[Federal Register Volume 76, Number 56 (Wednesday, March 23, 2011)]
[Notices]
[Pages 16427-16430]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-6826]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Memorandum of Agreement Between the Indian Health Service and the 
Department of Interior; Bureau of Indian Affairs and Bureau of Indian 
Education

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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SUMMARY: The Indian Health Service (IHS) is providing notice of a 
Memorandum of Agreement (MOA) between the IHS and the Department of the 
Interior (DOI), signed in 2009, and has developed an amendment to that 
MOA that includes language consistent with Section 703 of the Indian 
Health Care Improvement Act (IHCIA), Public Law 94-437, as amended. The 
purpose of the MOA and the amendment is to advance our partnership with 
Tribes and Federal stakeholders on alcohol and substance abuse 
prevention and treatment. The Patient Protection and Affordable Care 
Act's, Public Law 111-148, permanent authorization of the Indian Health 
Care Improvement Act (IHCIA) establishes timelines and requirements for 
coordinated actions by the Department of Interior (DOI), the Department 
of Health and Human Services (HHS), Tribes and Tribal organizations. 
Specifically, Section 703 of the IHCIA provides new authorities that 
permit the DOI and HHS, acting through the Indian Health Service (IHS), 
to develop and enter into a Memorandum of Agreement (MOA), or review 
and update any existing memoranda of agreement, as required by Section 
4205 of the Indian Alcohol and Substance Abuse Prevention and Treatment 
Act of 1986 (25 U.S.C.2411). DOI and IHS signed an MOA on this topic in 
2009, and have developed an amendment to that MOA that includes 
language consistent with the new IHCIA provision. In accordance with 
Section 703 of the IHCIA, which states that the MOA between the IHS and 
DOI shall be published in the Federal Register, the agency is 
publishing notice of this MOA and the amendment to this MOA.

DATES: The original MOA was effective on December 12, 2009. The 
amendment is effective March 1, 2011.

[[Page 16428]]


FOR FURTHER INFORMATION CONTACT: Dr. Rose Weahkee, Director, Division 
of Behavioral Health, Office of Clinical and Preventive Services, 
Indian Health Service, 801 Thompson Avenue, Rockville, MD 20852, (301) 
443-2038.

SUPPLEMENTARY INFORMATION: In accordance with Section 703 of the Indian 
Health Care Improvement Act (IHCIA), Public Law No. 94-437, as amended, 
which states that the MOA between the IHS and DOI shall be published in 
the Federal Register, the agency is publishing notice of this MOA and 
the amendment to this MOA.

    Dated: March 17, 2011.
Yvette Roubideaux,
Director, Indian Health Service.
3-CPS-10-0011
OCTOBER 2009
MEMORANDUM OF AGREEMENT
BETWEEN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
INDIAN HEALTH SERVICE
AND
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
AND
BUREAU OF INDIAN EDUCATION
ON
INDIAN ALCOHOL AND SUBSTANCE ABUSE PREVENTION

I. PURPOSE

The Memorandum of Agreement (MOA) emphasizes assisting tribal 
governments in their efforts to address substance abuse. It affirms the 
importance of a systematic approach to enhance the quality of life. 
This MOA shall include coordination of data collection, resources, and 
programs of the Indian Health Service (IHS), the Bureau of Indian 
Affairs (BIA), and the Bureau of Indian Education (BIE).

The Department of Health and Human Services (DHHS) and the Department 
of the Interior (DOI) shall coordinate and collaborate pursuant to this 
MOA. Special acknowledgment is given to the rights of tribes in 
accordance with Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450, et seq.) and local control in accordance with Section 
1130 of the Education Amendments of 1978 (25 U.S.C. 2010).

The tribes, in conjunction with Federal and state entities, will 
identify the need for services and their best applications.

