To: Area Director, JAO, Attention: Contract Administrator Subject: Modification IV-Contract Number E00C14201229 Please modify above contract by revising the budget per attached. Major modifications include the Contract Evaluation; Program Planning and Evaluation; Equipment Purchases; Personnel Services; and Social Services Grants. All other changes are minor ones to reflect more accurate cost projection. Members of the Contracting Team will be able to meet at your convenience. Please arrange the meeting through Eli Reyes, Administrative Manager for this Agency. The modification for the Transitional Quarter will be ready for negotiations by June 23, 1976. JOSEPH G. WILSON, Chief Negotiator. Attachment. ATTACHMENT NO 10 Mr. RAY PADDOCK, U.S. DEPARTMENT OF THE INTERIOR, President, Central Council of the Tlingit and Haida Indians of Alaska, Juneau, Alaska. DEAR MR. PADDOCK: Your application proposal for the Johnson O'Malley Contract programs and services to Southeast Alaska was received on August 11, 1976. It was reviewed by both the Educational and contracting staffs. Based on interpretation of our authority under the Indian Self Determination and Education Assistance Act, the regulations as outlined by Part 273, Johnson O'Malley contracts, and Part 271, contracts under Indian Self-Determination, and guidelines received from our Central Office, we find that we need additional information and data before the proposal can be negotiated and a contract awarded. We sincerely regret any misinterpretation by CCTTIA as to how they could legally contract. It appears that CCTTIA assumed that Johnson O'Malley was an agency function synonymous with such administrative entities as Employment Assistance, Social Services, etc. This is not the case with the Johnson O'Malley program. Johnson O'Malley is an entitlement program for the entire Bureau with Alaska getting its fair share. Funding for this program is distributed on a per capita basis for eligible students and pre school children. The local Indian Education committees determine the needs, and approve the services and programs for their children. Johnson O'Malley programs are not a separate and distinct administrative function and therefore it is not possible to contract for as it as such. Under Section 273.11 (c) a Tribal Organization mbust meet the requirements in Section 273.20 in addition to those in Section 271.14. The main thrust here is the education plan as outlined in Section 271.14. These plans were one of the omissions in your application. Plans from all Indian Education Committees should be included in order for the government to determine what type of supplemental services are being provided. These plans and programs should also be supported by a line item budget to facilitate accountability as pointed out in Section 273.20(e). The applications also should include a signed approval by each Indian Education Committee along with Organizational documents and by-laws of the IEC, including proper signatures of their officers. There are additional requirements pointed out in Parts 271 and 273 which we will be glad to discuss with CCTTIA in order to get the application and its requirements within the purview of P.L. 93-638 for a Johnson O'Malley contract. We hope that meeting these requirements will not unduly inconvenience your staff or cause too much delay in geting the JOM contract underway for the Southeast area villages. Sincerely, JOSEPH L. CHASE, Contract Administrator. ATTACHMENT No. 11 AUGUST 27, 1976. CLARENCE ANTIOQUIA, Area Director, Bureau of Indian Affairs, JAO, DEAR MR. ANTIOQUIA: This is to officially appeal the Contract Administrator's decision contained in his letter dated August 23, 1976. A copy of this letter is attached. Specifically, the third, fourth, and fifth paragraphs indicate we cannot contract for the administration of the Johnson O'Malley Act program under 25 CFR 271, but must contract under 25 CFR 273. More specifically, we are a prime contractor as stated in section 273.1(c). If you look closely at Section 273.1(c), you will find it does not cover us, it relates only to supplemental and operational support. In the definitions provided in Section 273.2 (1) and (t), you can see the Central Council of the Tlingit and Haida Indians of Alaska is clearly not contracting for supplemental and operational support. Reference in the letter to Section 273.11 (c) again is clearly related to supplemental and operational support. It is our intent to contract for the administration of the Johnson O'Malley Act programs per 25 CFR 271.1(a). Sincerely yours, Attachment. RAYMOND E. PADDOCK, JR., SOUTHEAST ALASKA REGIONAL HEALTH CORP., Hon. JAMES ABOUREZK, My name is Conrad P. Baines, Jr.; I am the executive director of the Southeast Alaska Regional Health Corporation. The corporation covers the same geographical area as Sealaska Corporation and the Central Council of Tlingit and Haida Indians of Alaska. The health corporation serves the Tlingit, Haida and Tsimpshin Indians of Southeast Alaska with the mandate to be a strong advocate and to improve their health status to the highest degree with as much community involvement as possible. My statements have not been approved by our board of directors and should not be construed as policy. I am speaking personally and drawing from my experience of the past year as an executive director. Although the intent and thrust of the hearing is to obtain testimony on Public Law 93-638 and contracting, I would like to offer testimony on other related and pertinent areas in manpower, facilities, program areas that need funding, Public Law 93-641 problem areas and the Indian Health Care Improvement Act. CONTRACTING SEARHC is a private non-profit health corporation. For the period July 1, 1975 to September 30, 1976, SEARHC was awarded three contracts from the Indian Health Service area office in Anchorage. The contracts were as follows: (1) Contract No. 243-75-0552, a cost reimbursement contract to develop the administrative capabilities of the health corporation; (2) Contract No. 243-76-0032, a fixed price contract to provide primary health care through our health aides in the Native communities where little or no primary health care exists; and, (3) Contract No. 243-76-0164, for purposes of training our employees in contract administration and finance. The amounts of the contracts were as follows: Community development--- Community health aide program_. Staff training-. Total IHS funds.. $214, 240 224, 442 6,600 445, 283 There are several problem areas in the contracting process that we find ob jectionable and should be considered by the policy review commission. For the coming year, the above contracts will be combined into one reimbursement contract. The areas that I wish to bring to your attention are as follows: (1) Cost Reimbursement Contracts with No Cash Advance.