[Federal Register Volume 81, Number 212 (Wednesday, November 2, 2016)]
[Notices]
[Pages 76365-76367]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-26488]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Organization and Functional Statement; Part GFG; California Area 
Office; Proposed Functional Statement

    Part G, of the Statement of Organization, Functions, and 
Delegations of Authority of the Department of Health and Human Services 
(HHS), as amended most recently at 63 FR 1486, January 9, 1998, is 
hereby amended to reflect a realignment of the California Area Indian 
Health Service.
    The California Area Indian Health Service (CAIHS) provides the 
healthcare delivery system to the State of California, the home of the 
largest population of American Indians/Alaska Natives (AI/AN) in the 
country. According to the 2010 Census, California's Indian population 
was 333,346 in 2010. The 2010 Census also indicated that there were 
294,216 additional people who stated that they were American Indian and 
a combination of one or more other races. California is home to 107 
Federally-recognized Tribes. There are presently 31 California Tribal 
health programs operating 57 ambulatory clinics under the authority of 
the Indian Self-Determination Act. The IHS funds ten California Area 
urban health programs that operate under the authority of the Indian 
Health Care Improvement Act. In fiscal year 2014, California Tribal 
health programs had 119,362 registered users and 69,238 active users. 
Registered users are a cumulative total for all Indian patients ever 
seen at Tribal facilities, and active users are those that have 
accessed care during the past three years. None of the Tribal 
facilities and programs currently operating in California originated as 
facilities previously operated by the IHS, as is the case in other IHS 
areas. Population sizes and dispersion of Tribal groups in the CAIHS 
makes it unlikely that a hospital-based service program will develop 
within the area, similar to other IHS areas where the Federal 
government has built, staffed and maintained hospitals and satellite 
clinics on Indian reservations. Tribal programs will continue to rely 
on private and public hospitals to meet inpatient and emergency needs. 
Some Tribal health program physicians have privileges at local 
hospitals and follow their patients through the local hospital system. 
Otherwise, the patients are referred to private physicians using 
Purchased Referred Care (PRC) funding, as well as other alternate 
resources. Most programs have not developed laboratory, pharmacy or x-
ray specialties, so these services are purchased from the private 
sector through PRC funding or other Tribal resources. The CAIHS is 
proposed to be organized as follows:

Office of the Area Director (GFGA)

    Provides overall direction and leadership for the CAIHS by: (1) 
Encouraging maximum consultation and participation by California area 
Tribes and Tribal and urban Indian organizations in establishing the 
goals, objectives and development of policies of the CAIHS; (2) 
coordinating the CAIHS activities and resources internally and 
externally with those of other Federal, state, local and privately 
funded health care programs to maximize quality health care services to 
Tribal and urban Indians in the State of California; (3) ensuring 
compliance to the IHS guidelines and administrative procedures 
pertinent to Indian self-determination contracting processes and Tribal 
self-governance compacting; (4) assuring that Indian Tribes and Indian 
organizations are informed regarding pertinent health policy and 
program management issues and coordinates meetings and other 
communications with Tribal delegations; (5) advocating for the health 
needs and concerns of AI/AN; (6) developing and demonstrating methods 
and techniques for continuous improvement of health services management 
and delivery by California area Tribes and Tribal and urban Indian 
organizations; (7) ensuring that the principles of Equal Employment 
Opportunity laws and the Civil Rights Act are applied in the management 
of the human resources of the CAIHS; (8) advising the Director, IHS, of 
issues and potential issues, relevant to the California area, or to the 
IHS in general, and recommending and participating in actions to 
prevent or correct problems; (9) providing leadership for the 
development of emergency preparedness plans, policies, and services, 
including the continuity of operations plans, deployment, public health 
infrastructure, and emergency medical services for the CAIHS 
responsibilities; and (10) advocating and coordinating support for 
Tribal emergency medical services programs, including training and 
equipment.

[[Page 76366]]

Office of Management Support (GFGAB)

    (1) Provides advice to the Area Director and functional area 
managers on CAIHS administrative and management policy and procedures 
requirements, delegations of authority, documenting the organizations 
and functions of the CAIHS, personnel administration and management, 
and agency agreements management; (2) develops, recommends and 
implements processes for management accountability and the periodic 
assessment of managerial performance; (3) provides guidance and support 
to area managers regarding resources, personal property, acquisition 
management; (4) provides a full complement of administrative services 
in support of the Area-wide health services delivery and management 
systems, i.e., forms management, travel management, communications 
management, supply management, printing, mail management, etc.; (5) 
advises the Area Director and functional area managers on the civil 
service and commissioned corps personnel programs' administration and 
management requirements; (6) directs the personnel security and 
suitability clearance, and other ethics in employment programs; and (7) 
provides advice, consultation, and assistance to Tribal officials and 
Tribal organizations on Tribal health program personnel policy issues.