II. GOAL

To promote tribal communities that are safe, healthy, and productive by 
the following means:

     Increase collaboration and coordination among the BIA, 
BIE, IHS, and tribes.
     Facilitate resource sharing (funding, personnel, 
information, knowledge, and skills) among the BIA, the BIE, IHS, and 
tribes.
     Support and assist local BIA agencies, schools, BIE line 
offices, and IHS area and service units in working with tribes in 
developing and implementing joint programs and services.

III. BACKGROUND

Substance abuse, including alcohol, illegal drugs, and controlled 
substances, impact the whole community. Probable consequences include 
depression, domestic violence, child neglect and abuse, elderly abuse, 
property damage, gang activity, and violent crime. It increases the 
burden on communities and on those Federal, state, and tribal 
governments attempting to assist these communities.

The production, distribution, and use of substances such as 
methamphetamine (meth) are not a new problem. Substance abuse threatens 
not only the user but threatens the well-being of the community. 
Related illicit acts encourage gang activities as well as organized 
crime on Indian lands. The production of meth results in toxic by-
products that are left in buildings, fields, and waterways. Some of 
these chemicals can cause disfigurement, illness, or death.

American Indian youth, ages 12-17, have the highest percentage rate for 
illegal drug use according to the Substance Abuse and Mental Health 
Services Administration (SAMHSA). Prevention efforts targeting youth 
and young adults are the most cost-effective in addressing this 
problem. It has been clearly demonstrated that the younger an 
individual is when he/she encounters a prevention message, the better 
the outcome.

Illegal drugs and controlled substances present a special challenge to 
agencies and organizations. Supply reduction, in combination with 
demand reduction, must be undertaken through a comprehensive and multi-
disciplinary approach if they are to be successful. The illegal 
production, distribution, and use of controlled substances within 
Indian Country is at an epidemic level. These challenges necessitate a 
comprehensive evaluation by the BIA, BIE, and IHS in order to address 
these issues.

IV. STATEMENT OF PURPOSE

A. Coordination Efforts

1. Juvenile and Adult Detention Centers
The IHS and BIA will collaborate to expand substance abuse resources 
for detoxification, treatment, and post-detention community re-entry 
and aftercare planning.
2. Youth Regional Treatment Centers (YRTC)
The IHS will continue to provide funding support for the operation of 
existing centers and to advocate for additional resources. The IHS will 
include BIE in the planning and identification of educational resources 
(curriculum, libraries, recreational facilities, computers, funds for 
teachers, etc.) for IHS-operated YRTC's. The BIE will be active in 
considering the needs of tribally-operated YRTC's. The BIE and IHS will 
collaborate regarding the most suitable placement to meet the needs of 
the individuals.
3. Residential Schools
The IHS, BIA and BIE will coordinate delivery of healthcare and 
wellness support services to boarding school residents and their 
families. The agencies will support efforts to align policies such that 
residents have appropriate access to healthcare services including a 
range of behavioral health services on-site. Such services will, where 
possible, be part of an integrated, holistic approach to student 
support that includes appropriate recognition and targeting of 
interventions to both general student populations and high risk 
students.
4. Community Based Adult Services
The IHS, BIA, and BIE will collaborate with tribes to enhance program 
coordination, planning, and implementation of community based 
prevention, referral, enforcement, treatment (both individual and 
family), recovery models, and implementation of programs with linkages 
to adjunct community services. These efforts will be implemented at the 
BIA agency, BIE line office, and IHS service unit levels jointly with 
the affected tribes.
5. Child Protection and Child Welfare
The BIA will include the BIE, IHS, and tribes in planning and 
implementation activities. These shall include defining the scope of 
services appropriate to tribal area needs and identifying resources to 
address the continuum of

[[Page 16429]]

care for American Indian children at risk for abuse and/or neglect.

