On February 9, 2016, the President submitted a proposed budget for FY 2017. This Memorandum reports on the proposal for the Indian Health Service (IHS). See our General Memorandum 16-005 of January 12, 2016, regarding the FY 2016 IHS enacted appropriations.
Under the Bipartisan Budget Act of 2015 (PL 114-74) FY 2017 spending caps were raised by $30 billion over the amount set in the Budget Control Act of 2011(PL 112-25). The funding increase is evenly split between defense and discretionary domestic programs. However, $15 billion in the context of the discretionary domestic portion of the federal budget is not considered enough to meet inflationary increases. In addition, some in Congress are advocating that the cap be lowered.
The Administration requests $5.185 billion for IHS, an increase of $377 million above the FY 2016 enacted level.
Built-in Costs. Of the total requested, $159 million is for inflationary increases:
$26 million for pay costs; $14.4 million for non-medical inflation (2.1%); $75.4 million for medical inflation (5.8%), and $43.2 million for population growth. Congress has not appropriated funding for IHS medical inflation since FY 2010 even though the Obama Administration has requested such funds.
Staffing Packages. Funding of $33 million is requested for staffing and operation of new facilities:
Kayenta Health Center, $182,000; Muskogee Creek Nation Health Center,
$10.7 million; Northern California Youth Residential Treatment Center, $3.4 million; Flandreau Health Center, $6.3 million; and Choctaw National Regional Medical Center in Oklahoma,
Program Increases. Program increases are proposed in the following programs:
$35 million in Hospitals and Clinics; $25 million in Mental Health; $16.8 million in Alcohol and Substance Abuse; $1.5 million in Purchased/Referred Care; $1.1 million in Urban Indian Health; and $500,000 in Maintenance and Improvement. There would be an $23.4 million increase in Health Care Facilities Construction. For Contract Support Costs, whose funding is proposed at “such sums as necessary”, the estimate in the budget justification is $82 million over the FY 2016 estimate of $717.9 million for a total estimate of $800 million. We provide more detail about proposed budget increases in the individual budget line items.
Proposed Mandatory Funding. The Administration has proposed mandatory funding of $10 million in FY 2017 to expand the number of behavioral professionals providing service in Indian communities and $15 million in FY 2017 to provide assistance “to prevent reoccurences to tribes experiencing behavioral health crises including specialized crisis response staffing, technical assistance, and community engagement.” The proposals are for two years of mandatory funding. In order for mandatory funding to be made available there would need to be legislation authorizing such appropriations. The Administration has also made proposals for new mandatory spending in various parts of the HHS budget, including the National Health Service Corps and the Substance Abuse and Mental Health Services Administration, some of it tribal-specific. The proposals for mandatory spending are strongly criticized by some in Congress as an attempt to get around the domestic discretionary spending cap, and prospects for such funding are slim.
Legislative Initiatives. These are proposals which are included in the budget justification, but will likely not be part of the appropriations process and would require separate legislation:
• The Administration proposes a permanent extension of the Special Diabetes Program for Indians at the current level of $150 million per fiscal year.
• The Administration again proposes that tribes, the IHS, and urban Indian organizations utilizing the Purchased/Referred Care program be charged Medicare-like rates (MLR) for non-hospital services, thus stretching the funding for Purchased/Referred Care. Medicare-like rates are currently required for hospital services. A 2013 Government Accountability Office report concluded that IHS and tribal facilities would save millions of dollars and be able to increase care if the MLR cap was imposed on non-hospital providers and suppliers through the Purchased/Referred Care program. This proposal is deemed to be revenue-neutral. The Budget Justification also notes that in December 2015 IHS submitted to the Office of Management and Budget proposed MLR rules. However, tribes have advocated for a legislative fix to more fully address the issue than can be done via regulations.
• The Administration proposes, as in past years, to make tax-exempt the IHS Health Professions Scholarship Program and Loan Repayment Program, thus not requiring recipients to count the benefits in their gross income. This would be similar to the tax treatment afforded recipients of the National Health Service Corps and the Armed Forces Health Professions scholarships. The Administration also proposes to exempt recipients from the Federal Employment Tax just as is afforded the National Health Service Corps.
