In this Memorandum we report on the recommendations of the House and Senate Appropriations Committees for FY 2016 appropriations for the Indian Health Service (IHS)
(HR 2822, H. Rept. 114-170; and S 1645, S. Rept. 114-70). The IHS budget, which is included in the Interior, Environment and Related Agencies appropriations bill, was approved by the House Committee on June 16 and by the Senate Committee on June 18. The House Interior Appropriations bill is being considered on the House floor this week.
The spending levels in the Administration’s FY 2016 request are based on the assumption that a budget deal will be reached for FY 2016 and the overall spending caps set by the Budget Control Act will be raised. The Appropriations Committees are reporting out bills, the Interior bill included, that adhere to the budget caps set in the Budget Control Act. The Administration and Congressional Democrats oppose the Interior and other appropriations bills and are advocating for Congress to reach a new budget agreement which would increase the spending caps. As of this writing, little if any progress has been made toward reaching a new budget agreement.
FUNDING OVERVIEW
The Administration requested $147 million for built-in costs increases. For program increases the request was $313 million which includes staffing for new facilities. The House bill would provide $145 million over the FY 2015 enacted amount but $315 million below the Administration’s request, while the Senate recommendation is $137 million over FY 2015 but $324 million below the Administration’s request. The House Committee agreed to some of the requested built-in costs increases while the Senate did not. The Senate Committee, on the other than hand, recommended more funding in the Facilities account than did the House Committee. More information is provided below.
A major development regarding FY 2016 appropriations was the Administration’s proposal to enact legislation to make IHS and BIA contract support costs (CSC) fully funded on a mandatory basis effective beginning in FY 2017. The proposal would require authorizing legislation. We report on CSC in a separate section of this Memorandum.
Other Administration proposals which would require enacting legislation are extension of the Special Diabetes Program for Indians for 3 years at $150 million per year and making tax-exempt the IHS Health Professions Scholarship Program and the Loan Repayment Program.
Built–in Costs. The Administration’s request is for built-in costs for the Services account is $139 million, while the built-in costs request in the Facilities account is $7.9 million. Lack of funding for built-in costs takes a toll on tribal and IHS health programs. For FY 2015 the Administration requested $63 million but no funding was provided for it. Below is a breakdown of built-in costs request:
Medical Inflation (3.8%)
Administration Request $71.2 million
House Committee $53.0 million
Senate Committee -0-
Pay Increase (1.3%)
Administration Request $19.3 million
House Committee $19.3 million
Senate Committee -0-
Population Growth
Administration Request $56.7 million
House Committee -0-
Senate Committee -0-
The lack of Senate built-in costs largely explains its lower number in the Services account.
Staffing of New Facilities. The Administration requested and the House and Senate Committees concurred in a request for $17.8 million for staffing of new facilities.
Funds (in the Services and Facilities accounts combined) are for: Southern California Youth Treatment Center ($3.2 million); Choctaw (MS) Alternative Rural Health Care Center ($10.9 million); and Ft. Yuma Health Center ($3.6 million). Both House and Senate Reports note that the staffing funds are provided “solely to support facilities on the Health Care Facilities Construction Priority System and Joint Venture construction projects that have opened in fiscal year 2015 or will open in fiscal year 2016. None of these funds may be allocated to a facility until such facility has achieved beneficial occupancy status.” (S. Rept. 114-70, p.70)
Program Increases: over FY 2015 requested by the Administration are: Contract Support Costs ($55 million); Purchased/Referred Care ($25 million); improving third party collections ($10 million); Resource Patient Management and Electronic Health Record requirements ($10 million); tribal youth behavioral health initiative ($25 million); Maintenance and Improvement ($35 million); and sanitation facilities construction ($35 million). The request for health facility construction is $100 million over the FY 2015 enacted level. Much of these requests were not included in the House and Senate Committee bills, due in significant part to the current statutory spending caps.
CONTINUING BILL LANGUAGE
The House and Senate Committees, consistent with the Administration’s request, continue bill language from previous years including the following:
IDEA Data Collection Language. Authorization for the BIA 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)
Prohibition on Implementing IHS Eligibility Regulations which were published September 16, 1987.
Services for Non-Indians. Allowing the IHS and tribal facilities to extend health care services to non-Indians, subject to charges.
Assessments by DHHS. Prohibition on the use of IHS funds 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 the Use of No-Bid Contracts. The provision specifically exempts Indian Self-Determination agreements from the limitation on no-bid contracts.
