so forth. This is an area
where I see entrepreneurial opportunities in tribally-owned
industries and individually-owned businesses. We have to help
them. That is something we need to get a push on.
How do we do that? How do we get this going? Then I will
come back to Mr. Rusco to see how we follow up so we know this
is moving and we are getting good progress going.
Mr. LaCounte. It is already going. I was tasked in 2015 to
put together a standard operating procedures manual and a
training set for all of Indian Affairs. To date, we have
trained over 500 people through that course. There is a course
happening in Albuquerque, New Mexico, as we speak. There are 60
employees in that.
We are not limiting it to your standard suspects, realty
specialists and whatnot. We want to train as many people as we
can so when we have another boom like occurred in your State,
we are ready to strike. We have put that together and it is
happening. We have a National Policy Memorandum establishing
that.
We have entered into agency agreements with BLM, OST, and
ONRR to do these things and they are part of this SOP training.
We have plenty of things happening. It is unfortunate that some
of those were not reported to this Committee.
I have a very capable assistant that I raided from another
location who has the same type of background that I have. Her
name is Johnna Black Hair. She has been vicious and bulldog on
this to say the least. I am very confident that we can take
care of these.
As Senator Udall alluded, yes, there is some checked box
but most we are looking at the long term and now to put
something in place that cannot be very easily messed with, for
lack of a better term.
The Chairman. If someone wanted you to follow up on this,
give me a timeline when you think we could do some follow up on
this. I would probably invite you and GAO back. It may be on
energy in a broader sense or maybe just this configuration
again. I am going to ask Admiral Weahkee the same question in
the next round.
What would you say is a productive timeline to bring you
back so we can hone in and you can give us a good progress
report?
Mr. LaCounte. I would say around the first of October.
The Chairman. Okay.
Mr. LaCounte. We have plenty of things in motion that
should be completed in September. I am confident we will stay
on those timelines.
The Chairman. Okay. Thank you.
Senator Udall.
Senator Udall. Thank you, Mr. Chairman.
Admiral Weahkee, as I mentioned earlier today, progress on
closing GAO recommendations and service reports, with a renewed
focus on improving quality of care, has not been enough to fix
the accreditation issues at the Gallup Indian Medical Center.
Given that disconnect, I am concerned that the Service is
not being forthcoming enough about the resources it needs to
quickly bring facilities facing accreditation issues into
compliance, let alone the resources it needs to enact real,
meaningful agency reforms.
Since GIMC joined the list of facilities in jeopardy, what
is the total amount of funding that has been put toward
addressing its accreditation issues?
Mr. Weahkee. Specifically for Gallup, I would have to go
back and pull those numbers together. We do have access to the
Accreditation Emergency Fund which is a relatively new line
item. The majority of that fund has been used in the Great
Plains, although Gallup is currently putting together their
list of projects that need support.
Off the top of my head, the major areas of need are
staffing for ED contracts. Eighty percent of their nursing
staff is via contract. Those contracts are at a very high cost.
Also ED-provider contracts and some renovation work both to
their HVAC system and to moving clinics around within the
facility are areas of need.
In your opening comments, you mentioned the age of GIMC.
The upkeep costs at Gallup are extensive.
Senator Udall. Admiral Weahkee, I would ask that you please
get back to me and my staff as quickly as you can with the
information on the costs and what funding is being addressed to
this accreditation issue.
Does the Service have all the financial resources and
personnel it needs to address these issues before the deadlines
imposed by CMS?
Mr. Weahkee. Specifically for Gallup, we still have very
high vacancy rates. We have identified a number of strategies
to fill those gaps, contracting being one of those. However, we
are looking at some other strategies, working with the Office
of the Surgeon General to identify commissioned Corps
appointees for that location.
We also have a couple of A-19 proposals that have been
submitted through the budget process to enable us to provide
more scholarships and loans to students and new graduates, if
we can address the taxability issue and the ability to provide
pay-back on a half-time basis.
We do have a number of things we would like to implement
but we need a little bit of help in turning that corner.
Senator Udall. I know IHS faces an uphill battle when it
comes to the age of its facilities. I know the same is true
with IHS workforce recruitment and retention. On the whole. we
can all agree that IHS is under-resourced.
