1. Portland Area Shares Methodology NPAIHB Quarterly Meeting April 18, 2012 Ocean Shores, WA

2. Portland Area Office of Environmental Health and Engineering (OEHE) Functions and Funding Methodology Facilities Appropriation (FEHSA)

3. Budget Structure

4. OEHE Methodology Recommendation - Fund Distribution Workgroup Using workload and dollar amounts from FY just completed, make payments to all Tribes as soon as allowance for current FY is received. Status All payments for 2012 will be made based on 2011 workload, in accordance with the recommendations of the Fund Distribution Workgroup, June 8, 2007

5. Total FSA, M&I and EQ Appropriation

6. Facilities Support Account (FSA) Uses: Facilities operations (utilities, Waste disposal, grounds keeping) Salaries for Professional Support Facility Operations (Mechanics, Grounds Keepers) Facility Expertise (Architect/Engineer) Biomedical Expertise Project Management Real Property Management Training (Facilities and Bio-med) Distribution Methodology: FSA is based on historical funding for Federally operated sites. This amount is adjusted in relation to overall increases or decreases in the appropriation. Lines 1,2,3,11,12,13,14,15,17 in Book 1 of Budget Books

7. Maintenance & Improvement (M&I) Use: Maintenance and Repair of Real Property, does not include “increases” to square footage (i.e expansion) Distribution Methodology: Modified Univ. of Oklahoma Formula Factors include: Replacement Value of Facility Size of Facility Intensity of Use Type of Construction (concrete, wood, etc.) Locality Lines 43, 44 in Book 1 of Budget Book, full formula available in Book 4 pg. 29

8. Medical Equipment Funds (EQ) Use: Replacement and Upgrade for Medical Equipment, for existing IHS and Tribal Facilities Distribution Methodology: Tribal Share = Total Funds appropriated * [(0.5* CWF) + (0.5* FSF)] CWF = Clinical Workload at facility Total Clinic workload of all IHS and tribal facilities FSF = Individual Facility Size Total Size of all IHS and Tribal Facilities Line 59 in Book 1 of Budget Books

9. M&I and EQ Distribution Full Detail on Distribution and Calculations in Book 4 of Budget Books

10. Total EHSA Appropriation 2012 reflects a rescission of.02% incurred in FY 2011 2013 will reflect the rescission of.016% incurred in FY 2012 * SFC Funding in 2012 was reduced nationally by $16M, and by $850,000 in Portland Area

11. Environmental Health Service (EHS) Program Planning - Consultation with Tribes on priorities Environmental Health Management - Facility Plan Reviews; Policy Development; Program/Project Development and Evaluation Epidemiology – Disease investigation/surveillance Community Injury Prevention – Surveillance, Project management, Technical assistance. Comprehensive Surveys - Head Starts; Casinos; Schools; Food Service; Sanitation Facilities. Training - Food Handler Training, OSHA/Bloodborne pathogens Institutional – X-ray surveys, hazards/safety audits, Infection Control/Occupational Health Program Lines 61-68 in Book 1 of Budget Books

12. Based on total number of facilities, and facility type. 155 - STILLAGUAMISH TRIBE, WA FacilityWorker CodeFacility NameDay 05 STILLAGUAMISH TRIBAL HEALTH STATION 6.15 13 STILLAGUAMISH METHODONE CLINIC 1.25 23 STILLAGUAMISH CHILD CARE AND KITCHEN 3.00 26 STILLAGUAMISH-ANGEL OF THE WINDS-CWS 4.50 28 STILLAGUAMISH CSS 2.00 31 STILLAGUAMISH O&M ORGANIZATION 3.10 44 STILLAGUAMISH ELDERLY NUTRITION PROGRAM 2.25 46 STILLAGUAMISH SMOKE SHOP 1.00 47 STILLAGUAMISH ESPRESSO 2.50 47 STILLIAGUAMISH ANGEL OF THE WINDS CASINO - 2.50 47 STILLAGUAMISH ANGEL OF THE WINDS CASINO - EDR 2.50 47 STILLAGUAMISH ANGEL OF THE WINDS CASINO - 2.50 48 STILLAGUAMISH ANGEL OF THE WINDS CASINO - 1.00 48 STILLAGUAMISH ANGELS OF THE WINDS CASINO - 1.00 49 STILLAGUAMISH ANGEL OF THE WINDS CASINO 2.50 Total Facilities:15Total Worker Days:37.75 EHS Workload Field ProgramInstitutional Injury PreventionProgram Mgt.Total Stillaguamish $8,657 $1,285 $122$596$ 10,660

