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Content provided by the Catalog of Federal Domestic Assistance
93.228 Indian Health Service_Health Management Development Program




Public Law 83-568, 42 U.S.C. 2001-2004a; Indian Self-Determination and Education Assistance Act, Section 104 (b), Public Law 93-638, 25 U.S.C. 450; Section 9, Public Law 98-250; Public Law 100- 472.
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To improve the quality of the health of American Indians and Alaska Natives by providing a full range of curative, preventive and rehabilitative health services; and to improve the management capability of American Indians and Alaska Natives to assume operation of all or part of an existing Indian Health Service (IHS) direct-operated health care program.


Project Grants.
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The assistance is used for six types of management related projects: (1) Feasibility Studies; (2) Planning; (3) Tribal Health Management Structure Development; (4) Evaluation; (5) Technical Assistance; and (6) Federal Programs Analysis. Tribal management grants may not be used to support operational programs, or to supplant existing public and private resources. This assistance is available to federally-recognized Indian tribes and tribal organizations.


Applicant Eligibility:   Federally-recognized tribes and tribal organizations.

Beneficiary Eligibility:   Individuals who are members of an eligible applicant tribe, band, or group or village and who may be regarded as within the scope of the Indian health and medical service program and who are regarded as an Indian by the community in which he lives as evidenced by such factors as tribal membership, enrollment, residence on tax exempt land, ownership of restricted property, active participation in tribal affairs or other relevant factors in keeping with general Bureau of Indian Affairs practices in the jurisdiction.

Credentials/Documentation:   Certification of Native Indian or Alaskan descent is required for direct services. Provisions of grants under Public Law 93-638 and its amendments require tribal endorsement in the form of a Resolution to sanction tribal participation. Costs will be determined in accordance with OMB Circular No. A-87 for State and local governments (and Circular No. A-122 for Nonprofit Organizations) as implemented through program regulations 42 CFR 36 and applicable grant administration regulations 45 CFR, Part 92, (45 CFR 74 for nonprofit organizations).

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Pre-application Coordination:   An applicant under Public Law 93-638 seeking to serve more than one tribe must have approval of each tribe involved. This program is excluded from coverage under E.O. 12372.

Application Procedure:   The standard application forms, as furnished by IHS and required by 45 CFR 92 for State and local governments, must be used for this program. Applications under Public Law 93-638 to staff and manage health services and facilities may be submitted to respective IHS Area Office. Tribal Management Program is processed and administered by IHS Headquarters. This program is subject to the provisions of 45 CFR 92 for Indian tribes and OMB Circular No. A-110, if applicant is a nonprofit tribal organization.

Award Procedure:   Grants are awarded on a competitive basis with processing and final approval by Headquarters.

Deadlines:   For Public Law 93-638 grants applications must be submitted 90 days prior to the proposed project start date. Specific types of grant projects may have specific deadlines imposed. Contact Headquarters Office for application deadlines.

Range of Approval/Disapproval Time:   90 days. Grants are approved/disapproved within ninety (90) days from receipt of application/proposal in IHS Headquarters.

Appeals:   Grant appeals will follow PHS appeals procedures: 42 CFR, Part 50, Subpart D and DHHS appeals procedures: 45 CFR 16.

Renewals:   Renewal of grants is on a year-to-year basis and requires the submission of continuation applications.


Formula and Matching Requirements:   This program has no statutory formula or matching requirements.

Length and Time Phasing of Assistance:   Not applicable.


Reports:   Public Law 93-638, grants are subject to Regulations in November 14, 1975, Federal Register, Vol. 40, No. 221; and administrative requirements under 45 CFR, Part 92 for grants to Indian Tribes and 45 CFR, Part 74 to nonprofit tribal organizations.

Audits:   In accordance with the provisions of OMB Circular No. A- 133 (Revised, June 24, 1997), "Audits of States, Local Governments, and Nonprofit Organizations," nonfederal entities that expend financial assistance of $300,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $300,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133. In addition, grants and cooperative agreements are subject to inspection and audits by DHHS and other Federal government officials.

Records:   HHS and the Comptroller General of the United States or any of their authorized representatives, shall have the right of access to any books, documents, papers, or other records of a grantee, subgrantee, contractor, or subcontractor, which are pertinent to the HHS grant, in order to make audits, examinations, excerpts and transcripts. In accordance with 45 CFR 92.42, grantees are required to maintain grant records 3 years after they submit their final expenditure report. If any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of the 3-year period, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later.


Account Identification:   75-0390-0-1-551.

Obligations:   (Grants) Tribal Management: FY 01 $2,311,000; FY 02 est $2,306,000; and FY 03 est $2,000,000. Health Services: FY 01 $3,642,793; FY 02 est $3,000,000; and FY 03 est $3,000,000.

Range and Average of Financial Assistance:  
$50,000 - $100,000 Range; $100,000 Average.

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In fiscal year 2001, 24 new and 5 continuing tribal management projects were awarded; in fiscal year 2002, 13 new and 12 continuing tribal management projects will be awarded; and in fiscal year 2003, an estimated 20 to 25 new and continuing tribal management project grants will be made. In fiscal year 2001, 20 continuing health services projects were awarded; in fiscal years 2002 and 2003, an estimated 20 continuing projects will be funded.


42 CFR 36; 45 CFR 92 and 45 CFR 74, PHS Grants Policy Statement, DHHS Publication No. (OASH) 94- 50,000, (Rev.) April 1, 1994; Program Guidelines for Competitive Projects.


Regional or Local Office:  
None. Program: Ms. Michelle Eaglehawk, Deputy Director, Office of Direct and Service Contract Tribes, Indian Health Service, 5600 Fishers Lane, Mail Stop: 08E20, Rockville, MD 20857, Phone: (301) 443-1104;

Grants Management Contact: Mr. Robert Tarwater, Director, Division of Grants Management, Indian Health Service, 5600 Fishers Lane, Mail Stop 09E70, Rockville, MD 20857. Telephone: (301) 443-5204, Fax (301) 594-0899.

Headquarters Office:   Grants Policy Office 5600 Fishers Lane, Mail Stop: 09E70, Rockville, Maryland 20857 Email: Phone: 301-443-5204

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The development of: (1) A management structure (2) an evaluation of tribal health programs; (3) a feasibility study and comprehensive health plan; (4) a management information system; (5) technical assistance; (6) a development of financial/management systems for Public Law 93-638 programs; and (7) a Federal program analysis.


(1) The apparent capability of the applicant to organize and manage the proposal project successfully considering the adequacy of staff, management systems, equipment and facilities; (2) the soundness of the applicant's plan for conducting the project and for assuring effective utilization of grant funds; (3) the adequacy of the budget in relation to the scope of the project and available funds; and (4) the relative effectiveness of the applicant's plan to carry out each of the requirements as set forth in the application.

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