Improving Federal Management of Programs that Serve Tribes and Their Members
What We Found
The Bureau of Indian Education, Indian Health Service, and Bureau of Indian Affairs should take additional actions to improve Indian education and health care programs, and better manage development of Indian energy resources.
Since our 2019 High-Risk Report, ratings for all five high-risk criteria in this area remain unchanged with partially met designations.
Within the education component, the Bureau of Indian Education (BIE) has made progress addressing weaknesses, but ratings for all five criteria remain unchanged as partially met. In the health care and energy components, the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA) each met the criterion for leadership commitment. However, in the education component, they partially met the criterion for leadership commitment because more progress is needed to address issues related to school facility safety. Ratings for the remaining criteria remain unchanged as partially met.
When we added this area to our High-Risk List in February 2017, there were 39 open recommendations. Since then, we have added 26 recommendations for a total of 65 recommendations. As of December 2020, 22 recommendations remain open.
The education segment has partially met all five criteria for addressing high-risk issues.
Leadership commitment: partially met. BIE leadership has shown commitment to addressing key weaknesses in the management of BIE schools. For example, in August 2019, the BIE Director created a leadership position to oversee BIE’s performance in meeting its strategic goals and addressing the management weaknesses identified in our previous reports.
However, more progress is needed in this area. For example, leaders in BIE and other offices under the Office of the Assistant Secretary-Indian Affairs (Indian Affairs) responsible for assisting BIE schools with safety have not identified which office should lead in developing a plan to build BIE schools’ capacity to promptly address facility safety issues, which we recommended in March 2016. We designated it as a priority recommendation and have sent several letters to the Secretary of the Interior about the importance of addressing it.
Capacity: partially met. BIE has made some progress in increasing its capacity to address risks to Indian education.
For example, BIE completed a strategic workforce plan to address recommendations in our 2013 and 2015 reports. The plan includes human capital information to help BIE plan for an adequate number of qualified staff in the appropriate offices to effectively oversee programs that provide administrative support to BIE schools. The plan also includes human capital strategies—such as relocation incentives, student loan repayment, and streamlining candidate background checks—to help fill vacant positions. In addition, as of December 2020, BIE filled 55 positions across the agency, including positions in the division supporting the largest number of bureau-funded schools.
However, about 33 percent of all BIE positions have not been filled, including key leadership positions in offices supporting and overseeing BIE schools. For example, the office responsible for monitoring schools’ compliance with federal education programs—including those for children with special needs and from low-income families—does not have a permanent head and about half of its positions are vacant.
Action plan: partially met. Indian Affairs’ safety office developed and implemented a plan to assess the training needs of all its employees, including BIE staff responsible for inspecting schools, as we recommended. However, the agency has not provided documentation of plans on other important issues, such as a comprehensive, long-term capital asset plan to inform its allocation of school facility construction funds, which we recommended in May 2017.
Monitoring: partially met. BIE has taken steps to monitor its safety inspection process for schools, such as assessing the performance of inspectors and holding them accountable for the agency’s required performance standards. However, BIE has not demonstrated it has fully implemented its high-risk monitoring policy for federal education programs or ensured that its schools are receiving timely monitoring reports, as we recommended in May 2020.
Demonstrated progress: partially met. Since our 2019 High-Risk Report, BIE fully addressed eight of the 12 outstanding recommendations on Indian education we identified in our report. Significant work, however, remains to address our outstanding recommendations in other key areas, such as accountability for BIE school construction projects and special education services. Continued progress will depend on the sustained direction and support of top management in Indian Affairs and BIE.
Steps IHS has taken since 2019 have resulted in IHS now meeting the criterion for leadership commitment. IHS continues to partially meet the four remaining criteria.
Leadership commitment: met. Since 2017, when we first added this area to the High-Risk List, IHS has chartered a policy advisory council that focuses on issues related to strategic direction, recommended policy, and organizational adjustments. According to IHS, this advisory council will, among other things, serve as a liaison to IHS leadership for issues involving strategic direction and policy, as well as monitor and facilitate related policy workgroups. IHS officials have also demonstrated leadership commitment by regularly meeting with us to discuss the agency’s progress in addressing our recommendations.
