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

Chapter 1 - Indian Health Service Manual System

Part 1 - General

Title Section
Introduction 1-1.1
        Purpose 1-1.1A
        Background 1-1.1B
        Scope 1-1.1C
        Policy 1-1.1D
        Definitions 1-1.1E
Responsibilities 1-1.2
        Director, Indian Health Service 1-1.2A
        Director, Office of Quality and/or Deputy Director for Quality Healthcare and Enterprise Risk Management 1-1.2B
        Executive Leadership Team 1-1.2C
        Director, Office of Information Technology 1-1.2D
        Director, Office of Management Services 1-1.2E
        Director, Division of Regulatory and Policy Coordination 1-1.2F
        DRPC Policy Coordinator 1-1.2G
        Headquarters Office Directors 1-1.2H
        Area Directors and Service Unit Chief Executive Officers 1-1.2I
        Area/Service Unit Office Deputy Director or Other Area/Service Unit Second Level Management 1-1.2J
        Area/Service Unit Policy Coordinator 1-1.2K
        Managers 1-1.2L
        Area Directors and Delegations Control Officers 1-1.2M
        All Indian Health Service Employees 1-1.2N
Parts and Chapters 1-1.3
        Authority for Indian Health Manual Parts and Chapters 1-1.3A
        Format for Parts and Chapters 1-1.3B
Transmittal Notices 1-1.4
General Administration Manual 1-1.5
Delegations of Authority 1-1.6
        Authority to Delegate or Re-Delegate 1-1.6A
        Types of Delegation of Authority 1-1.6B
        Format for Delegation of Authority 1-1.6C
Indian Health Manual Circulars 1-1.7
        Authority 1-1.7A
        Format for Indian Health Manual Circulars 1-1.7B
        Consolidation 1-1.7C
Special General Memorandum 1-1.8
        Authority 1-1.8A
        Format for Special General Memorandums 1-1.8B
Area and Service Unit Directives, Delegation of Authority, and Supplements to the Indian Health Manual 1-1.9
Area/Service Unit Parts and Chapters 1-1.10
        Area/Service Unit Supplements to the National Parts and Chapters. 1-1.10A
        Page Headers for Area/Service Unit Parts and Chapters and Supplements 1-1.10B
        Page Footers for Area/Service Unit Supplements 1-1.10C
Area/Service Unit Circulars 1-1.11
        Title Page Headers for Area/Service Unit Circulars 1-1.11A
        Title Page Footer for Area/Service Unit Circulars 1-1.11B
        Headers for the Second and Subsequent Pages 1-1.11C
Indian Health Service Manual Style Guidelines 1-1.12
Development and Coordination Procedures 1-1.13
        Directive Identification/Development 1-1.13A
        Review/Analysis and Coordination 1-1.13B
Review and Comment Period 1-1.14
        Exceptions 1-1.14A
        Waiver 1-1.14B
        Distribution 1-1.14C
        Consideration and Reconciliation of Comments and Recommendations 1-1.14D
Clearance and Signature 1-1.15
Control, Distribution, and Maintenance of Indian Health Service Directives 1-1.16
Procedures for Rescinding Indian Health Manual Directives 1-1.17
        Indian Health Manual Parts and Chapters 1-1.17A
        Indian Health Service Circulars 1-1.17B
        Special General Memorandum 1-1.17C
Tribal Consultation and Urban Confer on Indian Health Service Directives 1-1.18
Training 1-1.19
Workgroup, Council, or Committee 1.1.20
Manual Exhibits Description
Manual Exhibit 1-1-A, [PDF - 94 KB] Example – Transmittal Format
Manual Exhibit 1-1-B, [PDF - 154 KB] Example – National Part and Chapter and Table of Contents) Format
Manual Exhibit 1-1-C, [PDF - 99 KB] Area Part and Chapter Format
Manual Exhibit 1-1-D, [PDF - 77 KB] Appendix/Exhibit Format
Manual Exhibit 1-1-E, [PDF - 128 KB] Delegation of Authority Format
Manual Exhibit 1-1-F, [PDF - 121 KB] National Circular Format
Manual Exhibit 1-1-G, [PDF - 97 KB] Area Office Circular Format
Manual Exhibit 1-1-H, [PDF - 125 KB] Special General Memorandum Format
Manual Exhibit 1-1-I, [PDF - 149 KB] Action Memo Format
Manual Exhibit 1-1-J, [PDF - 135 KB] Individual Comment Template Format
Manual Exhibit 1-1-K, [PDF - 163 KB] Policy Process
Manual Exhibit 1-1-L, [PDF - 108 KB] Compiled Comment Log Format

1-1.1 INTRODUCTION

  1. Purpose.  This Chapter standardizes and establishes the policy, procedures, and responsibilities for developing, revising, and managing Indian Health Service (IHS) Headquarters (HQ) Offices, Area Offices, and Service Units (SU) Directives.  
  2. Background.  The IHS publishes directives related to the administration, operation, and/or its statutory authority in the Indian Health Manual (IHM).  The IHM is the electronic publication for IHS directives, and it is listed by subject matter containing HQ, Area, and SU directives in the following formats:  Parts and Chapters, Circulars, Special General Memorandums (SGM), and Delegation of Authority (DOA). The IHM provides information and instruction for IHS employees, as well as contractors, and volunteers when applicable and as defined in each directive.  The IHS national directives are listed on the HQ website and managed and maintained at HQ.  Area and SU-specific directives are managed and maintained by the Areas and SUs and will be listed on their websites, respectively.  The IHM also provides guidance to the Agency and to Tribes/Tribal organizations for activities operated under an Indian Self-Determination and Education Assistance Act (ISDEAA) contract or compact but is not binding on Tribes or Tribal organizations unless required by law or explicitly accepted by a Tribe or Tribal organization in its ISDEAA contract or compact. 
  3. Scope.  This Chapter applies to all directives developed and managed within IHS HQ offices, Area Offices, and SUs.
  4. Policy.  The IHS HQ Offices, Area Offices, and SUs will develop, review, clear, approve, and distribute directives in accordance with the requirements of this Chapter.  Each directive must be current, and contain appropriate and adequate information and procedural guidelines for IHS staff, as well as contractors and volunteers when applicable, to effectively perform their duties and responsibilities.
  5. Definitions: 
    1. Directive.  An official high-level standard or principle governing procedures, decisions, and actions within the IHS, signed by the Director, IHS; Area Director; or SU Chief Executive Officer (CEO). Also known as policy and is inclusive of IHM Parts and Chapters, Circulars, SGMs, and Delegation of Authorities (DOAs).
    2. Standard Operating Procedure.  A routine or step-by-step direction of how to perform a recurring programmatic activity or task within the IHS, its components offices/divisions, Areas, or SUs.  These steps may change or develop over time.  Standard Operation Procedures (SOPs) are not contained within the IHM.
    3. Procedure.  General or broad instructions, requirements, or criteria for managing a programmatic activity or task within the IHS or its component offices or divisions (applicable at all levels).
    4. Echelon.  The level or rank of an organizational component is based on the reporting relationships.
    5. Executive Leadership Team.  Refers to all IHS Office of the Director Key Leaders, including the Director, Deputy Director, Chief of Staff,  Chief Medical Officer, Deputy Director for Intergovernmental Affairs, Deputy Director for Management Operations, Chief Information Officer, Deputy Director for Healthcare and Enterprise Risk Management (DDQHERM), and Deputy Director(s) for Field Operations.