CONTRACT SUPPORT COSTS
FY 2015 Enacted $662,970,000
FY 2016 Admin. Request $717,970,000
FY 2016 House Committee $717,970,000
FY 2016 Senate Committee $717,970,000
A major development regarding FY 2016 appropriations was the Administration’s proposal to enact legislation to make IHS and BIA contract support costs (CSC) fully funded on a mandatory basis effective beginning in FY 2017 and the House and Senate Appropriations Committees subsequent recommendations regarding CSC funding.
Administration’s CSC Proposal: Under the proposal, FY 2016 funding would continue to be discretionary but the agencies would consult with tribes and work with Congress on the details of the proposal to make the funding mandatory beginning in FY 2017. There would be three years—FYs 2017, 2018, and 2019—of capped mandatory funding, after which the funding would need to be reauthorized. The funding proposed for FY 2016 is $717,970,000 for IHS and $272,000,000 for the BIA, with both amounts expected to fully fund the need. Any funds not used in one year would carry over to the following year. The proposal also includes a provision that would allow IHS to utilize up to 2 percent of the funding to increase its capacity to fulfill the requirements regarding administering the mandatory CSC funding. (See our General Memorandum 15-015 of February 6, 2015). Tribes and tribal organizations were very supportive of the Administration’s position on making CSC mandatory and fully-funded but advocated that the mandatory funding begin with FY 2016, that it be a permanent authorization, and that the IHS not be allowed to utilize up to 2 percent of funds for administrative costs.
Appropriations Committees’ Recommendations. The House and Senate Appropriations Committees, each assuming $717,970,000 for IHS CSC, take different approaches for the placement of CSC in the budget.
• The House Committee bill would maintain CSC as part of the IHS Services account, whereas the Senate Committee places CSC as a new separate account. Hence, Section 406 of the House bill provides that the only amounts available for IHS CSC are the sums appropriated under the Services account. Reflecting its recommendation to make CSC a separate budget account, the Senate Committee bill (also section 406) would provide that the only amounts available for IHS CSC are the sums appropriated under the new separate Contract Support Costs account.
• The House Committee bill would identify a specific amount of CSC to be made available thus reintroducing the CSC spending “caps” albeit at levels likely to enable full FY 2016 payment. Unspent funds could not be diverted and would carry forward until expended, but only for obligations in FY 2016 or before. The Office of Management and Budget criticized the House provision as a “limitation on funding for CSC that could perpetuate the funding issues described in the Supreme Court’s Salazar v. Ramah Navajo Chapter decision.”
• The Senate Committee bill, on the other hand, would provide “such sums as may be necessary” for FY 2016 with a restriction that CSC funds may not be transferred to the Services or Facilities accounts. Guaranteed full funding would protect against other funding being transferred to CSC as would having CSC in its own budget account. The Senate bill would provide a better path to achieving the tribal ultimate goal of permanent, indefinite, mandatory appropriations for contract support costs.
Below is the House and Senate Committee bill and report language regarding Indian Health Service CSC:
House Bill:
Provided further, That $717,970,000 shall be for payments to Indian tribes and tribal organizations for contract support costs associated with contracts, grants, self-governance compacts, or annual funding agreements between the Indian Health Service and an Indian tribe or tribal organization pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) prior to or during fiscal year 2016, and shall remain available until expended.” (HR 2822, p. 92)
House Committee Report:
Contract Support Costs – The recommendation includes $717,970,000 as requested for full funding of estimated contract support costs. Bill language has been added making these funds available until expanded and protecting against the use of other appropriations to meet unanticipated shortfalls. The Service is directed to work with Tribes and tribal organizations to ensure that budget estimates continue to be as accurate as possible. (H. Rept. 114-170, p. 76)
Senate Bill:
For payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education Assistance Act agreements with the Indian Health Service for fiscal year 2016, such sums as may be necessary: Provided, that amounts obligated but not expended by a tribe or tribal organization for contract support cost 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. (S 1645, p. 104)
Senate Committee Report:
The Committee has included new language establishing an indefinite appropriation for contract support costs estimated to be $717,970,000, which is an increase of $55,000,000 above the fiscal year 2015 level. The budget request proposed to fund this program within the “Indian Health Services” account. Under this heading the Committee has provided the full amount of the request for contract support costs. By virtue of the indefinite appropriation, additional funds may be provided by the agency if its budget estimate proves to be lower than necessary to meet the legal obligation to pay the full amount due to tribes. This account is solely for the purposes of paying contract support costs and no transfer from this account are permitted for other purposes. (S. Rept. 114-70, p. 70)
CSC Continuing Provisions. The House and Senate bills provide that Sections 405 and 406 of Division F of the Consolidated and Further Continuing Appropriations, 2015 (PL 113-235) remain in effect. The bills do not re-quote the FY 2015 language.
