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"This new rule further strengthens the relationship between the federal government and tribal governments," Secretary Thompson said. "By making a permanent option for tribal self-government, we create the opportunity for tribes to play a more active role as we fulfill our responsibility for providing health services to American Indian and Native American tribes."

The regulations, which will be published as a final rule in the May 17 Federal Register, establish a permanent self-governance program within HHS and stem from the Tribal Self-Governance Amendments of 2000. The rule takes effect June 17.

A rulemaking committee, involving 23 tribal representatives and seven federal representatives, negotiated the details of the rule as required under the law. The committee met six times between March and August 2001 and considered issues raised by tribal representatives around the country. The committee first negotiated a proposed rule, published Feb. 14, 2002, and then met again in April 2002 to review the comments and recommend final regulatory language.

"The Tribal-Federal Negotiated Rulemaking Committee is to be commended for addressing multiple issues and reaching consensus on hundreds of items," said Michael H. Trujillo, M.D., director of HHS' Indian Health Service. "The success of tribes managing their own programs is reflected in the health of their tribal members and the health services the tribe provides. Whether health services are provided by the tribe or by IHS, the quality of care is among the best in the nation."

The IHS works with tribes to provide health care services to about 1.5 million American Indians and Alaska Natives who belong to more than 560 federally recognized tribes. Under Title V, tribes can elect to provide all of their health services by assuming the operation and control of health programs provided by IHS for their benefit. Such programs can include the delivery of health care services, construction and environmental projects and public health programs. The funds for functions transferred to the tribe are negotiated on an annual basis.

Tribal self-governance for IHS programs began in 1994 as a demonstration involving 14 tribes. Today, there are 56 compacts, covered by 75 funding agreements, which transfer more than $744 million in operating funds for tribal health programs serving more than 279 tribes.

The final rule will make these demonstrations a permanent option for tribes -- allowing tribes to rely on such compacts as an option in the future. The rule also clarifies many of the details about how permanent compacts should be negotiated and renewed.

The final rule reflects the committee's consensus on more than 250 issues that needed to be resolved in order to create a permanent self-governance program, including the criteria for tribes to be eligible to participate in self-governance, the process for transferring funds and the tribal option to "purchase" services from the IHS. On three issues, where a consensus was not reached, the rule adopts the federal positions.

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