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Administrative Policies and Procedures
113 - Tribal Consultation Policy
Table of Contents
Introduction
Background
Policy
Philosophy
Vision
Objectives
Principles
Consultation Process
Joint Tribal/State Workgroups
Solicitation of Advice from Indian Health Programs and Urban Indian Organizations
Limitations
Summary
Authority
Revisions
INTRODUCTION
The mission of the Arizona Health Care Cost Containment System (AHCCCS) is to provide comprehensive,
quality health care to those in need. AHCCCS and Indian Tribes in the State of Arizona (hereinafter referred to
as "Indian Tribes") share the common goal of decreasing health disparities and maximizing access to critical
health services. In order to achieve this goal, it is essential that the AHCCCS Administration and Indian Tribes
engage in open, continuous, and meaningful consultation on a government-to-government basis. True
consultation consists of ongoing information exchange and mutual understanding which leads to informed
decision-making.
BACKGROUND
A unique government-to-government relationship exists between Indian Tribes and federal and state
governments. Since the formation of the Union, the United States has recognized Tribal Governments as
sovereign nations. Treaties and laws, together with court decisions, have defined a relationship between Indian
Tribes and the federal government that is unlike that between the federal government and any other group of
Americans. The federal government has enacted numerous regulations and policies that establish and define a
trust relationship with Indian Tribes (see Authority). As a state agency responsible for administering a federal
program, the AHCCCS Administration recognizes that these regulations and policies play a significant role in
the AHCCCS Tribal Consultation Policy.
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
2
Pursuant to A.R.S. 41-2051 Section C, this Policy ensures that reasonable notice and opportunity for
consultation with Indian Tribes are provided by the AHCCCS Administration prior to implementing policy
changes that are likely to have a direct effect on Indian Tribes. Adherence to this Policy contributes to a
strengthened relationship between the Indian Tribes and AHCCCS. Furthermore, AHCCCS shall designate staff
to assume responsibility for the agency’s implementation and serve as a point of contact for tribal issues.
AHCCCS shall review the Tribal Consultation Policy each year and submit a report to the Governor’s Office on
Tribal Relations to describe all action undertaken as a result of the implementation of the Policy.
POLICY
The guiding principle of this Policy is to guide and strengthen the special relationship between Indian Tribes
and federal and state governments, and ensure that, to the extent practicable and permitted by law, AHCCCS
seeks input from Indian Tribes before undertaking any action or policy that will, or is reasonably believed to,
have the potential to affect Tribal Communities or its members. Policy changes that are likely to have a direct
effect on Tribal Communities or its members refer to actions that have Tribal implications with direct effects
on:
● One or more Indian Tribes
● The relationship between the State of Arizona and Indian Tribes
● The distribution of power and responsibilities between the State of Arizona and Indian Tribes
AHCCCS recognizes that federal and state laws and regulations will be implemented as they apply to Indian
Tribes receiving payments for services provided under the AHCCCS program.
PHILOSOPHY
AHCCCS is the health care insurance provider for a considerable percentage of Arizona’s American Indian
population. The involvement of Indian Tribes in the development of AHCCCS policy allows for locally relevant
and culturally appropriate approaches to important issues. Therefore, the AHCCCS Administration is
committed to working with Indian Tribes to improve the quality, availability, and accessibility to care by
eliminating barriers for American Indians in Arizona.
VISION
Implementation of the AHCCCS Tribal Consultation Process requires a proactive bi-directional information
sharing and advisory process that allows Indian Tribes to express policy positions and reactions to proposed
policy changes. Consultation with Indian Tribes may be initiated by AHCCCS in the following scenarios, which
differ with respect to the extent AHCCCS has control over shaping policy.
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
3
● AHCCCS proposes a policy or programmatic change where AHCCCS has control as to how the policy
or programmatic change is shaped and implemented.
● State or Federal Law mandates a policy or programmatic change in which AHCCCS has limited or no
control over shaping and implementing the policy or programmatic change.
● State or Federal Law mandates a policy or programmatic change in which AHCCCS has more control
over shaping and implementing the policy or programmatic change.
