INDIAN HEALTH SERVICE
Description of Current Services Items and Budget Line Items
There is not one budget line item called Current Services. The traditional current services items
include pay costs, inflation, and population growth. The increases are distributed across the
budget line items consistent with what is funded by the line items, e.g., pay costs are distributed
to budget line items that fund salaries and benefits.
Summary of Federal pay cost calculation: the calculation for Federal pay costs is based on
IHS payroll costs, i.e., amounts obligated in the object classes 11 for salaries and 12 for
benefits, and includes three components:
1. Annualization of previous year’s pay raise (i.e., Oct thru Dec of the previous year) because
pay raises are enacted for a calendar year.
2. Calculation of the projected pay raise for the budget year (i.e., 9 months).
3. Adjustment for the number of compensable days for Federal employees for the budget
year. The number of compensable days for Federal employees varies from 260 days to
262 days. In FY 2008 there are 262 compensable days. In FY 2009 there are 261 days.
Therefore, 1 day of pay was subtracted from the FY 2009 pay estimate. There are 261
compensable days in FY 2010 therefore, this adjustment is not necessary for FY 2010.
The calculation for Tribal pay costs is based on the percentage of the IHS budget under Tribal
Administration (see Federal / Tribal Crosswalk table). Once the Federal pay costs are
determined, the percentage is applied to determine the total amount of Tribal pay costs. The
distribution across the line items is done pro rata according to the Tribal Administration
portion of the Crosswalk table.
Summary of inflation calculation: the obligations by sub-object class are the base used in the
inflation calculation. The sub-object class determines the inflation rate applied to the base
obligation. For example, the medical inflation rate is used on the sub-object class obligations
for medical supplies; the non-medical inflation rate is used on the sub-object class for
administrative supplies. Note: the obligations for object class 41 (grants, subsidies,
contributions) are reduced by 60 percent before the inflation rate is applied. Tribal payments
are obligated under object class 41 and the 60 percent represents an estimate of tribal payroll
costs, which are already included in the pay cost calculation.
Population growth is the projected growth in the IHS service population based on vital event
data (births and deaths) for the AI/AN population. The data for the population growth increase
is provided by the Division of Program Statistics, Office of Public Health Support.
Staffing of New Facilities: IHS provides funds for salary and operating costs for the staff
needed to operate a new facility the year of its opening. The staffing level of the facility is
based on the Resource Requirements Methodology (RRM), which projects staffing levels
based on the types of services provided and projected workload or user population. It is
longstanding IHS policy to request staffing at the 85 percent level of RRM requirements.
Salary and benefit costs are estimated using average position grade levels and GS salaries, with
additional funds included for operating costs of the facility.
BUDGET LINE ITEMS – SERVICES APPROPRIATION
Hospital and Clinics (H&C) – supports essential personal health services including inpatient
care, routine and emergency ambulatory care, and medical support services including laboratory,
pharmacy, nutrition, diagnostic imaging, medical records, physical therapy, etc. In addition,
specialized programs for diabetes, maternal and child health, youth services, communicable
diseases including HIV/AIDS, tuberculosis, and hepatitis, and a continuing emphasis on
women's and elders’ health and disease surveillance. Examples of how funds are used include:
staff salaries and benefits, contracts to support health care, e.g., locum tenens or lab services,
training, supplies, pharmaceuticals, and some equipment.
Indian Health Care Improvement Fund (IHCIF) (subset of H&C) -- The purpose of the
IHCIF is to address deficiencies in health status and resources of Indian tribes. IHCIF
resources are allocated using the Federal Disparity Index, which considers Indian user
counts, health status deficiencies, price benchmarks for mainstream health care insurance,
geographic variations related to remoteness, and coverage by third parties. By targeting the
greatest deficiencies, the IHCIF promotes greater equity of health care services among Indian
Information Technology (IT) – The national IT activities are primarily funded from the
H&C budget. This includes the national RPMS activities, NPIRS, the Data Warehouse, etc.
