[Federal Register Volume 83, Number 246 (Wednesday, December 26, 2018)]
[Notices]
[Pages 66284-66291]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-27793]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Organization, Functions, and Delegations of Authority; Part G; 
Indian Health Service

    Part G, of the Statement of Organization, Functions, and 
Delegations of Authority of the Department of Health and Human Services 
(HHS), as amended at 70 FR 24087, May 6, 2005, as amended at 75 FR 
38112, July 1, 2010, and most recently as amended at 79 FR 65671, 
November 5, 2014, is hereby amended to reflect a reorganization of the 
Indian Health Service (IHS) Headquarters (HQ).
    The IHS proposes a reorganization at IHS HQ to strengthen 
operations and oversight responsibilities to ensure quality health care 
by establishing an Office of Quality.
    Delete the functional statements for the IHS HQ Office of the 
Director, Office of Clinical and Preventive Services, and Office of 
Management Services, and replace with the following revised statements, 
which includes a new Office of Quality:

Chapter GA--Office of the Director

Section GA-10, Indian Health Service--Organization

    The IHS is an Operating Division within the Department of Health 
and Human Services (HHS) and is under the leadership and direction of a 
Director who is directly responsible to the Secretary of Health and 
Human Services. The IHS Headquarters is proposing to reorganize the 
following major components: Office of the Director (GA), Office of 
Clinical and Preventive Services (GAF), Office of Management Services 
(GAL), and the Office of Quality (OQ).

Section GA-20, Indian Health Service--Functions

Office of the Director (OD) (GA)
    Provides overall direction and leadership for the IHS: (1) 
Establishes goals and objectives for the IHS consistent with the 
mission of the IHS and ensures agency performance is managed through 
goals/objectives, achievements, and/or improved outcomes; (2) provides 
for the full participation of Indian tribes in the programs and 
services provided by the Federal Government; (3) develops health care 
policy; (4) ensures the delivery of quality comprehensive health 
services; (5) advocates for the health needs and concerns of American 
Indians/Alaska Natives (AI/AN); (6) promotes the IHS programs at the 
local, state, national, and international levels; (7) develops and 
demonstrates alternative methods and techniques of health services 
management and delivery with maximum participation by Indian tribes and 
Indian organizations; (8) supports the development of individual and 
tribal capacities to participate in Indian health programs through 
means and modalities that they deem appropriate to their needs and 
circumstances; (9) the IHS will carry out the responsibilities of the 
United States to Indian tribes and individual Indians; (10) affords 
Indian people an opportunity to enter a career in the IHS by applying 
Indian preference; (11) ensures full application of the principles of 
Equal Employment Opportunity laws and the Civil Rights Act in managing 
the human resources of