13. Sanitation Facilities Construction (SFC) Partner with tribes, housing authorities, utility commissions, and community organizations to: Design and construct water supply, sewer & solid waste disposal facilities. Inventory sanitation deficiencies affecting Indian homes and communities. Provide technical consultation and training on water & waste disposal systems Assist in developing operation and maintenance capabilities

14. Sanitation Facilities Construction (SFC) Typical Program Resource Allocation for a 4- year project Year 1 = 0%, Year 2 = 20%, Year 3 = 50%, Year 4 = 30% Lines 71, 72, 73,74 & 78 in Book 1 of Budget Books

15. SFC Workload

16. Public Health Emergency Management (PHEM) No resources allocated, auxiliary duty for EHS Director Assists in the development of COOP plans for Federal Sites, and participates in mock drills. Liaison with State & Federal agencies during emergency events. Coordinate deployments for Commissioned Officers All Hazards emergency planning

17. Title I Example (Quileute)

19. OEHE Administrative Fee Analogous to SUA but Different in application Reflects required support for all tribes on proportional basis For those tribes that retain OEHE shares a 12.5% administrative fee is charged to cover the functions needed to support the retained programs –Human Resources, Procurement, Finance

20. Budget Book Distribution Tribal Chairs Tribal Health Directors CEO’s at Service Units For CD copy Contact: Rena Macy 503-414-7778 rena.macy@ihs.gov

21. Questions ?’s Richard R. Truitt, P.E., Director (OEHE) Phone: (503) 414-7777 E-mail: richard.truitt@ihs.gov CDR Patrick Craney, P.E., Director (DSFC) Phone: (503) 414-7772 E-mail: Patrick.Craney@ihs.gov CDR Celeste Davis, REHS, Director (EHS) Phone: (503) 414-7774 E-mail: Celeste.davis@ihs.gov CDR Mathew Martinson, P.E., Director (DHFE) Phone: (503) 414-7780 E-mail: mathew.martinson@ihs.gov

22. Portland Area Office Tribal Shares Methodology Services Appropriation

23. Budget Structure

24. Area Shares vs. Program Funding Services Appropriation –The Portland Area Shares Methodology represents each tribes share of the Area Office which they are authorized to assume pursuant to the Indian Self Determination & Education Assistance Act (ISDEAA). –Tribal program funds are distributed on the recurring base amounts reflected on their annual funding agreements.

25. Area Shares Methodology Established through Tribal Consultation In 1992 amendments to the Indian Self Determination & Education Assistance Act authorized IHS to enter into compacts for Self-Governance demonstration projects. In 1994 amendments provided Title1 access to resources. In 1995 The “70/30 formula” for tribal shares. In 2000 corrections to methodology was made to prevent diminishment of administrative support for Direct Service Tribes which established the Service Unit Administration (SUA) amounts.