1-1.2 RESPONSIBILITIES

  1. Director, IHS.  The Director, IHS, will:
    1. Review, approve, and promote timely implementation and compliance with IHS directives consistent with this Chapter; 
    2. Provide administrative oversight of IHS directives; and
    3. Promote consistency and standardization of directives Agency-wide. 
  2. Director, Office of Quality and/or Deputy Director for Quality Healthcare and Enterprise Risk Management.  The OQ Director, the DDQHERM, or a designee will:
    1. Provide administrative oversight and management of directives that have been identified as inconsistent, non-compliant, or ineffective, by an oversight agency (e.g., Government Accountability Office (GAO), White House, Department of Health and Human Services (HHS), Office of the Inspector General (OIG), etc.), ensuring corrective actions are developed and implemented. 
    2. Review report(s) listing directives that have been identified as inconsistent, non-compliant, or ineffective by an oversight agency (e.g., GAO, White House, HHS, OIG, etc.) regularly or upon request from the HQ ELT.  Any findings must be submitted to the ELT and coordinated with the Office of the General Counsel (OGC); and
    3. Coordinate reviews and any corrective actions of directives that have been identified as inconsistent, non-compliant, or ineffective by an oversight agency (e.g., GAO, White House, HHS, OIG, etc.) with the HQ Office Directors and Area Directors, and notify DRPC and/or Area Policy Coordinators, as appropriate.
  3. Executive Leadership Team.  The Executive Leadership Team (ELT) will:
    1. Review national directives submitted for the IHS Director’s signature;
    2. Review reports or findings submitted by the Office of Quality (OQ) and/or DDQHERM that identify directives as inconsistent, non-compliant or ineffective.  The ELT will provide oversight and ensure Agency compliance with IHS directives;
    3. Coordinate with the appropriate HQ Office Director, Area Office Director, and any other appropriate staff from the ELT to respond to and/or remedy a policy identified by an oversight agency (e.g., GAO, White House, HHS, OIG, etc.) as inconsistent, non-compliant, or ineffective.  All coordination efforts must also include the OQ Director and/or DDQHERM, to ensure proper compliance; and
    4. Report directives or procedures that are identified as inconsistent, non-compliant, or ineffective by an oversight agency (e.g., GAO, White House, HHS, OIG, etc.), or regulatory/statutory provision to the IHS Director.
  4. Director, Office of Information Technology.  The Director, Office of Information Technology (OIT), or a designee will coordinate with HQ, Area, and/or SU staff to ensure all IHM web postings comply with section 508 of the Rehabilitation Act of 1973, 29 United States Code (U.S.C.) § 794d, as amended. 
  5. Director, Office of Management Services.  The Director, Office of Management (OMS), will:
    1. Provide administrative oversight of the IHS process to review, develop, and publish directives.  Reviews are to include but not limited to, the overall productivity and alignment with the Agency’s authorities, goals, plans, and initiatives; and
    2. Provide advice and updates to the DDMO or other members of the ELT on the IHM, as appropriate.  
  6. Director, Division of Regulatory and Policy Coordination.  The Director, Division of Regulatory and Policy Coordination (DRPC), is designated as the Agency Directives and Delegations Control Officer (DDCO) and is the principal contact for the Area and HQ Office Directors regarding national directives.  The Director, DRPC, will:
    1. Manage national directives and provide advisory services, coordination, and assistance to the IHS managers in the development, clearance, and distribution of the IHS directives; 
    2. Assess the overall process for issuing national directives and implement revisions, as appropriate;
    3. Oversee the review of each national directive every two years and, if necessary, recommend that it be updated or rescinded;  
    4. Report directive process updates to the OMS Director and other ELTs as appropriate; 
    5. Make an Agency-wide announcement of new or revised national directives published in the IHM; and 
    6. Distribute proposed national directives to the Area DDCOs and the HQ Office Directors, Area Directors, and any other members of the ELT, as appropriate, to obtain review and comments on the proposed directive from staff.
  7. Division of Regulatory and Policy Coordination Policy Coordinator.  The DRPC Policy Coordinator assists the DRPC Director in processing, managing, coordinating, and developing national directives.  They have expertise in policy development and serve as technical advisors to IHS managers and staff at the IHS HQ and Area offices.  The DRPC Policy Coordinator will:
    1. Provide advice and technical guidance to HQ and Area staff, including to  DDCOs, on the appropriate format, development process, and general rules for writing directives consistent with this Chapter;
    2. Coordinate with the HQ Office Directors, subordinate managers, or other HQ staff to facilitate, track, and manage the review of national directives every two years to ensure accuracy.  This responsibility includes generating a list of outdated directives and assisting HQ Office Directors, managers, and staff with identifying directives that require review and consideration for consolidation into a new or revised IHM directive; 
    3. Review proposed national directives, ensuring they are clear and concise, in the proper IHM format, and consistent with other related IHM directives or related regulatory or statutory provisions (in consultation with OGC);
    4. Coordinate and ensure that national directives are submitted for official IHS-wide review and comment consistent with Section 1-1.13 of this Chapter;
    5. Compile all comments received during the review and comment period and submit to HQ Office Directors and staff for review and disposition of all comments as appropriate; 
    6. Advise the HQ Office Directors and/or staff during the development of national directives as necessary;
    7. Assign and maintain a system for numbering, tracking, and controlling the IHS national directives;
    8. Maintain an electronic library that includes the official national IHM issuances consistent with the applicable records management policy and guidelines;
    9. Coordinate with the Office of Information Technology (OIT) on the publication of signed national directives on the HQ IHM website; and
    10. Consult and coordinate with OGC on legal matters related to developing and implementing an IHS directive. 
  8. Headquarters Office Directors.  The HQ Office Directors will: 
    1. Act as the principal contact for the ELT, the OQ, the Agency DDCO(s), and the Area Directors regarding national directives developed within their office.  Each Director may designate this responsibility to the Deputy Director or other management-level official within their respective office;
    2. Review and approve proposed directives, and provide administrative management and oversight of new and revised IHS directives developed within their respective office;
    3. Report development and progress of directives developed within their office to the ELT and DRPC as appropriate;
    4. Support compliance with the IHM directives and ensure proper staff implementation and adherence to requirements and responsibilities;
    5. Ensure that the appropriate staff reviews proposed directives received from the Agency DDCO.  Submit a copy of all comments received to the appropriate HQ Policy Coordinator.  If no comments are received, a signed “No Comment” memorandum or email must be sent to the appropriate HQ Policy Coordinator for national directives or to the Area DDCO for Area directives, when requested;
    6. Promote coordination with OGC on legal matters related to developing and implementing an IHS directive developed within their respective office; 
    7. Ensure directives developed within their respective office are reviewed every two years to ensure accuracy.  The reviews conducted every two years must be coordinated with DRPC.  A report will be generated, identifying the date the review was conducted, all outdated directives identified at that time of the review, and any action taken or tentative plans to revise/rescind any outdated directive(s).  The directives review report will be kept consistent with the Agency’s records management policy.
    8. Submit a comprehensive directive review report identifying the date the review was conducted, all outdated directives identified at that time of the report, and any action taken or tentative plans to revise/rescind the directive(s) to the ELT, when requested; 
    9. Designate a staff member who will be the principal contact for reviewing directives within their respective office every two years and tracking the progress of any revisions/updates in coordination with the DRPC Policy Coordinator(s) to ensure accuracy.  A directive review report as described in Subparagraph (8) of this Section must be submitted to the Agency DDCO 30 days after receiving a report from DRPC;
    10. Submit the directive review report as described in Subparagraph (8) of this Section to the Agency DDCO and/or the HQ Policy Coordinator for processing and review upon request; 
    11. Promote and ensure compliance with policy requirements identified by an oversight agency and advise and coordinate with OMS and OQ, as appropriate;
    12. Ensure directives are developed consistent with this Chapter and coordinated with appropriate HQ Policy Coordinator(s); and
    13. Oversee and ensure all staff within their respective offices participate in annual training consistent with Section 1-1.19 of this Chapter.
  9. Area Directors and Service Unit Chief Executive Officers.  The Area Directors and SU CEOs will:
    1. Provide administrative oversight of the IHM directives developed and published within their respective Area or SU.  Oversight will include, but is not limited to, the overall productivity and alignment with the Agency’s goals, plans, principles, and initiatives;
    2. Provide process guidance and updates to ELT regarding directives developed and issued within their respective Area Office or SU; 
    3. Review, approve, and sign Area or SU directives, and provide administrative management and oversight of such directives;
    4. Implement and promote a comprehensive directive development and review process consistent with this Chapter within their respective Area or SU;
    5. Ensure timely implementation of and compliance with current IHS directives; 
    6. Announce new and revised directives developed and published in the IHM within their respective Area or SU;
    7. Ensure the proposed Area or HQ directives are distributed to appropriate IHS staff to review during the IHS-wide review and comment period.  All comments received must be submitted to the appropriate DRPC Policy Coordinator(s) or Area contact.  If no comments are received, sign a “No Comment” memorandum or send an email to the appropriate DRPC staff or Area staff obtaining comments stating “no comments were received”;
    8. Promote coordination with OGC on legal matters related to the development and implementation of an Area or SU directive;
    9. Designate an Area Deputy Director or other management-level official to act as the principal contact for the DDFO(s), Area Directors, SU CEOs, and HQ Office Directors, including the Agency DDCO, regarding tracking, managing, and implementing Area or SU directives developed within their respective Area and SU.