Although there may be scenarios in which AHCCCS has limited control over shaping and implementing a
policy or programmatic change, AHCCCS will provide information to Indian Tribes as to what changes may be
expected prior to the enactment of laws by the state or federal government that are likely to have a direct effect
on Indian Tribes. AHCCCS will make information submitted by Indian Tribes on the effect of proposed
changes available on the AHCCCS website.
OBJECTIVES
In order to fully effectuate this Policy, the AHCCCS Administration will:
● Establish communication channels with the elected leader of each Indian Tribe and the appointed
leadership for health services for each Indian Tribe. The AHCCCS Administration recognizes that a
standing goal of working with Indian Tribes is to increase their knowledge and understanding of
AHCCCS programs and policies, as well as increase AHCCCS Administration’s understanding and
appreciation for the unique health needs of American Indian people within the context of their cultures.
● Set timely consultation with Indian Tribes to discuss potential changes to policy that would have an
impact on Indian Tribes.
● Allow for consultation with Indian Tribes in the development of new policy or a change in policy with
substantial Tribal implications, including State Plan Amendments and Waiver proposals that will be
submitted to the Centers for Medicare and Medicaid Services (CMS).
● Coordinate within the Agency to ensure consistent application of the Tribal Consultation Policy.
● Provide relevant background information on consultation topics given the scope of available AHCCCS
administrative resources so that Indian Tribes may fully consider information when providing
recommendations to AHCCCS. This information may include, but is not limited to, applicable statutes,
regulations, policy, guidance, and agreements between AHCCCS and CMS.
● Seek formal written recommendations from Indian Tribes which include pertinent impacts of proposed
changes.
● Provide opportunity on an ongoing basis for Indian Tribes to request tribal consultation on a specific
topic or issue affecting one or more Indian Tribe(s).
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
4
PRINCIPLES
Trust among the AHCCCS Administration and Indian Tribes is an indispensable element in establishing a good
consultative relationship. To establish and maintain trust, consultation must occur on an ongoing basis. The
AHCCCS Administration, guided by the Tribal Relations Liaison, shall use the process as described in this
Policy under “Consultation Process” to determine the nature and extent of consultation that should occur to
ensure that the intent of this Policy is satisfied.
Consultation occurs whenever the AHCCCS Director and Tribal Official(s) and/or their designees, engage in
oral or written communication to discuss an issue. Consultation with a single Indian Tribe will not substitute for
consultation with other Tribes on issues that may affect more than one Tribe.
AHCCCS staff persons who have a role in the development or implementation of policy substantially affecting
Indian Tribes shall understand the government-to-government relationship between the federal and state
governments and Indian Tribes, the uniqueness of Indian Tribes, the purpose of the AHCCCS Tribal
Consultation Policy, its expectations, applicability, and its anticipated outcomes.
CONSULTATION PROCESS
AHCCCS engages in consultation with Indian Tribes through a variety of methods and at a variety of levels
about policy issues that have a direct effect on Indian Tribes. Scenarios in which AHCCCS shall engage in the
consultative process with Indian Tribes include, but are not limited to the following:
● Proposed amendments to the AHCCCS Tribal Consultation Policy
● Proposed or existing tribal/state/federal intergovernmental or contractual language revisions
● Proposed resource distribution methodologies that may affect payments made to Indian Tribes or Indian
Health Service, Tribal programs operated under P.L. 93-638, and urban Indian health programs
● Proposed fee-for-service provider rate changes
● Proposed State Plan amendments, new waiver demonstration requests, waiver renewals, and waiver
amendments
● Proposed changes or limitation of eligibility or benefits
● Proposed gaming or other monetary distributions by tribal governments to eligible community members
that may affect eligibility for AHCCCS programs
Direct Consultation by the AHCCCS Administration (See Attachment 1 - Flow Chart)
1. New or Revised Policy
A. When it appears that a new or revised AHCCCS policy may be needed, the AHCCCS
Administration shall consider whether it is a policy change that is likely to have a direct effect on
Indian Tribes, as well as Indian Health Services, Tribal Health Organizations, Urban Indian
Health Organizations, or other tribal entities.
