U.S. Department of Health and
Human Services
Indian Health Service
Tribal Self-Governance Program
Indian Health Service
Office of Tribal Self-Governance
• Primary liaison and advocate for Tribes
participating in the IHS Self-Governance
Program (TSGP)
• Oversees the implementation of Tribal
Self-Governance legislation and
authorities within the IHS under Title V of
the Indian Self-Determination and
Education Assistance Act
Roles of OTSG:
Program Analysts
• Administer and Facilitate Self-Governance
Negotiation process
• Analyzes and evaluates the PSFAs being
considered for Self-Governance.
• Process completed Compacts and
Funding Agreements
• Provides support and technical assistance
on Self-Governance issues
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Roles of OTSG:
Policy Analysts
•
•
•
•
•
Works on a wide range of national issues
Administer OTSG Cooperative Agreements
Maintains and updates OTSG Policy Manuals
Review HHS Agency policy and regulations
Composes responses to Congressional
inquires
• Prepares briefing materials for OTSG and the
IHS Director
• Conducts research and analysis
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Roles of OTSG:
Financial Analysts
• Makes the payments to the SelfGovernance Tribes at the beginning of the
funding cycle (Fiscal, Calendar).
• Makes payments based on amendments
to funding tables throughout the year.
• Audit Review for Self-Governance
Eligibility
• OTSG Budget Activities
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OTSG Key Activities
• Reviewing eligibility requirements for Tribes
to participate in the TSGP and applications for
TSGP Planning and Negotiation Cooperative
Agreements.
• Participating in nation-to-nation negotiations
of ISDEAA Title V Compacts and Funding
Agreements and providing oversight of the
Agency Lead Negotiators (ALNs).
• Providing resources and technical assistance to
Tribes and Tribal Organizations for the
implementation of Tribal Self-Governance.
OTSG Key Activities
Coordinating Self-Governance Tribal Delegation
Meetings
– Purpose: TDMs are an opportunity for Tribes to meet
with the IHS Director or Senior Staff to address health
related projects and issues
– Respect the nation-to-nation relationship: Strengthen
and improve Tribal Partnerships by the government to
government relationship
OTSG Key Activities
• Developing and recommending policies, administrative
procedures, and guidelines for the IHS TSGP and
advising the IHS Director on TSGP actions and activities.
• Collaborating with Tribal and Federal partners to address
crosscutting issues and processes
• OTSG provides and partners with SGCE to provide
national, regional and individual trainings on the IHS
Tribal Self-Governance Program
OTSG Key Activities
Supporting the activities of the IHS Director's Tribal SelfGovernance Advisory Committee (TSGAC).
• Provides advice to the IHS Director on issues and
concerns pertaining to Self-Governance implementation
within the IHS.
• Represents all Self-Governance Tribes.
• Works directly with the Office of Tribal SelfGovernance (OTSG) to implement the Self-Governance
Act.
Upcoming Meetings
IHS TSGAC
Self-Governance Training
Quarterly Meetings August 18-19
July 21-22, 2015
Uncasville, CT
October 6-7, 2015
Washington, DC
Annual Self-Governance Strategy Session
September 9-10
Catoosa, OK
Annual Self-Governance Conference
April 24-29, 2016
Orlando, FL
Online Resources
For further information about the IHS Tribal
Self-Governance Program, please visit these
websites:
IHS Office of Tribal Self-Governance
http://www.ihs.gov/SelfGovernance/
Self-Governance Communication
& Education
http://www.tribalselfgov.org/
Trust Responsibility
“The Secretary is prohibited from waiving,
modifying, or diminishing in any way the
trust responsibility of the United States
with respect to Indian tribes and individual
Indians that exists under treaties,
Executive orders, other laws, or court
decisions.”
Legislative History
1988 - Tribal Self1992 - Self-Governance
Governance
Authority Extended to
Demonstration Project
IHS (P.L. 102-573)
(P.L. 100-472)
1991 - IHS Funded to
Perform Feasibility
Study
(P.L. 102-184)
1994 – Technical
Amendments to Title III
301 and 302(a)
2000 - ISDEAA Title V
Statute;
2002 - ISDEAA Title V
Regulations
2010 – ACA & IHCIA
Participation in Title I and Title V
Title I:
– 227 contracts and annual funding agreements
– $900 million transferred through Title I contracts
Title V:
– 87 compacts and 112 funding agreements
– 350 Tribes participating directly or through tribal
organizations and intertribal consortia
– Title V agreements transfer $1.8 billion, approximately
one-third of the IHS appropriation.
– Combined, these agreements transfer
approximately $2.5 billion, over half the IHS
appropriation.