I am committed to doing everything I can to address these
issues head-on. In order for both of us to be effective, I need
IHS to stand ready with information about what resources it
needs.
Mr. Dearman, earlier this year, the Department of Education
sent a letter to BIE reporting that the Bureau failed to comply
with the required accountability timelines set out in the
Elementary and Secondary Education Act.
As a result, the Department indicated it would withhold
Title I administrative funding from the Bureau. This news was
particularly concerning for us to hear as many members of this
Committee, including myself and Senator Cortez Masto, have
repeatedly asked you at hearings about whether BIE is meeting
student accountability reporting standards.
What is the current status of the withheld funds? Could you
answer yes or no, is BIE now in full compliance with ESEA?
Mr. Dearman. The yes or no answer would be no, Senator. I
need to explain and I can explain in writing in more detail.
The letter between BIE, the MOA that we had with the
Department of Education and BIE, gave us a deadline of October
2 to have negotiated Rule Committee members submitted to the
White House.
Senator Udall. The second of what year?
Mr. Dearman. October of 2017.
Senator Udall. Okay.
Mr. Dearman. They gave us a timeline of having our
committee members sent to the White House for vetting. There is
a process we have to go through to get a negotiated rulemaking
in place. We need to have tribal consultation regarding that.
That was why the funds were being withheld and are still
currently being withheld.
We are meeting with the Department of Education. Our
leadership and the Department are also meeting with the
leadership of the Department of Education. We will start having
regular discussions about how we can receive assistance and now
we can assist each other.
A lot of rapport is being built with the Department of
Education. We look forward to a continuing relationship.
Senator Udall. Mr. Rusco, how might issues like BIE's non-
compliance with Federal data monitoring standards impact GAO's
evaluation of BIE's high risk progress?
Mr. Rusco. I will turn that over to my colleague.
Ms. Emrey-Arras. I am Melissa Emrey-Arras, Education
Director, BIE.
Senator Udall. Thank you.
Ms. Emrey-Arras. We have not specifically looked at the
issue being discussed but I would say we are generally
concerned about management challenges at BIE. Given the limited
funding and the tremendous need at schools, we think it is
critical that all Federal resources go where they need to be
which is at these schools. Our interest would be in having the
funds go to the schools as well.
Senator Udall. Thank you very much.
Thank you, Mr. Chairman.
The Chairman. Admiral Weahkee, according to your written
testimony, IHS established wait time standards in 2017 for all
patient primary and urgent care visits to direct care IHS
facilities. What progress have you made in meeting those wait
times?
Mr. Weahkee. Thank you, Mr. Chairman.
We have approximately two-quarters worth of data now. As an
agency, overall, we are meeting the standard. However, if you
look at some of the individual sites, we do have some sites not
meeting the 28 days for a primary care appointment or the 48
hours for an urgent care appointment.
The Chairman. What do you do to address that?
Mr. Weahkee. We dig deep and do a root-cause analysis to
really determine why they are not meeting the standard. In many
of the cases, it is staffing and the inability to recruit
appropriate staffing. In some cases, it is the design of the
facility where there is maybe one provider to one room as
opposed to what would be more ideal, one provider having access
to three to four rooms so they can see patients more
efficiently.
Both of those root causes require funding and resources in
order to address them.
The Chairman. If those individuals then go to a facility
that is not an IHS facility off reservation or wherever, are
you getting reimbursement to those institutions in a timely way
so they will provide care to individuals who are not able to
access care at an IHS facility?
Mr. Weahkee. For PRC referrals specifically, we do have new
metrics in place where we are measuring those patients we refer
and patients who self-refer. Those metrics are identified as 60
days prompt pay for our IHS referrals.
The Chairman. How about self referral?
Mr. Weahkee. For self referral, 45 days is our metric. We
benchmark against Kaiser Permanente and our fiscal
intermediary, Blue Cross Blue Shield, to come up with those
benchmarks.
The Chairman. You are meeting?
Mr. Weahkee. We are not meeting that. Currently, we are at
61 days.
The Chairman. Would you provide this Committee with a
report on how you are doing both on IHS referrals and self
referrals in terms of providing that reimbursement?
Mr. Weahkee. Yes, sir, we can.