26. Area Shares Methodology Health Services dollars Does not determine OEHE shares – Line 67 –Separate methodologies more appropriate for the type of funding

27. Goals of Tribal Shares Methodology Reflects one methodology for all Tribes: fairness & consistency Identifies each Tribe’s share of the funding that had previously supported Area Office functions but which they have now assumed – including funding received for Tribes newly restored Prevents diminishment of health services to Tribes that choose to continue to have a federally-operated clinic Allows for annual updates to accurately reflect available resources Easily understood

28. Lines 1 - 69 Reflect the programs and services the Area Office had at a moment in time Most services remain, some do not, some new ones During negotiations Tribes decide what they want the Area to continue to provide e.g., DIRM, Business Office,

29. PORTLAND AREA INDIAN HEALTH SERVICE FY 2011 TRIBAL SHARES ALLOCATION METHODOLOGY Amounts Available FY 2011 (A)(B)(C)(D)(E)(F) (G) EarmarkedFY 2011Service Unit Title I PAO Budget& SiteResidualAdministration106(a)(1)RetainedFundable LinePROGRAM TITLEFY 2011Specific (1)Amount (6)Amount 1HOSPITALS & CLINICS: 2(a) -Office of Area Director (2)380,527 30,26228,447321,81830,599291,219 2(b) -Area Support Services640,587 54,47147,889538,22755,091483,136 2(c) -Division of Financial Mgmt.1,108,100 93,81282,839931,44994,864836,585 2(d) -Division of Human Resources760,603 66,57656,861637,16667,322569,844 2(e) -Division of Acqusition672,571 57,49750,280564,79458,142506,652 3 -Div. of Inform. Resource Mgmt915,694 254,18168,455593,0580 4Subtotal4,478,082 556,799334,7723,586,511306,0183,280,493 5 6 Office of Health Programs 7 -Physician Recruitment214,776 16,056198,7200 8 -Laboratory Services142,712 10,669132,0430 9 -Maternal & Child Health171,226 12,801158,4264,029154,396 10 -CO Liaison58,949 4,40754,5421,61352,929 11 -Pharmacy Services163,200 12,201151,0004,029146,971 12 -Central Supply Services307,789 23,010284,7800 13 -Public Health Nursing41,940 3,13538,8052,41936,386 14 -Health Education13,767 1,02912,7382,41910,319 15 -Spec.Diabetes Pgm. For Indians214,686 0000 16 -Alcohol & Subs. Abuse Prog.387,228 28,948358,2800 17 -CHR Program86,148 6,44079,7084,02975,679 18(a) -Contract Health Service (3)337,866 131,89025,258180,719806179,913 18(b) -Business Office (3)185,300 13,853171,4474,029167,417 19 -Health Information Network391,136 29,240361,8954,029357,866 20Subtotal2,716,725214,686131,890187,0472,183,10227,4042,155,698 21 22 -Self Determination Services173,616 12,979160,63740,308120,329 23SUBTOTAL H&C7,368,423214,686688,689534,7985,930,249373,7295,556,520 24 25DENTAL 26 -Area Consultant Services299,529 122,212963176,3547,382168,972 27 28MENTAL HEALTH 29 -Area Consultant Services266,474 103,61419,630143,2307,325135,905 30

30. 31ALCOHOLISM 32 -CDMIS0 0000 33 -Youth Treatment0 0000 34 -Women's Treatment0 0000 35Subtotal0 0000 36 37PUBLIC HEALTH NURSING 38 -Area Consultant Services84,348 6,51377,8365,37672,459 39 40HEALTH EDUCATION 41 -Area Consultant Services96,412 7,23489,1786,72482,454 42 43DIRECT OPERATIONS 44(a) -Office of Area Director (2)1,009,271 671,04179,576258,6554,643254,011 44(b) -Area Support Services315,829 207,41323,12685,2901,45383,837 44(c) -Division of Financial Mgmt.197,207 134,20814,44048,55990747,651 44(d) -Division of Human Resources154,718 97,60611,32945,78371145,073 44(e) -Division of Acqusitions169,557 109,80711,85447,89677947,118 45 -Div. of Inform. System Mgmt.181,899 145,43513,31923,1450 46Subtotal2,028,481 1,365,510153,643509,3278,493500,835 47 48 Office of Health Programs 49 -Health Programs Management179,911 157,36813,1749,3690 50 -Maternal & Child Health12,759 93411,8251,27410,551 51 -Pharmacy Services12,759 93411,8251,27410,551 52 -Dental Services33,312 2,43930,8731,27429,599 53 -Mental Health33,311 2,43930,8721,27429,598 54 -Alcohol & Subs. Abuse Prog.33,036 2,41930,6171,27429,343 55 -Contract Health Service172,546 12,634159,9111,274158,637 56Subtotal477,634 157,36834,974285,2927,643277,649 57 58 -Self Determination Services409,317 29,971379,345114,637264,708 59SUBTOTAL DIRECT OPS2,915,432 1,522,878218,5881,173,965130,7731,043,192 65NEW TRIBES144,047 31,60510,807101,6361,274100,362 66 67SERVICES APPROP. TOTAL11,174,665214,6862,468,998798,5337,692,447532,5837,159,864 68FACILITIES APPROP. - OEH&E 67FACILITIES APPROP. TOTAL 68 69TOTAL PAO11,174,665214,6862,468,998798,5337,692,447532,5837,159,864

