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Hobbs Straus successfully defended a former casino workers’ suit against a Tribe in a Tenth Circuit case finding absence of federal jurisdiction over non-Indian contract and tort disputes arising in Indian country. (2009)

General Memorandum 14-061

General Memorandum 14-061
House and Senate Appropriations Committee Recommendations for FY 2015 IHS Funding

On August 1, 2014, the Chairman and Ranking Member of the Senate Appropriations Subcommittee on Interior, Environment and Related Agencies – Chairman Reed (D-RI) and Ranking Member Murkowski (R-AK) released a draft of their Subcommittee's FY 2015 appropriations bill and report. In this memorandum we compare the Indian Health Service portion of that draft bill and report to the version approved by the House Appropriations Committee on July 15, 2014 (See our General Memorandum 14-054 of July 25, 2014 regarding the House bill). It is unlikely that either bill will progress any further through the legislative process (i.e., to a Senate Committee markup or to the House floor) but they are important as a reflection of each house's position in upcoming negotiations on an omnibus appropriations bill. At this point it looks likely that most, if not all, federal agencies' FY 2015 activities will be funded by a Continuing Resolution (CR) until after the November elections with a longer term bill being finalized during a lame duck session of Congress. Should the election result in a Republican majority in the Senate, a CR might run into next year, enabling a new Congress to enact the final FY 2015 appropriations bill(s).

The House bill and Report (HR 5171; H. Rept. 113-551) are the product of an Appropriations subcommittee and full committee markup. The Senate bill and report, on the other hand, are draft documents released by the Senate Interior Appropriations Subcommittee Chair and Ranking Member and did not go through a markup process. Hence there is no bill or report number for the draft Senate bill and report. The Senate IHS Report language is sparse compared to the House Report which comments on a number of initiatives.

FUNDING OVERVIEW

The House bill proposes $94.8 million more for the IHS than does the Senate bill. The difference is that the House, but not the Senate, bill includes $63 million for medical inflation; $10 million to restore the funding reallocated in FY 2014 to meet full funding for Contract Support Costs; $500,000 for a dental initiative in BIE schools; a $15.4 million program increase for Referred/Purchased Care; a $5 million increase for Indian Health Professions; and a
$2.8 million increase for Urban Indian Health. A reason the House Committee was able to recommend more funding than did the Senate is that the House bill would reduce the Environmental Protection Agency budget by nine percent, thus freeing up funds for other agencies. The Senate bill does not agree to this proposed dramatic reduction in the EPA budget.

Both bills would provide $2.6 million for a one percent pay cost increase at IHS and tribal service delivery level; $70.8 million for staffing of new facilities; and $7.9 million to partially fund five newly recognized tribes. And both would fund the estimated full costs of Contract Support Costs as requested by the Administration -- $617,205,000.

As expected, neither Committee recommended funding for the Administration's proposed Opportunity, Growth, and Security Initiative which would have provided $56 billion equally divided between defense and nondefense spending. The Administration had proposed
$200 million of this amount for construction of health care facilities on the IHS priority list.

Staffing of New Facilities. Consistent with the Administration's proposal, both bills would provide (in the Services and Facilities accounts combined) $70.8 million for staffing and operations costs for the following new facilities: San Carlos Health Center ($28.4 million); Southern California Youth Treatment Center ($3.2 million); Choctaw (MS) Alternative Rural Health Care Center ($10.9 million); and Kayenta Alternative Rural Healthcare Center ($28.3 million). The House Report cautions: "Funds are limited to facilities funded through the Health Care Facilities Construction Priority System or the Joint Venture Construction Program that are newly opened in fiscal year 2014 or that open in fiscal year 2015. None of the funds may be allocated to a facility until such facility has achieved beneficial occupancy status." The Senate Report has similar language.

Partial Funding for Built-in Costs. The Administration did not request, nor did the Committees recommend, funding for non-medical inflation or population growth. The $2.6 million for the one percent pay increase will not cover the full cost, estimated to be $20 million.

LEGISLATIVE PROVISIONS

Contract Support Costs (CSC). Neither bill would place a cap on CSC spending, but the accompanying Committee Reports recommend $617,205,000 for IHS, the same amount requested by the Administration and estimated to fully fund CSC. The House Report states that should this amount be insufficient, the IHS is to submit a reprogramming request.

The bills, as requested by the Administration, provide that no FY 2014 or FY 2015 CSC funds may be used by the IHS or the BIA to pay prior year contract support costs or to repay the Judgment Fund for judgments or settlements related to past-year CSC claims.

