Attachment A - 2023 SAP APPLICATION (Fallon Paiute Shoshone Tribe).pdf

APPLICATION COVER SHEET

INDIAN HEALTH SERVICE

FY 2023 SMALL AMBULATORY PROGRAM

FALLON PAIUTE SHOSHONE TRIBE

NOVEMBER 10, 2023

TABLE OF CONTENTS

Section A. Applicant’s Administrative Information Completed Online: http://new.grantreviewinfo.net/content/fiscal-years-2022-2023-ihs-small-ambulatory-program

Section B. Applicant’s Eligibility Determination Completed Online: http://new.grantreviewinfo.net/content/2022and2023-ihs-small-ambulatory-program-application

Section C. Technical Proposal

1. Project Title

2. Location of Project

3. Type of Project

4. Description of Health Care Programs and Services

5. Description of Proposed Project

6. Current Health Facility Location ……………………………………………………………………………………….….. 6

7. New Health Facility Location ……………………………………………………………………………………………..…. 6

8. FTHC Service Area ..………………………………………………………………………………………………………….…… 7

9. Project Business Plan

10. Funding Plan ..……………………………………………………………………………………………………………………. 12

11. Need for Project Calculation

12. Delivery Capability Brief

13. Construction Capability Brief

14. Applicant Financial Contribution Brief

15. Signature

Attachments A. Auditor’s Summary of Findings of last Single Agency Audit B. Tribe’s Balance Sheet C. Project Administration Organization Chart D. Location and Site Maps …………………………………………………………………………………………….……………28 E. Space List …………………………………………………………………………………………………………………….…..…….29 F. HSP User Population Report ..………………………………………………………………………….……………..…….. 30 G. HSP Building Area Summary …………………………………………………………………………..…………….………. 35 H. Tribal Resolution I. Application Checklist …………………………………………………………………………………………..….……………... 39 J. Applicable IHS Area Approval Letter

Section C Technical Proposal

1. Project Title.

Fallon Tribal Health Center Replacement Project

2. Location of Project

Williams Avenue/Sherman Street, Fallon, Churchill County, Nevada

Geographical Coordinates: 39.478391, -118.768022

Service Area: The Fallon Tribal Health Center serves Native Americans, primarily, from Churchill, Lander, Lyon, Nye, and Humboldt counties. See Attachment E. Comparing HSP data to the health Center’s EHR, the User Populations include: Churchill (100%); Lyon (5%) Pershing (100%); Lander (100%); Nye County (52%), Humboldt (25%).

3. Type of Project

(a) Construction of a Replacement Facility

4. Description of Health Care Program and Services:

The FTHC is a full-service clinic providing a variety of health and wellness services and programs:

family medicine, behavioral health services, moderate, complex and CLIA waived laboratory services, dental care for children and adults, pharmacy, optometry and ophthalmology, chiropractic, podiatry, nutrition, diabetes care, Joslin Vision Network screenings for retinopathy and injury prevention services.

The most significant limiting factor to delivering additional services, and bolstering existing services, is the lack of space. As of September 7, 2023, Patient Scheduling’s first opening to see a dentist is in 104 days, patients seeing the podiatrist would need to wait 99 days. According to the Phoenix Area Indian Health Service Area Health Services Master Plan, the total growth from CY2019 to CY2035 will be 68%, from 1,411 patients to 2,373. Additional Current programs and services as well as planned programs and services are described below, current services/programs are listed first and planned services/programs follow:

Medical, current: The FTHC offers treatment to patients with two full-time physicians, one full-time nurse practitioners (NP), and one part-time NP, along with a number of support staff (medical assistants and registered nurses). There is also an on-site laboratory that provides moderate, complex and CLIA waived laboratory services. Chiropractic clinics occur once a week and podiatry clinics occur once per month.

o Medical, planned: Internal Medicine, Pediatrics, Dialysis, Telemedicine, Cardiology, Physical Therapy and Radiography. New services were identified by health center staff based on the number of referrals made to outside providers, elevated rates of affliction within the Service Population and/or a geographical shortage of available care. FTHC priorities are reflected in the Phoenix Area Indian Health Service Area Health Services Master Plan.

