Attachment 5.pdf

Division of Environmental Health

RRM and Funds Distribution Methodology

DEHS

DEHS RRM and Funds Distribution Methodology

TABLE OF CONTENTS

SECTION PAGE

Background 1

DEHS Program Overview 1

Delivery Of Environmental Health Services 1

DEHS Funding Flow 2

Environmental Health Program Funding Criteria And Allocation Methodology 2

DEHS Resources Requirement Methodology (RRM) 2

Scope of the RRM 3

Determination of the Total DEHS Workload 3

Environmental Health Services Program Components 3

General Environmental Health RRM 3

Institutional Environmental Health RRM 4

Injury Prevention RRM 4

Program Base RRM 4

Administrative RRM 4

Application of RRM 5

Summary 5

FIGURES & DIAGRAMS

Figure 1-1: Environmental Health Services Funding Flow

Figure 1-2: Environmental Health Services Data Flow

APPENDICES

I Definitions

II Ten Essential Environmental Health Services

III Table of Historical Laws

IV Table 4-F

V Annual EHSA Distribution Tables

VI IP RRM Formula

VII Facility Type Definitions

VIII Narrative Description of Institutional Environmental Health Resource Requirement Methodology

IX Administrative Amount Calculations

Final Draft March 12, 2010

DEHS RRM and Funds Distribution Methodology

BACKGROUND INFORMATION

The purpose of this document is to provide information and guidance about how the Division of

Environmental Health Services (DEHS) Resource Requirement Methodology (RRM) is calculated and how RRM is related to funding. This document is the result of a DEHS Strategic

Planning Initiative that began in 2007. This document was developed under the Primary Vision

Element: DEHS will be actively involved in budget and RRM discussions. Definitions of key terms in this document are provided in Appendix I.

The Primary Vision Element Team determined this type of document to be a valuable contribution to the DEHS Program based on the following factors:

1. Upper level managers with an institutional knowledge of how the RRM is calculated and the budget is derived were retiring.

2. Incoming Area DEHS Directors were not knowledgeable about the process.

3. Tribal leaders had been asking for a written description of the DEHS RRM.

DEHS Program Overview

The Division of Environmental Health Services serves as a consultative public health advisor to tribes regarding environmental hazards and risk factors facing tribal groups. The three components of the IHS Environmental Health Services Program {General Environmental Health

(GEH), Injury Prevention (IP), and Institutional Environmental Health (IEH)} consider the Ten

Essential Environmental Health Services as a framework to provide a comprehensive environmental health program. The Ten Essential Environmental Health Services are included in

Appendix II. A table of historical laws that have guided DEHS Program development is included as Appendix III.

Delivery of Environmental Health Services

Under Self-Determination (Public Law 93-638) tribes have three options for receiving their EH services: (1) directly from the Indian Health Service (IHS), (2) through contracting with the IHS to have the administrative control, operation, and funding for EH programs transferred to

American Indian and Alaska Native tribal governments (Title I), or (3) through compacting with the IHS (Title V) and assuming even greater control and autonomy for the provision of their own health care services. About 50 percent of EH services are provided through contracted and compacted programs.

For Title I and V tribes, Areas determine and disburse tribal shares according to Area-specific funding formulas that may involve RRM and special negotiations tabulated on Tribal Shares

Worksheet Table 4F (Appendix IV). All tribes have a vested interest in the RRM formulas because of the funding implications.

DEHS Funding Flow

Funding for the DEHS program comes from Congress to the Facilities Appropriations of the

Indian Health Service. The Facilities Appropriation funds the Facilities and Environmental

Health Support account which is divided into the Facilities Support Account (FSA), the

Environmental Health Support Account (EHSA) and the Office of Environmental Health &

Engineering Support Account. The Environmental Health Support Account is further divided into two separate accounts: the Sanitation Facilities Construction Program (SFC) and the EHS programs at the Area level. This document is concerned with the EHS program account which funds Area level environmental health programs; both federal and tribal. Each Area receives a recurring amount adjusted by annual program increases based on the Area’s share of the total

RRM. An additional amount of non-recurring funds, based on RRM is distributed to address parity across the Areas. Please refer to Figure 1-1 for a diagram of the funding flow and

Appendix V for EHSA FY 2010 Area Allocations and RRM percentage by Area.

ENVIRONMENTAL HEALTH PROGRAM FUNDING CRITERIA AND ALLOCATION METHODOLOGY

DEHS funds are allocated based on a services workload concept, by which individual staff activities can be measured for the three program areas (GEH, IEH, and IP). The DEHS staff allocations to any one area, district, or service unit, are in part a function of the number and type of facilities, injury mortality data and user population.

DEHS program funds are generally used for salary and benefits, travel, supplies, training, and related costs for permanent and contract staff in the DEHS Program at the area, district and field levels. The relationship of workload to Area EHSA program funding for the DEHS program is shown in Figure 1-1 and Figure 1-2.

DEHS Resources Requirement Methodology (RRM)

Some version of the DEHS Program RRM has been in existence since the early 1970s.

Currently, it represents an estimate of staff workload based on historical data derived from individual activities recorded by DEHS staff. That historical data is used to determine the approximate time involved to conduct associated work with specific facility types and the number of facilities within an Area. Travel, training, and administrative activities are also included. The data drive the annual RRM calculations and are used in part to allocate EHSA funds to the Areas. The Area managers (typically the OEHE Associate Directors) then allocate the funds as needed within the Areas using Area-specific formulas.