Finally, the bills, consistent with the Interior appropriations acts for FYs 1999-2014, attempt to limit the ability of the IHS and BIA to fund past-year shortfalls in CSC funding from remaining unobligated balances for those fiscal years. This provision has been included in the appropriations acts for many years and has not precluded recovery on past-year CSC claims.

Please see the Contract Support Costs section elsewhere in this Memorandum for the text of the CSC Committee Report and bill language.
IDEA Data Collection Language. The bills would continue to authorize the BIA to collect data from the IHS and tribes regarding disabled children in order to assist with the implementation of the Individuals with Disabilities Education Act (IDEA):
Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service and tribes and tribal organizations operating health facilities pursuant to Public Law 93-638 such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act. (20 U.S.C. 1400, et. seq.)

Prohibition on Implementing Eligibility Regulations. The bills would continue the prohibition on the implementation of the eligibility regulations, published September 16, 1987.

Services for non-Indians. The bills would continue the provision that allows the IHS and tribal facilities to extend health care services to non-Indians, subject to charges. The provision states:
Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation.

Assessments by DHHS. The bills would continue the provision that has been in Interior appropriations acts for a number of years which provides that no IHS funds may be used for any assessments or charges by the Department of Health and Human Services "unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process."

Limitation on No-Bid Contracts. The bills would continue the provision regarding the use of no-bid contracts. The provision specifically exempts Indian Self-Determination agreements and reads: (Section 412 in the Senate bill)
Sec. 413. None of the funds appropriated or otherwise made available by this Act to executive branch agencies may be used to enter into any Federal contract unless such contract is entered into in accordance with the requirements of Chapter 33 of title 41 United States or chapter 137 of title 10, United States Code, and the Federal Acquisition Regulations, unless:
(1) Federal law specifically authorizes a contract to be entered into without regard for these requirements, including formula grants for States, or federally recognized Indian tribes; or
(2) such contract is authorized by the Indian Self-Determination and Education and Assistance Act (Public Law 93-638, 25 U.S.C. 450 et seq.) or by any other Federal laws that specifically authorize a contract within an Indian tribe as defined in section 4(e) of that Act (25 U.S.C. 450b(e)); or
(3) Such contract was awarded prior to the date of enactment of this Act.
FUNDING FOR INDIAN HEALTH SERVICES

FY 2014 Enacted $3,982,842,000
FY 2015 Admin. Request $4,172,182,000
FY 2015 House Committee $4,180,386,000
FY 2015 Senate Subcommittee $4,085,515,000

Definition of Indian. The House Committee acknowledges the problems caused by various definitions of "Indian" and urges the Department of Health and Human Services, the IHS, and the Treasury Department to work together to establish a consistent definition of Indian with regard to health care. The House Report states:
The Committee recognizes the Federal government's trust responsibility for providing healthcare for American Indians and Alaska Natives. The Committee is aware that the definition of who is an "Indian" is inconsistent across various Federal health programs, which has led to confusion, increased paperwork and even differing determinations of health benefits within Indian families themselves. The Committee therefore directs the Department of Health and Human Services, the Indian Health Service, and the Department of the Treasury to work together to establish a consistent definition of an "Indian" for purposes of providing health benefits. (H Rept. 113, p. 86).

SPECIAL DIABETES PROGRAM FOR INDIANS

While the entitlement funding for the Special Diabetes Program for Indians (SDPI) is not part of the IHS appropriations process, those funds are administered through the IHS. The SDPI is currently funded through FY 2015 at $150 million, minus a two percent reduction ($3 million) due to the sequestration of non-exempt mandatory programs. (PL 112-240).

HOSPITALS AND CLINICS

FY 2014 Enacted $1,790,904,000
FY 2015 Admin. Request $1,862,501,000
FY 2015 House Committee $1,857,625,000
FY 2015 Senate Subcommittee $1,838,665,000

Both bills include $41.6 million for staffing of new facilities; $3.6 million for newly-recognized tribes; $2.57 million for pay costs increase; $4.7 million for epidemiology centers; $172 million for Health Information Technology; and recurring funding of $8.9 million for the domestic violence prevention initiative.

The House, but not the Senate, bill includes $20.8 million for medical inflation,
$3 million to restore the Director's Emergency Fund and a transfer of $4.8 million to the loan repayment program.