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the IHS; and (12) participates in cross-cutting issues and processes, 
including but not limited to, emergency preparedness/security, quality 
assurance, internal controls, recruitment, budget formulation, self-
determination issues, and resolution of audit findings as may be needed 
and appropriate.
Congressional and Legislative Affairs Staff (CLAS) (GA1)
    (1) Serves as the principal advisor to the IHS Director on all 
legislative and congressional relations matters; (2) advises the IHS 
Director and other IHS officials on the need for changes in legislation 
and manages the development of IHS legislative initiatives; (3) serves 
as the IHS liaison office for congressional and legislative affairs 
with Congressional offices, the HHS, the Office of Management and 
Budget (OMB), the White House, and other federal agencies; (4) tracks 
all major legislative proposals in the Congress that would impact 
Indian health; (5) ensures that the IHS Director and appropriate IHS 
and HHS officials are briefed on the potential impact of proposed 
legislation; (6) develops legislative strategy for key policy and 
legislative initiatives; (7) provides technical assistance and advice 
relative to the effect that initiatives/implementation would have on 
the IHS; (9) provides support and collaborates with the Office of 
Finance and Accounting relative to IHS appropriations efforts; (10) 
directs the development of IHS briefing materials for congressional 
hearings, testimony, and bill reports; (11) analyzes legislation for 
necessary action within the IHS; (12) develops appropriate legislative 
implementation plans; (13) serves as the IHS liaison office to the 
Government Accountability Office (GAO) and Office of Inspector General 
(OIG); (14) except for personnel matters, coordinates the development, 
clearance, and transmittal of IHS responses and follow-up to reports 
issued by the OIG, the GAO, and other federal internal and external 
authorities; and (15) coordinates with IHS HQ and Area Offices as 
appropriate to provide leadership, advocacy, and technical support to 
respond to requests from the public, including tribal governments, 
tribal organizations, and Indian community organizations regarding IHS 
legislative issues.
Executive Secretariat Staff (ESS) (GA2)
    (1) Manages the processing of executive correspondence and related 
information to the IHS Director from tribes and tribal governments, 
tribal organizations, and Urban Indian organizations, federal 
departments and agencies, Congress and congressional staff offices, 
attorneys, patients, schools, universities, employees, grantees, 
contractors, and the general public; (2) reviews and monitors 
correspondence received by the IHS Director and assigns reply or 
follow-up action to appropriate IHS HQ program offices and IHS Area 
Offices; (3) ensures the quality (responsiveness, clarity, and 
substance) of IHS-generated correspondence prepared for the IHS 
Director's signature by coordinating the review of integrity and policy 
issues, and performing standard edits and revisions; (4) reviews and 
coordinates clearance of decision documents for the IHS Director's 
approval to ensure successful operations and policy-making within the 
agency; (5) assists IHS officials as they prepare documents for the HHS 
Secretary's review, decision, and/or signature; (6) serves as the 
agency's liaison with the HHS Office of the Secretary's Executive 
Secretariat on IHS program, policy, and special matters; (7) performs 
special writing assignments for the IHS Director; (8) maintains 
official records of the IHS Director's correspondence and conducts 
topic research of files, as needed; (9) oversees an electronic document 
