The Indian Health Service (IHS) is a health care program within the Department of Health and Human Services. (Agency Overview nd) It provides federal health services to eligible American Indians and Alaska Natives at IHS facilities. (Agency Overview nd) Services provided by IHS include medical, dental and vision services, ancillary services, such as laboratory and pharmacy, specialty care which includes services provided by the physician or specialist. (Agency Overview nd) Factors that affect the type of health care are dependent on community needs, the level of funding, and the medical necessity of treatment (Marx nd). American Indians and Alaska Natives can receive direct care in hospitals, health centers and it can be managed at the federal or tribal level. (Marx nd) If a direct care setting is unable to provide services, the individual will be referred to a public or private provider. (Marx nd) IHS is located on or near Indian reservations and services are provided by Indian tribes, urban Indian organizations, or IHS. IHS is responsible for providing medical and public health services to members of federally recognized Indian tribes and Alaska Natives. (Agency Overview) For a tribe to be recognized, it must meet that state's specific criteria that also includes lands and rights that are also accepted (Agency Overview). IHS's mission is to educate the people of India about physical, mental, social and spiritual health (agency overview). American Indians and Alaska Natives preside over their members and lands (Indian Health Service Definition 2012). The United States continues to work with Indian tribes on an individual basis, focusing on issues related to tribal government and other rights (Definition...... middle of document...... 24 November 2013). National Health Council of India (2009). REAUTHORIZATION OF THE INDIAN HEALTH CARE IMPROVEMENT ACT [ONLINE] Available at: www.nihb.org/docs/11182009/IHCIA%20Fact%20Sheet_Senate [Last accessed 25 Nov 13]. (OTSG) (nd). [ONLINE] Available at: www.ihs.gov/SelfGovernance/index.cfm?module=dsp_otsg_about [Last accessed November 20]. Ojibwa (2010). ] Available at: www.nativeamericannetroots.net/diary/782. [Last accessed November 23, 2013]. The Synder Act (nd). [ONLINE] Available at: http://www.ihs.gov/chs/documents/SNYDER_ACT. .pdf. [Last accessed November 27, 2013]. Trujillo, Michael H., MD, MPH, MS (2000). Testimony on the Indian Health Care Improvement Act [ONLINE] Available at: http://www.hhs.gov. /asl/testify/t000308c.html [Last accessed November 23. 13].