ACTIVITY/MECHANISM BUDGET SUMMARY

Department of Health and Human Services

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

#### Health Care Facilities Construction

[Program Authorization]{.underline}: Program authorized by U.S.C. 13
Snyder Act, P.L. 83-568, Transfer Act, 42 U.S.C. 2001, P.L. 94-437,
Indian Health Care Improvement Act, as amended, P.L. 99-570, Omnibus
Drug Bill.

+------------------+-----------+-------------+-------------+----------+
|                  | **FY      | **FY 2003** | **FY 2004** | **In     |
|                  | 2002**    |             |             | crease** |
|                  |           | **Pr        | *           |          |
|                  | *         | esident's** | *Estimate** | **or     |
|                  | *Actua**l |             |             | De       |
|                  |           | **Budget**  |             | crease** |
+------------------+-----------+-------------+-------------+----------+
| BA               | \$8       | \           | \           | -\$      |
|                  | 6,260,000 | $72,000,000 | $69,947,000 | 2        |
|                  |           |             |             | ,053,000 |
+------------------+-----------+-------------+-------------+----------+
| **Inpatient      |           |             |             |          |
| (Hospitals):**   |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| Ft. Defiance, AZ | \$2       | \           | \$ 0        | N/A      |
|                  | 7,827,000 | $20,400,000 |             |          |
+------------------+-----------+-------------+-------------+----------+
| Winnebago, NE    | 1         | 8,241,000   | 0           | N/A      |
|                  | 5,000,000 |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| **Total          | **\$42,   | **\$2       | \$ 0        | -\$28    |
| Inpatient**      | 827,000** | 8,641,000** |             | ,641,000 |
+------------------+-----------+-------------+-------------+----------+
| **Outpatient     |           |             |             |          |
| (Health          |           |             |             |          |
| Centers):**      |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| Piñon, AZ        | \$        | \           | \           | N/A      |
|                  | 2,600,000 | $13,900,000 | $21,573,000 |          |
+------------------+-----------+-------------+-------------+----------+
| Red Mesa, AZ     | 5,000,000 | 7,653,000   | 30,000,000  | N/A      |
+------------------+-----------+-------------+-------------+----------+
| Pawnee, OK       | 5,000,000 | 10,639,000  | 0           | N/A      |
+------------------+-----------+-------------+-------------+----------+
| St. Paul, AK     | 2,100,000 | 11,167,000  | 0           | N/A      |
+------------------+-----------+-------------+-------------+----------+
| Metlakatla, AK   | 3,400,000 | 0           | 14,511,000  | N/A      |
+------------------+-----------+-------------+-------------+----------+
| Sisseton, SD     | 2,333,000 | 0           | 3,863,000   | N/A      |
+------------------+-----------+-------------+-------------+----------+
| **Total          | **\$20,   | **\$4       | **\$6       | +\$26    |
| Outpatient**     | 433,000** | 3,359,000** | 9,947,000** | ,588,000 |
+------------------+-----------+-------------+-------------+----------+
| **Staff          |           |             |             |          |
| Quarters:**      |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| Bethel, AK       | \$        | \$ 0        | \$ 0        | N/A      |
|                  | 5,000,000 |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| Zuni, NM         | 2,000,000 | 0           | 0           | N/A      |
+------------------+-----------+-------------+-------------+----------+
| **Total Staff    | **\$      | **\$ 0**    | \$ 0        | \$ 0     |
| Quarters**       | 7,        |             |             |          |
|                  | 000,000** |             |             |          |
+------------------+-----------+-------------+-------------+----------+
|                  |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| **Joint Venture  | \$        | \$ 0        | \$ 0        | \$ 0     |
| Const.**         | 5,000,000 |             |             |          |
+------------------+-----------+-------------+-------------+----------+
|                  |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| **Small Amb.     | \$1       | \$ 0        | \$ 0        | \$ 0     |
| Program**        | 0,000,000 |             |             |          |
+------------------+-----------+-------------+-------------+----------+
|                  |           |             |             |          |
+------------------+-----------+-------------+-------------+----------+
| **Dental Units** | \$        | \$ 0        | \$ 0        | \$ 0     |
|                  | 1,000,000 |             |             |          |
+------------------+-----------+-------------+-------------+----------+

The Inpatient and Outpatient health care facilities and Staff Quarters
projects are shown in priority order but they are not prioritized
against other identified activities that are listed. For example, the
Bethel, AK, staff quarters project does not have a higher priority than
the Joint Venture Construction Program projects.

