SEP 18, 1990

When representatives of the Office of the Assistant Secretary for Health assessed Indian Health Service (IHS) management practices recently, they identified unauthorized policies and procedures issued by Headquarters as a serious weakness that we, as an agency, must now address.  This memorandum reiterates established policies and procedures, as set forth in the Indian Health Manual, Part 1, Chapter 1, governing the issuance of IHS directives.

Preparation and Clearance of Policy Issuances and Supplements

Authorized forms for policy issuances and supplements used within the IHS are listed below:

1. Indian Health Manual chapters, circulars, memorandums (e.g., Special General Memorandums), and bulletins;
2. Indian Health Service supplements to departmental and Public Health Service staff manuals; and
3. Indian Health Service contract policy letters issued by the Division of Contracts and Grants Policy.

Policy statements are issuances exclusively reserved for my use.  They are used only in rare instances.  Policy statements are not to be issued by Headquarters Office levels or below.

All IHS policy issuances, regardless of format, must be cleared through the Division of Management Policy (DMP), Office of Administration and Management (OAM).  The Indian Health Manual, Part 1, Chapter 1, Section 4.A.(l) states that "DMP, OAM, is responsible for the Service's issuance system."  Any office contemplating policy development or revision should contact DMP and ask for technical assistance before beginning, in order to ensure that the policy is prepared in one of the prescribed formats.

As a matter of policy, the office initiating a directive of any kind must send it to DMP for review and comment.  The DMP is responsible for sending drafts to IHS Area Directors, Headquarters Associate Directors, and other appropriate personnel for review and comment.  This procedure maintains the integrity of the directives process and ensures proper control over the issuance of directives.

In addition to receiving DMP clearance, all agency-wide policies must be signed by the Director, IHS.  The Indian Health Manual, Part 1, Chapter 1, Section 2.A.(2) states that only the Director, IHS, (or his designee) shall issue IHS policy.

Distribution and Control

Proper distribution and control of IHS policy documents hinge on those policies being prepared and issued in an authorized manner.  The DMP is responsible for establishing and maintaining a mailing list of recipients at the Headquarters, Area, and field facility levels.  This mailing list establishes the IHS mailing key used by the Department to distribute policy issuances.  When unauthorized procedures are employed in issuing policies, DMP is not involved and proper distribution is jeopardized.  The DMP tracks policy issuances by assigning control numbers to each, thus providing a means of locating issuances at later dates anywhere within the agency.

In summary, I must stress the importance I have placed on ensuring that policies are issued in the prescribed manner.  Management of IHS directives is a goal we can accomplish together by following established procedures.  Your assistance in maintaining the integrity of the directives management process is appreciated.  If you have questions or need assistance, please contact the Chief, Manual Issuance and Delegations Control Branch, DMP, at 443-2546, Maxima Building, Suite 603.