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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Office of Tribal Self-Governance (OTSG)

About OTSG

HISTORY OF
TRIBAL SELF-GOVERNANCE
LEGISLATION

    1975

    Indian Self-Determination and Education Assistance Act (Pub. L. No. 93-638)
    Authorized Tribes to contract with the IHS and the Bureau of Indian Affairs (BIA) to operate programs or portions of programs.

    1976

    Indian Health Care Improvement Act (Pub. L. No. 94-437)
    Implemented Federal responsibility for the care and education of Indian people.

    1988

    Tribal Self-Governance Demonstration Project (Pub. L. No. 100-472)
    Authorized BIA to negotiate compacts with Tribes; gave Tribes more flexibility in operation of programs.

    1991

    IHS Funded to Perform Feasibility Study (Pub. L. No. 102-184)
    Feasibility study funded on extending Tribal Self-Governance to the IHS.

    1992

    Self-Governance Authority Extended to IHS (Pub. L. No. 102-573)
    Authorized the IHS to negotiate Compacts with Tribes through the Demonstration Project; gave Tribes more flexibility in operation of programs.

    1994

    Technical Amendments to Title III Section 301 and Section 302(a) (Pub. L. No. 103-435)
    Extended Tribal Self-Governance Demonstration Project to 18 years; 30 Tribes per fiscal year to participate.

    2000

    Title V (Pub. L. No. 106-260)
    Created a permanent Tribal Self-Governance Program (TSGP) within the IHS.

    2002

    Title V Regulations (42 C.F.R. Part 137)
    Tribal Self-Governance Regulations promulgated to implement Title V.

    2010

    Patient Protection and Affordable Care Act (Pub. L. No. 111-148)
    Permanently reauthorized and expanded the Indian Health Care Improvement Act (IHCIA) authorities.

What is the Tribal Self-Governance Program?

The Tribal Self-Governance Program (TGSP) is more than an IHS program; it is an expression of the nation-to-nation relationship between the United States and each Indian Tribe. Through the TSGP, Tribes have the option to assume IHS program funds and manage them to best fit the needs of their Tribal communities. Tribes participating in the TSGP negotiate with the IHS and take on full funding, control, and accountability for those programs, services, functions, and activities (PSFAs), or portions thereof, that the Tribe chooses to assume.

Participation in the TSGP is one of three ways that Tribes can choose to obtain health care from the federal government for their members. Specifically, Tribes can choose to:
  1. Receive health care services directly from the IHS.
  2. Contract with the IHS to administer individual programs and services the IHS would otherwise provide (referred to as Title I Self-Determination Contracting).
  3. Compact with the IHS to assume control over health care programs the IHS would otherwise provide (referred to as Title V Self-Governance Compacting or the TSGP).

These options are not exclusive; Tribes may choose to combine them based on their individual needs and circumstances. Participation in the TSGP affords Tribes the most flexibility to tailor health care services to the needs of their communities.

The TSGP is and has always been a tribally driven initiative, and strong Federal-Tribal partnerships have been critical to the program's success. Tribal leaders and representatives have been involved in every stage of the TSGP's development and implementation.

The Office of Tribal Self-Governance (OTSG) serves as the primary liaison and advocate for Tribes participating in the TSGP. The OTSG was established to implement Tribal Self-Governance legislation and authorities in the IHS, beginning with the IHS Tribal Self-Governance Feasibility Study authorized in 1991. The OTSG develops, directs and implements Tribal Self-Governance policies and procedures; provides information and technical assistance to Self-Governance Tribes; and advises the IHS Director on Agency compliance with TSGP policies, regulations, and guidelines.