• The Administration proposes that the IHS Loan Repayment and Scholarship Program allow recipients to “satisfy their service obligations through half-time clinical practice for double the amount of time or to accept half the loan repayment award amount in exchange for a two-year service obligation.” This would be consistent with the statutory requirements for National Health Service Corps loan and scholarship recipients. The IHS states that this proposal could reduce the number and cost of Purchased/Referred Care program referrals, notably at sites that do not need full time specialty care services.
• The Administration proposes that the 100 percent Federal Medical Assistance Percentage (FMAP) be extended under the Medicaid program to apply to all American Indian/Alaska Native patients, including urban Indian health programs. One hundred percent FMAP already applies to tribally-operated health programs.
• The Administration proposes that the statutory definition of “Indian” in the Affordable Care Act be changed legislatively to utilize the definition relied on by Medicaid, Children’s Health Insurance Program and IHS.
CONTINUING BILL LANGUAGE
The proposed budget would continue language from previous bills, including the following:
IDEA Data Collection Language. Proposed is the continuation of the BIA authorization to collect data from the IHS and tribes regarding disabled children in order to assist with the implementation of the Individuals with Disabilities Education Act (IDEA). The provision is:
Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service and tribes and tribal organizations operating health facilities pursuant to Public Law 93-638 such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act. (20 U.S.C. 1400, et. seq.)
Prohibition on Implementing Eligibility Regulations. Proposed is the continuation of the prohibition on the implementation of the eligibility regulations, published September 16, 1987.
Services for Non-Indians. Proposed is the continuation of the provision that allows the IHS and tribal facilities to extend health care services to non-Indians, subject to charges. The provision states:
Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation.
Assessments by DHHS. Proposed is the continuation of the provision that has been in Interior appropriations acts for a number of years which provides that no IHS funds may be used for any assessments or charges by the Department of Health and Human Services “unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process.”
Limitation on No-Bid Contracts. Proposed is the continuation of the provision regarding the use of no-bid contracts. The provision specifically exempts Indian Self-Determination agreements:
Sec. 409. None of the funds appropriated or otherwise made available by this Act to executive branch agencies may be used to enter into any Federal contract unless such contract is entered into in accordance with the requirements of Chapter 33 of title 41 United States Code or chapter 137 of title 10, United States Code, and the Federal Acquisition Regulations, unless:
(1) Federal law specifically authorizes a contract to be entered into without regard for these requirements, including formula grants for States, or federally recognized Indian tribes; or
(2) such contract is authorized by the Indian Self-Determination and Education and Assistance Act (Public Law 93-638, 25 U.S.C. 450 et seq.) or by any other Federal laws that specifically authorize a contract within an Indian tribe as defined in section 4(e) of that Act (25 U.S.C. 450b(e)); or
(3) Such contract was awarded prior to the date of enactment of this Act.
Use of Defaulted Funds. The Act continues the provision that allows funds collected on defaults from the Loan Repayment and Health Professions Scholarship programs to be used to recruit health professionals for Indian communities.
CONTRACT SUPPORT COSTS
FY 2015 Enacted $662,970,000
FY 2016 Enacted Such sums as may be necessary
FY 2017 Admin. Request Such sums as may be necessary
Administration’s FY 2017 Contract Support Costs Proposal. The Administration proposes for FY 2017 to continue the FY 2016 enacted policy of Contract Support Costs (CSC) being an indefinite appropriation—”such sums as may be necessary”—in a separate account in both the IHS and the Bureau of Indian Affairs (BIA) discretionary budgets. The estimated amount listed for IHS CSC in the Explanatory Statement is $800 million ($82 million over the FY 2016 estimate), with IHS noting that the estimate will be adjusted as new information becomes available, and the estimated amount for the BIA is $278 million ($1 million over the FY 2016 estimate and which includes $5 million for the Indian Self Determination Fund). However, because the CSC accounts are indefinite and separate, there is no funding cap, and program funding would not be reprogrammed to cover unmet needs if the estimated amounts prove insufficient. Rather, the agencies could seek additional funding from the Treasury.