Scope of the RRM

The RRM is a concept theoretically similar to “Full Time Equivalent or FTE” since it provides a relative measure of the staff time necessary to carry out a comprehensive Environmental Health

Program over the course of one year of work. The RRM differs from FTE since it does not calculate workload for a specific position but is an aggregate of the workload required by several types of positions to perform a set of generally described functions and services associated with direct work and administrative functions in an Area DEHS program. RRM is a measure of the workload by staff and location that may include Environmental Health Specialists, Environmental Health Officers, Injury Prevention Specialists, Institutional Environmental Health

Specialists, Environmental Health Technicians, and administrative staff.

Determination of the Total DEHS Workload

The workload is defined in terms of work-days (A.K.A. person-days) needed to complete the program functions and services like environmental health surveys and is then converted to work-years. The DEHS data system (WebEHRS) provides real time access to the national RRM, includes an inventory of facilities served by IHS and tribal environmental health programs, and identifies each facility type’s associated work-day factor. The WebEHRS data system is designed to calculate the RRM based on the number of facilities in each facility type and the work-day factor associated with each facility in addition to other factors included in specific portions of the RRM. For example, other factors included in the Injury Prevention formula

(Appendix VI) and supplied by the Indian Health Service’s Office of Public Health Support through the Division of Program Statistics include user population and age-adjusted unintentional injury mortality rates.

ENVIRONMENTAL HEALTH SERVICES PROGRAM COMPONENTS

General Environmental Health RRM

The GEH RRM is based on the number of each facility type and the work-day factor associated with each facility type. Facility types and their associated work-day factors are defined in the

Facility Type Definitions attached as Appendix VII. The GEH RRM is maintained, tracked, and calculated using the WebEHRS data system.

Institutional Environmental Health Program RRM

The Institutional RRM calculation is a combination of Area and local services. There are some tasks that affect the Area-wide program and cannot be apportioned to individual facilities. For example, Area Office of Workers Compensation Programs (OWCP) Case Management team participation, emergency preparedness activities for the Area, data management activities, and new initiatives that result from regulatory changes contribute to workload. As a result, 40.5 days per year are allocated to the IEH Program Base at the Area Office level. Local services are tied directly to facility types and associated work-day factors. An inventory of the facilities, as well as the associated work-day factors, is maintained and calculated using the WebEHRS data system. The IEH RRM is described in detail in the memo entitled “Narrative Description of

Institutional Environmental Health Resource Requirement Methodology”. A copy of this memo is included as Appendix VIII.

Injury Prevention RRM

The Injury Prevention RRM is calculated based on excess injury mortality and user population for each IHS Area. The formula used to calculate the injury prevention RRM is called “The

60/40 Injury Prevention Formula” because it is weighted 60% towards User Population and 40% towards excess injury mortality. The IHS Area-specific injury mortality is calculated by the IHS

Division of Program Statistics and the U. S. injury mortality is calculated by the National Center for Health Statistics. Traditionally, IHS uses 10 person-days per 500 population to calculate the total person-days needed to provide comprehensive injury prevention services in communities. An explanation of the Injury Prevention RRM calculation is included in Appendix

VI.

Program Base RRM

The program base supports the delivery of the individual programs, functions, services, and activities to accomplish program budgeting, funding allocation and evaluation of the environmental health services program, activities not listed in the WebEHRS Facility Data

System and other non-RRM creditable functions. The Program Base is calculated as 26.5% of

Raw RRM + the IEH Program Base.

Administrative RRM

The administrative portion of RRM is intended to address the operational functions of the

Environmental Health Program. It is calculated based on percentage allowances of the

Combined Amount for training, travel, administrative time and office support staff. “COMBINED

AMOUNT” = (RAW RRM + PROGRAM BASE + INSTITUTIONAL PROGRAM BASE + IP RRM).

Training is equal to the COMBINED AMOUNT multiplied by 5 work days per year and divided by the total number of work days in a year (220). Travel is 10% of the COMBINED AMOUNT, administrative function is 25% of the COMBINED AMOUNT, and Office Support Staff is 20% of the COMBINED AMOUNT. The Administrative RRM Calculations are detailed in Appendix IX entitled “Administrative Amount Calculations”.

APPLICATION OF RRM

Application of the RRM varies by Area and is based on Area-specific formulas. At the

Headquarters level, allocation of resources for each Area is determined through the following process:

1. IHS Headquarters DEHS compiles and verifies the DEHS RRM data submitted by each

Area;

2. The DEHS RRM is submitted to the IHS Headquarters Office of Environmental Health &

Engineering (OEHE) Director;

3. The IHS Headquarters OEHE Director combines it with the Division of Sanitation

Facilities Construction (DSFC) RRM;

4. Area recurring amounts are adjusted by annual program increases based on the combined

RRM values.

5. The combined (DSFC & DEHS) RRM data, along with other factors, are used in calculating what proportion of the non-recurring funds for “workload adjustment” will go to each Area. This is done to minimize the potential impact of large fluctuations in workload.

Headquarters does not determine how much will go to DSFC or DEHS within an Area, but sends a total amount to the Area OEHE Associate Director so they can make that determination. Each

Area DEHS Director is encouraged to work with their Area OEHE Associate Director to determine their portion of the funding distribution from Headquarters.

SUMMARY

The Resource Requirement Methodology (RRM) and budget decisions directly impact the IHS

Area Division of Environmental Health Services programs and stakeholders since they ultimately contribute to program size and local budgets. DEHS program areas include General

Environmental Health, Institutional Environmental Health and Injury Prevention. DEHS staff workload allocations to any one IHS Area, District, or Service Unit are primarily a function of the number and type of facilities served, unintentional injury mortality data and user population.

