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Indian Health Service

Indian Health Service. Office of the Director. 2010 ANNUAL SELF-GOVERNANCE CONFERENCE TRAINING SESSION May 2, 2010. OTSG Presentation Outline. What is OTSG and What do we do? Legislation Compacting: Pre-Negotiation Compacting: Negotiation Process Tribal Health Care process

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Indian Health Service

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  1. Indian Health Service Office of the Director 2010 ANNUAL SELF-GOVERNANCE CONFERENCETRAINING SESSIONMay 2, 2010

  2. OTSG Presentation Outline • What is OTSG and What do we do? • Legislation • Compacting: Pre-Negotiation • Compacting: Negotiation Process • Tribal Health Care process • General outline of the process • Documents from the Compacting process • Self Governance Outcomes

  3. The Trust Language “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.” 25 U.S.C 458aaa-6(g)

  4. OTSG Key Activities • OTSG Works with 330 Self-Governance Tribes and other Tribes interested in Self-Governance • Self-Governance Implementation • Indian Self-Determination and Education Assistance Act (ISDEAA) • Policy Development for Tribal Self-Governance • Agency Advisor • Compact/Funding Agreement Negotiations • Special Project Oversight • Nation-wide Self-Governance Promotion

  5. Self-Governance Goals Formalize U.S. & Tribal relations on a Government to Government basis Promote social, economic, political, and cultural stability and self-sufficiency Establish better fiscal accountability through expanded Tribal decision making Change U.S. role from day-to-day management to advocates of Tribal interests

  6. Outreach and Education Partners • Self-Governance Communication & Education • National Indian Health Board • National Congress of American Indians • Other Tribal Organization; and • All TRIBAL GOVERNMENTS

  7. TSGAC Tribal Self-Governance Advisory Committee • Strengthening Government-to-Government Communication and Relations • Problem Solving (National Issues) • Providing Technical Assistance • Promoting Tribal Consultation

  8. Self-Governance Structure • IHS • Dr. Yvette Roubideaux, Director • Randy Grinnell, Deputy Director • Hankie P. Ortiz, Director, • Office of Tribal Self-Governance • Tribal • Jefferson Keel, Chairman - Tribal Self-Governance Advisory Committee (TSGAC), • Lt. Governor - Chickasaw Nation, • President - NCAI • National Forums • TSGAC • Workgroups

  9. DIRECTOR (Ortiz) Deputy Director (Smith) Program Analyst (Nuttle) Program Analyst (Manydeeds) Policy Analyst (Houle) Policy Analyst (Vacant) Financial Analyst (Quinn) Program Analyst (Larney) Financial Analyst (Vacant) Office of Tribal Self-Governance Program Analyst (COTA) Old Elk Total FTE: 12 Secretary Mary Beardsley Ofc. Auto Assistant Katie Fixico Note: Current Office as of 4/6/2010

  10. Tribal Self-Governance Legislation

  11. Self Governance Legislation • Legal basis for Indian Health Care • Legislative History of Self Governance • Recent authorizing laws and regulations

  12. Snyder Act Pub. L. 67-85 (1921) Transfer Act Pub. L. 83-568 (1955) Indian Health Care Improvement Act - IHCIA Pub. L. 94-437 (1976), Pub. L. 111-148 (2010) Major Indian Health Care Legislation

  13. Self-Governance Legislative History • Indian Self-Determination and Education Assistance Act P.L. 93-638 (1975) -contracting with the BIA or IHS. • 1988 - Tribal Self-Governance Demonstration Project P.L. 100-472 (1988)- authorized BIA to compact. • 1992 - Self-Governance Authority Extended to IHS P.L. 102-573 (1992) IHS authority to compact.

