FA Ryan

Document Type



The focus of this study was on identifying specific regulatory barriers or impediments to contracting with Indian Tribes and Alaska Natives, who wished to engage in alternative health care programs. This study provides an analysis of existing historic, as well as current statutory, regulatory, jurisdictional, policy, and health industry requirements which limited tribal participation in alternative health care delivery systems, including the Indian Self-Determination and Educational Assistance Act Amendments passed by Congress in September, 1988. The drive to maximize cost containment efficiencies and to improve quality of care has led the Indian Health Service to explore on an experimental demonstration project basis, innovative approaches to health care service delivery. Also paramount has been the drive to identify more flexible contracting avenues for realizing tribal assumption of control over IHS programs and services. The study identified ten recommendations that need to be addressed, in order for the new 1988 amendments not to become limitations on tribal participation in alternative health care systems.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research