[Federal Register Volume 88, Number 246 (Tuesday, December 26, 2023)]
[Notices]
[Pages 88928-88929]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28313]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Purchased/Referred Care Delivery Area Redesignation for 
the Mid-Atlantic Tribes in the States of Maryland, North Carolina, and 
Virginia

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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SUMMARY: Notice is hereby given that the Indian Health Service (IHS) 
has decided 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 (PRCDAs). 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.

DATES: This expansion is effective as of the publication date of this 
notice.

ADDRESSES: This notice can be found at https://www.federalregister.gov. 
Written requests for information should be delivered to: CAPT John 
Rael, Director, Office of Resource Access and Partnerships, Indian 
Health Service, 5600 Fishers Lane, Mail Stop 10E85C, Rockville, MD 
20857, or by phone at (301) 443-0969 (this is not a toll-free number).

SUPPLEMENTARY INFORMATION: The final collective PRCDA for the seven 
Mid-Atlantic Tribes now includes 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.
    The sole purpose of this expansion is to authorize additional 
Tribal members and beneficiaries to receive Purchased/Referred Care 
(PRC) services.
    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 published a proposed notice 
of redesignation and requested public comments on August 1, 2023 (88 FR 
50160). In response, the IHS received one comment. The

[[Page 88929]]

comment received expressed support of the proposed expansion.
    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 considered these Tribes collectively for purposes of the PRCDA 
expansion. This included considering their Tribal members collectively 
under the criteria set forth in 42 CFR 136.22(b). In support of this 
expansion, the IHS adopts the following findings:
    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. Members of one or more of the Tribes reside in 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 expanded PRCDA counties and independent cities form a 
contiguous area with the existing PRCDAs. Considering the seven Mid-
Atlantic 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.
    An updated listing of the PRCDAs for all federally recognized 
Tribes may be accessed via a link under the ``Purchased/Referred Care 
Delivery Area'' heading on the IHS PRC Resources website (https://www.ihs.gov/prc/resources).
    Public Comments: The IHS received one comment. The comment received 
expressed support of the proposed expansion.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-28313 Filed 12-22-23; 8:45 am]
BILLING CODE 4166-14-P