[Federal Register Volume 88, Number 152 (Wednesday, August 9, 2023)]
[Notices]
[Pages 53899-53900]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-17058]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Purchased/Referred Care Delivery Area Redesignation for 
the Spokane Tribe of Indians in the State of Washington

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 expand the geographic boundaries of the Purchased/
Referred Care Delivery Area (PRCDA) for the Spokane Tribe of the 
Spokane Reservation to include the counties of Spokane and Whitman in 
the State of Washington. The current PRCDA for the Spokane Tribe of the 
Spokane Reservation includes the Washington counties of Ferry, Lincoln, 
and Stevens. Spokane Tribal 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 Spokane Tribal members and 
beneficiaries to receive PRC services.

DATES: Comments must be submitted September 8, 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:
    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;
    (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 Spokane Tribe of the Spokane Reservation is located in the 
Northeastern part of Washington State. The Tribe is located on an 
approximately 157,000 acre reservation that is located in Stevens, 
Lincoln, and Spokane Counties.
    The PRC Program is operated as a Federal program through the 
Wellpinit

[[Page 53900]]

Service Unit in Wellpinit, WA. The Portland Area IHS estimates there 
are currently 480 Tribal members who live within Spokane and Whitman 
Counties and would become PRC eligible through this proposed expansion. 
The Tribe states that Tribal members who reside in Spokane and Whitman 
Counties are socially and economically affiliated with the Tribe 
through employment, family, community, or services. The Tribe would 
like to recognize them as eligible for PRC. Accordingly, the IHS 
proposes to expand the PRCDA of the Spokane Tribe of the Spokane 
Reservation to include the Washington counties of Spokane and Whitman.
    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 Spokane County and Whitman 
County, the Spokane Tribe of the Spokane Reservation's eligible 
population will be increased by an estimated 480 tribal members.
    2. The IHS finds that the Tribal members within the expanded PRCDA 
are socially and economically affiliated with the Spokane Tribe of the 
Spokane Reservation based on letters from the Tribe, dated May 31, 2022 
and August 8, 2022, which noted that the Spokane Tribal Council had 
determined that tribal members residing in Spokane and Whitman counties 
are socially and economically affiliated with the Tribe.
    3. Spokane and Whitman counties in the State of Washington are ``on 
or near'' the reservation, as they maintain a common boundary with the 
current PRCDA consisting of the counties of Ferry, Lincoln, and Stevens 
in the State of Washington. In addition to this, Spokane County 
includes a recent addition to the Spokane reservation (see 83 FR 
18860), and Whitman County includes the Tribe's aboriginal territory.
    4. The IHS administers the Wellpinit Service Unit PRC program and 
will use its existing Federal allocation for PRC to provide services to 
the expanded population. The Portland Area Director acknowledged that 
no additional financial resources will be allocated by the IHS to the 
Portland Area IHS to provide services to Spokane Tribal members 
residing in Spokane and Whitman counties in 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 1995.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-17058 Filed 8-8-23; 8:45 am]
BILLING CODE 4165-16-P