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General Memorandum 16-051

General Memorandum 16-051
Indian Health Service Fiscal Year 2017 Appropriations Update

The House of Representatives and the Senate Appropriations Committee have each approved their FY 2017 appropriations bills for Interior, Environment and Related Agencies. In this Memorandum we report on the recommendations for the Indian Health Service (IHS). The House and Senate bill and report numbers, are, respectively, HR 5538, H. Rept. 114-632, S 3068, and S. Rept. 114-281. For a description of the Administration's proposed FY 2017 IHS budget, see our General Memorandum 16-016 of February 20, 2016.

The House approved its Interior Appropriations bill on July 14, 2016, on a largely party- line vote of 231-196. President Obama issued a lengthy Statement of Administration Policy critical of the bill and its many legislative riders. The President also expressed appreciation for the funding level for Indian Affairs programs as a whole, noting Contract Support Costs, the Tiwahe Initiative and Indian Education, but criticized its lack of tribal funding in other areas.

Members of both parties remarked at the Subcommittee and full Committee markups of the Interior bills that funding for Indian programs is a high priority of the committees and has bipartisan support. In particular, Members expressed support for increased funding for tribal health, education and justice programs.

Given the shortened congressional session due to breaks taken for the Democratic and Republican Presidential conventions and the November election, we are not expecting "regular" appropriations bills to be enacted by the beginning of fiscal year 2017 (October 1, 2016). The highly partisan nature of Congress also works against enacting appropriations bills in a timely manner. It is likely that we will have a Continuing Resolution (CR) that will run well past the November election, maybe even into December, following which the appropriations bills would be bundled into one or several "omnibus" bills. Generally, a CR funds programs at their previous year's level and conditions although in some cases changes ("anomalies") are made for special circumstances. Even though we expect a CR, the FY 2017 recommendations made by the House and by the Senate Appropriations Committee are very important as they provide a foundation for negotiations on an end-of-year omnibus appropriations bill (s).

IHS OVERALL FUNDING

FY 2016 Enacted $4,807,589,000
FY 2017 Admin. Request $5,185,015,000
FY 2017 House $5,078,636,000
FY 2017 Senate Committee $4,993,778,000

The House proposes $84.8 million more than does the Senate Committee. The calculation of the difference between the two is a mix of the House concurring with nearly all the built-in costs requested by the Administration and recommending more for Purchased/Referred Care, for accreditation emergencies, and for Urban Indian health than would the Senate bill. The Senate Committee, on the other hand, provides more funding than does the House for a behavioral health initiative, a Native youth initiative, and clinic leases. In the Facilities area, the Senate would fund a small ambulatory health care facilities program while the House would fund new and replacement quarters. Both bills would provide "such sums as may be necessary" for Contract Support Costs, with an estimated need of $800 million.

Built-in Costs. The Administration requested $159 million for inflationary increases which would be allocated among the various programs: $26 million for pay costs; $14.4 million for non-medical inflation (2.1%); $75.4 million for medical inflation (5.8%); and $43.2 million for population growth. The House Committee recommended all but $16.1 million of the requested inflationary increase, for a total of $143 million. The only portion not in the House bill of the requested amount is $16.1 million of population growth funds under Hospitals and Clinics. By comparison, the FY 2016 final IHS appropriation contained only $19.4 million for inflationary purposes (for a 1.3 percent pay increase). It is apparent that the Senate Committee bill does not have nearly the amount of inflationary increases as recommended by the House, but we do not have the number at this time.

The House Committee Report questions the distribution of population growth funds, saying it does not reflect places where caseloads are growing and asks the IHS to consider an alternate method of distribution.

Staffing Packages. Both bills would provide the requested amount of $33 million for staffing and operation of new facilities: Kayenta Health Center, $182,000; Muskogee Creek Nation Health Center, $10.7 million; Northern California Youth Residential Treatment Center, $3.4 million; Flandreau Health Center, $6.3 million; and Choctaw National Regional Medical Center in Oklahoma, $12.4 million.

