[Senate Report 108-75]
[From the U.S. Government Publishing Office]
Calendar No. 143
108th Congress Report
SENATE
1st Session 108-75
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TO AUTHORIZE THE INTEGRATION AND CONSOLIDATION OF ALCOHOL AND SUBSTANCE
ABUSE PROGRAMS AND SERVICES PROVIDED BY INDIAN TRIBAL GOVERNMENTS, AND
FOR OTHER PURPOSES
_______
June 18, 2003.--Ordered to be printed
_______
Mr. Campbell, from the Committee on Indian Affairs, submitted the
following
R E P O R T
[To accompany S. 285]
The Committee on Indian Affairs to which was referred the
bill (S. 285) 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 in the nature of a substitute and recommends that the
bill as amended do pass.
Purpose
The Native American Alcohol and Substance Abuse Program
Consolidation Act of 2003 (S. 285) has two primary purposes.
The first purpose is to enable Indian tribes to create a
simpler and more efficient delivery system for alcohol,
substance abuse, and mental health treatment services by
consolidating and integrating administrative, management and
accounting functions into a single program, and thereby
recognizing that tribal governments, as the local entities
directly responsible for the well-being of their populations,
can best determine the most appropriate policies and methods
for achieving these goals in their communities.
The second purpose is to reauthorize the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986.
Background
Native communities are increasingly plagued by mental
health problems and alcohol and substance abuse at staggering
rates and this abuse is wreaking havoc on Native families
across the country. 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 627% higher than that of the
general population, and the trend is worsening. During the ten
years between 1987 and 1996, the rate of deaths due to
alcoholism increased 57% among American Indians and Alaskan
Natives.
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 1996 data, the rate of mortality due to alcoholism among
American Indian and Alaskan Native youth ages 15 to 24 was 3.4
per 100,000 which is 11 times the rate for white youth of the
same ages. The same data show a suicide rate among American
Indian and Alaskan Native youth of 34 per 100,000, a rate which
is 2.5 times the rate for the general population.
Native Americans also have higher rates of alcohol and drug
use than any other racial or ethnic group in America, another
worsening trend. The drug-related death rate for American
Indian and Alaskan Native--already 65% higher than the general
population--increased 240% between 1981 and 1996.
Despite previous treatment and preventive efforts,
alcoholism and substance abuse continue to be prevalent among
Native youth: a 2001 study by the Harvard School of Public
Health found that Native college students had the highest rates
of ``binge'' drinking among all college ethnic groups. In a
2001 study by the National Household Survey on Drug Abuse,
22.1% of American Indian and Alaskan Native teens reported the
use of marijuana, cocaine, and other illicit substances. The
Survey also found that 35% of Native youth used alcohol.
Reports issued by the Indian Health Service (IHS) indicate
that mental health and social problems are associated with more
than one-third of the demands made on Indian health facilities
for services. Data gathered by IHS and corroborated with data
from the Substance Abuse and Mental Health Services
Administration (SAMHSA) demonstrates that Native people have
the highest rates of mental distress of all ethnic and racial
groups in the United States.
The Federal government offers several disparate and
currently uncoordinated mental health and substance abuse
prevention and treatment programs for which Indian tribes and
tribal health organizations are eligible to receive funding.
Amounts available for the operation of these programs are
generally very small.
Pursuant to the Tribal Self Governance Amendments Act of
2000 (Pub. L. 106-260), the Department of Health and Human
Services (DHHS) conducted ``a study to determine the
feasibility of a tribal self-governance demonstration project
for appropriate programs, services, functions, and activities
(or portions thereof) of [DHHS].'' Essentially, the study was
aimed at identifying those DHHS programs that could be
consolidated by tribes into a self-governance compact, or that
would be useful to a self-governance compact, but could not be
consolidated due to statutory restrictions.
Mental health related programs that were identified
included the Community Services Block Grant, Child Welfare
Services, Promoting Safe and Stable Families, Family Violence
Prevention, and the Administration on Aging's Grants for Native
Americans, as well as various IHS programs. Additionally, a
couple of significant programs under SAMHSA, the Community
Mental Health Block Grant and the Substance Abuse Prevention
and Treatment Block Grant, were identified as appropriate for
consolidation, but due to statutory restrictions cannot be
distributed in block grants to tribes. Other possible candidate
programs include those administered by the National Institutes
of Health--National Institute on Alcohol Abuse and Alcoholism,
which includes several different grant programs for minorities
and the prevention of alcohol abuse.