History of the Tribal Self-Governance Program

In 1975, the Indian Self-Determination and Education Assistance Act (ISDEAA) (Pub. L. No. 93-638) was signed into law. The ISDEAA reaffirmed congressional support of the nation-to-nation relationship between the United States and each Tribal nation. The ISDEAA was enacted to ensure “effective and meaningful participation by the Indian people in the planning, conduct, and administration” of Federal services and programs provided to the Tribes and their members, see 25 U.S.C. § 450a(b). It provided Tribes with the option to exercise their sovereignty by either (1) assuming the administration and operation of PSFAs from the IHS or (2) continuing to receive health care through the IHS-administered, direct-care health system.

Following the passage of the ISDEAA, Tribes continued to advocate for increased autonomy in the administration of their health care programs. The ISDEAA was revised substantially in 1988 to “remove many of the administrative and practical barriers that [persisted] under the Indian Self-Determination Act” (Senate Report 100-274) and was comprehensively amended in 1994. In 1996, Tribal leaders and representatives participated with Federal agencies in a negotiated rulemaking process that resulted in a Final Rule to implement the program now known as Title I Self-Determination Contracting, see 61 FR 32482-534.

The 1988 amendments authorized the initial Self-Governance Demonstration Project (Pub. L. No. 100-472) within the US Department of the Interior (DOI). Following the success of the DOI Self-Governance Demonstration Project, Congress extended the same authority to the IHS through the Indian Health Amendments of 1992 (Pub. L. No. 102-573). The first IHS Demonstration Project agreements were signed on September 30, 1993. In 1994 the IHS Tribal Self-Governance Demonstration Project was extended to 18 years, with authority to add 30 Tribes per fiscal year (Pub. L. No. 103-435). In 1996, the Tribal Self-Governance Advisory Committee (TSGAC) was created to provide advice to the Director of IHS and assistance on issues and concerns pertaining to Tribal Self-Governance and the implementation of the self-governance authority within the IHS.

In 2000, Congress enacted permanent authority for the IHS Tribal Self-Governance Program under Pub. L. No. 106-260, the Tribal Self-Governance Amendments of 2000 (Title V). This legislation required that regulations implementing the TSGP be developed through negotiated rulemaking. The IHS promulgated the regulations implementing the TSGP in the Federal Register on May 17, 2002, published at 42 C.F.R. Part 137.

In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA), Pub. L. No. 111-148. The ACA contained several Indian-specific provisions and reforms that will positively affect many American Indians and Alaska Natives. The ACA also permanently reauthorized, revised, and expanded the Indian Health Care Improvement Act (IHCIA), including new authorities for Tribes participating in the TSGP.

Since the first Demonstration Project agreements were signed in 1993, the IHS TSGP has seen tremendous growth. As of December 2011, 337 Tribes are participating in the TSGP. That's nearly 60 percent of the 566 federally recognized Tribes in the United States. In fiscal year (FY) 2011, approximately one-third of the total IHS budget appropriation was transferred to Tribes to support 82 TSGP Compacts and 107 TSGP Funding Agreements. The TSGP is still growing. In FY 2011, nine new Tribes and Tribal Organizations joined the TSGP. With the addition of two new IHS Areas since 2009, the TSGP is now operating in 10 of the 12 IHS Areas.

The TSGP has proven to have a significant positive impact on the health and well-being of participating Tribal communities. The TSGP produces results because Tribal communities are in the best position to understand and address their own health care needs and priorities. Through the TSGP, Tribes continue to develop innovative solutions that address the health care delivery challenges facing their communities.

Laws and Regulations

The Indian Self-Determination and Education Assistance Act (ISDEAA), also known as Public Law 93-638, authorizes Indian Tribes and Tribal Organizations to contract for the administration and operation of certain Federal programs which provide services to Indian Tribes and their members. Under the ISDEAA, Tribes and Tribal Organizations have the option to either (1) administer programs and services the IHS would otherwise provide (referred to as Title I Self-Determination Contracting) or (2) assume control over health care programs and services that the IHS would otherwise provide (referred to as Title V Self-Governance Compacting or the TSGP). These options are not exclusive; Tribes may choose to combine them based on their individual needs and circumstances. The following links provide comprehensive information about Title I and Title V regulations:

Frequently Asked Questions

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