The proposal would also continue problematic bill language from FY 2016 in both the IHS and BIA CSC sections: “amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal years.” This language can be misread to endorse IHS’s “costs incurred” interpretation of the ISDEAA, which holds that tribes are only entitled to the amount of CSC expended in a given year—effectively denying the carryover authority granted by the ISDEAA. Requiring an offset against the succeeding year’s CSC entitlement for unspent CSC upends the indirect cost rate-making process as well as tribal budgets. Tribes have already begun advocating that this language be removed in FY 2017.
The Administration’s proposed IHS CSC bill language is:
For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education assistance agreements with the Indian Health Service for fiscal year 2017, such sums as may be necessary. Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal years; Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer to another budget account.
Administration’s Proposal for Mandatory CSC Funding in FY 2018 and Beyond. The Administration also proposes to reclassify CSC – beginning with FY 2018 – as a mandatory, 3-year appropriation “with sufficient increases year to year to fully fund the estimated need for the program, for both the IHS and BIA.” The IHS budget justification indicates the following estimated mandatory amounts, while noting that “new CSC estimates will be provided as part of the reauthorization process.”
FY 2018 $ 925,000,000
FY 2019 $1,100,000,000
FY 2020 $1,300,000,000
While the proposal to reclassify CSC as mandatory funding is encouraging, the amounts would be capped rather than indefinite. Finally, the IHS proposes that “a small amount of CSC can be used for program management and integrity, for example, 2 percent.” This 2 percent set-aside was also part of the Administration’s proposal for FY 2016, which included a similar three-year mandatory appropriation beginning in FY 2017. The set-aside was not supported by tribes.
Fiscal Year 2017 Limitation. Section 405 of the General Provisions provides that no FY 2017 funds may be used by the IHS or the BIA to pay prior year CSC or to repay for Judgement Fund for payment of judgments or settlements related to past year CSC claims:
SEC. 405. Amounts provided by this Act for fiscal year 2017 under the headings “Department of Health and Human Services, Indian Health Service, Contract Support Costs” and “Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Contract Support Costs” are the only amounts available for contract support costs arising out of self-determination or self-governance contracts, grants, compacts, or annual funding agreements for fiscal year 2017 with the Bureau of Indian Affairs or the Indian Health Service: Provided, That such amounts provided by this Act are not available for payments of claims for contract support costs for prior years, or for repayments of payments for settlements or judgements awarding contract support costs for prior years.
FUNDING FOR INDIAN HEALTH SERVICES
FY 2015 Enacted $3,519,177,000
FY 2016 Enacted $3,566,387,000
FY 2017 Admin. Request $3,815,109,000
HOSPITALS AND CLINICS
FY 2015 Enacted $1,836,789,000
FY 2016 Enacted $1,861,225,000
FY 2017 Admin. Request $1,979,998,000
Built-in Increases. Proposed are the following built-in increases: $16.8 million for pay increases; $2.4 million for non-medical inflation; $23.3 million for medical inflation;
$21.3 million for population growth. In addition, there is $20.1 million for staffing of new facilities.
Program Increases. Proposed program increases over FY 2016 are:
• $20 million for Health Information Technology. Among the uses for the program increase is making improvements needed for the 2015 certification and deployment for Meaningful Use, Stage 3 addressing interoperability and security of patient data.
• $4 million for the Domestic Violence Prevention program to fund approximately 30 additional, IHS, tribal and Urban Indian organizations.
• $2 million for the IHS Quality Consortium for Federal Hospitals “for the coordination of quality improvement activities among the 27 IHS Hospitals and Critical Access Hospitals to reduce Hospital Acquired Conditions and Avoidable Readmissions, while also developing standardized processes and procedures for inpatient care.”
• $9 million for Tribal Clinic Lease, Operations & Maintenance. In FY 2016,
• $2 million was provided to supplement existing funds for this purpose. Proposed bill language reads:
Provided further, that, of the funds provided, $11,000,000 shall remain available until expended to supplement funds available for operational costs at tribal clinics operated under an Indian Self-Determination and Education Assistance Act compact or contract where health care is delivered in space acquired through a full service lease, which is not eligible for maintenance and improvement and equipment funds from the Indian Health Service.
