[Senate Report 107-250]
[From the U.S. Government Publishing Office]
Calendar No. 560
107th Congress Report
SENATE
2d Session 107-250
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AUTHORIZING THE INTEGRATION AND CONSOLIDATION OF ALCOHOL AND SUBSTANCE
ABUSE PROGRAMS AND SERVICES PROVIDED BY INDIAN TRIBAL GOVERNMENTS, AND
FOR OTHER PURPOSES
_______
September 3, 2002.--Ordered to be printed
_______
Mr. Inouye, from the Committee on Indian Affairs, submitted the
following
R E P O R T
[To accompany S. 210]
The Committee on Indian Affairs, to which was referred the
bill (S. 210) to authorize the integration and consolidation of
alcohol and substance abuse programs and services provided by
Indian tribal governments, and for other purposes having
considered the same, reports favorably thereon with an
amendment and recommends that the bill (as amended) do pass.
PURPOSE
The primary purposes of the Native American Alcohol and
Substance Abuse Program Consolidation Act of 2002 (S. 210) are
twofold: to enable Indian tribes to consolidate and integrate
alcohol, substance abuse, and mental health treatment services
into one program to improve administrative, management,
accounting effectiveness, and in the process create a simpler
and more efficient service delivery system; and to recognize
that tribal governments, as the local entities directly
responsible for the well-being of their populations, can best
determine the most appropriate policy goals and methods for
achieving these goals in their communities.
BACKGROUND
Native American communities continue to be plagued by
alcohol and substance abuse at staggering rates and this abuse
and concomitant social pathologies are wreaking havoc on Native
people across the United States. The incidence of alcohol and
substance abuse among American Indian and Alaskan Native adults
is far greater than that of the general population. Alcoholism
occurs among American Indian and Alaskan Natives at a rate that
is 579% greater than the general population. Deaths due to
alcoholism occur at a rate that is 440% higher than that of the
general population.
Similarly, alcohol continues to be an important risk factor
associated with the top three killers of American Indian and
Alaskan Native youth--accidents, suicide, and homicide. Based
on 1993 data, the rate of mortality due to alcoholism among
American Indian and Alaskan Native youth ages 15 to 24 was 5.2
per 100,000 which is 17 times the rate for whites of the same
age.
Native Americans have higher rates of alcohol and drug use
than any other racial or ethnic group in America. Despite
previous treatment and preventive efforts, alcoholism and
substance abuse continue to be prevalent among Native youth:
82% of Native adolescents admit to having used alcohol,
compared with 66% of non-Native youth. In a 1994 school-based
study, 39% of Native high school seniors reported having
``gotten drunk'' and 39% of Native children acknowledged using
marijuana.
Alcohol and substance abuse also contribute to other health
and social problems including sexually transmitted diseases,
child and spousal abuse, poor school achievement and dropout
rates, drunk-driving related deaths, mental health problems,
general feelings of hopelessness and, too commonly, suicide.
In order to deal with the devastating affects of alcoholism
and substance abuse in all communities, Congress has authorized
and appropriated funds to many Federal agencies to address
these problems. An informal survey made by committee staff
identified approximately twenty (20) programs in seven Federal
departments which tribes may access for the prevention and
treatment of alcohol and other substance abuse.
Many of these programs and services are available to
tribes, but even where tribes secure access to program funding
from several different sources, the amounts are generally so
low, and the auditing and reporting requirements so onerous,
that it is simply not cost effective for a tribe to attempt to
participate in the programs.
The Native American Alcohol and Substance Abuse Program
Consolidation Act of 2002 addresses both the service needs of
the Native population and the inefficiencies of the current
programs by authorizing Indian tribes (hereinafter ``Indian
tribes'' or ``tribes'' and shall refer to Indian tribes, tribal
organizations, and/or tribal consortia) to develop and submit a
single plan to a single Federal agency to consolidate the
servicers currently available in an effort to discipline the
distribution of program services.
The provisions of S. 210 mirror those of the highly
successful Indian Employment, Training and Related Services
Demonstration act of 1992, as amended, Pub. L. 102-477, which
authorizes the integration of Federal job training and
employment-related activities into one consolidated program.