In addition, IHS officials reported filling a number of senior executive positions as well as expanding the number of senior executives serving the agency. Finally, after a number of years without permanent leadership, the Acting Director of IHS was confirmed as the permanent Director in April 2020. However, due to the transition to a new administration, he has tendered his resignation effective January 20, 2021. Moving forward, we will continue to monitor leadership stability at the agency, which is critical to addressing our high-risk concerns.
Capacity: partially met. Among other actions, IHS officials reported filling health care facility executive vacancies and taking numerous steps to enhance the recruitment and retention of providers.
However, according to IHS officials, the agency’s Coronavirus Disease 2019 response consumed considerable staff attention and effort in 2020 and resulted in the delay of several initiatives. For example, IHS delayed the implementation of efforts to improve its monitoring of health care facility readiness for required accreditation surveys.
Furthermore, IHS estimates that it is funded at approximately 49 percent of its level of need. Agency officials stated that this level of funding requires the agency to rigorously manage tradeoffs between numerous priorities, including electronic health records modernization, improving quality of care programs, and facility construction backlogs.
Action plan: partially met. IHS finalized a strategic plan in 2019. The plan identifies three strategic goals: (1) ensuring access to care, (2) promoting quality of care, and (3) strengthening program management and operations. IHS has developed a system to track agency-wide progress with respect to the strategic plan, and plans to conduct a gap analysis to ensure progress on the plan’s goals.
Monitoring: partially met. IHS has taken some steps toward monitoring the agency’s progress in addressing the root causes of its management weaknesses, and these steps have the potential to significantly improve monitoring.
In addition to establishing its Office of Quality in 2019, IHS established a Chief Compliance Officer role in 2020. Through this role, it developed a process to enhance the agency’s monitoring of area operations. IHS has also taken steps to develop a patient care survey, as well as standards for tracking patient wait times. IHS also purchased and implemented a new adverse event reporting system in response to our January 2017 recommendation.
Our 2020 reports have also shown that IHS needs to improve its oversight of federally operated facilities through enhanced monitoring of facility decision-making and provider performance.
Demonstrated progress: partially met. IHS has made progress in implementing corrective actions related to the management of health care programs. Specifically, since our 2019 High-Risk Report, IHS implemented seven of our eight open recommendations.
For example, in response to our March 2016 recommendation that IHS monitor patient wait times in its federally operated facilities and ensure corrective actions are taken when standards are not met, IHS developed electronic dashboards for monitoring wait times.
In addition, in response to our January 2017 recommendation that IHS develop standards for the quality of care and monitor facility performance with respect to these standards, the agency developed standards for quality and implemented a new adverse event reporting system.
However, we continue to find deficiencies in IHS oversight of important areas. For example, in November 2020, we found that IHS lacked processes to guide area offices in systematically assessing how federally operated facilities will effectively meet the medical needs of their patient populations.
Since 2019, BIA has met the criterion for leadership commitment and continues to partially meet the four remaining criteria.
Leadership commitment: met. Steps BIA has taken since 2019 have resulted in BIA now meeting this area. In 2019, the Assistant Secretary for Indian Affairs appointed a Director for BIA and a Deputy Director for BIA’s Office of Trust Services—which has significant responsibility over Indian energy activities. This action provided an opportunity to improve Indian Affairs’ oversight of federal actions associated with energy development.
BIA has shown leadership commitment by issuing updated regulations in December 2019 for how the Secretary will approve tribal energy resource agreements (TERA) that allow for tribes to enter into and manage energy-related leases, rights-of-way, and business agreements without review and approval by the Secretary.
In response to a Secretary of the Interior order, the Office of the Solicitor identified the federal functions that tribes can contract under an approved TERA and those that are considered “inherently federal functions” and not contractible. The clarity provided by the updated regulations and policy guidance may encourage tribal participation in a TERA.
Capacity: partially met. In November 2016, we made two recommendations to BIA to help ensure it has an adequate workforce at agency offices with the right skills, appropriately aligned to meet the agency’s goals and tribal priorities. BIA has taken steps to strengthen its workforce recruitment and planning capacity and to better understand its workforce needs. In fiscal year 2020, BIA committed funds for five new personnel to support strategic recruitment and workforce planning activities.