• Section 405 from PL 113-235, consistent with the Interior appropriations acts for FYs 1999-2014, attempts to limit the ability of the IHS and BIA to fund past-year shortfalls in CSC funding from remaining unobligated balances for those fiscal years. This provision has been included in the appropriations acts for many years and has not precluded recovery on past-year CSC claims.
• Section 406 from PL 113-235 provides that no FY 2014 funds may be used by the IHS or the BIA to pay prior year CSC or to repay the Judgment Fund for payment of judgments or settlements related to past-year CSC claims.
FUNDING FOR INDIAN HEALTH SERVICES
FY 2015 Enacted $4,182,147,000
FY 2016 Admin. Request $4,463,260,000
FY 2016 House Committee $4,321,529,000
FY 2016 Senate Committee $3,539,523,000*
*The reason the Senate Committee figure appears so low is that it reflects Contract Support Costs ($717.9 million) being moved to a separate account. The Senate Committee amount for IHS Services is actually $64 million below the House Committee level.
Definition of Indian. The House Committee repeats language from FY 2015 which notes the problems caused by various definitions of “Indian” referenced in various federal health programs and urges the Department of Health and Human Services, the IHS, and the Treasury Department to work together to establish a consistent definition of Indian with regard to health care.
The Committee recognizes the Federal government’s trust responsibility for providing healthcare for American Indians and Alaska Natives. The Committee is aware that the definition of who is an “Indian” is inconsistent across various Federal health programs, which has led to confusion, increased paperwork and even differing determinations of health benefits within Indian families themselves. The Committee therefore directs the Department of Health and Human Services, the Indian Health Service, and the Department of the Treasury to work together to establish a consistent definition of an “Indian” for purposes of providing health benefits. (H. Rept. 114-170, p. 76)
HOSPITALS AND CLINICS
FY 2015 Enacted $1,836,789,000
FY 2016 Admin. Request $1,936,323,000
FY 2016 House Committee $1,878,944,000
FY 2016 Senate Committee $1,846,076,000
Administration Request. The Administration requested $70 million for built-in costs for Hospitals and Clinics, some of which the House bill would fund, but not the Senate bill. Also included in the Administration’s request is $10 million for improvement of third party collections and $10 million for Health Information Technology, which do not appear to be in either Committee’s recommendation.
Initiatives Funding Distribution. The Administration proposed and the Senate Committee included bill language which provides that the funds for methamphetamine and suicide prevention and treatment, the domestic violence prevention initiative, and efforts to improve collections from public and private insurance at IHS and tribally-operated facilities are to be allocated at the discretion of the Director. The House did not include this language. (The Administration has announced that it will not allocate contract support costs for the meth/suicide and domestic violence prevention initiatives).
Health Clinics. The Senate, but not the House, provides in bill language $2 million “for operational shortfalls at health clinics previously authorized under the ‘Administrative Provisions, Indian Health Service’.”
Health Care Provider Shortage. The House Report repeats language from FY 2015, encouraging IHS “to work with Tribes and health care organizations to find creative ways to address the Service’s health care provider shortage, including improvements to the credentialing process.” (H. Rept. 114-170, p. 77)
DENTAL SERVICES
FY 2015 Enacted $173,982,000
FY 2016 Admin. Request $181,459,000
FY 2016 House Committee $178,959,000
FY 2016 Senate Committee $175,690,000
The House Report encourages the IHS to work with the BIE to establish a pilot program integrating preventive dental care at schools within the Bureau system. (H. Rept. 114-170, p. 76)
MENTAL HEALTH
FY 2015 Enacted $81,145,000
FY 2016 Admin. Request $84,485,000
FY 2016 House Committee $83,199,000
FY 2016 Senate Committee $81,578,000
ALCOHOL AND SUBSTANCE ABUSE
FY 2015 Enacted $190,981,000
FY 2016 Admin. Request $227,062,000
FY 2016 House Committee $198,172,000
FY 2016 Senate Committee $195,971,000
The Administration’s requested increase of $37 million besides providing for built-in costs would expand the methamphetamine/youth suicide prevention initiative by $25 million. The Senate Committee recommended a $2 million increase to focus on tribal youth.