31. Column A PAO Budget A historical benchmark that began in FY 1995/96 Starting point for calculation of the rest of the methodology Mandatories added each subsequent year Different from Area Office operating budget –Column A minus all shares taken –Plus non-recurring funds and assessment funds

32. Column A, PAO Budget $11,174,665

33. Column B Congressional Earmarks Site Specific –Diabetes Consultants – Indian Health Care Improvement Act (IHCIA)

34. Column C Area Office Residual Inherent Federal Functions (not contractible by Tribes) What the Area Office will continue to be responsible for, once all Tribes have taken 100% of shares These responsibilities have greatly expanded/changed –Information Technology –9/11 – Security Costs –Homeland Security Presidential Directive 12 (HSPD-12) –Health Insurance Portability & Accountability Act of 1996 (HIPAA) –Government Performance and Results Act (GPRA)

35. Column D Service Unit Administration (SUA) Funding required to support federally- operated service units beyond the shares left by Tribes who choose to have a Federal facility IHS still required to provide services to Direct Service Tribes.

36. SUA Calculation Factors New Workload Study - Time Spent on SU/Tribes/Area Office –Value Time S&B – Divide by Total Budgets for 7 SU –13.3% Admin Cost for Program Support –1.6% Admin Cost for CHS Program

37. SUA Example Wellpinit Service Unit Spokane Tribe $1,333,949 Recurring Base$1,423,600 CHS Base x 13.3%x 1.6% $177,415$ 22,778 $177,415 + $22,778 = $200,193 Spokane 106(a)(1) –$157,749 SUA Needed$ 42,444

38. What does SUA Pay For? Administrative Support for Federal Service Units and misc. programs without associated shares Financial services  Budget, Travel, Payments, reconciliation, Collections Property and Supply Acquisitions - Federal purchasing Personnel - Recruitment, hiring, benefits, payroll Supervision - Evaluation, appeals, discipline, policy development and enforcement, governance EEO

39. Column E 106(a) (1) Amount Column A – columns b, c, and d = e Section of P.L. 93-638 which reads –SEC. 106 [25 USC 450j-1]. (a)(1) The amount of funds provided under the terms of self-determination contracts entered into pursuant to this Act shall not be less than the appropriate Secretary would have otherwise provided for the operation of the programs or portions thereof for the period covered by the contract, without regard to any organizational level within the Department of the Interior or the Department of Health and Human Services, as appropriate, at which the program, function, service, or activity or portion thereof, including supportive administrative functions that are otherwise contractible. is operated. 70/30 calculation determines Tribal shares –30% of funding divided by 40 –70% divided based on 1998 user population

40. Column F Title I Retained What it costs to administer a Title I contract that is additional to a Title V compact –Area Staff responsible for proposal review, negotiations, amendments, audit review, resolution and payments. This amount is subtracted from Title I Tribes 106(a)(1) amount Title V Tribes do not leave shares to support T1 Retained

41. Column G Fundable Amount Tribal Shares available for contracting/compacting Title I Tribes 70/30 share of column E minus a pro rata share of Title I retained