B. If a policy is identified that is likely to have a direct effect on Indian Tribes, Indian Health
Services, Tribal Health Organizations, Urban Indian Health Organizations, and other tribal
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
5
entities, the AHCCCS Administration shall make every effort to provide, no less than 45 days
prior to implementation, written notice to Indian Tribes soliciting feedback and
recommendations regarding the issue, with a courtesy copy of the written notice being provided
to Indian health Services, Tribal Health Organizations, Urban Indian Health Organizations, and
other tribal entities. Such solicitations shall be directed to the Tribal Official, and/or their
designee, explaining the background, describing the proposed action, inviting Indian Tribes to a
formal consultation meeting, and requesting a response within a given timeframe.
C. If a Tribal Official and/or their designee, requests additional information or provides feedback
regarding an issue, the AHCCCS Administration shall communicate, verbally or through written
correspondence, with the official and/or their designee, to provide a timely and substantive
response.
D. Face-to-face, telephonic or web-based consultation sessions may be scheduled. Such sessions
may be scheduled as a single statewide meeting, or in conjunction with other statewide
meetings. Notice of such sessions, especially statewide meetings, will be disseminated to the
Indian Tribes, Indian Health Services, Tribal Health Organizations, Urban Indian Health
Organizations, and other tribal entities.
E. The AHCCCS Administration will provide an opportunity for submission of written comments
during any period of ongoing consultation. Written comments may be submitted electronically or
by mail in a format most conducive for the Tribe, Indian Health Service (IHS), Indian Tribe,
Tribal Organization, Urban Indian Organization, or other entity. In lieu of formal
correspondence, Attachment 2 - Formal Recommendations may be submitted to AHCCCS.
F. The AHCCCS Administration will also provide written notice and a solicitation for feedback to
organizations such as the Advisory Council on Indian Health Care, Inter Tribal Council of
Arizona, the Indian Health Service Area Offices in Arizona, Urban Indian Health Organizations,
and P.L. 93-638 Tribal organizations in Arizona. Such communications do not substitute for
direct communications with the individual Indian Tribes.
G. AHCCCS will provide a written response to Indian Tribes, and will send courtesy copies to
Indian Health Services, Tribal Health Organizations, Urban Indian Health Organizations, and
other tribal entities, regarding comments received and the outcome of the consultation
process. AHCCCS may post relevant information on the AHCCCS website.
2. Ongoing Consultation
A. At least annually, AHCCCS will meet with Indian Tribes to review existing AHCCCS policies,
regulations, anticipated budget changes, and their impact on Indian Tribes as well as provide
opportunities for Indian Tribes to establish priorities for the year. Courtesy notice of any
meetings with Indian Tribes will be provided to Indian Health Services, Tribal Health
Organizations, Urban Indian Health Organizations, and other tribal entities.
B. A Tribal Official and/or their designee may formally request tribal consultation on a topic. In lieu
of formal correspondence, Attachment 3 - Formal Request for Tribal Consultation may be
submitted to AHCCCS.
C. The AHCCCS Administration will continue to meet regularly with Indian Tribes. Such meetings
may occur in person, telephonically or using web-based technology. To the extent issues of
general application are discussed in such meetings, the Tribal Relations Liaison or other
designated AHCCCS staff will provide follow-up, as appropriate.
D. The AHCCCS Administration may request participation by other state agencies and/or the
Centers for Medicare and Medicaid Services in the consultation process when appropriate.
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
6
E. The AHCCCS Administration will participate in the U.S. Department of Health and Human
Services (HHS) regional consultations, and, as requested, in consultation meetings sponsored by
HHS agencies, including the Centers for Medicare and Medicaid Services and the IHS, or Indian
Tribes.
JOINT TRIBAL/STATE WORKGROUPS
Joint Tribal/Federal Workgroups and Task Forces: The AHCCCS Administration may establish or participate
in workgroups, task forces, or other groups or committees with Indian Tribes and others, including Indian
Health Services, Tribal Health Organizations, Urban Indian Health Organizations, and other tribal entities, to
address issues affecting Indian Tribes.
SOLICITATION OF ADVICE FROM INDIAN HEALTH PROGRAMS AND URBAN INDIAN
ORGANIZATIONS
AHCCCS shall seek advice from designees of the IHS, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations on a regular, ongoing basis on the matters that are likely to have a direct effect on such entities.