Optical, current: The FTHC provides optometrist services five days per week for patients which includes regular eye exams along with eye glass, frames, and contact lens ordering services.

Specialized services including Joslin Vision Network (JVN) exams for diabetic treatment and optomap imaging. Additionally, on quarterly basis, an ophthalmologist provider on-site services in the optical suite.

o Optical, planned: Under this area, the new facility would enable optical to add additional exam space and increase the size of their fitting and display area which is currently limited in size. The current optical suite is comprised of two exam rooms, one JVN/Optomap room, and a sitting area with a fitting and display station which equals to about 460 sq. ft. The new facility program would more than double its size.

Behavioral Health, curren: The FTHC provides mental health and substance abuse treatment and counseling services. There is a psychologist and a psychiatrist that is onsite 2-3 times a week, a child psychologist twice a month, two full-time substance abuse counselors, two family therapists, a family support coordinator, and a behavioral health assistant. The substance abuse program is currently housed in a remodeled building that the Tribe obtained from the U.S. Navy when it disposed of old residential buildings (built in the1940’s). The building houses two substance abuse counselors, two family therapists, a family support coordinator and a behavioral health assistant.

o Behavioral Health, planned: the new facility will enable the FTHC to house Behavioral Health in the same building as other services, with more room for offices, and a communal space to facilitate support groups and community meetings. Being located in a central location will help patients physically navigate their continuum of care.

Additionally, a functioning reception area will help ensure patient privacy and prevent distressed patients from accessing sensitive areas.

Dental, current: The FTHC has one full-time dentist to provide dental treatment for regular exams and for acute services that arise. The dentist is assisted by two dental assistants. There is also one full-time hygienist and one part-time hygienist to provide regular patient cleanings and screenings for oral diseases. The current wait time to see a dentist is more than one hundred days.

o Dental, planned: As is the case with virtually all departments, the main limiting factor to increased dental capacity is space. The new facility would double the size of the current department.

Pharmacy, current: The FTHC has a full-time pharmacy staff with two pharmacists and four technicians. The pharmacy fills all prescriptions from licensed providers from medical, dental, optical, and behavioral health.

o Pharmacy, planned: As outlined in the IHS Phoenix Area Master Plan, the number of patients requiring prescriptions will increase by 68% by the year 2035. Additional space and personnel will be required to maintain the current level of service that patients experience. Greater privacy will also be afforded to patients who require consultations for new medications in a closed off area – the area will also be used for administering vaccinations.

Administration & Business Services: The administration and business services of the FTHC provide the day-to-day operations of the Health Center and include twenty employees dealing with administration, billing and coding, community health representatives (patient transportation services), patient registration, purchased/referred care, benefits, and safety/maintenance. Procurement, Grants, and Billing currently occupy a modular building across the street from the health center.

o Administration, planned: The FTHC currently operates as a Title I Contractor, but is pursuing the status of Title V Compactor. Under Title V, the FPST will assume more control over patient care and IHS funding. In order to do so, additional personnel will be required, particularly in Administration. The ability of health center staff to effectively administer operations will be dramatically increased by locating in closer proximity. As the number of services, patients and providers increase, the need for greater communication and transparency will also increase. The Phoenix Area Indian Health Service Area Health Services Master Plan identifies that the FTHC currently has 29% of the space required for Administration.

5. Description of Proposed Project

Based on a four-year evaluation developed by a third party consulting firm working with IHS, space requirements for individual departments have been identified. IHS’s Health System Planning Software was utilized to ensure estimates are reasonable, and in keeping with the ability to provide culturally appropriate and comprehensive care to the community. The target opening date is December 2028.

Beyond projected space of the building itself and required total site area, the specific location of the new health facility has also been planned. The Tribe currently operates Fox Peak Cinema as well as Fox Peak Station (Locations pictured in Figure (1). The new facility will be located behind the cinema.