The BIA, BIE, and the IHS will obtain input from local tribes on 
planning initiatives. This will strengthen the coordinated interagency 
multidisciplinary response for the protection of children and the 
prevention of child abuse and neglect in American Indian and Alaska 
Native communities, especially for drug endangered children. These 
agencies will continually reaffirm the need for coordinated approaches 
to prevent child abuse and neglect and its long-term social and 
economic consequences (poor academic performance, substance use, 
multiple disorders, suicides, etc.) and promote a full range of 
effective services for abused American Indian and Alaska Native 
children and their families.
6. Data Collection, Analysis, and Sharing
The BIA, BIE, and IHS will consult with the tribes to determine the 
need for sharing information, data collection systems that are 
compatible with current systems in use, and data resources on substance 
abuse and collaboration and coordination on information collection and 
reporting will be encouraged. Linkages will be forged with other 
Federal, state, and local entities. This will facilitate appropriate 
recommendations and decisions about programs and initiatives.
7. Joint Multi-Disciplinary Meetings
The BIA and BIE Central Offices and IHS Headquarters staff, including 
participation by regional, line, and area office staff, will jointly 
conduct multidisciplinary meetings to discuss coordination and 
collaboration issues and identify barriers to the implementation of 
this MOA. These meetings will occur not less than every 6 months.

In addition, an annual, multidisciplinary meeting will be planned and 
coordinated that focuses on local BIA agency superintendents and BIE 
line officers (including superintendents or education specialists, IHS 
service unit chief executive officers, and tribal health directors and 
facility directors). It will address organizational coordination and 
effective responses to the impact of substance abuse in Indian Country.

B. Organizational Responsibility

1. Central Office/Headquarters
The BIA and BIE Central Office and IHS Headquarters are responsible 
for:

     Designing and delivering training and technical 
assistance;
     Identifying and advocating for financial resources; and
     Developing a biennial program plan, including specific 
objectives, performance improvement measures, benchmarks/milestones, 
and organizational responsibilities to be completed within 6 months of 
the last signature of this MOA.
2. BIA Regions, BIE Line Offices, and IHS Area Offices
The BIA regional directors, BIE line officers, and IHS area directors 
are responsible for encouraging the development of local MOA's between 
the IHS, BIA, and BIE in working with the local tribe(s) to increase 
collaboration and cooperation, facilitate resource sharing, and to 
develop joint programs/services to address substance abuse.

The BIA regional directors, BIE line officers, and IHS area directors 
are responsible for designating a staff member to attend the semi-
annual organizational planning and implementation meetings (see item 
IV.A.7) and report activities (accomplished, ongoing, and 
unaccomplished) to BIA and BIE Central Offices and IHS Headquarters.

The BIA Central Office will compile a comprehensive list of Indian 
Country activities (accomplished, ongoing, and unaccomplished) 
semiannually for distribution to all BIA regions and agencies (through 
the Deputy Bureau Director for Field Operations), BIE line offices 
(through the BIE Deputy Director, School Operations), and IHS service 
unit chief executive officers (through the IHS Director).

V. IDENTIFICATION OF STATUTORY AUTHORITIES

1. Snyder Act of November 2, 1921 (42 Stat. 208; 25 U.S.C. 13)
2. Economy Act of September 13, 1982 (96 Stat. 933; 31 U.S.C. 1535)
3. Indian Self-Determination and Education Assistance Act of January 4, 
1975 (88 Stat. 2203; 25 U.S.C. 450 et seq.)
4. Anti-Drug Abuse Act of 1988 (102 Stat. 4181; 21 U.S.C. 1501)
5. Indian Alcohol and Substance Abuse Prevention and Treatment Act of 
1986 (100 Stat. 3207-137; 25 U.S.C. 2401)
6. Indian Health Care Improvement Act of September 30, 1976 (90 Stat. 
1400; 25 U.S.C. 1600 et seq.)
7. Indian Child Protection and Family Violence Prevention Act of 
November 28, 1990 (104 Stat. 4544; 25 U.S.C. 3201)
8. No Child Left Behind Act of 2001 (115 Stat. 1425; 20 U.S.C. 6301)
9. Johnson-O'Malley Act of April 16, 1934, (48 Stat. 596; 25 U.S.C. 452 
et seq.)
10. Victims of Child Abuse Act of November 29, 1990 (104 Stat. 4792; 42 
U.S.C. 13001 et seq.)
11. Education Amendments of November 1, 1978 (92 Stat. 2143; 25 U.S.C. 
2010 et seq.)