    10. Ensure directives developed within their respective Area or SU are reviewed every two years to ensure accuracy.  A report identifying the date the review was conducted, outdated directives, and any action taken or tentative plans to revise/rescind must be submitted to the DDFO(s) or other ELT as appropriate;  
    11. Coordinate the review and remedy any findings of IHS directives that have been identified as inconsistent, non-compliant, or ineffective, by an oversight agency with the OQ, DDFO(s), ELT, and OGC, as appropriate;
    12. Designate one primary Area DDCO and at least one alternate to act as primary contact for coordinating Area responses on proposed national Area, or SU IHS directives distributed during the IHS-wide review and comment period.  The primary and alternate DDCO designations must be made through memorandum and copies of the memorandums must be submitted to the Agency DDCO; 
    13. Area Directors will also consult with the CEOs of each IHS-operated SU and with the Directors of each IHS-operated health center within their Area to designate a SU or a health center DDCO for each SU or facility.  It is recommended that the annual performance plans of each designated DDCO include standards for measuring the performance of the DDCO.  This responsibility is reserved for the Area Directors only;
    14. Designate staff to maintain an electronic library of the official Area or SU directive issued within in the respective Area or SU consistent with the applicable records management policy and guidelines;
    15. Report directive development and progress developed within their respective Area to the ELT upon request;
    16. Support compliance and implementation of national, Area, and SU directives published in the IHM;
    17. Ensure publication on the Area’s IHS website and distribution of new or revised Area and SU directives;
    18. Designate a staff member to act as the Area or SU Policy Coordinator for directives developed within their respective Area or SU to be the primary coordinator for policy review, coordination, advice, and guidance to Area staff; and 
    19. Coordinate and manage annual training consistent with Section 1-1.19 of this Chapter.
  10. Area Office/Service Unit Office Deputy Director or Other Area Office/Service Unit Second-Level Management.  The Area Office Deputy Director or other Area/SU second-level management will be the principal contact for the DDFO(s), Area Directors, and HQ Office Directors, including the Agency DDCO, regarding directives developed within their respective Area or SU.  The Area/SU Deputy Director or second-level management will:
    1. Oversee and maintain a standardized procedure for reviewing, processing, and implementing directives consistent with this Chapter.  Procedures established to implement this Chapter, at a minimum, must include the process established in the policy process document (see Manual Exhibit
      1-1-K);
    2. Manage and ensure the development, tracking, review, and clearance of directives issued within their respective Area or SU;
    3. Designate staff member(s) to act as the principal contact(s) for tracking, reviewing, and submitting directives for their respective Area or SU to the Area Director or SU CEO for signature and approval; 
    4. Oversee the review of each directive developed within their respective Area or SU every two years to ensure accuracy.  Submit a report identifying the date the review was conducted, the outdated directives, and any action taken or tentative plans to revise/rescind directives to the Area Director or SU CEO, DDFO(s), or other ELT, as appropriate.  This designation assists in eliminating duplicate and conflicting policy and procedural information and ensuring that IHS-wide directives and practices are consistent and compliant; 
    5. Submit the directive review report identifying outdated directives to the Area Director or other senior management official for review, as appropriate; 
    6. Coordinate with the Area DDCO to distribute proposed Area or SU directives and DOAs for review and comment to obtain subject matter expert input;
    7. Designate staff member(s) to act as the principal contact(s) for tracking, coordinating, and managing the review of Area and SU directives every two years to ensure accuracy; and 
    8. Coordinate with the Policy Coordinator within their respective Area to ensure Area and SU directives complement one another, consistent with national directives and other Area directives, as appropriate.
  11. Area Office /Service Unit Policy Coordinator.  The Policy Coordinator will be the administrative and technical advisor to Area Directors, CEOs, managers, and staff within their respective Area or SU for directive development and implementation.  The Area Policy Coordinator will:
    1. Advise Area Directors, functional managers, and staff within their respective Area or SU on the appropriate format, development, review, and approval process; and the general rules for writing directives consistent with this Chapter;
    2. Coordinate with the appropriate managers to facilitate, track, and manage the review of directives published within their respective Area or SU every two years to ensure accuracy.  This responsibility includes generating a report and assisting managers and staff with identifying directives that require review and consideration for consolidation into a new or revised national, Area, or SU directive; 
    3. Review proposed directives developed within their respective Area or SU, ensuring they are clear and concise, in the proper IHM format, and consistent with other related national, Area, or SU directives or any related regulatory or statutory provision (in consultation with OGC) and written consistent with the Plain Writing Act, Executive Secretariat guidelines, and any other writing guidance;
    4. Ensure directives issued within their respective Area or SU are developed and approved consistent with this Chapter; 
    5. Coordinate with the Area DDCO and ensure that proposed directives are submitted for official IHS-wide review and comment period consistent with Section 1-1.11 of this Chapter; 
    6. Compile all comments received from their respective Area or SU during the review and comment period and submit to appropriate staff within their respective Area or SU for review;
    7. Provide the Area Directors, CEOs, and/or staff with progress updates during the development of directives established within their respective Area Office or SU;
    8. Establish and maintain a system for numbering, tracking, and controlling the Area and SU directives; 
    9. Coordinate with the Area DDCOs to ensure approved and signed national, Area, and SU directives are distributed, published on the Area website, and accessible to appropriate Area/SU and HQ staff as appropriate;
    10. Coordinate with the Area DDCO to ensure that the official signed Area or SU IHM issuances are collected electronically, organized, categorized, and maintained consistent with the applicable records management policy and guidelines;
    11. Coordinate with the appropriate OIT staff to establish and maintain an Area IHM website listing signed directives by subject matter, date signed, dated reviewed, and by Area or SU facility, as appropriate;
    12. Provide technical advice and assistance on the development and implementation of the directives process to Area DDCOs and staff within their respective Area or SU;
    13. Consult and coordinate with OGC on legal matters related to the development and implementation of IHS directives; and
    14. Coordinate with the Area Director or SU CEO to facilitate and manage annual training as described in Section 1-1.19 of this Chapter.
  12. Managers.  Managers at all levels must ensure that all directives related to their areas of responsibility always convey current, appropriate, and accurate instructions for staff.  Managers will:
    1. Ensure the development and implementation of directives related to their areas of responsibility is standardized and consistent with this Chapter;
    2. Submit proposed or revised directives to either the Agency DDCO or the appropriate Area management official for review and processing;
    3. Consult the DRPC Policy Coordinator or the appropriate Area Policy Coordinator as early as possible in the development phase of IHS directives;
    4. Review directives related to their areas of responsibility at least every two years to ensure accuracy.  If revisions are necessary, coordinate with the appropriate Area or HQ Policy Staff.  Report any compliance reviews or revisions to OQ, DRPC, and/or the proper Area Director or SU CEO, if appropriate.  Findings of the reviews must be documented and managed consistent with the Agency records management policy and/or guidelines.  Assist in eliminating duplicate and conflicting directives and ensure that IHS-wide directives and practices are incorporated into an appropriate IHS directive format as described in this Chapter; 
    5. Ensure all IHS directives related to their areas of responsibility comply with the Internal Control areas under the IHS Federal Managers’ Financial Integrity Act (FMFIA) compliance program;
    6. Ensure all final versions of proposed directives, along with related documents (briefing memoranda, action memoranda, transmittal notices (TNs), etc.), are submitted to the Director, IHS or Area Director, or SU CEO, as appropriate, for approval and electronic signature using the latest version of Microsoft Word (.docx) and PDF, when available;  
    7. Ensure proposed directives developed within their respective office are clear and concise, free of errors, and in the proper format as described in this Chapter.  Proposed directives must also be consistent with other related directives or any related regulatory or statutory provision (in consultation with OGC), and written consistent with the Plain Language Act, Executive Secretariat guidelines, and any other writing guidance;
    8. Implement and promote compliance with IHS-wide standardization and consistency in developing directives at the national, Area, and SU levels; and 
    9. Ensure all staff comply with training requirements as described in Section 1-1.19 of this Chapter and are familiar with this Chapter to ensure proper implementation.
  13. Area Directives and Delegations Control Officers.  The Area DDCOs are the primary contacts for coordinating Area responses on the proposed IHS national and Area SU directives distributed during the IHS-wide review and comment period and maintaining a comprehensive list of all Area directives signed and issued within their respective Area.  The Area DDCOs will:
    1. Distribute proposed IHM directives for review and comment, as directed by the Agency DDCO or Area Policy Coordinator;
    2. Ensure the contact lists for the distribution of IHM issuances are kept current and distributed to the Agency DDCO and Area Directors; and
    3. Coordinate with the Area Policy Coordinator and prepare an electronic memorandum or email for the signature of the Area Director if no comments are received during the review and comment period.  The No Comment” memorandum or email must be sent to the appropriate DRPC Analyst or Area staff, stating “No Comment.”
  14. All Indian Health Service Employees.  The IHS employees at all levels will: 
    1. Participate in annual policy development and process training to ensure understanding and proper implementation of this Chapter; 
    2. Participate in directives review and comment processes when requested;
    3. Ensure they are familiar with and comply with IHS directives applicable to their roles and responsibilities.
    4. Email any errors or conflicts found in current directives to the policy mailbox at IHSPolicy@ihs.gov.