Commonly referred to as the ``477 program'', Public Law
102-477 is widely recognized as one of the most successful
employment training and economic development programs enacted
for the benefit of Indian tribes. Based on the success of the
original ``477'' experience, the Committee considers it viable
to extend the program to other areas such as alcohol, substance
abuse, and mental health services. Equally important, under
``477'' program authority, tribes have the ability to tailor a
program to address the specific needs of their communities,
which increases effectiveness and satisfaction.
As enacted, the ``477 program'' was designed to provide
Indian tribes with a mechanism to better leverage the wide
variety of employment training programs, while minimizing
administrative time, cost and expense, and reducing the burden
of Federal paperwork requirements. By all accounts, the ``477''
program has been successful in achieving these objectives.\1\
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\1\ In 2000, Congress recognized the success of the ``477 program''
and expanded its scope to include actual economic development
activities as an adjunct to its core mission of employment training.
See Title XI, Pub. L. 106-568.
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S. 210 expands upon the ``477'' concepts and would
authorize the integration of Federally-funded alcohol,
substance abuse, and mental health services and programs which
are well-suited for integration because it is common for these
program funds to be awarded in small sums. In fact, it is not
unusual for a tribe to receive a variety of Federal grants and
program dollars, each involving different audit, reporting and
management requirements.
SUMMARY OF MAJOR PROVISIONS
1. Overview and lead agency status
Operationally, the Native American Alcohol and Substance
Abuse Program Consolidation act of 2002 largely tracks the
framework of Pub. L. 102-477. S. 210 authorizes the Secretary
of the Department of Health and Human Services (DHHS) to be the
lead agent for purposes of coordinating alcohol, substance
abuse, and mental health programs at the Federal level. The
Secretary is the logical candidate to lead this effort as the
Secretary is responsible for administering the great majority
of Indian health programs through the Indian Health Service
(IHS).
Because the Secretary also has considerable experience
implementing the provisions of the Indian Self Determination
and Education Assistance Act, as amended, the activities
envisioned by S. 210 also logically fall under the Secretary's
purview.
Last, the Secretary oversees the operation of key agencies
within the DHHS which provide funding in the area of alcohol,
substance abuse and mental health treatment, making it an ideal
point of coordination for the consolidation program.
Though a representative of the Bureau of Indian Affairs
testified at the Committee's October, 1999 hearing in favor of
the Indian Health Service (IHS) assuming the role of lead
agency for purposes of program integration, recently the Bureau
of Indian Affairs (BIA) appears to be rethinking its position
on the basis of its operation of the Indian Alcohol and
Substance Abuse Program (ASAP). While ASAP plays an important
role in addressing alcohol and substance abuse, the Committee
believes that the BIA does not have institutional expertise in
the area of mental health problems and, consequently, because a
considerable number of the programs identified as important to
Indian behavioral health care program services are located
within the DHHS, the Committee believes that IHS should be the
lead agency for implementation of S. 210.
2. Definitions
A definition of ``substance abuse'' is included in the bill
as amended in response to concerns expressed by Committee
members that program monies consolidated under the bill could
not be used to treat inhalant abuse, which is a growing problem
among American Indian and Alaskan Native youth. It is the
intent of the committee that funds used under this legislation
be used to treat inhalant abuse where a tribe or tribal
consortia determines such uses to be necessary.
Definitions of ``automated clinical information system''
and ``Indian behavioral healthcare program'' are also included
in the bill as amended. The term automated clinical information
systems refers to computer software and/or hardware
specifically designed for use in a clinical health care
setting. The term Indian behavioral health care program is
defined to express the intent of the committee to include
within the purview of this act all Federal programs and,
necessarily, related Federal funding, for alcohol, substance
abuse prevention, diagnosis and treatment and mental health
analysis, counseling, treatment, support and related programs
for Indians and Indian tribes.