FIGURES and DIAGRAMS

Congress

Health facilities appropriation

Environmental Health

Support Account

(funds area programs)

IHS

appropriation

Environmental Health Support Account

Funding Flow Wednesday, March 10 th , 2010

Figure 1-1: Environmental Health Support Account Funding Flow

EHS & SFC RRM

(and other factors)

EHSA Funds to Areas

(Recurring and Non-Recurring)

Area OEHE Directors determine EHS & SFC

Funds Distribution

Facilities and Environmental Health Support Line Item

(funds all OEHE activities)

EHS

WebEHRS

SFC

wSTARS

Combined

RRM

Allocation to

Areas

Environmental Health Support Account

Data Flow Wednesday, March 10 th , 2010

Figure 1-2: Environmental Health Support Account Data Flow

APPENDICES

Appendix I

DEFINITIONS

EHSA - Environmental Health Support Account. The account which funds each Area OEHE program.

Facility - An entity where environmental health services are provided.

Facility Types - Defined categories of facilities, some of which receive RRM credit, for which environmental health staff provide surveys and other services. Each facility type is assigned a recommended survey frequency and a workday factor based on an estimate of the amount of time it would take to conduct a survey and write a report for that facility.

Full-Time Equivalent – represents the work one full-time employee or a combination of part-time employees can complete in one year. One FTE position represents 2,080 working hours in a year.

IHS User Population - the number of American Indian/Alaska Native registrants who have had at least one “direct” or “contract” inpatient, ambulatory or dental visit within a defined 3-year time frame. If a registrant does not show any activity during the 3-year time frame, they will not be counted in the active user population.

Mortality rate – A rate calculated by dividing the number of deaths occurring in the population during the stated period of time by the number of persons at risk of dying during the period.

Raw RRM – The number of facilities multiplied times the work day factor associated with each specific facility.

RRM - Resource Requirement Methodology is a system designed to project the staffing needs based on workload for a specific primary service area.

WebEHRS – Web-based Environmental Health Reporting System is an internet-based system that allows tracking of RRM and non-RRM facilities; activities performed by Environmental Health staff; and reporting of these activities.

The Essential Public Health Services

The Essential Public Health Services provide the fundamental framework for the public health activities that should be undertaken in all communities. The Public Health Functions Steering Committee developed the Essential Services in 1994. This steering committee included representatives from US Public Health Service agencies and other major public health organizations. The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems.

1. Monitor health status to identify and solve community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships and action to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.

Appendix II

Table of Historical Laws

Date Cite Name Description 1787 The Constitution of the United States, Article 1, Section 8

The Congress shall have the power … to regulate commerce with foreign nations, and among states, and with Indian tribes.

The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes.

1924 Snyder Act Principle legislation authorizing Federal funds for health services to recognized Indian tribes.

Aug. 5, 1954 P.L. 83-568 Indian Health Transfer Act

Transferred Indian health responsibility from Department of Interior to the Public Health Service.

July 31, 1959 P.L. 86-121 (Section 7 of the Transfer Act

Indian Sanitation Facilities Act

Authorizing legislation for the SFC program.

Jan. 4, 1975 P.L. 93-638, as amended

Indian Self- Determination and Educational Assistance Act

Authorizes Indian Self-Determination and Self- Governance

Sept. 30, 1976 P.L. 94-437, as amended

Indian Health Care Improvement Act

Implement Federal responsibility for care and education of Indian people by raising the health status of Indians to the highest possible level.

Oct. 5, 1988 P.L. 100-472, Title II, Sec. 209; added Title III of P.L. 93-

Tribal Self- Governance Demonstration Project

Allowed tribes to negotiate a compact with BIA for programs they want to operate.

Appendix III

Nov. 23, 1988 P.L. 100-713, Title III, Sec. 302; amend P.L. 94-437

Indian Health Care Amendments of

Congress reaffirms the primary authority of the IHS to provide sanitation facilities and services under P.L.

86-121. Replaced the language of Sec.

302 to the current version; mandated sanitation deficiency levels.

Oct. 25, 1994 P.L. 103-413,Title II, Sec. 201;

amended P.L. 93-

Indian Self- Determination Act Amendments of 1994; Tribal Self- Governance Act of

Made Self- Governance permanent for Department of Interior.

(c)

HQ

Line

(a) (b)

Activity Description Actual Avail106a1 Negotiated

Base Thru

AREA

Share Factor

HEADQUARTERS - Facilities Appropriation

Negot Base Thru

Current Funds Manager: Serv Type:

(d) (e) (f) (g) (h) (i) (j) (k) (m)(l)

Possible SG Tribe or Org:

Tribes Served:

Comments:

For Fiscal Year:

Actual Av 106a Calcul

Table 4F Estimated Area and Headquarters Facilities Appropriation Funds for FY 2011 SD/SG Negotiations

FY2010 FY2010FY2011 FY2011 FY2011 FY2011 FY2011

Routine M&I IHS owned Facility

Subtotal Non-base (26)

Routine M&I Tribally owned Facility Project M&I IHS owned Facility Project M&I Tribally owned Facility

Subtotal base (26)

HQ Real Property(based on net # of bldgs transferred to tribe) (29) a b a b c d a b c d a b a b

Available with line 2300

Maintenance and Improvement (M&I)(2100)

M&I Environmental Remediation Projects Sanitation Facilities (P.L. 86-121 Projs) (00) Health Care Facilities (NEW) (00)

San Fac Constr (SFC) Support - Proj Related AO SFC Program Mgmt - Proj Related SFC Support - Non-project Related AO SFC Program Management-Non-project Related Other:

Subtotal Non-Base (27) Subtotal Base (27)

Subtot HQ-OEHE Support -SFC Non-Base (29) Subtotal HQ-OEHE Support -SFC Base (29) Total HQ-OEHE Support - SFC Related (29)

Environ Health Support Account (EHSA) Facilities and Environ Health Support (2400)