Financial Management Division (GFGAB1)

    (1) Performs fund reconciliations and assists in coordination of 
discrepancies with financial officials; (2) provides support and 
technical assistance to area operational components in the development 
of area operations budgets; (3) provides fund certification and 
maintains commitment registers for area components; (4) supports cost 
accounting activities in IHS; (5) develops and implements budget, 
fiscal, and accounting procedures and conducts reviews and analyses to 
ensure compliance in budget activities in collaboration with 
Headquarters officials and the Tribes; and (6) participates in cross-
cutting issues and processes including, but not limited to emergency 
preparedness/security, budget formulation, self-determination issues, 
Tribal shares computations, and resolution of audit findings as may be 
needed and appropriate.

Acquisition Management Division (GFGAB2)

    (1) Develops, recommends, and oversees the implementation of 
policies, procedures and delegations of authority for the acquisition 
management activities in the CAIHS, consistent with applicable 
regulations, directives, and guidance from higher echelons in the 
Department of Health and Human Services and Federal oversight agencies; 
(2) provides advice, technical consultation, and training to California 
area managers and staff; (3) reviews and makes recommendations for 
approval/disapproval of contract-related documents such as: Pre- and 
post-award documents, unauthorized commitments, procurement planning 
documents, Justification for Other Than Full and Open Competition, 
waivers, and deviations; (4) executes and administers contracts for the 
CAIHS; and (5) reviews, recommends, and issues delegations of 
acquisition authority in the CAIHS.

Office of Public Health (GFGAC)

    (1) Provides leadership and consultation to Tribal and urban public 
health programs on the IHS goals, objectives, policies, program 
standards, and priorities; (2) serves as the primary source of 
technical and policy advice to the Area Director, area office staff, 
and Tribal and urban health program officials on the full scope of 
clinical health care programs, including their quality assurance and 
preventive aspects, and tort claims; (3) participates in identifying 
and articulating the health needs of the AI/AN population in the State 
of California; (4) coordinates the availability and accessibility of 
Medicare and Medicaid programs, and other managed care programs' 
services, to AI/AN in the State of California; (5) provides 
consultation and technical support to Tribal and urban public health 
programs including, but not limited to, dental services, diabetes and 
other chronic disease prevention, nutrition services, and nursing 
services, alcohol/substance abuse prevention and treatment, including 
the coordination of the Youth Regional Treatment Center services; (6) 
provides assistance in the development and implementation of area 
policy and procedures regarding managed care services, third-party 
collections and reimbursements, health care facility accreditation, 
risk management and quality assurance; (7) coordinates the 
reimbursement of allowable costs for qualified high cost PRC service 
cases from the IHS Catastrophic Health Emergency Fund to Tribal health 
care programs in the State of California; (8) serves as project officer 
on contracts awarded in the State of California for the delivery of 
health care services, and coordinates activities for monitoring and 
evaluating contractor performance; (9) provides advice to the Area 
Director on the activities and issues related to the implementation of 
Title V of the American Indian Health Care Improvement Act, as amended, 
in the State of California; (10) provides support to urban Indian 
health programs and organizations in managing health programs and 
attending financial and other types of support available from other 
public and private agencies and organizations, and (11) designs, 
maintains, and controls the data collection, analysis, and publication 
of health program information in the activities.

Information Technology Division (GFGAC1)

    (1) Develops, implements, and maintains policies, procedures and 
standards for information resource management and technology products 
and services in the CAIHS; (2) develops and maintains information 
technology strategic planning documents; (3) develops and maintains the 
CAIHS enterprise architecture; (4) develops and implements information 
technology management initiatives; (5) ensures IHS information 
technology infrastructure resource consolidation and standardization 
efforts support IHS healthcare delivery and program administration; (6) 
represents the IHS to Federal, Tribal, state, and other organizations; 
and (7) participates in cross-cutting issues and processes that involve 
information technology.

