Notice of Redesignation of Contract Health Service Delivery Area; Jamestown S'Klallam Tribe

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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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]

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