1-1.3 PARTS AND CHAPTERS.  The national, Area, and SU IHM Parts and Chapters are permanent policies, procedures, and principles listed by subject matter.  National Parts and Chapters are issued and managed by HQ staff and published electronically on the HQ IHS, IHM website.  Area and SU Parts and Chapters are issued to implement programmatic operations and authorities specific to the respective Area or SU, not nationally.  Area and SU Parts and Charters are managed by Area and SU staff and are published electronically on the Area websites.  The Areas may also supplement national Parts and Chapters when additional instructions are required to reflect the Area’s particular practices and must cite the national Part and Chapter that is to be supplemented.  Area and SU directives must not conflict with or override any national policy.   

  1. Authority for Indian Health Manual Parts and Chapters. 
    1. Only the Director, IHS, approves and authorizes the release of national Parts and Chapters.  Approval and authorization are indicated by affixing the IHS Director’s signature on the Transmittal Notice (TN) that covers the issuance (see Manual Exhibit 1-1-A).
    2. Only an Area Director may approve and authorize the release of Area Parts and Chapters issued within their respective Area.  Approval and authorization are indicated by affixing the Area Director’s signature on the TN that covers the issuance (see Manual Exhibit 1-1-A).
    3. Only an Area SU CEO may approve and authorize the release of SU Parts and Chapters issued within their respective SU.  Approval and authorization are indicated by affixing the SU CEO’s signature on the TN that covers the issuance (see Section 1-1.3 and Manual Exhibit 1-1-A).
  2. Format for Parts and Chapters .  All IHM Parts and Chapters will be formatted as described in this section unless otherwise noted in this Chapter (see Manual Exhibit 1-1-B).  The IHS organizational components have diverse missions, organizational structures, and statutory and policy/procedural requirements for their operations.  To accommodate for the diversity of the IHS programs and operations, each IHM Chapter must be broken down into sections to represent the first and subsequent levels of the Chapter.  In IHM citations, “section” refers to the first and subsequent levels of the breakdown below the Chapter level.  As a general rule, sections are subdivided and designated only to the extent that manual users may need to cite a specific subdivision of a section.  Each new section of text in an IHM Chapter is indented five character spaces to the right of the left margin of the primary blocked text. 

    The IHM Parts, Chapters, Sections, and Subdivisions of sections are separated and identified by numeric and alpha digits in the following declension and form:

    1   IHM Part

    1-1       IHM Part and Chapter

    1-1.1 IHM Part, Chapter, and Section

    1-1.1A     IHM Part, Chapter, Section, and Section Subdivisions

    1-1.1A(1   IHM Part, Chapter, Section, and Section Subdivisions

    1-1.1A(1)a     IHM Part, Chapter, Section, and Section Subdivisions

    1-1.1A(1)a(i)     IHM Part, Chapter, Section, and Section Subdivisions

    1-1.1A(1)a(i)(a) IHM Part, Chapter, Section, and Section Subdivisions

    1-1.1A(1)a(i)(a)i  IHM Part, Chapter, Section, and Section Subdivisions

    1. IHM Chapter Components.  The IHM Chapters contain standard informational components and must use the latest version of Microsoft Word (.docx) and PDF, when available.  Software is subject to change in light of future technological advancements.  To standardize the IHM organization and present the content of each Chapter in a logical sequence, the IHM Chapters (including revisions and Area Office IHM Parts and Chapters) are structured, to the extent practicable, as follows (unless otherwise noted in this section):
      1. Table of Contents.  Each IHM Chapter must include a table of contents delineating the text’s titles and numbers of sections and subsections.  Exhibits and/or appendices (as allowed by the Agency DDCO) to the Chapter must be listed at the end of the table of contents, appendices first.  The lists must include each exhibit or appendix number and title.  (See Manual Exhibit 1-1-B for an example of an IHM Chapter table of contents.)
      2. Table of Contents Page Headers.  The table of contents page headers contains the IHM Part title, Chapter number, and Chapter subject.  An example of a national table of contents page “header” for IHM Chapter is as follows:

        3. GENERAL  

        Chapter 1

        INDIAN HEALTH MANUAL SYSTEM

      3. Table of Contents Page Footers.  The table of contents page footers cite the IHM, the date of the Chapter issuance or update, and the TN number.  Footer information is presented in a single line that is over-scored.  Table of contents page numbers are indicated by lower-case Roman numerals centered above the footer line.  An example of a “footer” for a national IHM Chapter table of contents page is as follows:

      2. i

      Indian Health Manual     (00/00/2024   TN 2024-XX

    2. Chapter Sections - General or Introduction.  The following sections will be included in IHM Parts and Chapters.
      1. Purpose.  Contains information conveying the reason for the policy or directive, i.e., to establish or document changes to policy, procedures, and staff responsibilities related to the operations and/or management of a particular IHS functional area.
      2. Background.  Contains social, historical, and other antecedents or the description of the circumstances that led up to or helped explain the reason for developing the directive.
      3. Scope (Optional).  Contains a description of applicable staff.  
      4. Authorities.  Lists applicable regulations, statutes, and official guidance (e.g., 42 C.F.R. Part 136)
      5. Definitions (Optional).  Lists terms included in the Chapter.
      6. Goals (Optional).  List the objectives to accomplish with the establishment of the directive.
      7. Policy.  Contains information defining the methods or courses of action to be taken by IHS staff relative to the functional subject area.  The information must be written in an active voice, present tense, i.e., the IHS “does,” “must,” or the IHS policy “is.”  The policy statement should be brief and consistent with internal and external rules and regulations regarding the subject. 
      8. Other General Information as Appropriate.  
    3. Chapter Section - Organizational Responsibilities.  Lists IHS staff who are functionally responsible for the tasks or requirements described in the policy.  Official positions will be included, e.g., “Director, IHS.”  The list should include the organizational chain of responsibility starting from the top:
      1. Director, IHS
      2. Deputy Director or other OD staff in line of reporting
      3. Headquarters Staff
      4. Area Staff
      5. Service Unit Staff
      6. Other Organizational Staff
    4. Chapter Section - Procedures.  Generally, describes the process or method and other informational guidelines applicable at all levels in the IHS that are needed to implement the requirements listed in the Chapter.  Routine or specific day-to-day instructions or guidelines (i.e., SOPs) should not be included in this section. 
    5. Chapter Page Format. 
      1. Chapter Page Headers.  Chapter page headers for the text pages of an IHM Part and Chapter must be contained within the 1-inch left and right margins of the Chapter pages.  Part and Chapter page headers convey the IHM Part title, page number, Chapter number, and Chapter title.  All headers for Area-specific Parts and Chapters and any Area supplement to a national Part and Chapter must use the header format described in Section 1-1.  Headers for national Parts and Chapters should be formatted as follows: 

        2. GENERAL   Page 1

        Chapter 1

        INDIAN HEALTH SERVICE MANUAL SYSTEM

      2. Chapter Page Footers.  Chapter page footers for the text pages of an IHM Chapter must be contained within the 1-inch left and right margins of the Chapter pages.  The information on the footers reflects that the page is part of the IHM, the date the information was approved, and the TN number.