The House Committee directs IHS to address the need for more health care volunteers by implementing a simplified and centralized credentialing process. The House Report states:
Because IHS faces a health care provider shortage of 1,500 professionals, the Committee directs the Service to expeditiously convene a meeting of interested Tribes and health care organizations to design a pilot program to address credentialing problems and report the results to the Committee within 180 days of the enactment of this Act.
(H. Rept. 113-551, p. 85-86)

DENTAL SERVICES

FY 2014 Enacted $165,290,000
FY 2015 Admin. Request $175,654,000
FY 2105 House Committee $176,154,000
FY 2015 Senate Subcommittee $173,982,000

Both bills include $8.2 million for staffing of new facilities and $468,000 for newly-recognized tribes.

The House, but not the Senate, bill includes $1.67 million for medical inflation and $500,000 for an initiative to increase preventive dental care in Bureau of Indian Education (BIE)-funded elementary schools by bringing dentists and hygienists into the schools. The IHS and the BIE are directed to consult with tribes about the piloting of this initiative. The House and Senate Reports state with regard to this BIE school issue:

The House Report states:
Early childhood caries (i.e. cavities) is an epidemic in Indian country and among other things it impacts the ability of children to concentrate and learn. The Committee received testimony again this year about an initiative to increase preventive dental care for children by bringing dentists and hygienists into elementary schools. The Committee recommendation includes $500,000 in the Indian Health Service budget to begin the initiative and directs the BIE to work with the Service and to consult with Tribes about piloting the initiative in the BIE school system. (H. Rept. 113-551, p. 45)
The Senate Report states:
The Bureau, working with the Indian Health Service as appropriate, is also urged to consider integrating school-based preventative health services such as dental care into elementary schools in order to improve health outcomes of tribal students. (Senate Draft Report, p. 27-28)

The House Committee directs the IHS "to work toward completion of electronic dental records (EDR) at the remaining 80 of 230 Federal and tribal dental sites."

MENTAL HEALTH

FY 2014 Enacted $77,980,000
FY 2015 Admin. Request $82,025,000
FY 2015 House Committee $82,025,000
FY 2015 Senate Subcommittee $81,145,000

Both bills recommend $2.8 million for staffing of new facilities and $319,000 for newly-recognized tribes. The House bill would also provide $880,000 for medical inflation.

ALCOHOL AND SUBSTANCE ABUSE

FY 2014 Enacted $186,378,000
FY 2015 Admin. Request $193,824,000
FY 2015 House Committee $193,824,000
FY 2015 Senate Subcommittee $190,981,000

Both bills recommend $4.3 million for staffing of new facilities and $289,000 for newly-recognized tribes. The House bill would also provide $2.8 million for medical inflation.

Recurring funding of $15.5 million for the Meth/Suicide Prevention and Treatment Initiative is included.

PURCHASED/REFERRED CARE
(Formerly Contract Health Services)

FY 2014 Enacted $878,575,000
FY 2015 Admin. Request $929,041,000
FY 2015 House Committee $929,041,000
FY 2015 Senate Subcommittee $881,147,000

Both bills include $2.6 million for newly-recognized tribes and within the total
$51.5 million for the Catastrophic Health Emergency Fund. The House, but not the Senate, recommended $32.5 million for medical inflation and a program increase of $15.4 million.

The House Report, noting that the IHS and tribes must prioritize care under this program (Levels I-V), encourages them to measure the impact of funding increases at each level of care.

Medicare-like Rates Legislation Encouraged. The Administration has proposed that tribes, the IHS, and urban Indian organizations utilizing the Purchased/Referred Care program be charged Medicare-like rates for non-hospital services, thus stretching the funding for Purchased/Referred Care. Medicare-like rates are currently required for hospital services. A 2013 Government Accountability Office report concluded that IHS and tribal facilities would save millions of dollars and be able to increase care if the Medicare-like rate cap was imposed on non-hospital providers and suppliers through the Purchased/Referred Care program. The House Committee concurs and in its Report urges the IHS to "work aggressively with the relevant committees" to enact such authorizing legislation.

PUBLIC HEALTH NURSING

FY 2014 Enacted $70,909,000
FY 2015 Admin. Request $76,353,000
FY 2015 House Committee $76,353,000
FY 2015 Senate Subcommittee $75,640,000

Both bills include $4.5 million for staffing of new facilities and $257,000 for newly-recognized tribes. The House bill also includes $713,000 for medical inflation.

HEALTH EDUCATION

FY 2014 Enacted $17,001,000
FY 2015 Admin. Request $18,263,000
FY 2015 House Committee $18,263,000
FY 2015 Senate Subcommittee $18,026,000

Both bills include $861,000 for staffing of new facilities and $164,000 for newly-recognized tribes. The House bill also includes $237,000 for medical inflation.

