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Circular 91-03


DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Indian Health Service
Rockville Maryland, 20857

Refer to:  OTA/DTIS

INDIAN HEALTH SERVICE CIRCULAR NO. 91-3


Effective Date:  April 2, 1991

TRIBAL DELEGATION VISITS

  1. PURPOSE.  This Circular establishes the Indian Health Service (IHS) policy and procedure pertaining to meetings requested by tribal leaders/representatives in IHS Headquarters.

  2. BACKGROUND.  Tribal leaders and representatives frequently request meetings with the Director and Associate Directors of the IHS to discuss pertinent health policy and program management issues concerning the provision of health services to the Indian population.  To assure that IHS staff are properly briefed and prepared to respond to questions and requests of tribal delegations during the meeting, the following policy is established.

  3. POLICY.

    1. The Director, IHS (or his designee) will meet with tribal delegations upon their request.

    2. Requests, issues/concerns, or commitments requiring follow up will be completed and provided to the tribe in a timely manner.

  4. PROCEDURES.

    1. Coordination

      1. Each Area Director shall designate in writing an individual who will be responsible for providing general background information regarding the tribes served by that Area Office and specific information regarding issues/concerns raised by the tribes.

      2. Each Associate Director shall designate in writing an individual who will be responsible for coordinating with the Office of Tribal Activities (OTA) the IHS participation in tribal visits.

    2. Notification of Request for Tribal Delegation Meeting

      1. Tribal representatives who wish to visit IHS Headquarters should notify the OTA to request a meeting.  An advance notice of ten (10) working days is required for the IHS to adequately prepare for the meeting.  The OTA will obtain the following information from the tribe:

        1. Name of tribe.

        2. Date of visit.

        3. Tribal issues/concerns to be discussed.

        4. Names of tribal representatives attending the meeting.

        5. Names of individuals in the Area Office the tribe has contacted regarding the issues/concerns to be discussed and the Area Office response to the issues/concerns.

        6. Expectations from the tribe of the IHS.

        7. Name of contact person for tribe.

    3. Premeeting Arrangements

      1. The OTA will:

        1. Contact the Office of the Director to arrange the date and time for the meeting.

        2. Contact the tribe to confirm the scheduled time and date of the meeting.

        3. Alert the designated contact person in the appropriate Associate Director's Office to inform them of the meeting and the tribal issues/concerns to be discussed.

        4. Contact the designated person in the Area Office upon receipt of notification that a tribe has scheduled a visit to:

          1. Inform the Area Office that the tribe has requested a meeting in IHS Headquarters.

          2. Obtain background information not provided under 4, B on the tribe and clarify the tribal issues/concerns to be discussed.

          3. Determine what, if any, commitments the Area Office has made to the tribe regarding the tribal issues/concerns.

          4. Schedule a conference call which will include participation of Area staff.

        5. Prepare a briefing paper and schedule a premeeting and/or conference call with the Area in preparation for the meeting.

        6. Notify, in writing, the designated person in the appropriate Associate Director's Office of:

          1. Date, time, and location of scheduled meeting.

          2. Date, time, and location of scheduled premeeting and/or conference call.

          3. Issues/concerns to be discussed and necessary background information.

          4. List of proposed attendees.

        7. Designate IHS staff to attend the scheduled premeeting and/or conference call and the meeting.

    4. Conducting the Premeeting and/or Conference Call

      The OTA will conduct a premeeting and/or conference call with IHS staff to:

      1. Discuss tribal and Area perspective of the tribal issues/concerns based on background information obtained and identify possible resolution.

      2. Reach a consensus on issues prior to the tribal delegation meeting.

    5. Conducting the Meeting

      1. Meeting will be conducted by the OTA.

      2. Headquarters, Area, and tribal representatives attending the meeting will be introduced.

      3. Sign in sheet will be circulated to document attendance at the meeting.

      4. Proceedings of the meeting shall be recorded.

      5. Issues and concerns of the tribe which the IHS is prepared to discuss will be identified and discussed.  Following that discussion the tribe may introduce additional issues/concerns, however, IHS response to the new issues/concerns may be delayed.

