Activities and Funds Available to Tribes under ISDEAA

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Activities and Funds Available to Tribes under ISDEAA Powered By Docstoc
					  Activities and Funds Available to Tribes
  under ISDEAA

Concepts and practices with emphasis on TRIBAL SHARES, especially for
Key Concepts

    activities IHS carries out                                associated funds

                PSFA                    Associated
                                                                  Tribal Share
 means programs, services, functions,                 means the associated portion of funds
 and activities (or portions thereof)                 used by IHS to carryout the PSFAs to
 that IHS carries out that an Indian                  be contracted
 Tribe may elect to carryout through
 a contract or compact

      Inherent Federal Function          Associated
  mean those governmental functions                    means associated portion of funds
  which only IHS must perform which                    used by IHS to carry out remaining
  cannot legally be delegated to                       inherent Federal functions when all
  Tribes                                               other PSFAs are contracted
ISDEAA – Permits Transfer from IHS to

                                    activities                                         funds

                         Programs, Services,                                  Funds functionally
                      Functions, Activities (PSFA)                           associated with PSFA
         By IHS
                                l                                                  l
                             na                       al                        na                           l
                         tio            ea          oc el                    tio $        ea              ca
                       Na vel         Ar vel       L v                     Na vel       Ar vel $        Lo vel $
                         le             le           le                      le           le              le

                                                            TRANSFER *

       By Tribes                                                                Tribe’s portion of
                        Portions of PSFAs benefiting a
                      Tribe are transferred to a Contract     Associated        associated funds
                                                                                 a          $              $
                                                                               on s      ea s         al m
                            to carry out or redesign                        ati are
                                                                           N sh        Ar are       oc gra
                                                                                                   L o
                                                                             $           sh          pr

 * A Tribal choice.
Transferrable Categories of PSFA

                                                            No           No
  PFSA: Activities and
   associated funds are
    available to contract

Inherent Federal
Functions: are not
                                                       Clinical &      Facil-

                                                                                                       Contract Support Costs
 legally contractible and

                                                                                                                                I.H. Scholarships, Loans
associated funds are not                              Preventative     ities
  available (a very small

                                                                                Diabetes -- S.D.P.I.
   fraction of IHS funds)                            Health Services

                                                                                                                                Urban I.H.P.
       Categories:                                           Yes        Yes
  additional laws govern
  how Tribes participate
                                                                                laws also

  Figures are suggestive of the proportions of the IHS budget.
   Extent of Self-Determination Contracts –
   Current and Hypothetically

                                 ½ IHS Operated                        ½ Tribal Operated

  NOW             Govern-       Potentially Contractible PSFA              Contracted PSFA

                                            100% Tribal Operated

FUTURE                                               Contracted PSFA

      *Illustration only, bar           ISDEAA anticipates that direct Federal spending will decrease
      scale is hypothetical                    commensurately as functions are transferred to Tribes
Share – portion of funds benefiting each Tribe


Benefits multiple
     tribes         Tribe A         Tribe B           Tribe C

    A Tribe that contracts for its portion of an IHS PSFA which benefits
    multiple Tribes is entitled to that portion of funds (. . . the Secretary
    would have otherwise provided for the operation of the programs or
    portions thereof . . .) that benefit the Tribe or its members.
Ways to determine portions of PSFA
allocable to multiple Tribes.

Direct Financial Measures :               Shares are precisely determined   other-
when financial accounts record actual spending for PSFAs for a Tribe, e.g. IHS
funds at a local site serving 1 Tribe.

       Program Measures :               Shares may be calculated in proportion to other-
       workloads, services, or patient counts for each Tribe.
                                                                            2      wise

              Proxy Formula:          A proxy formula calculates shares in proportion to
              indirect measures such as user counts, number of Tribes, or other general
              distributive factors.
Total of 3 Levels of Shares are Available

PSFA and associated
funds are available        IHS-wide (HQ) Shares
from all 3 levels of the   Portion benefiting each Tribe
IHS. Location and
dispersion does not                     +
affect amounts               Area Level Shares
available for              Portion benefiting each Tribe
                             Local Level Shares
                           Portion benefiting each Tribe

“Transferred” for a Contract to Carry Out
“Retained” for IHS to Carry Out

                     PSFA                Shares

                                              A           Associated funds are
                      A                $      B
                                                          transferred to the contract

  Tribe elects to
                      C      Trans-
 contract A, B, C     .      ferred               XY            Associated funds
                      .                       $ Z               are retained by IHS
                      .                                         to perform X, Y, Z

                      X                    retained for
Leaves X, Y, Z for
  IHS to perform
                      Y     Retained       other Tribes
Example of a Direct Financial Measure:
1 IHS Site Serving only 1 Tribe

 When financial accounts record IHS expenditures for a program serving only 1 Tribe,
 the process to identify that Tribe’s shares is straightforward. The entire amount may
 be labeled “shares” and 100% are available when the Tribe contracts the program.

