Charting New Trails:

1. Charting New Trails: Building Tribal Capacity to Address Health Needs Through Tribal Self-Governance

2. Discuss with colleagues at least two legal and policy advantages associated with participation in the IHS Tribal Self-Governance Program to build Tribal capacity in addressing health needs • Incorporate Tribal consultation to strengthen the partnership between Tribes and the United States to improve health programs Learning Objectives

3. Overview of the IHS Tribal Self-Governance Program

4. PLANNING Eligibility: The Tribe must: (a) Successfully complete a planning phase (b) Request participation by official Tribal action. (c) Demonstrate three years of fiscal stability and financial management capability (2) Planning Cooperative Agreements: Available, not required (3) Mandatory Planning Phase Components (a) Legal and budgetary research (b) Internal Tribal government planning and organizational preparation relating to the administration of health care programs. (c) Completion to the satisfaction of the Tribe PRE-NEGOTIATION Review and discussion of issues identified during the planning phase IHS provides information related to IHS programs, financial matters, and Tribal shares A draft Compact, Funding Agreement (FA), and funding table are produced, typically by Tribe Review and discussion of the draft Compact, FA, and funding table Pre-negotiation may take the form of a formal meeting or a series of informal meetings or conference calls Overview of the IHS Tribal Self-Governance Program

5. POST-NEGOTIATION The ALN reviews the Compact, FA, and all attachments to ensure they reflect what was agreed to during negotiations, packages the documents, and sends the package to the OTSG Director. The OTSG reviews the package and processes it for review and signature by the IHS Director. IHS Director, or a designee, signs the Compact and FA. With a signed agreement in place, the payment process can begin. NEGOTIATION Having reviewed the draft documents, the Tribal and Federal negotiation teams work together to determine the terms of the Tribe’s Compact and FA. The Agency Lead Negotiator (ALN) is the only Federal team member with the authority to negotiate on behalf of the IHS Director DISPUTES Final Offer: If issues arise on which the parties cannot reach agreement, the Tribe may submit a Final Offer to the IHS. Within 45 days, the IHS must make a determination on the offer. Any rejected provision may be removed from an Agreement. The Tribe may appeal the Agency decision as described by regulation. Overview of the IHS Tribal Self-Governance Program

6. TRIBAL OPERATION Redesign and reallocation: The Tribe may redesign PSFAs and reallocation funding without IHS approval. Records: The Tribe is required to keep and provide records as required by regulation. Payments: Approved at IHS Headquarters. Performance monitoring: No routing monitoring is required. Overview of the IHS Tribal Self-Governance Program

7. Legal and Policy Advantages of Participation in the IHS Tribal Self-Governance Program

8. The IHS cannot evaluate the advantages for Tribal health programs, because Tribes define and evaluate their own successes. • But, the IHS evaluates the Tribal Self-Governance Program. How do we determine the advantages of participating in the Program?

9. Availability of options • Participation rates • Portion of the IHS budget • Geographic representation • Rights specific to Self-Governance Tribes • OTSG involvement • Educational efforts Possible advantages include:

10. Direct Service Tribal Self-Determination Program Tribal Self- Governance Program Other Tribally Specific Initiatives Availability of Options is an Advantage

11. Participation Rates are an Advantage

12. Participation Rates are an Advantage

13. Increased Budget Portion is an Advantage

14. Diverse Geographic Representation is an Advantage

15. No model agreements. Tribes typically provide the first draft of agreements. • Multi-year option. Compacts and Funding Agreements do not need to be negotiated annually. • Redesign. Tribes may redesign PSFAs without IHS approval in accordance with law. • No routine monitoring. There are no performance monitoring visits. • Limited reporting. Self-Governance Tribes must submit only annual single agency audit and health status reports. • Final offer process. An additional dispute resolution process exists. Rights Specific to SG Tribes are an Advantage

16. Decentralized program structure with national coordination and representation • Agency Lead Negotiator. Located at the IHS Area Office and negotiates on behalf of the HHS Secretary. • Office of Tribal Self-Governance (OTSG). Located in the Office of the IHS Directorand responsible for a wide range of Agency functions that are critical to partnerships with Tribes. • Office of Finance and Accounting (OFA). Responsible for the timely preparation of the annual IHS Headquarters financial tables and provides advice to the ALNs, as requested. • Office of the General Counsel (OGC). Located within the Office of the Secretary, HHS. Provides legal counsel to the IHS. Program Structure is an Advantage

17. 25 U.S.C. § 458 aaa, et seq. (2000); 42 U.S.C. Part 135 (2002) Secretary, HHS Director, IHS 60 Fed. Reg. 56605 (November 9, 1995) OTSG DHO/ALN ALASKA Delegation of Authority, Program #17 (Dec. 17, 1996) Delegation of Authority, Program #15 (March 14, 1996) Delegation of Authority, Program #16 (March 14, 1996)

18. IHS - Office of Tribal Self-Governance DIRECTOR (SES-340) [Acting-Smith] Deputy Director (GS-340-15) [Smith] Program Analyst (GS-343-14) [Manydeeds] Program Analyst (GS-343-14) [Larney] Program Analyst (GS-343-13) [King] Policy Analyst (GS-301-14) [Vacant] Policy Analyst (GS-301-13) [Patton] Financial Analyst (GS-501-14) [Quinn] Financial Analyst (GS-501-14) [Mayo] Financial Analyst (GS-501-14) [Vacant] Program Analyst (GS-343-11) [Johnson] Program Analyst (GS-343-11) [Smith-Kaprosy] Financial Analyst GS-501-9/11-13 [Vacant] Secretary (GS-318-9) [Beardsley] Staff Assistant GS-301-7/9 [Longenecker] Total FTE: 14 Total Temp: 1 Ofc. Auto Assistant STEP (GS-326-3) [Parkinson] SES to GS-FTE ratio: 1:14 Note: Current Office as of 6/22/2012

20. Incorporating Tribal Consultation

21. Tribal Consultation Brings Results • “No right is more scared to a nation, to a people, than the right to freely determine its social, economic, political, and cultural future without external interferences. The fullest expression of this right occurs when a nation freely governs itself.” • Joseph B. DeLaCruz • Quinault Indian Nation

22. Formation of the HHS Secretary’s Tribal Advisory Council (STAC)Continued Development of the Tribal-Federal Relationship

23. HHS Tribal Consultation ReportDiscussions of Tribal Consultation Efforts

24. Formation of the Director’s Advisory Workgroup on Tribal Consultation (DAWTC)Continued Development of the Tribal-Federal Relationship

25. OTSG Efforts Ensure Tribal Consultation is a Success

26. Coordinates the IHS Tribal Consultation Summits • Drafts IHS input for the HHS Tribal Consultation Report • Coordinates Tribal Delegation Meetings • Helps to determine when Tribal consultation is needed • Reviews and comments on circulars, policies, manuals, guidance to ensure Tribal consultation occurs OTSG Efforts to Ensure Tribal Consultation are a Success

27. The Tribal Self-Governance Advisory Committee (TSGAC) works with many other workgroups and committees • Tribes frequently comment on and recommend Agency action • Tribes fund and support national Tribal organizations • Tribes engage in continuous education to ensure effective Tribal consultation Tribal Efforts to Ensure Tribal Consultation are a Success

28. Thank you! Indian Health Service Office of the Director Office of Tribal Self-Governance 801 Thompson Ave., Suite 240 Rockville, Maryland 20852 Phone: (301) 443-7821