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

The objectives of the Indian Health Service (IHS) Health Care Facilities
Construction Program are to enhance IHS health care delivery capacity by
providing for optimum availability of functional, well-maintained IHS
and tribally operated health care facilities, and to provide staff
housing at IHS health care delivery locations if no suitable housing
alternative is available. The IHS capital improvement program, funded
through this budget activity, is authorized to construct health care
facilities and staff quarters, renovate/construct Youth Regional
Treatment Centers for substance abuse, administer the IHS/Tribal Joint
Venture Construction Program, provide construction funding for tribal
small ambulatory care facilities, replace/provide new dental units, and
to assist non-IHS funded renovation projects.

To determine the locations where new and replacement facilities are most
critically needed, the IHS has developed and is implementing
comprehensive priority system methodologies for health care facilities
and staff quarters construction. As needed, IHS Headquarters solicits
proposals from the IHS Areas for essential staff quarters projects,
replacement/new dental units, and for urgently needed new or replacement
health care facilities. These proposals are evaluated and prioritized.
Formal justification documents are prepared for those scoring highest.
Once justified, projects are placed on the appropriate construction
priority list and proposed for funding.

**[Health Care Facilities Construction Program]{.underline}**

During FY 1990, in consultation with the tribes, the IHS revised its
Health Facilities Construction Priority System (HFCPS) methodology. The
HFCPS ranks proposals using factors reflecting the total amount of space
needed; age and condition of the existing facility, if any; degree of
the isolation of population to be served in the proposed facility; and
availability of alternate health care resources. There are three phases
to the HFCPS. During FY 1991, Phase I of the methodology was applied to
149 IHS Area-generated proposals to construct new or replacement health
care facilities. Based on the Phase I result, the IHS proceeded with
Phase II of the methodology, using a more detailed analysis of the 28
highest ranked proposals. During FY 1992, the IHS consulted with tribes
about incorporating additional flexibility into the HFCPS in order to
give consideration to new concepts, such as low acuity beds in health
centers, as directed by the Congress in the FY 1992 Conference Report on
IHS appropriations. Few tribes urged the IHS to make changes to the
HFCPS. In FY 1993, 23 of the 28 proposals considered in Phase II were
advanced to Phase III. IHS Area Offices were asked to develop Program
Justification Documents (PJDs) for each of the 23 proposed facilities.
As PJDs are approved, projects are added to the Health Facilities
Construction Priority Lists.

The IHS has two processes for reviewing the staff housing needs. Under
the Quarters Construction Priority System methodology, the IHS reviews
the need for additional quarters at all existing health care facilities.
Phases I and II of this methodology were last applied in 1991. As the
Program Justification Document for Quarters (PJDQ) are completed for
these projects, they are added to the Quarters Construction Priority
List. The second process responds to the Department of Health and Human
Service office of the Inspector General report of April 17, 1990,
regarding needed improvements for planning and construction of IHS staff
housing. The IHS began reviewing the need for quarters at each location
where new or replacement health care facilities are being planned.

The IHS is authorized to construct Youth Regional Treatment Centers
(YRTCs) by section 704 of the IHCIA, P.L. 94-437, as amended. A YRTC is
to be constructed in each IHS Area except that two each are to be
constructed in California and Alaska to provide substance abuse
treatment to Indian youth.

For the IHS Joint Venture Construction Program, the Department of the
Interior and Related Agencies Appropriations Act for FY 1991
(P.L. 101-512) authorized and partially funded a "joint venture
demonstration program to equip, supply, operate, and maintain up to
three health centers." These health centers were to be "selected on a
competitive basis from those tribal applicants agreeing to provide an
appropriate facility for use as a health center for a minimum of 20
years, under a no cost lease." The costs of facility construction are
borne by participating tribes. The IHS is responsible for all costs
associated with staffing, equipping, and operating the facilities. This
authority for the current program is Section 818(e) of Public Law
94-437, the Indian Health Care Improvement Act (IHCIA), as amended in
1992.