Environ Health Services - Basic Program Environ Health Services - Institutional Hlth Environ Health Services - Injury Prevention AO Environmental Health Services Support Other:

Subtotal Non-Base (27) Subtotal Base (27)

Subtot HQ-OEHE Support EHS Non-Base (29) Subtotal HQ-OEHE Support EHS Base (29) Total HQ-OEHE Support - EHS Related (29)

Facilities Support Account (FSA) Service Unit Operations Biomedical AO FSA Support AO Real Property Support AO Biomedical Program M&I Engineering Support Other:

Total FSA (28) HQ Facilities and Real Property Support

Total HQ - OEHE Support - FSA Related (29)

Engineering Services Support M&I Contracting Services (29) New Health Care Facilities (29)

Equipment Replacement (01) TOTAL Facilities and Environ Support (29)

Total M&I (26) Calculated on line 2405a Available with accepted proposal

With line item construction project

Available with line 2300

Available through amendment process

Facilities Planning and Construction Support d:ver:h

SubTotal (Non-Base) SubTotal (Base Budget Pilot

GRAND TOTA

Page 1 of 1Print Date: 7/29/2009 Updated by:Last Update:

ktaylor Typewritten Text Appendix IV ktaylor

Appendix V

I.P. - RRM

131.7 TOTAL PERSON-YRS FOR ALL IHS

60-40

FORMULA

IHS POPULATIONAGE-ADJUSTED EXCESS NUMBER MORTALITY TOTAL FY 10 A IHS DEHS

AREA RRM IHS Unintentiona MORTALITY OF RRM IHS DEHS IHS DEHS R IP RRM

IHS USER FACTOR MORTALITY RATE EXCESS FACTOR IP RRM IP RRM E [Person Days] AREA POP [Person Days] RATE IHS-US DEATHS [Person Days]Person DaysPerson YRS A

FY 06 [99 - 01]* [US=35.5] [ = LINE 35 ]

ABERDEEN 118,347 1420.2 114.4 78.9 93.4 1217.9 2638.0 11.99 AB 2638.0

ALASKA 130,682 1568.2 124.4 88.9 116.2 1515.3 3083.4 14.02 AK 3083.4

ALBUQUERQU 86,504 1038.0 73.8 38.3 33.1 432.1 1470.2 6.68 AL 1470.2

BEMIDJI 98,825 1185.9 108.8 73.3 72.4 944.8 2130.7 9.69 BE 2130.7

BILLINGS 70,384 844.6 132.9 97.4 68.6 894.1 1738.7 7.90 BI 1738.7

CALIFORNIA 74,248 891.0 43.9 8.4 6.2 81.3 972.3 4.42 CA 972.3

NASHVILLE 47,379 568.5 38.8 3.3 1.6 20.4 588.9 2.68 NS 588.9

NAVAJO 236,893 2842.7 131.6 96.1 227.7 2969.2 5812.0 26.42 NV 5812.0

OKLAHOMA 309,542 3714.5 75.0 39.5 122.3 1594.7 5309.2 24.13 OK 5309.2

PHOENIX 150,886 1810.6 99.3 63.8 96.3 1255.6 3066.2 13.94 PH 3066.2

PORTLAND 100,395 1204.7 69.0 33.5 33.6 438.7 1643.4 7.47 PO 1643.4

TUCSON 24,164 290.0 105.9 70.4 17.0 221.9 511.8 2.33 TU 511.8

TOTAL 1,448,249 17379.0 888.3 11586.0 28965.0 131.66

TOTAL Person Days NEEDED (10 PD/500 POP): 28965.0 = Total Population from above X 10 PD/500 Pop

POPULATION RRM FACTOR (60%): 17379.0 Person Days 60 % OF TOTAL Person D 28965.0 X .60

MORTALITY RRM FACTOR (40%): 11586.0 Person Days 40 % OF TOTAL Person D 28965.0 X .40

* FOOTNOTES SEE PAGE 2 FOR EXPLANTIONS OF THE ABOVE COLUMNS AND HOW THEY WERE DERIVED ktaylor Typewritten Text Appendix VI ktaylor Typewritten Text

FY08 IHS/OEHE/DEHS INJURY PREVENTION RRM (LINE 35) BASED ON 60/40 IP FORMULA ................................................... PAGE 2 OF 2

HOW THE 60/40 FORMULA BREAKS DOWN:

TOTAL Person Days (PD) NEEDED = TOTAL IHS USER POPULATION MULTIPLIED BY 10 PD DIVIDED BY 500 POP

POPULATION RRM FACTOR (60%) = .60 MULTIPLIED BY THE TOTAL Person Days NEEDED REPORTED IN PD

MORTALITY RRM FACTOR (40%) = .40 MULTIPLIED BY THE TOTAL Person Days NEEDED REPORTED IN PD

WHAT EACH COLUMN REPRESENTS:

AREA USER POP = SOURCE: AREA'S USER POPULATION = ESTIMATES BY AREA - FY 2006, IHS/OPHS/DPS, 02/09/07

POPULATION RRM FACTOR = (USER POP) DIVIDED BY (500 POP) MULTIPLIED BY (6 Person Days)

IHS MORTALITY RATE = SOURCE: REGIONAL DIFFERENCES IN INDIAN HEALTH, CY 1999 - 2001, Pre-pub data, Age-adjusted Unintentional Injury Mortality Rates for CY99-01 -adjusted to compensate for miscoding of Indian race on death certificates

EXCESS MORTALITY = (AREA MORTALITY RATE) MINUS (THE US RATE) = 35.5 [ AS OF 2000]

NUMBER OF EXCESS DEATHS = (EXCESS MORTALITY) DIVIDED BY (100,000) , MULTIPLIED BY (USER POP)

MORTALITY RRM FACTOR = (NUMBER OF EXCESS DEATHS) DIVIDED BY (IHS TOTAL NUMBER OF EXCESS DEATHS)

MULTIPLIED BY (TOTAL MORTALITY RRM FACTOR)

TOTAL IP RRM = (POP RRM FACTOR) ADDED TO (THE MORTALITY RRM FACTOR)

FY 10 IP RRM= TOTAL Person Days= This equals Facility Type 35 in WebEHRS

FY 10 IP RRM = TOTAL Person Years

Facility Type Definitions

Document Generated on 07/02/2009 at 3:21:51 PM Eastern Time

Fac.