Explanatory language does not make clear which clinics are eligible for this funding.
Initiatives Funding Distribution. The proposed bill expands initiatives to include other behavioral health efforts−Zero Suicide Initiative and aftercare pilots at Youth Regional Treatment Centers−and reads:
Provided further, that, notwithstanding any other provision of law, the amounts made available within this account for the Substance Abuse and Suicide Prevention program, for the Domestic Violence Prevention Program, the Zero Suicide Initiative, for aftercare pilots at Youth Regional Treatment Centers, to improve collections from public and private insurance at Indian Health Service and tribally operated facilities, and for accreditation emergencies shall be allocated at the discretion of the Director of the Indian Health Service and shall remain available until expended.
The Administration announced last year that it will not allocate contract support costs for the meth/suicide and domestic violence prevention initiatives and we expect that will also apply to the expanded list of initiatives.
Tribal Epidemiology Centers. The Administration proposes $4.9 million for the 12 tribal Epidemiology Centers, a $194,000 increase over FY 2016. The increase is for built-in costs.
FY 2015 Enacted $173,982,000
FY 2016 Enacted $178,286,000
FY 2017 Admin. Request $186,829,000
The requested amount over FY 2016 consists of increases of $1.8 million for pay costs, $2 million for inflation, $1.2 million for population growth, and $2.6 million for staffing and operating cost of newly constructed facilities.
FY 2015 Enacted $ 81,145,000
FY 2016 Enacted $ 82,100,000
FY 2017 Admin. Request $111,143,000
The Administration is requesting a $25 million program increase. Of that amount $21.4 million would be for a Behavioral Health Integration Initiative. Funding would be available to tribes, tribal organizations, and urban Indian organizations to expand the behavioral health services to areas outside the traditional health care system. Funds could also be used for training, to hire behavioral health staff and for community-based programs. The remaining $3.6 million would fund pilot projects to implement a Zero Suicide Initiative. IHS notes that the current Zero Suicide model has not been tested or adopted for tribal communities and that it will take concerted effort to develop a model that will be appropriate and effective for tribal communities.
The Administration also requests the following funding increases: $816,000 for pay costs, $1.1 million for inflation, $928,000 for population growth, and $1.2 million for staffing and operations of newly constructed facilities.
ALCOHOL AND SUBSTANCE ABUSE
FY 2015 Enacted $190,981,000
FY 2016 Enacted $205,305,000
FY 2017 Admin. Request $233,286,000
The Administration is requesting a $16.8 million program increase which is focused on youth. Of that amount $15 million would expand the Generation Indigenous Initiative Support initiative which received $10 million in FY 2016. Focus will be on hiring staff to improve and provide more services and prevention programs for Native youth. The remaining $1.8 million is for a pilot project to provide a continuum of care for youth after they are discharged from the Youth Regional Treatment Centers (of which here are eleven).
In addition, the request includes $3.4 million inflation, $2.5 million for population growth, and $3.6 million for staffing and operating of newly constructed facilities.
FY 2015 Enacted $914,139,000
FY 2016 Enacted $914,139,000
FY 2017 Admin. Request $962,331,000
The requested amount over FY 2016 consists of increases of $37.4 million for medical inflation and $9.3 million for population growth. In addition the Catastrophic Health Emergency Fund would be allocated $53 million, a $1.5 million increase over FY 2016.
PUBLIC HEALTH NURSING
FY 2015 Enacted $75,640,000
FY 2016 Enacted $76,623,000
FY 2017 Admin. Request $82,040,000
The requested amount over FY 2016 consists of increases of $796,000 million for pay costs, $2 million for inflation, $874,000 for population growth, and $1.7 million for staffing and operating cost of newly constructed facilities.