Even in those instances where Indian tribes and tribal
organizations are able to access program funding from several
different sources, the amounts are generally so meager and the
auditing and reporting requirements so onerous, that it is
simply not cost effective to attempt to operate a program which
combines multiple sources of available funding.
S. 285 addresses these problems by allowing for the
submission of a plan to consolidate funding and develop a
single plan to meet auditing and other reporting requirements.
In the process, the Indian tribe or tribal organization is
encouraged to access several funding sources, make one report
to the Federal government on the use of funds, and to operate
these programs so that the resources are effectively targeted
at the communities that need them.
S. 285 will authorize and encourage Indian tribes and
tribal organizations to streamline alcohol and substance abuse
and mental health programs through consolidation and
integration of mental health diagnosis and treatment programs,
including alcohol and substance abuse prevention, diagnosis,
and treatment programs, and to provide unified and more
effective services to Native Americans with mental health and
substance abuse-related illnesses.
S. 285 tracks the highly-successful ``477 model'' that
Indian tribes and tribal organizations have used to effectively
integrate and consolidate employment, training and related
services through the Indian Employment Training and Related
Services Demonstration Act of 1992 (Pub. L. 102-477).
Pursuant to S. 285 an applicant tribe or Indian health
organization can file a single comprehensive plan to draw and
coordinate resources from many Federal agencies and administer
them through one office, which will be housed in the DHHS. To
facilitate this inter-agency resource transfer, Secretaries of
the agencies designated in the bill are required to negotiate
and enter into a memorandum of agreement.
Assisting Indian tribes and tribal organizations to access
alternative sources of funding for mental health services can
potentially increase the overall level of health care in Indian
country. In addition, recent studies by SAMHSA indicate that
preventive mental health programs can save substantial amounts
from having to be spent on medical treatment.
Summary of Major Provisions
1. Overview and coordinating agency status
The Native American Alcohol and Substance Abuse Program
Consolidation Act of 2003 authorizes the Secretary of the DHHS
to be the Federal official in charge of establishing the
framework for integration and coordination of Native American
alcohol, substance abuse, and mental health programs at the
Federal level. The Secretary is the logical candidate to lead
this effort as 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.
Additionally, the Secretary is in the best position to
successfully negotiate with other Federal departments for a
memorandum of agreement to effectuate the purposes of S. 285.
S. 285 designates the IHS as the ``coordinating agency''
for the consolidation program. Because the IHS has considerable
experience implementing the provisions of the Indian Self
Determination and Education Assistance Act (25 U.S.C. 450 et
seq), and is responsible for administering the great majority
of Indian health programs, the activities envisioned by S. 285
make the Service an ideal point of coordination for the
consolidation program.
2. Definitions
A definition of ``substance abuse'' is included in the bill
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 health care 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.
It is the intend of the Committee that, for purposes of
this Act, the term ``Indian tribe'' be broadly defined. There
are multiple types of non-profit organizations and clinics, as
well as Indian tribes and intertribal consortium, that shoulder
the responsibility of delivering critically needed alcohol and
substance abuse, and mental health services to American
Indians. Some clinics and organizations operate only on
reservations, serving only one tribal community, others operate
in urban settings, serving a number of different tribal
communities.
3. Types of programs that are eligible for consolidation
Section 104 of the bill, as amended, addresses the
different types of programs which may be included in plans for
consolidation under this legislation. Previous versions of the
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 drafted the authorization in S.
285 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.
The DHHS has expressed concerns that certain program
funding sources, such as SAMHSA's Community Mental Health Block
Grant and the Substance Abuse Prevention and Treatment Block
Grant, might need statutory amendments to work effectively with
the S. 285 consolidation program. Therefore, the Native
American Alcohol and Substance Abuse Program Consolidation Act
of 2003 has been amended from prior versions of the bill to
allow for inclusion of grant funding, as noted below, such as
that which tribes receive from the SAMHSA.
