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[Federal Register Volume 89, Number 238 (Wednesday, December 11, 2024)]
[Notices]
[Pages 99884-99885]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-29101]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Notice of Proposed Purchased/Referred Care Delivery Area 
Redesignation for the Iowa Tribe of Kansas and Nebraska

AGENCY: Indian Health Service, HHS.

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 Iowa Tribe of Kansas and 
Nebraska (Iowa Tribe, or Tribe) to include the counties of Jackson in 
the State of Kansas, and Holt in the State of Missouri. The current 
PRCDA for the Iowa Tribe includes the Kansas counties of Doniphan and 
Brown, as well as Richardson County, Nebraska. Iowa Tribe members who 
reside 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 Iowa Tribe members and beneficiaries to receive PRC 
services.

DATES: Comments must be submitted by January 10, 2025.

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 http://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

[[Page 99885]]

business information that is included in a comment.
    Background: 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 services 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 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 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 Iowa Tribe is located in White Cloud, Kansas, and operates 
their PRC program as a Tribal Health Program out of the White Cloud 
Health Center. The IHS and the Iowa Tribe estimate that approximately 
77 Tribal members reside in Jackson County, Kansas, and Holt County, 
Missouri, and would become PRC eligible through the proposed 
redesignation and expansion of the Tribe's PRCDA.
    If the Iowa Tribe's PRCDA redesignation and expansion is finalized 
as proposed, the Tribe's expanded PRCDA would overlap the PRCDAs of 
three other Tribes: the Sac and Fox Nation of Missouri in Kansas and 
Nebraska, the Kickapoo Tribe of Indians of the Kickapoo Reservation 
(Jackson County, Kansas), and the Prairie Band of Potawatomi Nation 
(Jackson County, Kansas). The Iowa Tribe and the Sac and Fox Nation of 
Missouri in Kansas and Nebraska share a PRC program, but currently have 
different PRCDAs; the Sac and Fox Nation of Missouri has submitted a 
concurrent request for redesignation and expansion of their own PRCDA. 
Both redesignation requests were submitted to the IHS through the same 
correspondence from the White Cloud Health Center. If the Iowa Tribe's 
and Sac and Fox Nation of Missouri's PRCDAs are each redesignated and 
expanded as requested, the Tribes would have identical, overlapping 
PRCDAs, simplifying the administration and operation of their local PRC 
program.
    The IHS has consulted with the Kickapoo Tribe of Indians of the 
Kickapoo Reservation and the Prairie Band of Potawatomi Nation 
regarding the potential for overlapping PRCDAs in Jackson County, 
Kansas. Neither the Kickapoo Tribe of Indians of the Kickapoo 
Reservation nor the Prairie Band of Potawatomi Nation expressed 
concerns regarding the proposed redesignation and 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 Jackson County, Kansas, and 
Holt County, Missouri, the Iowa Tribe's PRC eligible population will 
increase by an estimated 77 Tribal members.
    2. The Iowa Tribe communicated its governing body's determination 
that their members residing in the proposed expansion counties are 
socially and economically affiliated with the Tribe. The IHS therefore 
finds that the Tribe's members within the proposed, expanded PRCDA are 
socially and economically affiliated with the Iowa Tribe.
    3. The expanded PRCDA counties form a contiguous area with the 
existing PRCDA. Holt County, Missouri, shares a common boundary with 
the Iowa Tribe's reservation lands in Richardson County, Nebraska. 
Jackson County, Kansas, is contiguous with Brown County, which includes 
part of the Iowa Tribe's reservation lands and is currently included in 
the Iowa Tribe's PRCDA. Members of the Iowa Tribe reside in each of the 
counties proposed for inclusion in the expanded PRCDA. For these 
reasons, the IHS has determined the additional counties proposed for 
inclusion herein to be geographically proximate, meaning ``on or 
near,'' to the Tribe's reservation.
    4. The White Cloud Health Center has indicated that the 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.
    Accordingly, the IHS proposes to expand the PRCDA of the Iowa Tribe 
to include the counties of Jackson in the State of Kansas, and Holt in 
the State of Missouri.
    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. 2024-29101 Filed 12-10-24; 8:45 am]
BILLING CODE 4166-14-P
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