Indian Health Service reaches first tribal compact in Great Plains

The headquarters of the Spirit Lake Nation in Fort Totten, North Dakota. Photo from SLN

The Indian Health Service has entered into the first tribal self-governance compact in the Great Plains Area.

The agreement with the Spirit Lake Nation becomes effective on Wednesday. The tribe will now be responsible for running the Spirit Lake Health Center in Fort Totten, North Dakota.

“The Spirit Lake Tribe is the first tribe in the Great Plains Area to enter into a self-governance agreement, and it was a priority for IHS to support the tribe and provide assistance for this agreement that will allow the tribe the flexibility to administer program funds to best meet the needs of their citizens and tribal communities," Mary Smith, the acting director of the agency, said in a press release.

Self-governance compacts are common throughout Indian Country. According to the IHS, 353 of the 576 federally recognized tribes have entered into agreements to run facilities in their communities.

The situation is different in the Great Plains, where tribes have long relied on the IHS to provide direct services as required by their treaties and other agreements. But some tribes are considering taking over facilities due to long-standing management, funding and quality of care issues in the region.

"As a direct service tribe, I know we are still making gains to build our capacity to be able to take over our clinic and run it the way we would like in a culturally significant manner, free of federal bureaucracy," L. Jace Killsback, the executive health manager for the Northern Cheyenne Tribe of Montana, told the Senate Committee on Indian Affairs earlier this year.

The committee held a hearing and a listening session in February to examine the issues facing the Great Plains. A field hearing will take place on June 17 in Rapid City, South Dakota, to learn more about the region and to take testimony on S.2953, the Indian Health Service Accountability Act. The bill seeks to improve accountability, transparency and patient care at the troubled agency.

Senate Committee on Indian Affairs Notice:
Oversight/Legislative FIELD Hearing on "Improving Accountability and Quality of Care at the Indian Health Service though S. 2953." (June 17, 2016)

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)

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