The IHS is authorized to provide construction funding to tribes or
tribal organizations by section 306 of the IHCIA, P.L. 94-437, as
amended. Funding may be awarded only to tribes operating non-IHS
outpatient facilities under P.L. 93-638 contracts. This authorization is
administered under the IHS Small Ambulatory Program.

Appropriations for IHS in FYs 1994-2002 included funding to replace and
build new dental units.

The IHS is authorized to accept renovations and modernizations of any
Service facility through non-IHS funded sources and to assist by
providing equipment and personnel by section 305 of the IHCIA, P.L.
94-437, as amended.

Funding levels for the last 5 fiscal years follows:

+------------+-----------------------+--------------------------------+
| [Year]{.   | [Funding]{.underline} |                                |
| underline} |                       |                                |
+------------+-----------------------+--------------------------------+
| 1999       | \$41,087,000          | President's Budget             |
|            |                       |                                |
| 2000       | \$50,393,000          |                                |
|            |                       |                                |
| 2001       | \$85,525,000          |                                |
|            |                       |                                |
| 2002       | \$86,260,000          |                                |
|            |                       |                                |
| 2003       | \$72,000,000          |                                |
+------------+-----------------------+--------------------------------+

**[ACCOMPLISHMENTS]{.underline}**

Based on the funding levels available since 1998, \$305,000,000 expended
on construction projects has resulted in a positive impact. Per the
Economic Development Administraion, Department of Commerce criteria,
9,000 new jobs were created into the economy with 4,000 of these jobs
directly involved in the construction of health facilities. Experience
with health facilities construction contracts indicates that
approximately one fourth of the construction labor force is Native
American and approximately 1,300 jobs have been provided to residents of
Indian reservations.

In FY 2002, the following were accomplished. Unless specified otherwise,
the funds cited below are those appropriated in FY 2002.

1.  A portion of \$27,827,000 appropriated for the **Fort Defiance,
    Arizona**, replacement hospital and additional staff quarter's
    project was used to complete construction of the replacement
    hospital portion of the project. The new replacement hospital opened
    for service on August 1, 2002. A design-build contract was awarded
    for the staff quarters portion of the project.

2.  The \$15,000,000 appropriated for the replacement hospital project
    in **Winnebago, Nebraska**, was used to continue construction.

3.  The \$2,600,000 appropriated for the new health center and staff
    quarters project in **Pinon, Arizona**, is being used to commence
    construction of the health center portion of the project.

4.  The \$5,000,000 appropriated for the new health center and staff
    quarters project in **Red Mesa, Arizona**, is being used to commence
    construction of the health center portion of the project.

5.  The \$5,000,000 appropriated for the new health center in **Pawnee,
    Oklahoma**, is being used to continue construction.

6.  The \$2,100,000 appropriated for the new health center and staff
    quarters project in **St. Paul, Alaska**, is available for the start
    of construction of the health center portion of the project, once
    the Alaska Denali Commission completes the health center design.

7.  The \$3,400,000 appropriated for the new health center and staff
    quarters project in **Metlakatla, Alaska**, is being used to
    commence construction of the health center portion of the project.

8.  The \$2,333,000 appropriated for the new health center and staff
    quarters project in **Sisseton, South Dakota**, is being used to
    design the project.

9.  The \$5,000,000 appropriated for the additional staff quarters
    project in **Bethel, Alaska**, is being used to continue the
    design-build of the project.

10. The \$2,000,000 appropriated for the additional staff quarters
    project in **Zuni, New Mexico**, is being used for the first phase
    of the design-build of the project through a P.L. 93-638, Subpart J,
    contract with the Tribe.

11. The \$4,989,000 appropriated in FY 2001 for the IHS **Joint
    Venture** Construction Program (JVCP) has been allocated for the
    equipment procurement for the two tribal projects selected for the
    program. For the Jicarilla Apache Nation Project, a JVCP agreement
    has been executed and project design is underway. Execution of the
    JVCP Agreement for the second selected project with the Tohono
    O'odham Nation is pending the completion of negotiations. The
    \$5,000,000 appropriated for the IHS JVCP in FY 2002 has been
    allocated for two projects to be selected through a competitive
    process which is underway.