VI. ADMINISTRATIVE PROVISIONS

1. Nothing in this MOA may be construed to obligate BIA, BIE, IHS, or 
the United States to any current or future expenditures of resources in 
advance of the availability of appropriations from Congress. This MOA 
does not obligate BIA, BIE, IHS, or the United States to spend funds on 
any particular project or purpose, even if funds are available.
2. This MOA in no way restricts BIA, BIE, or IHS from participating in 
similar activities or arrangements with other public or private 
agencies, organizations, or individuals.
3. BIA, BIE, and IHS will comply with the Federal Advisory Committee 
Act to the extent it applies.
4. Upon the last signature, this MOA shall remain in effect, unless 
modified or terminated by the Assistant Secretary--Indian Affairs or 
the Director, Indian Health Service upon 60 days written notice. The 
Assistant Secretary--Indian Affairs, Director, BIA, Director, BIE, and 
Director, IHS shall review this MOA on a biennial basis.

VII. SIGNATURES OF EACH PARTY

Approved and accepted by:

/Larry Echohawk/                                10/13/09
Assistant Secretary--Indian Affairs             Date
 
/Yvette Roubideaux/                             12/16/09
Director, Indian Health Service                 Date
 
/Spike Bighorn/                                 10/15/09
(Acting) Director, Bureau of Indian Education   Date
 
/Jerry Gidner/                                  10/20/09
Director, Bureau of Indian Affairs              Date
 


[[Page 16430]]

Amendment to Memorandum of Agreement
between
Department of Health and Human Services
Indian Health Service
and
The Department of the Interior
Bureau of Indian Affairs and Bureau of Indian Education
on
Indian Alcohol and Substance Abuse Prevention

PURPOSE

Pursuant to the Patient Protection and Affordable Care Act, Pub. L. No. 
111-148, Title X, Subtitle B, Part III, Sec.  10221(a), 124 Stat. 119, 
935 (amending 25 U.S.C. Sec. Sec.  1665, 1665a, and 2411), this 
amendment updates the ``October 2009 Memorandum of Agreement (MOA) 
between the Department of Health and Human Services (DHHS) Indian 
Health Service (IHS) and the Department of the Interior (DOI) Bureau of 
Indian Affairs (BIA) and Bureau of Indian Education (BIE) on Indian 
Alcohol and Substance Abuse Prevention.''

AMENDMENTS

    The October 2009 MOA is amended, as follows:

    (1) The first sentence of Section I is amended to read:

I. PURPOSE

    The Memorandum of Agreement (MOA) emphasizes assisting tribal 
governments in their efforts to address certain behavioral health 
issues among Indians, specifically mental illness and dysfunctional and 
self-destructive behavior, including substance abuse, child abuse, and 
family violence.

    (2) Section IV A. is amended to read as follows:
2. Youth Regional Treatment Centers (YRTC)
The IHS will continue to provide funding support for the operation of 
existing centers and the implementation within the centers of alcohol 
and substance abuse treatment programs. IHS will also advocate for 
additional resources. The BIE will provide resources and funding for 
the education of the young people receiving treatment in the YRTCs 
(curriculum, libraries, recreational facilities, computers, funds for 
teachers, etc.), and will actively identify and seek funding and 
resources available from the states and other entities. IHS and BIE 
will work collaboratively to meet the needs of the YRTC residents.

