105(l) Lease Structures for Tribal Health PFSA
When a Tribal facility is used to deliver federal health services, your Tribe should receive fair value for that space. The 105(l) lease structure exists to make that happen. Face Rock has built more than 560 of these structures across 40+ Tribal partners. Most programs that qualify have not yet accessed it.
Talk to Face RockWhat 105(l) is and why it matters
A Tribal health program is more than its services. It is the physical space where care is delivered. Section 105(l) of ISDEAA authorizes IHS to reimburse the lease costs of those facilities, including clinic space, dental and behavioral health buildings, and associated support structures, so those costs come out of IHS reimbursement rather than your program budget.
These facilities are called PFSA: Program Facilities and Structures of Activities. Many Tribal programs have eligible PFSA that have never been enrolled in a 105(l) structure. The process requires expertise in IHS lease requirements, correct structuring, fair market value documentation, Area Office negotiation, and ongoing compliance. Face Rock manages it end-to-end.
What PFSA Covers
Program Facilities and Structures of Activities: the physical spaces used to deliver IHS-funded health services. Clinics, dental, behavioral health, administrative buildings, and associated support structures.
560+ Executed
Face Rock has structured and executed over 560 105(l) lease agreements across 40+ tribal nation partners. This is high-volume operational work we do at scale, not advisory.
Most eligible programs have never had their facilities assessed. A 105(l) structure can redirect significant facility costs from your program budget to IHS reimbursement.
What Face Rock does in your 105(l) program
PFSA assessment. We inventory your program's physical facilities, including those owned, leased from third parties, or partially used for IHS-funded services, and identify which qualify for 105(l) treatment.
Lease structuring. A 105(l) lease must meet IHS requirements: appropriate terms, fair market value documentation, and correct relationship to your ISDEAA contract or compact. We handle that structure. It is not a standard commercial lease.
IHS negotiation. We manage the Area Office negotiation, including documentation requirements, area director review, and any supplemental agreement adjustments needed to incorporate the lease into your contract or compact.
Execution and ongoing compliance. Once executed, the lease requires correct invoicing, annual review, and facility use documentation. Face Rock maintains that posture so the structure stays defensible and funded.
Expanded coverage over time. As your program grows with new facilities, renovations, or service delivery changes, Face Rock identifies and structures additional 105(l) coverage to match your footprint.
Face Rock's 105(l) process
PFSA Inventory
We identify all physical facilities your program uses, including owned, third-party leased, and partially used, and determine which qualify for 105(l) treatment.
Eligibility Determination
We confirm qualifying status under your ISDEAA contract or compact and determine the applicable lease structure for each PFSA.
Lease Structuring
We build the lease to meet IHS requirements: appropriate terms, fair market value documentation, and correct relationship to your ISDEAA agreement.
IHS Negotiation
We manage the Area Office review, including documentation, responses to information requests, and any supplemental agreement adjustments needed.
Compliance & Expansion
Executed leases require ongoing invoicing, annual review, and facility use documentation. As your program grows, we structure additional coverage.
Assess your 105(l) eligibility
Face Rock conducts a no-cost PFSA assessment to identify which of your facilities qualify for 105(l) lease treatment and what that means for your program's funding structure.