The Chairman. To the extent that you are behind or
backlogged at IHS facilities, there has to be some place these
people can go. They cannot get care or it is going to be harder
for them to get care if those institutions are not getting
reimbursed.
Mr. Weahkee. We can get you that data, sir.
The Chairman. Okay.
The credentialing, I am still running into situations where
I have health care officials raring to go on the reservation
and provide care, dentistry, for example, and they are having
trouble getting credentialed. How do we make sure we have this
squared away?
Mr. Weahkee. I believe the issue, specifically with
dentists, dental providers, and dental professionals, is they
are not used to going through a comprehensive, hospital-based
credentialing process. Most of them work in general offices or
either standalones.
The level of scrutiny and the process we use within the
Federal system has more comprehensive background investigation
checks. I think the centralized credentialing system we have
put in place will help because the burden will be up front once
they have entered their information. That information will now
be portable from site to site. It will just be a matter of
keeping their information updated in terms of licenses. There
is a bit more complexity involved in hospital-based
credentialing.
The Chairman. I would like a point person from IHS who will
work with this Committee and I will have someone from the
Dental Association. I want to at least get those people
together to see if we can work this out because I am still
hearing, particularly from dentists and there may be others,
that we have professionals willing to go onto the reservation
and provide care that is not being provided now. We do not want
to hold them up because of red tape or bureaucracy.
Mr. Weahkee. I would like to identify right now Dr. Michael
Toedt, Chief Medical Officer, as that point person.
The Chairman. Okay. Thank you.
Mr. Weahkee. Thank you, sir.
The Chairman. Senator Udall.
Senator Udall. Thank you, Mr. Chairman.
I applaud IHS for the strides it has made since the first
high risk hearing last May, but despite this progress, since
then, two more federally-operated IHS facilities are reportedly
at risk of losing their CMS accreditation. I am deeply
concerned that IHS is not doing enough to create real, lasting,
agency-wide improvements.
Admiral Weahkee, do you agree there appears to be a
disconnect between the IHS's reported progress on GAO high risk
designation and the continued noncompliance findings of CMS
surveys?
Mr. Weahkee. No, sir, I do not. I believe that many of the
actions that have been implemented at the national level, we
have yet to see their benefit, items like the centralized
credentialing and the National Accountability Dashboard for
Quality which is relatively new.
The GAO has identified for us that they need to monitor us
on a longer trajectory. Again, the issues tend to be the same
from site to site. It is inability to recruit, emergency
department staffing and many facilities issues, like
environment of care and life safety issues, are due to the age
of the facilities.
Senator Udall. In your testimony today, you said, ``IHS is
taking a comprehensive and integrated approach towards creating
an oversight capability at headquarters to improve the quality
of care and patient safety.''
When was the last time IHS conducted internal quality and
compliance surveys at GIMC and Crow-Northern Cheyenne Hospital?
Mr. Weahkee. Internal with an IHS review team, I would need
to go back and identify. We have contracted that work with
Joint Commission Resources. They are a consultative arm of the
Joint Commission which comes in and does an objective review on
our behalf via contract. We have utilized that methodology at
several of our locations.
Prior to having stood up the Office of Quality, that has
been our only mechanism. Once the Office of Quality is stood
up, we expect it will have the assets at its disposal to be
able to go out and do those reviews ourselves.
Senator Udall. Thank you.
Mr. LaCounte, Acting Assistant Secretary Tahsuda recently
told tribal leaders at NCAI's mid-year conference that 40
percent of the Department's employees would be eligible to
retire within the next few years.
In your testimony, you state ``Fifty-nine percent of BIA
employees who are engineers, technicians and environmental
scientists are eligible for retirement now or within five
years. This is in addition to a loss of 33 to 50 of these
specialists in just the past five years.''
Mr. LaCounte and Mr. Dearman, have BIA and BIE developed a
concrete plan to deal with the Department's looming retirement
issue, particularly the loss of field experts?
Mr. LaCounte. Senator, thank you.
I do not want you to think those numbers were specific to
the energy sector. When we talked about the engineers, we talk
about engineers across the board. They are not specific to
Indian energy.
