[Federal Register Volume 89, Number 157 (Wednesday, August 14, 2024)]
[Notices]
[Pages 66120-66121]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-18081]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


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

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

ACTION: Final notice.

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

SUMMARY: Notice is hereby given that the Indian Health Service (IHS) 
has decided to expand the geographic boundaries of the Purchased/
Referred Care Delivery Area (PRCDA) for the Confederated Tribes of the 
Grand Ronde Community of Oregon (CTGR) 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 sole purpose of this expansion is to 
authorize additional CTGR members and beneficiaries to receive 
purchased/referred care (PRC) services.

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 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

[[Page 66121]]

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 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 7, 2023 (88 FR 52185). The IHS 
received one comment in response to the proposed notice of 
redesignation; the comment requested that the IHS engage in additional 
Tribal Consultation regarding the proposed PRCDA expansion.
    Redesignation and expansion of the CTGR's PRCDA to include 
Clackamas County, Oregon, would create overlap with two Tribes whose 
existing PRCDAs also include Clackamas County: the Confederated Tribes 
of Siletz Indians of Oregon and the Confederated Tribes of the Warm 
Springs Reservation of Oregon.
    The IHS initiated Consultation with each of these Tribes in 2021, 
and continued Consultation, as requested, through 2024. The primary 
concern raised during Tribal Consultation was whether the proposed 
expansion of the CTGR's PRCDA to include Clackamas County, Oregon, 
exceeded Congressional intent as expressed in the Grande Ronde 
Restoration Act, Public Law 98-165, Nov. 22, 1983. Although the IHS 
acknowledges this concern, the IHS has, under the PRC regulations, 
preserved flexibility to redesignate areas as appropriate for inclusion 
in or exclusion from PRC service delivery. See 81 FR 20388.
    In support of this expansion, the IHS makes the following findings:
    1. By expanding the PRCDA to include Clackamas County, the CTGR's 
eligible population will increase by an estimated 179 Tribal members 
residing in Clackamas County.
    2. The Tribal members within the expanded PRCDA are socially and 
economically affiliated with the Confederated Tribes of the Grande 
Ronde Community of Oregon. A letter from the CTGR, dated May 19, 2021, 
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 intends to use its 
existing Federal allocation for PRC, along with Tribal resources, to 
provide services to the expanded population. The CTGR acknowledged that 
no additional financial resources will be allocated by the IHS to 
provide services to CTGR members residing in Clackamas County in the 
State of Oregon.
    An updated listing of the PRCDAs for all federally recognized 
Tribes may be accessed via a link on the IHS PRCDA Expansion website 
(https://www.ihs.gov/prc/prcda-expansion).
    Public Comments: The IHS received one comment in response to the 
notice of proposed expansion. The comment requested that the IHS engage 
in additional Tribal Consultation regarding the proposed expansion. The 
IHS did engage in such additional Tribal Consultation, and decided to 
finalize the PRCDA expansion for the Confederated Tribes of the Grand 
Ronde Community of Oregon as proposed.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2024-18081 Filed 8-13-24; 8:45 am]
BILLING CODE 4166-14-P