[Federal Register Volume 88, Number 146 (Tuesday, August 1, 2023)]
[Notices]
[Pages 50160-50162]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-16275]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Proposed Purchased/Referred Care Delivery Area 
Redesignation for the Mid-Atlantic Tribes

AGENCY: Indian Health Service, Department of Health and Human Services.

ACTION: Notice.

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SUMMARY: This Notice advises the public that the Indian Health Service 
(IHS) proposes to view the seven Mid-Atlantic Tribes in the 
Commonwealth of Virginia collectively and to expand the geographic 
boundaries of their current Purchased/Referred Care Delivery Areas 
(PRCDA). The seven Mid-Atlantic Tribes include the Pamunkey Indian 
Tribe, Chickahominy Indian Tribe, Chickahominy Indian Tribe--Eastern 
Division, Upper Mattaponi Tribe, Rappahannock Tribe, Monacan Indian 
Nation, and Nansemond Indian Tribe. The IHS previously designated a 
PRCDA for each of the seven Tribes, which include counties and/or 
independent cities in the Commonwealth of Virginia. The IHS is now 
proposing to expand those individual PRCDAs by creating a collective 
PRCDA for the seven Tribes. The collective PRCDA will include all of 
the counties and independent cities in each of the current PRCDAs, plus 
additional contiguous counties and independent cities in the 
Commonwealth of Virginia, the State of Maryland, and the State of North 
Carolina.

DATES: Comments must be submitted August 31, 2023.

ADDRESSES: In commenting, please refer to file code [Federal Register 
insert file code number]. Because of staff and resource limitations, we 
cannot accept comments by facsimile (FAX) transmission. You may submit 
comments in one of four ways (please choose only one of the ways 
listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
Comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Carl Mitchell, Director, Division of Regulatory and 
Policy Coordination Indian Health Service, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, Maryland 20857.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the above address.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments before the close of the comment period 
to the address above.
    If you intend to deliver your comments to the Rockville address, 
please call telephone number (301) 443-1116 in advance to schedule your 
arrival with a staff member.

SUPPLEMENTARY INFORMATION: The current PRCDAs for the seven Mid-
Atlantic Tribes are:
    Pamunkey Indian Tribe--Caroline, Hanover, Henrico, King William, 
King and Queen, and New Kent Counties; and the independent city of 
Richmond in the Commonwealth of Virginia.
    Chickahominy Indian Tribe--New Kent, James City, Charles City, and 
Henrico Counties in the Commonwealth of Virginia.
    Chickahominy Indian Tribe--Eastern Division--New Kent, James City, 
Charles City, and Henrico Counties in the Commonwealth of Virginia.
    Upper Mattaponi Tribe--Richmond, Middlesex, Essex, King and Queen, 
King William, New Kent, Hanover, Caroline, Henrico, Charles City, and 
James City Counties; and the independent city of Richmond in the 
Commonwealth of Virginia.
    Rappahannock Tribe, Inc.--King and Queen, Caroline, Essex, and King 
William Counties in the Commonwealth of Virginia.
    Monacan Indian Nation--Amherst, Nelson, Albemarle, Buckingham, 
Appomattox, Campbell, Bedford, Botetourt, Rockbridge, and Augusta 
Counties; and the independent cities of Lynchburg, Lexington, Buena 
Vista, Staunton, Waynesboro, and Charlottesville in the Commonwealth of 
Virginia.
    Nansemond Indian Tribe--the independent cities of Chesapeake, 
Hampton, Newport News, Norfolk, Portsmouth, Suffolk, and Virginia Beach 
in the Commonwealth of Virginia.
    The IHS is proposing to create a collective PRCDA for the seven 
Mid-Atlantic Tribes that will include the following counties and 
independent cities:
    Counties in the Commonwealth of Virginia: Accomack, Albemarle, 
Alleghany, Amelia, Amherst, Appomattox, Arlington, Augusta, Bath, 
Bedford, Botetourt, Buckingham, Campbell, Caroline, Charlotte, 
Chesterfield, Clarke, Cumberland, Culpeper, Dinwiddie, Essex, Fauquier, 
Floyd, Fluvanna, Gloucester, Greene, Greensville, Goochland, Hanover, 
Henrico, Isle of Wight, James City, King and Queen, King George, King 
William, Lancaster, Loudoun, Louisa, Lunenburg, Mathews, Mecklenburg, 
Middlesex, Montgomery, Nelson, New Kent, Newport News, Norfolk, 
Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, 
Prince George, Prince William, Pulaski, Richmond, Rockbridge, 
Rockingham, Southampton, Spotsylvania, Stafford, Warren, Westmoreland, 
and York.
    Independent Cities in the Commonwealth of Virginia: Alexandria, 
Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Covington, 
Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Hampton, 
Harrisonburg, Hopewell, Lexington, Lynchburg, Manassas, Manassas Park, 
Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, 
Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, 
Waynesboro, and Williamsburg.
    Counties in the State of Maryland: Allegany, Anne Arundel, 
Baltimore, Calvert, Carroll, Cecil, Charles, Frederick, Harford, 
Howard, Kent, Montgomery, Prince George's, Queen Anne's, St. Mary's, 
and Washington.
    Independent Cities in the State of Maryland: Baltimore City.
    Counties in the State of North Carolina: Alexander, Camden, 
Catawba, Chowan, Currituck, Davidson, Davie, Durham, Forsyth, Franklin, 
Gates, Granville, Guilford, Johnston, Orange, Pasquotank, Randolph, 
Rowan, Stanly, Stokes, and Wake.