The House addressed two matters affecting IHS programs across-the board:

Advance Appropriations Report. The House Committee Report asks for a GAO report and evaluation on the use of advance appropriations for healthcare programs across the federal government, and their application to the IHS:

The Government Accountability Office is directed to report on the use of advance appropriations authority for healthcare programs across the Federal government, including problems encountered, any estimates of cost savings, and applications to the Indian Health Service. (H. Rept. 114-632, p. 89)

Full Funding Report. The House Committee Report also directs IHS to provide a plan of what would be required to fully fund the Indian Health Care Improvement Act:
It has been over five years since the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), yet many of the provisions in the law remain unfunded. Tribes have specifically requested that priority areas for funding focus on diabetes treatment and prevention, behavioral health, and health professions. The Committee directs the Service to provide, no later than 90 days after enactment of this Act, a detailed plan with specific dollar amounts identified to fully fund and implement the IHCIA.
(H. Rept. 114-632, p. 89)

Na' Nizhoozhi Center. The Senate Committee Report expresses concern for the
Na' Nizhoozhi Center in Gallup, NM, which provides substance abuse services to members of many tribes and encourages the IHS to work with the Center and others to find a sustainable way to increase its capacity.

CONTRACT SUPPORT COSTS

FY 2016 Enacted Such sums as may be necessary
FY 2017 Admin. Request Such sums as may be necessary
FY 2017 House Such sums as may be necessary
FY 2017 Senate Committee Such sums as may be necessary

The House and the Senate Committee agreed, consistent with the Administration's request, to continue Contract Support Costs (CSC) in FY 2017 at "such sums as necessary" and that CSC be its own separate account. Specifically, the House and the Senate Committee:

• Recommended an indefinite appropriation for CSC for the IHS and BIA;
• Included in their reports the same estimate of CSC funds that will be needed as did the Administration: $800 million for IHS which is $82 million over the FY 2016 estimate; and $278 million for BIA, which is $1 million over the FY 2016 estimate; and they
• Did not continue the problematic proviso from FY 2016 that unspent CSC would count against the next year's requirement (see below).

Both House and the Senate Committee heeded the request of many tribes and tribal organizations and did not repeat the CSC language which was in the FY 2016 appropriations act that would effectively deny the carryover authority granted by the Indian Self-Determination and Education Assistance Act. Thus the pending FY 2017 appropriations bills do not contain this FY 2016 provision: "amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal years."

House and Senate Committee IHS bill language:

For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education Assistance Act agreements with the Indian Health Service for fiscal year 2017, such sums as may be necessary: Provided, That notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer to another budget account.

Senate IHS Committee Report Language:

The Committee has continued language from fiscal year 2016 establishing an indefinite appropriation for contract support costs estimated to be $800,000,000, which is an increase of $82,030,000 above the fiscal year 2016 level. The Committee has modified language to delete a provision that contradicted certain provisions of the Indian Self-Determination and Education Assistance Act. (S. Rept. 114-281, pp. 90-91)

House IHS Committee Report Language:

The Committee recommends an indefinite appropriation estimated to be $800,000,000 for contract support costs incurred by the agency as required by law, $82,030,000 above the fiscal year 2016 enacted level.
The recommendation continues bill language making available for two years such sums as are necessary to meet the Federal government’s full legal obligation, and prohibiting the transfer of funds to any other account for any other purpose. Language addressing contract funds that go unspent in a given fiscal year is discontinued. (H. Rept. 114-632, p. 90)

Finally, the House and the Senate Committee bills continue prior language in the General Provisions section:

Contract Support Costs, Prior Year Limitation

Sec. 405. Sections 405 and 406 of division F of the Consolidated and Further Continuing Appropriations Act, 2015 (Public Law 113-235) shall continue in effect in fiscal year 2017.
Contract Support Costs, Fiscal Year 2017 Limitation
Sec. 406. Amounts provided by this Act for fiscal year 2017 under headings “Department of Health and Human Services, Indian Health Service, Contract Support Costs” and “Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Contract Support Costs” 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 2017 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 repayment of payments for settlement or judgments awarding contract support costs for prior years.

The House and the Senate Committee did not act on the Administration's proposal to transition CSC to a capped mandatory program for a 3-year period beginning in FY 2018, a proposal that is beyond the jurisdiction of the Appropriations Committees in any event.

