ACTIVITY/MECHANISM BUDGET SUMMARY

Department Of Health and Human Services

Indian Health Service -- 75-0390-0-1-551

**URBAN INDIAN HEALTH PROGRAM**

[Program Authorization]{.underline}: Program authorized by Title V, P.L.
94-437, Indian Health Care Improvement Act, as amended.

 

+-------------+-------------+-------------+-------------+-------------+
|             | 2002        | 2003        | 2004        | Increase    |
|             |             |             |             |             |
|             | Actual      | President's | Estimate    | or Decrease |
|             |             |             |             |             |
|             |             | Budget      |             |             |
+-------------+-------------+-------------+-------------+-------------+
| BA          | \           | \           | \           | +\$40,000   |
|             | $30,947,000 | $31,528,000 | $31,568,000 |             |
+-------------+-------------+-------------+-------------+-------------+
| FTE         | 6           | 6           | 6           | 0           |
+-------------+-------------+-------------+-------------+-------------+

[Program Output Data]{.underline}

  -------------------------- ----------- ---------- ----------- ------------
  **Services Provided**      **FY 2002** **FY       **FY 2004** **Change**
                                         2003**                 

  Medical                    265,000     265,000    250,160     -14,840

  Dental                     69,000      69,000     65,136      -3,864

  Outreach/Community         221,000     221,000    208,624     -12,376
  Services                                                      

  Other                      186,000     186,000    175,584     -10,416

  TOTAL                      741,000     741,000    699,504     -41,496
  -------------------------- ----------- ---------- ----------- ------------

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

The 2000 census data indicate that over 57% of American Indians and
Alaska Natives now reside in urban areas. This reflects a shift from the
1990 census data, which indicated that 739,108 or 37.7 percent of the
total U.S. Indian population lived in Indian areas, and that 1,220,126
or 62.3 percent lived in non-Indian areas. Indian areas include
reservations, off-reservation trust lands, Alaska Native Regional
Corporations, Alaska Native Village statistical areas.

It should be noted that about 36 percent of the IHS service area
population resides in non-Indian areas, since the IHS service area
includes the "on or near" reservation counties that comprise the
contract health service delivery areas. Typically, these clients have
less accessibility to hospitals, health clinics, or contract health
services administered by the IHS and tribal health programs.

Studies on the urban AI/AN population documented poor health and
revealed limited health care options for most families. Since 1972, the
IHS has gradually increased its support for health related activities in
off-reservation settings aimed at assisting AI/A populations to gain
access to available health services, and also to develop direct health
services when necessary.

In the 1992 amendments to the Indian Health Care Improvement Act, the
Congress specifically declared the policy of the Nation "in fulfillment
of its special responsibilities and legal obligations to the American
Indian people to assure the highest possible health status for Indians
and urban Indians and to provide all resources necessary to affect that
policy." The IHS addresses this responsibility by funding 34 urban
Indian health organizations operating at 41 sites located in cities
throughout the United States. Primary care clinics and outreach programs
provide culturally acceptable, accessible, affordable, accountable, and
available health services to an underserved urban off-reservation
population. Approximately 605,000 American Indians are eligible to use
Title V Urban Indian health programs.

The IHS Urban programs are 501(3)(c) non-profit organizations operated,
in part, through \$21,268,479 in contracts and \$8,159,532 in grants
funded under Title V of the Indian Health Care Improvement Act and are
included in the FY 2004 Mandatory (or Discretionary) State/Formula
Grants Table.

The 34 programs engage in a variety of activities, ranging from the
provision of outreach and referral services to the delivery of
comprehensive ambulatory health care. Services currently include medical
services, dental services, community services, alcohol and drug abuse
prevention, education and treatment, AIDS and sexually transmitted
disease education and prevention services, mental health services,
nutrition education and counseling services, pharmacy services, health
education, optometry services, social services, and home health care.
Fifteen of the programs are designated as Federally Qualified Health
Centers (FQHC) and provide services to Indians and non-Indians.

**[Ambulatory medical care services]{.underline}** are provided
throughout the off-reservation Indian health programs, including:
pre-natal and postpartum care; women\'s health; immunizations for both
children and adults; pediatrics; chronic disease (geriatric health and
diabetes) clinics; adult health; maintenance; acute medical care,
infectious disease treatment and control (tuberculosis, sexually
transmitted disease); and referral to specialized providers when needed.
Many programs provide dental care services. The services include
preventive and restorative direct patient care, dental education and
screening for both children and adults and are provided in both the
clinic and community settings. When needed, referrals are made to
specialists for orthodontics, periodontics, selected restorative
procedures, and oral surgery.

**[Community outreach services]{.underline}** are provided throughout
the urban (off-reservation) health programs, including: patient and
community education; patient advocacy; outreach and referral; and
transportation. The outreach worker serves an important function as a
liaison between the off-reservation health program and the community,
and works to make health services more available and accessible to those
community members who need them.

**[Alcohol and substance abuse prevention, education, treatment, and
rehabilitation services]{.underline}** are provided through program and
community based services. Included as prevention and education programs
are as follows: community education conferences, seminars, and workshops
targeting adolescents; identification of high-risk clients in the clinic
and community; and appropriate referral for those at risk. Included in
the treatment and rehabilitation programs are assessments for alcohol
and drug abuse, appropriate intervention, outpatient and treatment
programs, and aftercare and follow-up services.

