PLANNING AND PREPARING
FOR SELF GOVERNANCE
Self-Governance Communication &
Education Tribal Consortium
Self-Governance 101 Training
June 2, 2015
Self-Governance Works!
Tribal Options for Delivery of Services
• Direct Services: IHS & BIA provide all services through
federal employees and facilities
• “638 Contracting:” Tribe signs Program Contracts with
BIA or IHS to deliver specific programs through tribal
departments.
• Self-Governance: Tribe signs Compact and Funding
Agreement with ability to redesign programs and services
as well as reallocate funds to meet the Tribe’s community
needs.
Self-Governance Works!
Reasons for Self-Governance
• Improve the quality & quantity of
services provided to Tribal members
• Recognize Tribe’s right to determine
priorities, redesign and create new
programs to meet local needs
• Formalize relations between the
United States and Indian Tribes on
government-to-government basis as
provided for in the US Constitution
• Promote greater social, economic,
political, cultural stability and selfsufficiency among Tribes
Self-Governance Works!
• Establish better fiscal accountability
through expanded Tribal
Governmental decision making
authority
• Institute administrative costefficiencies through reduced
bureaucratic burdens and streamline
decision-making authority
• Change roles of the Federal
Departments and agencies serving
Tribes by shifting their
responsibilities from day-to-day
management of Tribal affairs to that of
Protectors and Advocates of Tribal
interests
Tribal Management Under Self-Governance
Federal Control
Funding
Flexibility
• Advance Lump Sum
Payments
• Recurring Base
Budgets
• Redesign Programs
• Merge and Assign
Program Funds
• Adopt revised
regulations
Self-Governance Works!
Tribal Control
Program Design &
Delivery
Changes to Tribal
Gov’t
• Community-Driven
• Need’s Driven
• Priority Driven
• Outcomes vs. Jobs
• Long-term Planning
• Collaboration btwn
Tribal Depts. And
other entities
Self Governance Eligibility
•Successfully completed the “planning phase”
•Requested participation by resolution or other official
action by the governing body
•Three years of demonstrated financial stability and
financial management capability
Self-Governance Works!
Application Process & Timelines
• Planning and Negotiation Grants are available but NOT
Required
• Application Process begins with submission by Tribe
• Timelines depend upon meeting eligibility criteria and
length of negotiation process
Self-Governance Works!
Planning Phase
• Self-Governance Law, Regulations, and Draft Compact and
Funding Agreement
• Legal and Budgetary Research
• What funds are available from IHS (Program Shares, Area Shares,
Headquarters Shares)
• Third Party Billing Funds (previous fiscal years & future)
• Internal Tribal Research and Planning
• Direct Programs
• Administrative Planning
• Organizational Preparation and Training
Self-Governance Works!
Legal and Budgetary Research
(Funds Available from IHS)
• Program Shares: Sub-Sub Activity
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Hospitals & Clinics
Dental
Mental Health
Alcohol & Substance Abuse
Public Health Nursing
Health Education
Community Health Representative
Direct Operations
Contract Health Services
OEH (Environmental Health, M&I,
Facilities)
Self-Governance Works!
• Area Shares: Sub Activity and Line
Item Table
• Headquarters Shares: Sub Activity
and Line Item Table
• Inherent Federal Functions and
Stable Base Budgets
Third Party Billing Clinic Structure
Clinic Structure
• Provider (Hospital) Based
Status
• Federally Qualified Health
Center (FQHC)
• Fee for Service
Third Party Billing
• Medicaid
• Medicare
• Tribal Insurance
• Private Sector Insurance
• Implications for third party billing
• Implications for Licensure and Provider
numbers
• Service to Non-Beneficiaries
• Health Insurance Exchanges
Self-Governance Works!
