Overview of Self-Governance in the Indian Health Service

Overview of the
Tribal Self-Governance Program
in the Indian Health Service
Presented by:
Indian Health Service
Office of Tribal Self-Governance (OTSG) Staff
What is the
Tribal Self-Governance Program ?
• Indian Health Service (IHS) Tribal Self-Governance
Program is a tribally driven, congressional legislative
option that authorizes federally recognized Tribes and
Tribal Organizations to negotiate with the IHS and
assume full funding and control over programs, services,
functions, and activities (PSFAs), or portions thereof, that
the IHS would otherwise provide.
• IHS Tribal Self-Governance Program (TSGP) provides
Tribes with the flexibility to manage and design program
funds to best fit the needs of their citizens and Tribal
Growth in the IHS TSGP
Growth in
Agreements (FAs)
IHS Budget
awarded in
Areas participating in the
Tribal Self-Governance Program
The Trust Responsibility
and Self-Governance
“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 of the IHS
Tribal Self-Governance Program
• 1921: Snyder Act , Pub. L. No. 67-85
• 1955: Transfer Act, Pub. L. No. 83-568
• 1975: Indian Self-Determination and Education
Assistance Act, Pub. L. No. 93-638
• 1976: Indian Health Care Improvement Act
• Pub. L. No. 94-437 (1976)
• Pub. L. No. 111-148 (2010) amended
Legislative History of the TSGP
1992 - Self-Governance 2000 - ISDEAA Title V
1988 - Tribal SelfAuthority Extended to
IHS (P.L. 102-573)
2002 - ISDEAA Title V
Demonstration Project
(P.L. 100-472)
1994 – Technical
1991 - IHS Funded to
Perform Feasibility Amendments to Title III
301 and 302(a)
(P.L. 102-184)
2010 – IHCIA
Is your Tribe eligible for the
Tribal Self-Governance Program?
• Eligibility criteria to enter Self-Governance
1. Successfully complete a planning phase;
2. Request participation in the Tribal Self-Governance
Program by Tribal resolution or other official action
by the governing body of each Tribe to be served;
3. Demonstrate three (3) fiscal years of financial
stability and financial management capability.
• Title V eligibility criteria can be found at:
• 25 U.S.C. § 458aaa-2
• 42 C.F.R § 137.15-46
Title I
-Federal recognition
-Tribal resolution
Point of Contact
Title I
Awarding official
(Area Contracting
Title V
Agency Lead
Negotiator (ALN)
(assisted by Federal
negotiation team)
Signature Authority
Title I
Awarding official
(Area Contracting
Title V
IHS Director
or her designee
Title I
Processed by Area
Title V
Processed by
Office of Tribal
Alaska: Processed by
Area Office
Title V
-Title I requirements
-Three years of
financial stability and
Differences between
Title I Contracting and Title V Compacting
under the Indian Self-Determination
Education and Assistance Act (ISDEAA)
Title I
-Model Contract
(+ additional terms)
-Annual Funding
Title V
Title I
With IHS approval
to meet contract
Title V
Without IHS
approval in
accordance with
Title I
Generally, one visit
per contract year
Title V
No routine
monitoring is
Title I
Title V
-The eligible Tribe submits
a Title I Contract Proposal
to Awarding Official.
- The Tribe produces a
draft Compact
and FA.
-A draft Contract and AFA
are produced, the
Awarding Official
negotiates with the Tribe.
- The ALN assembles
a negotiation team and
reviews the draft.
-A proposal that is not
approved within 90 days is
deemed approved.
- Following
discussions, the ALN
negotiates with the
Tribe on behalf of the IHS
- If issues arise, the Tribe
may submit a Final Offer
to the IHS, which will be
deemed approved if not
declined within 45 days.
How do I learn more
about Self-Governance?
• Informational handout, includes excellent
• Other TSGP Resources
• Websites:
• http://www.ihs.gov/SelfGovernance/
• http://www.tribalselfgov.org
• OSTG staff:
• Contact us at: 301-443-7821
Planning & Negotiation
Cooperative Agreements
Assistance for the transition into Self-Governance
• Eligibility Criteria for a Cooperative Agreement
• Who can apply?