12. Awards have been made for all 17 projects selected through a
    competitive process to receive funds under the IHS **Small
    Ambulatory** Program, using the \$9,978,000 appropriated in FY 2001
    and \$10,000,000 appropriated in FY 2002. As authorized by each
    appropriation, P.L. 93-638, Subpart J, contracts were used for the
    award process.

13. The \$1,000,000 appropriated for the **dental units** construction
    program was added to funds previously appropriated and allowed three
    additional dental unit projects in Unalakleet, Alaska; Schurz,
    Nevada; and Toksook Bay, Alaska, to be processed for design and
    construction. Using prior year funding supplemented with tribal
    funding, four dental unit projects were completed and placed into
    service in Emmonak, Alaska; Sisseton, South Dakota; Eagle Butte,
    South Dakota; and White Swan, Washington.

14. Using funding provided in FY 2001, the construction of the health
    center in **Parker, Arizona**, was completed by the Colorado River
    Indian Tribes under a P.L. 93-638, Subpart J, contract, and was
    opened for service in November 2001.

##### [PERFORMANCE MEASURES]{.underline}

The Health Care Facilities Construction budget contributes to the
performance indicators that are included in the IHS FY 2004 Annual
Performance Plan. These indicators address some of the administrative
aspects of providing health care to the American Indian and Alaska
Native population. At the FY 2004 funding level, IHS could achieve the
following:

[Indicator 37]{.underline}: During FY 2004, increase the modern health
care delivery system to improve access and efficiency of health care by
construction of the following health care facilities:

[Outpatient]{.underline}:

Pinon, AZ -- continue construction of a new health center, including
supporting staff quarters.

Red Mesa, AZ -- continue construction of a new health center, including
supporting staff quarters.

Metlakatla, AK -- continue construction of replacement tribal health
center, including supporting staff quarters.

Sisseton, SD -- complete design and begin construction of a replacement
health center, including supporting staff quarters.

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

**[TOTAL REQUEST]{.underline}** \-- The FY 2004 request of \$69,947,000
is a decrease of \$2,053,000 under the FY 2003 President\'s Budget of
\$72,000,000. The request includes the following:

**[Pinon Health Center, Pinon, AZ: +\$21,573,000]{.underline}**

Funds in this request will be used to complete construction of the new
health center and supporting staff quarters in Pinon, Arizona.

The proposed new IHS health center will provide a full range of
ambulatory care, as well as, comprehensive community health programs,
which will address the curative and preventive health concerns for this
region. This project includes 62 units of staff quarters to provide
adequate housing for non-local staff at this remote location.

The IHS currently provides limited basic medical services from a health
station that was built in 1959 in Pinon, Arizona. The current program
does not support the needs of the service population with the nearest
IHS health care facility located over 75 kilometers from the center of
Pinon, The functional inadequacies of the existing building and site
constraints preclude expansion at the existing site.

**[Red Mesa Health Center, Red Mesa, AZ: +\$30,000,000]{.underline}**

Funds in this request will be used to continue construction of the new
health center in Red Mesa, Arizona.

The proposed new IHS health center will provide space to support a
modern and adequately staffed health care delivery program, which will
improve access to the medical services needed to maintain and promote
the health status and overall quality of life for the residents of the
service area. The new health center will include a 24-hour emergency
room and a six-bed short stay nursing unit, and will provide a full
range of ambulatory care, as well as, comprehensive community health
programs, which will address the curative and preventive health concerns
for this region. By constructing one new health center in the
demographic center of the region, the maximum number of health care
programs can be justified and provided for the user population. The
project includes 89 units of staff quarters to provide adequate housing
for non-local staff at this remote location.

Existing IHS health care services cannot support the needs of the user
population. The proposed new health center will replace the 26-year-old
Teec Nos Pos Health Station and the limited contract health services in
Montezuma Creek, Utah. In addition, the functional inadequacies of
existing facilities and site constraints preclude expansion at the
existing IHS site.

# [Annette Island Health Center and Staff Quarters, Metlakatla, AK: +\$14,511,000]{.underline}

Funds in this request will be used to complete construction of the
replacement tribal health center and the design and construction of the
supporting staff quarters in Metlakatla, Alaska.

The proposed health care facility will provide laboratory, radiology,
emergency and urgent care, ambulatory, community health, community
health nursing, public health nursing, social, health education,
environmental health, dental, pharmacy, and physical therapy services
for the service population. The staffing will increase from 38 to 69
positions. The new health care facility will provide services for a
projected service population of 1,965, with projected outpatient visits
of 18,895. This project includes eight units of staff quarters to
provide adequate housing for non-local staff at this location.

