Proposed Rule2026-18167
Reducing Bureaucracy and Burden for the Repatriation of Mentally Ill Nationals
Primary source
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Published
September 4, 2026
Issuing agencies
Health and Human Services DepartmentChildren and Families Administration
Abstract
The Department of Health and Human Services, Administration for Children and Families proposes to remove the Care and Treatment of Mentally Ill Nationals of the United States, Returned from Foreign Countries regulations to streamline regulations and to renumber it under a different Part.
Full Text
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<title>Federal Register, Volume 91 Issue 171 (Friday, September 4, 2026)</title>
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[Federal Register Volume 91, Number 171 (Friday, September 4, 2026)]
[Proposed Rules]
[Pages 56826-56828]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-18167]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
45 CFR Parts 211 and 1390
RIN 0970-AD48
Reducing Bureaucracy and Burden for the Repatriation of Mentally
Ill Nationals
AGENCY: Office Human Services Emergency Preparedness and Response
(OHSEPR), Administration for Children and Families (ACF), Department of
Health and Human Services (HHS).
ACTION: Notice of proposed rulemaking.
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SUMMARY: The Department of Health and Human Services, Administration
for Children and Families proposes to remove the Care and Treatment of
Mentally Ill Nationals of the United States, Returned from Foreign
Countries regulations to streamline regulations and to renumber it
under a different Part.
DATES: In order to be considered, written comments on this proposed
rule must be received on or before October 5, 2026.
ADDRESSES: You may submit written comments, identified by docket number
ACF-2026-0661 and/or RIN number 0970-AD48, by one of the following
methods:
<bullet> Federal eRulemaking Portal: Go to <a href="https://www.regulations.gov">https://www.regulations.gov</a>. Follow the instructions for submitting comments.
<bullet> Email: <a href="/cdn-cgi/l/email-protection#3e7a5b4c5b594b525f4a5751507e5f5d581056564d10595148"><span class="__cf_email__" data-cfemail="c387a6b1a6a4b6afa2b7aaacad83a2a0a5edababb0eda4acb5">[email protected]</span></a>. Include the docket number
ACF-2026-0661 and/or RIN number 0970-AD48 in the subject line of the
message.
Instructions: All submissions received must include the agency name
and docket number or RIN number for this rulemaking. All comments
received are a part of the public record and will be posted for public
viewing on <a href="http://www.regulations.gov">www.regulations.gov</a>, without change. Please be advised that
the substance of the comments and the identity of individuals or
entities submitting the comments will be subject to public disclosure.
The docket on <a href="https://www.regulations.gov">https://www.regulations.gov</a> will include a plain language
summary of the notice of proposed rulemaking (NPRM).
FOR FURTHER INFORMATION CONTACT: Adam N. Jones, Deputy Chief of Staff,
Immediate Office of the Assistant Secretary, Administration for
Children and Families, Department of Health and Human Services,
Washington, DC 202-417-0115 or <a href="/cdn-cgi/l/email-protection#e0a485928587958c8194898f8ea0818386ce888893ce878f96"><span class="__cf_email__" data-cfemail="eeaa8b9c8b899b828f9a878180ae8f8d88c086869dc0898198">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
I. Statutory Authority
This proposed regulation is being issued under the authority
granted to the Secretary of Health and Human Services by 74 Stat. 308-
310 (24 U.S.C. 321-329).
II. Background
45 CFR part 211, ``Care and Treatment of Mentally Ill Nationals of
the United States, Returned from Foreign Counties'' is a comprehensive
regulatory framework established under 74 Stat. 308-310, 42 U.S.C. 321-
329. Originally published on July 19, 1974, Part 211 establishes
uniform procedures for program applications, including requirements
addressing eligibility, procedures for the care and treatment of
mentally ill repatriates, and general administrative standards. This
Part was significantly reduced by 91 FR 36542, published on June 17,
2026.
III. Executive Summary
This NPRM proposes to remove the remaining sections of Part 211 and
combine them into a newly created Part 1390 promulgated under the same
title. This action would accomplish two tasks. First, it would
consolidate the language that is currently found in Sec. Sec. 211.3
and 211.6, which no longer reads cleanly following the removal of the
other sections of the Part following the publication of 91 FR 36542.
This consolidation will restate the language found in these two
sections into a more readable and understandable manner than the
current half-century old text.