• Tribes that have not received a Cooperative Agreement
• Tribes that received a Cooperative Agreement , but chose not to
enter the IHS Tribal Self-Governance Program
• Tribes that received a Cooperative Agreement and are planning to
assume new or expanded programs
• A Tribe that has received a Cooperative Agreement is under no
obligation to enter the IHS Tribal Self-Governance Program
IHS and Grantee Roles and
• Describe PSFAs at all levels (SU, Area, HQ)
• Identify staff on program management and delivery
• Provide statutes, regulations, and policies with IHS
authority to administer programs
• Grantee
 Research and analyze IHS budget
 Establish process to identify PSFAs that could be
incorporated into current Tribal programs
 Determine Tribal share of each PSFA and current level
of services provided
Planning Cooperative Agreements
• Planning activities must include:
• Legal and budgetary research
• Internal planning and organization
• Information gathering
• Current PSFAs
• Funding for PSFAs available at all organizational levels
• In fiscal year 2011, OTSG awarded 3 Planning Agreements at
$75,000 each
• This year, OTSG will announce 5 awards at $120,000 for
Planning Cooperative Agreements
Negotiation Cooperative Agreements
• Negotiation activities include:
• Determining what PSFAs will be negotiated
• Identifying Tribal shares
• Developing terms and conditions of a Compact and FA
• Cover expenses involved in and preparing for Compact
and FA negotiations
• In fiscal year 2011, OTSG awarded 2 Negotiation at
$30,000 each
• This year, OTSG will announce 5 awards available at
$48,000 each
Planning & Negotiation
Cooperative Agreements
• Objective Review Committee
• Funding Opportunities Announced by:
• www.Grants.gov
• www.ihs.gov/selfgovernance
• Federal Register Notice
• For more information, contact:
Anna Johnson, Program Analyst, Office of Tribal Self-Governance
(301) 443-7821
We’re ready for Self-Governance;
What happens next?
• Tribe develops a Compact and Funding Agreement
• A Tribe may also develop the applicable financial tables, or
• the Agency Lead Negotiator (ALN) may develop the financial tables on the
Tribe’s behalf.
• Tribe provides all proposed documents to its respective Agency
Lead Negotiator (ALN)
• Federal team will review
• The team may also utilize the assistance of subject matter experts (SMEs)
as appropriate and necessary
• The ALN may schedule a pre-negotiation with the Tribe
• The outstanding issues from the pre-negotiations will be on
the agenda during final negotiations
We’ve reached agreement;
What happens next?
• The Tribe and IHS reach agreement on all documents
• Tribe works to secure Tribal Leader signature
• Tribe sends two original signed Compacts and/or Funding
Agreements to the ALN
• The Tribe may also provide the Self-Governance Funding Table if it opts to
construct it.
• Otherwise, it may provide concurrence via email with the SelfGovernance Funding Table the ALN has prepared
• The ALN will review/certify the package and route to OTSG
• The OTSG Program/Financial Analysts will review and
recommend for signature via an internal routing slip
• The OTSG Director will review and recommend for IHS
Director’s signature
Who is on the IHS Team?
Roles and Responsibilities of the Federal Team
• Who are the players?
• Area, OTSG, OGC
• Program Staff/Subject Matter Experts
• Area Office
• Agency Lead Negotiator (ALN) has delegated authority to negotiate on
behalf of the Director, Indian Health Service
• ALN serves as the main point of contact for Compact and FA activity
• ALN coordinates all negotiation dates with IHS Team & Tribes
• Subject Matter Experts (SME), i.e. Finance Officer, CMO
• Office of Tribal Self-Governance (OTSG)
• Program Analyst
• Financial Analyst
• Office of the General Counsel (OGC)
• Regional Attorney
• Legal SME’s
Interested in learning more about the
Self- Governance negotiation process?
We welcome and encourage you to attend
The Art of Negotiations:
Nation-to-Nation Negotiation
of Self-Governance
Compacts and Funding Agreements
Tuesday, May 8, 2012
9:00 – 10:30 a.m.
Grand Ballroom A/B
( 5th Floor)
Building Relationships &
Establishing Partnerships
• Tribal Consultation
• Tribal Consultation Summit
• August 7-8, 2012, Denver, CO
• Tribal Delegation Meeting (TDM)
• A Tribe may request a TDM through the OTSG
• Provides an opportunity to present critical issues.
• Tribal Self-Governance Advisory Committee (TSGAC)
• Quarterly meetings
• Technical Advisory Groups
• Convened to work on technical issues, include tribal/federal SME’s
• Workgroups are established for consulting and working on
various issues as the need and opportunity is presented.
Success in Self-Governance
• Expanded services through collaboration
• Utilizing technology, such as telemedicine, to expand access to
care in remote areas
• Established innovative wellness and prevention programs
• Enhanced chronic disease management
• Enhanced well-baby programs, including screenings and
• Reduced costs though successful negotiation with private
health care providers
Thank you!
Office of Tribal Self-Governance (OTSG)
801 Thompson Avenue
Rockville, MD 20852