-We find this objectionable for obvious reasons. SEARHC must rely upon Control Council for daily cash flow. (2) Paternalistic Attitude of Contract and Project Officers.-The "would be" contractor has very little voice in the negotiation proceedings. A legal contract advisor (lawyer) is not an allowable cost. When a tribe negotiates for a contract, legal counsel should be made available at no cost so negotiations with the contract officer can be made on equal footing. In the past, all contract requirements were virtually spelled out by the contract officer with little regard to tribal input. This attitude is clearly documented by the Alaska Federation of Natives (AFN) and the Association of Regional Health Directors (ARHD). The Association is composed of the directors of 12 Native health corporations. The August 30 letter from Carl Jack, Director of AFN Health Affairs, to Gerald Ivey, Area Director of Alaska Area Native Health Service (AANHS), is submitted as documentation of the contracting situation. (3) Treatment of Indirect Costs.-Whenever we negotiate a contract amount, indirect costs must come from the negotiated amount therefore decreasing the amount of services that is to be performed in the contract. Many contracts have no provision for indirect costs as an allowable cost. The Indian Health Service requires strict accounting of all funds; but to allow little or no indirect costs is a conflict of interest. (4) Budget Revision. The contracts that IHS initiates require a five percent (5%) or $5,000 allowable transfer of line items. Any variance from the 5% flexibility is an unallowable cost. In order to get a budget amended, the contract allows the contract officer 30 days to respond to the proposed budget amendment. We find this 30 days clearly objectionable and unworkable. This response time must be reduced to a much shorter workable time, such as five (5) working days. INDIAN HEALTH CARE IMPROVEMENT ACT Testimony would also like to be provided on the Indian Health Care Improvement Act. First of all, we would like to reaffirm our support for the act and would like to emphasize the need for the bill to be passed in the $2 billion magnitude. The projected estimated unmet needs for the Indian health services in Southeastern Alaska is in the vicinity of $5.5 million. The documentation of this figure is presented within the Mt. Edgecumbe Service Unit Operating Plan. This plan has been obtained from Arthur Willman, Service Unit Director. The Indian Health Care Improvement Act provides for Indian manpower development. This provision is needed in order to truly fulfill goals of Indian Self-Determination. Since the inception of SEARHC April 1975, one of the main problems we have had is finding Indian manpower with formal education and experience in the health field. Indian people with administrative and/or clinical background are virtually nonexistent. To provide an example, since the inception of SEARHC, as the executive director, I have been the only staff member having a masters degree in a health related field. Information drawn from the Association of American Indian Physicians, shows that there exists no Tlingit physicians anywhere in the United States; however, there is a fourth year dental student who is a Tlingit presently working in Anchorage at this time. It is common knowledge from IHS printouts that most deaths among Southeast Alaska Indians are related to alcohol abuse and accidents. However, at this time, there exists no alcoholism treatment or injury control programs at the community levels. Most Indian communities in Southeast Alaska have either inadequate clinics or none at all. Although it is known and documented what the Indian health problems are, there exists no manpower, facilities or programs to combat the problems. The Indian Health Care Improvement Act can help remedy some of the problems. SEARHC has been corresponding with staff of the Secretary of Health, Education and Welfare as to his position on the bill. Correspondence from David Matthews indicates that he recognizes the need for improvement of health services; but, it is the opinion of the Secretary that the services should be improved through Titles XVIII and XIX of the Social Security Act. SEARHC would like to state our appreciation to the idea of using Medicare and Medicaid as the sole agents for improving health services to the American Indians. The Indian Health Service definitely is the mechanism to improve the services. PUBLIC LAW 93-641 There is another area that SEARHC would like to make comments on. These comments pertain to Public Law 93-641. The law is the National Health Planning and Resources Development Act of 1974. Even though the rural medically underserved are the number one priority, in Southeast Alaska these are Indian. here are no travel funds for the people from the area to participate in SEAHSA activities. The importance of PL 93641 to the Indian community cannot be overlooked. While the HSA will have only review and comment authority where Indian projects are concerned, the HSA, in performing their function, can defer forwarding