Secondly, the current Part 211 exists under Chapter II of Title 45,
which is called ``Office of Family Assistance (Assistance Programs),
Administration for Children and Families, Department of Health and
Human Services.'' The program office that implements the regulations
under current Part 211 is not the Office of Family Assistance (OFA) but
rather the Office of Human Services Emergency Preparedness and Response
(OHSEPR). This redesignation from Part 211 to Part 1390 would allow
that to be more clearly displayed to the public.
Severability
The provisions of this NPRM, if finalized, are intended to be
severable, such that, in the event a court were to invalidate any
particular provision or deem it to be unenforceable, the remaining
provisions would continue to be valid. None of the provisions contained
herein are central to an overall intent of the proposed rule, nor are
any provisions dependent on the validity of other, separate provisions.
IV. Discussion of Proposed Changes
Part 211 discusses the procedures and protections made for the care
and treatment of mentally ill American nationals returned from foreign
countries. This Part was heavily restructured and reduced in 2026
following ACF's intentional effort to remove duplicative and obsolete
regulations. See 91 FR 36542. The initial rulemaking related to this
Part resulted in the removal of 13 of the 15 sections that were
initially promulgated under Part 211. While the removal of those 13
sections allowed for more clarity as to what non-duplicative
requirements were in place, it did cause the remaining regulations to
appear disjointed. This NPRM proposes to address this by removing and
consolidating the remaining two sections into one concise, streamlined
section while not changing any of the operational practice or
protections for mentally ill American nationals.
Furthermore, this NPRM proposes to move the regulations into the
newly proposed designation of Part 1390 Subchapter J of Chapter XIII--
Administration for Children and Families, Department of Health and
Human Services. This allows the public to clearly see that the
regulations pertaining to the care and treatment of mentally ill
nationals returned from foreign countries are overseen by OHSEPR
instead of OFA.
V. Regulatory Process Matters
Paperwork Reduction Act
Under the Paperwork Reduction Act (44 U.S.C. 3501 et seq., as
amended) (PRA), all Departments are required to submit to the Office of
Management and Budget (OMB) for review and approval any reporting or
recordkeeping requirements inherent in a proposed or final rule. This
NPRM does not contain any information requiring OMB approval under the
PRA and, therefore, will not create any new paperwork burdens or modify
existing burdens subject to OMB review.
Executive Order 13132
Executive Order 13132 requires federal agencies to consult with
State and local government officials if they develop regulatory
policies with federalism implications. Federalism is rooted in the
belief that issues that are not national in scope or significance are
most appropriately addressed by the level of government close to the
people. This proposed rule would not have substantial direct impact on
the States, on the relationship between the federal government and the
States, or on the
[[Page 56827]]
distribution of power and responsibilities among the various levels of
government. This NPRM would not pre-empt State law. The changes
proposed in the NPRM are removing unnecessary and obsolete regulations
from the Office of Human Services Emergency Preparedness and Response
Repatriation Program rules. Therefore, in accordance with Section 6 of
Executive Order 13132, it is determined that this action does not have
sufficient federalism implications to warrant the preparation of a
federalism summary impact statement.
Assessment of Federal Regulations and Policies on Families
Assessment of Federal Regulations and Policies on Families Section
654 of the Treasury and General Government Appropriations Act of 1999
(Pub. L. 105-277) requires federal agencies to determine whether a
policy or regulation may negatively affect family well-being. If the
agency determines a policy or regulation negatively affects family
well-being, then the agency must prepare an impact assessment
addressing seven criteria specified in the law. HHS believes it is not
necessary to prepare a family policymaking assessment because the
actions proposed in this NPRM will not have any impact on the autonomy
or integrity of the family as an institution.
VI. Regulatory Impact Analysis
We have examined the impacts of the proposed rule under Executive
Order 12866, Executive Order 13563, Executive Order 14192, the
Regulatory Flexibility Act (5 U.S.C. 601-612), and the Unfunded
Mandates Reform Act of 1995 (Pub. L. 104-4).
Executive Orders 12866 and 13563 direct us to assess all benefits
and costs of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits.
Executive Order 14192 requires that any new incremental costs
associated with significant new regulations ``shall, to the extent
permitted by law, be offset by the elimination of existing costs
associated with at least ten prior regulations.'' The Office of
Information and Regulatory Affairs (OIRA) has determined that this
proposed rule is a significant action under Executive Order 12866
Section 3(f).