The location was chosen for ease of access and its central location. Additionally, the FPST owns the land pictured in green (Figure 3).

Figure 1: Current Health Facility Location

Figure 2: New Health Facility Location

Figure 3: FTHC Service Area

The purpose of the SAP grant application is to secure funding for Phases One and Two of constructing a replacement health facility with the capacity to deliver care to the community for the next twenty-five years: Phase One includes Planning, Architectural and Engineering Design and NEPA Environmental Assessment, Phase Two will include preparation of the site. Working with a contractor who was selected for a separate project, construction of twenty-three housing unit, estimates regarding Phase One costs have been established. Additionally, priorities regarding green energy and suitable building materials have been communicated by the Tribe. The estimated cost of Phase One will constitute 10% of overall project cost. In order to receive definitive construction and energy details, Phase One of the project will need to be completed. Requirements of a selected firm will include demonstrated knowledge and experience in health facility design, particularly relating to environmental sustainability.

The Fallon Tribal Health Center (FTHC) is a regional hub of primary care, serving Native Americans from across Northern Nevada. The FTHC is a modest building, always spotless and teaming with patients and providers. A dedicated staff of sixty supports the community. The health care provided is extensive: family medicine, behavioral health services, moderate, complex and CLIA waived laboratory services, dental, pharmacy, optometry and, chiropractic, podiatry, nutrition, diabetes care, Joslin Vision Network screenings for retinopathy and injury prevention services.

Since construction of the FTHC was completed in 1997, the service population has increased substantially and is predicted by the Indian Health Service to increase by 68% by the year 2035 (from 1,411 to 2,373). Currently, the FTHC operates out of one main facility and four modular units and there is a desperate need for more treatment/exam areas for patients. Additionally, space for new services including dialysis, physical therapy, radiology and endodontics becomes a more urgent need as the service population ages – as of June 2023, 59% of patients are 65 or older, 3.5x the national average.

The current layout of the FTHC is problematic for patients, creating confusion when they need to locate services in five buildings. Four modular buildings have been added to the parking lot across the street from the main facility, approximately one hundred yards from the main building, creating a barrier to access. The physical layout also impedes egress for patients and staff. The only ramp to the building is at the front entrance – ideally, each entrance would be handicap accessible.

The energy management, floor plan, handicap access, fire and life safety and mechanical infrastructure of the FTHC are all rated “poor” according to IHS criteria. “Poor” condition refers to needs for extensive repairs, exceeding 10% of replacement cost. Considering the repairs and additional space required, the necessity of a replacement facility becomes clear.

The need for more space is apparent in all departments of the FTHC, but none more so than Clinical Services. As of September 13, 2023, the next available dental appointment was December, 19th;

the next podiatry appointment was December 6th, and optical appointments were nearly two months out (October 31st). Because FTHC patients are older than the general population, labs are required for 90% of appointments with doctors. There is currently only one lab technician on staff, creating a bottleneck for providers and patients. The bottleneck not only affects members of the Fallon Paiute Shoshone Tribe, but tribal members from across Northern Nevada. Patients are from Churchill, Lander, Lyon, Nye, and Humboldt counties – the User Populations include: Churchill (100%); Lyon (5%) Pershing (100%); Lander (100%); Nye County (52%), Humboldt (25%).

One factor that drives patients to FTHC is the lack of coverage they can find elsewhere. FTHC is effectively a free clinic for many of its patients. 34% of patients are uninsured, 31% are on Medicaid and an estimated 20% qualify for Medicaid but are not enrolled.

The need for a health center with greater capacity was recognized by the Tribe nearly ten years ago. To identify specific needs, space requirements, and future planning, the Fallon Paiute Shoshone Tribe participated in the development of the Indian Health Service Phoenix Area Services Master Plan, itself a four-year process. Identified gaps in service include Internal Medicine, Pediatrics, Dialysis, Telemedicine, Cardiology, Physical Therapy and Radiography.