FUNDING FOR INDIAN HEALTH SERVICES

FY 2016 Enacted $3,566,387,000
FY 2017 Admin. Request $3,815,109,000
FY 2017 House $3,720,690,000
FY 2017 Senate Committee $3,650,171,000

HOSPITALS AND CLINICS

FY 2016 Enacted $1,857,225,000
FY 2017 Admin. Request $1,979,998,000
FY 2017 House $1,928,879,000
FY 2017 Senate Committee $1,890,303,000

Tribal Clinic Leases. The Senate Committee would provide $11 million ($9 million above the FY 2016 enacted level) as requested by the Administration to supplement funds for tribal clinic leases, while the House Committee would provide $2 million for this purpose.
Senate Committee bill language reads:

Provided further, that, of the funds provided, $11,000,000 shall remain available until expended to supplement funds available for operational costs at tribal clinics operated under an Indian Self-Determination and Education Assistance Act compact or contract where health care is delivered in space acquired through a full service lease, which is not eligible for maintenance and improvement and equipment funds from the Indian Health Service.

House bill language reads:

Provided further, that, of the funds provided, $2,000,000 shall be used to supplement funds available for operational costs at tribal clinics operated under an Indian Self-Determination and Education Assistance Act compact or contract where health care is delivered in space acquired through a full service lease, which is not eligible for maintenance and improvement and equipment funds from the Indian Health Service.

Health Information Technology. The Senate Committee did not provide the requested $20 million for a Health Information Technology Initiative, noting that IHS was allocated $60 million of Nonrecurring Expenses Fund from HHS, some of which can be used for IT programs.

Accreditation Emergencies. The House would provide $6 million for accreditation emergencies, while the Senate Committee would provide no funding for this specific purpose. The FY 2016 enacted appropriations included $2 million for this purpose.
The House Committee Report directs:

Funds may be used for personnel or other expenses essential for sustaining operations of an affected service unit, but these are not intended to be recurring base funds. The Director should reallocate the funds as necessary to ensure that agreements with CMS are reinstated, and to restore third-party collection shortfalls. Shortfalls should be calculated relative to a baseline, which should be the average of the collections in each of the two fiscal years preceding the year in which an agreement with CMS was terminated or put on notice of termination. (H. Rept. 114-632, p. 88)

Prescription Drug Monitoring Program. The House would provide $1 million to fund the creation of a multi-state prescription drug monitoring program authorized by Section 196 of the Indian Health Care Improvement Act.

DENTAL SERVICES
FY 2016 Enacted $178,286,000
FY 2017 Admin. Request $186,829,000
FY 2017 House $186,029,000
FY 2017 Senate Committee $180,923,000

The House amount is the same as the Administration's Dental Services request as it includes a transfer of $800,000 to Direct Operations "to backfill vacant dental health positions in headquarters. The Service is encouraged to coordinate with the Bureau of Indian Education (BIE) to integrate preventive dental care at schools within the BIE system"
(H. Rept. 114-632, p. 88)

Volunteer Dentists/Centralized Credentialing. Both the House and the Senate Committees expressed strong interest in IHS establishing a pilot project for a centralized credentialing system for volunteer dentists, similar to what the Department of Defense and Veterans Affairs have. The House Report directs the IHS to consult with those federal agencies and with private organizations to develop this pilot project. The Senate Report asks the IHS to consult with federal agencies, private organizations and state dental organizations and work to establish a pilot project.

The House Committee Report reads:

The Committee understands that the geographic isolation of Indian tribes makes it difficult to attract and retain dentists and may limit access to care as tooth decay continues to be a problem. One way to help address access would be to allow volunteer dentists to treat patients who can provide important services that will improve access to oral health care. The Committee directs the Service to conduct a pilot project to explore establishing a centralized credentialing system to address workforce needs as well as volunteer providers similar to the Departments of Defense and Veterans Affairs who have centralized credentialing systems. The Committee directs the Service to consult with these agencies and private organizations to include the credentialing of dentists in a pilot program. (H. Rept. 114-632, p. 88)

The Senate Committee Report reads:

The Committee is concerned that tooth decay in Indian Country has reached epidemic proportions and notes that preschool children of American Indian and Alaska Natives have the highest level of tooth decay of any population group in the United States. The Committee understands that the geographic isolation of tribal health facilities makes it difficult to attract dentists to serve as providers and believes that one alternative to improve access to dental care is to allow volunteer dentists to treat patients. However, the Committee has heard reports that delays in getting approved healthcare providers credentialed to work at tribal or Indian Health Service facilities have resulted in candidates abandoning their efforts to volunteer because they could not be processed in a timely fashion. To address this problem, the Committee urges the Service to explore establishing a centralized credentialing system to encompass volunteer providers. The Departments of Defense and Veterans Affairs have centralized credentialing systems and the Committee believes that the Service should consult with those Departments, as well as private sector credential verification organizations and state dental associations, and work to establish a pilot project to test the feasibility of a centralized credentialing system. (S. Rept. 114-281, p. 90)