            Budget of the
           Local IHS Site to
            be contracted
                                      100% of the               Shares
                                      Site Budget
                                      is Available
                                                        =        ($) for
                                                               the Tribe
                                      to that Tribe
            Only 1 Tribe is
             served there
Example of a Program Measure Formula:
CHS Fiscal Intermediary PSFA (IHS-wide)

 The FI processes claims for IHS operated CHS programs. The FI is paid a
 fee per claim processed. A tribe can contract for this function. Shares
 associated with the CHS FI are proportional to the claims workload.

 FI Fee Contract
    Amount $

                          Average           # Claims          Shares
                          Cost Per
                                      x      for the
                                            particular   =     ($) for
                           ($ / #)            Tribe          the Tribe
  Total # Claims
  Processed by
      the FI
Example of a proxy formula
Tribal Size Adjustment (for most HQ PSFA)

 Most HQ PSFA collectively benefit more than 560 tribes. The TSA calculates a $
 benefit for all tribes in proportion to tribal user counts.

 •   92% of the total funds associated with HQ PSFA are calculated on a per user basis
     (applies to every tribe)
 •   8% of the total funds are identified for small tribes of less than 2,500 users and
     are calculated on a sliding scale that diminishes approaching 2,500 users
                                      TSA Formula

       Aggregate                    92% of TSA $ is
     funds for ~ 50              calculated per user for             Portions
       HQ PSFA                          all tribes                    for all

                                   8% if < 2,500 users
Timing and Protections

                                 Subsequent negotiations
 Shares are determined at                                       Recurring shares for
                                   occur before annual
the point in time when the                                      contracted PSFA are
                                appropriations are known.
PSFA is initially contracted.                                protected from reductions
                                Shares are ESTIMATED then
  The amount is recurring                                    except for limited reasons
                                    adjusted when the
         thereafter.                                           stated in ISDEEA law.
                                 appropriation is enacted.

                                  When IHS reconfigures
 Congress anticipated that      retained PSFA, shares may
                                                              Funds maybe added to a
    IHS would downsize,          be reconfigured too. HQ
                                                             contract for special projects
 redesign, and reconfigure         has protected shares
                                                             or limited time periods but
   as PSFA and funds are         despite reconfigurations
                                                                  are not recurring.
        transferred.               and will continue this
                                    practice if practical.
A few special circumstances

  l Consortia – shares associated with individual tribes
    maybe consolidated for ISDEAA agreements
  l Delegation to another Tribe – a tribe may direct it’s
    shares to another Tribe to carry out the PSFA for its
    members (some examples in Oklahoma)
  l Grandfathered shares – a few unique agreements
    were implemented early in the 1990’s especially in pilot
    projects before self-governance became permanent.
    Some of the arrangements were grandfathered.
                                                           Shares Tables for 3 Levels

 3) National Level                                                           2) Area Level Tables
Table #1                                                                                     Area Budget
 Shows any CHANGES to entire IHS
 appropriation                                         APPROPRIATION
                                                                                 Area PSFA & $
Table #2                                                                                                 Local Budgets
Splits Appropriation into parts
managed by HQ and Areas                        HQ Budget      AREA Budgets        Area Shares

                 Table #3
                                                                             1) Local Level Tables
  HQ Tracked $

                 Breakout of HQ PSFA and funds.              HQ PFSA & $

                                                                                         Local PSFA & $

                 Table #4
                                                              HQ SHARES
                 Exists for each individual tribe and
                 shows the portion of $ available to it.                                  Local Shares

Format and content of Area and Local level tables will vary, but will generally cover the topics listed above.
          Overview of Tables for HQ
Entire Appropriation   Tracked by HQ

                        Table 3 – HQ
     Table 1 -
    Entire IHS
                        Breakout by

     Table 2 -
   Split into HQ        Table 4 -
     and Area            Portion
     Tracked           Available to
     Budgets             a Tribe
            Table 1 -IHS Appropriation
                                   Final IHS
Major IHS

             made by
Table 2 – HQ and Area
Budget Split

                        on HQ
   Total                Tables
   tracked on
   Area or
                     Table 3 – HQ PSFA Breakout

       for Shares

                                        for Shares

Table 4 – Shares Available to a

Tribe’s                     available
Portion                    in contract
of each                    year 1 or 2
 PSFA                           if
Final points about HQ Tables

l PSFA relate to functional categories – HQ PSFA tables
  do NOT correspond closely with the HQ organizational structure or
  staffing. HQ staff contribute to many different PSFA and staffing is
  managed in aggregate.
l Protected Shares – although the organizational structure has
  changed several times and staff and work evolves for changing
  circumstances and needs, shares for every tribe are protected –
  regardless of HQ internal realignments.
l Office of Finance and Accounting – responsible for HQ
l Other HQ Offices – responsible for carrying out the PSFA and
  descriptions in the PSFA manual.
Activities and Funds Available to Tribes


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