3. Types of programs that are eligible for consolidation
Section 5 of the bill as amended addresses the different
types of programs which may be included in plans for
consolidation under this legislation. The predecessor bill
authorized only those programs which are formula-funded. In the
106th Congress, the Committee was made aware that formula
funding is rarely used to fund alcohol and substance abuse
programs, and that the majority of funds used for these
programs are provided through competitive grant or other
programs. Accordingly, the Committee has amended the
authorization in S. 210 to include grant programs and other
types of funding that may be distributed for the treatment of
alcohol, substance abuse or mental health treatment. The
Committee intends that tribes have significant latitude in
securing funding sources for inclusion in a consolidated plan.
Testimony from the IHS and BIA in the 106th congress
indicated that both agencies were concerned with the provisions
regarding the availability of grant funding and how tribes and
tribal consortia might utilize the consolidation program. In
October 1999, both agencies pledged to present a report to the
Committee not later than February, 2000, which would address
this issue and identify viable alternatives to the language of
S. 1507, as introduced.
While a report was never submitted to the Committee, a
feasibility study mandated by Title VI of Pub. L. 106-260 was
provided to the committee in draft form which indicated that
several programs that fall within the purview of Indian
behavioral health care programs could be consolidated into a
demonstration project. Such programs would therefore be
candidates for consolidation under this legislation.
The Department has expressed concerns that certain program
funding sources, such as the Substance Abuse and Mental Health
Services Administration's (SAMHSA) Community Mental Health
Block Grant and the Substance Abuse Prevention and Treatment
Block Grant, might need statutory amendments to work
effectively with the S. 210 consolidation program.
The Native American Alcohol and Substance Abuse Program
Consolidation Act of 2002 has been amended from prior versions
to allow for inclusion of grant funding, as noted below, such
as that which tribes receive from the SAMHSA.
In drafting Section 5, considerable thought was given to
the provision which allows grant funds to be consolidated. The
committee recognizes that without the inclusion of grant monies
this program authority would be ineffective because the
majority of monies available to tribes for the treatment of
alcohol and substance abuse problems are distributed through
grants.
The Committee does not intend that the enactment of S. 210
provide justification for the denial of grant applications
submitted by tribes because the DHHS prefers that the funds not
be consolidated. At the same time, the Committee desires to
protect the integrity of the grant process. Accordingly, a
tribe must still apply for and secure a competitive grant
before it can include the grant funding in a consolidation
plan.
Section 5 also accommodates the granting agency by allowing
a consolidation where the plan to include grant funds is
essentially the same as the requirements of the grant program.
This allows some flexibility for the tribe but still requires
conformity to the requirements of the grant program.
4. Initiation of program
Under the Native American Alcohol and Substance Abuse
Program Consolidation Act of 2002, the Secretary is obligated
to develop and implement the Interdepartmental Memorandum of
Agreement (MOA) at the Cabinet level. This MOA will provide the
framework for the implementation and operation of the
consolidation program among relevant Federal agencies. The
Committee does not anticipate that there will be any problem
drafting and adopting this MOA as there is an existing model
readily available.
Initially, the Committee expects that the departments of
Health and Human Services, Interior, Justice and Education will
cooperate in the development of the MOA. Eventually, each
Federal department or agency which funds alcohol, substance
abuse and mental health programs can be expected to be
signatories to the MOA and to participate in a meaningful way.
The Committee expects that, similar to the MOA developed to
implement Congress' mandate in Pub. L. 102-477, the MOA
required by the Native American Alcohol and Substances Abuse
Program Consolidation Act of 2002 will address the following
issues:
1. Advising tribal governments regarding their eligibility
to integrate programs and how they may develop and implement a
tribal for consolidation of funds.
2. Procedures for the review and approval of plans,
including time lines for their review and approval.
3. The agreement which will be used by tribes and Federal
departments or agencies to govern their relationships under the
program. It is anticipated that the agreement that is currently
being used will provide guidance to the Secretaries who enter
into the Memorandum of Agreement.
4. An expedited process for the review of waiver
applications from tribes participating in this program.
Additionally, it is anticipated that appeals from a denial will
also be accelerated.
5. An agreement and procedure for the timely payment of
funds to tribes participating in the program.
The Committee expects that the opportunity to access this
program will be extended to all tribes that express a desire to
participate.