PURCHASED/REFERRED CARE
FY 2015 Enacted $914,139,000
FY 2016 Admin. Request $984,475,000
FY 2016 House Committee $935,726,000
FY 2016 Senate Committee $915,347,000
Consistent with the Administration’s request, the House and Senate bills include within the total $51.5 million for the Catastrophic Health Emergency Fund.
Medicare-Like Rates Legislation Encouraged. As noted above, the Administration included in its budget recommendation a proposal supporting enactment of legislation to provide for Medicare-like rates for non-hospital services, thus stretching the funding for Purchased/Referred Care. The House Committee agrees, stating:
The Committee urges the Service to work expeditiously with the relevant Congressional authorizing committees to enact authorization for the Service to cap payment rates for non-hospital services, as recommended by the Government Accountability Office (GAO 13-272). Failure to do so costs the program an estimated $30 million annually that could be used to purchase more services. (H. Rept. 114-170, p. 76)
The House Committee also referenced a GAO report (GAO 12-446) critical of the program:
The Committee urges the Service, Tribes, and the congressional authorizing committees to make reasonable and expeditious progress to address the concerns and recommendations made by the Government Accountability Office (GAO), most notably with regard to unfair allocations, third-party overbilling and under-enrollment in other qualifying Federal programs. (H. Rept. 114-170, p. 76)
The Senate Committee, on the other hand, addressed a Purchased/Referred Care issue specific to Indian people in Oregon:
The Committee is aware that certain Indian people in Oregon have not been counted for purposes of purchased and referred care under current Service policies and that the Service is currently considering options to address the situation, including the potential expansion of service delivery areas. The Committee believes that it is important that this issue be resolved without impacting existing purchased and referred care allocations to California and Oregon. Within 60 days of enactment of this act, the Service is directed to provide a report to the Committee detailing its proposed management actions to address the situation. (S. Rept. 114-70, p. 70)
PUBLIC HEALTH NURSING
FY 2015 Enacted $75,640,000
FY 2016 Admin. Request $79,576,000
FY 2016 House Committee $78,499,000
FY 2016 Senate Committee $76,140,000
HEALTH EDUCATION
FY 2015 Enacted $18,026,000
FY 2016 Admin. Request $19,136,000
FY 2016 House Committee $18,802,000
FY 2016 Senate Committee $18,122,000
COMMUNITY HEALTH REPRESENTATIVES
FY 2015 Enacted $58,469,000
FY 2016 Admin. Request $62,363,000
FY 2016 House Committee $61,129,000
FY 2016 Senate Committee $58,469,000
HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA
FY 2015 Enacted $1,826,000
FY 2016 Admin. Request $1,950,000
FY 2016 House Committee $1,826,000
FY 2016 Senate Committee $1,950,000
URBAN INDIAN HEALTH
FY 2015 Enacted $43,604,000
FY 2016 Admin. Request $43,604,000
FY 2016 House Committee $44,410,000
FY 2016 Senate Committee $43,604,000
The House, but not the Senate, includes new bill language instructing IHS to “develop a strategic plan for the Urban Indian Health program in consultation with urban Indians and the National Academy of Public Administration…”
The House Report, which recommends an $806,000 increase, states:
The agency is directed to include current services estimated for Urban Indian Health in future budget requests. The Committee notes the agency’s failure to report the results of the needs assessment directed by House Report 111-180. Therefore the recommendation includes a reduction to the Service leadership budget, along with bill language requiring a program strategic plan developed in consultation with urban Indians and the National Academy of Public Administration. (H. Rept. 114-170, pp. 76-77)
INDIAN HEALTH PROFESSIONS
FY 2015 Enacted $48,342,000
FY 2016 Admin. Request $48,342,000
FY 2016 House Committee $48,342,000
FY 2016 Senate Committee $48,342,000
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.
Proposal to Exempt Scholarship and Loan Repayment Programs from Federal Taxes. The Administration proposed, as in past years, to make the IHS Health Professions Scholarship Program and Loan Repayment Program tax-exempt, thus freeing up funding now used to pay taxes on these benefits.
Use of Defaulted Funds. The Committee bills continue 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:
Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a).
TRIBAL MANAGEMENT
FY 2015 Enacted $2,442,000
FY 2016 Admin. Request $2,442,000
FY 2016 House Committee $2,442,000
FY 2016 Senate Committee $2,442,000
Funding is for new and continuation grants for the purpose of evaluating the feasibility of contracting the 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.