      6. The discussion will begin with the issue of primary concern to the tribe.

      7. Issues discussed and decisions reached shall be summarized, commitments made by IHS restated, and a date provided when action or a written response can be expected by the tribe.

    6. Meeting Follow Up

      1. If the Area Office was not represented at the meeting the OTA will contact the designated Area Office person to brief them on the meeting, including decisions, commitments, and time frames for action/response no later than the next day.

      2. Prepare and send follow up letter to tribe, Area Director, Associate Directors, and all participants within 10 working days after the meeting, identifying action(s) items that will resolve the issues/concerns identified at the meeting.

      3. Track actions/responses.

      4. All participants who prepare written responses to issues/concerns discussed with tribe will provide OTA with a copy of responses.

    7. Files

      A file will be established and maintained by the OTA on each tribal delegation meeting.

  5. RESPONSIBILITIES.

    1. Office of Tribal Activities (OTA)

      The OTA is responsible for:

      1. Coordinating and conducting all tribal delegation meetings and follow up activities including:

        1. Arranging the meeting around the IHS Director schedule.

        2. Obtaining preliminary information from the tribe including date of visit, tribal issues/concerns to be discussed, etc.

        3. Notifying the appropriate Area and Associate Directors Offices that the tribe has requested a meeting in IHS Headquarters, and informing them of the issues/concerns the tribe wants to discuss.

        4. Obtaining pertinent background information.

        5. Preparing briefing materials.

      2. Contacting the designated Area Office person to brief them on the meeting, including decisions, commitments, and time frames for action/response, no later than the day following the meeting.

      3. Logging and monitoring responses, and maintaining files of tribal delegation meetings.

      4. Preparing and sending follow up letters to tribe, within 10 working days after the meeting, identifying action(s) items that will resolve the issues/concerns identified at the meeting and providing copies to appropriate Area and Associate Directors.

      5. Recording proceedings of meetings and providing copies to Associate Directors, Area Directors, tribe, and all attendees.

      6. Preparing reports to the Director, IHS at the end of each fiscal year on the tribal delegation meetings.

    2. Area Directors

      Area Directors shall be responsible for:

      1. Designating an individual to assist OTA in coordinating IHS participation for tribal visits.

        1. The Designated Contact Person in each Area Office shall be responsible for:

          1. Providing general and specific background information on the tribe(s) served by that Area Office and regarding issues/concerns raised by the tribe(s).

          2. Keeping the Area Director and appropriate Area staff informed.

          3. Assigning appropriate Area staff to participate in scheduled conference calls.

      2. If necessary sending appropriate representative to attend both the premeeting and the tribal meeting at IHS Headquarters.  Travel expenses for Area staff will be incurred by the Area Office.  Delegation of decision making authority rests with the Area Director.

    3. Associate Directors

      Associate Directors shall be responsible for:

      1. Designating an individual and an alternate to assist OTA in coordinating IHS participation for tribal visits.

        1. The designated contact person in each Associate Director's Office shall be responsible for:

          1. Assigning appropriate staff to attend both the premeeting and the tribal meeting.

          2. Keeping the Associate Director and appropriate staff informed.

      2. Assuring that appropriate staff attend both the premeeting and the tribal meeting.

        1. Headquarters staff designated to attend tribal meetings shall be responsible for:

          1. Contacting their counterparts at the Area Office to obtain relavant information prior to the tribal meeting.

          2. Preparing for the meetings by reading and becoming familiar with briefing material provided by the OTA.

          3. Attending the premeeting and tribal delegation meeting.

          4. Following up and preparing responses to tribal issues/concerns assigned to his/her office as agreed to at the meeting.

      3. Ensuring that necessary follow up actions and responses are provided to OTA within established time frames.

      4. Providing OTA with a copy of all responses to tribe concerning the meeting.

  6. REPORTS.  A report shall be submitted to the Director, IHS at the end of each fiscal year on the tribal delegation meetings including:

    1. Number of tribal delegation meetings by Area.

    2. List of issues/concerns discussed.

    3. Summary of problems encountered.

    /Everett R. Rhoades, M.D./
    Everett R. Rhoades, M.D.
    Assistant Surgeon General
    Director, Indian Health Service


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