Overview of the Tribal Self-Governance Program in the Indian Health Service

1. Overview of the Tribal Self-Governance Program in the Indian Health Service Presented by: Indian Health Service Office of Tribal Self-Governance (OTSG) Staff

2. 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 communities.

3. Growth in the IHS TSGP

4. Areas participating in the Tribal Self-Governance Program

5. 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.”

6. Legislative History of the IHSTribal 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

7. Legislative History of the TSGP 1992 - Self-Governance Authority Extended to IHS (P.L. 102-573) 2000 - ISDEAA Title V Statute; 2002 - ISDEAA Title V Regulations 1988 - Tribal Self-Governance Demonstration Project (P.L. 100-472) Amendments 1994 – Technical Amendments to Title III 301 and 302(a) 2010 – IHCIA 1991 - IHS Funded to Perform Feasibility Study (P.L. 102-184)

8. Is your Tribe eligible for the Tribal Self-Governance Program? • Eligibility criteria to enter Self-Governance • Successfully complete a planning phase; • 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; and • 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

9. Differences between Title I Contracting and Title V Compacting under the Indian Self-Determination Education and Assistance Act (ISDEAA) Eligibility Payments Point of Contact Monitoring Redesign Signature Authority Documents Process Title I Processed by Area Office Title V Processed by Office of Tribal Self-Governance Alaska: Processed by Area Office • Title I • Federal recognition • Tribal resolution • Title V • Title I requirements • PLUS • Three years of financial stability and management • Title I • Model Contract • (+ additional terms) • Annual Funding Agreement • Title V • Compact • Funding Agreement Title I Awarding official (Area Contracting Officer) Title V Agency Lead Negotiator (ALN) (assisted by Federal negotiation team) Title I With IHS approval to meet contract requirements Title V Without IHS approval in accordance with ISDEAA Title I Awarding official (Area Contracting Officer) Title V IHS Director or her designee Title V - The Tribe produces a draft Compact and FA. - The ALN assembles a negotiation team and reviews the draft. - Following pre-negotiation discussions, the ALN negotiates with the Tribe on behalf of the IHS Director. - If issues arise, the Tribe may submit a Final Offer to the IHS, which will be deemed approved if not declined within 45 days. Title I -The eligible Tribe submits a Title I Contract Proposal to Awarding Official. -A draft Contract and AFA are produced, the Awarding Official negotiates with the Tribe. -A proposal that is not approved within 90 days is deemed approved. Title I Generally, one visit per contract year Title V No routine monitoring is required

10. How do I learn more about Self-Governance? • Informational handout, includes excellent FAQ’s • Other TSGP Resources • Websites: • http://www.ihs.gov/SelfGovernance/ • http://www.tribalselfgov.org • OSTG staff: • Contact us at: 301-443-7821

11. 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

12. IHS and Grantee Roles and Responsibilities • IHS • Describe PSFAs at all levels (SU, Area, HQ) • Identify staff on program management and delivery methods • 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

13. 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

14. 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

15. 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 Anna.Johnson2@ihs.gov

16. 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

17. 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

18. 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

19. Interested in learning more about theSelf- 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)

20. 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.

21. 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 immunizations • Reduced costs though successful negotiation with private health care providers

22. Questions?

23. Thank you! Office of Tribal Self-Governance (OTSG) 801 Thompson Avenue Rockville, MD 20852 301-443-7821