Notice2024-29102
Notice of Proposed Purchased/Referred Care Delivery Area Redesignation for the Sac and Fox Nation of Missouri in Kansas and Nebraska
Primary source
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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 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 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.
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 99885-99887]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[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
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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 <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 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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