5. Review and approval of tribal plans
Central to the success of this program is a well-though
out, comprehensive plan to develop and implement programs in a
consolidated manner. It is the belief of the Committee that
Tribes can best determine where scarce resources will be used
most economically and what type of services are most
appropriate to serve their members. Accordingly, the Federal
agencies that administer program funds which are authorized to
be consolidated under this legislation are expected to give
deference to tribal allocations of resources and program
design.
The Secretaries are expected to allow tribes a great deal
of flexibility in designing the plan which will be submitted
pursuant to this legislation. Creativity in the use of multi-
year plans, mix of services and innovative approaches to
treatment should not be stifled. The primary objective of the
Native American Alcohol and Substance Abuse Program
Consolidated Act of 2002 is the reduction of the incidence of
alcohol and substance abuse suffered by American Indians and
Alaskan Natives.
It is clear that ``mainstream'' treatment approaches to
treating these problems have not been effective and that tribal
involvement in developing new and culturally appropriate
services is needed. It is expected that the Secretary will keep
this in mind when reviewing plans under the act. The Secretary
should focus on the following when reviewing such plans:
1. Does the plan effectively address the purposes of the
program, how those purposes meet Tribal goals to address the
existing problems, and what is the projected effect the program
is expected to have on individuals served?
2. Does the plan lay out an overall strategy for dealing
with alcohol and substance abuse and mental health problems
within the tribe's service area?
3. Does the plan integrate other available resources?
Where tribes or tribal consortia have integrated or have an
intent to consolidate competitive grant programs, it is
expected that Federal agencies will provide maximum flexibility
program participants who are attempting to match grant
requirements to tribal needs. The character of a grant program
is, of course, relevant but, unless there is a statutory
mandate, serious consideration should be given to allowing a
Tribe whose plan does not match with the requirements of a
grant to consolidate funds.
6. Waiver authority
As a part of the plan submission and review process, the
bill provides that the tribe and Federal government review the
plan and identify any rules, regulations, policies, procedures
or underlying statutory provisions which need to be waived in
order to successfully implement the plan.
One of the purposes of this bill is to simplify Federal
requirements pertaining to the operation of Federal programs.
The Committee expects that unless a Federal requirement is
central to the nature of the program involved, it should be
considered an appropriate requirement to be waived under the
authority provided.
7. Amendments made to S. 210 as introduced
During the business meeting at which S. 210 was approved,
several amendments to the bill were made by the Committee.
Section 4 language regarding use of program funds for
acquisition of technology by lease, license or purchase, or for
training to use such technology, is intended to clarify that,
in developing a consolidation program, tribes and tribal
consortia are authorized and encouraged to utilize modern
technological advances in computer hardware and software,
communications and other electronic devices.
In the private health care industry, such advances have
proven to greatly improve efficiencies in clinical practices,
as well as in third party and Medicare/Medicaid billing. It is
the intent of the Committee that S. 210 be interpreted to give
tribal health facilities the widest latitude in adopting
industry best practices, for the purpose of providing the
highest quality health care to Indian people possible given the
limited budgets on which most such facilities operate.
Similarly, Section 6 language regarding technology site
assessments and plan descriptions of technology use and
implementation are intended to encourage tribal health
facilities to utilize, where appropriate, industry best
practices for computer hardware and software communications and
other electronic devices. It is the intent of the Committee for
tribal health facilities and Federal agencies to, where
appropriate, utilize the authorization granted under this
legislation to develop modern, reliable and valid systems to
improve the accountability, quality and continuity of the
mental health and substance abuse programs serving Indian
people, while at the same time more efficiently utilizing the
funding received and the ability to bill third party providers
and access Medicaid/Medicare system.
LEGISLATIVE HISTORY
S. 210 was introduced on January 30, 2001, by Senator
Campbell for himself and for Senator Inouye, and was referred
to the Committee on Indian Affairs. Senator Johnson was added
as a cosponsor on February 13, 2001. On July 10, 2002, the
Committee, in open business session, voted unanimously to
favorably report S. 210 to the full Senate.
