[Federal Register Volume 61, Number 208 (Friday, October 25, 1996)]
[Notices]
[Pages 55309-55311]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-27411]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
[0917-ZA____]
Notice of Redesignation of Contract Health Service Delivery Area;
Jamestown S'Klallam Tribe
AGENCY: Indian Health Service, HHS.
ACTION: Final notice.
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[[Page 55310]]
SUMMARY: This notice advises the public that the Indian Health Service
(IHS) is redesignating the geographic boundaries of the Contract Health
Service Delivery Area (CHSDA) for the Jamestown S'Klallam Tribe (``The
Tribe''). The Jamestown S'Klallam CHSDA has been comprised of Clallam
County in the State of Washington. This county was designated as the
Tribe's CHSDA in the Federal Register of January 10, 1984 (49 FR 1291).
Jefferson County, Washington, is being added to the existing CHSDA.
This notice is issued under authority of 43 FR 34654, August 4, 1978.
EFFECTIVE DATE: October 25, 1996.
FOR FURTHER INFORMATION CONTACT:
Leslie M. Morris, Acting Director, Division of Legislation and
Regulations, Office of Planning, Evaluation and Legislation, Indian
Health Service, Suite 450, 12300 Twinbrook Parkway, Rockville, MD
20852, telephone 301/443-1116. (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: The Secretary of the Interior acknowledged
the Tribe as an Indian tribe, effective February 10, 1981 (45 FR
81890). The Tribe has entered into a self-governance compact with the
IHS under Title III of the Indian Self-Determination Act (Pub. L. 93-
638, as amended) to provide direct services at a clinic facility and
also to provide, for eligible Indians, services purchased from private
sector health care providers. Such purchased services are called
``contract health services.''
On August 4, 1978, the IHS published regulations establishing
eligibility criteria for receipt of contract health services and for
the designation of CHSDAs (43 FR 34654, codified at 42 CFR 36.22, last
published in the 1986 version of the Code of Federal Regulations). On
September 16, 1987, the IHS published new regulations governing
eligibility for IHS services. Congress has repeatedly delayed
implementation of the new regulations by imposing annual moratoriums.
Section 719(a) of the Indian Health Care Amendments of 1988, Pub. L.
100-713, explicitly provides that during the period of the moratorium
placed on implementation of the new eligibility regulations, the IHS
will provide services pursuant to the criteria in effect on September
15, 1987. Thus, the IHS contract health services program continues to
be governed by the regulations contained in the 1986 edition of the
Code of Federal Regulations in effect on September 15, 1987. See 42 CFR
36.21 et seq. (1986).
As applicable to the Tribe, these regulations provide that, unless
otherwise designated, a CHSDA 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 36.22(a)(6) (1986)). The
regulations also provide that after consultation with the tribal
governing body or bodies of those reservations included in the CHSDA,
the Secretary may, from time to time, redesignate areas within the
United States for inclusion in or exclusion from a CHSDA. 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 contract health services.
Additionally, the regulations require that any redesignation of a
CHSDA must be made in accordance with the procedures of the
Administrative Procedure Act (5 U.S.C. 553). In compliance with this
requirement, we published the proposal to redesignate the Tribe's CHSDA
in the Federal Register of August 3, 1995, requesting public comment
(60 FR 39761). One comment was received. A tribal government official
commented that the Jefferson County trust land should not be designated
as eligible for contract health services if the residents of that
county are located in an urban setting. However, the map of Jefferson
County, Washington, shows that it is a rural county with no urban
areas. Consequently, redesignation of the Tribe's CHSDA to include
Jefferson County does not conflict with the comment.
Since approximately 1984, the Tribe has been providing contract
health services to 20 of its tribal members residing in Jefferson
County, Washington. Under existing regulations, the CHSDA for the
Tribes consists of only Clallam County. On December 21, 1992, the Tribe
most recently requested the Secretary to redesignate its CHSDA as
Clallam County and Jefferson County in the State of Washington. The
Tribe based its request on the fact that S'Klallam tribal members are
indigenous to Jefferson County, Washington, yet are still ineligible to
receive contract health services because they do not reside within the
Tribe's existing CHSDA. In addition, the Tribe has developed a land
consolidation plan, which has been approved by the Department of the
Interior, through the Bureau of Indian Affairs, and which includes
tribal trust land in Jefferson County. However, the Jefferson County
tribal trust land has not yet been added to the reservation by
proclamation of the Secretary of the Interior, but that action is
reportedly pending.
In applying the aforementioned CHSDA redesignation criteria
required by operative regulations (43 FR 35654), the following findings
are made:
(1) There are 112 Indians residing in Jefferson County, of which 59
are members of the Tribe or have close socioeconomic ties to the Tribe.
Of these 59, 20 are already receiving services due to a previous
administrative decision. The remaining 53 individuals are not covered
by this request as they do not have close social and economic ties to
the Tribe and are, therefore, not eligible for contract health services
under existing law.
(2) The Tribe has determined that contract health services would be
available to all of its members and to all federally recognized Indians
in Jefferson County having social and economic affiliation with the
Tribe.
(3) Although the Tribe's reservation is in Clallam County, the
Tribe has trust land in Jefferson County that is included in an
approved land consolidation plan and is pending proclamation to add it
to the Tribe's reservation. This tribal trust land is contiguous to the
existing reservation and extends into Jefferson County.
(4) It is estimated that the current eligible contract health
service population will be increased by 39 individuals, changing the
active patient population from 192 to 231, assuming 100 percent
utilization for Jefferson County eligibles. Based upon data from the
fiscal year 1994 application of the health services priority system and
the modified resource requirements methodology, the total clinical work
units (CWUs) generated by the user population of 192 was 998.4, or 5.2
per individual. Assuming the same utilization, the 39 new users will
generate an additional 202.8 CWUs. The calculated cost per CWU in the
inpatient and ambulatory care category, which includes contract health
care costs, was $139.22 for the Tribe. Therefore, potential added costs
for contract health services resulting from new users is approximated
at $139.22 x 202.8 CWUs=$28,233.82. Total resources available to the
program in fiscal year 1994 were $139.000. The
[[Page 55311]]
addition of new usage would not be expected to result in an increase in
funding for the Tribe. The impact on existing contract health services
will not be substantial. The current level of funding will allow
sufficient flexibility to assure that there will be no significant
reduction in the level of contract health services to current CHSDA
residents, so the designation of the two-county CHSDA is within
available resources.
Accordingly, after considering the Tribe's request in light of the
criteria specified in the regulations, the IHS is redesignating the
CHSDA of the Tribe to consist of Clallam and Jefferson Counties of 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 1980.
Dated: September 24, 1996.
Michael H. Trujillo,
Assistant Surgeon General Director.
[FR Doc. 96-27411 Filed 10-24-96; 8:45 am]
BILLING CODE 4160-16-M