        On numbered pages, the citation “Indian Health Manual” is flush with the left margin, the effective date is centered, and the TN citation is flush with the right margin, as follows:

        3. Indian Health Manual   (00/00/2024)   TN 24-XX


    6. Manual Exhibits.  Manual Exhibits provide supplemental information, forms, reference materials, etc., in support of the material presented in the Chapter.  (See Manual Exhibit 1-1-F, “Example of Appendix/Exhibit Format.”)  Exhibits include copies of flowcharts, tables, or other graphics that might assist the reader in understanding the directives and procedures, management objectives, and expected outcomes as a result of staff compliance to the requirements in an IHS directive.  Manual Exhibits may also illustrate or provide templates of forms and formats of reports or correspondence to be used by staff when performing staff work and/or providing services. 

      Area managers whose activities require the use of existing principles or specifically designed forms must cite the applicable form numbers and approved dates within the directive text.  The source(s) or website where copies of the forms can be electronically retrieved must be included in the directive text.

      The IHM Part and Chapter exhibits are distinguished from the Chapter text by page headers that reflect the IHM Part and Chapter number, the alpha digit assigned to the exhibit, and the exhibit page numbers. 
    7. Manual Appendix.  A Manual Appendix contains specific information that significantly supplements the statements or text of the IHS directive.  Information included as appendices may be developed by the IHS or other sources.  The information may include regulations, higher echelon government oversight agency requirements, or segments of another IHS HQ or Area Office policy/procedure that would apply to the HQ or Area Office for which the directive is established.

      Oversight policy and/or guidelines in their full text must not be included in the appendix.  Requirements for conformance to higher echelon organization or oversight agencies’ policy and/or guidance must be selectively synopsized in the Policy and/or Procedures section(s) of the IHS directive.  Source(s) for copies of the higher echelon organization or Government oversight agency guidance or policy must also be referenced within the text of the IHS directive.

      The IHM Chapter appendices are distinguished from the Chapter text by page headers and footers that reflect the IHM Part and Chapter number, the alpha digit assigned to the appendix, and the appendix page numbers. 

1-1.4 TRANSMITTAL NOTICES

A TN is a single-page document covering each signed IHM Part and Chapter, DOA, and subsequent revisions thereof.  The TN includes background information on the new or revised IHM Part and Chapter or DOA; the signature of the IHS Director, Area Director or SU CEO; information on materials superseded by the issuance; and retention and disposition instructions.  (See Manual Exhibit 1-1-A for an example of an IHM TN.)  

1-1.5 GENERAL ADMINISTRATION MANUAL

The IHS General Administration Manual (GAM) covers administrative subject-matter areas not covered by the IHM Parts and Chapters, Circulars, and SGMs.  Plans are underway to eliminate the IHS GAM by incorporating its subject matter into the appropriate IHM Parts and Chapters or rescinding portions or all of the GAM if the subject matter is outdated and no longer required.

1-1.6 DELEGATIONS OF AUTHORITY

The DOAs are written conveyances of legal authority and responsibility from one official to a subordinate official to make specified decisions, take specified actions, and expend funds.  These delegations provide administrative and/or program authority from the Director, IHS, to appropriate IHS officials.   (See Manual Exhibit 1-1-E for an example of a DOA.)

The DOAs are listed in the IHM and are transmitted under a TN signed by the Director, IHS, Area Director, or a designee.  The national DOA index is maintained on the HQ IHM website.  Area-specific DOAs are managed and listed on Area office websites.  The DOA documents are maintained consistent with the Agency’s records management policy. 

All authorities delegated by IHS officials to subordinate IHS officials must be made via a written memorandum and be addressed from official position to official position.  The IHS managers who determine a need for re-delegation of authority from the higher organizational echelon or a need to further delegate authority received from the higher echelon must contact the Agency DDCO and/or DRPC policy staff for guidance and assistance. 

  1. Authority to Delegate or Re-Delegate.  The Director, IHS, may delegate or re-delegate any authority of the Director, IHS, whether found in a statute, the HHS Statement of Organization, Functions, and Delegations of Authority (52 Fed. Reg. 47053; Dec. 11, 1987), or subsequent delegations from the Secretary or another official of the HHS, unless the law or delegation prohibits such delegation or re-delegation.
  2. Types of Delegation of Authority.
    1. Administrative Authorities.  These are authorities that are derived primarily from statutes that apply to all of the Federal Government, (i.e., the Administrative Procedures Act, the Chief Financial Officers Act, the Federal Managers Financial Integrity Act, etc.), or from regulations that are issued by central control agencies such as the Office of Management and Budget, GAO, or the General Services Administration.  Administrative DOAs allow for delegees to take actions related to purchasing equipment, approving travel, hiring employees, issuing building passes, etc., and generally flow from the Secretary to an Assistant Secretary, who would then re-delegate to the Director, IHS.  Recommendations for further re-delegation of the Director’s authorities within the IHS are coordinated with appropriate functional area managers by the DRPC policy staff and/or Area staff. 
    2. Program Authorities.  These are substantive authorities contained in statutes or Executive Orders of the President of the United States.  Program authorities generally allow specific actions such as issuing program guidelines, awarding grants, adjudicating eligibility for benefits, etc.  The Director, IHS, has specific statutory authorities.  (See, e.g., 25 U.S.C. § 1661.)  In addition, program authorities vested in the Secretary, HHS, may be delegated to the Director, IHS. 
      1. Some laws confer specific authorities on the Secretary and sometimes authorize the Secretary to delegate these authorities with certain conditions.
      2. Some Executive Orders may authorize the Secretary to delegate and authorize re-delegation of authorities contained in statutes.  If the Executive Order does not specifically authorize re-delegation, IHS officials must obtain legal interpretation from OGC.
    3. Personnel Authorities. 
      1. Personnel administrative authorities are legal and regulatory authorities exercised by Servicing Personnel Offices.  These authorities include the appointment, promotion, demotion, or separation of personnel; classification of positions; fixing of pay; or authorization of training.  Personnel administrative authorities for personnel within the Area Offices are delegated to the Regional Personnel Officers, or directly to the Area Directors. 
      2. Personnel management authorities are authorities exercised by line managers, such as the selection of personnel, acceptable level of competence determination, employee appraisal, quality increases, performance awards, adverse actions, leave, overtime, or approval of training.  Personnel management authorities are delegated to the line managers through the reporting relationship chain.
    4. Commissioned Corps.  These are authorities that only apply to Commissioned Corps officers.  These authorities often are governed by Commissioned Corps regulations, rules, and guidelines. 
  3. Format for Delegation of Authority .  The DOA contains standard informational components and must use the latest version of Microsoft Word (.docx) and PDF, when available.  Software is subject to change in light of future technological advancements.  To standardize the IHM organization and present the content of each DOA in a logical sequence, the DOA are structured, to the extent practicable, as follows (See Manual Exhibit 1-1-E.):
    1. Authority Delegated.  Contains the origin of authority (e.g., statutory/regulatory provision, HHS Secretary, etc.), the ELT position currently holding the delegation (e.g., IHS Director), and the date delegated.
    2. To Whom Delegated.  Identifies the management position to which the authority is being delegated or re-delegated.  This should not include the delegee’s actual name. 
    3. Authority to Re-Delegate.  Indicates whether re-delegation is authorized and the positions to which the authority may be re-delegated. 
    4. Restrictions and Limitations (Optional).  Lists restrictions and limitations on dollar amounts (e.g., $100,000.00), training, positions, etc.
    5. Supersedure.  Lists previously issued DOAs that the current DOA is replacing, if any.
    6. Effective Date.  Lists the specific date IHS employees’ compliance with the DOA’s requirements is to begin, which is usually the date of signature.