**[Alcohol treatment services]{.underline}** are provided at 10
off-reservation Indian sites originally funded by the National Institute
of Alcohol Abuse and Alcoholism (NIAAA). Funds were transferred into the
Urban Indian Health Program in FY 1993 to continue these urban treatment
centers under Title V of the Indian Health Care Improvement Act. The
NIAAA programs, established within urban sites, are in the final stages
of being transferred.

The **[AIDS and sexually transmitted disease (STD)
information]{.underline}** is provided at conferences, seminars,
workshops, and community meetings at all of the IHS Title V funded
off-reservation Indian health programs. These education and prevention
services include culturally sensitive information provided to a variety
of audiences through the use of posters, pamphlets, presentations, and
community education. Additional AIDS services include HIV testing, pre
and post-test counseling, family support groups, and referral for
additional treatment if needed.

**[Mental health and social services]{.underline}** include individual
family and group counseling and support groups to address the problems
of abuse, self-esteem, depression, and other emotional problems and
conditions.

Additional services available at various off-reservation Indian health
programs include, primary and secondary prevention activities, i.e.,
diabetes, maternal and child health, women\'s health, men\'s health,
nutrition education, counseling for prenatal care, chronic health
conditions, social services, community health nursing, home health care,
and other health promotion and disease prevention activities.

The program output data for FY 2004 reflects a decrease in services due
to medical inflation and population growth.

**[ACCOMPLISHMENTS]{.underline}**

Some of the accomplishments of the urban Indian health program (UIHP)
include: continued substantial programmatic involvement with the
national urban Indian health organization through a cooperative
agreement, continued participation in the IHS budget formulation
process, participation in the reauthorization of the Indian Health Care
Improvement Act (P.L. 94-437), facilitation of urban Indian health
program board of director training, and planning for urban information
technology and data collection.

The national urban Indian organization is the National Council of Urban
Indian Health (NCUIH). The Council focuses on its\' policy concerns and
communications among the nation's urban Indian health programs.

The urban Indian health program was involved in and participated in the
FY 2003 and FY 2004 budget formulation processes. The purpose is to
formulate a budget that reflects the priorities of the Indian Health
Service, Tribal health programs and urban Indian health programs.

The urban Indian health program provided board of director training to
urban Indian health programs throughout the nation. The training
addresses the roles and responsibilities of a board of directors, as
well as its relationship to its executive directors.

With the assistance of the IHS Information Technology Support Center
Self-Determination staff, the UIHP defined program requirements of a
diabetes specific data mart pilot project that would provide a user
friendly, web-based application to (1) support locally exported IHS
Resource and Patient Management System (RPMS) and Patient Care Component
(PCC) data; and (2) begin making PCC clinical data available to urban
programs. The system was designed, developed and hosted by the Indian
Health Performance Evaluation System (IHPES). All defined requirements
of Phase I of the pilot project were met or exceeded and included six
(6) urban programs. Those sites now have access to a web-based reporting
system to assist in monitoring and tracking currently exported PCC data
and they have access to a menu driven "point and click" series of
reports to assist in better managing health services provided for
Diabetes related care.

As a result of the "data quality" tools available in the application, it
is evident that supplemental RPMS training will be required to ensure
PCC data is accurately documented, coded and exported to the national
programs for use in other performance measurements (GPRA) or resource
allocation applications. An Urban Indian Health Program data workgroup
is currently defining the best approach to providing data quality
training.

**[PERFORMANCE PLAN]{.underline}**

The Urban Health budget contributes to the following Government
Performance and Results Act performance indicator:

[Indicator 19]{.underline}: During FY 2004, reduce the number of I/T/U
sites that are lacking mutually compatible automated information systems
that allow for the capture of health status and patient care data by 3%
over the FY 2003 level.

Funding for the Urban Indian Health Program during the last five years
has been as follows:

  ------------------------ ------------------------------ -----------------------
  **[Year]{.underline}**   **[Funding]{.underline}**      **[FTE]{.underline}**

  1999                     26,382,000                     4

  2000                     27,813,000                     5

  2001                     29,843,000                     5

  2002                     30,947,000                     6

  2003                     31,528,000                     6
  ------------------------ ------------------------------ -----------------------

####### RATIONALE FOR BUDGET REQUEST

**[TOTAL REQUEST]{.underline}** \-- The request of \$31,568,000 and 6
FTE is an increase of \$40,000 over the FY 2003 request of \$31,528,000
and 6 FTE. The increase includes the following:

#### Pay Cost Increases: +\$486,000

The request of \$486,000 will fund urban program pay costs which will
assist the IHS in maintaining access to services for the IHS patient
population. Maintaining the current I/T/U health system is necessary in
eliminating disparities in health status between the American Indian and
Alaska Native population and the rest of the U.S.

[Management Savings: -\$446,000]{.underline}

HHS\'s FY 2004 budget supports the President\'s Management Agenda and
includes cost savings from consolidating administrative functions,
organizational delayering to speed decision making processes,
competitive sourcing, implementation of effective workforce planning and
human capital management strategies, and adoption of other economies and
efficiencies in administrative operations.

The savings will come from IHS, Tribal and Urban programs. The IHS
programs will absorb their share through the elimination of 195 FTEs.
Every effort will be made to minimize the impact at the service delivery
level of the organization, however, some impact on programs and services
may occur.

The agency will also judiciously control and reduce costs associated
with administrative travel, overtime, copying, and the purchase of
administrative equipment and supplies, while carefully controlling
training costs and promoting distance learning and training at the local
level whenever applicable.