1. Funding Tables Melanie Fourkiller, Choctaw Nation of Oklahoma
“Excellence in Rural Health Care”

2. Planning Objective
Objective: to acquire and analyze financial and programmatic information, in order to form a basis for decision-making.
Understand the funding distribution at 100%;
Understand the purpose of and workload for the PSFAs benefitting the Tribe;
Analyzing specific PSFAs to inform decision-making;
Achieve more accountability for PSFAs retained by IHS.

3. Common Terms
Program Base, Service Unit Funds: a Tribe’s share of funding from the Service Unit Level;
Tribal Shares: a Tribe’s shares of the associated programs at the Area Office and Headquarters IHS
Recurring funding: funding that reoccurs each year
Non-recurring funding: funding of a one-time nature that may not recur in a future year
“X-year” funds: funds without expiration in the federal appropriation

4. Common Terms
Inherent Federal Functions – functions that must, by law be carried out by a federal official official
Residual – the amount of funds required to perform IFFs, under the theorectical assumption that all available programs have been compacted
Buyback – PSFAs assumed by the Tribe, and then purchased back from the IHS
Full Cost Recovery Fee – the fee associated with a “buyback” PSFA
Retained – PSFAs eligible to be transferred to a Tribe which the Tribe chooses for IHS to perform (not assumed by the Tribe)

5. Fund Distribution Funding Tables Available from IHS Headquarters
Tables 1 – 3: Tracks funding from Appropriation
HQ Distribution: Specific table showing funding for your Tribe

6. Headquarters Table #1

7. Headquarters Table #1

8. Headquarters Table #1

9. Headquarters Table #1

10. HQ Tribal Share Table

11. Fund Distribution Area Tables Vary in format by Area
Formulas can vary by Area
Example: Oklahoma Tribal Size Adjustment Formula
Formulas should be Tribally-driven and a result of Tribal Consultation

12. Area Office Table

13. Fund Distribution Facilities Appropriation Table 4f
Contains all Facilities PSFAs, including:
Maintenance and Improvement
Sanitation Facilities Construction
Equipment
Facilities Support

14. Table 4f

15. Program Base Funding Program Base, or Service Unit Level
Table Format can vary by Area
Funding formulas can vary by Area
Example: Oklahoma Area
Location of Service Unit – by County
Location of Tribal former reservation area/historic jurisdiction
User population distribution in Service Unit
Allocation of ‘non-affiliated’ Tribal Users

16. Understanding PSFA Workload
Information Available from IHS:
PSFA Manuals
Additional PSFA descriptions – example: Recruitment
Workload reports – examples: outpatient visits by type; PCP visits; specific services benefitting the Tribe
Revenue reports – 3rd party collections
Staffing/organizational information
Other reports upon request by the Tribe
Discussions with IHS Programmatic Staff

17. Final Thoughts PSFAs may be assumed “all or a portion of”
Not an all-or-nothing proposition
Request additional breakouts of functions or funding as needed for responsible decisions
Phase-in strategies can be used - incrementally add ‘feasible’ PSFAs over time
Allows infrastructure growth alongside Tribal assumption of health programs.

18. Final Thoughts
Request workload or further descriptions of benefits to the Tribe currently performed by IHS as needed
Consider Tribal readiness and priorities
Consider alternative service delivery models
PSFAs are negotiated at the option of the Tribe – and can change over time.

19. “Excellence in Rural Health Care”
Questions?
Yakoke!
“Excellence in Rural Health Care”