COMMUNITY HEALTH REPRESENTATIVES

FY 2014 Enacted $58,345,000
FY 2015 Admin. Request $59,386,000
FY 2015 House Committee $59,386,000
FY 2015 Senate Subcommittee $58,469,000

Both bills include $124,000 for newly-recognized tribes. The House bill also includes $917,000 for medical inflation.

HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA

FY 2014 Enacted $1,826,000
FY 2015 Admin. Request $1,855,000
FY 2015 House Committee $1,855,000
FY 2015 Senate Subcommittee $1,826,000

The House, but not the Senate, bill includes $29,000 for medical inflation.
The Budget Justification noted a need for data sharing agreements with tribal partners in order to access screening test results.

URBAN INDIAN HEALTH

FY 2014 Enacted $40,729,000
FY 2015 Admin. Request $41,375,000
FY 2015 House Committee $44,250,000
FY 2015 Senate Subcommittee $40,729,000

The House, but not the Senate, bill recommends $2.87 million above the requested level and also includes $646,000 for medical inflation.

INDIAN HEALTH PROFESSIONS

FY 2014 Enacted $33,466,000
FY 2015 Admin. Request $38,466,000
FY 2015 House Committee $48,342,000
FY 2015 Senate Subcommittee $33,466,000

The $14 million over the FY 2014 enacted level recommended by the House Committee consists of: 1) restoration of the $5 million taken from the program in FY 2014 in order to meet contract support costs needs; 2) a $4.8 million transfer of loan repayment funding from the Hospitals and Clinics line item, thus consolidating loan repayment funds in one line item; and 3) a $5 million program increase.

Programs funded under Indian Health Professions and their estimated FY 2015 amounts are: Health Professions Preparatory and Pre-Graduate Scholarships ($3.68 million); Health Professions Scholarships ($10 million); Extern Program ($1.11 million); Loan Repayment Program ($30 million); Quentin N. Burdick American Indians Into Nursing Program ($1.66 million – four grants); Indians Into Medicine Program ($1.09 million – three grants); and American Indians into Psychology ($717,078 – three grants).

Proposal to Exempt Scholarship and Loan Repayment Programs from Federal Taxes. The Administration proposed, as in past years, to make the IHS Health Professions Scholarship Program and Loan Repayment Program tax-exempt, thus freeing up funding now used to pay taxes on these benefits. The Committee agrees that such legislation should be enacted, noting that 25 percent of the Loan Repayment funds go to pay Federal tax liabilities and that in FY 2013 over 500 loan repayment applicants were turned away due to limited funds. The House Committee suggests that the cost of such legislation might be offset by private collections:
The Committee encourages efforts to extend fair tax treatment of Federal scholarship and loan repayment programs to IHS-funded programs so that appropriated funds can help more applicants and further reduce vacancies. To that end, the Committee notes that IHS collected $85.3 million from private insurers in fiscal year 2013, which suggests that increased costs to the government to hire more IHS professionals by fairly adjusting the tax code are at least partially offset by private collections as a result of services provided by those newly-hired professionals. The Committee encourages IHS to re-submit its legislative proposal with the fiscal year 2016 budget and to include defensible estimate of offsets via third party collections. (H. Rept. 113-551, p. 87)

Use of Defaulted Funds. The bills would continue the provision that allows funds collected on defaults from the Loan Repayment and Health Professions Scholarship programs to be used to recruit health professionals for Indian communities:
Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a).

TRIBAL MANAGEMENT

FY 2014 Enacted $1,442,000
FY 2015 Admin. Request $2,442,000
FY 2015 House Committee $2,442,000
FY 2015 Senate Subcommittee $1,442,000

The House, but not the Senate, bill would restore the $1 million taken from the program in FY 2014 in order to meet contract support costs needs.

Funding would be for new and continuation grants for the purpose of evaluating the feasibility of contracting the IHS programs, developing tribal management capabilities, and evaluating health services. Funding priorities are, in order, 1) tribes that have received federal recognition or restoration within the past five years; 2) tribes/tribal organizations that are addressing audit material weaknesses; and 3) all other tribes/tribal organizations.

DIRECT OPERATIONS

FY 2014 Enacted $67,894,000
FY 2015 Admin. Request $68,065,000
FY 2015 House Committee $67,894,000
FY 2015 Senate Subcommittee $68,065,000

The Senate, but not the House, bill includes $171,000 for newly-recognized tribes.