FY 2015 Enacted $18,026,000
FY 2016 Enacted $18,255,000
FY 2017 Admin. Request $19,545,000
The requested amount over FY 2016 consists of increases of $175,000 for pay costs, $598,000 for inflation, $210,000 for population growth, and $307,000 for staffing and operating cost of newly constructed facilities.
COMMUNITY HEALTH REPRESENTATIVES
FY 2015 Enacted $58,469,000
FY 2016 Enacted $58,906,000
FY 2017 Admin. Request $62,428,000
The requested amount over FY 2016 consists of increases of $500,000 for pay costs, $2.3 million for inflation, and $685,000 for population growth.
HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA
FY 2015 Enacted $1,826,000
FY 2016 Enacted $1,950,000
FY 2017 Admin. Request $2,062,000
The requested amount over FY 2016 consists of increases of $17,000 for pay costs, $74,000 for inflation, and $21,000 for population growth.
URBAN INDIAN HEALTH
FY 2015 Enacted $43,604,000
FY 2016 Enacted $44,741,000
FY 2017 Admin. Request $48,157,000
The Administration requests a program increase of $1,137,000 to develop a strategic plan for the Urban Indian Health program in consultation with urban Indians and the National Academy of Public Administration. This effort was begun in FY 2016 with $1.1 million being appropriated for the development of a strategic plan.
The requested amount over FY 2016 also consists of increases of $265,000 for pay costs, $1.5 million for inflation, and $479,000 for population growth. As noted earlier, the Administration also proposes that 100 percent FMAP be extended to all Indian health programs, including urban Indian health centers.
INDIAN HEALTH PROFESSIONS
FY 2015 Enacted $48,342,000
FY 2016 Enacted $48,342,000
FY 2017 Admin. Request $49,345,000
The requested amount over FY 2016 consists of increases of $18,000 for pay costs and $985,000 for inflation.
Programs funded under Indian Health Professions are: Health Professions Preparatory and Pre-Graduate Scholarships; Health Professions Scholarships; Extern Program; Loan Repayment Program; Quentin N. Burdick American Indians Into Nursing Program; Indians Into Medicine Program; and American Indians into Psychology. Consistent with the Administration’s request, bill language provides $36 million for the loan repayment program.
FY 2015 Enacted $2,442,000
FY 2016 Enacted $2,442,000
FY 2017 Admin. Request $2,488,000
The requested $46,000 increase is for inflation.
Funding is for new and continuation grants for the purpose of evaluating the feasibility of contracting IHS programs, developing tribal management capabilities, and evaluating health services. Funding priorities are, in order: 1) tribes that have received federal recognition or restoration within the past five years; 2) tribes/tribal organizations that are addressing audit material weaknesses; and 3) all other tribes/tribal organizations.
IHS notes that in FY 2015, 88 percent funding awarded focused on Health Management Structure, 8 percent on planning grants, and 4 percent on Evaluation studies.
FY 2015 Enacted $68,065,000
FY 2016 Enacted $68,338,000
FY 2017 Admin. Request $69,620,000
The requested amount over FY 2016 consists of increases of $641,000 for pay costs and $641,000 for inflation. The IHS noted in its budget submission that 58.7 percent of the Direct Operations budget would go to Headquarters and 41.3 percent to the 12 Area Offices. Tribal Shares funding for Title I contracts and Title V compacts are also included.
FY 2015 Enacted $5,727,000
FY 2016 Enacted $5,735,000
FY 2017 Admin. Request $5,837,000
The requested amount over FY 2016 consists of increases of $20,000 for pay costs and $82,000 for inflation.
The Self-Governance budget supports implementation of the IHS Tribal Self-Governance Program including funding required for Tribal Shares; oversight of the IHS Director’s Agency Lead Negotiators; technical assistance on tribal consultation activities; analysis of Indian Health Care Improvement Act new authorities; and funding to support the activities of the IHS Director’s Tribal Self-Governance Advisory Committee.
The IHS estimated in its budget justification that in FY 2016, $1.8 billion will be transferred to tribes to support 92 ISDEAA Title V compacts and 117 funding agreements.
