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[Federal Register Volume 89, Number 238 (Wednesday, December 11, 2024)]
[Notices]
[Pages 99885-99887]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-29102]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Notice of Proposed Purchased/Referred Care Delivery Area 
Redesignation for the Sac and Fox Nation of Missouri in 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 Sac and Fox Nation of 
Missouri in Kansas and Nebraska (Sac and Fox Nation of Missouri, or 
Tribe) to include the counties of Doniphan and Jackson in the

[[Page 99886]]

State of Kansas, and Holt in the State of Missouri. The current PRCDA 
for the Sac and Fox Nation of Missouri includes Brown County, Kansas, 
and Richardson County, Nebraska. The Sac and Fox Nation of Missouri 
Tribal 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 Sac and Fox Nation of Missouri 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 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 Sac and Fox Nation of Missouri is located in Reserve, Kansas. 
The Sac and Fox Nation of Missouri's PRC program is operated, as 
authorized by Tribal resolution, by the Iowa Tribe of Kansas and 
Nebraska as a Tribal Health Program out of the White Cloud Health 
Center. The IHS and the Sac and Fox Nation of Missouri estimate that 
approximately seven Tribal members reside in Doniphan and Jackson 
Counties, Kansas, and Holt County, Missouri, and would become PRC 
eligible through the proposed redesignation and expansion of the 
Tribe's PRCDA.
    If the Sac and Fox Nation of Missouri's PRCDA redesignation and 
expansion is finalized as proposed, the Tribe's expanded PRCDA would 
overlap the PRCDAs of three other Tribes: the Iowa Tribe of 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 Sac and Fox Nation of Missouri and the 
Iowa Tribe of Kansas and Nebraska share a PRC program, but currently 
have different PRCDAs; the Iowa Tribe of Kansas and Nebraska 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 Sac and Fox Nation of Missouri's and the Iowa Tribe'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 Doniphan and Jackson Counties 
in Kansas, and Holt County, Missouri, the Sac and Fox Nation of 
Missouri's PRC eligible population will increase by an estimated seven 
Tribal members.
    2. Through communication with the Tribe and information relayed by 
the White Cloud Health Center, the IHS understands that the Tribe's 
governing body has determined that its members

[[Page 99887]]

residing in the proposed expansion counties are socially and 
economically affiliated with the Tribe. The IHS therefore finds that 
the Tribal members within the proposed, expanded PRCDA are socially and 
economically affiliated with the Sac and Fox Nation of Missouri.
    3. The expanded PRCDA counties form a contiguous area with the 
existing PRCDA, and members of the Sac and Fox Nation of Missouri 
reside in each of the counties proposed for inclusion in the expanded 
PRCDA. Jackson County, Kansas and Doniphan County, Kansas both share a 
common boundary with Brown County, Kansas, where the Sac and Fox Nation 
of Missouri has reservation lands. Holt County, Missouri, shares a 
common boundary with Richardson County, Nebraska, where the Sac and Fox 
Nation of Missouri has reservation lands. 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 Sac and 
Fox Nation of Missouri in Kansas and Nebraska to include the counties 
of Doniphan and 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. 2024-29102 Filed 12-10-24; 8:45 am]
BILLING CODE 4166-14-P
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