Unfortunately, the individuals who are most impacted by service gaps are those who are low and moderate income. When the FTHC doesn’t provide a required service, like radiography, patients rely on referrals for care, which has historically left patients receiving calls from collections.

6. Project Business Plan

a. Project Management Plan

1. Organization

The Fallon Paiute Shoshone Tribe (FPST) possesses the managerial, technical, and administrative capabilities necessary to successfully complete the proposed health center replacement project. The FPST has the organizational resources or will obtain the organizational resources necessary to successfully implement and carry out the proposed project activities in accordance with its implementation schedule. There is a capacity gap in the Tribe’s ability to develop architectural and engineering designs, but the FPST will hire contractors with demonstrated expertise in health facility planning who will complete the designs. The following describes the roles, responsibilities and experience of key staff who will work on the project:

Table 1: Project Management Team

Staff Member and Title

Role for this Project Responsibilities for this Project

Jon Pishion

SAP Project Director

Direct supervisory and administrative management of grant activities and oversight of staff duties. Acts as administrator for the project ensuring activities are in accordance with the grant agreement and approved policies, rules and regulations as adopted by the Fallon Business Council and IHS. Reviews all inspections and oversees all reporting.

Reports to the Fallon Business Council.

Position is responsible for coordinating implementation of grant activities, including contract management. Creates bid documents, evaluates bids and recommends awards to the Fallon Business Council.

Responsible for maintaining contract records and monitoring expenditures. Monitors implementation to ensure project is on schedule and within budget. Responsible for

SAP Project Manager Coordinator – (TBD)

SAP Project Manager all grant reporting. Reports to the Health Director.

Lynn Castro, Finance Comptroller

Finance Comptroller

Responsible for oversight of all grant expenditures, ensuring the project stays within budget. Reviews invoices and manages accounts payable. Ensures compliance with CFR and grant requirements. Ensures completion of quarterly financial reports.

Denea Zulz, Grants Accountant

Grants Accountant

Assists Finance Comptroller with financial management and reporting, ensuring compliance with applicable federal regulations. Reports to Finance Comptroller.

Contractors – (TBD)

Construction Contractors

Responsible for completing architectural and engineering designs, legal review and site work according to contracted work plans.

Reports to Project Director.

The Fallon Paiute Shoshone Tribe has documented and established that we are administratively capable of administering this specific project to its full potential and completion. Our management and technical capabilities are demonstrated by the grants and contracts we manage and have successfully managed in the past, year after year, from the Bureau of Indian Affairs, the Indian Health Service, the Environmental Protection Agency, the Department of Justice, SAMHSA awards, and other intervention programs and grants. The FPST currently manages more than 90 federal grants/cooperative agreements.

The FPST is qualified to implement and carry out this project with the abilities of the following staff members who are experienced in planning, developing, and managing federal grants and programs:

o Jon Pishion, Project Director: Mr. Pishion, Health Director, has full line responsibility for the administrative management of the health care delivery system for the FTHC which includes, but is not limited to, fifteen departments: Administration, Laboratory, Behavioral Health, Dental, Optometry, Diabetes, Chiropractic, Podiatry, Pharmacy, Information Technology, Medical Records, Safety, Senior Center, Wellness Center, and Revenue Development.

Recent, Relevant, and Successful Experience: Mr. Pishion has served as the Fallon Tribal Health Center’s Health Director since 2018, and was the President of the Fallon Tribal Development Corporation (FTDC) from 2008 until 2020 – the FTDC is a federally-chartered corporation charged with pursing economic development projects for the Fallon Paiute-Shoshone Tribe. He has also been an elected member of the governing body of the FPST, the Fallon Business Council. Mr. Pishion has overseen tribal projects including infrastructure, health center expansion, and construction of the Tribe’s Fox Peak Cinema. Having worked in tribal administration since 1992, Mr. Pishion is well qualified to manage SAP and ensure the new health facility is designed to meet the growing needs of the FPST and tribes from across the state.