handling system to assist in managing the timely processing of internal 
and external executive correspondence; (10) conducts training to 
promote conformance by IHS HQ and Area staff to the IHS Executive 
Correspondence Guidelines; (11) tracks reports required by Congress; 
and (12) manages the IHS review of non-IHS regulatory documents that 
impact the delivery of health services to Indians.
Diversity Management and Equal Employment Opportunity Staff (DMEEOS) 
(GA3)
    (1) Administers the IHS equal employment opportunity, civil rights, 
and affirmative action and Alternative Dispute Resolution programs, in 
accordance with applicable laws, regulations, and HHS policies; (2) 
plans and oversees the implementation of IHS affirmative employment and 
special emphasis programs; (3) reviews data and advises IHS managers of 
possible discriminatory trends; (4) ensures immediate implementation of 
required actions on complaints of alleged sexual harassment or 
discrimination; (5) decides on accepting, for investigation, or 
dismissing discrimination complaints and evaluates accepted complaints 
for procedural sufficiency and investigates and resolves complaints; 
(6) evaluates accepted formal complaints of discrimination for 
procedural sufficiency and adjudicates and resolves complaints; and (7) 
develops/administers equal employment opportunity education and 
training programs for IHS managers, supervisors, counselors, and 
employees.
Public Affairs Staff (PAS) (GA4)
    (1) Serves as the principal advisor for strategic planning on 
communications, media relations, and public affairs policy formulation 
and implementation; (2) ensures IHS policy is consistent with 
directives from the HHS Assistant Secretary for Public Affairs; (3) 
provides leadership and advocacy to establish and implement policy for 
internal and external dissemination of agency information intended for 
public release or employee and stakeholder information; (4) serves as 
the central office for technical guidance and assistance to IHS staff 
for the development of public affairs and media communication; (5) 
coordinates public affairs activities with other public and private 
sector organizations; (6) coordinates the clearance of IHS public 
relations activities, campaigns, and communications materials; (7) 
represents the IHS in discussions regarding policy and public affairs 
initiatives/implementation; (8) provides technical assistance and 
advice relative to the effect public affairs initiatives/implementation 
would have on the IHS; (9) collaborates with the Division of Regulatory 
and Policy Coordination, for review and response to media requests 
received under the Freedom of Information Act (FOIA) or the Privacy 
Act, and ensures the security of IHS documents used in such responses 
that contain sensitive and/or confidential information; and (10) serves 
as the IHS liaison office for press and public affairs activities with 
HHS, IHS Area Offices, media and other external organizations and 
representatives.
Office of Clinical and Preventive Services (OCPS) (GAF)
    (1) Advises the IHS Director and Chief Medical Officer on clinical, 
preventive, and public health programs for the IHS, Area Offices, and 
Service Units; (2) serves as the primary source of national advocacy, 
policy development, budget development and allocation for these 
programs; (3) provides leadership in articulating the clinical, 
preventive, and public health needs of AI/AN, including consultation 
and technical support to clinical and public health programs and 
coordination with the Office of Quality to ensure quality standards are 
met for all clinical, preventive and public health programs; (4) 
develops, manages, and administers program functions that include, but 
are not limited to, oral