In drafting section 104 of S. 285, 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 intends that the enactment of S. 285 should
not be used as a 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, the tribe must still apply for and secure a
competitive grant before it can include the grant funding in a
consolidation plan.
Section 104 also accommodates the granting agency by
allowing 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 2003, the Secretary is obligated
to develop and implement the interdepartmentalMemorandum 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.
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 Substance Abuse
Program Consolidation Act of 2003 will address the following
issues:
1. Advising tribal governments regarding their eligibility
to integrate programs and how they may develop and implement a
tribal plan 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 deliberative
and comprehensive plan to develop, consolidate and implement
programs in an integrated 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 communities. 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 plans 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
Consolidation Act of 2003 is the reduction of the incidence of
alcohol and substance abuse, and other mental health
afflictions 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 are needed. It is expected that the Secretary will
keep this in mind when reviewing plans under the act. The
Committee believes that in reviewing such plans, the Secretary
should focus on the following issues:
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
to program participants who are attempting to match grant
requirements to tribal needs. The character of a grant program
is relevant but, unless there is a statutory mandate, serious
consideration should be given to allowing a tribe or
organization whose plan does not match with the requirements of
a grant to consolidate funds.
The Committee is cognizant that, to be effective, proposed
tribal consolidation plans, must account for the timing,
availability and receipt of the program funding to be
consolidated. The DHHS has expressed concerns about the ability
to adequately review tribal plans without such information.
Therefore, as part of the substitute amendment to S. 285
adopted by the Committee, section 107 was clarified to specify
that information regarding the timing, availability and receipt
of program funding must be included in a tribal consolidation
plan, or the plan may be disapproved by the Secretary.
6. Use of technology
The language in section 108 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. 285 be interpreted to give
tribal clinics 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.
It is also the intent of the Committee that tribal health
facilities and Federal agencies utilize the authorization 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 the Medicaid/Medicare system.
Concerns were also expressed by DHHS that Indian tribes or
clinics may ``unwisely'' overinvest in technology. To address
those concerns, changes were made in previous versions of the
bill, clarifying the importance of not cutting program
activities when acquiring technology.
Specifically, this concern was addressed in the section
detailing the required elements of a tribal plan. Pursuant to
section 105, paragraph (4), a tribal consolidation plan must
contain a ``descri[ption of] the manner in which services are
to be integrated and delivered and the results expected under
the plan (including, if implemented, the manner and expected
results of implementation of an automated clinical information
system)''. Section 108, which provides the authority for tribes
to acquire technology, conditions that authority on compliance
with the requirements of an approved plan.
Similarly, DHHS' concern was addressed in the section
specifying grounds for the Secretary to disapprove a tribal
plan. In section 107, subparagraph (b)(1)(C) the Secretary may
disapprove a plan if--``the plan provides for the purchase,
lease, license, or training for, an automated clinical
information system, but the purchase, lease, license, or
training would require aggregate expenditures of program
funding at such a level as would render other program
activities substantially ineffectual''.
To be certain that the Secretary has all of the necessary
information to review and approve or disapprove a tribal plan,
subsection 105(5) requires a tribal plan to ``identify the
projected expenditures under the plan in a single budget''.
While the Committee appreciates the DHHS concerns, the
Committee is confident that the consolidation plan requirements
contained in section 105, and the authority given to the
Secretary in section 107 to disapprove a tribal plan that does
not meet those requirements, provides sufficient opportunity
for the Secretary to insure the continued efficacy of program
services under a consolidation plan.
7. Waiver authority
One of the purposes of S. 285 is to simplify Federal
requirements pertaining to the operation of Federal programs.
As 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. 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 in
section 106.
The DHHS has expressed concerns that the scope of the
waivers that can be requested by tribes and tribal consortia
and organizations may be too broad to effectively assess the
appropriateness of waivers. This concern was addressed in the
previous version of the bill, and that language was carried
forward in S. 285.
Specifically, section 106, subsection (c), in providing
authority for waiver of statutory, regulatory, or policy
requirements, expressly states that the head of the affected
Federal agency cannot waive a requirement that ``is
inconsistent with--(3) any underlying statutory objective or
purpose of a program to be consolidated under the plan, to such
a degree as would render ineffectual activities funded under
the program.'' Section 106 is further strengthened by section
107, subsection (b), which allows the Secretary to disapprove a
plan that ``identifies waivers that cannot be waived under
section 106(c).''