o SAP Project Manager: The Fallon Paiute Shoshone Tribe will follow its Personnel and Hiring policies to select a Project Manager for the proposed initiative. The incumbent of this position will be required to bring recent experience (within the past 5 years) in construction management, procurement, contract management, self-monitoring, budget preparation, and personnel management. In selection of the position, the review and hiring panel will consider recent experience on projects that met all benchmarks, completed on time according to approved implementation schedules, and which were completed within budget.

o Lynn Castro, Finance Comptroller: The Chief Financial Officer has recent and successful experience monitoring tribal budgets and grants and will work closely with the Project Director to properly procure contracts, review pay requests, authorize payments and ensure that the operations of the project fall within the overall goals of the Tribe and that the project is completed in a timely manner and within budget. Ms. Castro has successfully managed and monitored all in-house accounting functions, supervising the Finance Department, and ensuring that all accounting transactions are in compliance with NAHASDA, OMB, and other HUD regulations.

Recent, Relevant, and Successful Experience: In the last two years, Ms. Castro has successfully accounted for an annual tribal budget of over $20,000,000, resulting in repeated unqualified audits and has successfully managed the submission all required financial reports for the FPST’s grants programs. Recent audits have been submitted on time due to Ms. Castro’s management and direction.

o Denea Zulz, Grants Accountant: Denea Zulz serves as the Tribe’s Grants Accountant.

Denea is responsible for managing and monitoring all in-house grant accounting functions and will continue to do so for the proposed project. Denea works with the Tribe’s grant writer and has been successful in grant monitoring and review of tribal department grants and project activities.

Recent, Relevant, and Successful Experience: In the last seven years, Ms. Zulz has successfully accounted for the Tribe’s financial reporting on all tribal grants.

Ms. Zulz works directly with department managers to submit financial reports as required under award documents and contract agreements. Ms. Zulz successfully provides monthly R & E reports to the tribal departments. Denea works with the grants writer and tribal comptroller to provide training and monitoring services to all tribal programs on proper financial grant management. Within the past two years, Ms. Zulz’s work has resulted in successful submission of required financial reporting, clean audits, and unqualified opinions on FPST audits.

o Construction Contractors: The proposed project will be contracted according to FPST procurement policies and procedures.

Recent, Relevant and Successful Experience: Only contractors with relevant experience that is recent (within the past five years) and successful (met or exceeded benchmarks and timelines of past projects) will be considered in selection by the review panel for work on this project.

2. Performance Period for Project

Table 2:

Fiscal Year CY 24 CY25 Start and end dates

Quarter Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Grant Award Executed x x February, 2024

– March, 2024

Advertise and hire SAP Project Manager x x x March, 2024 – May, 2024

Solicit architectural & engineering bids x x x x March, 2024 – June, 2024

Review bids, bonds, insurance and qualifications x x x x x April, 2024 – August, 2024

Legal review x x x September, 2024 – November 2024

Award design contracts x December, Pre-design:

survey, zoning, etc.

x x x x x January, 2025 – May, 2025

Environmental Review x x x x x January, 2025 – May, 2025

Services planning x x x June, 2025 – August, 2025

Design Development.

SDs, DDs, CDs x x x x September, August, 2026

Site Work &

September, 2026 – September, Inspection

August, 2028 – September, Transition from current facility to new facility

October 2028 December ,2028

Opening new facility

December, Grant reporting x x x x x x x April, 2024 - May, 2027

3. National Environmental Protection Act

The Tribe acknowledges that it will provide all necessary information and documentation regarding the expansion project to the appropriate SAP contact person and will involve that individual during all applicable period of the project in accordance comply the National Environmental Protection Act (NEPA) requirements. Given the scope of the project, the FPST anticipates an Environmental Assessment, but not an Environmental Impact Statement, will be required.

4. Quality Control Procedures

The FPST considers the General Provisions section (which is a part of the contract that will be used to award SAP funding if the project is selected) to be a part of this application, and that the applicant will comply with the quality control items in the General Provisions (provided by DES).

