Notice of Redesignation of Contract Health Service Delivery Area

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

[0905-ZA93]

Notice of Redesignation of Contract Health Service Delivery Area

AGENCY: Indian Health Service, HHS.

ACTION: Notice with request for comments.

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

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 Jamestown S'Klallam Tribe

(``The Tribe''). The Jamestown S'Klallam CHSDA currently is comprised

of Clallam County in the State of Washington. This county was

designated as the Tribe's CHSDA when the IHS published its updated list

of CHSDA's in the Federal Register of January 10, 1984 (49 FR 1291). It

is proposed that the redesignated CHSDA be comprised of Clallam County

and Jefferson County in the State of Washington. This notice is issued

under authority of 43 FR 34654, August 4, 1978.

DATES: Comments must be received on or before September 5, 1995.

ADDRESSES: Comments may be mailed to Betty J. Penn, Regulations

Officer, Indian Health Service, Room 450, 12300 Twinbrook Parkway,

Rockville, 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, Room 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 CHSDA's (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 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 are publishing this proposal and requesting public

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 Tribe

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.

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

[[Page 39762]]

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 (CWU's) 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 CWU's. The calculated cost per CWU in the

inpatient and ambulatory contract health care category 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

CWU's = $28,233.82. Total resources available to the program in fiscal

year 1994 were $139,000. The 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 funding level 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, I am proposing to redesignate

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 1930.

Dated: May 23, 1995.

Michel E. Lincoln,

Acting Director.

[FR Doc. 95-19095 Filed 8-2-95; 8:45 am]

BILLING CODE 4160-16-M