Routine IT operating costs, e.g., purchase of PCs, laptops, IT supplies, etc., are funded within
each program’s operating budget.
Dental Health – supports the provision of dental care through clinic-based treatment and
prevention services and oral health promotion and disease prevention activities, including topical
fluoridation application and dental sealants. Examples of how funds are used include: staff
salaries and benefits, contracts to support dental services, e.g., dental lab services, training,
supplies, and some equipment.
Mental Health – supports community-oriented clinical and preventive mental health service
program that provides inpatient hospitalization, outpatient mental health and related services,
crisis triage, case management, prevention programming and outreach services. The most
common program model is an acute, crisis-oriented outpatient service staffed by one or more
mental health professionals. Examples of how funds are used include: staff salaries and benefits,
contracts to support health care, e.g., locum tenens, and training.
Alcohol and Substance Abuse – supports the efforts of Tribes in the provision of holistic
alcoholism and other drug dependency treatment, rehabilitation, and preventive services for
individuals and families. Youth regional treatment center operations are also funded by this
budget line item.
Contract Health Services - supports the provision of care in IHS and Tribally-operated facilities
with the acquisition of health care and medical services that are otherwise not available. The
CHS program purchases medical care and urgent health care services from private, local, and
community health care providers that include hospital care, physician services, outpatient
services, laboratory, dental, radiology, pharmacy, and transportation services.
Public Health Nursing - supports population-focused services to promote healthier communities
through outreach activities including community screenings, home visits, well-child
examinations, immunizations, prenatal care, postpartum care, and follow-up visits for skilled
Health Education – supports activities directed towards promoting healthy lifestyles,
community capacity building, and the appropriate use of health services through public health
education targeted at school health, employee health promotion, community health, and patient
Community Health Representatives – supports Tribally-administered program of AI/AN
community members trained in basic disease control and prevention. These activities include
serving as outreach workers with the knowledge and cultural sensitivity to effect change in
community acceptance and utilization of health care resources and use community based
networks to enhance health promotion/disease prevention.
Alaska Immunization Program – supports program activities of the Haemophilus Influenza
type B Immunization and Hepatitis Programs for AI/AN people.
Urban Indian Health – supports contracts and grants to 34 urban health programs funded under
Title V of the Indian Health Care Improvement Act.
Indian Health Professions - supports scholarships, loan repayments, and recruitment and
retention of health professionals. Based on FY 2007 awards information, 95.3 percent of the
budget has been awarded to students.
Tribal Management – supports grants to Tribes and Tribal organizations to further develop and
improve their management capacity and capability to contract programs, services, functions and
activities provided by the IHS.
Direct Operations - supports the IHS in carrying out its responsibility of providing leadership,
oversight, executive direction and administrative support to 12 regional offices serving
approximately 1.9 million AI/AN across the United States.
Self Governance - supports the provision of technical assistance to Tribes and Tribal
organizations with planning and negotiation cooperative agreements; funds the Government
Performance and Results Act (GPRA) pilot projects; and addresses Tribal shares funding needs
in Areas and Headquarters for new Tribes entering self-governance.
Contract Support Costs – supports the costs that are required to be provided to Tribal
governments and Tribal organizations, to assist in establishing and maintaining support systems
(e.g., administrative and accounting systems) needed to administer self-determination
agreements and to ensure compliance with the contract and prudent management.
BUDGET LINE ITEMS – FACILITIES APPROPRIATION
Maintenance and Improvement - supports the maintenance and improvement of IHS and tribal
health care facilities.
Sanitation Facilities Construction - supports essential sanitation facilities including water
supply, sewage, and solid waste disposal facilities to AI/AN homes and communities.
Health Care Facilities Construction – supports the construction costs of health care facilities
where direct health care services will be provided to AI/AN people.
Facilities and Environmental Health Support - supports personnel who provide facilities and
environmental health services throughout the IHS at the IHS Area, district, and service unit
levels, and to pay operating costs associated with provision of those services and activities.
Equipment - supports maintenance and replacement of biomedical equipment at IHS and Tribal
health care facilities.