A predecessor bill to S. 210 (S. 1507) was introduced by
Senator Campbell in the 106th Congress. The bill was reported
out of Committee and in June 2000, passed the Senate. However
that bill was never taken up by the House of Representatives.
When originally introduced in the 106th Congress as S.
1507, the bill designated the Bureau of Indian Affairs (BIA) as
the lead agency for coordination and implementation. This
initial designation was based on BIA operation of the Indian
Alcohol and Substance Abuse Program. However, all witnesses who
appeared at a hearing held on S. 1507 in October 1999,
recommended that the Indian Health Service be designated the
appropriate, lead agency in which the coordination of this
program should be housed. Therefore, when reintroduced as S.
210, the bill designated the Indian Health Service rather than
the Bureau of Indian Affairs as the lead agency for
coordination and implementation of the Native American Alcohol
and Substance Abuse Program Consolidation Act of 2002.
Also, when originally introduced, S. 1507 provided only for
consolidation of alcohol and substance abuse programs. However,
testimony received at the October, 1999, hearing, as well as
substantial submissions of written testimony and information
brought to the Committee emphasized the need to expand the
scope of the bill beyond merely alcohol and substance abuse.
Quite often, alcohol and substance abuse problems are
symptomatic of or are triggered by other mental health
problems. Without treating the mental health problem at the
same time as the alcohol or substance abuse problem, the effect
of treatment islimited. Accordingly, the Committee amended the
bill to provide for the inclusion of mental health programs.
When reintroduced as S. 210, the bill provided for the
expanded scope of programs eligible for consolidation, to
include programs for the treatment of mental health problems as
candidates for consolidation.
SECTION-BY-SECTION ANALYSIS
Section 1. Short title
The Act may be cited as the Native American Alcohol and
Substance Abuse Program Consolidation Act of 2002.
Section 2. Statement of purpose
The primary purposes of this Act are to enable Indian
Tribes to consolidate and integrate alcohol and other substance
abuse programs, and mental health and related programs, and to
recognize that Indian tribes can best determine the goals and
methods for establishing and implementing mental health and
alcohol and substance abuse programs for their communities.
Section 3. Definitions
This section contains definitions for Automated Clinical
Information System, Indian Behavorial Healthcare Programs,
Federal Agency, Indian Tribe, Indian, Secretary and Substance
abuse.
Section 4. Integration of services authorized
The Secretary of Health and Human Services, in cooperation
with the other appropriate heads of departments and agencies
shall, upon the receipt of an acceptable plan from a tribe,
authorize the tribe to consolidate Federally-funded Indian
behavioral health care programs into a single, coordinated,
comprehensive program. This will include utilizing, where
appropriate, and automated clinical information system to
better manage services, costs and reporting requirements.
Additionally, Indian Tribes are authorized to use funds from a
consolidated program to purchase, lease or license, or provide
training, for technology for an automated clinical information
system.
Section 5. Programs affected
The programs that may be integrated include Indian
behavioral health care programs under which Indian tribes are
eligible for receipt of funds under a statutory or
administrative formula, competitive or other grant program, or
any other funding scheme. In the case of grant funding, a tribe
must obtain permission to consolidate programs from the agency
that is awarding the grant or, in the alternative, tailor its
reporting structure closely to the reporting required by the
grant program.
Section 6. Plan requirements
The requirements for an applicant tribe under this Act are
to: identify the programs to be integrated, consistent with the
purposes of this Act; describe a comprehensive program
strategy, including identifying programs available on and near
the relevant tribe's service area and technology assessments;
how the services are to be integrated, delivered and budgeted,
including the implementation of an automated clinical
information system, if used; develop a consolidated budget;
identify the agencies involved in integrating the programs;
identify any statutory provisions, regulations, policies or
procedures that the tribe believes need to be waived; and be
approved by the appropriate tribal governing body.
Section 7. Plan review
In reviewing the plan the Secretary is to consult with the
other Federal agencies providing funding and with the tribe.
The parties shall identify any waivers necessary to enable
implementation of the plan. Affected agencies shall have the
authority to provide waivers, unless the affected agency
determines that such a waiver is inconsistent with the purposes
of this Act.