Type Fac. Description

Surv.

Freq.

WorkDay

Factor Definition

01 Comprehensive Health Care

Referral Facility

12 24.75 An IHS or Tribally operated medical facility that

Includes more comprehensive health services and incorporates more medical specialists than a general hospital, has been designated as a referral center for Service Units in that Area.

Includes Only: Alaska Native Medical Center, Phoenix Indian Medical Center, Gallup Indian Medical Center

02.1 Hospital w/ Surgery w/ DEHS

Funded Safety Officer

12 109.20 An IHS or Tribally operated medical facility:

Contains inpatient beds, Organized staff including physician services, Continuous 24-hour per day nursing services

24-hour diagnosis and treatment services for patients.

Routinely provides scheduled surgical services, rather than just in an emergency situation before transporting to another hospital.

Surgical services includes routine obstetric /delivery care with cesarean section.

The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a staff member funded by DEHS (Environmental Health Support

Account).

Note: The person with the title of “Safety Officer” is funded through the Environmental Health Support Account.

02.2 Hospital w/ Surgery and No

DEHS Funded Safety Officer

12 24.70 An IHS or Tribally operated medical facility:

Contains inpatient beds, Organized staff including physician services, Continuous 24-hour per day nursing services

24-hour diagnosis and treatment services for patients.

Routinely provides scheduled surgical services, rather than just in an emergency situation before transporting to another hospital.

Surgical services includes routine obstetric /delivery care with cesarean section.

The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a position that is not funded by DEHS (Environmental Health

Support Account).

Note: The Environmental Health program does not fund the Safety Officer position. Someone else has been hired or designated to do the work.

02.3 Hospital w/o Surgery /w DEHS

Funded Safety Officer

12 95.90 An IHS or Tribally operated medical facility:

Contains inpatient beds, Organized staff including physician services, Continuous 24-hour per day nursing services, and diagnosis and treatment for patients.

24-hour diagnosis and treatment services for patients.

Does not routinely provide scheduled surgical services, Does not routinely provide obstetrical/delivery care with cesarean sections.

The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a staff member funded by DEHS (Environmental Health Support

Account).

Note: The person with the title of “Safety Officer” is funded through the Environmental Health Support Account.

02.4 Hospital w/o Surgery w/ no

DEHS Funded Safety Officer

12 21.90 An IHS or Tribally operated medical facility:

Contains inpatient beds, Organized staff including physician services, Continuous 24-hour per day nursing services, and diagnosis and treatment for patients.

24-hour diagnosis and treatment services for patients.

Does not routinely provide scheduled surgical services, Does not routinely provide obstetrical/delivery care with cesarean sections. The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a position that is not funded by DEHS (Environmental Health Support Account).

Note: The Environmental Health program does not fund the Safety Officer position. Someone else has been hired or designated to do the work.

03.1 Health Center w/ DEHS Funded

Safety Officer

12 64.80 An IHS or tribally operated medical facility:

Staffed with a basic health care team (e.g., a combination of physician, dental, nursing services, etc.), Offering services at least 40 hours per week

Treatment provided for acute and chronic ambulatory problems, Facility meets the requirements of an Ambulatory Health Care Center or Business Occupancy as defined in the National Fire Protection Association's

(NFPA) Life Safety Code.

The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a staff member funded by DEHS (Environmental Health Support

Account).

Note: The person with the title of “Safety Officer” is funded through the Environmental Health Support Account.

03.2 Health Center w/ no DEHS

Funded Safety Officer

12 13.00 An IHS or tribally operated medical facility:

Staffed with a basic health care team (e.g., a combination of physician, dental, nursing services, etc.), Offering services at least 40 hours per week, Treatment provided for acute and chronic ambulatory problems, Facility meets the requirements of an Ambulatory Health Care Center or Business Occupancy as defined in the National Fire Protection Association's

(NFPA) Life Safety Code.

The facility safety officer/safety management responsibilities are fulfilled full-time or part-time by a position that is not funded by DEHS (Environmental Health

Support Account).

Note: The Environmental Health program does not fund the Safety Officer position. Someone else has been hired or designated to do the work.

ktaylor

Appendix VII

04 School Health Center 12 0.40 An IHS or tribally operated medical facility:

Staffed with a basic health care team (e.g., a combination of physician, dental, nursing services, etc.), Offering services at least 40 hours per week

Treatment provided for acute and chronic ambulatory problems, Facility meets the requirements of an Ambulatory Health Care Center as defined in the National Fire Protection Association's (NFPA) Life Safety Code, Facility is located on a School campus, Primarily serves students.

05 Health Station 12 6.15 An IHS or tribally operated medical facility:

Physically and geographically separated and functionally distinct from a hospital or health center, one or more clinical treatment services (e.g. physician, dentist, nursing, etc.) are available on a regularly scheduled basis but, Operates less than 40 hours per week .

The facilities should meet the requirements of a Business Occupancy in NFPA'S Life Safety Code.