Scenarios that shall require solicitation of advice prior to submission include state plan amendments, waiver
requests, and proposals for demonstration projects that are likely to have a direct effect on the aforementioned
entities.
LIMITATIONS
Interaction with the Advisory Council on Indian Health Care, other workgroups, task forces or committees will
not take the place of Tribal consultation. This interaction is intended to enhance the consultation process by
gathering individuals with extensive knowledge of particular policy, practice, issues, or concerns to work
collaboratively and offer recommendations for consideration by the AHCCCS Administration.
An official resolution and/or action approved by a quorum of the member tribes of the Inter Tribal Council of
Arizona shall constitute a joint position presented by the Inter Tribal Council of Arizona. If a member tribe of
the Inter Tribal Council of Arizona indicates in writing that the joint position of the Inter Tribal Council of
Arizona is supported by such tribe, the documented support will be recognized as the position of the tribe.
SUMMARY
The AHCCCS Administration views Tribal consultation as a dynamic process. Joint effort between the Indian
Tribes, the AHCCCS Director, the Tribal Relations Liaison, and AHCCCS divisions will promote the
objectives of the Tribal Consultation Policy. Together, they will further consistent implementation of the Policy
and work to ensure that the Policy plays a meaningful role in addressing issues affecting Indian Tribes.
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
7
AUTHORITY
The special relationship between the Federal Government and Indian Tribes is affirmed in statutes and various
Presidential Executive Orders including, but not limited to:
● The Snyder Act, P.L. 67-85
● Older Americans Act of 1965, P.L. 89-73 as amended
● Indian Self-Determination and Education Assistance Act, P.L. 93-638, as amended
● Native American Programs Act of 1974, P.L. 93-638, as amended
● Indian Health Care Improvement Act, P.L. 93-644, as amended
● Social Security Act, Titles XIX, XX, and XXI
● Unfunded Mandates Reform Act of 1995, P.L. 104-4
● Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L. 104-193
● Presidential Executive Memorandum to the Heads of Executive Departments dates April 29, 1994
● Presidential Executive Order 13084, Consultation and Coordination with Indian Tribal Governments,
May 14, 1998
● Presidential Executive Order 13175, Consultation and Coordination with Indian Tribal Governments,
November 6, 2000
● Presidential Memorandum, Government-to-Government Relationship with Tribal Governments,
September 23, 2004
● Children's Health Insurance Program Reauthorization Act of 2009, P.L. 111-3
● American Recovery and Reinvestment Act of 2009, P.L. 111-5
The State of Arizona Statute to mandate Tribal Consultation:
● Arizona Revised Statutes Title 41. State Government § 41-2051. Governor’s office on tribal relations;
director; responsibilities of state agencies; report.
The Office of the Director is responsible for this policy.
REVISIONS
Effective Date: 08/12/2008
1. Revisions:
A. Revised Date: 06/08/2010
B. Revised Date: 10/21/2014
C. Revised Date: [UPDATE ONCE POLICY REVISIONS ACCEPTED]

Administrative Policies and Procedures: 113 - Tribal Consultation Policy
8
AttachmentA‐FlowChart

Administrative Policies and Procedures: 113 - Tribal Consultation Policy
9

Flow Chart - Direct Consultation by the AHCCCS Administration
Proposed
Policy
Modification
Initial
Informational
Meeting
Comment
Period
Meeting or
Correspondence
Reviewing
Considerations and/
or Incorporation
Final
Policy
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
10
AttachmentB‐FormalRecommendations

Tribal Consultation Form
Formal Recommendations
Date:
NameofSubmitter:
Title:
Program:
Tribe/Organization:
DescriptionofIssue/Topic:
Impact:
Recommendation:
11of13
Administrative Policies and Procedures: 113 - Tribal Consultation Policy
12
AttachmentC‐FormalRequestforTribalConsultation
Tribal Consultation Form
Formal Request for Tribal Consultation
Date:
Name of Tribal Executive Leadership
Requesting Tribal Consultation:
Tribe/Organization:
Name of Submitter:
Title of Submitter:
Submitter Email:
Address:
City: State: Zip:
Description of Issue/Topic:
Additional Information Pertaining to the Request:
13 of 13
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