[Federal Register Volume 60, Number 215 (Tuesday, November 7, 1995)]
[Notices]
[Pages 56159-56160]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-27564]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service
[0917-ZA00]
Notice of Redesignation of Contract Health Service Delivery Area
AGENCY: Indian Health Service, HHS.
ACTION: Notice with request for comments.
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SUMMARY: This Notice advises the public that the Indian Health Service
(IHS) proposes to redesignate the geographic boundaries of the Contract
Health Service Delivery Area (CHSDA) for the Confederated Tribes of the
Chehalis Reservation, Washington (``the Tribes''). The Chehalis CHSDA
currently is comprised of Grays Harbor and Thurston Counties in the
State of Washington. These counties were designated as the Tribes'
CHSDA in the Federal Register of January 10, 1984 (49 CFR 1291). It is
proposed that Lewis County, Washington, be added to the existing CHSDA.
This notice is issued under authority of 43 FR 34654, August 4, 1978.
DATES: Comments must be received on or before December 7, 1995.
ADDRESSES: Comments may be mailed to Betty J. Penn, Regulations
Officer, Indian Health Service, Suite 450, 12300 Twinbrook Parkway,
Rockville,
[[Page 56160]]
Maryland 20852. Comments will be made available for public inspection
at this address from 8:30 a.m. to 5:00 p.m. Monday-Friday, beginning
approximately 2 weeks after publication of this notice.
FOR FURTHER INFORMATION CONTACT:
Leslie M. Morris, Deputy Director, Division of Legislation and
Regulations, Office of Planning, Evaluation and Legislation, Indian
Health Service, Suite 450, 12300 Twinbrook Parkway, Rockville, Maryland
20852, Telephone 301/443-1116 (This is not a toll-free number.)
SUPPLEMENTARY INFORMATION: On August 4, 1978, the IHS published
regulations establishing eligibility criteria for receipt of contract
health services (CHS) 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 CHS 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 43 CFR
36.21 et seq. (1986).
As applicable to the Tribes, 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 are publishing this proposal and requesting public
comment.
The request of the Confederated Tribes of Chehalis Reservation to
expand their CHSDA was presented in their Tribal Resolution 1994-38,
dated August 17, 1994. The Tribes' request will expand their current
CHSDA, which incorporates Grays Harbor and Thurston Counties in the
State of Washington, to include Lewis County, Washington.
Under 42 CFR 36.23 those otherwise eligible Indians who do not
reside on a reservation but reside within a CHSDA must be either
members of the tribe or maintain close economic and social ties with
the tribe. In this case, the tribe estimates that the current eligible
CHS population will be increased by 25 individuals consisting of 13
enrolled Chehalis tribal members and 12 non-Chehalis members not
currently covered because these individuals have no close economic and
social ties with the Yakama but do with the Chehalis.
In applying the aforementioned CHSDA redesignation criteria
required by operative regulations (43 FR 35654), the following findings
are made:
1. Lewis County is contiguous with Thurston County. Both counties
are within the State of Washington.
2. Lewis County is part of the Tribes' traditional territory and
many tribal members retain ownership of public domain allotments there.
3. The Tribes share co-management responsibility with the State of
Washington for 2,600 square miles of rivers and streams in the Chehalis
River Basin, which includes Lewis County. Lands adjacent to the
Chehalis River have historically been considered in defining the
original tribal homeland.
4. The majority of potential new CHS users who reside in Lewis
County are within 15 miles of the Tribes limited direct care facility
and depend on the Tribes for their health care requirements.
5. The nearest IHS comprehensive health center available to provide
care for these beneficiaries is located in Toppenish, Washington, which
is 150 miles away.
6. The current CHS patient care resources available to the tribes
total $331,364 for 392 users. Per capita combined workload units (CWUs)
are estimated at 5.7. The estimated costs associated with this request
are $21,090 and are calculated as follows:
392 current users x 5.7 CWUs=2,234 CWUs
$331,364 (current funding)/2,234 CWUs=$148 per CWU
$148 x 25 (new users) x 5.7 CWUs=$21,090
7. The financial resources required to meet the immediate needs of
potential Lewis County users will not be substantial and will be
absorbed by that tribe's total health care program within available
resources.
Since CHS is a critical component of the Tribes' overall health
care system for its members, the Tribes feels that the members living
in Lewis County, Washington, should be included within the CHSDA for
the Tribes.
Accordingly, after considering the Tribes' request in light of the
criteria specified in the regulations, I am proposing to redesignate
the CHSDA of the Tribes to consist of Grays Harbor, Thurston, and Lewis
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: October 31, 1995.
Michel E. Lincoln,
Deputy Director.
[FR Doc. 95-27564 Filed 11-6-95; 8:45 am]
BILLING CODE 4160-16-M
