Self- Governance The Path To Solutions

1. Self- GovernanceThe Path To Solutions

2. Tribal Government Services3 Options for Delivery from IHS and BIA • Direct Services: IHS & BIA provide all services through federal employees and facilities • “638 Contracting:” Tribe signs Program Contracts with BIA or IHS to deliver specific programs through tribal departments. (Self-Administration) • Self-Governance: Compact and Funding Agreement with ability to redesign programs and services as well as reallocate funds to meet community need. (Expanded Block Grant)

3. History of Self-Governance In 1970, President Richard Nixon delivered a message to Congress on “Indian Affairs” in which he laid the groundwork for a change in federal Indian policy from “termination and assimilation” to Indian Self-Determination. • Title I, Public Law 93-638—Authorized the contracting of programs to Tribes-- 1975 • Title II, Title III, Public Law 100-472 & Public Law 102-184 Demonstration for BIA & IHS-- 1988 • Title IV, Public Law 103-413 Permanent BIA-- 1994 • Title V, HR 1167—Permanently established Tribal Self-Governance for IHS-- 2000 • Title VI, Feasibility Study for other DHHS Programs-- 2000

4. Self-Governance • Definition: A Federal process of Tribal control made possible through Congressional authorization and appropriation support (P.L. 93-638) • Definition: Tribal control and decision making with effective governing institutions– practical sovereignty

5. Reasons for Self-Governance • Establish better fiscal accountability through expanded Tribal Governmental decision making authority • Institute administrative cost-efficiencies through reduced bureaucratic burdens and streamline decision-making authority • Change roles of the Federal Departments and agencies serving Indian Tribes by shifting their responsibilities from day-to-day management of Tribal affairs to that of Protectors and Advocate of Tribal interests • Improve the quality & quantity of services provided to tribal members • Recognize Tribe’s right to determine priorities, redesign and create new programs to meet local needs • Formalize relations between the United States and Indian Tribes on government-to-government basis as provided for in the US Constitution • Promote greater social, economic, political, cultural stability and self-sufficiency among Indian tribes

6. Self-Governance: What is it? • The exercise of sovereignty (genuine decision-making power) • Empowerment • Self-Reliance • Self-Sufficiency • Responsibility • Accountability • Self-Governance is a way of life, it is an ongoing process • What it is not: • Dependency • Federal dominance • Paternalism and Control • Not another Federal Program

7. Tribal Management Under Self-Governance • Federal Control Tribal Control $$$ • Advance Lump Sum Payments • Recurring Base Budgets Flexibility • Ability to redesign programs • Ability to merge and assign program funds • Ability to adopt revised regulations Changes Focus of Program Design/Deliver • Community-Driven • Needs-Driven • Priority-Driven Changes Mentality of Tribal Gov’t • Outcomes versus jobs • Long-term planning • Collaboration between tribal dept. • Collaboration between tribe and other governmental entities

8. Best Practices

9. THE CHOCTAW NATION OF OKLAHOMA

12. Atoka Clinic About the Facility Year Built: 2008 Last Remodel: None Square Footage: 11,892 About the Staff Staff Members: 14 (not including medical staff) Medical Staff : MD or DO: 1 DPM: Shared with 0.25 Idabel and Hugo Mid-level Providers 1

13. Broken Bow Clinic About the Facility Year Built: 2007 Last Remodel: None Square Footage: 6,281 About the Staff Staff Members: 6 (not including medical staff) Medical Staff : Mid-level Provider: 1

14. Hugo Clinic About the Facility Year Built: 1977 Last Remodel: In Progress Square Footage: 8,964 About the Staff Staff Members: 21 (not including medical staff) Medical Staff : MD or DO 2 DDS 1 DPM: Shared with 0.25 Idabel and Atoka Mid-level Providers 1

15. Idabel Clinic About the Staff Staff Members: 60 (not including medical staff) Medical Staff : MD or DO 4 DPM: Shared with 0.25 Hugo and Atoka OD 2 DDS 2 Mid-level Providers 1 About the Facility Year Built: 2005 Last Remodel: None Square Footage: 54,546

16. McAlester Clinic About the Staff Staff Members: 52 (not including medical staff) Medical Staff : MD or DO 4 OD 1 DDS 2 Mid-level Providers 1 About the Facility Year Built: 2007 Last Remodel: None Square Footage: 44,807

17. Poteau Clinic About the Staff Staff Members: 52 (not including medical staff) Medical Staff : MD or DO 3 DDS 2 Mid-level Providers 2 About the Facility Year Built: 1995 Last Remodel: 2007 Square Footage: 30,754 Poteau Clinic is the home of the CNHSA Pharmacy Refill Center.

18. Stigler Clinic About the Facility Year Built: 2004 Last Remodel: 2005 (New Addition) Square Footage: 11,120 About the Staff Staff Members: 13 (not including medical staff) Medical Staff : MD or DO 1 OD 1 Mid-level Providers 1

19. Choctaw Nation Hospital About the Facility Year Built: 1999 Last Remodel: Ongoing Square Footage: CNHCC - 155,580 DWC - 14,760 About the Staff Staff Members: 494 (not including medical staff) Medical Staff : MD or DO 39 DPM 2 OD 2 DDS 3 Mid-level Providers 16