Existing health care services are being provided in four buildings owned
by the Metlakatla Indian Community, which are a part of a civic center
that contains the City Hall, day care and Head Start facilities, as well
as the community's elementary and high schools. These buildings are
modular structures assembled on site in 1975. These structures are
functionally obsolete and cannot support a modern health care delivery
system for the service population.

**[Sisseton Health Center, Sisseton, SD: +\$3,863,000]{.underline}**

This request will be used to begin construction of the replacement
health center in Sisseton, South Dakota, including supporting staff
quarters.

In the proposed replacement health care facility, direct inpatient and
emergency care services will be discontinued and provided by contract.
The Coteau Des Prairies Hospital is located 13 km from the present IHS
facility. All existing outpatient services will be maintained, and
optometry and physical therapy services will be added. In addition,
space will be provided for certain health programs operated by the
Sisseton-Wahpeton Sioux Tribe, including community health, maternal and
child health, child protection, tribal health administration, and
ambulance service.

Currently, the IHS has 12 buildings at the Sisseton site, plus two units
of staff quarters. The main hospital building, built in 1936, is a
two-story (including basement) masonry structure with a wood frame roof.
The original structure was renovated in 1984, and a temporary, modular
outpatient unit was added in 1986. The existing main building is
functionally inadequate and is configured in a way that it cannot be
remodeled to support the standard health care system required to meet
the needs of the targeted population.

To have sufficient staff housing for the non-local staff authorized for
this project, IHS is in the process of re-evaluating the number of staff
quarters needed to properly house the non-local staff for this facility.