Furthermore, through a July 2020 interagency agreement, BIA contracted with the Office of Personnel Management (OPM) for a number of workforce planning activities for the Office of Trust Services. OPM will develop a methodology for and conduct a workforce analysis to determine workforce composition needs, assess gaps, prepare a workforce plan, and identify competencies for a number of mission-critical occupations. OPM plans to complete this work in fiscal year 2021.
Action plan: partially met. BIA officials met with us numerous times in fiscal years 2019 and 2020 to discuss actions for implementing our recommendations related to Indian energy resources. However, the agency does not have a comprehensive plan in place to address the problems with oversight of its energy development activities or data limitations for timely leasing activities. BIA needs to develop such a plan with clear milestones.
Monitoring: partially met. BIA monitors its progress in implementing our recommendations and reports on this progress to Indian Affairs. However, BIA does not have well-defined performance measures or a process to monitor its oversight of energy development activities, which limits its ability to assess its progress.
Demonstrated progress: partially met. BIA has made progress with workforce capacity and agency coordination. For example, the recently formed Indian Energy Service Center assisted several field offices with backlogs in work associated with leasing and permitting for Indian energy development. It also hosted training on oil and gas development standard operating procedures for Interior employees.
The Indian Energy Service Center also established and coordinated meetings of six regional groups of federal agencies involved in Indian energy development to identify and resolve issues. However, more needs to be done to close open recommendations, as discussed below.
Because our work has shown federal agencies have ineffectively administered Indian education and health care programs, and inefficiently met their responsibility for managing the development of Indian energy resources, we added this area to our High-Risk List in 2017. It includes three components across agencies in two departments, including BIE and BIA under Interior’s Office of the Assistant-Secretary of Indian Affairs, and IHS in Health and Human Services.
Education. BIE challenges include limited capacity to support and oversee schools and ensure accountability for school construction projects.
Health care. HHS’s inadequate oversight has hindered IHS’s ability to ensure that Indian communities have timely access to quality health care.
Energy. BIA mismanagement of Indian energy resources held in trust limited opportunities for tribes and their members to use those resources to create economic benefits and improve the well-being of their communities.
To strengthen its capacity to administer and oversee its schools, BIE needs to address critical staff vacancies by fully implementing its strategic workforce plan.
Further, in May 2020, we added seven recommendations on BIE’s need to improve its support and oversight of schools’ special education programs. As of December 2020, 11 recommendations related to this high-risk area remain open, and Indian Affairs concurred with all 11 recommendations. BIE needs to implement these recommendations, including:
- Develop a plan to build schools’ capacity to address building safety issues;
- Develop a comprehensive, long-term capital asset plan to inform its allocation of school facility construction funds; and
- Ensure the full implementation of its high-risk monitoring process and timely monitoring reports to schools on special education and other programs.
As of December 2020, one of the eight recommendations in our 2019 High-Risk Report remain open, and we have added six recommendations—for a total of seven open recommendations related to this high-risk area. IHS fully concurred with these seven recommendations.
IHS needs to implement these recommendations including:
- continue to enhance monitoring of area operations and implement a system to track and analyze agency-wide progress with respect to the strategic plan;
- develop processes to guide area offices in systematically assessing how facilities will meet the medical needs of their patients;
- develop a process to review area office policies and trainings related to provider misconduct and substandard performance; and
- obtain agency-wide information on facility use of temporary provider contractors and use the information to inform decisions about resource allocation and provider staffing.
As of December 2020, four of the 12 recommendations in our 2019 High-Risk report remain open. BIA fully concurred with all four recommendations. For example, BIA needs to:
- complete an assessment of the composition of its workforce and implement a comprehensive workforce planning system; and
- develop a process to monitor its oversight of energy development activities and assess its progress.
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Indian Health Service: Actions Needed to Improve Oversight of Federal Facilities' Decision-Making About the Use of Funds
Indian Education: Actions Needed to Ensure Students with Disabilities Receive Special Education Services
Indian Health Service: Facilities Reported Expanding Services Following Increases in Health Insurance Coverage and Collections