Lump Sum
Funding
Redesign &
Rebudget
Recurring Base
Funds
Savings,
Interest, and
Use of
Carryover Funds
Contract
Support Costs &
Start Up Costs
Access of
Federal Sources
of Supply
Federal Torts
Claims Act
Coverage
Indian Health
Care
Improvement
Act
Terms of
compact and
funding
agreement
Examples of Benefits of the Indian Self-Determination and
Education Assistance Act
Required Contractual
Documents
• Title I: (1) A Contract that includes the model agreement
in the ISDEAA and any other provisions agreed to by the
parties, and (2) an Annual Funding Agreement (AFA)
describing all PSFAs to be performed or administered,
the associated funding, and method of payment.
• Title V: (1) A Compact that sets forth the general terms
of the nation-to nation relationship between the Tribe or
Tribal organization and the Secretary and (2) an annual
or multi-year Funding Agreement (FA) that generally
identifies the PSFAs to be performed or administered
and describes financial terms and the responsibilities.
Common Features of ISDEAA
Agreements:
Not Procurement Contracts
• In general, Federal contracting and cooperative
agreement laws do not apply to ISDEAA
agreements.
• Title I contracts must include the model contract
included in the statute, but there are no model
agreements in Title V.
– Title V does specify a small number of
mandatory terms.
Common Features of ISDEAA
Agreements:
Funds Provided
• Tribes can contract for any IHS program, service,
function, or activity (or portion thereof) that is not
inherently federal or congressionally restricted
(earmarked).
• The funding associated with these PSFAs
includes:
1. Funding the Secretary would have otherwise spent,
plus
1. “Contract support costs” which are an amount for the
reasonable costs for activities which must be carried
out by the contractor to ensure “compliance with the
terms of the contract and prudent management.”
Common Features of ISDEAA
Agreements:
Funds Provided
• Funds may only be reduced in subsequent years
pursuant to congressional action or tribal
authorization.
• Tribes may supplement their ISDEAA funds to
expand services while retaining the benefits of
the ISDEAA.
• Any savings due to Tribal operation may be used
to provide additional services or be expended to
carry out the ISDEAA agreement in the
succeeding fiscal year.
ISDEAA Title V Overview
Topic
Discussion
Program
Summary
Federally recognized Tribes or Tribal organizations compact with
the IHS to assume full funding and control over programs,
services, functions or activities (PSFAs), or portions thereof,
that the IHS would otherwise provide for Indians because of their
status as Indians.
25 U.S.C. § 458aaa-3-4(b)
Eligibility
Eligibility for Title V requires that the Tribe or Tribal
organization
(1) successfully complete a planning phase,
(2) request participation in Self-Governance by Tribal resolution
or other official action by the governing body and
(3) demonstrate three fiscal years of financial stability and
financial management capability.
25 U.S.C. § 458aaa–2; 42 C.F.R. §§ 137.15-23
ISDEAA Title V Overview
Topic
Discussion
Process
The Tribe or Tribal organization produces a draft Compact and FA.
The IHS Agency Lead Negotiator (ALN) assembles a negotiation
team and reviews the draft. Following
pre-negotiation discussions, the ALN negotiates with the Tribe or
Tribal organization on behalf of the IHS Director.
See generally 25 U.S.C. § 458aaa et seq.; 42 C.F.R. § 137.1 et seq.
Appeals
If issues arise on which the parties cannot reach agreement, the Tribe
or Tribal organization may submit a Final Offer to the Agency. Within
45 days, the Agency
must make a determination on the offer in accordance with the ISDEAA.
25 U.S.C. §§ 458aaa-6(b)-(d); 42 C.F.R. §§ 137.131-150
Redesign
A Tribe or Tribal organization may redesign or consolidate PSFAs
and Funding and reallocate or redirect funding without IHS approval in accordance
Reallocation
with the ISDEAA.
25 U.S.C. §§ 458aaa-4 & 458aaa-5(e); 42 C.F.R. § 137.185
ISDEAA Title V Overview
Topic
Discussion
Oversight:
Performance
Monitoring
No routine monitoring is required.
Mandatory
Reporting
Annual single agency audit as required by the Single
Agency Audit Act of 1984 and Health Status Reports.
25 U.S.C. §§ 458aaa-5(c) & 458aaa-6(a)(1); 42 C.F.R. §§
137.165—173 & 137.200—207
Grants
Statutorily-mandated grants may be included.
25 U.S.C. § 458aaa-4(b); 42 C.F.R. §§ 137.75-77
ISDEAA Title V Overview
Topic
Discussion
Retrocession
A Tribe or Tribal organization may choose to partially or fully
retrocede to the IHS.