Section 8. Plan approval
The Secretary shall have 90 days after the receipt of a
tribe's plan to approve or disapprove the plan. If the plan is
disapproved, the tribal government shall be informed, in
writing, of the reasons for the disapproval and shall be given
an opportunity to amend its plan or petition for a
reconsideration of the Secretary's decision.
Section 9. Federal responsibilities
Paragraph (a) provides that within 180 days following the
date of enactment of this Act, the appropriate Secretaries
shall enter into an interdepartmental Memorandum of Agreement
providing for the implementation of the plans authorized under
this Act. The lead agency under this Act is the Indian Health
Service. The responsibilities of the IHS will include: the
development of a single report format to be used by a tribe to
report on the activities undertaken by the plan and on all plan
expenditures, and the development of a single system of Federal
oversight for the plan, including the provision of technical
assistance to tribes and convening of a meeting not less than
two times during each fiscal year between the affected Federal
agencies and tribes and tribal organizations.
Paragraph (b) provides that the single report format shall
be developed by the Secretary of HHS and should contain
information that will allow a determination that the tribe has
compiled with the requirements incorporated in its approved
plan.
Section 10. No reduction in amounts
In no case shall the amount of Federal funds available to a
participating tribe involved in any project be reduced as a
result of the enactment of this Act.
Section 11. Interagency fund transfers authorized
The appropriate Secretaries are authorized to take such
action as necessary to provide for interagency transfer of
funds otherwise available to a tribe.
Section 12. Administration of funds and overage
Program funds shall be administered to allow for a
determination that funds from specific programs are spent on
allowable activities; however, tribes are not required to
maintain separate records tracing any services or activities
conducted under approved plans to the individual programs under
which funds were authorized. All administrative costs may be
commingled and participating tribes shall be entitled to the
full amount of such costs.
Section 13. Fiscal accountability
Nothing in this Act shall be construed to interfere with
the ability of the Secretary to fulfill his responsibilities
for the safeguarding of Federal funds.
Section 14. Report on statutory and other barriers to integration
Within two years after the date of enactment of this Act,
the Secretary shall submit a report to the Committee on Indian
Affairs of the Senate and the Committee on Resources of the
House of Representatives on the implementation of this program.
Within five years after the date of the enactment of this Act,
the Secretary shall submit a report to the Committee on Indian
Affairs of the Senate and the Committee on Resources of the
House of Representatives on the results of the implementation
of the program, which identifies statutory barriers to the
ability of tribes to more effectively integrate their mental
health programs and services.
Section 15. Assignment of Federal personnel to State Indian alcohol and
drug treatment programs
Any State with an alcohol and substance abuse program
targeted to Indian tribes shall be eligible to receive, at no
cost to the State, such Federal personnel assignments deemed
appropriate to help insure the success of such program.
COST AND BUDGETARY CONSIDERATIONS
The cost estimate for S. 210 as calculated by the
Congressional Budget Office, is set forth below:
U.S. Congress,
Congressional Budget Office,
Washington, DC, July 30, 2002.
Hon. Daniel K. Inouye,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 210, the Native
American Alcohol and Substance Abuse Program Consolidation Act
of 2002.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Eric Rollins.
Sincerely,
Barry B. Anderson
(For Dan L. Crippen, Director).
Enclosure.
S. 210--Native American Alcohol and Substance Abuse Program
Consolidation Act of 2002
CBO estimates that implementing S. 210 would cost about
$600,000 in 2003 and less than $500,000 annually after that,
assuming appropriation of the necessary funds. The bill would
permit Indian tribes to consolidate alcohol and substance abuse
programs that are currently funded through a number of federal
agencies.
Under S. 210, tribes would submit plans to the Department
of Health and Human Services (HHS) for approval. HHS would
approve or reject plans after consulting with the federal
agencies that would be affected. During this approval process,
these agencies would be able to waive statutory and other
requirements to enable tribes to implement their plans. CBO
estimates that the costs of approving plans, monitoring their
implementation, and providing technical assistance would cost
about $600,000 in 2003 and $350,000 annually in later years.
