Overview of Self-Governance in the Indian Health Service.pptx

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					        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
Self-Governance    1994      2000      2012

Compacts            14        44        82

Funding             14        63       107
Agreements (FAs)

                    14       262       337
                   (2.6%)   (47.1%)   (59.5%)
IHS Budget
awarded in Self    2.4%     27.6%     33.7%
Areas participating in the
 Tribal Self-Governance
      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
  1988 - Tribal Self- 1992 - Self-Governance 2000 - ISDEAA Title V
     Governance        Authority Extended to        Statute;
Demonstration Project    IHS (P.L. 102-573)  2002 - ISDEAA Title V
    (P.L. 100-472)                               Regulations


            1991 - IHS Funded to   1994 – Technical        2010 – IHCIA
             Perform Feasibility Amendments to Title III
                    Study           301 and 302(a)
               (P.L. 102-184)
          Significant Milestones in the TSGP
• The Snyder Act is a general and broad statutory mandate authorizing
  IHS to "expend such moneys as Congress may from time to time
  appropriate, for the benefit, care, and assistance of Indians" and for
  the "relief of distress and conservation of health." 25 U.S.C. § 13

• Transfer Act transferred the responsibility for Indian health care from
  the Bureau of Indian Affairs (BIA) to the IHS. 42 U.S.C. § 2001(a)

• Tribal Self-Governance Demonstration Project authorized the BIA to
  negotiate and enter into Compacts with Tribes, which resulted in more
  flexibility in the operation of programs.

• Feasibility Study funding was provided for the purpose of conducting
  a feasibility study on expanding Tribal Self-Governance to IHS.

• Title III Amendments extended and expanded Self-Governance.
            ISDEAA, 1975
• The Indian Self-Determination and
  Education Assistance Act (ISDEAA)
  authorized tribes to contract with IHS and
  the BIA to operate programs or portions of
        IHCIA, 1976 & 2010
• The Indian Health Care Improvement Act
  (IHCIA) implemented Federal
  responsibility for the care and education
  of Indian people.
• The Patient Protection and Affordable
  Care Act permanently reauthorized and
  expanded the IHCIA in 2010
   Title V of Pub. L. No. 93-638
• Title V created a permanent Tribal Self-
  Governance Program (TSGP) within the IHS.
• Title V Regulations
 • Tribal Self-Governance Regulations
   promulgated to implement Title V
 • 42 C.F.R. Part 137
    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
                                       Eligibility                                              Differences between
                    Title I                     Title V
                                                                                     Title I Contracting and Title V Compacting
                    -Federal recognition
                    -Tribal resolution
                                                -Title I requirements                   under the Indian Self-Determination
                                                -Three years of                       Education and Assistance Act (ISDEAA)
                                                financial stability and
         Point of Contact                       management
Title I             Title V
Awarding official   Agency Lead
(Area Contracting   Negotiator (ALN)
Officer)            (assisted by Federal
                    negotiation team)                    Documents                                                    Process

                                           Title I                   Title V                    Title I                       Title V
                                           -Model Contract           -Compact
                                           (+ additional terms)      -Funding                   -The eligible Tribe submits   - The Tribe produces a
                                           -Annual Funding
     Signature Authority                   Agreement
                                                                     Agreement                  a Title I Contract Proposal
                                                                                                to Awarding Official.
                                                                                                                              draft Compact
                                                                                                                              and FA.
Title I
                    Title V                                                                     -A draft Contract and AFA     - The ALN assembles
Awarding official
                    IHS Director                                                                are produced, the             a negotiation team and
(Area Contracting
Officer)            or her designee                        Redesign                             Awarding Official             reviews the draft.
                                                                                                negotiates with the Tribe.
                                                                                                                              - Following
                                           Title I                   Title V                    -A proposal that is not       pre-negotiation
                                           With IHS approval         Without IHS approval       approved within 90 days is    discussions, the ALN
                                           to meet contract          in accordance with         deemed approved.              negotiates with the
              Payments                                               ISDEAA                                                   Tribe on behalf of the IHS
                    Title V
                    Processed by                                                                                              - If issues arise, the Tribe
Title I             Office of Tribal                                                                                          may submit a Final Offer
Processed by Area   Self-Governance                      Monitoring                                                           to the IHS, which will be
Office                                                                                                                        deemed approved if not
                    Alaska: Processed by                             Title V                                                  declined within 45 days.
                                           Title I
                    Area Office                                      No routine
                                           Generally, one visit
                                                                     monitoring is
                                           per contract year
       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-
(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 Self-
    Governance 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

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