[Federal Register Volume 60, Number 149 (Thursday, August 3, 1995)]
[Notices]
[Pages 39761-39762]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-19095]



-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
[0905-ZA93]


Notice of Redesignation of Contract Health Service Delivery Area

AGENCY: Indian Health Service, HHS.

ACTION: Notice with request for comments.

-----------------------------------------------------------------------

SUMMARY: This notice advises the public that the Indian Health Service 
(IHS) proposes to redesignate the geographic boundaries of the Contract 
Health Service Delivery Area (CHSDA) for the Jamestown S'Klallam Tribe 
(``The Tribe''). The Jamestown S'Klallam CHSDA currently is comprised 
of Clallam County in the State of Washington. This county was 
designated as the Tribe's CHSDA when the IHS published its updated list 
of CHSDA's in the Federal Register of January 10, 1984 (49 FR 1291). It 
is proposed that the redesignated CHSDA be comprised of Clallam County 
and Jefferson County in the State of Washington. This notice is issued 
under authority of 43 FR 34654, August 4, 1978.

DATES: Comments must be received on or before September 5, 1995.

ADDRESSES: Comments may be mailed to Betty J. Penn, Regulations 
Officer, Indian Health Service, Room 450, 12300 Twinbrook Parkway, 
Rockville, Maryland 20852. Comments will be made available for public 
inspection at this address from 8:30 a.m. to 5:00 p.m., Monday-Friday, 
beginning approximately 2 weeks after publication of this notice.

FOR FURTHER INFORMATION CONTACT:
Leslie M. Morris, Deputy Director, Division of Legislation and 
Regulations, Office of Planning, Evaluation and Legislation, Indian 
Health Service, Room 450, 12300 Twinbrook Parkway, Rockville, MD 20852, 
telephone 301-443-1116. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: The Secretary of the Interior acknowledged 
the Tribe as an Indian tribe, effective February 10, 1981 (45 FR 
81890). The Tribe has entered into a self-governance compact with the 
IHS under Title III of the Indian Self-Determination Act (Pub. L. 93-
638, as amended) to provide direct services at a clinic facility and 
also to provide, for eligible Indians, services purchased from private 
sector health care providers. Such purchased services are called 
``contract health services.''
    On August 4, 1978, the IHS published regulations establishing 
eligibility criteria for receipt of contract health services and for 
the designation of CHSDA's (43 FR 34654, codified at 42 CFR 36.22, last 
published in the 1986 version of the Code of Federal Regulations). On 
September 16, 1987, the IHS published new regulations governing 
eligibility for IHS services. Congress has repeatedly delayed 
implementation of the new regulations by imposing annual moratoriums. 
Section 719(a) of the Indian Health Care Amendments of 1988, Pub. L. 
100-713, explicitly provides that during the period of the moratorium 
placed on implementation of the eligibility regulations, the IHS will 
provide services pursuant to the criteria in effect on September 15, 
1987. Thus, the IHS contract health services program continues to be 
governed by the regulations contained in the 1986 edition of the Code 
of Federal Regulations in effect on September 15, 1987. See 42 CFR 
36.21 et seq. (1986).
    As applicable to the Tribe, these regulations provide that, unless 
otherwise designated, a CHSDA shall consist of a county which includes 
all or part of a reservation and any county or counties which have a 
common boundary with the reservation (42 CFR 36.22(a)(6) (1986)). The 
regulations also provide that after consultation with the tribal 
governing body or bodies of those reservations included in the CHSDA, 
the Secretary may, from time to time, redesignate areas within the 
United States for inclusion in or exclusion from a CHSDA. The 
regulations require that certain criteria must be considered before any 
redesignation is made. The criteria are as follows:
    (1) The number of Indians residing in the area proposed to be so 
included or excluded;
    (2) Whether the tribal governing body has determined that Indians 
residing in the area near the reservation are socially and economically 
affiliated with the tribe;
    (3) The geographic proximity to the reservation of the area whose 
inclusion or exclusion is being considered; and
    (4) The level of funding which would be available for the provision 
of contract health services.
    Additionally, the regulations require that any redesignation of a 
CHSDA must be made in accordance with the procedures of the 
Administrative Procedure Act (5 U.S.C. 553). In compliance with this 
requirement, we are publishing this proposal and requesting public 
comment.
    Since approximately 1984, the Tribe has been providing contract 
health services to 20 of its tribal members residing in Jefferson 
County, Washington. Under existing regulations, the CHSDA for the Tribe 
consists of only Clallam County. On December 21, 1992, the Tribe most 
recently requested the Secretary to redesignate its CHSDA as Clallam 
County and Jefferson County in the State of Washington. The Tribe based 
its request on the fact that S'Klallam tribal members are indigenous to 
Jefferson County, Washington, yet are still ineligible to receive 
contract health services because they do not reside within the Tribe's 
existing CHSDA. In addition, the Tribe has developed a land 
consolidation plan, which has been approved by the Department of the 
Interior, through the Bureau of Indian Affairs, and which includes 
tribal trust land in Jefferson County. However, the Jefferson County 
tribal trust land has not yet been added to the reservation by 
proclamation of the Secretary of the Interior.
    In applying the aforementioned CHSDA redesignation criteria 
required by operative regulations (43 FR 35654), the following findings 
are made:
    (1) There are 112 Indians residing in Jefferson County, of which 59 
are members of the Tribe or have close socioeconomic ties to the Tribe. 
Of these 59, 20 are already receiving services due to a previous 
administrative decision. The remaining 53 individuals are not covered 
by this request as they do not have close social and economic ties to 
the Tribe and are therefore, not eligible for contract health services 
under existing law.
    (2) The Tribe has determined that contract health services would be 
available to all of its members and to all federally recognized Indians 
in Jefferson 