8. Amendment made to S. 285 as introduced
During the business meeting at which S. 285 was approved by
the Committee, a substitute amendment was adopted which
contained several amendments to the bill as introduced. The
primary amendments are the following:
1. The rationales for Secretarial disapproval of a tribal
consolidation plan were clarified to specify that information
regarding the timing, availability and receipt of program
funding must be included in a tribal consolidation plan, or the
plan may be disapproved.
2. The designated role of the IHS was amended from being
``Lead Agency'' to that of ``Coordinating Agency.''
3. Reauthorization of the Indian Alcohol and Substance
Abuse Prevention and Treatment Act through Fiscal Year 2008 was
added.
Legislative History
S. 285 was introduced on February 4, 2003, by Senator
Campbell for himself, and was referred to the Committee on
Indian Affairs. Senators Domenici and Murkowski were added as a
cosponsors on February 10, 2003. Senator Inouye was also added
as a cosponsor on May 13, 2003.
A predecessor bill to S. 285 (S. 210) was introduced by
Senator Campbell in the 107th Congress. The bill was reported
out of Committee on July 10, 2002, and was approved by the
Senate on September 17, 2002, but was never than up by the
House of Representatives.
On April 9, 2003, the Committee held a hearing on S. 285 at
which testimony was provided by the DDHS, the National Indian
Health Board (``NIHB''), and Our Youth Our Future, Inc.
(``OYOF''), a nonprofit Native American substance abuse clinic.
Both the NIHB and OYOF testified in favor of S. 285. The DHHS
expressed some concerns with the bill, which were addressed in
a substitute amendment.
Subsequent to the hearing, Committee staff determined that
the best method of effecting a reauthorization of the Indian
Alcohol and Substance Abuse Prevention and treatment Act of
1986 (ASAP) was to include it in S. 285. The ASAP waslast
authorized in FY2001. A new Title II was added to the substitute
amendment to S. 285, providing for reauthorization of the ASAP through
Fiscal Year 2008.
Section-by-Section Analysis
Section 1. Short Title; Table of Contents. The Act may be
cited as the Native American Alcohol and Substance Abuse
Program Consolidation Act of 2003. Section 1 also contains a
Table of Contents.
Title I--Integration and Consolidation of Alcohol and Substance Abuse
Programs and Services
Sec. 101. Purposes. The 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 assist Indian tribes in maximizing the use of
public, tribal, human and financial resources for Indian
behavioral healthcare programs.
Sec. 102. Definitions. This section contains definitions
for Automated Clinical Information System, Federal Agency,
Indian, Indian Behavioral Healthcare Program (which includes
alcohol and substance abuse, and mental health programs),
Indian Tribe, Secretary and Substance Abuse.
Sec. 103. Plans. This section provides that the Secretary
of Health and Human Services, in cooperation with the other
appropriate Secretaries shall, upon the receipt of an
acceptable plan from an Indian tribe, authorize the tribe to
consolidate its Federally-funded Indian behavioral healthcare
programs into a single, coordinated, comprehensive program,
that uses, to the extent necessary, an automated clinical
information system to better manage services, costs and
reporting requirements.
Sec. 104. Programs Affected. Section 104 provides that the
programs that may be integrated include Indian behavioral
healthcare programs under which an Indian tribe is 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 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.
Sec. 105. Plan Requirements. The requirements for plan
submitted by an applicant tribe or tribal organization under
this Act are to: identify the programs to be integrated,
consistent with the purposes of this Act; describe a
comprehensive program strategy, including technology
assessments; describe how the services are to be integrated,
delivered and budgeted, including the implementation of an
automated clinical information system, if used; identify any
statutory provisions, regulations, policies or procedures that
the tribe believes need to be waived; and be approved by the
appropriate tribal or tribal organization governing body.
Sec. 106. Plan Review. In reviewing the plan the Secretary
is to consult with the other Federal agencies providing funding
and with the tribe or tribal organization. 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, any
statutory requirements applicable to the program to be
integrated, or the underlying statutory objectives or purposes
of a program to be integrated.
Sec. 107. 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 reconsideration by the Secretary.