Internal Tribal Research and Planning
Direct Programs
• Identify PSFAs available to compact and identify funding amounts of such
PSFA’s available to the Tribe and determine which PSFAs the Tribe may
elect to assume
• Gather data of user population and funding allocations
• Access previous materials and budgets to analyze cash flow
• Evaluate the current level of health care being provided for each of the
Tribe's share of each PSFA to determine cost vs. benefit
• Compare the level of services provided currently to the level of services the
Tribe will have the ability to provide per compacting program assumption
Self-Governance Works!
Internal Tribal Research and Planning
Direct Programs
• Identify successes and challenges with intent to identify exemplary models of
Title V compacting.
• Prepare a summary of effective measures that the Tribe will need to take in
order to successfully execute a Title V compact.
• Develop a detailed budget to express the costs the Tribe will assume
Self-Governance Works!
Administrative Planning
Contract Support Costs…Direct and Indirect
Costs
• Direct Contract Support Costs– Negotiated with IHS Area Office
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Fringe Benefits such as unemployment taxes, workers compensation
Insurance
Facility support not otherwise provided
Training required to maintain certification
• Indirect Contract Support Costs – Negotiated with the DOI
National Business Center or DHHS
• IHS CSC Policy – 3 Pools (ISD/Start-up, Prior Year Funding, New
Funding)
Self-Governance Works!
Administrative Planning Reports
• PSFA's
• IHS Budget & Tribal Shares
• Facility Budget & Administrative
Costs
• Tribal Allocation (Methodology) of
dollars under Funding Agreement
• Develop Tribal budget
• Patient workload
• CHS workload
Self-Governance Works!
• Summary of effective measures
needed to execute Title V
Compare current services to
Title V services
• Clinic user population reports
• Billing report, billed vs. collected
• Operational Cash Flow showing
where third party is budgeted
• Third party revenue trends
• Recommendations to redesign
delivery systems
Organizational Preparation & Planning:
Public Awareness and Education
• Management Meetings
• Tribal Management – ensure all departments understand the potential impact on
the tribe and their departments
• Tribal Council/Committees – ensure the governing body of the Tribe
understands the potential impact on the Tribe and their constituents
• IHS Area Office and IHS Headquarters – Intent of Tribe
• Other Tribes served
• Service Unit or facility impacted
• Employee Meetings
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Explain Self-Governance Overview & Authority
Update on Intent to Compact
Explain Plans for Future including services redesign, etc.
Explain Employment Benefits and Options (IPA/MOA)
Self-Governance Works!
Organizational Preparation & Planning:
Public Awareness and Education
• Printed Communications
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Tribal Letter of Intent to IHS
Tribal Letter to other Tribes served
Information Packets for Elected Officials (Tribal, Local, & State)
Press Release
Information Handout (FAQ) for Employees
• Oral Communications
• Tribal Communities
• Explanation of Self-Governance and its authorities
• Ascertain their desires and needs
• Other Tribes
• Meet with other Tribes for Resolutions and/or support
Self-Governance Works!
Organizational Preparation & Planning
• Administrative
• Organizational Structure within the Tribe
• Direct Services Delivery
• Indirect Functions
• Current Employees
• IHS organizational chart
• Staffing list with position, pay grade, status, and pay
• Develop offer of employment
• Financial Operational
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Review operational budget for last few fiscal years
Review revenue and expenditure reports for last few fiscal years
Outstanding Audits including compliance and billing
Review original source documents – increases allocated to this budget for last
few years
Self-Governance Works!
Organizational Preparation
• Implementation
• Administrative
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Letters of Intent
Background and Screenings
Offers of Employment
Employee Notice of Separation
Develop Administrative capacity through IDC resources for HR, Fiscal and
Procurement services
• Financial Operational
• Scheduled Meetings
Self-Governance Works!
Keys to Successful Implementation of
Self-Governance
• Plan to Understand and/or Implement:
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Fundamentals of Self-Governance—Compact and Funding Agreement
IHCIA and ACA Provisions
IHS Programs, Budgets, and Funding Formulas
Contract Support Costs
Health Care Implementation at Clinic or Hospital Level—Structure,
Third Party Billing
• Comprehensive Tribal Capacity and Implementation Plan
Self-Governance Works!