[[Page 39762]]
County having social and economic affiliation with the Tribe.
    (3) Although the Tribe's reservation is in Clallam County, the 
Tribe has trust land in Jefferson County that is included in an 
approved land consolidation plan and is pending proclamation to add it 
to the Tribe's reservation. This tribal trust land is contiguous to the 
existing reservation and extends into Jefferson County.
    (4) It is estimated that the current eligible contract health 
service population will be increased by 39 individuals, changing the 
active patient population from 192 to 231, assuming 100 percent 
utilization for Jefferson County eligibles. Based upon data from the 
fiscal year 1994 application of the health services priority system and 
the modified resource requirements methodology, the total clinical work 
units (CWU's) generated by the user population of 192 was 998.4, or 5.2 
per individual. Assuming the same utilization, the 39 new users will 
generate an additional 202.8 CWU's. The calculated cost per CWU in the 
inpatient and ambulatory contract health care category was $139.22 for 
the Tribe. Therefore, potential added costs for contract health 
services resulting from new users is approximated at $139.22 X 202.8 
CWU's = $28,233.82. Total resources available to the program in fiscal 
year 1994 were $139,000. The addition of new usage would not be 
expected to result in an increase in funding for the Tribe. The impact 
on existing contract health services will not be substantial. The 
current funding level will allow sufficient flexibility to assure that 
there will be no significant reduction in the level of contract health 
services to current CHSDA residents, so the designation of the two-
county CHSDA is within available resources.
    Accordingly, after considering the Tribe's request in light of the 
criteria specified in the regulations, I am proposing to redesignate 
the CHSDA of the Tribe to consist of Clallam and Jefferson Counties of 
the State of Washington.
    This notice does not contain reporting or recordkeeping 
requirements subject to prior approval by the Office of Management and 
Budget under the Paperwork Reduction Act of 1930.

    Dated: May 23, 1995.
Michel E. Lincoln,
Acting Director.
[FR Doc. 95-19095 Filed 8-2-95; 8:45 am]
BILLING CODE 4160-16-M