[Federal Register Volume 68, Number 52 (Tuesday, March 18, 2003)]
[Notices]
[Pages 12913-12914]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-6398]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Redesignation of Contract Health Service Delivery Area

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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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 Rosebud Sioux Tribe (``The 
Tribe''). The Tribe's CHSDA was comprised of Bennett, SD, Cherry, NE, 
Mellette, SD, Todd, SD and Tripp, SD counties in South Dakota and 
Nebraska. These counties were designated as the Tribe's CHSDA when the 
IHS published its updated list of CHSDAs in the Federal Register of 
January 10, 1984 (49 FR 1291). It is proposed that the redesignated 
CHSDA be comprised of seven counties in the States of South Dakota and 
Nebraska, Bennett, SD, Cherry, NE, Mellette, SD, Todd, SD, Tripp, SD, 
Gregory, SD and Lyman, SD. This notice is issued under authority of 43 
FR 34654, August 4, 1978.

DATES: Comments must be received on or before April 17, 2003.

ADDRESSES: Comments may be mailed to Betty Gould, Regulations Officer, 
Division of Regulatory and Legal Affairs, Indian Health Service, 12300 
Twinbrook Parkway, Suite 450, Rockville, MD 20857, Telephone 301-443-
7899 (This is not a toll-free number). Comments received will be 
available for inspection at the address above from 9 a.m. to 3 p.m., 
Monday through Friday, beginning approximately two weeks after 
publication.

FOR FURTHER INFORMATION CONTACT: Leslie Morris, Director, Division of 
Regulatory and Legal Affairs, Office of Management Support, Indian 
Health Service, 12300 Twinbrook Parkway, Suite 450, Rockville, MD 
20857, 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 and for the designation of CHSDAs (43 FR 34654, 
codified at 42 CFR 136.22, last published in the 2002 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 in effect on 
September 15, 1987. See 42 CFR 136.21, et seq. (2002).
    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 136.22). 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

[[Page 12914]]

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.
    Pursuant to a Tribal Resolution 2000-32, dated March 9, 2000, the 
Tribe requested the IHS to redesignate their current CHSDA, which 
incorporates Mellette, Bennett, Todd, Trip and Cherry Counties in the 
State of South Dakota and Nebraska, to include Gregory and Lyman 
counties. In applying the aforementioned CHSDA redesignated criteria 
required by required by 42 CFR 136.22, the following findings are made:
    (1) The Tribe enrollment and census records identify 519 tribal 
members residing in Gregory County and 0 tribal members residing in 
Lyman County.
    (2) The Tribe has determined that contract health services would be 
available to all its members and members of other federally recognized 
tribes who reside in Gregory County and Lyman County having close 
social and economic ties with the Tribe.
    (3) Gregory County is presently a CHSDA county for the Yankton 
Sioux Tribe. There are 159 Tribal members, of the 519 total, who are 
eligible for the Yankton Sioux CHS program because of close economic-
social ties. The Yankton Sioux and Rosebud Sioux CHS programs will work 
together on the eligibility and CHS coverage on a case-by-case basis. 
Lyman County is presently a CHSDA county for the Lower Brule Sioux 
Tribe. There are 0 Tribal members who are eligible for the Lower Brule 
Sioux CHS program. The Lower Brule and Rosebud CHS program will work 
together on the eligibility and CHS coverage on a case-by-case basis 
if/when there are Rosebud Sioux residing within Lyman County.
    (4) At this time, although Gregory County does not border the 
Rosebud Sioux's reservation, Gregory County was within the original 
boundaries of the reservation and continues to have a significant 
population of Rosebud Sioux. The Tribe chose to include Lyman County in 
the expansion even though, at the time of the analysis, there were no 
Rosebud Sioux tribal members residing in Lynn County. The close 
proximity to the original boundaries of the reservation was considered 
because there could be members residing in Lyman County in the future.
    (5) The 519 tribal members residing in Gregory County presently 
utilize the Rosebud Indian Health Service facility's direct care 
services. Therefore, the clinical work load units will not be impacted. 
It is estimated that the current eligible contract health service 
population will be increased by 519 in Gregory County. The Rosebud CHS 
program has a recurring CHS funding base of $4,233,730. The formula 
used to determine what impact the additional 519 members, residing in 
Gregory County, would have on the Rosebud CHS fund is determined by 
using the Aberdeen Area's type of facility per capita of $327 x 519 = 
$169,713. The 0 number residing in Lyman County would have no impact at 
this time. The Rosebud Indian Health Service facility recognizes that 
there will be no additional CHS funding for this CHSDA expansion but 
they do not expect a significant impact on their present funding and 
support the tribe's CHSDA expansion and redesignation. The expansion 
and redesignation of the CHSDA to include both Gregory County and Lyman 
County is within the present 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 Bennett, SD, Cherry, NE, Mellette, SD, 
Todd, SD, Tripp, SD, Gregory, SD and Lyman, SD, Counties of South 
Dakota and Nebraska.
    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: March 10, 2003.
Charles W. Grim,
Assistant Surgeon General, Interim Director, Indian Health Service.
[FR Doc. 03-6398 Filed 3-17-03; 8:45 am]
BILLING CODE 4160-16-M