Indian Health Service:
Contracting for Health Services Under the Indian Self-Determination Act
HRD-86-99, Sep 17, 1986
In response to a congressional request, GAO presented information concerning contracting activities between various Indian tribes and the Department of Health and Human Services' Indian Health Service (IHS) under the Indian Self-Determination Act.
The act established a policy to permit Indians to effectively and meaningfully participate in the planning, conduct, and administration of programs and services through contracts with the federal government. GAO found that the majority of Indian tribal contractors had problems working with IHS in obtaining and administering contracts. Disagreements over subject matter or funding levels for contracts have resulted in delays in approving or disapproving contract proposals and delays in approving renewals of existing contracts. However, these delays did not result in loss of services to tribal members. According to most Indian contractors, Indian self-determination has not been achieved. The Indian contractors view the law as giving them the opportunity to determine the manner in which health care services should be delivered and IHS restricts this with various contract regulations. IHS views self-determination as Indian tribes being able to operate IHS activities through contracts that adhere to applicable contracting rules and regulations.