5. Design Reviews

The FPST will provide the IHS at least one opportunity to review and approve design documents at the schematic, design development, or final construction documents phases

6. Subcontracts

The FPST agrees to use licensed and qualified Architects and Engineers in the design and construction oversight of the new health facility project. The bulk of SAP funds, $2,000,000, will contribute to planning and design, constituting 10% of project costs. Established policies regarding subcontractor qualifications will be followed, and have been summarized below:

The Tribe will only contract with responsible contractors (i.e., those who have the technical and financial competence to perform and who have a satisfactory record for integrity.) Before awarding a contract, the Tribe shall review the proposed contractor’s ability to perform the contract successfully, considering factors such as the contractor’s integrity (including a review of the List of Parties Excluded from Federal Procurement and Non-Procurement Programs published by the U.S. General Services Administration, as well as its own list of debarred/suspended entities), record of past performance (including contracting previous clients of the contractor), and financial, administrative, and technical capability to perform contract work of the size and type involved and within the time provided under the contract. A proposed contractor shall not be considered responsible if they have a history of non-compliance with said laws. If a prospective contractor is found to be nonresponsible, a written determination of non-responsibility shall be prepared and included in the contract file, and the prospective contractor shall be advised of the reasons for the determination.

b. Project Financial Management Plan

1. Funding Plan: All funds needed over and above the available funding and the requested SAP funding is the responsibility of the FPST.

a. Administrative and legal expenses

Item Description Project Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

SAP Project Manager:

Salary (100%

FTE)

SAP Project Manager:

Benefits

(100% FTE)

Tribal Legal Counsel:

Year 1: 31.09/hour x 2,040 hours

Year 2: 32.02/hour x 2040 hours

Year 3: 32.98/hour x 2,040 hours

Year 1: $12,600 (Health Insurance) + $2,002 retirement + .54% Workers’ Comp + FICA

(7.65%), SUTA

(2.35%)

Year 2: $12,600 (Health Insurance) + $2,002 retirement + .54% Workers’ Comp + FICA

(7.65%), SUTA

(2.35%)

Year 3: $12,600 (Health Insurance) + $2,002 retirement + .54% Workers’ Comp + FICA

(7.65%), SUTA

(2.35%)

1 - 3 If awarded, funds will be available for Phase 1 in February, Year 1:

$63,424

Year 2:

$65,321

Year 3:

$67,279

Year 1:

$21,286

Year 2:

$21,487

Year 3:

$21,693

$179,200

$63,424

$65,321

$67,279

$21,286

$21,487

$21,693

$179,200

$0 $0 contract review, conflicts, closeout

Indirect cost rate based on an approved negotiated agreement between the Fallon Paiute- Shoshone Tribe and the U.S.

Department of the Interior, National Business Center

$224/hour x 800 hours

33.76% x salary Year 1, 2 and 3, collectively

$66,177

$66,177

$505,867 $505,867 $0 $0

b. Site acquisition

Item Description Project Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

8-acre site located at Williams Avenue/Sherman Street, Fallon, Churchill County, Nevada

Land for the new health facility has been purchased by the Tribe.

Estimated value based on similar properties.

Site has already been acquired by the FPST

$500,000 0 $500,000 $0

$500,000 $0 $500,000 $0

c. Planning (including NEPA determination/activities)

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

NEPA review funds in accordance with estimate from IHS

Environmental Review will occur during the Pre- Design phase of the project and will follow IHS guidelines.

If awarded, funds will be available for Phase 1

$20,000 $20,000 $0 $0 in February, $20,000 $20,000 $0 $0

d. Design

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Design Contractor (provides architectural design services)

Estimated contract amount:

$1,200,000 (Architectural Design Contract Portion – NTE $1,200,000, 6% of project cost)

If awarded, funds will be available for Phase 1 in February, $1,200,000 $1,200,000 $0 $0

$1,200,000 $1,200,000 $0 $0

e. Engineering Services

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Design Contractor (provides engineering design services)

Estimated contract amount:

$800,000 (Engineering Contract portion – NTE $800,000, 4% of project cost)

If awarded, funds will be available for Phase 1 in February, $800,000 $800,000 $0 $0

$800,000 $800,000 $0 $0

f. Construction inspection

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Construction Inspection Services

Consulting firm to provide review of plans, conduct safety inspections, etc. on behalf of the Tribe to ensure facility is constructed in accordance with current UBC and

If awarded, funds will be available for Phase 3 in August, $750,000 0 $0 $750,000 other mandatory safety standards

$750,000 $0 $0 $750,000

g. Site work

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Site Work in preparation for construction of health facility

Pre-Construction work by the Contractor on the site including excavation, clearing, and fill.