1-1.7 INDIAN HEALTH MANUAL CIRCULARS

The IHM Circulars are used to formalize a workgroup, council, or committee.  Circulars are also used to issue temporary policy when specific instruction for an IHS program or administrative function and/or responsibility is required, and:

Subject-matter policies and procedures are being developed incrementally over an extended period, generally a two-year policy development time frame; or a decision/determination regarding the appropriate IHM chapter to incorporate new policy and procedures is not immediately available.

  1. Authority.  Only the Director, IHS, Area Director(s), and SU CEO(s) may approve and authorize the release of IHS Circulars.  Circulars are approved by obtaining the signature of the Director, IHS, Area Director, or SU CEO on the last page of the Circular.
  2. Format for IHM Circulars.  All IHM circulars will be formatted as described in this section unless otherwise noted in this Chapter.  (See Manual Exhibit 1-1-F for an example of the national Circular format.)
    1. Information Sections.  At a minimum, the sections listed in this section will be included in IHS Circulars.  Depending on the Area managers’ and staffs’ needs for adequately conveying subject-matter information and administrative requirements, additional sections may be included in IHS circulars.
      1. Purpose.  Contains the reason the Circular is being issued and specific objectives.
      2. Background.  Inclusion of relevant statutes, higher-level directives, or specific requirements for program or administrative activities to meet higher-level directives or statutory requirements, etc., that compel issuance of the Circular.
      3. Policy.  As available, administrative procedures may be the only information available for inclusion in IHS Circulars, pending a policy statement.
      4. Organizational Responsibilities.  Description of the responsibilities of the Area managers accountable for successfully overseeing and accomplishing the functions covered by the IHS Circular.
      5. Procedures/Instructions/Operations Information.  General information for readers and specific guidance for the functional IHS staff.
      6. Supersedure.  List of previously issued directives that the Circular is replacing, if any.
      7. Effective Date.  The Circular must cite a specific date on which IHS employees’ compliance with its requirements is to begin, which is usually the date of signature.  However, a circular may be issued in advance of this date.
    2. Circular Section Designations.  Numerical digits designate principal sections of IHS circulars and paragraphs, and subparagraphs within a section are designated by numeric and alpha digits in the following declension and form:

      1 Section number

      1A Section, paragraph

      1A(1)     Section, paragraph, sub-paragraph

      1A(1)a   Section, paragraph, sub-paragraph, sub-paragraph sections

      1A(1)a(i  Section, paragraph, sub-paragraph, sub-paragraph sections

      1A(1)a(i)(a) Section, paragraph, sub-paragraph, sub-paragraph sections

    3. Circular Page Headers and Footers.  The text pages of IHS Circulars must have headers and footers within 1-inch margins (left, right, top, and bottom) on each page.
    4. Circular First Page Header.
      1. Only the first page of an IHS circular contains a header and a footer. 
      2. Text pages after the first page and appendices and/or exhibits to a circular have only headers.
      3. The header on the first page of an IHS circular includes the address of the IHS, the originating Headquarters Office, and the IHS circular number.  An example of a national IHS Circular first-page header is as follows:

        4. INDIAN HEALTH SERVICE

            Rockville, Maryland 20857    Refer to:  OCPS

        INDIAN HEALTH SERVICE CIRCULAR NO. 24-XX

        (Also see Manual Exhibit 1-1-F for an example of a Circular header.) 

    5. Circular First Page Footer.  The footer on the first page of an IHS circular notes the distribution and the date the circular is approved and signed by the Director, IHS, or his/her designee.  This information is inserted under a single over score line.  An example of a national IHS circular first-page footer is as follows:

      Distribution: IHS-wide

      Date:

      (Also see Manual Exhibit 1-1- F for an example of a Circular footer.) 

    6. Circular headers on the second and subsequent pages.  Headers on the second and subsequent pages of IHS Circulars include the Circular page number and IHS circular number.  An example of a national IHS Circular second-page header is as follows:

      Page 2   INDIAN HEALTH SERVICE CIRCULAR NO. 2024-XX 

    7. Circular Appendices/Exhibits.  (See Section 1-1.3B (6) and (7) of this Chapter regarding the requirements for IHS directives appendices and the text for exhibits.)  Circular appendices and exhibits are distinguished from the circular text pages by a header that reflects the circular number, alpha digit assigned to the appendix/exhibit, appendix/exhibit page numbers, and date of the appendix/exhibit. 

      Managers who use guidance, policies, procedures, or specifically-designed forms developed in formats other than the IHM must cite the applicable guidance, policy, procedure, or form numbers and the source within the text of the circular.
    8. Control Numbers.  The Agency DDCO assigns a control number to each Circular.  The control number is configured to reflect the calendar year and sequential number of issuance, e.g., Circular No. 24-01, Circular
      24-02, etc.
  3. Consolidation.  Except for workgroup charters, the IHS circular format is used to issue IHS directives and/or operating procedures; the information contained in an IHS circular must be consolidated into an existing or a new IHM Chapter within two years or renewed as a new Circular.

1-1.8 SPECIAL GENERAL MEMORANDUM

The Special General Memorandum (SGM) is for the exclusive use of the Director, IHS, the Area Director, or their designee.  An SGM is used to interpret and/or reiterate existing IHS directives that require special attention by IHS employees.  The SGM format may also be used to announce (not establish) new policy and/or informational or procedural requirements that must be implemented immediately as directed by the Director, IHS, by statute, or by regulation.  The SGMs are temporary and will be rescinded or incorporated into permanent policy yearly, as appropriate.  The SGMs are developed and processed as described in this Chapter.

  1. Authority.  Only the Director, IHS, may approve and sign an SGM.
  2. Format for a Special General Memorandum.  The SGM is prepared in the memorandum format prescribed in the Indian Health Service Executive Correspondence Guidelines.  The memo must be electronically prepared using the latest version of Microsoft Word (.docx) and PDF.  Software is subject to change in light of future technological advancements.   As an official IHS directive format, the SGM is normally prepared as information to all IHS employees; however, the SGM may occasionally be developed for and distributed to select Area managers and staff.  “IHS All” emails are not official IHM directives.  (See Manual Exhibit 1-1-H for an example of an SGM.) 
  3. Control Numbers.  The Agency DDCO assigns a control number to each SGM.  The control number is configured to reflect the calendar year and sequential number of issuance, e.g., SGM 24-01, SGM 24-02, etc.

1-1.9 AREA OFFICE AND SERVICE UNIT DIRECTIVES, AND SUPPLEMENTS TO THE INDIAN HEALTH MANUAL

All Area-specific directives governing Area and SU practices and principles will be managed by the respective Area and SU.  Area and SU staff will review, process, and formalize Area Office and SU directives and supplements to the IHM into the proper IHM format consistent with this Chapter and Exhibit manual 1-1-C.  

Area directives must be reviewed, at a minimum, every two years by the respective Area Office and SU to ensure accuracy.  In addition, Area and SU directives cannot conflict with and must be consistent with national IHM issuances.  Area and SU directives must also complement one another, as appropriate.  Directives must also be styled in the same format and specifically cite the sections of the HQ-issued Chapters that the Area/SU directive supplements.  Area/SU directives will be organized by subject matter and SU facility, as appropriate, and listed electronically on the respective Area Office’s website.  The Area Office IHM websites will be structured and organized in the same format or similar to the HQ IHM website (e.g., by subject matter, date signed, date reviewed) to the extent practicable.  All web postings must be compliant with section 508 of the Rehabilitation Act of 1973, 29 United States Code (U.S.C.) § 794d, as amended.  (For more information on Section 508 Implementation, see IHM 8-20.)

