Tribal Consultation

The Centers for Medicare & Medicaid Services (CMS) seeks the guidance of Tribal leaders on the delivery of health care for American Indians/Alaska Natives (AI/AN) served by Medicare, Medicaid, Children's Health Insurance Program (CHIP), Exchanges or any other health care program funded by CMS.

CMS accomplishes this in several ways.

Tribal Technical Advisory Group (TTAG)

The Centers for Medicare & Medicaid Service Tribal Technical Advisory Group (CMS TTAG) was established 2004. The TTAG charter complies with the statutory provisions set forth at 2 U.S.C. Sec. 1534(b)1 (1) & (2), 2 USC 1534 and therefore is exempt from the Federal Advisory Committee Act (FACA). The TTAG was formed to provide advice and input to the CMS on policy and program issues affecting delivery of health services to American Indians and Alaska Natives (AI/AN) served by CMS-funded programs. Since its inception, the TTAG has carried out its responsibilities as an advisory group by holding monthly conference calls and three face-to-face meetings each year. In order to be more effective and perform more in-depth analysis of Medicare, Medicaid,  CHIP and Exchange policies, effecting AI/ANs, the TTAG has formed smaller subject specific subcommittees.

The CMS TTAG is comprised of one elected tribal leader, or an appointed representative from each of the twelve geographic Areas of the Indian Health Service (IHS) delivery system. In addition, there is one representative from each of the national Indian organizations headquartered in Washington DC, the National Indian Health Board (NIHB), the National Congress of American Indians (NCAI), and the Tribal Self-Governance Advisory Group (TSGAC). Recently, the American Recovery and Reinvestment Act of 2009 (Recovery Act) section 5006(e)(1), which became effective July 1, 2009 codified the TTAG and added two additional positions. These two new positions will permit a representative from a national urban Indian health organization and a representative of the Indian Health Service (IHS) to be members of the TTAG. A separate web page has been developed for the TTAG.

Tribal Consultation 

CMS has developed a formal consultation policy consistent with the Department of Health and Human Services Tribal Consultation Policy. The guiding principle of the policy is to ensure that broad based input is sought by CMS prior to taking actions that have the potential to affect federally recognized tribes.

• The Centers for Medicare and Medicaid Services (CMS) is committed to fulfilling its government to government relationship with Indian Tribes, and is pleased to announce that CMS has developed an agency specific to policy to establish a clear, concise and mutually acceptable  process through which consultation can take place between CMS and Tribes.   In response to the release of this policy, CMS held an All Tribes Call on Friday, December 9, 2011 to discuss the policy and answer questions the Tribes had.
• During 2009, CMS consulted with Tribes. The consultation was regarding the provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), and the American Recovery and Reinvestment Act of 2009 (Recovery Act). A series of All Tribes Calls were held to provide a brief overview of the CHIP and Recovery Act provisions. 
• In addition CMS hosted Tribal consultation sessions on July 8th and 10th, 2009 in Denver, Colorado in conjunction with the Indian Health Summit. The two sessions focused on the CMS provisions in the American Recovery and Reinvestment Act of 2009 (Recovery Act) and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). CMS assembled an expert panel of Departmental and Operations Directors to address the many questions and concerns raised by Tribal Leaders. 

The National Indian Health Board (NIHB) 

CMS has an agreement with NIHB to carry out research activities of the TTAG subcommittees on Long Term Care, Data, and Outreach and Education.

For more information about CMS and Tribal consultation, see below.