Funding Tables Melanie Fourkiller, Choctaw Nation of Oklahoma “Excellence in Rural Health Care”

Planning Objective Objective: to acquire and analyze financial and programmatic information, in order to form a basis for decision-making. Understand the funding distribution at 100%; Understand the purpose of and workload for the PSFAs benefitting the Tribe; Analyzing specific PSFAs to inform decision-making; Achieve more accountability for PSFAs retained by IHS.

Common Terms Program Base, Service Unit Funds: a Tribe’s share of funding from the Service Unit Level; Tribal Shares: a Tribe’s shares of the associated programs at the Area Office and Headquarters IHS Recurring funding: funding that reoccurs each year Non-recurring funding: funding of a one-time nature that may not recur in a future year “X-year” funds: funds without expiration in the federal appropriation

Common Terms Inherent Federal Functions – functions that must, by law be carried out by a federal official official Residual – the amount of funds required to perform IFFs, under the theorectical assumption that all available programs have been compacted Buyback – PSFAs assumed by the Tribe, and then purchased back from the IHS Full Cost Recovery Fee – the fee associated with a “buyback” PSFA Retained – PSFAs eligible to be transferred to a Tribe which the Tribe chooses for IHS to perform (not assumed by the Tribe)

Fund Distribution Funding Tables Available from IHS Headquarters Tables 1 – 3: Tracks funding from Appropriation HQ Distribution: Specific table showing funding for your Tribe

Headquarters Table #1

Headquarters Table #1

Headquarters Table #1

Headquarters Table #1

HQ Tribal Share Table

Fund Distribution Area Tables Vary in format by Area Formulas can vary by Area Example: Oklahoma Tribal Size Adjustment Formula Formulas should be Tribally-driven and a result of Tribal Consultation

Area Office Table

Fund Distribution Facilities Appropriation Table 4f Contains all Facilities PSFAs, including: Maintenance and Improvement Sanitation Facilities Construction Equipment Facilities Support

Table 4f

Program Base Funding Program Base, or Service Unit Level Table Format can vary by Area Funding formulas can vary by Area Example: Oklahoma Area Location of Service Unit – by County Location of Tribal former reservation area/historic jurisdiction User population distribution in Service Unit Allocation of ‘non-affiliated’ Tribal Users

Understanding PSFA Workload Information Available from IHS: PSFA Manuals Additional PSFA descriptions – example: Recruitment Workload reports – examples: outpatient visits by type; PCP visits; specific services benefitting the Tribe Revenue reports – 3rd party collections Staffing/organizational information Other reports upon request by the Tribe Discussions with IHS Programmatic Staff

Final Thoughts PSFAs may be assumed “all or a portion of” Not an all-or-nothing proposition Request additional breakouts of functions or funding as needed for responsible decisions Phase-in strategies can be used - incrementally add ‘feasible’ PSFAs over time Allows infrastructure growth alongside Tribal assumption of health programs.

Final Thoughts Request workload or further descriptions of benefits to the Tribe currently performed by IHS as needed Consider Tribal readiness and priorities Consider alternative service delivery models PSFAs are negotiated at the option of the Tribe – and can change over time.

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