+--------------------------------+--------------+----------------------+
| ## INDIAN HEALTH FACILI        |              |                      |
| TIES CONSTRUCTED SINCE FY 1980 |              |                      |
+--------------------------------+--------------+----------------------+
|                                | **YEAR**     | #### TOTAL \$        |
|                                |              |                      |
|                                | ###  *       | #### [APPRO          |
|                                | *COMPLETED** | PRIATED]{.underline} |
+--------------------------------+--------------+----------------------+
| ### **Hospitals**              |              |                      |
+--------------------------------+--------------+----------------------+
| Bethel, AK                     | 1980         | 34,100,000           |
+--------------------------------+--------------+----------------------+
| Ada, OK                        | 1980         | 14,374,000           |
+--------------------------------+--------------+----------------------+
| Cherokee, NC                   | 1981         | 10,341,000           |
+--------------------------------+--------------+----------------------+
| Red Lake, MN                   | 1981         | 9,566,000            |
+--------------------------------+--------------+----------------------+
| Chinle, AZ                     | 1982         | 19,758,000           |
+--------------------------------+--------------+----------------------+
| Tahlequah, OK                  | 1983         | 21,334,000           |
+--------------------------------+--------------+----------------------+
| Browning, MT                   | 1985         | 15,086,000           |
+--------------------------------+--------------+----------------------+
| Kanakanak, AK                  | 1987         | 16,578,000           |
+--------------------------------+--------------+----------------------+
| Crownpoint, NM                 | 1987         | 17,734,000           |
+--------------------------------+--------------+----------------------+
| Sacaton, AZ                    | 1988         | 15,765,000           |
+--------------------------------+--------------+----------------------+
| Rosebud, SD                    | 1989         | 20,000,000           |
+--------------------------------+--------------+----------------------+
| Pine Ridge, SD                 | 1993         | 27,090,000           |
+--------------------------------+--------------+----------------------+
| Shiprock, NM                   | 1995         | 51,558,000           |
+--------------------------------+--------------+----------------------+
| Crow Agency, MT                | 1995         | 23,091,000           |
+--------------------------------+--------------+----------------------+
| Kotzebue, AK                   | 1995         | 62,483,000           |
+--------------------------------+--------------+----------------------+
| Anchorage, AK                  | 1997         | 67,915,000           |
+--------------------------------+--------------+----------------------+
| Ft. Defiance, AZ               | 2002         | [\*111,              |
|                                |              | 971,000]{.underline} |
+--------------------------------+--------------+----------------------+
| Subtotal                       |              | \$538,744,000        |
+--------------------------------+--------------+----------------------+
| ### **Health Centers**         |              |                      |
+--------------------------------+--------------+----------------------+
| Cibecue, AZ                    | 1980         | 750,000              |
+--------------------------------+--------------+----------------------+
| Lodge Grass, MT                | 1982         | 1,485,000            |
+--------------------------------+--------------+----------------------+
| Inscription House, AZ          | 1983         | 3,890,000            |
+--------------------------------+--------------+----------------------+
| Ft. Duchesne, UT               | 1984         | 2,220,000            |
+--------------------------------+--------------+----------------------+
| Tsaile, AZ                     | 1984         | 3,856,000            |
+--------------------------------+--------------+----------------------+
| Huerfano, NM                   | 1984         | 3,304,000            |
+--------------------------------+--------------+----------------------+
| Ft. Thompson, SD               | 1988         | 3,449,000            |
+--------------------------------+--------------+----------------------+
| Wolf Point, MT                 | 1990         | 3,654,000            |
+--------------------------------+--------------+----------------------+
| Kyle, SD                       | 1990         | 3,209,000            |
+--------------------------------+--------------+----------------------+
| Toppenish, WA                  | 1990         | 9,350,000            |
+--------------------------------+--------------+----------------------+
| Ft. Hall, ID                   | 1990         | 6,002,000            |
+--------------------------------+--------------+----------------------+
| Sallisaw, OK                   | 1992         | 4,265,000            |
+--------------------------------+--------------+----------------------+
| Puyallup, WA                   | 1993         | 8,472,000            |
+--------------------------------+--------------+----------------------+
| Taos, NM                       | 1993         | 5,765,000            |
+--------------------------------+--------------+----------------------+
| Wagner, SD                     | 1993         | 6,119,000            |
+--------------------------------+--------------+----------------------+
| Belcourt, ND (OPD)             | 1994         | 19,449,000           |
+--------------------------------+--------------+----------------------+
| Tohatchi, NM                   | 1995         | 9,279,000            |
+--------------------------------+--------------+----------------------+
| Stilwell, OK                   | 1995         | 7,663,000            |
+--------------------------------+--------------+----------------------+
| Ft. Belknap, MT                |              | 18,885,000           |
+--------------------------------+--------------+----------------------+
| Hays, MT                       | 1997         |                      |
+--------------------------------+--------------+----------------------+
| Harlem, MT                     | 1998         |                      |
+--------------------------------+--------------+----------------------+
| White Earth, MN                | 1998         | 13,462,000           |
+--------------------------------+--------------+----------------------+
| Lame Deer, MT                  | 1999         | 14,100,000           |
+--------------------------------+--------------+----------------------+
| Hopi, AZ                       | 2000         | 34,558,000           |
+--------------------------------+--------------+----------------------+
| Parker, AZ                     | 2001         | [21,                 |
|                                |              | 641,000]{.underline} |
+--------------------------------+--------------+----------------------+
| Subtotal                       |              | \$204,827,000        |
+--------------------------------+--------------+----------------------+

\* The hospital opened for service on August 1, 2002. An additional
\$20,400,000 is included in the FY 2003 President's Budget for staff
quarters which are scheduled for completion in FY 2004.

