**ACTIVITY / MECHANISM BUDGET SUMMARY**

**Department of Health and Human Services**

**Indian Health Services -- 75-0390-0-1-551**

**DIRECT OPERATION**

Program Authorization: Program authorized by U.S.C. 13, Snyder Act, and
P.L. 83-568, Transfer Acts, 42 U.S.C. 2001.

(In Dollars)

+------------------+------------+------------+------------+----------+
|                  | FY 2003    | FY 2004    | FY 2005    | Increase |
|                  |            |            |            |          |
|                  | Actual     | Enacted    | Estimate   | or       |
|                  |            |            |            | Decrease |
+------------------+------------+------------+------------+----------+
| BA               | \$         | \$         | \$         | +\$1     |
|                  | 60,176,000 | 60,714,000 | 61,795,000 | ,081,000 |
+------------------+------------+------------+------------+----------+
| FTE              | 374        | 414        | 414        | 0        |
+------------------+------------+------------+------------+----------+

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

The Indian Health Service **Headquarters provides leadership, oversight,
and executive direction to 12 regional offices** to ensure that
comprehensive health care services are provided to approximately
1.6 million American Indians and Alaska Natives. In addition,
Headquarters **actively administers the Agency's accomplishment of the
President's Management Agenda and HHS Secretarial priorities and
initiatives**, while simultaneously maintaining the special
Tribal-Federal relationship based in treaty and law.

[Headquarters]{.underline} \-- The Headquarters operations are
determined by statute and administrative requirements set forth by the
Department of Health and Human Services, the Administration, the
Congress, and field operations (12 Area Offices, and 155 Service Units
according to FY 2001 data report). Headquarters actively works with the
Department to formulate and implement national health care priorities,
goals, and objectives. The agency works with the Department to formulate
a budget and necessary legislation. In addition, it responds to
congressional inquiries, and interacts with other governmental entities
to enhance and support health services for Indian people. The
Headquarters also formulates policy and distributes resources, provides
general program direction and oversight for IHS Areas and Service Units,
provides technical expertise to all components of the Indian health
system (I/T/U), maintains national statistics, identifies trends and
projects future needs.

[Area Offices]{.underline} \-- The 12 Area Offices distribute resources,
monitor and evaluate the full range of comprehensive health care and
community oriented public health programs and provide technical support
to IHS direct and tribally operated programs. They ensure the delivery
of quality health care through the155 Service Units and participate in
the development and demonstration of alternative means and techniques of
health services management and delivery to promote the optimal provision
of health services to Indian people through the I/T/U.

The Direct Operations' funding is discretionary and it funds
Headquarters and 12 Area Offices operations across the country. In FY
2005, it is estimated the operating budget will continue the spending
trend as shown below. In FY 2003, the operating budget of Headquarters
was about 43% of the total with 429 FTE and 12 Area Offices about 57%
with a combined FTE of 1,198. Included in the operating budget are
Tribal shares for Title I contracts and Title V compacts.

  -------------- -------------------- ------------------ ------------------ ------------------
                                      (in dollars)                          

                                      FY 2003            FY 2004            FY 2005

                                      Actual             Conference (Net)   Estimate

  Headquarters                        \$25,875,680       \$26,107,020       \$26,571,850
  (43%)                                                                     

                 *Title I Contracts*  *1,743,238*        *1,786,819*        *1,813,621*

                 *Title V Compacts*   *4,853,279*        *4,974,611*        *5,049,230*

  Area Offices                        34,300,320         34,606,980         35,223,150
  (12) (57%)                                                                

                 *Title I Contracts*  *1,731,221*        *1,774,502*        *1,801,119*

                 *Title V Compacts*   *6,717,480*        *6,885,417*        *6,988,698*

  **BA**                              **\$60,176,000**   **\$60,714,000**   **\$61,795,000**

                                                                            

  **FTE**                             374                414                414

                 *Headquarters*       *212*              *252*              *252*

                 *Area Offices (12)*  *162*              *162*              *162*
  -------------- -------------------- ------------------ ------------------ ------------------

In addition to providing management and administrative direction and
oversight, in FY 2005 Headquarters will continue frontline work on many
management and administrative priorities and initiatives.

The Headquarters will continue to develop and expand its crosscutting
collaborations and partnership with other Federal agencies and outside
organizations to achieve common goals and objectives addressing health
disparities of American Indian and Alaska Natives. The magnitude of
health disparities and resources needed require crosscutting network, as
well as challenges in meeting some GPRA performance measurements, such
as (a) linking performance measurements to the budget and eventually to
cost, and (b) Human Resources development, work life improvements, and
recruitment and retention. Also, (c) the development and refinement of
Information Technology Planning, Capital Planning, and Program
Evaluation will continue as important challenges, as the environment
changes in response to tribal contracting and compacting, changes in
technology, and health care in the U.S. And, without significant funding
increase for program functions, these measures could be delayed or not
met.

**[ACCOMPLISHMENTS]{.underline}**

**Performance Plan FY 2005** \-- The IHS FY 2005 Performance Plan
complies with the requirements of the GPRA and defines the Agency's
concerted effort in response to the President's Management Agenda, the
One Department initiative of the Secretary of Health and Human Services
(HHS), and the *HealthyPeople 2010* goals of achieving equivalent and
improved health status for all Americans over the next decade. The
long-term projected outcome of the FY 2005 Performance Plan has been
enhanced (in FY 2003) to incorporate revisions to the IHS Strategic Plan
and the new HHS Strategic Plan. For example, a roadmap table was
developed that shows individual GPRA annual performance measures linked
to specific long-term health outcome goals developed for the IHS
Strategic Plan. The IHS and its stakeholders have always considered the
GPRA and its requirements as a natural extension of the public health
model the Agency has used effectively for almost a half century to make
significant improvements in the health status of Indian people.

**Health Promotion / Disease Prevention** -- In November 2002, the IHS
has launched the Director's Health Promotion/Disease Prevention (HP/DP)
Initiative linking to the President's HealthierUS and the Secretary's
Steps to a HealthierUS. In partnership with other Federal agencies and
non-Federal organization (e.g., Boys and Girls Clubs of America), the
IHS and the Tribes are taking actions to lessen the significant
disparities in the health status of AI/AN people. Expansion of
organizational and community capacity and expertise for health promotion
will occur through training, guidelines and best practices
dissemination, and support for community and clinic level interventions.
In addition, a model for ongoing community health assessment is being
developed and disseminated. A Prevention Task Force of community
providers has developed a best practices compendium for program
development and a policy advisory group made up of Tribal leaders,
Federal policymakers, and private sector leaders (e.g., CEO's from
private businesses with international scope) provides the agency with
high level counsel to target capacity building.

##### PERFORMANCE PLAN

The Direct Operations budget contributes to the performance indicators
that are included in the IHS FY 2005 Annual Performance Plan. The
indicators address some of the administrative aspects of providing
health care to American Indian and Alaska Native population.

Following are the funding levels for the last 5 fiscal years:

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

FY 2000 \$50,988,000 1,629

FY 2001 \$52,946,000 1,491

FY 2002 \$54,819,000 384

FY 2003 \$60,176,000 374

FY 2004 \$60,714,000 414

##### RATIONALE FOR THE BUDGET REQUEST

**[TOTAL REQUEST]{.underline}** \-- The request of \$61,795,000 is an
increase of \$1,081,000 and zero FTE over the FY 2004 Enacted level of
\$60,714,000 and 414 FTE.

#### Pay Cost Increases: +\$1,081,000

The request of \$1,081,000 will fund pay cost increases for federal and
tribal/urban staff.

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.