Sovereign Nation agreements (SNA) and scope of work for behavioral health services
In 2019, following 2017 Tribal Consultation regarding health integration, the Health Care Authority (HCA) worked collaboratively with the Department of Social and Health Services (DSHS) and Tribes to establish Tribal agreements for behavioral health programs transitioned to HCA. The first Government-to-Government agreements were completed through negotiation with Tribes during formal Consultation.
On this page
About the SNA
The SNA has two main components, including the umbrella agreement that is focused on the general terms and conditions of the SNA and various program scopes of work called Service Level Agreements (SLA). Many of these SLAs are focused on behavioral health services, However, additional SLA's have been added for various Tribes as funding has expanded through either pilot projects, additional funding available, competitive, and noncompetitive grant submissions.
This page provides a collaborative space for Indian Nations and HCA to review and develop agreements.
INA restatement: newly named Sovereign Nation Agreement (SNA) for July 1, 2025
On April 17, 2025, OTA completed a Consultation on the INA Restatement Umbrella Agreement, newly named the Sovereign Nation Agreement. The SNA will replace the INA for July 1, 2025. See Consultation meeting details.
- Sovereign Nation Agreement best practices
- Download the Sovereign Nation Agreement Template (final template)
- Summary of Changes INA restatement (SNA)
- Service Level Agreement Template
- Service Level Agreement Tribal Plan instructions and Tribal Plan Template
Subrecipient monitoring plan
HCA performs biennial desk monitoring of the activities funded under the SNA as outlined in the SNA Scope of Work for Behavioral Health Services. Under 45 CFR Part 75, HCA is legally obligated to monitor the activities of subrecipients of federal funds for compliance with applicable federal rules, including 2 CFR Part 200 and 45 CFR Part 75.
- Biennial Monitoring Desk Review checklist: This form serves as the monitoring tools for the SNA biennial desk monitoring review.
Risk Assessment and Monitoring Plan
On July 7, 2023, HCA finalized the Indian Nation Agreement and Urban Indian Organization (INA/UIO) Risk Assessment and Monitoring Plan Tool following Consultation held on May 28, 2023. Risk Assessments are conducted annually, unless otherwise deemed necessary to be updated by the HCA.
During our implementation, HCA identified that the risk assessment did not accurately reflect the level of risk based on contract monitoring concerns. HCA has revised the risk assessment and monitoring plan tool to clarify risk categories and has made the following changes, updated in 2025:
- Clarification and expansion of existing risk categories reflect certain scenarios that were missing from the prior tool.
- Split the timeliness and spending pattern category from one category with both topics to two risk categories.
- Dear Tribal Leader Letter INA UIO Risk Assessment
- Revised Risk Assessment and Monitoring Plan Tool: This revised document serves as the new risk assessment and monitoring plan tool.
Background
The purpose of the SNA and UIO Risk Assessment is to comply with federal regulations (2 CFR 200.332) over subrecipient monitoring related to risk assessments and contract monitoring based on risk.
Sovereign Nation Agreement monthly workgroup
Please join us for a Tribal-state workgroup to improve our shared work on the SNAs starting May 2025. Meetings will be held via TEAMS on the fourth Thursday of every month at 2:00 p.m.
How to submit your feedback
To submit comments and advice contact Tribal Affairs.