Actually, we just assigned an individual to develop our
workforce plan, within the last week, for trust services. We
understand the risk we face with the numbers Mr. Tahsuda
referenced at NCAI.
I have been looking at this for over ten years. What we
have found is that most of our employees do not leave even
though they are eligible. For instance, I am eligible next
month; I do not have any intentions of going anytime soon,
unless I am run out.
We are working on it. It has been an issue but we are
trying our best to bring people up through the ranks, so to
speak, to get to management positions and whatnot. Recruiting
engineers and those kinds of people is always a priority.
You have to understand, when that occurs, we have to
compete with private industry, especially in the oil and gas
business because that could be booming again. We seem to lose
more people to that than we do to retirement.
Senator Udall. You definitely have assigned someone to work
on this and think about it looking at the long term?
Mr. LaCounte. Yes, sir.
Senator Udall. Mr. Dearman?
Mr. Dearman. Thank you, Vice Chairman.
As I stated in our workforce plan, we felt we have to get
our strategic direction first. in order to determined the
direction of the organization. Now we are going to start
working on our workforce plan.
Also, going back to how we advertise our teachers, we have
increased our outreach by not just advertising our positions on
USAJOBS, but we use multiple advertisement resources and
websites. Right now, we are reaching over 200 universities and
colleges where we are advertising.
Our plan is to include our Title V employees in that
advertisement and also getting out to Indian Country promoting
BIE, and working with the National Education Association,
really getting the word out that we are a good place to be. We
have a lot of challenges but it is very rewarding. We do have a
plan.
Senator Udall. You do have a plan and you are going to
dedicate people to work on that?
Mr. Dearman. Yes. My human resource officer is watching
this. He started today and that will be one of his tasks.
Senator Udall. Mr. Rusco, how important does GAO feel
workforce and succession planning are to ensuring the long term
success of agency reform?
Mr. Rusco. It is very important. There is a general endemic
wave of retirement-eligible SES in the government broadly. In
particular, also when it comes to energy issues, it is very,
very difficult to keep the right number of engineers and
trained professionals in order to do that work. That is
something we found more broadly at Interior but I think it is
also true of the BIA.
Senator Udall. Thank you very much.
Thank you, Mr. Chairman.
The Chairman. Thank you, Vice Chairman Udall.
I would like to thank all the witnesses. We appreciate your
being here today.
If there are no more questions for today, members may also
submit follow-up, written questions for the record. The hearing
record will be open for two weeks.
Again, we appreciate the witnesses.
With that, this hearing is adjourned.
[Whereupon, at 4:26 p.m., the Committee was adjourned.]
A P P E N D I X
Response to Written Questions Submitted by Hon. Tom Udall to
RADM Michael Weahkee
Workforce
Question 1. At the first Indian Affairs Committee ``High Risk''
oversight hearing this Congress, GAO testified that workforce planning
is one of the five core reasons the Department of the Interior (DOI)
and the Department of Health and Human Services (HHS) have mismanaged
and ineffectively administered federal Indian education, health, and
energy programs. \1\ At this most recent hearing, GAO testified that
vacancies in key offices at DOI and HHS limit the overall capacity of
the Department to address the root causes of their high risk
designation. And the Centers for Medicare and Medicaid (CMS) have
repeatedly found staffing violations at the federally-operated IHS
facilities in the Great Plains, Navajo, and Billings Service Areas
where CMS accreditation is in jeopardy. What are the current clinical
and administrative vacancy levels for IHS?
---------------------------------------------------------------------------
\1\ High Risk, No Reward: GAO's High Risk List for Indian Programs
Hearing Before S. Comm. on Indian Affairs, 115th Cong. 1 (2017)
(statement Melissa Emrey-Arras, Dir. Of Education, Workforce, and
Income Security, Gov't Accountability Office).
---------------------------------------------------------------------------
Answer. As of May 2018, the vacancy rate for clinical positions is
22 percent and the vacancy rate for administrative positions is 17
percent.
Question 1a. Is there a system in place so that Area Offices and
IHS leadership in Rockville, MD, can monitor staffing at all federally-
operated IHS facilities to ensure they are in compliance with all
industry and legal staffing on-call requirements?