+----------------------------------+---------------+------------------+
| ## INDIAN HEALTH FACI            |               |                  |
| LITIES CONSTRUCTED SINCE FY 1980 |               |                  |
+----------------------------------+---------------+------------------+
|                                  | #####         | ######  TOTAL \$ |
|                                  | ###  **YEAR** |                  |
|                                  |               | > **[APPROPRIATE |
|                                  | > *           | D]{.underline}** |
|                                  | *[COMPLETED]{ |                  |
|                                  | .underline}** |                  |
+----------------------------------+---------------+------------------+
| ### **Staff Quarters**           |               |                  |
+----------------------------------+---------------+------------------+
| Chinle & Inscription             |               |                  |
+----------------------------------+---------------+------------------+
| House, AZ (Design)               |               | 336,000          |
+----------------------------------+---------------+------------------+
| Inscription House, AZ (21)       | 1982          | 1,764,000        |
+----------------------------------+---------------+------------------+
| Chinle, AZ (161)                 | 1983          | 12,236,000       |
+----------------------------------+---------------+------------------+
| Huerfano, NM (9)                 | 1983          | 1/               |
+----------------------------------+---------------+------------------+
| Ft. Duchesne, UT                 | 1984          | 1/               |
+----------------------------------+---------------+------------------+
| Crownpoint, NM (36)              | 1984          | 3,352,000        |
+----------------------------------+---------------+------------------+
| Tsaile, AZ (23)                  | 1985          | 2,141,000        |
+----------------------------------+---------------+------------------+
| Ft. Thompson, SD (13)            | 1985          | 1,279,000        |
+----------------------------------+---------------+------------------+
| Kanakanak, AK (17)               | 1986          | 4,133,000        |
+----------------------------------+---------------+------------------+
| Browning, MT (26)                | 1987          | 2,470,000        |
+----------------------------------+---------------+------------------+
| Kyle, SD (24)                    | 1987          | 1,615,000        |
+----------------------------------+---------------+------------------+
| Supai, AZ (2)                    | 1990          | 246,000          |
+----------------------------------+---------------+------------------+
| Rosebud, SD (29 of 66)           | 1990          | 7,345,000        |
+----------------------------------+---------------+------------------+
| Neah Bay, WA (4)                 | 1991          | 472,000          |
+----------------------------------+---------------+------------------+
| Dulce, NM (4)                    | 1993          | 515,000          |
+----------------------------------+---------------+------------------+
| Barrow, AK (29)                  | 1993          | 18,183,000       |
+----------------------------------+---------------+------------------+
| Rosebud, SD (remaining 37 units) | 1993          | 7,695,000        |
+----------------------------------+---------------+------------------+
| Pine Ridge, SD (45)              | 1993          | 9,517,000        |
+----------------------------------+---------------+------------------+
| Kotzebue, AK (50)                | 1993          | 26,155,000       |
+----------------------------------+---------------+------------------+
| Belcourt, ND (21)                | 1997          | 3,912,000        |
+----------------------------------+---------------+------------------+
| Hopi, AZ (Polacca) (73) 2/       | 2001          | [4,995,          |
|                                  |               | 000]{.underline} |
+----------------------------------+---------------+------------------+
| Subtotal                         |               | \$108,361,000    |
+----------------------------------+---------------+------------------+
|                                  |               |                  |
+----------------------------------+---------------+------------------+
| ### **Yo                         |               |                  |
| uth Regional Treatment Centers** |               |                  |
+----------------------------------+---------------+------------------+
| Alaska - Fairbanks, AK           | 1933          | 1,466,000        |
+----------------------------------+---------------+------------------+
| Alaska - Mt. Edgecumbe, AK       | 1994          | 866,000          |
+----------------------------------+---------------+------------------+
| Phoenix -- Sacaton, AZ           | 1994          | 2,357,000        |
+----------------------------------+---------------+------------------+
| Portland - Spokane, WA           | 1996          | 7,343,000        |
+----------------------------------+---------------+------------------+
| Aberdeen - Chief Gall, SD        | 1996          | [5,373,          |
|                                  |               | 000]{.underline} |
+----------------------------------+---------------+------------------+
| Subtotal                         |               | \$ 17,405,000    |
+----------------------------------+---------------+------------------+
|                                  |               |                  |
+----------------------------------+---------------+------------------+
| ### **Joint                      |               |                  |
| Venture Demonstration Projects** |               |                  |
+----------------------------------+---------------+------------------+
| Warm Springs, OR                 | 1993          | 959,000          |
+----------------------------------+---------------+------------------+
| Poteau, OK                       | 1994          | [700,            |
|                                  |               | 000]{.underline} |
+----------------------------------+---------------+------------------+
| Subtotal                         |               | \$ 1,659,000     |
+----------------------------------+---------------+------------------+
|                                  |               |                  |
+----------------------------------+---------------+------------------+
| GRAND TOTAL                      |               | \$991,326,000    |
+----------------------------------+---------------+------------------+
|                                  |               |                  |
+----------------------------------+---------------+------------------+
| 1/ Includes funds reprogrammed   |               |                  |
| from other projects and other    |               |                  |
| facilities accounts.             |               |                  |
|                                  |               |                  |
| 2/ Hopi Tribe constructed staff  |               |                  |
| quarters with their own funds.   |               |                  |
| \$4,995,000 was appropriated to  |               |                  |
| partially fund staff quarters    |               |                  |
| construction so rental rates for |               |                  |
| IHS staff could be reduced.      |               |                  |
+----------------------------------+---------------+------------------+