The IHS states in its budget submission that 56.5 percent of the Direct Operations budget would go to Headquarters and 43.5 percent to the 12 Area Offices. Tribal Shares funding for Title I contracts and Title V compacts are also included.

SELF-GOVERNANCE

FY 2014 Enacted $4,727,000
FY 2015 Admin. Request $5,727,000
FY 2015 House Committee $5,727,000
FY 2015 Senate Subcommittee $4,727,000

The House, but not the Senate, bill would restore the $1 million taken from the program in FY 2014 in order to meet contract support costs needs.

The Self-Governance budget supports implementation of the IHS Tribal Self-Governance Program including funding required for Tribal Shares; oversight of the IHS Director's Agency Lead negotiators; technical assistance on tribal consultation activities; analysis of Indian Health Care Improvement Act new authorities; and funding to support the activities of the IHS Director's Tribal Self-Governance Advisory Committee.

The IHS estimates that in FY 2015, $1.6 billion will be transferred to tribes to support 89 ISDEAA Title V compacts and 114 funding agreements.

CONTRACT SUPPORT COSTS

FY 2014 Enacted $587,376,000
FY 2015 Admin. Request $617,205,000
FY 2015 House Committee $617,205,000
FY 2015 Senate Subcommittee $617,205,000

Neither bill contains a cap on CSC spending, but the accompanying House and Senate Committee Reports recommend $617,205,000 for IHS and $246,000,000 for BIA, the amounts requested by the Administration. The House Report states that should those amounts be insufficient, the agencies are to submit a reprogramming request. The House Report language reads as follows:
The Committee recommendation includes $617,205,000 as requested for full funding of the estimated contract support costs. The Committee expects IHS to submit a reprogramming request to the Committee if the final calculated contract support costs exceed this amount, in order to ensure that contract support costs are fully paid. The Committee recognizes that inconsistencies exist between Indian Affairs and IHS in the ways that contract support costs are estimated and managed, and encourages both the agencies and the Tribes to recommend ways that the Committee can be helpful in promoting consistency. Tribes that exercise their self-determination rights and enter into contracts with multiple Federal agencies shouldn’t have to navigate inconsistent rules across different agencies. (H. Rept. 113-551, p. 87)
The BIA report language is substantively the same except for the recommended amount.

Both bills, as requested by the Administration, provide that no FY 2014 or FY 2015 CSC funds may be used by the IHS or the BIA to pay prior year CSC or to repay the Judgment Fund for payment of judgments or settlements related to past-year CSC claims. For contract support costs, fiscal year 2015, the bills provide (Section 406 regarding FY 2014 is comparable):
Sec. 407. Amounts provided by this Act for fiscal year 2015 under the headings "Department of Health and Human Services, Indian Health Service, Indian Health Services" and "Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Operation of Indian Programs" are the only amounts available for contract support costs arising out of self-determination or self-governance contracts, grants, compacts, or annual funding agreements for fiscal year 2015 with the Bureau of Indian Affairs or the Indian Health Service: Provided, That such amounts provided by this Act are not available for payment of claims for contract support costs for prior years, or for repayments for settlements or judgments awarding contract support costs for prior years.

Both bills, consistent with the Interior appropriations acts for FYs 1999-2014, attempt to limit the ability of the IHS and BIA to fund past-year shortfalls in CSC funding from remaining unobligated balances for those fiscal years. This provision has been included in the appropriations acts for many years and has not precluded recovery on past-year CSC claims.
Sec. 405. Notwithstanding any other provision of law, amounts appropriated to or otherwise designated in committee reports for the Bureau of Indian Affairs and the Indian Health Service by Public Laws 103-138, 103-332, 104-134, 104-208, 105-83, 105-277, 106-113, 106-291, 107-63, 108-7, 108-108, 108-447, 109-54, 109-289, division B and Continuing Appropriations Resolution, 2007 (division B of Public Law 109-289, as amended by Public Law 110-5 and 110-28), Public Laws 110-92, 110-116, 110-137, 110-149, 110-161, 110-329, 111-6, 111-8 and 111-88, 112-10, 112-74 and 113-6 for payments for contract support costs associated with self-determination or self-governance contracts, grants, compacts, or annual funding agreements with the Bureau of Indian Affairs or the Indian Health Service as funded by such Acts, are the total amounts available for fiscal years 1994 through 2013 for such purposes, except that for the Bureau of Indian Affairs, tribes and tribal organizations may use their tribal priority allocations for unmet contract support costs of ongoing contracts, grants, self-governance compacts or annual funding agreements.

