[Federal Register Volume 60, Number 215 (Tuesday, November 7, 1995)]
[Notices]
[Pages 56159-56160]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-27564]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
[0917-ZA00]


Notice of Redesignation of Contract Health Service Delivery Area

AGENCY: Indian Health Service, HHS.

ACTION: Notice with request for comments.

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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 Confederated Tribes of the 
Chehalis Reservation, Washington (``the Tribes''). The Chehalis CHSDA 
currently is comprised of Grays Harbor and Thurston Counties in the 
State of Washington. These counties were designated as the Tribes' 
CHSDA in the Federal Register of January 10, 1984 (49 CFR 1291). It is 
proposed that Lewis County, Washington, be added to the existing CHSDA. 
This notice is issued under authority of 43 FR 34654, August 4, 1978.

DATES: Comments must be received on or before December 7, 1995.

ADDRESSES: Comments may be mailed to Betty J. Penn, Regulations 
Officer, Indian Health Service, Suite 450, 12300 Twinbrook Parkway, 
Rockville, 

[[Page 56160]]
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, Suite 450, 12300 Twinbrook Parkway, Rockville, Maryland 
20852, Telephone 301/443-1116 (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: On August 4, 1978, the IHS published 
regulations establishing eligibility criteria for receipt of contract 
health services (CHS) and for the designation of CHSDAs (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 new eligibility 
regulations, the IHS will provide services pursuant to the criteria in 
effect on September 15, 1987. Thus the IHS CHS 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 43 CFR 
36.21 et seq. (1986).
    As applicable to the Tribes, 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.
    The request of the Confederated Tribes of Chehalis Reservation to 
expand their CHSDA was presented in their Tribal Resolution 1994-38, 
dated August 17, 1994. The Tribes' request will expand their current 
CHSDA, which incorporates Grays Harbor and Thurston Counties in the 
State of Washington, to include Lewis County, Washington.
    Under 42 CFR 36.23 those otherwise eligible Indians who do not 
reside on a reservation but reside within a CHSDA must be either 
members of the tribe or maintain close economic and social ties with 
the tribe. In this case, the tribe estimates that the current eligible 
CHS population will be increased by 25 individuals consisting of 13 
enrolled Chehalis tribal members and 12 non-Chehalis members not 
currently covered because these individuals have no close economic and 
social ties with the Yakama but do with the Chehalis.
    In applying the aforementioned CHSDA redesignation criteria 
required by operative regulations (43 FR 35654), the following findings 
are made:
    1. Lewis County is contiguous with Thurston County. Both counties 
are within the State of Washington.
    2. Lewis County is part of the Tribes' traditional territory and 
many tribal members retain ownership of public domain allotments there.
    3. The Tribes share co-management responsibility with the State of 
Washington for 2,600 square miles of rivers and streams in the Chehalis 
River Basin, which includes Lewis County. Lands adjacent to the 
Chehalis River have historically been considered in defining the 
original tribal homeland.
    4. The majority of potential new CHS users who reside in Lewis 
County are within 15 miles of the Tribes limited direct care facility 
and depend on the Tribes for their health care requirements.
    5. The nearest IHS comprehensive health center available to provide 
care for these beneficiaries is located in Toppenish, Washington, which 
is 150 miles away.
    6. The current CHS patient care resources available to the tribes 
total $331,364 for 392 users. Per capita combined workload units (CWUs) 
are estimated at 5.7. The estimated costs associated with this request 
are $21,090 and are calculated as follows:

392 current users  x  5.7 CWUs=2,234 CWUs
$331,364 (current funding)/2,234 CWUs=$148 per CWU
$148  x  25 (new users)  x  5.7 CWUs=$21,090

    7. The financial resources required to meet the immediate needs of 
potential Lewis County users will not be substantial and will be 
absorbed by that tribe's total health care program within available 
resources.
    Since CHS is a critical component of the Tribes' overall health 
care system for its members, the Tribes feels that the members living 
in Lewis County, Washington, should be included within the CHSDA for 
the Tribes.
    Accordingly, after considering the Tribes' request in light of the 
criteria specified in the regulations, I am proposing to redesignate 
the CHSDA of the Tribes to consist of Grays Harbor, Thurston, and Lewis 
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 1980.

    Dated: October 31, 1995.
Michel E. Lincoln,
Deputy Director.
[FR Doc. 95-27564 Filed 11-6-95; 8:45 am]
BILLING CODE 4160-16-M