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 Growth in Self-Governance 199420002012 Compacts 144482 Funding Agreements (FAs) 1463107 Tribes 14 (2.6%) 262 (47.1%) 337 (59.5%) IHS Budget awarded in Self-Governance 2.4%27.6%33.7%

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 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

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

8. 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.

9. 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 programs.

10. 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

11. 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

12. 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; and 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

13. Differences between Title I Contracting and Title V Compacting under the Indian Self-Determination Education and Assistance Act (ISDEAA) Differences between Title I Contracting and Title V Compacting under the Indian Self-Determination Education and Assistance Act (ISDEAA)

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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 ( 5 th Floor)

24. 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.

25. 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

26. Questions?

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