[[Page 50161]]

    Members of the seven Mid-Atlantic Tribes residing outside of the 
current PRCDAs are eligible for direct care services, however, they are 
not eligible for Purchased/Referred Care (PRC) services. The sole 
purpose of this expansion would be to authorize additional Tribal 
members and beneficiaries to receive PRC services.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment.

FOR FURTHER INFORMATION CONTACT: CAPT John Rael, Director, Office of 
Resource Access and Partnerships, Indian Health Service, 5600 Fishers 
Lane, Mail Stop: 10E85C, Rockville, Maryland 20857. Telephone (301) 
443-0969. (This is not a toll free number).
    Background: The IHS provides services under regulations in effect 
as of September 15, 1987, and republished at 42 CFR part 136, subparts 
A-C. Subpart C defines a Contract Health Service Delivery Area (CHSDA), 
now referred to as a PRCDA, as the geographic area within which PRC 
will be made available by the IHS to members of an identified Indian 
community who reside in the PRCDA. Residence within a PRCDA by a person 
who is within the scope of the Indian health program, as set forth in 
42 CFR 136.12, creates no legal entitlement to PRC, but only potential 
eligibility for services. Services needed, but not available at an IHS/
Tribal facility, are provided under the PRC program depending on the 
availability of funds, the relative medical priority of the services to 
be provided, and the actual availability and accessibility of alternate 
resources in accordance with the regulations.
    The regulations at 42 CFR part 136, subpart C provide that, unless 
otherwise designated, a PRCDA 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(a)(6). The 
regulations also provide that after consultation with the Tribal 
governing body or bodies on those reservations included within the 
PRCDA, the Secretary may from time to time, redesignate areas within 
the United States for inclusion in or exclusion from a PRCDA--42 CFR 
136.22(b). 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 PRC.
    Additionally, the regulations require that any redesignation of a 
PRCDA must be made in accordance with the procedures of the 
Administrative Procedure Act (5 U.S.C. 553)--42 CFR 136.22(c). In 
compliance with this requirement, the IHS is publishing this Notice and 
requesting public comments.
    The Pamunkey Indian Tribe was the first federally recognized Tribe 
in the Commonwealth of Virginia, recognized through the Department of 
the Interior's Federal Acknowledgement of American Indian Tribes 
administrative process effective January 28, 2016. The Pamunkey Indian 
Tribe does not have a reservation land base within the meaning of 42 
CFR 136.22(a)(6). As a result, the Director, IHS, exercised reasonable 
administrative discretion to designate a PRCDA for the Pamunkey Indian 
Tribe, effective August 28, 2017, 82 FR 35227.
    On January 29, 2018, the President signed into law H.R. 984, the 
``Thomasina E. Jordan Indian Tribes of Virginia Federal Recognition Act 
of 2017,'' which provided Federal recognition to six additional Tribes 
in the Commonwealth of Virginia, and identified geographical (e.g., 
county or city) service delivery areas for each. These service delivery 
areas included overlapping areas for many of the Tribes, and also 
overlapped the Pamunkey Indian Tribe's designated PRCDA. The IHS 
designated the PRCDAs for each of these six Tribes, effective February 
21, 2020, in accordance with Congressional intent. The IHS has 
historically established PRCDAs in accordance with Congressional intent 
while preserving regulatory flexibility to re-designate areas as 
appropriate for inclusion in or exclusion from a PRCDA under PRC 
regulations. Expansion of the PRCDAs for the seven Mid-Atlantic Tribes 
would extend these already existing and overlapping PRCDAs, to create a 
collective PRCDA for these seven Tribes, for the sole purpose of 
authorizing additional Tribal members and beneficiaries to receive PRC 
services. Representatives from all seven Mid-Atlantic Tribes 