Includes: Self-contained mobile units

06 Dental Health Station 12 1.80 An IHS or tribally operated facility:

Physically and geographically separated, and functionally different from a hospital or health center;

Containing dental operatories where dental clinical treatment services are available on a regularly scheduled basis.

Excludes: Dental clinics on the campus of a Comprehensive Health Care Facility, Hospital, or Health Center, but in a physically separate structure, i.e: The Dental

Clinic trailer at a hospital.

Includes: Dental Health Stations that are stand-alone facilities in a geographically and administratively separate location from all other health care services. Includes

Dental Facilities associated with Health Stations (05). Mobile

07 Dialysis Unit 12 2.00 A medical unit whether part of a health care facility or not, which provides outpatient dialysis services to patients.

Includes: Contract dialysis facilities located in communities.

Clarification: Facilities cannot be counted if they are included in a state or other party’s workload. IHS must have primary responsibility or a Tribal request to survey for these facilities to be counted.

08 Nursing Care Facility 12 6.50 A facility, however named:

Designed, equipped, and staffed for the care of individuals who may not be in need of hospital care, Provides skilled or intermediate nursing services, Nursing services are available 24 hours a day.

09 X-Ray Unit, Medical 12 1.99 A single tube head operable from a single control panel that may control more than one tube head.

10 X-Ray Unit, Dental 24 0.23 A single tube head operable from a single control panel that may control more than one tube head.

11 X-Ray Unit, Mammographic 12 2.73 A single tube head operable from a single control panel that may control more than one tube head. If the IHS staff is certified for these inspections and performs them, these facilities may be counted.

12 Custodial/Residential Care

Facility

12 3.50 A facility, however named:

Designed, equipped, staffed, and operated for the care of individuals not requiring hospital or nursing care;

Patients in need of custodial or residential care and assistance with the essential activities of everyday living in a protected environment, but not in need of daily nursing care.

Includes: Senior Citizen Residential Care Home, Children's Home, Orphanage, Home for the abused or handicapped.

Excludes: Nursing Home, see Facility Type 08 .

13 Substance Abuse Rehabilitation

Center

12 1.25 A IHS or tribally operated facility:

Physically and geographically separated, and organizationally independent from a hospital or health center;

Provides substance abuse treatment services on an in-patient or out-patient basis, Includes:

Social Detoxification Unit

A facility where individuals who are under the influence of alcohol/drugs are admitted for undergoing treatment for withdrawal not requiring medical attention.

Medical Detoxification Unit

A facility for individuals under the influence of alcohol/drugs who have concurrent health problems which require immediate medical attention.

Drop-In Center

A 40 hour per week, nonmedical, nonresidential facility where individuals admit themselves for the purpose of receiving nourishment, temporary shelter, and first aid.

Halfway House

A nonmedical, residential treatment facility where individuals who have been detoxified and require a moderately structured non-permanent living arrangement are admitted.

Excludes: Substance abuse services provided as component of a health care system, such as a detox unit in a hospital, a substance abuse treatment program at a clinic or other business occupancies.

14 Foster Care Homes 12 0.50 A licensed or tribally approved/permitted residential home providing care for a foster child or adult in a family setting, for which Indian Health Service/Tribe has primary survey responsibility. To be listed in the FDS under this facility code, the home must be licensed by the tribe and have been in operation for at least two years. It must also be a facility where DEHS or the Tribal EHS performs the survey on a regular basis.

15.1 Summer Youth Camp 12 3.50 A facility, under the jurisdiction or primacy of the tribe, used on a seasonal basis, equipped and staffed to accommodate children for short periods of time.

Facilities surveyed should be primary responsibility of tribe and /or Indian Health Service.

15.2 Migrant Labor Camp 12 3.50 A facility, under the jurisdiction or primacy of the tribe, used on a seasonal basis, equipped and staffed to accommodate migrant laborers for short periods of time.

Facilities surveyed should be primary responsibility of tribe and /or Indian Health Service.

16 Jail, Detention Home 12 3.30 A building or group of buildings for the confinement of persons in lawful custody. Facility should be under tribal or BIA jurisdiction with survey responsibility by

Tribe, BIA and/or Indian Health Service.

20 School (Public, BIA, Tribal) 12 4.00 A primary, secondary, higher education or vocational institution that offers instruction to children or adults. This includes tribal, BIA, public, and private schools in which Indian Health Service/Tribe has primary responsibility for conducting surveys. The facility shall be solely dedicated to education. This does not include tutoring classes or computer training classes held in a community building.

21 Dormitory 12 3.50 A building (residence hall) or group of buildings (campus) used to house students attending school.

Clarification: Several buildings equal one facility on the FDS.

22.1 Head Start 12 2.75 A school conducted for children, ages 0 to 5 years of age, which has been awarded a grant to operate a Head Start and/or an Early Head Start program. The school is awarded the grant through the Head Start Bureau’s American Indian-Alaska Native Program Branch (AI-ANPB), or the Migrant and Seasonal Program Branch, or by one of the Administration for Children and Family Services (ACF) Regional Offices.

Clarification: Head Starts will be counted separately if they are separated by physical distance. They must also be under separate management and kitchen services, not merely separate classrooms.

22.2 Preschool, Kindergarten 12 2.75 A school conducted for children ages 3 months to 5 years of age. Shall include kindergartens not attached to or operated as part of a school as defined under Facility

Type #20.

23 Day-care Center, Nursery 12 3.00 A licensed, independent, facility or unit designed, equipped and staffed for the care of clients needing custodial care.

Clarification: This does not include facilities where individuals live at the facility.

26 Community Water System 12 4.50 A public water system which has at least 15 service connections or regularly serves at least 25 people a minimum of 60 days out of the calendar year. Includes

BIA and Indian Health Service operated systems. (Includes source, treatment, storage, and distribution). The Tribe, Indian Health Service or EPA has primary survey responsibility.

