Notice of Redesignation of Contract Health Service Delivery Area

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]

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