Overview

Activities and Funds Available to Tribes under ISDEAA

Concepts and practices with emphasis on TRIBAL SHARES, especially for Headquarters.

Associated

Associated

Key Concepts

PSFA Tribal Sharemeans programs, services, functions, and activities (or portions thereof) that IHS carries out that an Indian Tribe may elect to carryout through a contract or compact

means the associated portion of funds used by IHS to carryout the PSFAs to be contracted

Inherent Federal Function Residual

mean those governmental functions which only IHS must perform which cannot legally be delegated to Tribes

means associated portion of funds used by IHS to carry out remaining inherent Federal functions when all other PSFAs are contracted

activities IHS carries out

associated funds

Associated

Associated

ISDEAA – PERMITS TRANSFER FROM IHS TO TRIBES

Programs, Services, Functions, Activities

(PSFA)

activities funds

Funds functionallyassociated with PSFA

Tribe’s portion of associated funds

Portions of PSFAs benefiting a Tribe are

transferred to a Contract to carry out or redesign Nati

onal

$ share

s

National

level

By IHS

Area

level Local

level National

level

$Area

level $ Loca

l

level

$

By Tribes

T R A N S F E R *

Area $

share

sLoca

l

program $

* A Tribal choice.

Transferrable Categories of PSFA

Clinical & Preventative Health

Services

Facil-ities

Additional laws also

apply

PFSA: Activities and associated funds are available to contract

Inherent Federal Functions: are not legally contractible and

associated funds are not available (a very small fraction of IHS funds)

Other Categories: additional laws govern

how Tribes participate

Figures are suggestive of the proportions of the IHS budget.

I.H. S

chol

arsh

ips,

Loa

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Dia

bete

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S.D

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Urb

an I.

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Con

trac

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port

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NoNo

Yes Yes

Extent of Self-Determination Contracts – Current and Hypothetically

NOW Inherently Govern-mental

Contracted PSFAPotentially Contractible PSFA

½ IHS Operated

½ Tribal Operated

Contracted PSFAFUTURE

“Residual”

100% Tribal Operated

*Illustration only, bar scale is hypothetical

ISDEAA anticipates that direct Federal spending will decrease commensurately as functions are transferred to

Tribes

Share – portion of funds benefiting each Tribe

A Tribe that contracts for its portion of an IHS PSFA which benefits multiple Tribes is entitled to that portion of funds (. . . the Secretary would have otherwise provided for the operation of the programs or portions thereof . . .) that benefit the Tribe or its members.

PSFA

Tribe A Tribe B Tribe CBenefits multiple tribes

Ways to determine portions of PSFA allocable to multiple Tribes.

Direct Financial Measures: Shares are precisely determined when financial accounts record actual spending for PSFAs for a Tribe, e.g. IHS funds at a local site serving 1 Tribe.

Program Measures: Shares may be calculated in proportion to workloads, services, or patient counts for each Tribe.

Proxy Formula: A proxy formula calculates shares in proportion to indirect measures such as user counts, number of Tribes, or other general distributive factors.

other-wise

other-wise

1

2

3

Total of 3 Levels of Shares are Available

IHS-wide (HQ) Shares

Portion benefiting each Tribe

Area Level SharesPortion benefiting each Tribe

Local Level SharesPortion benefiting each Tribe

PSFA and associated funds are available from all 3 levels of the IHS. Location and dispersion does not affect amounts available for contract.

+

+

“Transferred” for a Contract to Carry Out“Retained” for IHS to Carry Out

A

CB

.

.

.

X

ZY

PSFA Associated

Shares

Trans-ferred

Retained

Shares retained for other Tribes

Tribe elects to contract A, B,

C

Leaves X, Y, Z for IHS to

perform

Associated funds are transferred to the contract

Associated funds are retained by IHS to perform X, Y, Z

XYZ

ABC

$

$

Terminology

Example of a Direct Financial Measure:1 IHS Site Serving only 1 Tribe

100% of the Site Budget is Available to that Tribe

Shares ($) for

the Tribe

Budget of the Local IHS Site to

be contracted

When financial accounts record IHS expenditures for a program serving only 1 Tribe, the process to identify that Tribe’s shares is straightforward. The entire amount may be labeled “shares” and 100% are available when the Tribe contracts the program.

