> ACTIVITY/MECHANISM BUDGET SUMMARY

Department of Health and Human Services

Indian Health Facilities -- 75-0391-0-1-551

#### Facilities and Environmental Health Support

[Program Authorization]{.underline}: Program authorized by U.S.C. 13,
Snyder Act, and P.L. 83-568 Transfer Act, 42 U.S.C. 2001.

+-------------+-------------+-------------+-------------+-------------+
|             | 2002        | 2003        | 2004        | Increase    |
|             |             |             |             |             |
|             | Actual      | President's | Estimate    | or Decrease |
|             |             |             |             |             |
|             |             | Budget      |             |             |
+-------------+-------------+-------------+-------------+-------------+
| BA          | \$          | \$          | \$          | +           |
|             | 126,775,000 | 132,963,000 | 139,522,000 | \$6,559,000 |
+-------------+-------------+-------------+-------------+-------------+
| FTE         | 1,095       | 1,113       | 1,141       | +28         |
+-------------+-------------+-------------+-------------+-------------+

**[PURPOSE AND METHOD OF OPERATION]{.underline}**

The Indian Health Facilities programs, managed at Indian Health Service
(IHS) Headquarters by the Office of Environmental Health and Engineering
(OEHE) and carried out by Area, field, and service unit staff, provide
an extensive array of real property, health care facilities and staff
quarters construction, maintenance, and operation services, as well as
community and institutional environmental health, injury prevention, and
sanitation facilities construction services. Services are delivered
directly by Federal or Tribal employees or by tribal contractors. In
addition to staffing costs, funds appropriated for this activity are
used to pay for utilities in IHS health care facilities, certain
non-medical supplies and personal property, and biomedical equipment
repair. This umbrella account is further managed and distributed through
three categories: facilities support, environmental health support, and
office of environmental health and engineering support. Currently, costs
for permanent positions that constitute the Federal portion of this
program are paid from this account. Costs for approximately 195
additional temporary and permanent sanitation facilities construction
support personnel are paid from specific sanitation facilities project
accounts. Also costs for positions in tribally contracted environmental
health activities are included among the permanent positions paid from
this account. Costs for health care facilities/staff quarters operation
and maintenance personnel are paid from this account or from
reimbursements.

**The OEHE Headquarters staff** includes components in Rockville,
Dallas, and Seattle. The staff has management responsibility for IHS
facilities and environmental health programs, provides direct technical
services and support to Area personnel, and performs critical management
functions. Headquarters OEHE management activities include national
policy development and implementation; budget formulation; project
review and approval; congressional report preparation; quality assurance
(internal control reviews, Federal Managers Financial Integrity Act
activities, and other oversight); technical assistance (consultation and
training for both tribal and IHS personnel); long-range planning;
meetings (with Members of Congress and their representatives, with
tribes, and with other Federal agencies); realty services; and
recruitment and retention. Also, OEHE Engineering Services staff located
in Dallas, Texas and Seattle, Washington provide architectural,
engineering, construction, contracting, and real property services to
IHS and tribal health care facilities programs.

There are counterparts of most facilities and environmental health
organizational elements in each IHS Area Office. **Staff of facilities
and environmental health related programs in IHS Area Offices** vary in
size depending on program scope; the number and size of IHS facilities
served; the number, size, and complexity of construction projects; the
number and location of Indian communities served; transportation
considerations; and the method of providing technical services within
the Area. Area facilities and environmental health personnel include
architects, engineers, sanitarians, real property and staff quarters
management specialists, biomedical technicians, facilities planners,
injury prevention specialists, construction inspectors, utility
operations consultants, draftspersons, and land surveyors.

**Area personnel** perform local management functions while devoting a
predominance of time and effort to providing direct support to service
unit, district office, and tribal contracted personnel. Typical of
direct support functions are services performed by Area-based technical
experts who visit IHS facilities and Indian communities to make
institutional (hospital, school, restaurant, water supply) inspections,
complete sanitation facilities construction survey work, train
water/wastewater treatment plant operators or hospital maintenance
personnel, survey real property including IHS staff quarters, perform
epidemiological studies of injury occurrences, provide onsite
construction inspection services, troubleshoot mechanical/electrical
problems in IHS facilities.

The **management functions** performed by IHS Area personnel parallel
those performed by Headquarters but are focused on Area and service unit
needs and, therefore, are less broad in scope. They include Area policy
development and implementation, quality assurance in Area/service unit
operations (oversight), technical assistance (consultation and
training), long-range planning, recruitment, and retention.

**District Offices** are opened when professional/technical services are
needed at two or more IHS health care facilities or sanitation
facilities construction projects, which are not large enough to
individually merit full-time staff coverage, when the Area Office is too
distant, or when the size of the service area is too large to provide
suitable services, oversight, or technical assistance from the Area
Office. Currently, IHS has approximately 30 such offices staffed by
engineers, sanitarians, construction inspectors, land surveyors,
environmental health and construction technicians, and support
personnel. All provide direct program support services.

Funding levels for the last 5 fiscal years follows:

+--------------+-------------------+----------+------------------------+
| [Year]       | [Fun              | #####    |                        |
| {.underline} | ding]{.underline} | #### FTE |                        |
+--------------+-------------------+----------+------------------------+
| 1999         | \$107,682,000     | 1,192    | President's Budget     |
|              |                   |          |                        |
| 2000         | \$116,282,000     | 1,178    |                        |
|              |                   |          |                        |
| 2001         | \$121,336,000     | 1,037    |                        |
|              |                   |          |                        |
| 2002         | \$126,775,000     | 1,073    |                        |
|              |                   |          |                        |
| 2003         | \$132,963,000     | 1,113    |                        |
+--------------+-------------------+----------+------------------------+

Facilities and Environmental Health Support is divided into three
program sub-activities (facilities support, environmental health
support, and office of environmental health and engineering (OEHE)
support).

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**[TOTAL REQUEST]{.underline}** -- The request of \$139,522,000 and
1,141 FTE is an increase of \$6,559,000 and 28 FTE over the FY 2003
President\'s Budget of \$132,963,000 and 1,113 FTE. The increases
include the following:

#### 

#### [Pay Costs: +\$2,830,000]{.underline}

The request of \$2,830,000 would fund pay cost increases for
Federal/Tribal/Urban.

The IHS continues to strive to increase access for the IHS patient
population. Maintaining the current I/T/U health system is necessary in
eliminating disparities in health status between American Indians and
Alaska Natives and the rest of the U.S. population.

#### [Phasing-In of Staff for New Facilities: +\$3,729,000 and 28 FTE]{.underline}

The request of \$3,729,000 and 28 FTE provides for the phasing-in of
staff and related costs for new facilities allowing IHS to expand
services in areas where existing capacity is most overextended. The
staffing of new facilities also contributes to the recruitment and
retention of medical staff and promotes self-determination activities.
The following table displays the requested increase.

+---------------------------------------+---------------------+--------+
| **[Facilities]{.underline}:**         | **[Dol              | **[    |
|                                       | lars]{.underline}** | FTE]{. |
|                                       |                     | underl |
|                                       |                     | ine}** |
+---------------------------------------+---------------------+--------+
| Ft. Defiance, AZ Hospital             | +\$1,567,000        | +13    |
|                                       |                     |        |
| Winnebago, NE Hospital                | 1,187,000           | 7      |
|                                       |                     |        |
| Pawnee, OK Health Center              | [9                  | [8]    |
|                                       | 75,000]{.underline} | {.unde |
| Total                                 |                     | rline} |
|                                       | +\$3,729,000        |        |
|                                       |                     | +28    |
+---------------------------------------+---------------------+--------+

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