Notice2024-29101
Notice of Proposed Purchased/Referred Care Delivery Area Redesignation for the Iowa Tribe of Kansas and Nebraska
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Published
December 11, 2024
Issuing agencies
Health and Human Services DepartmentIndian Health Service
Abstract
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.
Full Text
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<title>Federal Register, Volume 89 Issue 238 (Wednesday, December 11, 2024)</title>
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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 [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[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 <a href="http://www.regulations.gov">http://www.regulations.gov</a>. 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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