Indian project proposals to the Secretary of HEW up to 60 days. Such delay could interrupt services supported by various grants and/or contracts. Further, a negative comment concerning Indian proposals could influence the Secretary's decision to fund or not to fund an Indian health proposal. Personally, I feel this seems to be in infringement upon the American Indians special relationship with the United States federal government. We would like to thank you, Mr. Chairman, for coming to Southeast Alaska and hope you return again. Sincerely, Enclosures. CONRAD P. BAINES, Jr., ALASKA FEDERATION OF NATIVES, INC., Reference: Fiscal year 1977 Contract Negotiations with the Region Native GERALD IVEY, Area Director, Alaska Area Native Health Service, DEAR MR. IVEY: Pursuant to the directive of the Association of Regional Health Directors in their August 20th meeting held in the AFN, Inc. Conference Room at which time a quorum was present and the actions taken were during the "General Session", I am herewith, forwarding to you the following list of grievances in regards to how the fiscal year 1977 contracts negotiations were conducted. The so-called negotiations were conducted between the office of Community Health Development and the Regions from August 1, through 16, 1976. (1) A policy be established by IHS to notify the region a minimum of 15 days prior to any contract negotiations. Furthermore that IHS convey to the Regions as to the content of what is to be negotiated to insure preparating time for the Regions to negotiate the contract. Reason. Many of the Regions felt that they were not given sufficient advance notice to negotiate the contract. Some were given as much as 2 days notice that they were to negotiate the contract. (2) That the Regional Health Corporation/Non-profit organizations be afforded legal council and that the costs incurred be an allowable cost in the contracts and a representative from AFN, Inc., be present during in and all the negotiations. Reason.-Practically all of the Regions did not have legal council during the so-called negotiations with the exception of Tanana Chiefs Conference, Inc. (3) IHS and ARHD's establish a Task Force for criteria for fund allocation and that IHS adhere to these fund allocations in contracting with the region. Reason. Fund allocation as determined by the ARHD's during the spring meeting was not adhered, too, resulting in the IHS personnel to make arbitrary decisions on Regional entitlements. (4) A clear definition of the Project Director and the Contracting Officer be strictly adhered too by the IHS personnel during all the negotiations and that all project officers be present during the negotiations. Reason-Many of the contracts were negotiated (both technical aspects and Price) without the presence of the Contracting Officer. (5) No misleading or deceptive information be practiced by IHS personnel (A-OCD) during the so-called negotiations. Reason. Many of the Regions felt such misleading and deceptive information was conveyed to them during the so-called negotiations. (6) Proper attendance of IHS personnel be adhered too during the negotiations. Reason. Self-explanatory. (7) There was lack of professionalism on the part of IHS personnel (A-OCD) which affronts the personal dignity of the representative of the Regional Native organizations. Reason. Some derogatory statement were made by IHS personnel regarding various Native organizations which provoked regional dessertions. (8) IHS conducting negotiations in detrimental manner for future directors which could result in bad relationships between IHS and the Native organization. Reason. Self-explanatory. It was for these reasons cited above that the ARHD's as the representative. of their respective regions by majority vote and during the "General Session" on the evening of August 20, 1976 formally took the following actions. (1) Nullify current contracting process for process for fiscal year 1977. (2) ARHD's meet with the Area Director, Deputy Director and the Executive Officer to determine confirmed dollars available for fiscal year 1977 contracts. (3) Reconvene ARHD's to determine Regional Contract allocation. (4) Renegotiate fiscal year 1977 contracts with legal council with representative from AFN, Inc. present during in and all negotiations. It is the sincerest desire of the ARHD's to come to a constructive resolution of this matter in a manner of mutual respect for all parties. Therefore, ARHD's is requesting to meet with you, your Deputy Director, Executive Officer, Contracting Officer, Chief Finance Branch and Area Office of Community Development personnel on the afternoon of August 30, 1976 commencing at 2:00 p.m. in your conference room. It is understood that such a meeting will occur on the date and time set above. Executive Director, Southeast Alaska Regional Health Corp., 130 South Seward Street, Juneau, Alaska. DEAR MR. BAINES: Your telegram of April 7 to Secretary Mathews concerning the Indian Health Care Improvement Act has been referred to this Agency for reply. We appreciate your interest in improving and expanding the level of health care services to Indian and Alaska Native peoples. While this Department shares those concerns, we find the Indian Health Care Improvement Act legislation pending in the Congress objectionable. It is our view that the legislation is essentially unnecessary primarily because it does not contain any significant new authority which would enable this Department to better meet the health needs of Indians and Alaska Natives. This bill would mainly authorize funds to be appropriated over the next seven years to expand the Indian Health Service programs to meet identified health needs, but would not appropriate any funds. Since the Indian Health Service is already authorized to expend such funds as the Congress appropriates, the Indian Health Care Improvement Act would not increase the present authorization under which the Indian Health Service now operates. |