Also includes costs to ensure facility ground work meets earthquake standards for Churchill County area.

If awarded, funds will be available for Phase 2 in September, $985,733 $985,733 $0 $0

$985,733 $985,733 $0 $0

h. Demolition and removal

Not Applicable

i. Construction

Item Description Project Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Construction of new health facility

Costs for General Contractor to do site/construction of new facility.

If awarded, funds will be available for Phase 2 in September

$14,000,000 $0 $0 $14,000,000

$14,000,000 $0 $0 $14,000,000

j. Equipment

Not Applicable

k. Miscellaneous or other

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Office Computer

Cell Phone

Postage & Mailing

Office Supplies

One-time cost of $1,500 - computer for SAP Project Manager to review designs, communicate with stakeholders, and track project progress

$660/year for Tribal cell phone plan x 3 years = $1,980

$440/year x 3 years = $1,320 for keeping public informed of project progress, viewing opportunities

$1,200/year x 3 years = $3,600

If awarded, funds will be available for Phase 1 in February, $1,500

$1,980

$1,320

$3,600

$1,500

$1,980

$1,320

$3,600

$0 $0

$8,400 $8,400 $0 $0

l. Subtotal (Sum of Items “a” thru “k”)

PROJECT COSTS EXCLUDING CONTINGECY AND NEPA REVIEW: $18,750,000

SAP PROJECT COSTS EXCLUDING NEPA: $3,500,000

m. Project contingency

Phase

Total Cost IHS SAP Funds

FPST

Funds

Other Funds

Project Contingency

Estimated at 10% of Construction Costs (unplanned items)

If awarded, funds will be available for Phase 2

$1,400,000 $0 $0 $1,400,000 in March, $1,400,000 $0 $0 $1,400,000

n. Total project costs (Sum of Items “l” and “m”)

TOTAL PROJECT COSTS EXCLUDING NEPA: $20,150,000

SAP PROJECT COSTS EXCLUDING NEPA: $3,500,000

2. Advance Payment Schedule

The Tribe has identified the advance funds needed within 21 days after the start of each quarter to ensure subcontractors have no interruption of payment:

Quarter 1. $125,000

Quarter 2. $125,000

Quarter 3. $250,000

Quarter 4. $300,000

Quarter 5. $300,000

Quarter 6. $300,000

Quarter 7. $300,000

Quarter 8. $300,000

Quarter 9. $300,000

Quarter 10. $400,000

Quarter 11. $400,000

Quarter 12. $400,000

7. Need for Project Calculation

8. Delivery Capability Brief

The current Fallon Tribal Health Center has operated since 1997, and successfully provides comprehensive health care to American Indians in Northern Nevada. The FTHC is a full-service clinic providing a variety of health and wellness services and programs: family medicine, behavioral health services, moderate, complex and CLIA waived laboratory services, dental care for children and adults, pharmacy, optometry and ophthalmology, chiropractic, podiatry, nutrition, diabetes care, Joslin Vision Network screenings for retinopathy and injury prevention services. As members of the Tribe continue to have children and the elderly population grows, the most significant limiting factor to delivering additional services, and bolstering existing services, is the lack of space.

According to the FTHC’s EHR, the FTHC currently provides care to 2,218 patients. Clinical Services, Behavioral Health and Business Services are housed at the facility and meet the needs of the community. As the patient population has increased, the FTHC has increased capacity. Funding for expanding capacity comes from private insurance billing, federal, state and private grants and IHS.

