[Federal Register Volume 89, Number 13 (Friday, January 19, 2024)]
[Notices]
[Pages 3669-3670]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-01017]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service


Notice of Proposed Purchased/Referred Care Delivery Area 
Redesignation for the Mashantucket Pequot Tribal Nation in the State of 
Connecticut

AGENCY: Indian Health Service, Department of Health and Human Services.

ACTION: Notice.

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SUMMARY: This Notice advises the public that the Indian Health Service 
(IHS) proposes to expand the geographic boundaries of the Purchased/
Referred Care Delivery Area (PRCDA) for the Mashantucket Pequot Tribal 
Nation to include the counties of Fairfield, Hartford, Litchfield, 
Middlesex, New Haven, Tolland, and Windham in the State of Connecticut. 
The current PRCDA for the Mashantucket Pequot Tribal Nation includes 
the Connecticut county of New London. Mashantucket Pequot Tribal Nation 
members residing outside of the PRCDA are eligible for direct care 
services, however, they are not eligible for Purchased/Referred Care 
(PRC) services. The sole purpose of this expansion would be to 
authorize additional Mashantucket Pequot Tribal Nation members and IHS 
beneficiaries to receive PRC services.

DATES: Comments must be submitted by February 20, 2024.

ADDRESSES: Because of staff and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. You may submit comments in 
one of four ways (please choose only one of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to https://www.regulations.gov. Follow the ``Submit a 
Comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Carl Mitchell, Director, Division of Regulatory and 
Policy Coordination, Indian Health Service, 5600 Fishers Lane, Mail 
Stop: 09E70, Rockville, Maryland 20857.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the above address.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments before the close of the comment period 
to the address above. If you intend to deliver your comments to the 
Rockville address, please call telephone number (301) 443-1116 in 
advance to schedule your arrival with a staff member.

FOR FURTHER INFORMATION CONTACT: CAPT John Rael, Director, Office of 
Resource Access and Partnerships, Indian Health Service, 5600 Fishers 
Lane, Mail Stop: 10E85C, Rockville, Maryland 20857. Telephone (301) 
443-0969 (This is not a toll free number).

SUPPLEMENTARY INFORMATION: 
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment.
    Background: The IHS provides services under regulation 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 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,

[[Page 3670]]

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 is publishing this Notice and 
requesting public comments.
    The Mashantucket Pequot Tribal Nation's (MPTN, or Tribe) 
reservation is located in New London County, Connecticut. The PRC 
Program is operated as a Tribal Health Program by the MPTN in 
Mashantucket, CT. The MPTN estimates that approximately 32 Tribal 
members and MPTN employees who are members of other federally 
recognized Tribes reside in the proposed expansion counties, and would 
become PRC eligible through this proposal. The MPTN states that the 
Tribal members and American Indian and Alaska Native (AI/AN) employees 
who reside in the expanded counties are socially and economically 
affiliated with the Tribe, including through employment and the 
utilization of direct health care services. The MPTN would like to 
recognize these persons as eligible for PRC. Through communication with 
MPTN's representatives, the IHS also understands that MPTN's members 
live in all of the counties requested. Accordingly, the IHS proposes to 
expand the PRCDA of the Mashantucket Pequot Tribal Nation to include 
the Connecticut counties of Fairfield, Hartford, Litchfield, Middlesex, 
New Haven, Tolland, and Windham.
    If the Mashantucket Pequot Tribal Nation's PRCDA expansion is 
finalized as proposed, the Tribe's PRCDA would overlap completely with 
the PRCDA of the Mohegan Tribe of Connecticut. The Mohegan Tribe of 
Connecticut has previously expressed support of any future request made 
by a federally recognized Tribe to establish the entire state of 
Connecticut as a PRCDA, and has not expressed any objection to the 
Mashantucket Pequot Tribal Nation's proposed PRCDA expansion.
    Under 42 CFR 136.23, those otherwise eligible Indians who do not 
reside on a reservation, but reside within a PRCDA, must be either 
members of the Tribe or other IHS beneficiaries who maintain close 
economic and social ties with the Tribe. In this case, applying the 
aforementioned PRCDA redesignation criteria required by operative 
regulations codified at 42 CFR part 136, subpart C, the following 
findings are made:
    1. By expanding the PRCDA to include Fairfield, Hartford, 
Litchfield, Middlesex, New Haven, Tolland, and Windham Counties, the 
Mashantucket Pequot Tribal Nation's eligible population will be 
increase by an estimated 32 Tribal members and AI/AN employees.
    2. The IHS finds that the Tribal members and AI/AN employees within 
the expanded PRCDA are socially and economically affiliated with the 
Mashantucket Pequot Tribal Nation based on a tribal resolution in which 
the MPTN Tribal Council identified its intent to expand the PRCDA to 
include all of Connecticut, and stated that the Native Americans 
residing in such areas are socially and economically affiliated with 
MPTN.
    3. The expanded PRCDA counties form a contiguous area with the 
existing PRCDA, and within one of the smallest states. In addition to 
their AI/AN employees, MPTN's members reside in each of the counties 
proposed for inclusion. For these reasons, the IHS has determined the 
additional counties proposed for inclusion herein to be geographically 
proximate, meaning ``on or near,'' to the existing PRCDA.
    4. The MPTN has indicated that its PRC program can continue 
providing the same level of care to the PRC eligible population if the 
PRCDA is expanded as proposed, without requiring additional funding or 
reduction of the current medical priority level.
    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.

Roselyn Tso,
Director, Indian Health Service.
[FR Doc. 2024-01017 Filed 1-18-24; 8:45 am]
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