[Federal Register Volume 61, Number 208 (Friday, October 25, 1996)]
[Notices]
[Pages 55309-55311]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-27411]


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


Notice of Redesignation of Contract Health Service Delivery Area; 
Jamestown S'Klallam Tribe

AGENCY: Indian Health Service, HHS.

ACTION: Final notice.

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[[Page 55310]]

SUMMARY: This notice advises the public that the Indian Health Service 
(IHS) is redesignating the geographic boundaries of the Contract Health 
Service Delivery Area (CHSDA) for the Jamestown S'Klallam Tribe (``The 
Tribe''). The Jamestown S'Klallam CHSDA has been comprised of Clallam 
County in the State of Washington. This county was designated as the 
Tribe's CHSDA in the Federal Register of January 10, 1984 (49 FR 1291). 
Jefferson County, Washington, is being added to the existing CHSDA. 
This notice is issued under authority of 43 FR 34654, August 4, 1978.

EFFECTIVE DATE: October 25, 1996.

FOR FURTHER INFORMATION CONTACT:
Leslie M. Morris, Acting Director, Division of Legislation and 
Regulations, Office of Planning, Evaluation and Legislation, Indian 
Health Service, Suite 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 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 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 published the proposal to redesignate the Tribe's CHSDA 
in the Federal Register of August 3, 1995, requesting public comment 
(60 FR 39761). One comment was received. A tribal government official 
commented that the Jefferson County trust land should not be designated 
as eligible for contract health services if the residents of that 
county are located in an urban setting. However, the map of Jefferson 
County, Washington, shows that it is a rural county with no urban 
areas. Consequently, redesignation of the Tribe's CHSDA to include 
Jefferson County does not conflict with the 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 
Tribes 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, but that action is 
reportedly pending.
    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 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 (CWUs) 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 CWUs. The calculated cost per CWU in the 
inpatient and ambulatory care category, which includes contract health 
care costs, 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 CWUs=$28,233.82. Total resources available to the 
program in fiscal year 1994 were $139.000. The

[[Page 55311]]

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 level of funding 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, the IHS is redesignating 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 1980.

    Dated: September 24, 1996.
Michael H. Trujillo,
Assistant Surgeon General Director.
[FR Doc. 96-27411 Filed 10-24-96; 8:45 am]
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