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$36a.33 Grace period.

(a) Upon the effective date referred to in 836a.32(a), individuals who would lose their eligibility under the new eligilibity regulations published on September 16, 1987, and who have made use of an Indian Health Service of Indian Health Service funded service within three years prior to September 16, 1987 (date of publication of the new eligibility regulations) shall retain their eligibility for a six month grace period ending September 16, 1988. During this grace period such individual's eligibility will continue to be determined under the former regulations except that the new residency requirements established by subparts A and B must be met for the individual to be eligible.

(b) All individuals who receive services during the grace period based on paragraph (a) of this section and whose eligibility will terminate on September 16, 1988, shall be notified in writing that after September 16, 1988 they will no longer the eligible for services as Indian Health Service beneficiaries. Such written notice should include an explanation of their appeal rights as provided in $36a.14 of the part. These patients shall be offered assistance in locating other health care providers and medical assistance programs. (52 FR 35050, Sept. 16, 1987, as amended at 65 FR 53914, Sept. 6, 2000)

(2) Those actively undergoing course of outpatient treatment either in Indian Health Service and Indian Health Service funded facilities or through contract health services, termination of which would impair the health of the individual patient, may continue to receive the treatment at Indian Health Service expense for a reasonable length of time, until the course of treatment reaches a point where it may safely be terminated or the patient transferred to other providers as determined by the responsible Indian Health Service or tribal physician, all other conditions being met including medical priorities.

(3) Those under treatment for chronic degenerative conditions may be provided additional treatment at Indian Health Service expense for no longer than 1 year beyond the end of the grace period notwithstanding any determination that it was otherwise safe to transfer treatment to other providers, all other conditions being met including medical priorities.

(b) All patients receiving care under paragraph (a) of this section shall be notified in writing that, after discharge from care provided under any of the above circumstances, they will longer be eligible for services as Indian Health Service beneficiaries. Such notice shall include an explanation of their appeal rights as provided in 836a.14 of this part. These patients shall be offered assistance in locating other health care providers and medical assistance programs.

no

(52 FR 35050, Sept. 16, 1987, as amended at 65 FR 53914, Sept. 6, 2000)

Subpart E-Preference in

Employment

§ 36a.34 Care and treatment of people

losing eligibility. (a) Individuals who lose their eligibility on September 16, 1988, (end of the grace period) and on that date are actively undergoing treatment may still be provided services for a limited period in the following circumstances;

(1) Inpatients in IHS and IHS funded facilities and those receiving inpatient care under contract, including contract health services, may continue to receive such care and necessary follow-up services at Indian Health Service expense until the need for hospitalization and follow-up services has ended as determined by the responsible Indian Health Service or tribal physician, all other conditions being met including medical priorities;

AUTHORITY: 25 U.S.C. 44, 45, 46 and 472; Pub. L. 83-568, 42 U.S.C. 2003.

$36a.41 Definitions.

For purposes of making appointments to vacancies in all positions in the Indian Health Service a preference will be extended to persons of Indian descent who are:

(a) Members of any recognized Indian tribe now under Federal jurisdiction;

(b) Descendants of such members who Subpart F-Abortions and Related were, on June 1, 1934, residing within Medical Services in Indian the present boundaries of any Indian Health Service Facilities and reservation;

Indian Health Service Pro(C) All others of one-half or more In

grams dian blood of tribes indigenous to the United States;

AUTHORITY: Sec. 1, 42 Stat. 208, 25 U.S.C. 13; (d) Eskimos and other aboriginal peo

sec. 1, 68 Stat. 674, 42 U.S.C. 2001; sec. 3, 68 ple of Alaska; or

Stat. 674, 42 U.S.C. 2003. (e) Until January 4, 1990 or until the

SOURCE: 47 FR 4018, Jan. 27, 1982, unless Osage Tribe has formally organized,

otherwise noted. whichever comes first, a person of at least one-quarter degree Indian ances

$36a.51 Applicability. try of the Osage Tribe of Indians, This subpart is applicable to the use whose rolls were closed by an act of of Federal funds in providing health Congress.

services to Indians in accordance with

the provisions of subparts A, B, C, H, I (43 FR 29783, July 11, 1978, as amended at 54

and J of this part. FR 48246, Nov. 22, 1989)

$36a.52 Definitions. $36a.42 Appointment actions.

As used in this subpart: (a) Preference will be afforded a per- Physician means a doctor of medicine son meeting any one of the definitions

or osteopathy legally authorized to of $ 36a.41 whether the placement in the practice medicine and surgery at an Inposition involves initial appointment, dian Health Service or tribally run fareappointment, reinstatement, trans- cility, or by the State in which he or fer, reassignment, promotion, or any she practices. other personnel action intended to fill a vacancy.

8 36a.53 General rule. (b) Preference eligibles may be given

Federal funds may not be used to pay a schedule A excepted appointment for or otherwise provide for abortions under 5 CFR 213.3116(b)(8). If the indi- in the programs described in $36a.51, viduals are within reach on a Civil except under the Circumstances Service Register, they may be given a

discribed in 836a.54. competitive appointment.

