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1 1 (February 3, 2023)

handle is hein.crs/goveklh0001 and id is 1 raw text is: Congressional ____ ~ Research Service Advance Appropriations for the Indian Health Service (IHS) February 3, 2023 The Indian Health Service (IHS) within the Department of Health and Human Services (HHS) is the lead federal agency charged with improving the health of American Indians and Alaska Natives. In FY2022, IHS provided health care to approximately 2.7 million eligible American Indians and Alaska Natives through a system of programs and facilities located on or near Indian reservations, and through contractors in certain urban areas. The enactment of the FY2023 Consolidated Appropriations Act (CAA; P.L. 117-328) provided IHS with both FY2023 annual appropriations and FY2024 advance appropriations. Prior to the CAA, IHS was the only major federal provider of health care solely funded through regular discretionary appropriations on an annual basis. Other federal health care providers, such as the Veterans Health Administration (Department of Veterans Affairs), receive the majority of their funding through discretionary advance appropriations, and a number of health programs, including Medicare and Medicaid (HHS), receive mandatory funding, which is controlled outside appropriations acts. This Insight describes advance appropriations conceptually, summarizes IHS advance appropriations in the CAA, provides a brief history of the prior interest in providing advance appropriations to IHS, and presents future considerations for this IHS funding schedule. (For further background, see CRS Report R46265, Advance Appropriations for the Indian Health Service: Issues and Options for Congress.) What Are Advance Appropriations? The annual appropriations process provides agencies with the authority to obligate federal funds for specified purposes, and subsequently expend those funds. The funding is available for obligation during a single fiscal year, unless otherwise specified. This period of availability typically begins on the first day of the fiscal year of the appropriations act (October 1), also referred to as the budget year, even when those appropriations are enacted after the start of the fiscal year. For example, appropriations provided by the CAA, which was enacted on December 31, 2022, were generally available for FY2023 obligations (October 1, 2022-September 30, 2023), unless otherwise specified. Advance appropriated funding becomes available one or more fiscal years after the budget year covered by the appropriations act. For example, in the CAA, advance appropriations were enacted for FY2024 and Congressional Research Service https://crsreports.congress.gov IN12087 CRS INSIGHT Prepared for Members and Committees of Congress

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