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U.S. Department of Health and Human Services
Indian Health Manual

The Tribal Leaders Diabetes Committee

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
Rockville, Maryland 20857

Refer to: OCPS

INDIAN HEALTH SERVICE CIRCULAR NO. 25-11
Sec.
1. Background
2. Vision Statement
3. Mission Statement
4. Objectives
5. Membership
6. Leadership
7. Technical Advisors
8. Meeting
9. Quorum and Voting
10. Subcommittees and Workgroups
11. Supersedure
12. Effective Date
  1. BACKGROUND.  The Special Diabetes Program for Indians (SDPI), was created by Congress, as part of the Balanced Budget Act of 1997, Public Law 105-33, in recognition of the disproportionate impact of diabetes in American Indian and Alaska Native (AI/AN) communities. The Tribal Leaders Diabetes Committee (TLDC) was created by the Indian Health Service (IHS) Director, Dr. Charles Grim, in 1998. The TLDC makes recommendations to the IHS Director regarding the distribution of SDPI funds.  The TLDC also provides the IHS and Tribal leadership with an ongoing forum to discuss all matters related to diabetes and the impact of other chronic diseases on AI/AN communities.

  2. VISION STATEMENT.  The TLDC will empower AI/AN people to live free of diabetes and related chronic diseases by promoting healthy lifestyles while preserving culture, traditions, and values through Tribal leadership.

  3.  MISSION STATEMENT.  The TLDC will make recommendations to establish
    broad-based policy and advocacy priorities for diabetes and related chronic disease activities to the Director, IHS.

  4. OBJECTIVES. The TLDC will:

    1. Make recommendations and provide advice on policy and advocacy issues concerning diabetes and related chronic diseases.
    2. Provide advice and guidance to ensure the incorporation of appropriate culture, traditions, and values in program development, research, and community-based activities.
    3. Provide broad-based guidance and assistance in defining how other Federal agencies and organizations, states, Tribal epidemiology centers, institutions of higher learning, and private health organizations can play a role in addressing diabetes and related chronic diseases.
  5. MEMBERSHIP.
    1. Composition.  The TLDC membership consists of one Delegate and one Alternate from each of the 12 IHS Areas.
    2. Tribal Representatives.  Each TLDC Delegate and Alternate must be an elected officer of a Tribal government, or their designated representative with authority to act on their behalf, acting in their official capacity.  The TLDC Alternate may represent the Delegate in TLDC meetings and other TLDC activities if the Delegate cannot attend.  A designated Alternate must be qualified to represent the same IHS Area as the Delegate.
    3.  Selection Process.  The IHS Area Directors are responsible for soliciting nominations and selecting one Tribal Delegate and Alternate from their respective Area in consultation with Area Tribes.
      1. Nominations must be submitted to the Area Director on official Tribal letterhead or other recognized documentation signed by the respective officials.
      2. Upon selection, the Area Director must submit the names of the TLDC Delegate and Alternate on official IHS letterhead, to the IHS Director, the Federal Co-Chair, and the Tribal Co-Chair.
      3. IHS Appointees.  One IHS Federal Member and one IHS Federal Alternate shall be appointed by the IHS Director as the Federal Co-Chair and Alternate Co-Chair.  The IHS Federal Co-Chair or Alternate Co-Chair shall keep the IHS Director apprised of TLDC issues, decisions, recommendations, and concerns.
    4. Vacancy.  When a vacancy occurs:
      1. The IHS Area Director and Federal Co-Chair shall notify the TLDC of the vacancy within 30 days and initiate the appropriate process to name a new TLDC Delegate.
      2. The Alternate shall attend meetings until the vacancy is filled.
    5. Missed Meetings.  The TLDC Delegate shall notify the Alternate if a Delegate cannot attend a scheduled TLDC meeting.  If neither the Delegate nor the Alternate is available for a meeting or meetings, the Delegate may designate an "interim representative or proxy."  The interim representative or proxy must be an elected officer of a Tribal government or employee with authority to act on their behalf, acting in their official capacity, to serve in their place.  The interim representative or proxy will have the same voting rights as the TLDC Delegate.  Before the meeting, the Delegate must designate the interim representative or proxy in writing to the Area Director, Federal Co-Chair, and the Tribal Co-Chair.
    6. Replacement Request.  TLDC Delegates and Alternates must make a good-faith effort to attend all official meetings in person or virtually.  If a TLDC Delegate or Alternate does not participate in a scheduled meeting on two successive occasions, the IHS Area Director may be notified by the TLDC with a request to replace the representative(s) with individuals who are able to participate regularly.

    7. Term Limits.  In recognition of the variety of procedures used to determine committee representation within each IHS Area, TLDC membership is not subject to term limits.  Changes in TLDC membership will be submitted to the TLDC in writing by the appropriate IHS Area Director.