MENTAL HEALTH

FY 2016 Enacted $ 82,100,000
FY 2017 Admin. Request $111,143,000
FY 2017 House $ 86,143,000
FY 2017 Senate Committee $108,331,000

The Senate Committee would fully fund the Administration's requested $25 million program increase. Of that amount $21.4 million would be for a Behavioral Health Integration Initiative. The Administration's Budget Justification explains that funding would be available to tribes, tribal organizations, and urban Indian organizations to expand the behavioral health services to areas outside the traditional health care system. Funds could also be used for training, to hire behavioral health staff and for community-based programs. The remaining $3.6 million would fund pilot projects to implement a Zero Suicide Initiative.

Domestic Violence Program/CSC for Grants. The Senate Committee would provide the requested increase of $4 million for the Domestic Violence Prevention program.

Of note is that both the House and the Senate Committee address the issue of the IHS not paying contract support costs (CSC) on its grants – Domestic Violence Prevention; Substance Abuse and Suicide Prevention; Zero Suicide Initiative; after-care pilots projects at Youth Regional Treatment Centers; funding for the improvement of third party collections; and accreditation emergencies. Neither bill continues the FY 2016 bill language of "Notwithstanding any other provision of law" preceding the listing in the appropriations bill of these programs which was apparently used by IHS to justify not paying CSC on these programs.

ALCOHOL AND SUBSTANCE ABUSE

FY 2016 Enacted $205,305,000
FY 2017 Admin. Request $233,286,000
FY 2017 House $216,486,000
FY 2017 Senate Committee $225,750,000

The Senate Committee would fund the Administration's requested $16.8 million program increase which is focused on youth. The Senate Report notes that the funding is for "the alcohol and substance abuse program to focus on tribal youth and the incorporation of more holistic healthcare modes to improve outcomes. The Service is directed to allocate $2,000,000 of the increase provided for the alcohol and substance abuse program to fund essential detoxification and related services provided by the Service's public and private partners to IHS beneficiaries." (S. Rept. 114-281, p. 89)

PURCHASED/REFERRED CARE

FY 2016 Enacted $914,139,000
FY 2017 Admin. Request $962,331,000
FY 2017 House $960,831,000
FY 2017 Senate Committee $914,139,000

Included in the above House and the Senate Committee figures is $53 million for the Catastrophic Health Emergency Fund, which is $1.5 million over FY 2016. The House Committee Report references a GAO report on the distribution of Purchased/Referred Care funds and instructs how the increase is to be used. It also comments on the use of federal facilities outside of the IHS system. The House Committee Report reads:
The recommendation includes $960,831,000 for Purchased/Referred Care (PRC), $46,692,000 above the fiscal year 2016 enacted level. The Committee remains concerned about the inequitable distribution of funds as reported by the Government Accountability Office (GAO–12–446). The Service is therefore directed to allocate the increase above the fiscal year 2016 enacted level according to the PRC allocation formula normally reserved for program increases only.

The IHS is encouraged to evaluate the feasibility of entering into reimbursable agreements with Federal health facilities outside of the IHS system for patient referrals. Such agreements should be considered only when such referrals save costs and patient travel times relative to referrals to the nearest non-Federal health facilities, and when such referrals do not significantly increase patient wait times at such Federal facilities.
(H. Rept. 114-632, pp. 88-89)

PUBLIC HEALTH NURSING
FY 2016 Enacted $76,623,000
FY 2017 Admin. Request $82,040,000
FY 2017 House $82,040,000
FY 2017 Senate Committee $78,312,000

HEALTH EDUCATION
FY 2016 Enacted $18,255,000
FY 2017 Admin. Request $19,545,000
FY 2017 House $19,545,000
FY 2017 Senate Committee $18,562,000
COMMUNITY HEALTH REPRESENTATIVES
FY 2016 Enacted $58,906,000
FY 2017 Admin. Request $62,428,000
FY 2017 House Committee $62,428,000
FY 2017 Senate Committee $58,906,000

HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA
FY 2016 Enacted $1,950,000
FY 2017 Admin. Request $2,062,000
FY 2017 House $2,062,000
FY 2017 Senate Committee $2,062,000

URBAN INDIAN HEALTH
FY 2016 Enacted $44,741,000
FY 2017 Admin. Request $48,157,000
FY 2017 House Committee $48,157,000
FY 2017 Senate Committee $45,741,000

The Administration requested a program increase of $1,137,000 to develop a strategic plan for the Urban Indian Health program in consultation with urban Indians and the National Academy of Public Administration. This effort was begun in FY 2016 with $1.1 million being appropriated for the development of a strategic plan.

