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    Subject Term: "Native American health services"

    4 publications with a total of 9 open recommendations including 1 priority recommendation
    Director: Kathy King
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure that quality care is provided to AI/AN people, as part of the implementation of its quality framework, the Secretary of HHS should direct the Director of IHS to ensure that agency-wide standards for the quality of care provided in its federally operated facilities 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.

    Agency: Department of Health and Human Services
    Status: Open
    Priority recommendation

    Comments: HHS agreed with our recommendation and cited steps it already has underway to improve the quality of care in IHS's federally-operated facilities. HHS described the development of the IHS Quality Framework and Implementation Plan released in November 2016. However, as of June 2017, IHS had not developed agency-wide standards for the quality of care provided in its federally operated facilities.
    Director: William T. Woods
    Phone: (202) 512-4841

    3 open recommendations
    Recommendation: To ensure consistent implementation of the Buy Indian Act procurement authority across the agencies and to enhance oversight of implementation of the Act at regional offices, the Secretaries of the Interior and Health and Human Services should direct the Bureau of Indian Affairs and Indian Health Service respectively, to clarify and codify their policies related to the priority for use of the Buy Indian Act, including whether the Buy Indian Act should be used before other set-aside programs.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Department of Health and Human Services (HHS) has made progress towards addressing this recommendation. The Indian Health Service (IHS) is currently working on efforts to revise the Acquisition Management section of the Indian Health Manual to clarify and codify policies related to the priority for use of the Buy Indian Act. IHS plans for the revision to include implementation and reporting mechanisms for contracts awarded under the Buy Indian Act. HHS reported that IHS plans to issue new policy guidance relating to the Buy Indian Act and how it is to be implemented and prioritized in conjunction with other set asides.
    Recommendation: To ensure consistent implementation of the Buy Indian Act procurement authority across the agencies and to enhance oversight of implementation of the Act at regional offices, the Secretaries of the Interior and Health and Human Services should direct the Bureau of Indian Affairs and Indian Health Service respectively, to collect data on regional offices' implementation of key requirements, such as challenges to self-certification.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: Officials at the Department of Health and Human Services' Indian Health Service (IHS) told us they plan to continue oversight to ensure that contractors comply with key requirements such as (1) maintaining the proportion of Indian ownership, (2) not subcontracting more than half the work to other than Indian firms, and (3) providing a preference to Indians in employment, training, and subcontracting. However, as of July 2017, IHS had not provided evidence that they were collecting data on regional offices' implementation of these key requirements. IHS officials told us they plan to incorporate Buy Indian Act policy language and clauses into all contracts and track Buy Indian award actions and obligations. IHS officials also stated they will ensure that the contracting officer authenticates an Indian Economic Enterprise's categorization/credentials, before award and throughout the contract period.
    Recommendation: To ensure consistent implementation of the Buy Indian Act procurement authority across the agencies and to enhance oversight of implementation of the Act at regional offices, the Secretaries of the Interior and Health and Human Services should direct the Bureau of Indian Affairs and Indian Health Service respectively, to include Buy Indian Act contracts as a part of their regular procurement review process.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: Department of Health and Human Services officials told us initial on-site communications to raise awareness of the Buy Indian Act was included in the fiscal year 2017 Indian Health Service (IHS) Procurement Management Reviews (PMR) being conducted at all area offices. Starting in the fall of 2017, IHS plans to develop webinar training sessions to ensure that a large, diverse audience of contracting and management officials have access to the training. IHS will also incorporate the Buy Indian Act Policy into the established annual procurement management reviews beginning in fiscal year 2018 to ensure compliance.
    Director: J. Alfredo Gómez
    Phone: (202) 512-3841

    3 open recommendations
    Recommendation: To develop an estimate of the scope of work remaining to address uranium contamination on or near the Navajo reservation, Congress should consider requiring that the Environmental Protection Agency take the lead and work with the other federal agencies to develop an overall estimate of the remaining scope of the work, time frames, and costs.

    Agency: Congress
    Status: Open

    Comments: As of December 2016, we are not aware of any legislation being enacted to address this matter for congressional consideration.
    Recommendation: In light of the problems BIA has encountered in managing the cleanup at the Tuba City Dump site, the Secretary of the Interior should direct the Assistant Secretary for Indian Affairs to employ best practices in creating the schedule and cost estimates for the remedial action cleanup phase.

    Agency: Department of the Interior
    Status: Open

    Comments: As of December 2016, GAO is awaiting action by the agency to implement this recommendation.
    Recommendation: In light of the problems BIA has encountered in managing the cleanup at the Tuba City Dump site, the Secretary of the Interior should direct the Assistant Secretary for Indian Affairs to identify and examine any lessons learned from managing the remedial investigation and feasibility study contract and consider these lessons as part of the acquisition planning process for the remedial action contract.

    Agency: Department of the Interior
    Status: Open

    Comments: As of December 2016, GAO is awaiting action by the agency to implement this recommendation.
    Director: King, Kathleen M
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: In an effort to ensure that IHS has meaningful information on the timeliness with which it issues purchase orders authorizing payment under the CHS program and to improve the timeliness of payments to providers, the Secretary of the Department of Health and Human Services (HHS) should direct the Director of IHS to: (1) modify IHS's claims data system to separately track IHS referrals and self-referrals, revise the Government Performance Results Act measure for the CHS program so that it distinguishes between these two types of referrals, and establish separate timeframe targets for these referral types; and (2) improve the alignment between CHS staffing levels and workloads by revising its current practices, where appropriate, to allow available funds to be used to pay for CHS program staff.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of July 2016, HHS officials reported that they have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: As HHS and IHS monitor the effect that new coverage options available to IHS beneficiaries through PPACA have on CHS program funds, the Secretary of HHS direct should the Director of IHS to proactively develop potential options to streamline program eligibility requirements.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of July 2016, HHS officials reported that they have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.