  6. LEADERSHIP.  The Tribal and Federal Co-Chairs will lead the TLDC:
      1. Tribal Co-Chair and Alternate Co-Chair.  The TLDC members representing the 12 IHS Areas shall elect from among themselves one Tribal representative to serve as the Tribal Co-Chair and one Alternate Tribal Co-Chair.  In the absence of the Tribal Co-Chair, the Alternate will serve in the Tribal Co-Chair’s capacity.
      2. Elections.  The TLDC will hold elections for the Tribal Co-Chair and Alternate Co-Chair every 3 years, staggered by 1 year, when the seated Delegates or their Alternates of the TLDC call for nominations or an election.  TLDC Delegates, or their Alternates, may maintain the same members as the Tribal Co-Chair and Alternate Co-Chair or may vote for a new Tribal Co-Chair and Alternate Co-Chair.
      3. Federal Co-Chair and Alternate Co-Chair.  The Federal Co-Chair serves as the lead point of contact for the TLDC. The Federal Co-Chair and Alternate Co-Chair are IHS officials.  In the absence of the Federal Co-Chair, the Alternate Co-Chair will serve in the Federal Co-Chair’s capacity. 

        The Federal Co-Chair/Alternate Co-Chair Responsibilities:

        1. Provides programmatic guidance, technical assistance, and administrative support;
        2. Selects key IHS leaders and staff to serve as resources to the TLDC by providing leadership, technical assistance, and subject matter expertise;
        3. Monitors and tracks the total resources allocated annually to serve AI/AN populations through IHS Division of Diabetes Treatment and Prevention (DDTP) programs and initiatives; and
        4. Actively engages the TLDC in creating the agenda for all in-person and virtual TLDC meetings and conference calls.
  7. TECHNICAL ADVISORS.
    1. Technical Advisors.  Each TLDC Delegate can bring a technical advisor or advisors to each TLDC meeting to assist in performing the Delegate's duties and responsibilities as a TLDC member.  The advisor's role is limited to advising the member in a non-disruptive manner, in the form of private counsel, either communicated discreetly and directly to the member or away from the group meeting.
    2. Representatives from the following groups may advise TLDC members individually and attend TLDC meetings.
      1. National Congress of American Indians
      2. National Indian Health Board
      3. Tribal Self-Governance Advisory Committee
      4. Direct Service Tribes Advisory Committee
      5. National Council of Urban Indian Health
      6. Centers for Disease Control and Prevention
      7. American Diabetes Association
      8. Association of Diabetes Care & Education Specialists
  8. MEETINGS.
    1. Quarterly Meetings.  The TLDC shall meet no less than four times annually on dates and locations as determined by the TLDC.
    2. Meeting Materials.  All TLDC meeting materials, including meeting notices, correspondence, etc., shall be provided to TLDC Delegates and Alternates, as well as to any Federal officials attending the meeting, such as the IHS Director or their alternate, the Federal Co-Chair or their alternate, etc.
      1. Minutes.  Written minutes will be recorded at each TLDC meeting by a representative assigned by the DDTP.  The minutes will be given to the TLDC members for review within 30 days of the meeting.  The meeting minutes will be approved at the beginning of the next TLDC meeting and adopted for the official record. 
      2. Agenda.  The agenda will be developed by the Federal Co-Chair or Alternate Co-Chair in draft form 30 days prior to the TLDC meeting and circulated among TLDC members and alternates.  The TLDC members will make suggestions and comments based on the draft agenda.  The final agenda will be sent to TLDC members at least five working days prior to the TLDC meeting.
    3. Travel Expense Reimbursement.  Reimbursement for approved travel expenses shall be provided by the DDTP either directly or through the IHS-designated agent.
  9.  QUORUM AND VOTING.
    1. Quorum.  A quorum is established when at least seven TLDC Delegates or respective Alternates are present for a meeting in person or virtually for any official TLDC business transaction.  Informational sessions may occur in the absence of a quorum.
    2. Voting.  To the extent possible, TLDC decisions and actions will be taken by a consensus of Tribal Delegates or Alternate members only.  The Federal Co-Chair is not a voting member to the TLDC.  To resolve differences where consensus cannot be reached, a simple majority vote may be taken by the positions represented in person and virtually (a quorum being present), or the Tribal Co-Chair or Alternate Co-Chair may authorize another voting process to attempt to achieve consensus.
  10. SUBCOMMITTEES AND WORKGROUPS.  The TLDC may establish subcommittees and workgroups to address specific tasks, assignments, or directives assigned to the TLDC.  All protocols outlined in the TLDC Charter shall apply to any established subcommittee and workgroup.  Upon the completion of the task, charge, directive or assignment by a subcommittee or workgroup, a report shall be provided to the full TLDC membership.
  11. SUPERSEDURE.  This Charter replaces Circular No. 07-03, “The Tribal Leaders Diabetes Committee - Charter,” dated June 20, 2007.
  12. EFFECTIVE DATE.  This circular becomes effective on the date of signature.

/P. Benjamin Smith, M.B.A., M.A./
Acting Director
Indian Health Service

Distribution:  IHS-wide
Date: 02/25/2025