Office of Tribal Self-Governance Negotiation Cooperative Agreement

The purpose of this Negotiation Cooperative Agreement is to provide Tribes with resources to help defray the costs associated with preparing for and engaging in Tribal Self-Governance Program (TSGP) negotiations. TSGP negotiations are a dynamic, evolving, and Tribally-driven process that requires careful planning, preparation and sharing of precise, up-to-date information by both Tribal and Federal parties. Because each Tribal situation is unique, a Tribe's successful transition into the TSGP, or expansion of their current program, requires focused discussions between the Federal and Tribal negotiation teams about the Tribe's specific health care concerns and plans. One of the hallmarks of the TSGP is the collaborative nature of the negotiations process, which is designed to: 1) enable a Tribe to set its own priorities when assuming responsibility for Indian Health Service (IHS) Programs, Services Functions, and Activities (PSFAs); 2) observe and respect the government-to-government relationship between the U.S. and each Tribe; and 3) involve the active participation of both Tribal and IHS representatives, including the Office of Tribal Self-Governance (OTSG). Negotiations are a method of determining and agreeing upon the terms and provisions of a Tribe's Compact and FA, the implementation documents required for the Tribe to enter into the TSGP. The Compact sets forth the general terms of the government-to-government relationship between the Tribe and the Secretary of the U.S. Department of Health and Human Services (HHS). The FA: 1) describes the length of the agreement (whether it will be annual or multi-year); 2) identifies the PSFAs, or portions thereof, the Tribe will assume; 3) specifies the amount of funding associated with the Tribal assumption; and 4) includes terms required by Federal statutes and other terms agreed to by the parties. Both documents are required to participate in the TSGP and they are mutually negotiated agreements that become legally binding and mutually enforceable after both parties sign the documents. Either document can be renegotiated at the request of the Tribe.

The negotiation process has four major stages, including: 1) planning; 2) pre-negotiations; 3) negotiations; and 4) post-negotiations. Title V of the Indian Self-Determination and Education Assistance Act (ISDEAA) requires that a Tribe or Tribal organization complete a planning phase to the satisfaction of the Tribe. The planning phase must include legal and budgetary research and internal Tribal government planning and organizational preparation relating to the administration of health care programs. See 25 U.S.C. 5383(d). The planning phase is critical to the negotiation process and assists Tribes with making informed decisions about which PSFAs to assume and what organizational changes or modifications are necessary to support those PSFAs. A thorough planning phase improves timeliness and efficient negotiations and ensures that the Tribe is fully prepared to assume the transfer of IHS PSFAs to the Tribal health program.