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health, medicine, telehealth, alcohol and substance use prevention and 
treatment, mental health, suicide prevention, domestic and sexual 
violence, behavioral health integration, Youth Regional Treatment 
Centers, dental services, forensic nursing services, medical services, 
Health Promotion/Disease Prevention, pharmacy and pharmaceutical 
acquisition, community health representatives (CHRs), emergency medical 
services, health records, disabilities, Human Immunodeficiency Virus/
Acquired Immune Deficiency Syndrome (HIV/AIDS), maternal health, child 
health, clinical nursing, public health nursing, men's health, women's 
health, nutrition and dietetics, elder care, cancer prevention and 
treatment; and chronic diseases such as diabetes, asthma, hypertension, 
and obesity; (5) leads and coordinates tribal consultation and urban 
Indian confer sessions for clinical and preventive health topics, 
funding, and other priority areas; (6) investigates service delivery 
and community prevention evidence-based and best practice models for 
dissemination to community service locations; (7) expands the 
availability of resources available for AI/AN health by working with 
public and private entities as well as federal agencies within and 
outside the HHS; (8) coordinates development of staffing requirements 
for new or replacement health care facilities and approves 
Congressional budget requests for staffing, in collaboration with the 
Office of Environmental Health and Engineering; (9) provides clinical 
oversight and direction for the health facilities planning process; 
(10) develops and coordinates various grant programs; (11) provides the 
national focus for recruitment and retention of health professionals 
and coordinates with the scholarship and loan repayment programs; (12) 
works with the Purchased/Referred Care (PRC) program on PRC denial 
appeals to the IHS Director and in determining PRC medical priorities; 
(13) works with the Office of Human Resources in managing the clinical 
aspects of the IHS workers' compensation claims; (14) monitors 
approximately one-half of the IHS's Government Performance and Results 
Act (GPRA) indicators, overseeing indicator development, data 
collection, and reporting results; (15) responds to tribal, 
Departmental, and Congressional inquiries; and (16) participates in 
cross-cutting issues and processes, including but not limited to, 
emergency preparedness/security, quality assurance, internal controls, 
recruitment, budget formulation, self-determination issues, and 
resolution of audit findings as may be needed and appropriate.
Division of Behavioral Health (DBH) (GAFA)
    (1) Manages, develops, and coordinates comprehensive clinical, 
preventive, and community-based programs for mental health, social 
work, and alcohol and substance abuse focused on: Prevention, 
treatment, training, technical assistance, evaluation, quality 
improvement, data collection, trauma informed care, Native youth 
programming, recovery services, suicide prevention, tele-behavioral 
health, behavioral health integration, Youth Regional Treatment 
Centers; (2) provides, develops, and implements IHS guidelines, 
standards, policies, and procedures for professional and program 
standards related to behavioral health services, including maintenance 
of existing or development of new relevant chapters in the Indian 
Health Manual; (3) monitors, measures, and evaluates the quality of 
behavioral health programs to improve the effectiveness and efficacy of 
behavioral health programs including the development of behavioral 
health budget materials for resource management, program data 
collection, behavioral health-related GPRA measures, administrative 
system integrity and accountability; (4) coordinates behavioral health 
professional staff recruitment and training needs by serving as a 
subject matter expert for the American Indians into Psychology, 
scholarship, and loan repayment assignments to meet Area Office, 
Service Unit, and tribal health professional human resource needs; (5) 
develops and monitors behavioral health contracts and grants with IHS 
programs and other entities, in collaboration with the Division of 
Acquisition Policy and the Division of Grants Management; (6) develops 
and disseminates IHS behavioral health program information and 
materials to IHS facilities and to tribes and Urban Indian 
organizations including the dissemination of culturally appropriate and 
traditional best practices in behavioral health; (7) leads and 
coordinates the National Tribal Advisory Committee on Behavioral 
Health; (8) partners with tribes and urban Indian organizations on the 
evaluation of health outcomes of clinical and community behavioral 
health services; (9) develops, coordinates, and maintains public and 
private professional partnerships with philanthropies, universities, 
community-based, and faith-based organizations to promote training, 
resources, and technical assistance to expand, leverage, increase 
access to, and coordinate behavioral health resources and services 
outside of the typical health care setting; (10) manages the operation 
of direct behavioral health services provided through the Tele-
Behavioral Health Center of Excellence; (11) provides continuing 
education for behavioral health providers, nurses, pharmacists, 
physicians, and other health care providers and paraprofessionals on 
current and pressing behavioral health clinical issues; and (12) 
provides financial resources and programmatic oversight for complying 
with the Americans With Disabilities Act through programs such as the 
Indian Children's Program that focus on autism spectrum disorders, 
fetal alcohol spectrum disorders, and other neurobiological disorders.
Division of Clinical and Community Services (DCCS) (GAFB)
    (1) Manages, develops, and coordinates comprehensive clinical, 
preventive, and community-based programs using a public health approach 
focused on: Medicine, pharmacy and pharmaceutical acquisition, 
emergency medical services, CHRs, men's health, maternal and child 
health, cancer prevention, elder health, hepatitis C prevention and 
surveillance, medicine, HIV/AIDS, health records, health education, 
health promotion, and disease prevention; (2) develops objectives, 
priorities, and methodologies to conduct and evaluate clinical, 
preventive, and community-based programs; (3) coordinates the analysis 
and implementation of approaches for recognizing and supporting 
traditional medicine and cultural practices in the health of all AI/AN; 
(4) serves as the IHS HQ liaison for the IHS Chief Clinical 
Consultants; (5) serves as the agency's liaison and coordinating role 
for the American College of Obstetrics & Gynecology and Association of 
American Indian Physicians contracts; (6) manages the Veterans Affairs 
Pharmaceutical Prime Vendor Contract and IHS National Core Formulary; 
(7) manages the pharmacy residency program; (8) develops program budget 
materials for resource management, program data collection, clinical 
and community health-related GPRA measures, administrative system 
integrity and accountability; (9) applies identified profession and 
program standards for clinical, preventive, and community health 
services, including relevant chapters in the Indian Health Manual; (10) 
disseminates culturally appropriate clinical and community