S. 210 also would require HHS to submit reports on the
bill's implementation within two and five years of enactment.
CBO estimates that these reports would each cost less than
$100,000. The additional costs of S. 210 would be borne by the
Indian Health Service, the lead agency for the bill's
implementation.
Enacting S. 210 would not affect direct spending or
receipts; therefore, pay-as-you-go procedures would not apply.
This bill contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act. By
allowing tribes to consolidate programs for behavioral health
care, including substance abuse, the bill would provide tribes
with greater programmatic flexibility.
The CBO staff contact for this estimate is Eric Rollins.
This estimate was approved by Peter H. Fontaine, Deputy
Assistant Director for Budget Analysis.
REGULATORY AND PAPERWORK IMPACT STATEMENT
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires that each report accompanying a bill to
evaluate the regulatory and paperwork impact that would be
incurred in carrying out the bill. The Committee has concluded
that S. 210 will reduce regulatory or paperwork requirements
and impacts.
EXECUTIVE COMMUNICATIONS
A copy of a letter from the Department of Health and Human
Services (DHHS) dated October 18, 2001, is set out below.
The Secretary of Health and Human Services,
Washington, DC, October 18, 2001.
Hon. Daniel K. Inouye,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: This is in response to your request for
the views of the Department of Health and Human Services (HHS)
on S. 210, the ``Native American Alcohol and Substance Abuse
Program Consolidation Act of 2001'', and S. 214, the bill to
elevate the position of Director of the Indian Health Service
within HHS to Assistant Secretary for Indian Health.
S. 210, the ``Native American Alcohol and Substance Abuse Program
Consolidation Act of 2001''
S. 210 would permit Indian tribes to consolidate substance
abuse prevention and treatment and mental health funds that
they are eligible for under formula and competitive grants and
other programs, according to a plan approved by the Secretary.
It would not provide for consolidation of programs providing
specific guaranteed packages of health care benefits to
identifiable individual beneficiaries, such as Medicare,
Medicaid, and the State Children's Health Insurance Program
(SCHIP).
In general, the Department supports the principle that
Indian tribes best know how to meet the needs of their members
through alcohol and substance abuse prevention programs. We
also have no objection in principle to allowing tribes to
consolidate programs addressing substance abuse and mental
health problems where appropriate, consistent with program
intent and for the purposes of achieving administrative
efficiencies. However, we have some concerns about provisions
of S. 210 which we would need to work with the Committee to
resolve. For example, we are concerned about how the
distribution of funds authorized and appropriated under
existing competitive or formula grant authority could be
affected.
The Department is currently preparing, in compliance with
recent amendments to the Indian Self-Determination and
Education Act, a feasibility study for possible demonstration
projects on self-governance. The study will address tribes'
operation of substance abuse prevention and treatment
activities, including consolidation of funds awarded under
separate programs. Completion of the feasibility study
(currently projected to be by February 2002) will provide us
with information that will better enable us to identify
possible changes needed to S. 210 to prevent problems and
disagreements that could arise in implementing the contemplated
consolidation program. The Department, therefore, would prefer
that the committee delay action on S. 210 until we have
completed work on the study. At that time, the Department will
provide its views and looks forward to working with the
Committee to address any substantive concerns with S. 210.
S. 214, to elevate the position of IHS Director to Assistant Secretary
S. 214 would elevate the position of Director of the Indian
Health Service within HHS to Assistant Secretary for Indian
Health. The Department is currently in the process of
reorganizing and has not finalized its restructuring. We
therefore have no position on this bill at this time.
Thank you for the opportunity to provide the Committee with
the Department's views on these bills. We look forward to
working closely with your Committee on these important issues.
We are advised by the Office of Management and Budget that
there is no objection to the transmittal of this report from
the standpoint of the Administration's program.
Sincerely,
Tommy G. Thompson.
CHANGES IN EXISTING LAW
In compliance with subsection 12 of rule XXVI of the
Standing Rules of the Senate, changes in existing law made by
the bill are required to be set out in that accompanying
Committee report. The Committee finds that enactment of S. 210
will not result in any changes in existing law.