  14. Current Self-Governance Legislation P.L. 106-260 • Title V, P.L. 106-260, 25 U.S.C 458aaa – Permanent Tribal Option Within IHS (August 18, 2000) • Title VI – Authorizes Feasibility Study for HHS Programs • Title V – Negotiated rulemaking process and the Regulations promulgated (May 17, 2002)

  15. Compacting Process Pre-negotiation

  16. Self-Governance Eligibility Successfully Complete Planning Phase Submit Official Request (Tribal Resolution) Demonstrate Financial Stability and Management Capability

  17. Planning Phase • 42 C.F.R. 137.20 • Planning completed to satisfaction of the Tribe and includes: • Legal and Budgetary Research • Internal Tribal government planning and organizational preparation relating to the administration of health programs

  18. Financial Stability and Financial Management Capability • For three years prior, no uncorrected significant and material audit exceptions in the required annual audit of the Tribe’s self-determination contracts or self-governance funding agreements with any Federal agency (42 C.F.R. 137.21)

  19. Compacting Programs Tribes/Tribal Organizations may assume any Program, Service, Function, Activity (PSFA) or portions thereof, that are not inherently Federal.

  20. Compacting Process • PLANNING • Gathering information needed to determine what PSFA’s to compact, when and how to implement • Information on what services IHS currently provides to the Tribe NEGOTIATION • Negotiation involves reaching agreement on the Compact and Funding Agreement

  21. Planning and Negotiation Cooperative Agreements • FY 2010 Cycle - Closed; FY 2011 Cycle - TBA • Planning Activities (8 Available) • $75,000 • Negotiation Activities (8 Available) • $30,000

  22. Title V vs. Title I • Compact v. Contract • Agency Lead Negotiator • Signature Authority • Model Agreement Language • Autonomy and Flexibility • Federal Oversight • Reporting Requirements

  23. Determining What Programs to Compact • Examples of Tribal Guiding Principles: • The Tribe/Tribal Organization may not assume a program if services to the people would be diminished. • The Tribe/Tribal Organization must be assured that it could, at a minimum, maintain the current level of service being provided by the Federal Government. • The program could be successfully operated administratively

  24. Acquiring Federal Information • Program by program listing of all funding available • Program, title, description, and total program budget amount • Identification and justification of residual at all levels • Identification of the Tribe’s program amount • Identification of Tribal share for each program • Basis for determining Tribal share (distribution formula or allocation methodology) • Relevant information on the number of people served, etc., for each program

  25. Compacting Process Negotiation

  26. Negotiation Teams IHS Agency Lead Negotiator Office of Tribal Self-Governance Office of the General Counsel (optional) Financial personnel (optional) Program personnel (optional) Tribe (Not limited to these, but examples) Designated Negotiator Health Board (optional) Tribal Council (optional) Health personnel (optional) Tribal Attorney (optional)

  27. Self-Governance Negotiations • Determine with the Tribal Governments the: • Functions and responsibilities to be transferred • Resources to transfer – both direct program and support resources • Services to be provided under the Compact • Maintain the United States Government’s trust responsibility • Prevent reduction in services, contracts or funds available to Tribes/Tribal Organizations not participating in Tribal Self-Governance

  28. Self-Governance Compacts and Funding Agreements • Compact: • Establishes legal commitments between • the IHS and the tribe. • Funding Agreement: • Serves as the business document • establishing the dollar amount the Tribe • will receive and serves as the fiscal • obligation document. • Both documents are negotiated legal • agreements between Tribal Governments and • the IHS.

  29. Responsibilities of Self-Governance Compacts and Funding Agreements • Transfers Federal functions and responsibilities • Transfers Service Unit resources and proportionate shares of Headquarters and Area Office resources to Tribes • Provides flexibility to the Tribe to redesign programs and realign resources to better address local needs and priorities

  30. Impact on Federal Employees • Tribal Employment – Direct Hire • Personnel Action and Options • Memorandum of Understanding (MOU) for Commission Corps personnel • Intergovernmental Personnel Act (IPA) for civil service personnel • Reduction in Force (RIF) • Myths

  31. Self-Goverance Outcomes Examples and Statistics

  32. Self-Governance Today

  33. Examples of Tribal Success Through Self-Governance • Negotiating with private health providers for more cost effective services • Providing Tribal members with a choice of health providers • Improving and expanding the quality and quantity of services to their elderly population • Improving and expanding dental and visual care programs • Development of special diabetes treatment programs with staff specially trained in the treatment of diabetes • Construction of new facilities for health care services/programs through the leverage of other resources

  34. Contact Information Indian Health Service Office of Tribal Self-Governance 801 Thompson Ave., Suite 240 Rockville, MD 20852 Tel. 301.443.7821 Fax. 301.443.1050 www.ihs.gov/SelfGovernance

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