27 Community Water Distribution

System

12 2.25 A public water system that is limited to distribution only and is dependent upon a source from and under separate jurisdiction.

28 Community Liquid-waste

Disposal System

12 2.00 A public sewage collection, treatment and disposal system that serves at least 15 service connections or regularly serves at least 25 people a minimum of 60 days out of the calendar year. Includes BIA and Indian Health Service operated systems. The Tribe, Indian Health Service, or EPA has primary survey responsibility.

29 Community Liquid-waste

Collection System

12 1.00 A public sewage collection system that is dependent upon a separate entity for treatment and final disposal of sewage.

30 Community Solid-waste

Collection/Disposal System

12 1.50 A system for collection, removal, and disposal/recycling of solid waste from home or communities. System must include either disposal on the reservation or a system of solid waste transfer stations, and should include routine operation and maintenance. The system should be under the primary survey responsibility of the

Tribe or Indian Health Service.

31 O & M Organization 12 3.10 An established, active tribally supported group having the responsibility and authority to operate, manage, and maintain sanitation facilities (water, wastewater, and solid waste).

32.1 Trailer Park 12 1.50 A parcel (or contiguous parcels) of land which has been so designed and improved that it contains five or more mobile home lots available to the general public for rent and the placement thereon of mobile homes for occupancy.

32.2 Motel/Hotel 12 1.50 A building or group of buildings used as a facility in which rooms are rented and meets the appropriate NFPA Life Safety Code definition.

33 Barber/Beauty Shop 12 0.75 A business to render services for cutting and dressing hair, body piercing, body tattooing or nail care. Tanning salons and massage parlors are included in this definition.

34 Industrial or Manufacturing

Establishment

12 3.00 A manufacturing or industrial operation where chemical or biological processes are conducted that may be hazardous to the health of workers or the public, requiring routine industrial hygiene surveillance activities. This definition does not apply to Agricultural operations, ranches, farms, maintenance shops, garages, auto shops, gas stations. The intent of this definition is not to include all facilities that are under jurisdiction of OSHA.

35 Injury Prevention 10

MD/500-User Population)

0 0.00 A comprehensive public health program which addresses epidemiology, surveillance, intervention, and evaluation of injuries. All injury prevention program activities are to be reported under this premise code.

42 Bakery, Cannery, Bottling 6 2.50 A commercial establishment or operation processing and/or packaging raw food products for human consumption off the premises. Facility type shall include bakery operations and meat market/butchers with cutting or grinding machines in grocery stores and water bottling plants. Also included under this facility type are stand-alone meat markets/butchers. Indian Health Service or the Tribe has primary survey responsibility.

43 Slaughter House, Fish-processing Plant

6 2.50 A commercial establishment or operation processing and/or packaging raw animal or fish products for human consumption off the premises. Indian Health Service, USDA or the Tribe has primary survey responsibility. Meat Markets located in grocery stores are not included under this definition. They are included under facility type 42.

44 Senior Citizens' Center 12 2.25 A non-residential facility which is designated, equipped, and staffed to provide social and physical activities and nutritional feeding programs to senior citizens. A center under this facility type includes the elderly nutrition food service.

Food service primarily for use by the Senior program should be coded under Facility Type #80.

Food service operated regularly by other programs (bingo players) independently of the Senior program code food service under Facility Type #47.

45 Food Warehouse 6 3.00 A free-standing, independently operated warehouse used to receive, store, and dispense food including surplus commodities. Include food warehouses that serve casinos in addition to serving other facilities in the community.

46 Trading Post, Grocery, Convenience Store

6 1.00 Any establishment or section of an establishment where food and food products are offered to the consumer and intended for off premise consumption. This does not include facilities that serve only pre-packaged, non-potentially hazardous foods as defined by the most recent FDA Food Code. Meat markets with cutting and grinding machines and bakeries within groceries are listed in Facility Type 42. Delicatessens within groceries are included in Facility Type 47.

47 Cafe/Restaurant 6 2.50 Any place where food is prepared and intended for individual portion service, and includes the site at which individual portions are provided. The term includes any such place regardless of whether consumption is on or off the premises and regardless of whether there is a charge for the food. The term includes delicatessens within grocery stores or stand-alone, that offer prepared food in individual service portions. Excludes private homes.

48 Bar 6 1.00 Any independently operating establishment serving alcoholic beverages by the drink to the public for consumption on the premises. Include bars that are located within any other facility listed on FDS that can operate independently of that facility. Separate entrance or a bar attached to casino. Waitress stations serving water, coffee, carbonated beverages are not included.

49 Bingo Parlor / Gaming Facility 12 2.50 A commercial establishment providing frequent, regularly scheduled games of chance for the public (such as bingo, poker, slot machines) and providing sanitation facilities and requiring life safety code monitoring. Church bingo operations held on a regularly scheduled basis (once per month, once per week) do not meet this definition. Bars, hotels, and/or restaurants located in casinos should be listed separately as facility types 48, 32.2, and 47, respectively).

50 Community Building, Chapter

House

12 1.80 A structure only used as a public meeting place or for group related activities and possessing food preparation facilities. Senior Citizens Centers that are used for this purpose are accounted for under #44. Not to be listed as a Community Building as well as Sr. Citizens Center.

55 Swimming Pool 12 2.80 A body of water contained in an impervious structure of such size in relation to the bathing load that the quality and quantity of the water confined must be mechanically controlled for the purpose of filtration and disinfection. Pools/Spas on independent mechanical systems are considered separate facilities. One pool and one spa operating mechanically independent would constitute 2 facility type #55.