Answer. There are electronic reporting systems in place for
reporting on the staffing levels at all federally-operated IHS
facilities. IHS leadership at Headquarters is able to report and
monitor the number of positions in each Area and every federally-
operated facility within an Area. On-call requirements are governed by
union collective bargaining agreements to include on-call conditions,
response times, etc. Each agreement may have different negotiated
parameters for on-call procedures. Monitoring on-call hours is the
responsibility of the local service unit leadership and department
supervisors. Time spent on-call is not documented in the time and
attendance system since, under Fair Labor Standards Act, time spent on-
call is not considered work hours (5 CFR 551.431).
In addition, CMS Conditions of Participation and the Joint
Commission Hospital Accreditation Standards survey include a
comprehensive review of on-call staffing and associated procedures to
comply with the Emergency Medical Treatment and Labor Act. This
includes verification of Area Office Governing Body oversight of on-
call staffing and response.
Question 2. On June 21st, the White House released a proposal
entitled ``Delivering Government Solutions in the 21st Century: Reform
Plan and Reorganizations Recommendations.'' \2\ This proposal would
seek to reduce the size of the Public Health Service Commissioned Corps
by nearly 40 percent and require agencies employing the Corps officer
to pay their retirement costs. According to the Washington Post, ``The
largest number of [Corps] officers--1,887--is assigned to the Indian
Health Service.'' \3\ How many Public Health Service Corps officers
currently work for IHS overall and, specifically, in leadership
positions? Please provide a breakdown of number of Corps officers and
the percentage of the total workforce they represent for each Service
Area.
---------------------------------------------------------------------------
\2\ Office of Management and Budget, Delivering Government
Solutions in the 21st Century: Reform and Reorganization
Recommendations (2018) (available at https://www.whitehouse.gov/wp-
content/uploads/2018/06/Government-Reform-and-Reorg-Plan.pdf).
\3\ Lena H. Sun, White House want to cut this public health service
corps by nearly 40 percent, THE WASHINGTON POST (June 27, 2018),
https://www.washingtonpost.com/news/to-your-health/wp/2018/06/27/white-
house-wants-to-cut-this-public-health-service-corps-by-nearly-40-
percent/?noredirect=on&utm_term=.1dc8463601eb.
---------------------------------------------------------------------------
Answer. As of July 1, 2018, there are 1,885 Commissioned Corps
Officers assigned to the Indian Health Service (IHS). Approximately 850
of these officers occupy supervisory positions throughout IHS,
including roughly 500 officers in leadership positions at the Program/
Department, Service Unit, Area, and Headquarters levels.
The number of Corps officers and the percentage of the total
workforce they represent for each Service Area is provided below.
------------------------------------------------------------------------
Corps
Civil Total Officer
IHS Area Corps Service Federal percent of
Officers Employees Workforce Federal
Workforce
------------------------------------------------------------------------
Alaska 270 85 355 76.06%
Albuquerque 126 916 1,042 12.09%
Bemidji 92 486 578 15.92%
Billings 72 935 1,007 7.15%
California 27 125 152 17.76%
Great Plains 151 2,130 2,281 6.62%
Nashville 47 156 203 23.15%
Navajo 276 3,957 4,233 6.52%
Oklahoma City 313 1,429 1,742 17.97%
Phoenix 299 2,279 2,578 11.60%
Portland 97 416 513 18.91%
Tucson 40 271 311 12.86%
IHS Headquarters 75 611 686 10.93%
Total IHS 1885 13,796 15,681 12.02%
------------------------------------------------------------------------
Question 2a. Did IHS work with the Office of Budget and Management
to evaluate this proposal to reduce the size of the Corps? And does IHS
or OMB have an estimate of how implementation of the proposed reduction
in number of Corps members would affect each Service Area?
Answer. The proposal states that the reduction would affect
officers who ``do not provide critical public health services,'' and
that newly commissioned officers would ``initially work in a hard-to-
fill area.'' Most Corps officers assigned to IHS are either fulfilling
a direct patient care role or providing critical public health services
in hard to fill areas in support of the overall health of American
Indians and Alaska Natives.
Question 2b. Does IHS have an estimate of the cost the Service
would incur if it were required to pay for retirement of Corps
personnel working at IHS?
Answer. Budgetary estimates are in the preliminary stages of
development.