FUNDING FOR INDIAN HEALTH FACILITIES

FY 2014 Enacted $451,673,000
FY 2015 Admin. Request $461,995,000
FY 2015 House Committee $461,995,000
FY 2015 Senate Subcommittee $460,234,000

MAINTENANCE AND IMPROVEMENT

FY 2014 Enacted $53,614,000
FY 2015 Admin. Request $53,614,000
FY 2015 House Committee $53,614,000
FY 2015 Senate Subcommittee $53,614,000

Maintenance and Improvement (M&I) funds are provided to Area Offices for distribution to projects in their regions. Funding is for the following purposes: 1) routine maintenance;
2) M&I Projects to reduce the backlog of maintenance; 3) environmental compliance; and
4) demolition of vacant or obsolete health care facilities. Of the funding requested, $50.1 million would be allocated to sustain the condition of federal and tribal healthcare facilities buildings;
$3 million for environmental compliance projects; and $500,000 for demolition projects.

FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT

FY 2014 Enacted $211,051,000
FY 2015 Admin. Request $220,585,000
FY 2015 House Committee $220,585,000
FY 2015 Senate Subcommittee $219,612,000

Both bills include $8.5 million for staffing of new facilities and $67,000 for newly-recognized tribes. The House bill also includes $973,000 for medical inflation.

MEDICAL EQUIPMENT

FY 2014 Enacted $22,537,000
FY 2015 Admin. Request $23,325,000
FY 2015 House Committee $23,325,000
FY 2015 Senate Subcommittee $22,537,000

The House, but not the Senate, bill includes $788,000 for inflation. The IHS budget proposed to distribute the FY 2015 requested funds as follows: $17.3 million for new and routine replacement medical equipment at over 1,500 federally- and tribally-operated health care facilities; $5 million for new medical equipment in tribally-constructed health care facilities; and $500,000 each for the TRANSAM and ambulance programs.

CONSTRUCTION

Construction of Sanitation Facilities

FY 2014 Enacted $79,423,000
FY 2015 Admin. Request $79,423,000
FY 2015 House Committee $79,423,000
FY 2015 Senate Subcommittee $79,423,000
Four types of sanitation facilities projects are funded by the IHS: 1) projects to serve new or like-new housing; 2) projects to serve existing homes; 3) special projects such as studies, training, or other needs related to sanitation facilities construction; and 4) emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities in HUD-built homes.

The IHS proposes to distribute up to $48 million to the Area Offices for prioritized projects to serve existing homes; up to $5 million for projects to clean up and replace open dumps on Indian lands; and $2 million would be reserved at IHS Headquarters ($1 million for special projects and emergency needs; $500,000 to collect homeowner data and demographic information in three IHS Areas; and $500,000 for improving data collection systems to help fund a Water Resource Center to develop teaching materials and techniques for homeowners and communities to support usage in a way that promotes health). The Water Resource Center is in partnership with the Alaska Native Tribal Health Consortium whose funding stream began in
FY 2012 with $250,000 and is expected to be funded for five years through FY 2016.

Remaining funding will be for new and like-new homes, including sanitation facilities for homes of the disabled or sick with a physician referral, with priority for BIA Housing Improvement Projects.

Construction of Health Care Facilities

FY 2014 Enacted $85,048,000
FY 2015 Admin. Request $85,048,000
FY 2015 House Committee $85,048,000
FY 2015 Senate Subcommittee $85,048,000

The FY 2015 IHS health facility construction is proposed as follows:

• Kayenta Health Center in Kayenta, AZ – $18,869,000 to complete construction of the health care facility and staff quarters
• Northern California Regional Youth Treatment Center in Davis, CA – $17,161,000 for site preparation and to begin and complete construction of the treatment center
• Fort Yuma Health Center in Winterhaven, CA – $46,292,000 to begin and complete construction of the replacement health center which received design funding in 2008
• Gila River Southeast Health Center in Chandler, AZ – $2,726,000, to continue construction of the health center which received design funding in 2008 and initial construction funds in 2009.

OTHER

TRANSAM Equipment, Ambulances, Demolition Fund. The bills would continue language to provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense, $500,000 to be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings, and up to $2.7 million for the purchase of ambulances.

If we may provide additional information or assistance regarding FY 2015 Indian Health Service appropriations, please contact us at the information below.

# # #

Inquiries may be directed to:
Karen Funk (kfunk@hobbsstraus.com)

Available Documents for Download ( any referenced attachments are included in download )


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