(47 FR 4018, Jan. 27, 1982, as amended at 65

FR 53914, Sept. 6, 2000] [43 FR 29783, July 11, 1978, as amended at 65 FR 53914, Sept. 6, 2000)

8 36a.54 Life of the mother would be

endangered. 836a.43 Application procedure for

Federal funds are available for an preference eligibility.

abortion when a physician has found To be considered a preference eligi- and so certified in writing to the approble, the person must submit with the priate tribal or other contracting orgaemployment application à Bureau of nization, or service unit or area direcIndian Affairs certification that the tor, that “on the basis of my profesperson is an Indian as defined by sional judgement the life of the mother $36a.41 except that an employee of the would be endangered if the fetus were Indian Health Service who has a cer- carried to term.” The certification tificate of preference eligibility on file must contain the name and address of in the Official Personnel Folder is not

the patient. required to resubmit such proof but

8 36a.55 Drugs and devices and termimay instead include a statement on

nation of ectopic pregnancies. the application that proof of eligibility is on file in the Official Personnel

Federal funds are available for drugs Folder.

or devices to prevent implantation of

the fertilized ovum, and for medical (43 FR 29783, July 11, 1978, as amended at 65 procedures necessary for the termiFR 53914, Sept. 6, 2000)

nation of an ectopic pregnancy.

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SPECIFICATIONS FOR PERFORMING CHEST

ROENTGENOGRAPHIC EXAMINATIONS 37.40 General provisions. 37.41 Chest roentgenogram specifications. 37.42 Approval of roentgenographic facili

ties. 37.43 Protection against radiation emitted

by roentgenographic equipment.

$36a.61 Payor of last resort.

(a) The Indian Health Service is the payor of last resort of persons defined as eligible for contract health services under these regulations, notwithstanding any State or local law or regulation to the contrary.

(b) Accordingly, the Indian Health Service will not be responsible for or authorize payment for contract health services to the extent that:

(1) The Indian is eligible for alternate resources, as defined in paragraph (c), or

(2) The Indian would be eligible for alternate resources if he or she were to apply for them, or

(3) The Indian would be eligible for alternate resources under State or local law or regulation but for the Indian's eligibility for contract health services, or other health services, from the Indian Health Service or Indian Health Service funded programs.

(c) Alternate resources means health care resources other than those of the Indian Health Service. Such resources include health care providers and institutions, and health care programs for the payment of health services including but not limited to programs under title XVIII and XIX of the Social Secu

SPECIFICATIONS FOR INTERPRETATION, CLASSI

FICATION, AND SUBMISSION OF CHEST ROENT

GENOGRAMS 37.50 Interpreting and classifying chest

roentgenograms. 37.51 Proficiency in the use of systems for

classifying the pneumoconioses. 37.52 Method of obtaining definitive inter

pretations. 37.53 Notification of abnormal

roentgenographic findings. 37.60 Submitting required chest roentgeno

grams and miner identification documents.

REVIEW AND AVAILABILITY OF RECORDS 37.70 Review of interpretations. 37.80 Availablity of records.

Subpart-Autopsies

37.200 Scope. 37.201 Definitions. 37.202 Payment for autopsy. 37.203 Autopsy specifications. 37.204 Procedure for obtaining payment.

AUTHORITY: Sec. 203, 83 Stat. 763; 30 U.S.C. 843, unless otherwise noted.

SOURCE: 43 FR 33715, Aug. 1, 1978, unless otherwise noted.

Subpart-Chest Roentgenographic Examinations

$37.1 Scope.

The provisions of this subpart set forth the specifications for giving, interpreting, classifying, and submitting chest roentgenograms required by section 203 of the act to be given to underground coal miners and new miners.

$37.2 Definitions.

Any term defined in the Federal Mine Safety and Health Act of 1977 and not defined below shall have the meaning given it in the act. As used in this subpart:

(a) Act means the Federal Mine Safety and Health Act of 1977 (30 U.S.C. 801, et seq.).

(b) ALOSH means the Appalachian Laboratory for Occupational Safety and Health, Box 4258, Morgantown, WV 26505. Although the Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, has programmatic responsibility for the chest roentgenographic examination program, the Institute's facility in Morgantown—ALOSH-is used throughout this subpart in referring to the administration of the program.

(c) Chest roentgenogram means a single posteroanterior roentgenographic projection or radiograph of the chest at full inspiration recorded roentgenographic film.

(d) Convenient time and place with respect to the conduct of any examination under this subpart means that the examination must be given at a reasonable hour in the locality in which the miner resides or a location that is equally accessible to the miner. For example, examinations at the mine during, immediately preceding, or immediately following work and a “no appointment” examination at a medical facility in a community easily accessible to the residences of a majority of the miners working at the mine, shall

be considered of equivalent convenience for purposes of this paragraph.