FY 2004 FUNDING STATUS

+-----------------------------------------+--------+---------+--------+
| # FACILITY                              | *      | **FY    | *      |
|                                         | *PRIOR | 2004    | *TOTAL |
|                                         | TO FY  | BUDGET  | P      |
|                                         | 20     | REQUEST | ROJECT |
|                                         | 04\*** | TOTAL   | ESTI   |
|                                         |        | EST     | MATE** |
|                                         | **(\$  | IMATE** |        |
|                                         | 000)** |         | **(\$  |
|                                         |        | **(\    | 000)** |
|                                         |        | $000)** |        |
+-----------------------------------------+--------+---------+--------+
| ## Planning Studies                     | 0      | 0       | 1,000  |
+-----------------------------------------+--------+---------+--------+
| **[Inpatient Facilities]{.underline}**  |        |         |        |
+-----------------------------------------+--------+---------+--------+
| Ft. Defiance, AZ                        | 1      | 0       | 1      |
|                                         | 32,371 |         | 32,371 |
+-----------------------------------------+--------+---------+--------+
| Winnebago, NE                           | 47,911 | 0       | 47,911 |
+-----------------------------------------+--------+---------+--------+
| PIMC System, AZ                         | 225    | 0       | 2      |
|                                         |        |         | 99,173 |
+-----------------------------------------+--------+---------+--------+
| Barrow, AK                              | 0      | 0       | 1      |
|                                         |        |         | 04,324 |
+-----------------------------------------+--------+---------+--------+
| Nome, AK                                | 0      | 0       | 96,222 |
+-----------------------------------------+--------+---------+--------+
| ### Whiteriver, AZ                      | 0      | 0       | 1      |
|                                         |        |         | 30,740 |
+-----------------------------------------+--------+---------+--------+
| **[Outpatient Facilities]{.underline}** |        |         |        |
+-----------------------------------------+--------+---------+--------+
| Pinon, AZ                               | 18,427 | 21,573  | 40,000 |
+-----------------------------------------+--------+---------+--------+
| Red Mesa, AZ                            | 15,408 | 30,000  | 63,782 |
+-----------------------------------------+--------+---------+--------+
| Pawnee, OK                              | 17,380 | 0       | 19,374 |
+-----------------------------------------+--------+---------+--------+
| St. Paul, AK                            | 13,320 | 0       | 13,320 |
+-----------------------------------------+--------+---------+--------+
| Metlakatla, AK                          | 3,448  | 14,511  | 17,959 |
+-----------------------------------------+--------+---------+--------+
| Sisseton, SD                            | 2,380  | 3,863   | 29,401 |
+-----------------------------------------+--------+---------+--------+
| Clinton, OK HC                          | 0      | 0       | 19,800 |
+-----------------------------------------+--------+---------+--------+
| **[Quarters]{.underline}**              |        |         |        |
+-----------------------------------------+--------+---------+--------+
| Bethel, AK                              | 9,989  | 0       | 20,000 |
+-----------------------------------------+--------+---------+--------+
| Zuni, NM                                | 2,920  | 0       | 5,445  |
+-----------------------------------------+--------+---------+--------+
| Wagner, SD                              | 0      | 0       | 2,475  |
+-----------------------------------------+--------+---------+--------+
| Ft. Belknap, MT                         | 0      | 0       | 7,986  |
+-----------------------------------------+--------+---------+--------+
| Kayenta, AZ                             | 0      | 0       | 16,801 |
+-----------------------------------------+--------+---------+--------+
| **Regional Treatment Centers**          |        |         |        |
+-----------------------------------------+--------+---------+--------+
| PHX-Nevada Satellite                    | 515    | 0       | 3,897  |
+-----------------------------------------+--------+---------+--------+
| S. California YRTC                      | 0      | 0       | 6,936  |
+-----------------------------------------+--------+---------+--------+
| N. California YRTC                      | 0      | 0       | 7,117  |
+-----------------------------------------+--------+---------+--------+

\* Includes FY 2003 President's Budget.