Mr. Chairman and Members of the Committee:
Good morning. I am Luana L. Reyes, Director of Headquarters
Operations (IHS). Accompanying me today is Paula K. Williams,
Director, Office of Tribal Self-Governance. We are pleased to be
here today to discuss H.R. 1833, the "Tribal Self-Governance
Amendments of 1998."
The IHS goal is to raise the health status of American Indians and
Alaska Natives (AI/ANs) to the highest possible level. The mission
is to provide a comprehensive health services delivery system for
AI/ANs with opportunity for maximum Tribal involvement in
developing and managing programs to meet their health needs. The
provision of Federal health services to American Indians and Alaska
Natives (AI/ANs) is based upon a special government-to-government
relationship between Indian tribes and the United States,
which has been reaffirmed throughout the history of this Nation.
This relationship has been repeatedly reaffirmed by all three
branches of this Nation's government. In l997, the President issued
an Executive Memorandum directing all Federal Departments and
Agencies to implement policies and procedures for consulting with
Indian Tribes on matters that effect Indian people.
The IHS Self-Governance Demonstration Project (SGDP) was
authorized in October 1992 pursuant to Public Law 102-573, the
Indian Health Amendments of 1992. In May 1993, the Agency
began its first compact negotiations with tribes under the
demonstration authority. Since that time, the Agency has entered
into 39 Self-Governance (SG) Compacts and 55 Annual Funding
Agreements (AFA) through Fiscal Year (FY) 1998. These compacts
transfer approximately $410 million to 211 tribes in Alaska and 38
tribes in the lower 48 states participating in the SGDP. As part of
these agreements, we have negotiated the transfer of $347 million in
program services and $63 million in IHS administrative funds
associated with the transfer of non-residual functions, activities, and
services from Area and Headquarters budgets to the tribes to carry
out these responsibilities.
The 249 tribes participating in this project constitute 45% of the
federally recognized tribes and they collectively serve over 31% of
the total IHS users. We anticipate that participation in the Self-Governance
will continue to grow by approximately 15 tribes per
year. This Project has provided Tribal Governments the needed
local control of their health programs to allow Tribal leadership to
implement aggressive and successful health promotion and disease
prevention initiatives which are truly responsive to the health needs
of their service population. Local control has also provided more
ownership by local leadership which has resulted in significant
improvements in the quality and quantity of health services. Tribes
have been able to increase the number of physicians and clinic sites
to make health care more accessible to the people. Others have
implemented special services to address the unique needs of the
elderly. And, most impressive, tribally operated health facilities are
scoring higher in their accreditation reviews than they did under
Agency administration. For example, the Chippewa Cree Health
Center and laboratory each scored a perfect 100 points and their
Chemical Dependency Center Scored 98 points in the accreditation
review conducted by the Commission on Accreditation of Health
care Organizations.
The Self-Governance Demonstration Project has been a success.
However, we must assess the impact of continued transfers of funds
upon the Agency's ability to carry out its residual functions and to
continue providing direct health services to tribes who choose not to
contract or compact. The Agency is taking steps to downsize and
reorganize in order to free up resources for transfer to tribes but
these efforts could be out paced by increased compacting and certain
provisions of this bill.
The challenge before the Tribes, Indian health programs, the IHS
and the Congress is to retain the Indian Health Services's applied
expertise in core public health functions that are critical to elevating
the health status of American Indians/Alaska Natives (AI/ANs) and
reducing the disparity in the health status of AI/ANs compared with
the general population. We, who are involved in Indian health care,
must deal with a changing external environment with new demands,
new needs, and new priorities.
The Indian Health Service supports the spirit and intent of
the Tribal Self-Governance Amendments. H.R. 1833 is consistent
with our goal of providing maximum participation of tribes in the
development and management of Indian health programs. Although
we have concerns about certain provisions contained in the bill as it
was introduced, we are committed to working with the Committee to
resolve these issues.
I want to express my appreciation to the Title V Tribal
Workgroup and to commend their cooperative spirit in working with
the IHS and other components of the Department in the evolution of
H.R. 1833. The version of H.R. 1833 we are discussing today is the
result of many in-depth discussions and analysis.
Efforts to promote Tribal self-determination must continue to
allow us to perform inherent functions and maintain our trust
responsibility to all Tribes.
Any redesign of programs or eligibility for services resulting
from funding agreements must not disenfranchise groups or
individuals who are currently eligible for services. The
Department's eligibility regulations must apply to title V in order to
ensure IHS and the Department have the resources and responsibility
to provide services to otherwise eligible American Indians and
Alaska Natives. The ability of the Secretary to allocate resources
and provide adequate services to members of non-compacting Tribes
must be preserved.
We are pleased to note that the IHS and tribal representatives
have successfully negotiated provisions in the bill for tribal
assumption of construction projects. The negotiated provisions of
the bill authorize a specific process for tribes to elect to carry out
construction of health and sanitation facilities as a self-governance
activity.
Competitive grant programs such as the Indian Health
Professions Scholarships and the Tribal Management Grant Program
have been established for specific public purposes. Likewise, the
Department and IHS have agency-wide initiatives that address
national concerns and are carried out under general grant authorities
from general agency funds. All competitive grant programs,
including those that support national needs and benefit all Tribes,
should be exempted from Tribal shares. We believe that this bill
sufficiently addresses our concerns in this area.
In conclusion, we support making self-governance authority
permanent within the IHS so long as these changes continue to allow
the Department and the IHS to perform its inherent functions and to
maintain its trust responsibility to all Tribes. We also support
exploring the expansion of self-governance demonstration authority
to non-IHS programs of the Department, but only after consultation
with all stakeholders and more specific guidance from Congress.
I commend you for your commitment to rights of the
Nation's Tribes and to providing them opportunities to administer
those federal programs affecting the health and welfare of their
people. The Indian Health Service and the Department of Health
and Human Services stand ready to work collaboratively with this
Committee, the Congress, and the Tribes to ensure that such efforts
are successful.
Mr. Chairman, this concludes my statement. We will be pleased to
answer any questions that you may have. Thank You.