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health best practices, including traditional medicine and cultural 
healing and disseminates this information among clinical, medical, and 
community health program directors, division staff, Area staff, and 
other agencies and institutions; and (11) manages virtual and in-person 
training for CHRs to ensure that basic training requirements are met 
for new CHRs, refresher training is available, and continuing education 
is provided regularly.
Division of Nursing Services (DNS) (GAFC)
    (1) Plans, develops, coordinates, evaluates, manages and advocates 
for administrative, clinical, and public health nursing services 
focused on acute care, ambulatory care, breastfeeding, prevention, 
forensic nursing, elder care, infectious disease control and care, 
immunizations, and adolescent and prenatal care in AI/AN communities; 
(2) develops objectives, priorities, and methodologies for the conduct 
and evaluation of clinical, preventive, and public health nursing 
programs; (3) provides, develops, and implements IHS guidelines, 
standards, policies, and procedures related to nursing, including 
relevant chapters in the Indian Health Manual; (4) provides nursing 
staff with advanced education opportunities in the field of nursing in 
exchange for payback service obligations; (5) provides funding for 
nursing programs where junior level commissioned officers with IHS and 
tribal programs gain experience in nursing; (6) provides specialized 
training opportunities for specialized nursing experience in critical 
nursing shortage areas such as obstetrics, intensive care, and the 
operating room; (7) coordinates professional nursing staff recruitment 
and training needs, and loan repayment and scholarship recipient 
assignments and development to meet Area Office, Service Unit, and 
tribal health professional human resource needs; (8) develops program 
budget materials for resource management, program data collection, 
administrative system integrity and accountability; and (9) coordinates 
nursing quality improvement and other nurse-led initiatives on behalf 
of the agency, such as Relationship-Based Care and Baby-Friendly 
Hospitals.
Division of Oral Health (DOH) (GAFD)
    (1) Develops broad-based objectives, priorities, and methodologies 
to evaluate dental health programs; (2) monitors personnel orders for 
appointments and transfers; (3) processes special pay and retention 
bonus contracts; (4) disseminates information to IHS, tribal, and urban 
(I/T/U) dental programs on issues of importance, emerging technologies, 
standards of care, clinical best or promising practices; (5) provides 
an annual budget narrative and funding justification; (6) responds to 
Department, tribal, and other inquiries as required; (7) develops long-
term training opportunities to help fill critical dental specialty 
needs; (8) maintains a continuing dental education program to relay 
oral health standards of care, educate I/T/U dental staff, and retain a 
high quality oral health workforce; (9) provides recruitment 
information, including available positions, for I/T/U dental programs; 
(10) oversees an externship program to expose dental students to I/T/U 
dental programs; (11) works with IHS Loan Repayment, Human Resources, 
and Commissioned Corps to promote loan repayment, special pays, etc., 
to help recruit a competent, qualified oral health workforce; (12) 
utilizes existing workforce models, including alternative dental 
workforce models, to provide maximum, effective, and quality oral 
health care to AI/AN; (13) monitors clinical productivity, efficiency, 
and effectiveness of dental programs; (14) establishes standards for 
staffing ratios, productivity, and efficiency of dental programs; (15) 
maintains a centralized database of dental productivity and efficiency 
data; (16) develops and incorporates public health clinical standards 
of care and publishes clinical guidelines to support I/T/U programs; 
(17) promotes quality improvement through continuing education of 
providers on clinical best practices, incorporation of various quality 
models, and continuous evaluation of program quality, efficiency, and 
effectiveness; (18) communicates with internal and external 
stakeholders to provide information on oral health; (19) fosters 
collaborations with non-dental partners to improve the oral health of 
AI/AN; (20) serves as a liaison for oral health issues with other 
federal agencies; (21) develops resource opportunities to promote 
disease prevention programs; (22) evaluates programs on community-based 
services and oral health promotion/disease prevention; (23) promotes 
quality assurance/improvement principles in improving the delivery of 
oral health services in programs; (24) oversees clinical and preventive 
support centers that aid in management of oral health promotion/disease 
prevention programs; (25) monitors the prevalence and burden of dental 
disease in AI/AN; (26) educates internal and external stakeholders on 
disease prevalence and disparities and develops strategies for 
improvement; and (27) supports clinical research and demonstration 
projects designed to identify and promote evidence-based best 
practices.
Division of Diabetes Treatment and Prevention (DDTP) (GAFE)
    (1) Plans, manages, coordinates, and evaluates a comprehensive 
clinical and community program focusing on type 2 diabetes in AI/AN 
communities and other related chronic conditions; (2) plans, manages, 
develops, coordinates, and evaluates the Congressionally-mandated 
Special Diabetes Program for Indians (SDPI), a large grant program 
focused on the prevention and treatment of diabetes; (3) coordinates 
requirements for and monitors program performance related to contracts 
and grants with IHS, tribal, Urban Indian organizations and other 
entities; (4) develops objectives, priorities and methodologies for the 
conduct of clinical and community diabetes programs; (5) monitors, 
evaluates, and provides consultation to clinical and community diabetes 
grant programs and other new initiatives; (6) provides leadership, 
professional guidance, and staff development to Area Diabetes 
Consultants and IHS, tribal, Urban diabetes program providers; (7) 
provides virtual and in-person trainings on diabetes clinical care, 
nutrition education, SDPI program management, and other topics; (8) 
develops and implements IHS standards of care and clinical guidelines, 
policies, and procedures for diabetes and diabetes-related conditions; 
(9) conducts an annual collection and assessment of clinical process 
and outcomes data for diabetes and diabetes-related conditions; (10) 
develops and disseminates diabetes-related information and materials to 
I/T/U facilities; (11) coordinates the Tribal Leaders Diabetes 
Committee; (12) provides annual estimates of diabetes prevalence; (13) 
provides national nutrition and tele-ophthalmology consultation, 
training, and programming; (14) coordinates and oversees the Healthy 
Lifestyles for Youth cooperative agreement which funds grants to 
provide the Together Raising Awareness for Indian Life obesity 
prevention program at Boys & Girls Clubs in Indian Country; and (15) is 
responsible for preparing budgetary data, analysis and program 
evaluations for budget presentations and congressional hearings.