The Regulatory Flexibility Act (RFA) requires agencies to consider
the impact of their regulatory proposals on small entities. Because
this action would simply repeal obsolete and unnecessary language, we
propose to certify that the proposed rule would not have a significant
economic impact on a substantial number of small entities.
The Unfunded Mandates Reform Act of 1995 (UMRA) generally requires
that each agency conduct a cost-benefit analysis; identify and consider
a reasonable number of regulatory alternatives; and select the least
costly, most cost effective, or least burdensome alternative that
achieves the objectives of the rule before promulgating any proposed or
final rule that includes a Federal mandate that may result in
expenditures of more than $100 million (adjusted for inflation) in at
least one year by State, local, and tribal governments, in the
aggregate, or by the private sector. Each agency issuing a rule with
relevant effects over that threshold must also seek input from State,
local, and tribal governments. The current threshold after adjustment
for inflation is $193 million, using the most current (2025) Implicit
Price Deflator for the Gross Domestic Product. This proposed rule would
not result in an expenditure in any year that meets or exceeds this
amount.
VII. Tribal Consultation Statement
Executive Order 13175, Consultation and Coordination with Indian
Tribal Governments, requires agencies to consult with Indian Tribes
when regulations have ``substantial direct effects on one or more
Indian Tribes, on the relationship between the Federal Government and
Indian Tribes, or on the distribution of power and responsibilities
between the Federal Government and Indian Tribes.'' Similarly, ACF's
Tribal Consultation Policy says that consultation is triggered for any
legislative proposal, new rule adoption, or other policy change that
significantly affects Tribes, meaning there exists a reasonable
presumption that it has or may have substantial direct effects on one
or more Indian Tribes, on the relationship between the Federal
Government and Indian tribes, on the amount or duration of ACF program
funding, on the delivery of ACF programs or services to one or more
Indian Tribes, or on the distribution of power and responsibilities
between the Federal Government and Indian Tribes.
List of Subjects
45 CFR Part 211
Grant programs-social programs, Health care, Mental health
programs, Public assistance programs.
45 CFR Part 1390
Grant programs-social programs, Health care, Mental health
programs, Public assistance programs.
For the reasons set forth in the preamble, ACF proposes to remove
45 CFR part 211 and add 45 CFR subchapter J as follows:
PART 211--[REMOVED AND RESERVED]
0
1. Under the authority Secs. 1-11, 74 Stat. 308-310; 24 U.S.C. 321-329,
remove and reserve part 211.
Subchapter J--Office of Human Services Emergency Preparedness and
Response
PART 1390--CARE AND TREATMENT OF MENTALLY ILL NATIONALS OF THE
UNITED STATES, RETURNED FROM FOREIGN COUNTRIES
Sec.
1301.1 General.
0
2. The authority citation for part 1390 is proposed to read as follows:
Authority: Secs. 1-11, 74 Stat. 308-310; 24 U.S.C. 321-329.
Sec. 1390.1 General.
(a) Required certificates. To establish eligibility, the following
certificates are required:
(1) Nationality certificate. A certificate issued by an authorized
Department of State official stating that the individual is a United
States national.
(2) Mental condition certificate. Either:
(i) A certificate obtained or transmitted by an authorized
Department of State official stating that the individual has been
legally adjudged insane in a specified foreign country; or
(ii) A certificate from an appropriate authority or person stating
that the individual was in a specified foreign country and required
mental hospital care and treatment. When available, the certificate
shall include relevant medical and other information.
(b) Appropriate authority or person. For paragraph (a)(2)(ii), an
appropriate authority or person is a qualified mental health
professional. If none are available, an authorized Department of State
official may serve in that capacity and shall state the unavailability
of a qualified mental health professional.
(c) Reception and temporary assistance. Upon arrival at the port of
entry, the agency shall meet the individual, arrange an appropriate
medical examination, and plan needed temporary care and treatment with
the individual, legal guardian, or other interested persons.
(d) Temporary care, treatment, and assistance. The agency shall
provide temporary care, treatment, and assistance reasonably necessary
for the individual's health and welfare,
[[Page 56828]]
including hospitalization, medical and remedial care, attendants, food,
lodging, money, transportation, and other goods or services. Pending
other arrangements, the agency shall use the nearest suitable hospital
or another suitable hospital for hospitalization, medical care, and
diagnostic services.
Robert F. Kennedy, Jr.,
Secretary, Department of Health and Human Services.
[FR Doc. 2026-18167 Filed 9-3-26; 8:45 am]
BILLING CODE 4184-PL-P
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