1-1.10  AREA OFFICE/SERVICE UNITS PARTS AND CHAPTERS

The Area/SU Parts and Chapters will be approved and authorized by the Area Director and/or SU CEO, by affixing their signature to the TN developed by Area staff.  All Area/SU directives should be in the latest version of Microsoft Word (.docx) and PDF.  Software is subject to change in light of future technology advancements.   (See Manual Exhibit 1-1-C for an example of the IHS Area Office Part and Chapter format.)

  1. Area Office/Service Unit Supplements to the National Parts and Chapters.  Supplements to the national Parts and Chapters will be developed and issued by an Area Office and/or SU when additional instructions are required to reflect the Area’s or SU’s particular practices. 
  2. Page Headers for Area Office/Service Unit Parts and Chapters and Supplements.  All headers in Area/SU supplements to national Parts and Chapters, and Area/SU-specific Parts and Chapters must include the title of the Area Office and SU, if applicable.  Area/SU Parts and Chapters and supplements to the national Parts and Chapters should be formatted as follows: 

    3. GENERAL   GREAT PLAINS AREA Page 1

    Chapter 1

    INDIAN HEALTH SERVICE MANUAL SYSTEM

    (Also see Manual Exhibit 1-1-C for an example of the header format for IHS Area Office/SU Part and Chapters.)

  3. Page Footers for Area Office/Service Unit Supplements.  All footers used in the Area/SU Parts and Chapters will use the same footer formats described and illustrated in Section 1-1.2C(5)b.  (See Manual Exhibit 1-1-C for an example of the footer format for IHS Area Office/SU Part and Chapters.)

1-1.11  AREA OFFICE/SERVICE UNIT CIRCULARS

  An Area may issue Circulars to clarify specific guidance or responsibility at that level.  Area/SU Circulars must be formatted as described in Section 1-1.7, but will include the following headers and footers to reference the respective Area Office.  (See Manual Exhibit 1-1-G for an example of the IHS Area Office circular format.) 

  1. Title Page Headers for Area Office/Service Unit Circulars.  Area/SU Circulars and supplements to national circulars must be formatted as illustrated above, except that the headers must include the Area Office title and SU, if applicable.  An example of Area/SU Circular supplement title-page header is as follows:

    2. DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Indian Health Service

       California Area

             Refer to:  (insert responsible office)

    INDIAN HEALTH SERVICE CIRCULAR NO. 24-XX

  2. Title Page Footer for Area/Office/Service Unit Circulars: 

    3. Distribution:   California Area IHS Office     Date:

    (Also see Manual Exhibit 1-1-G for an example of the IHS Area Office Circular footer format.) 

  3. Headers for the Second and Subsequent Pages.  An example of the second and subsequent pages of Area/SU supplements to national Circulars is as follows:
    1. An example of an Area/SU Circular supplement even-numbered page header is as follows:

      CALIFORNIA AREA IHS

      INDIAN HEALTH SERVICE CIRCULAR NO.  24-XX Page 2

      (Also see Manual Exhibit 1-1-G for an example of the IHS Area Office Circular second or subsequent pages format.) 

1-1.12  INDIAN HEALTH SERVICE MANUAL STYLE GUIDELINES

All final directives, and related documents (briefing memoranda, action memoranda, TNs, etc.) must be submitted to the Director, IHS, for signature electronically using the latest version of Microsoft Word (.docx) and PDF, when available.  Software is subject to change in light of future technological advancements.  Directives must be submitted in Times New Roman font, 12 characters per inch (12 cpi, pt).  The text for all directives must be in standard block style with left print justification only.  On each page, including headers and footers, all margins (left, right, top, and bottom) are set at 1 inch.

1-1.13  DEVELOPMENT AND COORDINATION PROCEDURES. 

  1. Directive Identification/Development.  Once the HQ and Area Office staff coordinate with managers and subject matter staff to identify the need for development, revision, or rescission of a national, Area, or SU directive, the appropriate officials and staff will take the following actions, consistent with the responsibilities identified above.  All directives are considered in draft until signed by the IHS Director, Area Director, or SU CEO. 
    1. Intake Meeting/Initial Consultation.
      1. HQ.  Upon recognizing the need to develop, revise, or rescind a directive, an HQ Office Director will contact and/or meet with the Director, OMS, and/or the Agency DDCO.  
      2. Area.  Upon recognizing the need to develop, revise, or rescind an Area directive, Area Directors, SU CEOs, and other Area staff will contact the appropriate staff within their respective Area.  Area/SU directives should be coordinated and developed with the respective Area Director, SU CEO, OGC, and Area Policy Coordinator, as appropriate.  The HQ Policy Coordinator may be contacted for technical support and guidance. 
    2. Submission for review/analysis.  An email or cover memorandum explaining the intent of the directive is required when submitting it to the appropriate staff for review and processing.
      1. HQ.  All proposed national directives, and related documentation, including exhibits and appendices, must be submitted electronically to the Agency DDCO for review and processing. 
      2. Area.  All proposed Area or SU directives must be submitted electronically to the respective Area Director, SU CEO, or other appropriate Area management staff for review and processing.
  2. Review/Analysis and Coordination.  All IHS proposed directives will undergo an internal review prior to signature by the IHS Director, Area Director, or SU CEO, and publication on the IHM website.  Proposed directives will be reviewed for grammatical errors, formatting, missing components, clarity and consistency, compliance with any HHS and other current IHS directives, and applicable regulations and statutes.  All reviews must ensure that a proposed directive does not duplicate or conflict with existing national, Area, or SU directives. 
    1. Headquarters.  Upon receiving a proposed directive, the HQ Policy Coordinator will review and process all proposed national directives.  The HQ Policy Coordinator will review, process, and coordinate approvals with all appropriate staff.  The HQ Policy Coordinator will work with the HQ and Area representatives and other managers affected by the directives to address any needed edits or revisions.  Directives will be sent to OGC to address any legal issues. 
    2. Area Offices.  Upon receiving a proposed Area or SU directive or, the designated Area Policy Coordinator or other assigned staff member will review, process, and coordinate approvals of all proposed Area directives within their respective Area.  The Area Policy Coordinator will coordinate review and approvals with all appropriate staff.  All efforts to address edits or revisions will be coordinated with the Area Policy Coordinator, Area representative, and/or other managers affected by the directive.  Area directives will be sent to the appropriate regional attorney to address legal issues. 

1-1.14  REVIEW AND COMMENT PERIOD

All national, Area, and SU proposed directives will be transmitted electronically IHS–wide for a controlled review and comment period.  The review and comment period for IHM Parts and Chapters and IHS Circulars will be distributed for a minimum of 14 calendar days from the date the final proposed directive is released and should not exceed 90 calendar days, unless directed by the IHS Director, Area Director, or SU CEO or other senior management.  

The review and comment period for Area and SU directives must be coordinated and distributed by the Area Policy Coordinator and Area DDCO.  The review and comment period for SU policies governing specific facility principles will be distributed locally and to HQ staff as appropriate.

  1. Exceptions.  The Agency DDCO, Area Director, or SU CEO may extend the review and comment period upon the concurrence of the appropriate functional Area managers.  The directive review and comment period may be shortened to no less than five business days under limited circumstances, including (but not limited to):
    1. The immediate implementation of the directive as directed by the IHS Director, Area Director, and SU CEO;
    2. Any mandates issued by Executive Order, Congress, the Office of Management and Budget, GAO, the Office of the Secretary, HHS, or another Federal oversight agency to avoid delay in implementation; and
    3. The directive is a product of workgroups composed of select IHS managers or staff, Tribal leaders, and/or other Federal agencies charged explicitly by the Director, IHS, to develop and implement management, administrative, or program-improvement actions.  The DRPC policy staff and appropriate Area staff must be made aware of the workgroup assignment as soon as practicable.
  2. Waiver.  The review and comment period as required by IHM 1-1.12(B) of this Chapter may be suspended by the Director, IHS, the Area Director, SU CEO, or appropriate ELT member when the directive is deemed a high priority and requires an immediate implementation to fulfill a critical IHS mission-related function or activity (e.g., public emergency).  The waiver must be approved by the Director, IHS, Area Director, SU CEO, or an appropriate ELT member in writing and submitted to the Director, OMS and/or the Agency DDCO.  All approved waivers must be kept and maintained with the respective directives consistent with the Agency’s records management policy. 
  3. Distribution.  The IHS staff members are extended the opportunity to review and comment on all proposed national, Area, and SU directives.  In coordination with DRPC policy staff or the Area/SU Policy Coordinator, the Area DDCO will forward all proposed directives along with an individual comment template (see Manual Exhibit 1-1-J) to HQ, Area, and/or SU staff for review and consideration by the appropriate subject-matter staff.  All staff will comment by completing the comment template and forwarding it to the appropriate Area DDCO or appropriate OMS/DRPC policy staff.  