25 U.S.C. § 458aaa-5(f); 42 C.F.R. § 137.185
Reassumption
by the IHS
The IHS may reassume operation of a PSFA and its associated
funding if there is a specific finding of imminent endangerment of
the public health caused by an act or omission of the Tribe or Tribal
organization and arising out of a failure to carry out the Compact
or FA or a finding of gross mismanagement of the funds
transferred by the Compact and FA.
25 U.S.C. § 458aaa-6(a)(2); 42 C.F.R. §§ 137.255-265
Funding
Available for
Planning and
Negotiation
Activities
Planning and Negotiation Cooperative Agreements are available..
Tribal Management Grants may not be used for Self-Governance
planning or negotiation activities.
25 U.S.C. § 458aaa-2(e); 42 C.F.R. §§137.24-26
Benefits of Title V
Compacting
• Participation in the TSGP affords Tribes the most
flexibility to set its own health care priorities and
tailor heath care services to the needs of their
communities when assuming IHS PSFAs.
• A Tribe or Tribal Organization may redesign or
consolidate PSFAs and reallocate or redirect
funding without IHS approval in accordance with the
ISDEAA.
• Strong Federal-Tribal partnerships have been critical
to the continued success of Title V and the TSGP.
• No routine monitoring is required.
Title I and Title V: Differences
Topic
Discussion
Program
Authority
Title I of the ISDEAA
25 U.S.C. § 450 et seq.
25 C.F.R. § 900 et seq.
Title V of the ISDEAA
25 U.S.C. § 458aaa et seq.
42 C.F.R. § 137 et seq.
Program
Summary
Under Title I, Federally recognized Tribes or Tribal Organizations
contract with the IHS to plan, conduct, and administer one or more
individual programs, functions, services, or activities (PSFAs), or
portions thereof, that the IHS would otherwise provide for Indians
because of their status as Indians.
Under Title V, Federally recognized Tribes or Tribal Organizations
compact with the IHS to assume full funding and control over
programs, functions, services, or activities (PSFAs), or portions
thereof, that the IHS would otherwise provide for Indians because of
their status as Indians.
Title I and Title V: Differences cont.
Topic
Discussion
Eligibility
Under Title I, any Federally recognized Tribe or Tribal Organization is
eligible for Title I contracting upon request of the Tribe by Tribal
resolution.
Eligibility for Title V requires that the Tribe or Tribal organization:
(1) successfully complete a planning phase, (2) request participation
in Self-Governance by Tribal resolution or other official action by the
governing body and (3) demonstrate three fiscal years of financial
stability and financial management capability.
Documents
Required
Title I: (1) A Contract that includes the model agreement in the
ISDEAA and any other provisions agreed to by the parties, and (2) an
Annual Funding Agreement (AFA) describing all PSFAs to be
performed or administered, the associated funding, and method of
payment.
Title V: (1) A Compact that sets forth the general terms of the nationto nation relationship between the Tribe or Tribal organization and the
Secretary and (2) an annual or multi-year Funding Agreement (FA)
that generally identifies the PSFAs to be performed or administered
and describes financial terms and the responsibilities.
Title I and Title V: Differences cont.
Topic
Discussion
Process
Under Title I, the eligible Tribe or Tribal Organization submits a
letter or Notice of Intent. The Tribe or Tribal Organization submits
a Self-Determination Contract proposal for review. A draft
Contract and AFA are produced, and negotiations are held with
the Tribe or Tribal Organization. Within 90 days after receipt of the
proposal, the IHS Area contracting officer must either approve the
proposal and award the Contract or provide written declination of
the proposal.
Under Title V, The Tribe or Tribal organization produces a draft
Compact and FA. The IHS Agency Lead Negotiator (ALN)
assembles a negotiation team and reviews the draft. Following
pre-negotiation discussions, the ALN negotiates with the Tribe or
Tribal organization.
Title I and Title V: Differences cont.
Topic
Discussion
Redesign and
Funding
Reallocation
Under Title I, a Tribe or Tribal Organization may redesign
PSFAs with IHS approval and may rebudget funding to meet
Contract requirements without IHS approval in accordance
with the ISDEAA.
Under Title V, a Tribe or Tribal organization may choose to
partially or fully retrocede to the IHS.
Retrocession
Under Title I, a Tribe or Tribal Organization may choose to
retrocede individual PSFAs or the entire Contract award to
the IHS.
Under Title V, a Tribe or Tribal organization may choose to
partially or fully retrocede to the IHS.
Thank you!
Office of Tribal Self-Governance:
301-443-7821
http://www.ihs.gov/selfgovernance