    (3) A new paragraph is added to Section IV A. Coordination Efforts:
8. Certain Behavioral Health Issues
IHS, BIA, and BIE will collaborate to:

(a) Assess the scope and nature of mental illness and dysfunctional and 
self-destructive behavior, including substance abuse, child abuse, and 
family violence, among Indians;

(b) Identify existing Federal, tribal, State, local, and private 
services, resources, and programs available to provide behavioral 
health services for Indians;

(c) Determine the unmet need for additional services, resources, and 
programs necessary to improve the mental and behavioral health of 
Indians;

(d) Support the right of Indians, as citizens of the United States and 
of the States in which they reside, to have access to behavioral health 
services to which all citizens have access;

(e) Delineate the responsibilities of IHS and BIA, including mental 
illness identification, prevention, education, referral, and treatment 
services (including services through multidisciplinary resource teams), 
at the central, area, and agency and service unit, service area, and 
headquarters levels;

(f) Develop a strategy for the comprehensive coordination of behavioral 
health services provided by IHS and BIA, including:

(i) the coordination of alcohol and substance abuse programs of IHS, 
BIA, and Indian tribes and tribal organizations developed under the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act with 
behavioral health initiatives, particularly with respect to the 
referral and treatment of dually diagnosed individuals requiring 
behavioral health and substance abuse treatment, and;

(ii) ensuring that IHS and BIA programs and services (including 
multidisciplinary resource teams) addressing child abuse and family 
violence are coordinated with such non-Federal programs and services.

(g) Direct appropriate officials, particularly at the agency and 
service unit levels of BIA and IHS, to cooperate fully with tribal 
requests made pursuant to community behavioral health plans adopted 
under section 702(c) [25 U.S.C. Sec.  1665a(c)] and section 4206 of the 
Indian Alcohol and Substance Abuse Prevention and Treatment Act.

    (4) A new paragraph is added to Section IV B. Organizational 
Responsibility:
3. IHS shall assume responsibility for:
(a) the determination of the scope of the problem of alcohol and 
substance abuse among Indians, including the number of Indians within 
the jurisdiction of the Service who are directly or indirectly affected 
by alcohol and substance abuse and the financial and human cost;

(b) an assessment of the existing and needed resources necessary for 
the prevention of alcohol and substance abuse and the treatment of 
Indians affected by alcohol and substance abuse, and;

(c) an estimate of the funding necessary to adequately support a 
program of prevention of alcohol and substance abuse and treatment of 
Indians affected by alcohol and substance abuse.

    (5) A new paragraph is added to Section VI ADMINISTRATIVE 
PROVISIONS:

5. The Secretaries of DHHS and DOI will conduct an annual review of 
this MOA which will be provided to Congress and Indian tribes and 
tribal organizations.

    (6) Paragraph (4) in Section VI is amended to read:

4. Upon the last signature, this MOA shall remain in effect, unless 
modified or terminated by the Assistant Secretary--Indian Affairs or 
the Director, Indian Health Service or the Director, Bureau of Indian 
Education, or the Director, Bureau of Indian Affairs, upon 60 days' 
written notice.

    (7) Section V is amended to read:

6. Indian Health Care Improvement Act of September 30, 1976 (90 Stat. 
1400; 25 U.S.C. 1600 et seq.) as amended by Patient Protection and 
Affordable Care Act, Pub. L. No. 111-148, Title X, Subtitle B, Part 
III, Sec.  10221(a), 124 Stat. 119, 935 (amending 25 U.S.C. Sec. Sec.  
1665, 1665a, 2411).

Signatures of Each Party

/Yvette Roubideaux/

Director, Indian Health Service
Department of Health and Human Services
Date: March 1, 2011

/Larry Echohawk/

Assistant Secretary--Indian Affairs
Department of the Interior
Date: March 1, 2011

[FR Doc. 2011-6826 Filed 3-22-11; 8:45 am]
BILLING CODE 4165-16-P