[Federal Register Volume 88, Number 246 (Tuesday, December 26, 2023)]
[Notices]
[Pages 88927-88928]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-28311]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Purchased/Referred Care Delivery Area Redesignation for 
the Spokane Tribe of Indians in the State of Washington

AGENCY: Indian Health Service, HHS.

ACTION: Notice.

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SUMMARY: Notice is hereby given that the Indian Health Service (IHS) 
has decided to expand the geographic boundaries of the Purchased/
Referred Care Delivery Area (PRCDA) for the Spokane Tribe to include 
the counties of Spokane and Whitman in the State of Washington. The 
final PRCDA for the Spokane Tribe now includes the Washington counties 
of Ferry, Lincoln, Spokane, Stevens, and Whitman. The sole purpose of 
this expansion is to authorize additional Spokane Tribal members and 
beneficiaries to receive Purchased/Referred Care (PRC) services.

DATES: This expansion is effective as of the publication date of this 
notice.

ADDRESSES: This notice can be found at https://www.federalregister.gov. 
Written requests for information should be delivered to: CAPT John 
Rael, Director, Office of Resource Access and Partnerships, Indian 
Health Service, 5600 Fishers Lane, Mail Stop 10E85C, Rockville, MD 
20857, or by phone at (301) 443-0969 (this is not a toll-free number).

SUPPLEMENTARY INFORMATION: The IHS provides services under regulations 
in effect as of September 15, 1987, and republished at 42 CFR part 136, 
subparts A-C. Subpart C defines a Contract Health Service Delivery Area 
(CHSDA), now referred to as a PRCDA, as the geographic area within 
which PRC will be made available by the IHS to members of an identified 
Indian community who reside in the PRCDA. Residence within a PRCDA by a 
person who is within the scope of the Indian health program, as set 
forth in 42 CFR 136.12, creates no legal entitlement to PRC but only 
potential eligibility for services. Services needed, but not available 
at an IHS/Tribal facility, are provided under the PRC program depending 
on the availability of funds, the relative medical priority of the 
services to be provided, and the actual availability and accessibility 
of alternate resources in accordance with the regulations.
    The regulations at 42 CFR part 136, subpart C provide that, unless 
otherwise designated, a PRCDA 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 136.22(a)(6). The 
regulations also provide that after consultation with the Tribal 
governing body or bodies on those reservations included within the 
PRCDA, the Secretary may from time to time, redesignate areas within 
the United States for inclusion in or exclusion from a PRCDA. 42 CFR 
136.22(b). 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 PRC.
    Additionally, the regulations require that any redesignation of a 
PRCDA must be made in accordance with the procedures of the 
Administrative Procedure Act (5 U.S.C. 553). 42 CFR 136.22(c). In 
compliance with this requirement, the IHS published a proposed notice 
of redesignation and requested public comments on August 9, 2023 (88 FR 
53899). The IHS did not receive any comments to the notice of the 
proposed expansion.
    Two other Tribes currently have PRCDAs which include one or both of 
the counties to be included in the Spokane Tribe's expanded PRCDA--the 
Coeur d'Alene Tribe (both Spokane and Whitman Counties) and the 
Kalispel Tribe of Indians (Spokane County only). On December 10, 2021, 
the Portland Area Director notified both Tribes of the Spokane Tribe's 
request to expand their PRCDA, and requested any comments in response. 
The Kalispel Tribe of Indians did not provide any comments. The Coeur 
d'Alene Tribe responded with objections to the proposed expansion. The 
Portland Area IHS engaged in further conversations and correspondence 
with the Coeur d'Alene Tribe throughout 2021 and 2022.
    Through letters from the Spokane Tribe, dated May 31, 2022 and 
August 8, 2022, the Tribe expressed its support for the expansion, 
described the geographic proximity of Spokane and Whitman counties to 
the Tribe's reservation, and explained that the Tribe's reservation 
expanded into Spokane County in 2001 and that some of the Tribe's 
members reside in Whitman County.
    In support of this expansion, the IHS adopts the following 
findings:
    1. By expanding the PRCDA to include Spokane County and Whitman 
County, the Spokane Tribe's eligible population will be increased by an 
estimated 480 Tribal members. Although the Coeur d'Alene Tribe has a 
PRCDA which includes these two counties, the Coeur d'Alene Tribe does 
not provide PRC services to Spokane Tribal members residing in those 
counties. Expansion of the Spokane Tribe's PRCDA to include Spokane and 
Whitman Counties will therefore increase access to care for those 
individuals.
    2. The IHS finds that the Tribal members within the expanded PRCDA 
are socially and economically affiliated with the Spokane based on 
letters from the Spokane Tribe, dated May 31, 2022 and August 8, 2022, 
which noted that the Spokane Tribal Council had

[[Page 88928]]

determined that Tribal members residing in Spokane and Whitman counties 
are socially and economically affiliated with the Tribe.
    3. Spokane and Whitman Counties in the State of Washington are ``on 
or near'' the reservation, as they maintain common boundaries with the 
current PRCDA consisting of the counties of Ferry, Lincoln, and Stevens 
in the State of Washington. Additionally, Spokane County includes part 
of the Spokane reservation, and Whitman County includes the Tribe's 
aboriginal territory.
    4. The IHS administers the Wellpinit Service Unit PRC program and 
will use its existing Federal allocation for PRC to provide services to 
the expanded population. No additional financial resources will be 
allocated by the IHS to the Portland Area IHS to provide services to 
Spokane Tribal members residing in Spokane and Whitman Counties in the 
State of Washington.
    An updated listing of the PRCDAs for all federally-recognized 
Tribes may be accessed via a link under the ``Purchased/Referred Care 
Delivery Area'' heading on the IHS PRC Resources website (https://www.ihs.gov/prc/resources).
    Public Comments: The IHS did not receive any comments to the notice 
of the proposed expansion.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2023-28311 Filed 12-22-23; 8:45 am]
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