56 Campground 12 1.00 A land site designated as a campground for overnight occupancy and has water and/or wastewater and solid waste disposal facilities to accommodate motor homes, travel trailers, vans, tents, etc. A natural swimming area is included as part of a campground not a separate facility. Multiple campsites are coded as one campground.

57 Recreation Area 12 0.50 A land site designated as a recreation area used primarily for picnicking or recreational activities but no overnight occupancy. The land site must provide water and/or wastewater and solid waste facilities.

58 Celebration/Fair 12 2.25 A regularly scheduled tribally or commercially sponsored event providing food service, wastewater, and solid waste facilities.

Facility Type Definitions - Non RRM Creditable

Non RRM Items Fac.

Type Fac. Description

Surv.

Freq.

WorkDay

Factor Definition

60 Rabies Clinics 0 0.00 A fixed site where annual rabies vaccinations are offered.

61 Itinerant Food Vendors 0 0.00 A food service establishment which operates on a temporary/seasonal basis and may operate at a fixed location or from a mobile unit.

62 Epidemiological

Investigations

0 0.00 The investigation of the occurrence in a community or region of a group of illnesses (or an outbreak) of a similar nature which are clearly in excess of a normal expectancy and derived from a common or a propagated source.

63 EHS Projects 0 0.00 A narrowly defined, programmatic area of environmental health activity, over and above routine implementation of Chapter 11 or other EHSB guidelines; which must include formal documentation by means of a narrative description or summary that, at a minimum, contains the following:

description of the problem or activity; 1.

justification of the project; 2.

scope of work for the project; 3.

defined budget; 4.

evaluation component; 5.

a final narrative report. As a rule of thumb, a proposed EHS project should require a minimum of 80 person hours to justify a project designation.6.

65 Area Specific 0 0.00 Billings

66.01 Tucson IEH Activities 0 0.00 IEH Activities provided by the Phoenix area for the Tucson area.

70 Area Specific 0 0.00 Billings

75 Area Specific 0 0.00 Billings

80 Food Service

Operations

6 0.00

81 Area Specific 0 0.00 Nash

81.01 Shawnee, OK Well Data 0 0.00

81.02 Abq - WNV 0 0.00 Albuquerque West Nile Virus Geospatial Data

81.03 Abq - Open Dump Sites 0 0.00 Albuquerque Open Dump Sites Data

81.04 Abq - UST Sites 0 0.00 Albuquerque Underground Storage Tank Data

81.05 Abq - TWS 0 0.00 Albuquerque Traditional Water Source

81.06 Abq - HEA 0 0.00 Albuquerque Home Environmental Assessment

82 Area Specific 0 0.00 Nash, Abq

83 Area Specific 0 0.00 Port

84 Area Specific 0 0.00 Nash

85 Area Specific 0 0.00 Nash, Abq

86 Multi-Purpose Bldg 12 0.00

87 Public Bldg/Safety

Audit

12 0.00

88 Area Specific 0 0.00 Nash, Abq

89 Area Specific 0 0.00 Abq

90 Area Specific 0 0.00

91 Area Specific 0 0.00 Alaska

92 Area Specific 0 0.00 Nash, Abq

93 Community Profile 12 0.00

94 Area Specific 0 0.00 Nash

95 Area Specific (Animal

Bites)

0 0.00 OK - Animal Bites

96 Area Specific 0 0.00 Abq

97 Area Specific 0 0.00 Abq

98.01 Fire Station 0 0.00

98.02 Police Station 0 0.00

98.03 Shelter (Tornado, Fallout, etc.)

0 0.00

98.04 Haz. Material Location 0 0.00

98.05 Abandoned Well 0 0.00

99 Area Specific 0 0.00 Nashville -

Portland -

Oklahoma - correspondence

Tucson -

99.91 Field Office 0 0.00

99.92 District Office 0 0.00

99.93 Area Office 0 0.00

99.94 HQ Office 0 0.00

99.95 Supply Center 0 0.00

99.96 Office Building 0 0.00

TO: The Record

FROM: Director, Division of Environmental Health Services

SUBJECT: Narrative Description of Institutional Environmental Health Resource Requirement Methodology

DATE: June 21, 2001

In July 1997, the Institutional Environmental Health (IEH) Resource Requirement Methodology (IEHRRM) Workgroup began development of a proposed revision of the IEHRRM. This revision was necessary because the previous IEH RRM was based primarily on the time necessary to complete comprehensive environmental health surveys. Changes in program emphases brought about by legislative mandates and accreditation standards necessitated a move away from these surveys several years in favor of more focused issue-specific assessments and interventions. Current IEH activities go beyond simple surveillance and data collection. A comprehensive approach was needed that includes anticipation, recognition, and evaluation of environmental hazards, and most importantly, development of effective intervention strategies. (See the attached description of these concepts.) In addition to the above four concepts, it is often necessary to monitor the effectiveness of an intervention for a period of time. The proposal was finally submitted to the Director, Division of Environmental Health Services (DEHS) in the fall of 1998. The proposed revisions were presented with two implementation options:

• Option 1 awarded total credit for IEH workload regardless of who in the facility actually provided the services. This option would increase the total DEHS RRM by approximately 27% and the DEHS share of the total RRM by approximately 9%.

• The Workgroup recognized that the Associate Directors may not be willing to accept increasing the DEHS share of the total RRM by such a significant portion in one year, so they offered a second option that only awarded full RRM credit if the IEH work was done by staff paid from the Facilities and Environmental Health Support Account (FEHSA). If the Facility Safety Officer was paid from non-FEHSA funds, no RRM credit was awarded.

The Director, DEHS presented the two options to the Associate Directors in the fall of 1998.