2016 IHS Billings Area Training Billings, MT December 14, 2016 Title V Eligibility Requirements Indian Health Service Office of Tribal Self-Governance 2016 IHS Billings Area Training Billings, MT December 14, 2016

Eligibility Overview: 3 Requirements To be eligible for the IHS Tribal Self-Governance Program, a Tribe must: Successfully complete a planning phase; Request participation in self-governance by resolution or other official action by the governing body of each Tribe to be served; and Demonstrate, for 3 fiscal years, financial stability and financial management capability. (25 USC 458aaa-2(c)); 42 C.F.R. Part 137, Subpart C; 42 C.F.R. 137 Sections15–26)

1. Planning Phase The planning phase shall be conducted to the satisfaction of the Tribe Usually, this stage is the longest and most work. It must include: Legal and budgetary research Internal Tribal government planning and organizational preparation When complete, a “planning statement” is submitted to OTSG. Assessment of existing systems and resources Determination of Tribal priorities and goals Community engagement This stage is the longest and usually takes the most work, but a thorough planning phase makes the rest of the negotiations process more timely and efficient. This phase helps Tribes make informed decisions about which PSFAs to assume and what organizational changes or modifications are necessary to successfully support those PSFAs. It ensures that the Tribe is fully prepared for the transfer of IHS PSFAs to the Tribal health program. IHS is involved during this stage by providing information about the programs, services, functions, and activities that the Tribe may assume and the associated funding, but most of the work is internal to the Tribe. Resources for assistance: $$  Planning Cooperative Agreement; Best resource– other Tribes. OTSG, SGCE, or your ALN can help connect you with other Tribes in similar circumstances. TSGAC meetings are a great way to observe the types of issues that Self-Governance Tribes discuss when they meet with the Director (and are open to the public) and the Tribal Self-Governance conference.

2. Request Participation The Tribe or Tribal Organization requests participation in self-governance by resolution or other official action by the governing body of each Tribe to be served; (25 USC 458aaa-2(c)); 42 C.F.R. PART 137, Subpart C; 42 C.F.R. 137.15–26)

3. Financial Requirement For the purpose of eligibility and to demonstrate financial stability and capability - a Tribe must provide evidence that during the most recent 3-year period they had no uncorrected significant and material audit exceptions in the required annual audit of their self-determination contracts or self-governance funding agreements with any federal agency. (25 USC 458aaa-2(c)(2))

3. Financial Requirement (Continued) Uncorrected: Title V does not include terms “clean audit” or “mature contract” Audit exceptions: Usually provided by a Tribe’s auditor in the audit Self-determination contracts or self-governance funding agreements with any federal agency: The review only looks at the BIA and the IHS contracts/compacts findings, except for cross-cutting centralized functions (e.g. personnel, payroll, property management, etc.). (42 CFR 137.22) It does not include casino, HUD, or DHHS/Child Care grant findings.

Thank you! Office of Tribal Self-Governance: 301-443-7821 http://www.ihs.gov/selfgovernance