Sec. 108. Use of Funds for Technology. Indian tribes and
tribal organizations are authorized by this section to acquire
technology for an automated clinical information system, as
long as such acquisition is in accordance with a plan approved
by the Secretary.
Sec. 109. Federal Responsibilities. Paragraph (a) provides
that within 180 days following the date ofenactment 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 Coordinating Agency under this Act is
the Indian Health Service, within the Department of Health and Human
Services. The responsibilities of the IHS will include: The use 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 complied with the requirements
incorporated in its approved plan.
Sec. 110. 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.
Sec. 111. 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.
Sec. 112. Administration of Funds; Excess Funds. 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 Indian tribes shall be entitled to the full
amount of such costs.
Sec. 113. 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.
Sec. 114. Report on Statutory and Other Barriers to
Integration. Within two years after the date of enactment of
this Act, the Secretary of HHS 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 of HHS 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 integrate more
effectively their mental health programs and services.
Sec. 115. Assignment of Federal Personnel to State Indian
Alcohol and Drug Treatment Programs. Any State with an Indian
behavioral healthcare 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.
Title II--Reauthorization of Certain Indian Alcohol and Substance Abuse
Prevention and Treatment Programs
Sec. 201. Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986. This section reauthorizes the Indian
Alcohol and Substance Abuse Prevention and Treatment Act of
1986 for each of fiscal years 2004 through 2008.
Sec. 202. Effective Date. This section make the
reauthorization effective on the date of enactment of this Act.
Committee Recommendation and Tabulation of Vote
On May 14, 2003, the Committee, in an open business
session, considered S. 285 and approved an amendment in the
nature of a substitute to S. 285, and ordered the substitute
amendment favorably reported to the full Senate with a
recommendation that the substitute amendment do pass.
Cost and Budgetary Considerations
The cost estimate for S. 285 as calculated by the
Congressional Budget Office, is set forth below:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 2, 2003.
Hon. Ben Nighthorse Campbell,
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. 285, the Native
American Alcohol and Substance Abuse Program Consolidation Act
of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Eric Rollins.
Sincerely,
Douglas Holtz-Eakin, Director.
Enclosure.
S. 285--Native American Alcohol and Substance Abuse Program
Consolidation Act of 2003
Summary: S. 285 would authorize the appropriation of such
sums as necessary for fiscal year 2004 through 2008 for the
Bureau of Indian Affairs (BIA) to provide assistance to Indian
tribes to prevent alcohol and substance abuse. The bill also
would permit Indian tribes to consolidate alcohol and substance
abuse programs that are currently funded through a number of
federal agencies.
CBO estimates that implementing S. 285 would cost $38
million in 2004 and $226 million over the 2004-2008 period,
assuming the appropriation of the necessary funds. Almost all
of those costs would be for BIA programs to prevent alcohol and
substance abuse. The bill would have no effect on direct
spending or revenues.
S. 285 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
By allowing tribes to consolidate programs for behavioral
health care, including substance abuse, the bill would provide
tribes with greater programmatic flexibility.
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 285 is shown in the following table. The
costs of this legislation fall within budget functions 450
(regional and community development) and 550 (health).
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By fiscal year, in millions of dollars--
--------------------------------------------
2004 2005 2006 2007 2008
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CHANGES IN SPENDING SUBJECT TO APPROPRIATION
BIA Substance Abuse Programs:
Estimated Authorization Level.................................. 47 47 47 47 47
Estimated Outlays.............................................. 37 47 47 47 47
Consolidation of Alcohol and Substance Abuse Programs:
Estimated Authorization Level.................................. 1 * * * *
Estimated Outlays.............................................. 1 * * * *
Spending Under S. 285:
Estimated Authorization Level.................................. 48 47 47 47 47
Estimated Outlays.............................................. 38 47 47 47 47
----------------------------------------------------------------------------------------------------------------
*=Less than $500,000.
Basis of estimate:
BIA alcohol and substance abuse prevention
S. 285 would authorize the appropriation of such sums as
are necessary through 2008 for the Bureau of Indian Affairs to
provide assistance to Indian tribes to prevent alcohol and
other substance abuse. Such programs would include law
enforcement and judicial training, emergency shelters for
youth, and juvenile detention centers. No funds were provided
for this program in 2003, but based on the level of funding
authorized for such programs in previous years, and information
from the Bureau of Indian Affairs regarding demand for various
programs under this title, CBO estimates that implementing
these provisions would cost $37 million in fiscal year 2004 and
$225 million over the 2004-2008 period.