unanimously sought to move forward collectively to request re-
designation of their PRCDAs to include the entire Commonwealth of 
Virginia. Following consultation with those Tribes, the IHS also 
considered portions of Maryland and North Carolina that are close to 
the border of Virginia. Since all seven of the Mid-Atlantic Tribes 
requested the same PRCDA, the IHS is proposing to consider these Tribes 
collectively for purposes of the PRCDA expansions. This includes 
considering their Tribal members collectively under the criteria set 
forth in 42 CFR 136.22(b), as described above. In doing so, the IHS has 
determined which portions of the Commonwealth of Virginia, Maryland, 
and North Carolina would meet the necessary criteria for one or more of 
the seven Mid-Atlantic Tribes. For example, the IHS is not proposing to 
add any counties where no members of any Mid-Atlantic Tribe reside, or 
counties that are not contiguous with the existing or proposed PRCDAs. 
Accordingly, the IHS proposes to expand the individual PRCDAs for these 
seven Mid-Atlantic Tribes to create a collective PRCDA that includes 
sixty-six (66) counties and thirty-two (32) independent cities in the 
Commonwealth of Virginia; twenty-one (21) counties in North Carolina; 
and sixteen (16) counties and one (1) independent city in Maryland.
    Under 42 CFR 136.23, those otherwise eligible Indians who do not 
reside on a reservation, but reside within a PRCDA, must be either 
members of the Tribe or other IHS beneficiaries who maintain close 
economic and social ties with the Tribe. In this case, applying the 
aforementioned PRCDA redesignation criteria required by operative 
regulations codified at 42 CFR part 136, subpart C, the following 
findings are made:
    1. By expanding each Tribe's PRCDA and creating one collective 
PRCDA, the seven Mid-Atlantic Tribes estimate the current eligible 
population will collectively increase by 1006 individuals.
    2. The seven Mid-Atlantic Tribes have determined that these 1006 
individuals are members of the federally recognized Tribes in the 
Commonwealth of Virginia and that these members are socially and 
economically affiliated with these Mid-Atlantic Tribes.
    3. The existing PRCDAs for these seven Mid-Atlantic Tribes, 
consisting of twenty-one (21) counties and fourteen (14) independent 
cities collectively, will be expanded to include sixty-six (66) 
counties and thirty-two (32) independent cities in the Commonwealth of 
Virginia; twenty-one (21) counties in North Carolina; and sixteen (16) 
counties, and one (1) independent city in Maryland. Members of one or 
more of the Tribes reside in

[[Page 50162]]

each county that is included in the proposed expansion, and those 
members live near enough to their Tribe's seat of government to 
maintain close social and economic ties with their Tribe. According to 
the leadership for each of the Tribes, those members live close enough 
to regularly participate in-person in Tribal affairs, events, 
activities, or other functions held by or carried out by the Tribe 
within its current PRCDA. Furthermore, the proposed counties and 
independent cities form a contiguous area with the existing PRCDAs. 
Considering the Tribes collectively, the IHS has determined the 
additional counties and independent cities proposed for inclusion 
herein to be geographically proximate, meaning ``on or near,'' to the 
area analogous to reservations for the seven Mid-Atlantic Tribes.
    4. PRC programs operated by/for the seven Mid-Atlantic Tribes will 
use their existing Federal allocation for PRC funds to provide services 
to the expanded population. No additional financial resources will be 
allocated by the IHS to these programs to provide services to members 
residing in the expanded counties and independent cities in the 
Commonwealth of Virginia, State of Maryland, or State of North 
Carolina.
    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 1995.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-16275 Filed 7-31-23; 8:45 am]
BILLING CODE 4165-16-P