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Office of Management Services (OMS) (GAL)
    (1) Advises the IHS Director on all aspects of the management of 
grants, acquisitions, records management, personal property, supply, 
and the regulations program and provides agency-wide guidance and 
support for these programs; (2) formulates, administers, and 
coordinates the review and analysis of IHS-wide policies, delegations 
of authority, and organizations and functions development; (3) develops 
and oversees the implementation of policies, procedures and delegations 
of authority for IHS grants management activities, including grants 
added to self-governance compacts; (4) ensures that IHS policies and 
practices for the administrative functions identified above are 
consistent with applicable regulations, directives and guidance from 
higher echelons in the HHS and other federal oversight agencies; (5) 
advises the IHS Director on regulatory issues related to the IHS; (6) 
provides overall coordination and leadership for policies, services, 
including the continuity of operations plans, deployment, and public 
health infrastructure for the IHS HQ emergency preparedness plans 
consistent with those of the Department of Homeland Security and the 
HHS, addressing the IHS mission critical elements of emergency plans; 
(7) provides leadership and direction of activities for continuous 
improvement of management accountability and administrative systems for 
effective and efficient program support services IHS-wide; (8) ensures 
the accountability and integrity of grants and acquisition management, 
records management, personal property utilization and disposition of 
IHS resources; (9) assures that the IHS OMS services, policies, 
procedures, and practices support IHS Indian Self-Determination Act 
policies; (10) oversees and coordinates the annual development and 
submission of the agency's federal Activities Inventory Reform Act 
report to the HHS; and (11) participates in cross-cutting issues and 
processes, including but not limited to, emergency preparedness/
security, quality assurance, internal controls, recruitment, budget 
formulation, self-determination issues, and resolution of audit 
findings as may be needed and appropriate.
Division of Asset Management (DAM) (GALA)
    (1) Plans, develops, and administers the IHS personal property and 
supply management program in conformance with federal personal property 
management laws, regulations, policies, procedures, practices, and 
standards; (2) interprets regulations and provides advice on execution 
and coordination of personal property and supply management policies 
and programs; (3) administers management systems and methods for 
planning, utilizing, and reporting on personal property and supply 
programs, including the precious metals recovery program and IHS 
personal property and supply accountability and control systems; (4) 
provides guidance and serves as principal administrative authority for 
IHS on federal personal property and supply management laws, 
regulations, policies, procedures, practices, and standards; (5) 
conducts surveys and studies involving evaluation and analysis of the 
personal property and supply management activities IHS-wide; (6) 
maintains liaison with the HHS and the General Services Administration 
(GSA) on personal property and supply management issues and programs 
affecting the IHS; (7) plans, develops and administers the IHS Fleet 
Management Program; (8) prepares reports on IHS personal property and 
supply management activities; and (9) administers the local HQ personal 
property management program to include receiving, tagging, storage and 
disposal in addition to conducting the annual inventory for all HQ 
locations.
Division of Administrative and Emergency Services (DAES) (GALB)
    (1) Administers physical security, facility management, space 
management services, parking management, including the employee transit 
subsidy program, the IHS mail and commercial printing programs, and 
Homeland Security Presidential Directive 12 (HSPD-12) badge issuance 
for HQ; (2) coordinates with OIT to provide telecommunication services 
to HQ; (3) serves as liaison with HHS and the GSA on logistics issues 
affecting the IHS; (4) provides guidance and oversight to the IHS on 
the control and safeguard of classified national security information; 
(5) plans, develops and administers the IHS-wide HSPD-12 program to 
include providing leadership on the Physical Access Control Systems, 
and the Physical Security Program; (6) provides special transportation 
and security; (7) provides overall coordination and leadership for the 
IHS HQ emergency preparedness plans consistent with those of the 
Department of Homeland Security and the HHS, addressing the IHS mission 
critical elements of emergency plans; (8) provides leadership for the 
development of emergency preparedness plans, policies, and services, 
including the continuity of operations plans, deployment, and public 
health infrastructure; (9) coordinates IHS HQ with the IHS Area Offices 
activities and available resources of other government and non-
government programs for essential services related to homeland security 
and emergency preparedness; (10) coordinates periodic national 
emergency preparedness exercises with the HHS and Area Offices; (11) 
maintains and administers the HQ emergency preparedness equipment 
including the office-site and alternative locations; (12) advocates for 
the emergency preparedness needs and concerns of AI/AN and promotes 
these program activities at the local, state, national, and 
international levels; (13) serves as an information gathering and 
dissemination point for local and national emergency preparedness 
information including situational awareness; (14) distributes key 
information to IHS locations on a routine and as-needed basis including 
federal agencies/partners; (15) provides leadership and guidance for 
the IHS Forms Management Program; and (16) provides leadership and 
coordination in the planning, development, operation, oversight, and 
evaluation of special office support projects for office relocations, 
and inter-and intra-agency activities.
Division of Acquisition Policy (DAP) (GALC)
    (1) Develops, recommends, and oversees the implementation of 
policies, procedures and delegations of authority for the acquisition 
management activities in the IHS, consistent with applicable 
regulations, directives, and guidance from higher echelons in the HHS 
and federal oversight agencies; (2) advises the OMS Director, Deputy 
Director for Management Operations, and other senior staff of proposed 
legislation, regulations, and directives that affect contracting in the 
IHS; (3) provides leadership for compliance reviews of all IHS 
acquisition operations and oversees completion of necessary corrective 
actions; (4) administers the agency conference management policy; (5) 
manages for the agency, the HHS acquisition training and certification 
program; (6) supports and maintains the IHS Contract Information System 
and controls entry of data into the HHS Contract Information System; 
(7) serves as the IHS contact point for contract protests and the HHS 
contact for contract-related issues; (8) reviews and makes 
recommendations for approval/disapproval of contract-related