Recently, the Tribe was awarded a HRSA Substance Abuse and Overdose Prevention grant, Special

Diabetes Program for Indians, a Suicide Prevention grant and a Dementia Care grant through IHS.

Collectively, the Tribe manages over 90 federal grant programs.

As needs of the community shift, FTHC management are agile in their response. During the COVID-19 crisis, the FTHC provided testing and vaccinations and community health education to limit damage caused by the virus. Skepticism around the efficacy of the vaccine required culturally competent education, and it is a battle health center staff continue to fight.

The FTHC is also responsible for delivering health care to two neighboring Tribes, the Yomba Shoshone and the Lovelock Paiute. FTHC providers travel to the Lovelock and Yomba tribes once per month to deliver care. The Lovelock Paiute Tribe of the Lovelock Indian Colony is a federally recognized tribe of Northern Paiute Indians in Pershing County, Nevada. The reservation was established in 1907.

In 1990, 80 tribal members lived on the reservation. In 1992, 110 people were enrolled in the tribe. The Yomba Shoshone Tribe of the Yomba Reservation is a federally recognized tribe of Western Shoshone Indians. The reservation is divided into two remote, rural districts, the Upper, including Doyle Ranch, and Lower, including Bowler Ranch. In 1992, Yomba’s total population was 192. Most of the Yomba Tribe is reachable by unpaved roadways and residences which are miles apart; during the winter months, many roadways are reachable only by 4x4 vehicles. No paved roads connect the Yomba Reservation to the outside world. Most patients receiving health care from the Fallon Tribal the FTHC are transported to the clinic from Yomba by Community Health Representatives (CHR’s) working for the FTHC. The one-way trip is a 100+-mile commute for these patients; round-trip commute mileage is at 200+ miles.

FPST members rely on the FTHC for culturally competent care, and it is the only health care resource many can access. Essentially operating as a free clinic, the FTHC delivers health care to American Indians regardless of income. The FTHC has been, and will continue to be, a cornerstone of the community.

9. Construction Capability Brief

Under the SAP Project Management Team section of the application, four individuals have been identified who will oversee project operations. Two primary members of the Construction Management Team have also been identified. Additionally, the SAP Organization Chart is comprised of individuals to help compliment the oversight of this project and ensure its successful completion. Members of the SAP team have overseen the completion of major public works including, transportation infrastructure, canals, bridges, water supply and treatment and municipal buildings.

Management of planning and construction will follow the process outlined in the Project Administration Organization Chart. The Tribal Chairwoman and Tribal Council will hold high level authority over the program, but day-to-day operations will be managed by the Health Director as well as the SAP Project Manager. Funds will be managed by the Comptroller, Senior Accountant, Grants Accountant, and Accounting Specialist – their efforts have led to auditors’ unqualified opinion included in this application.

As referenced in Section 6.6, Subcontracts, The Tribe will only contract with responsible contractors (i.e., those who have the technical and financial competence to perform and who have a satisfactory record for integrity.) With established protocols in place, the FPST will ensure a safe work site. Additionally, quality control will be managed by the primary members of the Construction Management Team as well as through the Construction Inspection Contractor referenced in the Funding

Space List & Floor Plan

Administration

5,604.30 square feet

Ambulatory

9,863.75 square feet

Ancillary

5,363.70 square feet

Facility Support

685.00 square feet

Preventive

3,862.90 square feet

Support Services

6,431.95 square feet

Building Circulation and Envelope

7,952.90

Marjor Mechanical Space

4,771.74

Building Gross Square Feet Total

44,536.24 square feet

The floor plan of the new health facility will be developed during the Design phase of the program. SAP funds will enable this process to take place. The current health facility’s floor plan is not optimized because of many necessary expansions that have occurred over the lifetime of the building.

The new facility’s floor plan will be designed to allow for future additions to avoid the current functionality issues.

*The FPST participated in the development of the Phoenix Area Indian Health Service Area Health Services Master Plan 2019-2035, and the projected user population is 2,373.