Consolidation of alcohol and substance abuse programs
S. 285 would permit Indian tribes to consolidate alcohol
and substance abuse programs that are currently funded through
a number of federal agencies. Under the bill, 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 andother 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 2004, and $350,000 annually in later
years.
S. 285 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 the provisions in S. 285 that
deal with program consolidation would be borne by the Indian
Health Service (IHS), the lead agency for the bill's
implementation.
Intergovernmental and private-sector impact: S. 285
contains no intergovernmental or private-sector mandates as
defined in UMRA. By allowing tribes to consolidate programs for
behavioral health care, including substance abuse, the bill
would provide tribes with greater programmatic flexibility.
Estimate prepared by: Federal Costs: Lanette Walker and
Eric Rollins. Impact on State, Local, and Tribal Governments:
Marjorie Miller. Impact on the Private Sector: Cecil McPherson.
Estimate 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. 285 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 June 6, 2003, is set out below.
The Secretary of Health and Human Services,
Washington, DC, June 6, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: We take this opportunity to advice you
of the views of the Department of Health and Human Services
(HHS) and the Department of the Interior on S. 285, the
``Native American Alcohol and Substance Abuse Program
Consolidation Act of 2003'', as recently ordered reported by
your Committee.
The Administration supports the principle that Indian
Tribes best know how to meet the needs of their members for
programs such as those addressed by S. 285. However, we
continue to have the serious concerns about title I
(Integration and Consolidation of Alcohol and Substance Abuse
Programs and Services) that we stated in our recent testimony
before the Committee (copy attached) and in an HHS report on
similar legislation (S. 210) in the 107th Congress. Therefore,
we cannot support title I of S. 285 as currently drafted.
Our concerns about title I, which are fully discussed in
our recent testimony, are: (1) lack of clear delineation of
affected programs and of permissible uses of consolidated
funds; (2) limitation on the flexibility of the Secretary in
considering the merits of waiver request; (3) insufficient time
for appropriate Federal decisionmaking; (4) designation of the
Indian Health Service as the lead (or coordinating) agency; (5)
lack of control on the possible use of grant funds for
administrative overhead and information technology; and (6)
lack of adequate and effective Federal oversight for
consolidated programs. We look forward to working with you to
address our concerns on title I.
The Administration does not object to title II
(Reauthorization of Certain Indian Alcohol and Substance Abuse
Prevention and Treatment Programs). The Department of the
Interior (Interior) advises that its Bureau of Indian Affairs
(BIA) has recently reorganized. Under the new reorganization,
the Office of Alcohol and Substance Abuse Prevention reports
directly to the Deputy Director of Tribal Services, who reports
to the Director of the Bureau of Indian Affairs. BIA placed the
Office of Alcohol and Substance Abuse Prevention under the
Deputy Director of Tribal Services to enhance BIA's
responsiveness for social and community programs. Under the
Indian Alcohol and Substance Abuse Prevention and Treatment Act
of 1986 (the Act), the Office of Alcohol and Substance Abuse
Prevention is located within the Office of the Assistant
Secretary for Indian Affairs. Interior requests, therefore, to
be consistent with the reorganization and to better meet the
needs of tribal communities, that a new provision be added to
S. 285 to reflect this organizational change. Such a new
provision would amend section 4207 of the Act (25 U.S.C. 2413)
by striking ``Office of the Assistant Secretary of Interior for
Indian Affairs'' and inserting ``Bureau of Indian Affairs'',
and by striking ``Assistant Secretary of the Interior for
Indian Affairs'' and inserting ``Director of the Bureau of
Indian Affairs''.
Thank you for considering these views on S. 285.
The Office of Management and Budget has advised that there
is no objection to the presentation 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 S. 285, as ordered reported, are shown as follows
(existing law proposed to be omitted is enclosed in black
brackets, new matter is printed in italic, existing law in
which no change is proposed is shown in roman):
Public Law 99-570
A bill to strengthen Federal efforts to encourage foreign
cooperation in eradicating illicit drug crops and in halting
international drug traffic, to improve enforcement of Federal
drug laws and enhance interdiction of illicit drug shipments,
to provide strong Federal leadership in establishing effective
drug abuse prevention and education programs, to expand Federal
support for drug abuse treatment and rehabilitation efforts,
and for other purposes.
