Key Issues > High Risk > Improving Federal Management of Programs that Serve Tribes and Their Members
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Improving Federal Management of Programs that Serve Tribes and Their Members

The Bureau of Indian Education (BIE), Indian Health Service (IHS), and Bureau of Indian Affairs (BIA) have demonstrated some progress in all high-risk area segments. All three agencies continue to face challenges retaining permanent leadership and a sufficient workforce.

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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 (Indian Affairs), and IHS in Health and Human Services. 

Education. BIE challenges included poor conditions at BIE school facilities that endangered students and the agency’s weak oversight of school spending. 

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.    

Improving Federal Management of Programs that Serve Tribes and Their Members

We added this area to our High-Risk List in 2017 and are assessing all three segments against our high-risk criteria for the first time. Overall, the three agencies have partially met the leadership commitment, capacity, action plan, monitoring, and demonstrated progress criteria for the education, health care, and energy areas.

Since we added this area to our High-Risk List in 2017, we have testified at seven congressional hearings. We believe that it is vital for Congress to maintain its focus on improving the effectiveness with which federal agencies meet their responsibilities to serve tribes and their members in these areas.

When we added this area to our High-Risk List in February 2017, there were 39 open recommendations.  Since then, we added 13 recommendations.  As of December 2018, 32 recommendations remain open.


Education

Improving Federal Management of Programs that Serve Tribes and Their Members

The education segment has partially met all five criteria for addressing high-risk issues.

Leadership commitment: partially met. Indian Affairs leaders have shown commitment to addressing key weaknesses in the management of BIE schools. For example, the BIE Director formed an internal working group, convened meetings with other senior leaders within Indian Affairs, and publicly stated that his agency is committed to implementing our recommendations. We also met with the new Assistant Secretary-Indian Affairs, who expressed her commitment to supporting the agency’s efforts to address weaknesses in the management of BIE schools. However, frequent turnover in key leadership positions in recent years has hampered Indian Affairs’ efforts to make improvements to Indian education.

Capacity:  partially met.  BIE and other Indian Affairs offices that support BIE schools have made some progress in increasing their capacity to address risks to Indian education. For example, BIE officials hired a full-time program analyst to coordinate the agency’s working group and help oversee the implementation of our recommendations. However, about 50 percent of all BIE positions have not been filled and the bureau has not completed a workforce plan to address staffing and training gaps, as we previously recommended. BIE officials told us they are developing a workforce plan, which they plan to complete by the end of 2018.

Action plan: partially met. Among other actions, BIE implemented a new action plan, including written procedures and risk criteria for overseeing BIE school expenditures, which fully addressed two priority recommendations. However, Indian Affairs has not provided documentation that it has developed and put in place action plans on other important issues, such as a comprehensive, long-term capital asset plan to inform its allocation of school facility funds, which we recommended.

Monitoring:  partially met. Indian Affairs, in consultation with Department of Interior’s Office of Occupational Safety and Health, has taken actions to monitor corrective measures that address weaknesses with the agency’s safety program—which covers safety at BIE schools. However, the agency has not yet demonstrated that it is monitoring several other areas, such as whether relevant employees are being held to the agency’s required performance standards for safety inspections.

Demonstrated progress: partially met.  Since our 2017 High-Risk report, Indian Affairs has fully addressed 11 of our 23 outstanding recommendations on Indian education. Overall, this represents a substantial increase in implementing our recommendations on Indian education since we identified the area as high-risk. Significant work, however, remains to address our outstanding recommendations in several key areas, such as workforce planning and accountability for BIE school safety and school construction projects.


Health Care

Improving Federal Management of Programs that Serve Tribes and Their Members

IHS has partially met all five criteria to address the health care high-risk segment.

Leadership commitment: partially met. IHS officials have demonstrated leadership commitment by regularly meeting with us to discuss the agency’s progress in addressing our recommendations. In addition, IHS has chartered a policy advisory council that will focus 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 among IHS leadership for issues involving strategic direction and policy, as well as monitor and facilitate related policy workgroups. However, IHS still does not have permanent leadership—including a Director of IHS.

Capacity: partially met. Among other actions, IHS officials stated that the agency is expanding the role of internal audit staff within its enterprise risk management program to augment internal audits and complement both the Department of Health and Human Services Inspector General and our audits. In addition, IHS has developed a new Office of Quality, which is expected to develop and monitor agency-wide quality of care standards. However, according to IHS, there are still vacancies in several key positions.

Action plan: partially met. IHS is in the final stages of developing a strategic plan and a related work plan to address certain root causes of management challenges and define solutions and corrective measures for the agency. The draft strategic plan divides these challenges into three categories: (1) access to care, (2) quality of care, and (3) program management and operations. We will examine the final strategic plan and related work plan to determine whether they contain the needed elements of an action plan once issued.

Monitoring: partially met. IHS has taken some steps toward monitoring the agency’s progress in addressing the root causes of their management weaknesses. In addition to developing its new Office of Quality, IHS has taken steps to develop a patient experience of care survey, as well as standards for tracking patient wait times. These efforts should be reflected in the agency’s corrective plan, as part of an overall framework for monitoring progress that includes goals and performance measures to track their efforts and ultimately verify the effectiveness of their efforts.