The House Committee Report encourages review and changing of authorizing statutes with the goal of providing Urban Indian organizations equitable reimbursement with IHS and tribal health programs:

The recommendation includes $48,157,000 as requested for Urban Indian Health, $3,416,000 above the fiscal year 2016 enacted level. IHS should continue to include current services estimates for Urban Indian Health in future budget requests. The Committee recognizes that seven out of ten American Indian/Alaska Natives live in urban centers, according to the latest census data. Many of these individuals are, or are descendants of, individuals encouraged by the Federal government to move to urban centers during the termination and relocation era of the 1950s and 1960s, and are thus entitled to receive vital culturally appropriate health services from urban Indian organizations, just as they would have received health services from IHS-run and tribally-run facilities if they lived on or near a reservation. Unfortunately, urban Indian health organizations are struggling to recover their costs because they are not designated in relevant statutes as eligible providers on an equal par with IHS and Tribal Health Program facilities. The Committee urges the authorizing committees of jurisdiction to review these statutes and make any changes necessary for urban Indian organizations to receive equitable reimbursement for the culturally appropriate services they provide to Native individuals, including Native veterans. (H. Rept. 114-632, p. 89)

INDIAN HEALTH PROFESSIONS
FY 2016 Enacted $48,342,000
FY 2017 Admin. Request $49,345,000
FY 2017 House $49,345,000
FY 2017 Senate Committee $49,345,000

Programs funded under Indian Health Professions are: Health Professions Preparatory and Pre-Graduate Scholarships; Health Professions Scholarships; Extern Program; Loan Repayment Program; Quentin N. Burdick American Indians Into Nursing Program; Indians Into Medicine Program; and American Indians into Psychology. As requested by the Administration, the Senate bill language would provide $36 million for the loan repayment program, while the House bill would provide $37 million for this purpose.

Health Administration. The House Committee Report notes that the term "any other health profession" in the definition of health profession at section 1603(10) of title 25, United States Code, includes "health administration".

TRIBAL MANAGEMENT

FY 2016 Enacted $2,442,000
FY 2017 Admin. Request $2,488,000
FY 2017 House $2,488,000
FY 2017 Senate Committee $2,442,000

Funding is for new and continuation grants for the purpose of evaluating the feasibility of contracting 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.

IHS notes that in FY 2015, 88 percent of the funding awarded focused on Health Management Structure; 8 percent on planning grants; and 4 percent on Evaluation studies.

DIRECT OPERATIONS

FY 2016 Enacted $72,338,000
FY 2017 Admin. Request $69,620,000
FY 2017 House $70,420,000
FY 2017 Senate Committee $69,620,000

The IHS noted in its budget submission that 58.7 percent of the Direct Operations budget would go to Headquarters and 41.3 percent to the 12 Area Offices. Tribal Shares funding for Title I contracts and Title V compacts are also included.

SELF-GOVERNANCE
FY 2016 Enacted $5,735,000
FY 2017 Admin. Request $5,837,000
FY 2017 House $5,837,000
FY 2017 Senate Committee $5,735,000

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 estimated in its budget justification that in FY 2016, $1.8 billion will be transferred to tribes to support 92 ISDEAA Title V compacts and 117 funding agreements.

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. SDPI is currently funded through FY 2017 at $150 million (see our General Memorandum 15-032 of April 17, 2015). As mentioned under the Legislative Initiatives section, the Administration is proposing that SDPI be permanently authorized at $150 million per fiscal year.

FUNDING FOR INDIAN HEALTH FACILITIES

FY 2016 Enacted $523,232,000
FY 2017 Admin. Request $569,906,000
FY 2017 House $557,946,000
FY 2017 Senate Committee $543,607,000

MAINTENANCE AND IMPROVEMENT
FY 2016 Enacted $73,614,000
FY 2017 Admin. Request $76,981,000
FY 2017 House $76,464,000
FY 2017 Senate Committee $76,981,000

As of October 1, 2015, the Backlog of Essential Maintenance, Alteration, and Repair is $473 million. 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. The Act provides that up to $500,000 may be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings.

FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT

FY 2016 Enacted $222,610,000
FY 2017 Admin. Request $233,858,000
FY 2017 House $233,858,000
FY 2017 Senate Committee $226,005,000

MEDICAL EQUIPMENT

FY 2016 Enacted $22,537,000
FY 2017 Admin. Request $23,654,000
FY 2017 House $23,654,000
FY 2017 Senate Committee $22,537,000

The House and the Senate Committee bills continue language to provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense, up to $2.7 million for the purchase of ambulances, and $500,000 for a Demolition Fund to destroy Federal buildings.

The Administration's request was to distribute the FY 2017 requested funds as follows: $18 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 2016 Enacted $ 99,423,000
FY 2017 Admin. Request $103,036,000
FY 2017 House $103,036,000
FY 2017 Senate Committee $103,036,000

IHS projects that the funds would be distributed as follows: 1) $57 million for projects to serve new or like-new housing; 2) $43 million for projects to serve existing homes; 3) $2 million for projects such as studies, training, or other needs related to sanitation facilities construction; and 4) $1 million emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities for HUD-built homes.

Construction of Health Care Facilities

FY 2016 Enacted $105,048,000
FY 2017 Admin. Request $132,377,000
FY 2017 House $120,934,000
FY 2017 Senate Committee $115,048,000

While neither the House nor the Senate Committee recommended the full amount requested by the Administration, under the Administration's request the following would have been provided:
Phoenix Northeast Health Center $52.5 million
Whiteriver Hospital, Whiteriver, AZ $15.0 million
Rapid City Health Center $28.7 million
Dikon Alternative Rural Health Center, Dikon, AZ $15.0 million

The Senate Committee Report directs the IHS to provide within 60 days of enactment "a spending plan to the Committee that details the project-level distribution of funds provided for healthcare facilities construction." It also directs the IHS to work with the Southeast Alaska Regional Health Consortium "to formulate options for facilities upgrades and ultimately a replacement facility at Mt. Edgecombe in Sitka." (S. Rept. 114-281, p. 91)

Small Ambulatory Program Health Care Facilities. As requested by the Administration, the Senate Committee would provide $10 million for this program which has not been funded since 2008. The Senate Committee noted that "this program is another critical tool for addressing facilities maintenance and construction backlogs throughout the nation. The Committee encourages the Service to give strong consideration to utilizing these new resources to assist with infrastructure improvements at remote sites such as Gambell and Savoonga on St. Lawrence Island, Alaska" (S. Rept. 114-281, p. 91)
The Administration's description of its request for the Small Ambulatory Program is:
Funding would be for facilities smaller than health centers which do not qualify for the IHS Health Care Facilities Construction Priority System. Funds are for "the construction, expansion or modernization of non-IHS owned small tribal ambulatory health care facilities located apart from a hospital." (p. CJ-176)

New and Replacement Quarters. The House Committee Report, "recognizing that inadequate and non-existent staff quarters are a significant impediment to recruitment, the staff recommendation includes $12,000,000 as requested for staff quarters." (H. Rept. 114-632, p. 90)The Administration's description of its request for new and replacement quarters is:

Citing that the greatest need for new and replacement quarters is in the Great Plains, Navajo and Alaska Areas, the funds would be used "to initiate the replacement and addition of quality housing for health care professionals in these three Areas. The amount distributed to each Area will be based on each Area's internal priority list that will be completed by mid-FY 2016". (p. CJ-176)

Facility Access Analysis. The House Committee Report requests a" gap analysis" from IHS regarding health facility access for IHS patients:

In order to ensure that IHS patients across the system have fairly equal access to healthcare, the IHS is directed to conduct and publish a gap analysis of the locations and capacities of patient health facilities relative to the IHS user population. The analysis should include: facilities within the IHS system, including facilities on the Health Facilities Construction Priority System list and the Joint Venture Construction Program list; and facilities within private or other Federal health systems for which agreements with IHS exist, or should exist, to see IHS patients. (H. Rept. 114-632, p. 90)

If we may provide additional information or assistance regarding FY 2017 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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