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documents such as: Pre- and post-award documents, unauthorized 
commitments, procurement planning documents, Justification for Other 
Than Full and Open Competition waivers, deviations, and determinations 
and findings that require action by the agency Head of the Contracting 
Activity, or the Office of the Secretary; (9) processes unsolicited 
proposals for the IHS; (10) coordinates the IHS Small Business 
programs; (11) oversees compliance with the Buy Indian Act; and (12) 
manages the processing of Inter- and Intra-agency agreements as well as 
Memoranda of Understanding.
Division of Grants Management (DGM) (GALD)
    (1) Directs grants management and operations for the IHS; (2) 
authorizes, awards and administers discretionary grants and cooperative 
agreements for IHS financial assistance programs; (3) provides guidance 
for the resolution of audit findings for grant programs; (4) manages 
for the agency, the HHS grants training and certification program; (5) 
continuously assesses grants operations; (6) oversees implementation of 
corrective action plans for those entity recipients (grantees) 
receiving IHS discretionary grant support; (7) reviews and makes 
recommendations for improvements in grantee and potential grantee 
management systems; (8) serves as the IHS liaison to the HHS and the 
public for discretionary grants and cooperative agreements authorized 
by the IHS; (9) maintains the Catalog of Federal Domestic Assistance 
for IHS financial assistance programs; (10) provides guidance and 
limited, technical, grants-related training and assistance for IHS 
staff, grantees, and applicants; (11) coordinates payment to 
scholarship recipients; (12) serves as liaison to the Centers for 
Excellence (grant award system) and controls data entry into the grant 
award system; and (13) maintains the official, electronic grant files 
for funded grants.
Division of Regulatory and Policy Coordination (DRPC) (GALE)
    (1) Manages the IHS' overall regulations program and 
responsibilities, including determining the need for and developing 
plans for changes in regulations, developing or assuring the 
development of needed regulations, and maintaining the various 
regulatory planning processes; (2) serves as IHS liaison with the 
Office of the Federal Register (FR) on matters relating to the 
submission and clearance of documents for publication in the FR; (3) 
assures proper agency clearance and processing of FR documents; (4) 
informs management and program officials of regulatory activities of 
other federal agencies; (5) advises the OMS Director on such matters as 
regulations, related policy issues, and administrative support issues; 
(6) manages the retrieval and transmittal of information in response to 
requests received under the FOIA, Privacy Act, the Health Insurance 
Portability and Accountability Act (HIPAA) and the Health Information 
Technology for Economic and Clinical Health (HITECH) Act, in 
collaboration with the Public Affairs Staff; (7) ensures the security 
of sensitive and/or confidential information when responding to FOIA, 
Privacy Act, HIPAA, and HITECH Act issues; (8) advises the IHS Director 
regarding requests for IHS employees to serve as expert witnesses when 
IHS is not a party to the suit; (9) provides leadership and guidance 
for the IHS Records Management Program; (10) develops and recommends 
policies and procedures for the protection and disposition of IHS 
records and oversees the evaluation of records management activities in 
the IHS; (11) develops and implements a management control system for 
evaluation of records management functions IHS-wide; (12) maintains and 
updates various regulatory agendas; (13) manages, administers, 
implements and monitors the IHS's Paperwork Reduction Act and OMB 
information collection/activities; (14) provides guidance and technical 
assistance to IHS regarding information collection requirements and 
procedures for obtaining OMB approvals and extensions for IHS 
information collections; (15) coordinates the implementation and the 
application of Privacy Act, HIPAA, and HITECH Act requirements, 
including but not limited to HIPAA and HITECH Act compliance; (16) 
formulates, administers, and supports IHS-wide policies, delegations of 
authority, and organizations and functions development; (17) provides 
leadership, on behalf of the IHS Director, to functional area managers 
at IHS HQ in developing, modifying, and overseeing the implementation 
of IHS policies and procedures; (18) provides analysis, advisory, and 
assistance services to IHS managers and staff for the development, 
clearance, and filing of IHS directives and delegations of authority; 
and (19) serves as principal advisor and source for technical 
assistance for establishment or modification of organizational 
infrastructures, functions, and Standard Administrative Code 
configurations.
Office of Quality (OQ) (GAP)
    (1) Advises the IHS Director on all aspects of assuring quality 
health care and develops and implements a strategic quality framework, 
integrating feedback and inputs from various levels of the organization 
and Tribal/Urban Indian organization partners; (2) oversees 
accreditation readiness activities and compliance with accreditation 
requirements for all IHS Direct Service facilities, to include periodic 
mock surveys and formal accreditation surveys; (3) conducts training 
and informational activities that promote skills development in quality 
improvement, quality assurance, and performance improvement; (4) 
routinely assesses and reports on patient satisfaction and experience 
using standardized survey instruments and processes, and facilitates 
improvement activities based on survey results; (5) coordinates and 
organizes participation of IHS facilities and staff in interagency 
quality improvement activities; (6) develops and monitors quality 
improvement and assurance metrics for health care delivery processes 
and outcomes, and advises other IHS Offices on quality improvement 
methods to improve support and outcomes of IHS administrative functions 
and processes; (7) develops programs to assess, address, and 
continuously improve systems and processes to improve health care 
quality, promote sustained compliance with relevant federal regulations 
and accreditation and professional standards, reduce and improve 
patient wait times and patient experience of care in all related health 
care settings; (8) consults on and provides guidance for 
standardization of health care delivery policies and protocols; (9) 
develops programs which promote patient safety management and reporting 
systems and processes, sentinel event investigations/root cause 
analysis, and clinical risk management; (10) supports credentialing of 
licensed independent practitioners via standardized methods and a 
uniform system; (11) supports patient-centered care processes, 
engagement of patients as partners in care, and patient activation 
through self-management support and involvement in service delivery 
improvements; (12) oversees and coordinates across IHS to establish and 
communicate IHS's Enterprise Risk Management (ERM) vision, culture, 
strategy, and framework; (13) oversees and coordinates the agency's 
efforts to establish and maintain proper internal controls and ensures 
that requirements are met under OMB Circular A-123; (14) facilitates 
enterprise-wide, integrated