Demonstrated progress: partially met. IHS has made progress in implementing corrective actions related to the management of health care programs. Specifically, since our 2017 High-Risk report, IHS implemented four of our 13 open recommendations. For example, in response to our April 2013 recommendation, to ensure that IHS’s payment rates for contracted services do not impede patient access to physician and other nonhospital care, IHS developed an online tool that enables the agency to track providers that do not accept IHS’s payment rates. In addition, IHS officials told us that they plan to complete the implementation of additional recommendations in 2019.   


Energy

Improving Federal Management of Programs that Serve Tribes and Their Members

BIA has partially met all five criteria to address the energy high-risk segment.

Leadership commitment: partially met. In June 2018, a permanent Assistant Secretary for Indian Affairs was confirmed.  This action provided an opportunity to improve Indian Affairs’ oversight of federal actions associated with energy development.  However, BIA does not have a permanent Director, and BIA’s Office of Trust Services—which has significant responsibility over Indian energy activities—does not have a permanent Director or Deputy Director. 

Capacity:  partially met. In November 2016, we recommended that BIA establish a documented process for assessing the workforce at its agency offices. BIA conducted a survey to identify workforce needs related to energy development to support staffing decisions at the new Indian Energy Service Center. However, BIA officials said the agency does not have the staff or resources to implement a comprehensive workforce planning system to ensure it has staff in place at its agency offices to meet its organization needs.  

Action plan: partially met. BIA officials met with us several times in fiscal year 2018 to discuss actions and plans for implementing our recommendations related to Indian energy resources.  BIA officials told us that they proposed several modifications to the bureau’s land records data management system that will enable increased tracking and monitoring of key documents that BIA must review prior to the development of Indian energy resources. However, the agency does not have a comprehensive plan in place to identify causes of long-standing management weaknesses or an action plan to address the problems.

Monitoring:  partially met. BIA has taken steps to improve monitoring by holding frequent meetings assessing its progress in implementing our recommendations.  However, BIA has not taken steps to monitor its progress addressing the root causes of management weaknesses.

Demonstrated progress: partially met. BIA has shown significant progress developing data collection instruments and processes needed to track and review response times for a number of different actions associated with energy development.  However, more needs to be done to close open recommendations, as discussed below.    

 

Education

Continued progress will depend on sustained direction and support of top management in Indian Affairs and BIE. In addition, to increase its capacity to support functions related to administering and overseeing BIE schools, BIE needs to conduct strategic workforce planning and determine how best to align its human capital program with its mission and programmatic goals, as we have recommended. As of December 2018, 12 recommendations related to this high-risk area remain open and Indian Affairs concurred with all 12 recommendations. 


Health Care

We have identified several priority actions for IHS in its role of providing accessible health care services to Indian tribes.

  • IHS needs to ensure stable, permanent leadership that can assign the tasks needed to address weaknesses and hold individuals accountable for progress.
  • IHS needs to continue to develop a corrective action plan that defines root causes, identifies solutions, and provides for substantially completing corrective measures.
  • IHS needs to set up goals and performance measures to monitor the outcomes from its action plan.
  • IHS needs to continue to address our open recommendations in this area, including (1) ensuring that agency-wide standards for the quality of care are developed, that facility performance in meeting these standards is systematically monitored over time, and that enhancements are made to its adverse event reporting system, and (2) monitoring patient wait times and ensuring corrective actions are taken when standards are not met.

As of December 2018, 7 out of the 13 recommendations in our 2017 High-Risk report remain open, and we have added one additional recommendation—for a total of 8 open recommendations related to this high-risk area.  IHS fully concurred with these 8 recommendations. 

Congressional Actions Needed

We have an open matter for Congress to consider requiring IHS to develop and use a new method to more equitably allocate Purchased/Referred Care program funds—which allow patients to receive care from external providers—across areas.


Energy

BIA needs to (1) provide decision makers with key information on resources needed to assess the composition of its workforce and implement a comprehensive workforce planning system, and (2) continue to identify causes of weaknesses with the management of Indian energy and mineral resources, and develop a plan to address these problems with clear milestones, well-defined performance measures, and a monitoring approach. As of December 2018, 12 of the 14 recommendations in our 2017 High-Risk report remain open.  BIA fully concurred with all 12 recommendations. 

Looking for our recommendations? Click on any report to find each associated recommendation and its current implementation status.
  • portrait of Melissa Emrey-Arras
    • Melissa Emrey-Arras
    • Director, Education, Workforce, and Income Security
    • emreyarrasm@gao.gov
    • 617-788-0534
  • portrait of Jessica Farb
    • Jessica Farb
    • Director, Education, Workforce, and Income Security
    • farbj@gao.gov
    • 202-512-7114
  • portrait of Frank Rusco
    • Frank Rusco
    • Director, Natural Resources and Environment
    • ruscof@gao.gov
    • 202-512-3841