Modernizing the Implementation of 638 Contracting at the Indian Health Service.
House Subcommittee on Indian and Insular Affairs
2025-12-11
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Source: Congress.gov
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Good morning. The subcommittee on Indian and Insular Affairs will come to order. Without objection, the chair is authorized to declare recess of the subcommittee at any time. The subcommittee is meeting today to hear testimony for an oversight hearing entitled Modernizing the Implementation of 638 Contracting at the Indian Health Service. Under Committee Rule 4F, any oral opening statements at hearings are limited to the chairman and the ranking minority member. I therefore ask unanimous consent that all other members' opening statements be made part of the hearing record if they are submitted in accordance with Committee Rule 3-0. Without objection, so ordered. I ask unanimous consent that the gentleman from Montana, Mr. Downing, be allowed to sit and participate in today's hearing. Without objection, so ordered. I will now recognize myself for an opening statement. Good morning and thank you to our witness and witnesses in the second panel for being here. Today we are holding an oversight hearing titled Modernizing the Implementation of 638 Contracting at the Indian Health Service. 50 years ago, Congress passed the Indian Self-Determination and Education Assistance Act. The law empowered tribes to take control of federal programs that directly affect their communities. In the health context, that means Title I contracts and Title V self-governance compacts, what we collectively refer to as 638 contracts and compacts. Today, tribes and tribal organizations manage the majority of the IHS budget through 638 contracts. This is a testament to the success of self-determination and self-governance. But it also means IHS's mission has fundamentally changed. Instead of serving primarily as a direct provider, IHS must now negotiate hundreds of complex agreements, process amendments, pay support costs, and support increasingly sophisticated tribal health systems. How IHS can meet that modern mission is the core oversight issue before us.
We know there are serious challenges. Tribes regularly report delays and uncertainty in basic 638 administration, slow action on contract amendments, lack of clear process maps, and long waits on 105L leases. IHS does not publish standard metrics or review timelines or pending actions. Without consistency or information sharing, tribes cannot plan effectively and delays ultimately affect health services on the ground. The Government Accountability Office, or GAO, has raised similar concerns. IHS has been on the GAO high risk list since 2017 for deficiencies in capacity, oversight, and demonstrated progress. The most recent iteration of the list acknowledges some effort, but concludes the agency still fails to meet key criteria for removal. That finding aligns with what tribes often experience on the ground. too many delays that turn self-governance into negotiation rather than a predictable process. Variation across the 12 IHS area offices remains one of the biggest challenges. Some areas maintain strong collaborative relationships with tribes. Others are known for slow responses and unclear guidance. Unlike the Bureau of Indian Affairs, which recently updated its self-governance manual and standardized its policies, IHS still lacks uniform guidance. That absence contributes to uneven performance and prevents tribes from receiving consistent federal partnership. Another major structural issue is electronic health record or EHR modernization. Tribes in IHS still rely on RPMS, a legacy system that is now more than 40 years old. IHS has selected a new EHR system and is working on deploying it, and we appreciate the administration's efforts in this area. Finally, we are meeting at a moment when IHS is proposing a major strategic realignment of its structure.
The stated goal, creating a more accountable, efficient, and self-determination-driven agency, is one all of us share in principle. If done thoughtfully, this realignment could reduce variation across areas and strengthen technical support. Our responsibility today is straightforward to assess whether IHS is equipped to support the self-governance system that Congress created and which tribes have embraced. That means clear guidance, transparent data, timely contract processing, consistent area office performance, and modern systems that work for tribal governments. But tribes have made clear that they need more detail, more transparency, and more assurance that promised reforms will translate into real improvements. Our responsibility is something that is critical, and I look forward to hearing from our witnesses on these important issues and making sure that federal implementation is as strong as the self-determination principles that it's meant to uphold. The chair now recognizes the ranking minority member for any statement.
M
Mr. Benjamin Smith
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