Be it enacted by the Senate and House of Representatives of
the United States in Congress assembled,
TITLE IV--INDIAN ALCOHOL AND SUBSTANCE ABUSE PREVENTION AND TREATMENT
PROGRAMS
* * * * * * *
SEC. 4206. * * *
* * * * * * *
(d) [(1) The Secretary] (1) In General.--The Secretary of
the Interior may make grants to Indian tribes adopting a
resolution pursuant to subsection (a) to provide technical
assistance in the development of a Tribal Action Plan. The
Secretary shall allocate funds based on need.
[(2) There are authorized to be appropriated for grants
under this subsection not more than $2,000,000 for fiscal year
1993 and such sums as are necessary for each of the fiscal
years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.]
(2) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this subsection such sums as
are necessary for each of fiscal years 2004 through 2008.
* * * * * * *
SEC. 4206. * * *
* * * * * * *
[(f) Grants for training, education, and prevention
programs.
[(1) The Secretary] (f) Grants for In-School Training
Programs.--
(1) In general.--The Secretary of the Interior may
make grants to Indian tribes adopting a resolution
pursuant to subsection (a) to implement and develop
community and in-school training, education, and
prevention programs on alcohol and substance abuse,
fetal alcohol syndrome and fetal alcohol effect.
[(2) Funds] (2) Use of funds.--Funds provided under
this section may be used for, but are not limited to,
the development and implementation of tribal programs
for--
(A) youth employment;
(B) youth recreation;
(C) youth cultural activities;
(D) community awareness programs; and
(E) community training and education
programs.
[(3) There are authorized to be appropriated to carry
out the provisions of this subsection $5,000,000 for
fiscal year 1993 and such sums as are necessary for
each of the fiscal years 1994, 1995, 1996, 1997, 1998,
1999, and 2000.] (3) Authorization of appropriations.--
There are authorized to be appropriated to carry out
this subsection such sums as are necessary for each of
fiscal years 2004 through 2008.
* * * * * * *
SEC. 4210. * * *
* * * * * * *
[(b) Authorization of Appropriations. There are authorized
to be appropriated to carry out this section $500,000 for
fiscal year 1993 and such sums as may be necessary for each of
the fiscal years 1994, 1995, 996, 1997, 1998, 1999, and 2000.]
(b) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section such sums as are
necessary for each of fiscal years 2004 through 2008.
* * * * * * *
SEC. 4212. * * *
(a) [The Assistant Secretary of Indian Affairs] (1) In
General.--The Assistant Secretary of Indian Affairs shall
develop and implement pilot programs in selected schoolsfunded
by the Bureau of Indian Affairs (subject to the approval of the local
school board or contract school board) to determine the effectiveness
of summer youth programs in furthering the purposes and goals of the
Indian Alcohol and Substance Abuse Prevention Act of 1986. [The
Assistant Secretary shall]
(2) Defrayment of Costs._The Assistant Secretary shall
defray all costs associated with the actual operation and
support of the pilot programs in the school from funds
appropriated for this section. [For the pilot programs there
are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 1987, 1988, 1993, 1994, 1995,
1996, 1997, 1998, 1999, and 2000.]
(3) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this subsection such sums as
are necessary for each of fiscal years 2004 through 2008.
* * * * * * *
SEC. 4213. * * *
* * * * * * *
(e)[(1) For the planning and design, construction, and
renovation of, or purchase or lease of land or facilities for,
emergency shelters and half-way houses to provide emergency
care for Indian youth, there are authorized to be appropriated
$10,000,000 for fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994, 1995, 1996, 1997,
1998, 1999, and 2000.
[(2) For the staffing and operation of emergency shelters
and half-way houses, there are authorized to be appropriated
$5,000,000 for fiscal year 1993 and $7,000,000 for each of the
fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000.