SPECIAL DIABETES PROGRAM FOR INDIANS
While the entitlement funding for the Special Diabetes Program for Indians (SDPI) is not part of the IHS appropriations process, those funds are administered through the IHS. SDPI is currently funded through FY 2017 at $150 million (see our General Memorandum 15-032 of April 17, 2015). As mentioned under the Legislative Initiatives section, the Administration is proposing that SDPI be permanently authorized at $150 million per fiscal year.
FUNDING FOR INDIAN HEALTH FACILITIES
FY 2015 Enacted $460,234,000
FY 2016 Enacted $523,232,000
FY 2017 Admin. Request $569,906,000
MAINTENANCE AND IMPROVEMENT
FY 2015 Enacted $53,614,000
FY 2016 Enacted $73,614,000
FY 2017 Admin. Request $76,981,000
Proposed is a $517,000 program increase and increases of $1.87 million for inflation and $978,000 for population growth. As of October 1, 2015 the Backlog of Essential Maintenance, Alteration, and Repair is $473 million.
Maintenance and Improvement (M&I) funds are provided to Area Offices for distribution to projects in their regions. Funding is for the following purposes: 1) routine maintenance; 2) M&I Projects to reduce the backlog of maintenance; 3) environmental compliance; and 4) demolition of vacant or obsolete health care facilities. The Act provides that up to $500,000 may be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings.
FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT
FY 2015 Enacted $219,612,000
FY 2016 Enacted $222,610,000
FY 2017 Admin. Request $233,858,000
The requested amount over FY 2016 consists of increases of $2.4 million for pay costs, $2.9 million for inflation, $2.5 million for population growth, and $3.4 million for staffing and operating cost of newly constructed facilities.
FY 2015 Enacted $22,537,000
FY 2016 Enacted $22,537,000
FY 2017 Admin. Request $23,654,000
The requested amount over FY 2016 consists of increases of $858,000 for inflation and $259,000 for population growth.
The Administration proposes to continue bill language to provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense and up to $2.7 million for the purchase of ambulances.
The Administration’s request is to distribute the FY 2017 requested funds as follows: $18 million for new and routine replacement medical equipment at over 1,500 federally- and tribally-operated health care facilities; $5 million for new medical equipment in tribally-constructed health care facilities; and $500,000 each for the TRANSAM and ambulance programs.
Construction of Sanitation Facilities
FY 2015 Enacted $ 79,423,000
FY 2016 Enacted $ 99,423,000
FY 2017 Admin. Request $103,036,000
The requested amount over FY 2016 consists of increases of $2.3 million for inflation and $1.3 million for population growth.
IHS projects that the funds would be distributed as follows: 1) $57 million for projects to serve new or like-new housing; 2) $43 million for projects to serve existing homes; 3) $2 million projects such as studies, training, or other needs related to sanitation facilities construction; and 4) $1 million emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities for HUD-built homes.
Construction of Health Care Facilities
FY 2015 Enacted $ 85,048,000
FY 2016 Enacted $105,048,000
FY 2017 Admin. Request $132,377,000
Under the Administration’s request the following would be provided:
Phoenix Northeast Health Center $52.5 million
Whiteriver Hospital, Whiteriver, AZ $15.0 million
Rapid City Health Center $28.7 million
Dikon Alternative Rural Health Center, Dikon, AZ $15.0 million
In addition, funding is requested for:
Small Ambulatory Program Health Care Facilities $10.0 million Funding would be for facilities smaller than health centers which do not qualify for the IHS Health Care Facilities Construction Priority System. Funds are for “the construction, expansion or modernization of non-IHS owned small tribal ambulatory health care facilities located apart from a hospital.” (p. CJ-176)
New and Replacement Quarters $12.0 million Citing that the greatest need for new and replacement quarters is in the Great Plains, Navajo and Alaska Areas, the funds would be used “to initiate the replacement and addition of quality housing for health care professionals in these three Areas. The amount distributed to each Area will be based on each Area’s internal priority list that will be completed by mid-FY 2016”. (p. CJ-176)
Inflation $ 3.8 million
If we may provide additional information or assistance regarding FY 2017 Indian Health Service appropriations, please contact us at the information below.