    The following individuals are extended an opportunity to review and comment on proposed national, Area, and SU directives proposed by HQ managers, as appropriate to the nature of the directive:

    1. Area and Headquarters Office Directors;
    2. Headquarters Division Directors;
    3. Area Executive Officers;
    4. Area Chief Medical Officers;
    5. Chief Executive Officers/Health Center Directors;
    6. Staff at Area Offices and Headquarters;
    7. The Office of the General Counsel;
    8. All DDCOs – with redistribution to Area SMEs;
    9. The IHS Records Management Officer (when the directives propose files/records management-related instructions that differ from the information contained in IHM Part 5, Chapter 15, “Records Management”);
    10. Bargaining unit officials, through the IHS Labor Relations Specialist (when directives impact the working conditions of bargaining unit employees); and
    11. The IHS Privacy Officer.
  4. Consideration and Reconciliation of Comments and Recommendations.  After the review and comment period:
    1. All the submitted comments will be compiled from the individual comment templates, (see Manual Exhibit 1.1-J) into one comment log (see Manual Exhibit 1.1-L). 
    2. The comment log will be given to the appropriate Area, SU, or HQ staff.  The staff must review and consider all comments and recommendations and incorporate accepted recommendations into the final proposed directive in a timely fashion. 
    3. Upon receipt of the comment log, managers and/or staff must review and address all concerns and recommendations made by the reviewers during the official review and comment period.  The deliberations of all the comments must be listed and addressed on the comment log.  The final comment log must include the disposition of all the comments, an explanation describing the rationale for incorporating or rejecting the comment into the proposed directive, and any action taken.  The completed comment log will be reviewed by the appropriate HQ or Area Policy Coordinator for review.  The comment log becomes part of the official directive record and will be filed consistent with the Agency’s records management policy and guidelines. 

1-1.15  CLEARANCE AND SIGNATURE

All IHM directives must be approved and signed by the IHS Director, Area Director, or SU CEO.  All clearance efforts must be done in coordination with the HQ or Area Policy Coordinator, or other appropriate Area staff.  The following steps must take place when obtaining approval and signature:

  1. All final draft documents are prepared for “pre-clearance” (i.e., error-free final draft and related documents) and submitted to the Executive Secretariat Staff or other pre-clearance approving official(s) for review, as appropriate.  Upon approval, the pre-clearance package must be finalized and prepared for signature as described in Manual Exhibit 1-1-K.   
  2. The final directive is assigned control and transmittal numbers by the HQ Policy or Area Policy Coordinator.
  3. Upon receiving pre-clearance approval, a final package (i.e., directive and related documents) must be prepared and distributed to the appropriate staff, management, and OGC, for final clearance;   
  4. The directive is submitted to the IHS Director, Area Director, or SU CEO under an action memo (see Manual Exhibit 1-1-I); and
  5. All signed IHM directives are promptly submitted to the HQ or the Area Policy Coordinator for filing, distribution, and coordination of web posting.

1-1.16  CONTROL, DISTRIBUTION, AND MAINTENANCE OF INDIAN HEALTH SERVICE DIRECTIVES

Regardless of format, a reference copy of each signed directive is immediately transmitted via email to the HQ Office Directors, Area Directors, and Area DDCOs by the Agency DDCO or Area DDCO (see 1-1.16(E) below).  The Area HQ Office Directors and DDCOs are responsible for ensuring that the Area Directors, Area Executive Officers, Chief Executive Officers/SU Directors, Area managers, and other individuals within their Area or HQ office receive an electronic or printed copy of the national, Area, or SU directive, as appropriate.  An electronic copy of the signed directive is collected, organized, and maintained consistent with the Agency’s records schedule as follows:

  1. The original and final electronic file copy of each directive and the accompanying signed TN for that chapter are filed in a directives repository file and maintained by DRPC staff or Area Office staff, as appropriate.
  2. Each current national IHM directive may be retrieved electronically from the IHM website:  https://www.ihs.gov/aboutihs/indianhealthmanual. 
  3. Area or SU directives may be retrieved from the Area-specific websites.  For an official copy of a national directive, contact the Director, DRPC.  For an official copy of an Area or SU directive, contact the Area Director within the respective Area Office.
  4. The Area Offices will maintain an original electronic records management library of their Area-specific IHS Chapters and TNs.  
  5. A reference copy of each national directive is transmitted via email to the Area DDCOs.  It is filed by the Area Office in a specifically designated space for that part of the IHM and maintained electronically location on each Area Office’s website.

1-1.17  PROCEDURES FOR RESCINDING INDIAN HEALTH MANUAL DIRECTIVES

  1. Indian Health Manual Parts and Chapters.  Generally, IHM Parts and Chapters are not rescinded.  Information in IHM Chapters may be updated by revising a page or replacing the entire Chapter.  Guidance regarding the disposition of superseded pages or copies of the Chapters is included in the TNs.  The superseded copies of Part and Chapter information and related documents are retained and disposed of by the Agency DDCO in accordance with the IHS Records Disposition Schedule.
  2. Indian Health Service Circulars.  The IHS Circulars serve as a temporary directive and is reviewed every two years to ensure accuracy.  After two years, Circulars are usually incorporated into existing IHM Parts and Chapters or transcribed into new IHM Chapters but can be reissued with a revised date.  The superseded copies of IHS Circulars and related documents are retained and disposed of by the Agency DDCO in accordance with the IHS Records Disposition Schedule.
  3. Special General Memorandum.  An SGM expires on a specific date that is cited in the body of the memorandum.  Functional area managers who request the subject matter of an SGM continue in effect beyond one year or the specified date are required to develop and submit a new memorandum for the Director’s signature in accordance with the requirements of this chapter.  The Agency DDCO retains and disposes of copies of the SGMs in accordance with the IHS Records Disposition Schedule.

1-1.18  TRIBAL CONSULTATION AND URBAN CONFER ON INDIAN HEALTH SERVICE DIRECTIVES.

Consistent with applicable law and with HHS and IHS policies, the IHS may occasionally consult with Tribes, solicit the participation of Tribal Organizations, and/or confer with Urban Indian Organizations (UIOs) when creating, revising, or rescinding IHS directives.  Any Tribal review and comment period that takes place for any proposed IHS directive is separate and does not replace the internal review and comment period for IHS management and staff described in this Chapter.  Proposed directives containing ongoing reviews and discussions within IHS are deliberative process materials and should remain internal to IHS only.  Only the final proposed new or revised directive should be released when consulting with and soliciting the input of Tribes and Tribal organizations or conferring with UIOs.  The process for obtaining internal review and comment described in this Chapter continues to apply but should be coordinated with the IHS offices responsible for Tribal Consultation and Confer with UIOs.  Proposed directives for publication in the IHM are submitted to DRPC, the Area Office’s Director, or SU CEO for review and processing before consulting with Tribes or conferring with UIOs, as appropriate. 

1-1.19. TRAINING

Training will be provided to staff upon the beginning of employment and annually to ensure IHS staff, volunteers, and contractors understand and implement this Chapter effectively.  Training will be developed and made available by OMS, Area Offices, and SU, as appropriate. 

1-1.20  WORKGROUP, COUNCIL, OR COMMITTEE

Any charter/charge of a formal workgroup, council, or committee established within the IHS must be incorporated into a Circular, formalizing membership and requirements.  The initiating program office director or designee leading the IHS workgroup, council, or committee must coordinate all efforts with DRPC, the Area Director, or the SU CEO, as appropriate.