(e) Institute and NIOSH mean the National Institute for Occupational Safety and Health Center for Disease Control, Public Health Service, Department of Health and Human Services.

(f) ILO-U/C Classification means the classification of radiographs of the pneumoconioses devised in 1971 by an international committee of the International Labor Office and described in "Medical Radiography and Photography," volume 48, No. 3, December 1972. “ILO Classification" means the classification of radiographs of the pneumoconioses revised in 1980 by an international committee of the International Labor Office and described in "Medical Radiography and Photography” volume 57, No. 1, 1981, and in ILO publication 22 (revised 1980) from the ILO Occupational Safety and Health Series.

(g) Miner means any individual including any coal mine construction worker who is working in or at any underground coal mine, but does not include any surface worker who does not have direct contact with underground coal mining or with coal processing operations.

(h) Operator means any owner, lessee, or other person who operates, controls, or supervises an underground coal mine or any independent contractor performing services or construction at such mine.

(i) Panel of 'B' Readers means the U.S. Public Health Service Consultant Panel of “B” Readers, c/o ALOSH, P.O. Box 4258, Morgantown, WV 26505.

(j) Preemployment physical examination means any medical examination which includes a chest roentgenographic examination given in accordance with the specifications of this subpart to a person not previously employed by the same operator or at the same mine for which that person is being considered for employment.

(k) Secretary means the Secretary of Health and Human Services and any other officer or employee of the Department of Health and Human Services to whom the authority involved may be delegated.

on

190-164 D-00--6

(1) MSHA means the Mine Safety and Health Administration, Department of Labor.

(43 FR 33715, Aug. 1, 1978, as amended at 49 FR 7563, Mar. 1, 1984)

$ 37.3 Chest roentgenograms required

for miners. (a) Voluntary examinations. Every operator shall provide to each miner who is employed in or at any of its underground coal mines and who was employed in underground coal mining prior to December 30, 1969, or who has completed the required examinations under $37.3(b) an opportunity for a chest roentgenogram in accordance with this subpart:

(1) Following August 1, 1978 ALOSH will notify the operator of each underground coal mine of a period within which the operator may provide examinations to each miner employed at its coal mine. The period shall begin no sooner than the effective date of these regulations and end no later than a date specified by ALOSH separately for each coal mine. The termination date of the period will be approximately 5 years from the date of the first examination which was made on a miner employed by the operator in its coal mine under the former regulations of this subpart adopted July 27, 1973. Within the period specified by ALOSH for each mine, the operator may select a 6-month period within which to provide examinations in accordance with a plan approved under $37.5.

Erample: ALOSH finds that between July 27, 1973, and March 31, 1975, the first roentgenogram for a miner who was employed at mine Y and who was employed in underground coal mining prior to December 30, 1969, was made on January 1, 1974. ALOSH will notify the operator of mine Y that the operator may select and designate on its plan a 6-month period within which to offer its examinations to its miners employed at mine Y. The 6-month period shall be scheduled between August 1, 1978 and January 1, 1979 (5 years after January 1, 1974).

(2) For all future voluntary examinations, ALOSH will notify the operator of each underground coal mine when sufficient time has elapsed since the end of the previous 6-month period of examinations. ALOSH will specify to the operator of each mine a period within which the operator may provide

examinations to its miners employed at its coal mine. The period shall begin no sooner than 342 years and end no later than 41/2 years subsequent to the ending date of the previous 6-month period specified for a coal mine either by the operator on an approved plan or by ALOSH if the operator did not submit an approved plan. Within the period specified by ALOSH for each mine, the operator may select a 6-month period within which to provide examinations in accordance with a plan approved under $37.5.

Example: ALOSH finds that examinations were previously provided to miners employed at mine Y in a 6-month period from July 1, 1979, to December 31, 1979. ALOSH notifies the operator at least 3 months before July 1, 1983 (342 years after December 31, 1979) that the operator may select and designate on its plan the next 6-month period within which to offer examinations to its miners employed at mine Y. The 6-month period shall be scheduled between July 1, 1983, and July 1, 1984 (between 342 and 41/2 years after December 31, 1979).

(3) Within either the next or future period(s) specified by ALOSH to the operator for each of its coal mines, the operator of the coal mine may select a different 6-month period for each of its mines within which to offer examinations. In the event the operator does not submit an approved plan, ALOSH will specify a 6-month period to the operator within which miners shall have the opportunity for examinations.

(b) Mandatory eraminations. Every operator shall provide to each miner who begins working in or at a coal mine for the first time after December 30, 1969:

(1) An initial chest roentgenogram as soon as possible, but in no event later than 6 months after commencement of employment. A preemployment physical examination which was made within the 6 months prior to the date on which the miner started to work will be considered as fulfilling this requirement. An initial chest roentgenogram given to a miner according to former regulations for this subpart prior to August 1, 1978 will also be considered as fulfilling this requirement.

(2) A second chest roentgenogram, in accordance with this subpart, 3 years following the initial examination if the miner is still engaged in underground coal mining. A second roentgenogram

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