Tribal leaders tell House subcommittee IHS must modernize 638 contracting but warn against centralizing negotiators

A House Natural Resources Subcommittee on Indian and Insular Affairs field hearing reviewed Indian Health Service (IHS) plans to modernize implementation of Public Law 93-638, the Indian Self-Determination and Education Assistance Act, and to realign certain IHS functions.

Chair opening remarks framed the oversight goal: tribes now manage a majority of IHS-funded programs and the agency must improve contract processing, transparency, and modernize systems so tribal health programs can plan reliably. The chair said delays in amendments, inconsistent area-office performance, and a legacy electronic health record system impede services and tribal self-governance.

Deputy Director Benjamin Smith of IHS told the subcommittee IHS oversees a system with 12 area offices, roughly 2,800,000 American Indian and Alaska Native patients annually, and that tribes now manage about 62% of the IHS budget. Smith said IHS’s priorities include addressing contract support costs and 105(l) lease issues after recent litigation, modernizing the RPMS electronic health record, and addressing workforce shortages. Smith described a proposed realignment as a ‘‘realignment, not a reduction’’ intended to standardize…