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and comprehensive assessments across IHS's risk portfolio including 
leading the development of the agency's risk profile and guiding 
management's prioritization of risks across the agency; and (15) 
participates in cross-cutting issues and processes, including but not 
limited to, emergency preparedness/security, quality assurance, 
recruitment, budget formulation, self-determination issues, and 
resolution of audit findings as may be needed and appropriate.
Division of Quality Assurance (DQA) (GAPA)
    (1) Develops and implements programs to promote sustained 
compliance with relevant federal regulations and accreditation and 
professional standards: Manages and coordinates mock surveys, promotes 
accreditation services coordination, provides accreditation resource 
management, provides survey corrective action plan development 
assistance and coordination, manages accreditation and certification 
survey reports, promotes multidisciplinary integration of survey 
readiness support activities, supports and promotes patient-centered 
care including Patient and Family Engagement, and promotes unification 
of Area Quality Managers and Service Unit Quality Assurance and 
Performance Improvement Officers; and (2) develops and implements 
programs to manage credentialing standards and policy, acquires and 
maintains centralized credentialing software system, promotes 
unification of credentialing officers/prime source verification 
officers, and promotes standardized training and support resources for 
credentialing officers.
Division of Patient Safety and Clinical Risk Management (DPSCRM) (GAPB)
    (1) Develops and implements programs to promote patient safety 
including: Promoting a culture of safety, providing education, training 
and application, establishing and monitoring systems and metrics 
related to adverse events, establishing policy and guidelines to reduce 
adverse events, reducing all types of hospital acquired conditions 
through technological innovation, attention to detail, and 
implementation of high reliability science, and reduce avoidable 
hospital readmissions through enhanced transition-of-care planning and 
coordination, communication with primary care, and management of 
community-based resource delivery; (2) develops and implements programs 
to employ strategies that reduce the possibility of a specific loss, 
systematically gathers and utilizes data, implements proactive and 
reactive components to prevent losses and mitigates impact of losses, 
implements strategies to reduce the risk of harm to patients, liability 
exposure of health care providers, and financial loss to the IHS; and 
(3) develops and implements programs to perform incident identification 
and reporting, identifies and addresses potential tort claims, 
sequestering medical records, and investigation of medical adverse 
events, reviews patient grievances concerning quality of care, performs 
sentinel event/root cause analysis review and documentation, analyzes 
methods for dismissal of patients from care, reviews outside requests 
for medical records, responds to inquiries from governmental agencies, 
media, and advocacy groups, promotes compliance with regulatory, 
accreditation, and contractual agreements, examining issues related to 
determination of standards of care, represents IHS when claims are 
presented for review by the Malpractice Claims Review Panel chartered 
by the HHS, maintains case files and a malpractice claims database, 
provides case summaries, peer review, outcome information, and feedback 
of risk management recommendations, disseminates information about the 
review process, responds to outside organizations requesting tort 
claim-involvement histories on former employees, assists providers with 
Malpractice Claims Review Panel, and submits payment reports to the 
National Practitioner Data Bank.
Division of Innovation and Improvement (DII) (GAPC)
    (1) Develops and implements programs to increase quality 
improvement capacity in the Indian health system including training 
health care staff and support team members in the Model for Improvement 
to rapidly test small scale changes at the local level for improvement 
in clinical processes to improve patient outcomes, experience of care, 
and resource utilization, builds capability in all staff to support 
improvement and ensure that patients, families, providers and care team 
members are involved in quality improvement activities, establishes and 
monitors metrics to evaluate improvement efforts and outcomes and 
ensures all staff members understand the metrics for success, optimizes 
use of health information technology and data to continuously improve 
performance, quality and service (Resource and Patient Management 
System and iCare), and improves patient and staff satisfaction with 
health care service delivery; (2) leads change management for practice 
transformation to embrace new models of care delivery and to enhance 
efficiency of the care delivery process, develops and implements 
programs to promote the implementation of the patient-centered medical 
home model of care including: Increase patient empanelment to 
facilitate care management and population health, promotes continuous 
and team-based healing relationships in which roles are well defined 
and tasks are distributed among multidisciplinary care team members to 
reflect the skills, abilities and credentials of the individual team 
members, fosters patient-centered interactions through expanded patient 
roles in decision making, health-related behaviors and self-management, 
reduces barriers to accessing care through more efficient service 
delivery processes, alternative care delivery methods, expanded access 
to the care team, and appointment scheduling flexibility; boosts care 
coordination through community resource linkages, integrating specialty 
care referral and coordination processes, assisting with referral-
related processes, and assuring completion of all elements of care; and 
(3) develops and implements programs to promote a competent health care 
management staff to include coordinating training and support resources 
for standardized position descriptions and competencies for management 
staff, standardizing management tools and resources, provides 
leadership development and skill-building, and facilitates change 
management to support quality assurance and quality improvement.
Division of Enterprise Risk Management and Internal Controls (DERMIC) 
(GAPD)
    (1) Coordinates with key HQ Offices to ensure cross-cutting agency 
strategic planning, ERM, and management of internal controls across 
IHS; (2) ensures IHS' portfolio of enterprise risks are appropriately 
and effectively managed by identifying accountable individual risk 
owners; (3) advises on risk management and provides expertise, advice, 
and assistance to the IHS Director, Office Directors, Area Directors 
and other key staff at both HQ and Area levels on ERM matters; (4) 
develops goals and objectives for the ERM program, integrates them with 
broader IHS-wide strategic goals/objectives, and tracks progress toward 
achieving them; (5) evaluates and monitors systems of internal control 
across IHS and uses the assessments of the internal control program as 
an integral part of ERM to effectively manage risks across IHS; and (6) 
coordinates the agency's ERM program and administers the agency's

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internal control program in compliance with the Federal Managers' 
Financial Integrity Act, OMB Circular No. A-123, and other applicable 
requirements.

Section GA-30, Indian Health Service--Delegations of Authority

    All delegations of authority and re-delegations of authority made 
to IHS officials that were in effect immediately prior to this 
reorganization, and that are consistent with this reorganization, shall 
continue in effect pending further re-delegation.

Alex M. Azar II,
Secretary.
[FR Doc. 2018-27793 Filed 12-21-18; 11:15 am]
BILLING CODE 4165-17-P