[(3) The Secretary of the Interior shall allocate funds
appropriated pursuant to this subsection on the basis of
priority of need of the various Indian tribes and such funds,
when allocated, shall be subject to contracting or available
for grants pursuant to the Indian Self-Determination Act.](1)
In General._There are authorized to be appropriated to carry
out planning and design, construction, and renovation of, or to
purchase or lease land or facilities for, emergency shelters
and halfway houses to provide emergency care for Indian youth,
such sums as are necessary for each of fiscal years 2004
through 2008.
(2) Staffing and Operation.--There is authorized to be
appropriated for staffing and operation of emergency shelters
and halfway houses described in paragraph (1) $7,000,000 for
each of fiscal years 2004 through 2008.
(3) Allocation.--(A) In General.--The Secretary of the
Interior shall allocate funds made available under this
subsection to Indian tribes on the basis of priority of need of
the Indian tribes.
(B) Contracting and Grants.--Funds allocated under
subparagraph (A) shall be subject to contracting or available
for grants under the Indian Self-Determination Act (25 U.S.C.
Sec. 450f et seq.).
[(4) Funds] (4) Conditions for Use._Funds appropriated
under the authority of this subsection may be used by any
Indian tribe or tribal organization to purchase or lease any
land or facilities if--
(A) the Secretary of the Interior determines that no
Federal land or facilities are reasonably available for
emergency shelters or halfway houses described in
subsection (a) to serve the needs of that Indian tribe
or tribal organization, and
(B) the Indian tribe or tribal organization enters
into an agreement with the Secretary of the Interior
that requires the Indian tribe or tribal organization
to use the land or facilities for emergency shelters or
half-way houses described in subsection (a).
[(5) Nothing in this Act may be construed] (5) Effect on
Other Authority._Nothing in this Act--
(A) [to limit] limits the authority for contracts
with, or grants to, Indian tribes or tribal
organizations under the Indian Self-Determination Act
for the construction, improvement, renovation,
operation, repair, land acquisition, or maintenance of
tribal juvenile detention facilities, emergency
shelters, or half-way [houses, or] houses; or
(B) [to require] requires a lease of tribal
facilities to the United States to qualify for
financial assistance for the facilities under this or
any other Act.
* * * * * * *
SEC. 4216. * * *
(a) * * *
[(3) For the purpose of providing the assistance
required by this subsection, there are authorized to be
appropriated--
[(A) $500,000 under paragraph (1)(A) for
fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994,
1995, 1996, 1997, 1998, 1999, and 2000,
[(B) $500,000 under paragraph (1) (B) for
fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994,
1995, 1996, 1997, 1998, 1999, and 2000, and
[(C) $500,000 under paragraph (1) (C) for
fiscal year 1993 and such sums as may be
necessary for each of the fiscal years 1994,
1995, 1996, 1997, 1998, 1999, and 2000.]
(3) Authorization of appropriations.--There is
authorized to be appropriated--
(A) to carry out paragraph (1)(A), $1,000,000
for each of fiscal years 2004 through 2008; and
(B) to carry out provisions of this
subsection other than paragraph (1)(A), such
sums as are necessary for each of fiscal years
2004 through 2008.
* * * * * * *
SEC. 4218. * * *
* * * * * * *
[(b) Authorization. For the purposes of providing the
training required by subsection (a), there are authorized to be
appropriated $2,000,000 for fiscal year 1993 and such sums as
may be necessary for each of the fiscal years 1994, 1995, 1996,
1997, 1998, 1999 and 2000.]
(b) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section such sums as are
necessary for each of fiscal years 2004 through 2008.
* * * * * * *
SEC. 4220. * * *
* * * * * * *
[(b) Authorization.
[(1) For the purpose of constructing or renovating
juvenile detention centers as provided in subsection
(a), there are authorized to be appropriated
$10,000,000 for fiscal year 1993s and such sums as may
be necessary for each of the fiscal years 1994, 1995,
1996, 1997, 1998, 1999, and 2000.
[(2) for the purpose of staffing and operating
juvenile detention centers, there are authorized to be
appropriated $7,000,000 for fiscal year 1993 and such
sums as may be necessary for each of the fiscal years
1994, 1995, 1996, 1997, 1998, 1999, and 2000.]
(b) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section such sums as are
necessary for each of fiscal years 2004 through 2008.
* * * * * * *