Office of Environmental Health & Engineering (GFGAD)

    (1) Serves as the principal advisor, advocate, consultant, and 
technical assistant on all services relating to sanitation facilities 
construction, environmental health services, operation and maintenance, 
injury prevention, and facilities management for the CAIHS; (2) plans, 
coordinates, implements, and evaluates all aspects of Title I 
contracting and Title V compacting under the Indian Self-Determination 
and Education Assistance Act, as amended; (3) consults with Tribal 
groups/organizations in the development and implementation of 
environmental health and engineering policies and initiatives; (4) 
provides consultation and technical guidance to Tribal health programs 
including preventive maintenance surveys, personnel training, and 
fiscal reviews; (5) performs or directs surveys and

[[Page 76367]]

investigations to determine the condition of Tribal health facilities; 
(6) serves as the principal advisor regarding the real property 
management program which oversees owned and leased real property and 
General Services Administration (GSA) assigned space; interacts with 
GSA Region IX and Engineering Services to ensure adequacy of 
facilities; and (7) coordinates property management activities 
including space assignments, space need determinations, regulatory 
compliance, and reporting.

Environmental Health Services Division (GFGAD1)

    (1) Maintains relationships with other Federal agencies and Tribes 
to maximize responses to environmental health issues and maximize 
benefits to Tribes by coordinating program efforts; (2) identifies 
environmental health needs of AI/AN populations and supports efforts to 
build Tribal capacity; (3) provides personnel support services and 
advocates for environmental health providers; and (4) performs 
functions related to environmental health programs such as injury 
prevention, emergency response, water quality, food sanitation, 
occupational health and safety, solid and hazardous waste management, 
environmental health issues in health care and non-health care 
institutions, and vector control.

Sanitation Facilities Construction Division (GFGAD2)

    (1) Manages the environmental engineering programs, including the 
Sanitation Facilities Construction (SFC) program, and compliance 
activities associated with environmental protection and historic 
preservation legislation; (2) consults with Tribal groups/organizations 
in the development and implementation of SFC policies and initiatives, 
and in the identification of sanitation needs for single family housing 
and community facilities; and (3) works closely with other Federal 
agencies to resolve environmental issues and maximize benefits to 
Tribes by coordinating program efforts.

OEHE District Offices/Field Offices

Redding District Office--GFGAD2A
Arcata Field Office--GFGAD2A1
Sacramento District Office--GFGAD2B
Ukiah Field Office--GFGAD2B1
Clovis Field Office--GFGAD2B2
Escondido District Office--GFGAD2C

    (1) Implements the SFC and Environmental Health Services 
responsibilities; (2) serves as the principal advisor to communities, 
individuals, contractors, and other organizations on all matters 
pertaining to SFC and Environmental Health Services; (3) implements 
activities that assist all health programs to attain accreditation by 
appropriate accrediting agencies; (4) implements the area fluoridation 
and operation and maintenance activities, and (5) implements the 
provision of sanitation facilities for new housing projects sponsored 
by other government agencies and for existing housing.

Health Facilities Engineering Division (GFGAD3)

    (1) Develops, implements, and manages the programs affecting health 
care facilities operations, including routine maintenance and 
improvement, real property asset management, realty, facilities 
environmental, quarters, and clinical engineering programs; (2) serves 
as the principal resource for coordination of facilities operations and 
provides consultation to IHS and the Tribes on health care facilities 
operations; and (3) monitors the improvement, alteration, and repair of 
health care facilities.

Desert Sage Youth Wellness Center--GFGAE

    (1) The Desert Sage Youth Wellness Center in Southern California 
provides inpatient substance abuse and alcohol treatment to eligible 
AI/AN youth as a Youth Regional Treatment Center (YRTC) and will help 
California Tribal youth find healthy directions in life; and (2) in 
addition to providing treatment services, the YRTC will work with 
Tribal and urban Indian programs to help provide a continuum of care, 
including preventive and aftercare services.

Sacred Oaks Healing Center--GFGAF

    (1) The Sacred Oaks Healing Center in Northern California provides 
inpatient substance abuse and alcohol treatment to eligible AI/AN youth 
as a YRTC and will help California Tribal youth find healthy directions 
in life; and (2) in addition to providing treatment services, the YRTC 
will work with Tribal and urban Indian programs to help provide a 
continuum of care, including preventive and aftercare services.

    Dated: October 25, 2016.
Elizabeth A. Fowler,
Deputy Director for Management Operations, Indian Health Service.
[FR Doc. 2016-26488 Filed 11-1-16; 8:45 am]
 BILLING CODE 4165-16-P