At the turn of the century, the Joint Commission--the nation's largest health care accrediting organization--began requiring spiritual assessments in hospitals and many other mental health settings frequented by Native Americans. Despite high levels of service use, culturally unique forms of spirituality, and a history of oppression in mainstream settings, no research has explored how to best implement this new requirement with Native Americans. Accordingly, this mixed-method study asked recognized experts in Native American culture (N = 50) to identify the degree of cultural consistency, strengths, and limitations of the new assessment framework and a culturally valid question protocol to operationalize the requirements. The results indicate that the framework is moderately consistent with Native American culture, and a number of practice-oriented suggestions and tools are offered to implement the requirements in a culturally valid manner.