Only 1 Tribe is served there

=

Example of a Program Measure Formula: CHS Fiscal Intermediary PSFA (IHS-wide)

Average Cost Per Claim

($ / #)

Shares ($) for

the Tribe

FI Fee Contract Amount $

The FI processes claims for IHS operated CHS programs. The FI is paid a fee per claim processed. A tribe can contract for this function. Shares associated with the CHS FI are proportional to the claims workload.

Total # Claims Processed by

the FI

# Claims for the

particular Tribe

x =

Example of a proxy formulaTribal Size Adjustment (for most HQ PSFA)

92% of TSA $ is calculated per user for

all tribes

8% if < 2,500 users

TSA Formula

+

Aggregate funds for ~ 50 HQ

PSFAPortions

for all tribes

Most HQ PSFA collectively benefit more than 560 tribes. The TSA calculates a $ benefit for all tribes in proportion to tribal user counts.

• 92% of the total funds associated with HQ PSFA are calculated on a per user basis (applies to every tribe)

• 8% of the total funds are identified for small tribes of less than 2,500 users and are calculated on a sliding scale that diminishes approaching 2,500 users

Timing and Protections

Shares are determined at the point in time when the PSFA is initially contracted.

The amount is recurring thereafter.

Subsequent negotiations occur before annual

appropriations are known. Shares are ESTIMATED then

adjusted when the appropriation is enacted.

Recurring shares for contracted PSFA are

protected from reductions except for limited reasons

stated in ISDEEA law.

Congress anticipated that IHS would downsize,

redesign, and reconfigure as PSFA and funds are

transferred.

When IHS reconfigures retained PSFA, shares may be reconfigured too. HQ

has protected shares despite reconfigurations

and will continue this practice if practical.

Funds maybe added to a contract for special projects or limited time periods but

are not recurring.

A few special circumstances

Consortia – shares associated with individual tribes maybe consolidated for ISDEAA agreements

Delegation to another Tribe – a tribe may direct it’s shares to another Tribe to carry out the PSFA for its members (some examples in Oklahoma)

Grandfathered shares – a few unique agreements were implemented early in the 1990’s especially in pilot projects before self-governance became permanent. Some of the arrangements were grandfathered.

Shares Tables for 3 Levels

2) Area Level Tables

NEWAPPROPRIATION

HQ BudgetAREA Budgets

HQ PFSA & $

HQ SHARES

Breakout of HQ PSFA and funds.

Table #1

Table #3

Shows any CHANGES to entire IHS appropriation

Splits Appropriation into parts managed by HQ and Areas

Exists for each individual tribe and shows the portion of $ available to it.

Table #4

Area Budget

Area PSFA & $Table #2

3) National Level Tables

Local Budgets

Local PSFA & $

Local Shares

1) Local Level Tables

Area Shares

Format and content of Area and Local level tables will vary, but will generally cover the topics listed above.

HQ

Tra

cked

$

Overview of Tables for HQ

Table 1 -Entire IHS

Appropriation

Table 3 – HQ Budget Breakout by PSFA

Table 2 -Split into HQ

and Area Tracked Budgets

Table 4 -Portion

Available to a Tribe

Entire Appropriation

Tracked by HQ

Table 1 -IHS Appropriation

Major IHS Accounts

Changes made by Congress

Final IHS Budget

Table 2 – HQ and Area Budget Split

Total Amounts tracked on Area or Local Tables

Amounts tracked on HQ Tables

Table 3 – HQ PSFA Breakout

PSFA

Available for Shares

Unavailable for Shares

Table 4 – Shares Available to a Tribe

Tribe’s Portion of each

PSFA

Portion available

in contract year 1 or

2 if applicable

Final points about HQ Tables

PSFA relate to functional categories – HQ PSFA tables do NOT correspond closely with the HQ organizational structure or staffing. HQ staff contribute to many different PSFA and staffing is managed in aggregate.

Protected Shares – although the organizational structure has changed several times and staff and work evolves for changing circumstances and needs, shares for every tribe are protected – regardless of HQ internal realignments.

Office of Finance and Accounting – responsible for HQ tables. Other HQ Offices – responsible for carrying out the PSFA and

descriptions in the PSFA manual.

END

Activities and Funds Available to Tribes