DIRECT OPERATIONS
FY 2015 Enacted $68,065,000
FY 2016 Admin. Request $68,338,000
FY 2016 House Committee $67,384,000
FY 2016 Senate Committee $70,065,000
The IHS states 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.
SELF-GOVERNANCE
FY 2015 Enacted $5,727,000
FY 2016 Admin. Request $5,735,000
FY 2016 House Committee $5,735,000
FY 2016 Senate Committee $5,727,000
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 2015, $1.8 billion will be transferred to tribes to support 89 ISDEAA Title V compacts and 114 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).
FUNDING FOR INDIAN HEALTH FACILITIES
FY 2015 Enacted $460,234,000
FY 2016 Admin. Request $639,725,000
FY 2016 House Committee $466,329,000
FY 2016 Senate Committee $521,818,000
MAINTENANCE AND IMPROVEMENT
FY 2015 Enacted $53,614,000
FY 2016 Admin. Request $89,097,000
FY 2016 House Committee $53,614,000
FY 2016 Senate Committee $73,614,000
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. Of the funding requested, $50.1 million would be allocated to sustain the condition of federal and tribal healthcare facilities buildings;
$3 million for environmental compliance projects; and $500,000 for demolition projects.
FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT
FY 2015 Enacted $219,612,000
FY 2016 Admin. Request $226,870,000
FY 2016 House Committee $224,882,000
FY 2016 Senate Committee $221,196,000
MEDICAL EQUIPMENT
FY 2015 Enacted $22,537,000
FY 2016 Admin. Request $23,572,000
FY 2016 House Committee $23,362,000
FY 2016 Senate Committee $22,537,000
The Administration’s request was to distribute the FY 2016 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
Construction of Sanitation Facilities
FY 2015 Enacted $ 79,423,000
FY 2016 Admin. Request $115,138,000
FY 2016 House Committee $ 79,423,000
FY 2016 Senate Committee $ 99,423,000
Four types of sanitation facilities projects are funded by the IHS: 1) projects to serve new or like-new housing; 2) projects to serve existing homes; 3) special projects such as studies, training, or other needs related to sanitation facilities construction; and 4) emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities in HUD-built homes.
Most of the Administration’s requested increase was for $30 million to service new and like-new homes, some of which could be used for sanitation facilities for individual homes of disabled or ill persons with a physician referral, with priority for BIA Housing Improvement Projects. Funding would be established by Headquarters after reviewing Area proposals. The Senate Committee recommended a $20 million increase while the House Committee proposed flat funding.
The remaining funding in the Administration’s request would be distributed as follows: up to $48 million to the Area Offices for prioritized projects to serve existing homes of which up to $5 million would be for projects to clean up and replace open dumps on Indian lands; and $2 million would be reserved at IHS Headquarters ($1 million for special projects and emergency needs; $500,000 to collect homeowner data and demographic information in three of the IHS Areas; and $500,000 for improving data collection systems to help fund a Water Resource Center to develop teaching materials and techniques for homeowners and communities to support usage in a way that promotes health). The Water Resource Center is in partnership with the Alaska Native Tribal Health Consortium whose funding stream began in FY 2012 with $250,000 and is expected to be funded for five years through FY 2016.
Construction of Health Care Facilities
FY 2015 Enacted $ 85,048,000
FY 2016 Admin. Request $185,048,000
FY 2016 House Committee $ 85,048,000
FY 2016 Senate Committee $105,048,000
The Administration’s health facility construction proposal is $100 million over FY 2015 enacted and would provide for:
• Gila River Southeast Health Center, Chandler, AZ – $63.6 million to complete construction.
• Salt River Northeast Health Center, Scottsdale, AZ – $50 million to design and begin construction.
• Rapid City Health Center, Rapid City, SD – $50.8 million to design and begin construction of a facility to replace the Sioux San Hospital.
• New Dilkon Alternative Rural Health Center, Dilkon, AZ – $20.5 million to design and to construct infrastructure.
The Senate recommends a $20 million increase over FY 2015 and the Committee Report notes that it is “in order to make progress on the next facility on the Service’s Health Care Facilities Construction Priority System.”
OTHER
TRANSAM Equipment, Ambulances, Demolition Fund. The bills would continue language to provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense, $500,000 to be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings, and up to $2.7 million for the purchase of ambulances.
If we may provide additional information or assistance regarding pending FY 2016 Indian Health Service appropriations, please contact us at the information below.
