As requested by your committee, this report presents the results of our efforts to determine problems that exist between the Department of Health and Human Services' Indian Health Service and various Indian tribes in contracting for health services under Public Law 93-638 (the Indian Self-Determination Act). We are sending copies of this report to interested congressional committees, the Executive Summary Purpose Background Under Public Law 93-638 (commonly called the Indian SelfDetermination Act), Indian tribes are authorized to plan, conduct, and administer (through contracts and grants) programs that have been the responsibility of the Secretaries of the Interior and Health and Human Services. Senator Mark Andrews, Chairman of the Select Committee on Indian Affairs, has been concerned about problems in contracting between Indian tribes and tribal organizations and the Indian Health Service (IHS) within the Department of Health and Human Services (HHS). In September 1985, Senator Andrews asked GAO to give him information on the contracting process and to determine the problems, if any, that tribal governments and tribal organizations have experienced with the administration of contracts under Public Law 93-638. Also, GAO was asked to review the relationship between IHS and the Health Resources and Services Administration, within HHS's Public Health Service, to determine if the Health Resources and Services Administration was interfering with IHS's approval of Public Law 93-638 contracts. IHS provides comprehensive health care to about 987,000 Indians and Alaska Natives. It does this at 47 hospitals, 80 health centers, and over 500 health stations and satellite clinics. IHS also contracts with private and public health care facilities. Twelve field offices administer the program. Public Law 93-638, enacted January 4, 1975, established a policy to permit an effective and meaningful participation by the Indian people in the planning, conduct, and administration of programs and services previously provided by federal agencies. This participation is achieved by Indian tribes operating health care activities through contracts with the federal government. In fiscal year 1985, $162 million or 43 percent of IHS's contracts for its health care system was for contracts awarded under Public Law 93-638. IHS is specifically responsible under Public Law 93-638 for approving all contracts dealing with Indian selfdetermination. The Health Resources and Services Administration is responsible for overseeing IHS's contracting activities. As agreed with the committee staff, GAO reviewed the involvement of 12 Indian contractors (tribes or tribal organizations) with four IHS local offices in contracting under Public Law 93-638. GAO also reviewed the involvement of IHS headquarters and the Health Resources and Services |