[Federal Register Volume 88, Number 150 (Monday, August 7, 2023)]
[Notices]
[Pages 52185-52186]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-16843]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Purchased/Referred Care Delivery Area Redesignation for 
the Confederated Tribes of Grand Ronde in the State of Oregon

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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

SUMMARY: This Notice advises the public that the Indian Health Service 
(IHS) proposes to expand the geographic boundaries of the Purchased/
Referred Care Delivery Area (PRCDA) for the Confederated Tribes of 
Grand Ronde (CTGR) in the State of Oregon to include the county of 
Clackamas in the State of Oregon. The current PRCDA for the CTGR 
includes the Oregon counties of Washington, Polk, Yamhill, Marion, 
Multnomah, and Tillamook. The CTGR members residing outside of the 
PRCDA 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 CTGR members and 
beneficiaries to receive PRC services.

DATES: Comments must be submitted September 6, 2023.

ADDRESSES: 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.

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).

SUPPLEMENTARY INFORMATION: 
    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.
    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 person's relative medical priority, 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;

[[Page 52186]]

    (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 CTGR is located in Grand Ronde, Oregon, which is located in 
Western Oregon where it has an 11,500-acre reservation in Yamhill 
County. The Tribe has requested to add Clackamas County to their PRCDA 
which is currently comprised of Washington, Polk, Yamhill, Marion, 
Multnomah, and Tillamook Counties in Oregon. Multnomah and Marion 
Counties are contiguous to the requested expansion into Clackamas 
County, and part of ceded lands from the Willamette Valley Treaty.
    The CTGR's PRC Program is operated under a long standing Title V 
agreement. The Portland Area IHS estimates there are currently 179 
Tribal members who live within Clackamas County and would become PRC 
eligible through this proposed expansion. The Tribe states that many of 
these members routinely travel to Portland, or to the Tribal facilities 
in Grand Ronde, to seek care as they are not currently eligible for 
PRC. They are also active members of the community and routinely 
participate in Tribal elections, General Council meetings, and Tribal 
events. The Tribe would like to recognize them as eligible for PRC. 
Accordingly, the IHS proposes to expand the PRCDA of the CTGR to 
include the Oregon county of Clackamas.
    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 the PRCDA to include Clackamas County, the CTGR's 
eligible population will be increased by an estimated 179 Tribal 
members residing in Clackamas County.
    2. The IHS finds that the Tribal members within the expanded PRCDA 
are socially and economically affiliated with CTGR based on a letter 
from the CTGR, dated May 19, 2021, which noted that the CTGR members 
residing in Clackamas County are active members of the community and 
routinely participate in Tribal elections, General Council meetings, 
and Tribal events.
    3. Clackamas County in the State of Oregon is ``on or near'' the 
reservation, as it maintains a common boundary with the current PRCDA 
consisting of the counties of Washington, Polk, Yamhill, Marion, 
Multnomah, and Tillamook in the State of Oregon.
    4. The CTGR administers the PRC program and will use its existing 
Federal allocation for PRC, along with Tribal resources, to provide 
services to the expanded population. The Tribe acknowledged that no 
additional financial resources will be allocated by the IHS to the 
Portland Area IHS to provide services to CTGR members residing in 
Clackamas County in the State of Oregon.
    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. 2023-16843 Filed 8-4-23; 8:45 am]
BILLING CODE 4165-16-P