42. Column G Fundable Amount Forty Tribes No Fundable Amount for Tribes with an Associated SUA –Takes all their shares to support SU & Title I contracts –If Tribes with an SUA amount take shares, the SU will assist in providing administrative support necessary for the operation of that SU

43. Column G, Fundable amount $7,159,864

44. Direct Service Tribes It requires All Yakama, Colville, Spokane, Warm Springs, Shoshone Bannock 106(a)(1) amounts plus the SUA to support these operating units –Yakama, Colville, Ft. Hall, Warm Springs, Wellpinit, Western Oregon, NPAIHB, Healing Lodge of the Seven Nations. 43 Tribes have to leave $798,533 to support SUA

45. Individual Tribal Shares Where you look to see your Tribe’s share amounts Newly recognized Tribes received a specific amount for base funding and shares –Have to track separately –Can not reduce contracted shares

46. Individual Tribal Shares PORTLAND AREA INDIAN HEALTH SERVICE FY 2011 TRIBAL SHARES ALLOCATION METHODOLOGY Amounts Available Burns-Paiute Contract # 0248-96-0017 (D)(E)(F) (H) Service Unit Title I Administration106(a)(1)RetainedFundable LinePROGRAM TITLEAmount 1HOSPITALS & CLINICS: 2(a) -Office of Area Director (2)2612,9585712,387 2(b) -Area Support Services4404,9471,0293,919 2(c) -Division of Financial Mgmt.7618,5611,7716,790 2(d) -Division of Human Resources5235,8571,2574,600 2(e) -Division of Acqusition4625,1911,0854,106 3 -Div. of Inform. Resource Mgmt6295,4510 4Subtotal3,07732,9665,71327,252 5 6 Office of Health Programs 7 -Physician Recruitment1481,8270 8 -Laboratory Services981,2140 9 -Maternal & Child Health1181,456751,381 10 -CO Liaison4150130471 11 -Pharmacy Services1121,388751,313 12 -Central Supply Services2112,6180 13 -Public Health Nursing2935745312 14 -Health Education91174572 15 -Spec.Diabetes Pgm. For Indians0000 16 -Alcohol & Subs. Abuse Prog.2663,2930 17 -CHR Program5973375657 18(a) -Contract Health Service (3)2321,661151,646 18(b) -Business Office (3)1271,576751,501 19 -Health Information Network2693,326753,251 20Subtotal1,71920,06651219,554 21 22 -Self Determination Services1191,476753724 23SUBTOTAL H&C4,91654,5086,97747,531 24 25DENTAL 26 -Area Consultant Services91,6211381,483 27

47. Individual Tribal Shares 28MENTAL HEALTH 29 -Area Consultant Services1801,3171371,180 36 37PUBLIC HEALTH NURSING 38 -Area Consultant Services60715100615 39 40HEALTH EDUCATION 41 -Area Consultant Services66820126694 42 43DIRECT OPERATIONS 44(a) -Office of Area Director (2)7312,377872,291 44(b) -Area Support Services21378427757 44(c) -Division of Financial Mgmt.13344617429 44(d) -Division of Human Resources10442113408 44(e) -Division of Acqusitions10944015426 45 -Div. of Inform. System Mgmt.1222130 46Subtotal1,4124,6821594,523 47 48 Office of Health Programs 49 -Health Programs Management121860 50 -Maternal & Child Health91092485 51 -Pharmacy Services91092485 52 -Dental Services2228424260 53 -Mental Health2228424260 54 -Alcohol & Subs. Abuse Prog.2228124258 55 -Contract Health Service1161,470241,446 56Subtotal3212,6221432,480 57 58 -Self Determination Services2753,4872,1401,347 59SUBTOTAL DIRECT OPS2,00910,7912,4418,349 65SERVICES APPROP. TOTAL7,24069,7719,91959,852

48. Footnotes and Background Information Tracks historical changes to the methodology Describes how AIDS, Alcohol and Substance Abuse, CHS Purchase of Service funding amounts are distributed –Tables on last three pages