1.  “Excellence in Rural Health Care”

2.  Many transitions of Programs, Services, Functions and Activities to a Tribe under Self- Governance include existing IHS facilities, such as hospitals and/or clinics.  Tribes have options to retain the Federal personnel that are providing the PSFA(s) being assumed: o Contract o Tribal Hire o Inter-Agency Personnel Agreement (IPA) o Memorandum of Agreement (MOA)

3.  IPAs and MOAs are Federal employees that are assigned to the Tribe  Existing Federal staff can convert to either an IPA or MOA upon agreement between the employee, IHS and the Tribe o IPAs are civil service employees o MOAs are commissioned personnel

4.  The Tribe/TO determines what mix of contract, Tribal hire, and IPA/MOAs to have in the organization  Items to consider: o It is least disruptive to existing Federal personnel to offer everyone an IPA/MOA; o IPA/MOAs are a good tool to retain the existing staff performing the PSFAs; o IPA/MOA staff typically cost more than Tribal direct hires; o

5.  Some Federal staff may prefer a Tribal hire, depending upon their career plans;  Tribes will only receive the Direct Contract Support costs for Fringe differential associated with Tribal hires (not IPA/MOA personnel);  The Tribe can make policy exceptions in the transition, and then IPA/MOAs would gradually reduce by attrition, thus reducing costs over time.

6.  The Tribe’s evaluation of its Human Resources policies, job descriptions and compensation structure to accommodate Health professionals: o Position Descriptions o Work schedules o Licensure o Continuing education o Recruitment costs (relocation, etc) o Health Professional Salary Schedule – competitive with both the market and with existing Federal employment

7.  An Agreement is entered between the IHS, Tribe and the Federal employee;  2-year agreements, with the ability to extend indefinitely;  IPA/MOAs retain their Federal employment status, compensation and benefits and perform the same functions;

8.  All Federal employees performing PSFAs to be assumed by a Tribe may be eligible, except: o Employees not having at least a “satisfactory” performance rating, or o Employees on a time-limited, temporary or term appointment.  Directed and supervised by the Tribe/TO;  Federal personnel may be members of a Union, however it is a Tribal choice to recognize unions;  Paycheck still comes from the Federal government;

9.  Treated as a “buy back” in the Funding Agreement;  The Tribe/TO provides a prepayment to IHS to pay the costs of IPA/MOA staff, which is a rolling balance;  Tribe is invoiced monthly to reimburse for IPA/MOAs, along with a Full Cost Recovery Fee. o FCR Fee pays for IHS finance and human resources workload to maintain the Federal employee (functions are typically at the Area Office) o Example: FCR Fee in Oklahoma Area is 2.19%, applied to IPA/MOA cost

10.  Determine as early as possible how employment offers will be made and announce: o All eligible staff to be offered IPA/MOA, or on what other basis? o Will all employees also receive a Tribal hire offer? o Schedule for the transition.  Identify the IHS Human Resources Contact, and the Tribal Human Resources Contact

11.  Complete a comparison of Federal vs. Tribal benefits and policy: o Fringe Benefits o Leave Policies (accrual, retention, payment upon separation) o Background Checks o Drug Testing o Holiday Schedule o Others

12.  Get data from IHS: o Number of staff o Title o Grade, step, etc o Compensation level o Special Pays o Employment status o Eligibility for IPA/MOA – if not eligible, describe reason

13.  Make determinations on Tribal direct hire offers for transitioning Federal staff o Compensation – will the Tribe offer at least the same level of base pay; o Health Professional Salary Schedule, including special pays o Transition of tenure for purposes of leave accrual, leave usage and participation in insurance and retirement plans o Acceptance of any background and drug testing results in the Federal personnel file

14.  Make determinations on Tribal direct hire offers for transitioning Federal staff o Licensure of Health Professionals: in State of practice, or from any State; o Tribal Preferences – Indian or Veterans preference, for example; o Transition decisions can be one-time exceptions to Tribal policy, as a means to retain all of the Federal personnel possible; o Option to use the Federal Health Benefit Package for employee health insurance.

15.  Develop and administer Offers of Employment as soon as possible;  Tribes/TO have the flexibility to do written Offers of Employment or Letters of Intent to assist in retaining personnel;  Offer is made by the Tribe, and can be accepted or declined by the employee;  Includes such agreement as type of employment (IPA, MOA or Tribal), base salary, contingency upon background and/or drug testing as applicable, release of information, any licensure requirements.

16.  Offers can be made many months in advance of actually entering an IPA or MOA;  Can be very useful to commit both the Tribe and the Federal employee and reduce attrition.  The earliest that Offers/Letters of Intent are signed, the more comfortable staff will be, and the less uncertainty and unrest that will result among the staff.

17.  Discuss with IHS in advance the plan for continuing to fill vacancies until the Compact effective date.  Options are: o (1) IHS continues to recruit/fill, with or without Tribal input; o (2) IHS effort is deferred in favor of Tribal recruitment for these vacancies; or o (3) there is an agreed upon joint recruitment effort for the transition.  It is critical that recruitment efforts do not stall or halt during the transition process.

18.  Tribes/TO can work more flexibly with potential employees to make offers or deliver letters of intent to secure recruitment well in advance of the entire personnel process.  Employees hired prior to the assumption date are potentially eligible for IPA/MOA, while employees hired after the effective date will be Tribal hires.

19.  Communication and relationship-building with the Workforce is critical;  Employees must feel valued and that the Tribe wishes to retain their service;  Communicate early and often in several different forums (materials, letters, web, meetings);  Build personal relationships with staff by being present and available;

20.  Host group employee meetings jointly with IHS;  Schedule Individual meetings to answer questions, discuss options and make offers;  Tribal administration (usually Health and HR officials) must be accessible daily o email/phone o “walking around” the facility

21.  Make a determination that all eligible employees can have an offer of IPA/MOA and Tribal Direct Hire;  Make HR decisions that facilitate keeping employees on board (example, retention pays and base pay);  Communicate! By group, individually and with materials and media. Be present often in the facilities, formally and informally. Answer employee questions as timely and completely as possible.

22.  SGCE: www.tribalselfgov.orgwww.tribalselfgov.org  Federal Employee Health Benefit Plan information:  Personnel Aspects of the ISDEAA Handbook: ISDEAA Handbook