Subpart A-Scope and Definitions § 36.1 Purpose and effect.

(a) The regulations in this part establish the general principles to be followed in the discharge of this Department's responsibilities for continuation and improvement of the Indian health services. Officers and employees of the Department will be guided by these policies in exercising discretionary authority with respect to the matters covered.

(b) The Surgeon General of the Public Health Service is authorized to adopt, and from time to time revise or add, administrative instructions relating to methods or procedures appropriate to implementing these principles, or for their supplementation as to matters not covered, including instructions providing for the continuation or appropriate modification of practices and procedures previously observed in the provision of Indian health services in particular jurisdictions.

§ 36.2 Meaning of terms.

When used in this part, the term:

(a) "Indian health program" includes the Alaska Native Health Services.

(b) "Indian" includes Indians in the continental United States, and Indians, Aleuts and Eskimos in Alaska.

(c) "Jurisdiction" shall have the same geographical meaning as in Bureau of Indian Affairs usage.

(d) "Bureau of Indian Affairs" means the Bureau of Indian Affairs, Department of the Interior.

Subpart B-Availability of Services to Individuals in Programs (Including Facilities Constructed or Supported With Tribal Funds) Operated for Indian Beneficiaries by the Public Health Service

§ 36.11 Services available.

Within the limits of available funds, facilities, and personnel, the Public Health Service will make available, within the area served by the local facility, hospital and medical and dental care, including outpatient services and services of mobile clinics and public health nurses, and preventative care including immunizations and health examinations of special groups, such as school children.

§ 36.12 Persons to whom services will be provided.

(a) In general. (1) Services will be made available, as medically indicated, to persons of Indian descent belonging to the Indian community served by the local facilities and program, and non-Indian wives of such persons.

(2) Generally, an individual may be regarded as within the scope of the Indian health and medical service program if he is regarded as an Indian by the community in which he lives as evidenced by such factors as tribal membership, enrollment, residence on tax-exempt land, ownership of restricted property, active participation in tribal affairs, or other relevant factors in keeping with general Bureau of Indian Affairs practices in the jurisdiction.

(b) Doubtful cases. (1) In case of doubt as to whether an individual applying for care is within the scope of the program, the Medical Officer in Charge shall obtain from the appropriate Bureau of Indian Affairs officials in the jurisdiction information pertinent to his determination of the individual's continuing relationship to

the Indian population group served by the local program.

(2) If the applicant's condition is such that immediate care and treatment are necessary, services shall be provided pending identification as an Indian beneficiary.

(c) Priorities when funds, facilities, or personnel are insufficient to provide the indicated volume of services. Priorities for care and treatment, as among individuals who are within the scope of the program, will be determined on the basis of relative medical need and access to other arrangements for obtaining the necessary care.

§ 36.13 Charges to Indian beneficiaries for services provided in Public Health Service facilities or by Public Health Service personnel.

(a) In general. In order to make the most effective use of funds and facilities available for needed health and medical services, individual Indians who are clearly able to pay the costs of hospital care (and of other major items of service specified in instructions of the Surgeon General) will be encouraged to do so, and services may be conditioned upon payment in appropriate cases. No charge may be made for immunizations, health examination of school children or similar preventive services, or for the hospitalization of Indian patients for tuberculosis.

(b) Amount of charges. Payment may be requested in accordance with a schedule of charges established for the jurisdiction by the Area Medical Officer, but such charges may in no case exceed the cost of providing the service, as determined by the Surgeon General or in accordance with instructions issued by him.

(c) Circumstances under which payment may be requested; Authority of the Medical Officer in Charge. Whenever it is established to the satisfaction of the Medical Officer in Charge, from information available from the local Pureau of Indian Affairs officers or from other sources, that an Indian applying for care for himself or his family is able to meet the scheduled charge for the needed care without impairing his prospects for economic independence, he may be asked to pay

the scheduled charge. Charges may be reduced in individual cases, or payment may be waived and needed services may nevertheless be provided if, in the judgment of the Medical Officer in Charge, the health objectives in the area served will be advanced thereby.

[21 FR 9833, Dec. 12, 1956, as amended at 22 FR 6412, Aug. 10, 1957]

§ 36.14 Nonbeneficiaries; emergency care and treatment; charges.

(a) In case of emergency, as an act of humanity, nonbeneficiaries of the Service may be provided temporary care and treatment in hospitals and facilities of the Service which are operated for Indian beneficiaries.

(b) Persons referred to in paragraph (a) of this section who, as determined by the medical officer in charge, are able to defray the cost of their care and treatment shall be charged for such care and treatment at the following rates (which shall be deemed to constitute the entire charge in each instance): In the case of hospitalization, at the current interdepartmental reimbursable per diem rate as established by the Bureau of the Budget; and in the case of outpatient treatment, at rates established by the Surgeon General.

(Interpret or apply sec. 322(d), 58 Stat. 696, sec. 501, 65 Stat. 290; 42 U.S.C. 249(d), 31 U.S.C. 483a)

[24 FR 10108, Dec. 15, 1959]

Subpart C-Contract Services

§ 36.21 Availability of contract services. Availability of contract services to individual Indian beneficiaries will be governed by the terms of the contract.

Subpart D-Contagious and Infectious Diseases

TUBERCULOSIS

AUTHORITY: Sec. 1, 38 Stat. 584; 25 U.S.C.

198.

SOURCE: 25 FR 10063, Oct. 21, 1960, unless otherwise noted.

§ 36.30 Applicability.

The regulations in this subpart relative to the commitment of Indians afflicted with tuberculosis apply only to Indian reservations where effective procedures for the commitment of persons afflicted with tuberculosis are not available under the laws of the State in which the reservation is located.

§ 36.31 Commitment of Indians afflicted with tuberculosis.

(a) Upon a determination by a tribal court or other Indian court of competent jurisdiction that an Indian within its jurisdiction has tuberculosis in a communicable form and that under applicable tribal law such Indian may be committed to a hospital or other place for medical treatment, the Area Medical Officer in Charge may, upon request of such court, certify that facilities and services of the Public Health Service are available to provide necessary medical treatment for the Indian if he determines in accordance with applicable instructions of the Division of Indian Health that the health of the afflicted Indian or that of other persons requires the isolation or quarantine of the Indian in a hospital or other place of treatment.

(b) If, after such certification the court commits the afflicted Indian to the custody of the Public Health Service, the Medical Officer in Charge may accept such commitment and transport and admit the Indian to any hospital or institution operated by the Public Health Service for the medical care and treatment of tuberculosis patients whether within or without the jurisdiction of the court.

(c) An Indian admitted to a facility of the Public Health Service pursuant to this subpart shall be subject to the rules and regulations of the Public Health Service applicable to patients and to the facility.

§ 36.32 Retention of custody; utilization of law enforcement authorities.

(a) The Medical Officer in Charge having custody of a patient whose commitment has been accepted under this subpart is authorized to employ such means as may be necessary for the retention of custody of, and the

provision of necessary treatment to, the afflicted Indian including the provision of attendants during periods of transportation, until such time as the patient is discharged.

(b) When necessary to retain custody of the patient the Medical Officer in Charge is authorized to call upon the police force of the Bureau of Indian Affairs, of the tribe, or of the State, as may be appropriate.

§ 36.33 Discharge of patients.

When the Medical Officer in Charge of a medical facility to which an afflicted Indian has been admitted is satisfied that the disease is inactive and not in a communicable stage, he shall discharge the patient: Provided, That he may discharge the patient or release him on parole under such conditions as he deems appropriate if he is satisfied that such action would not endanger the health of the patient or the health of other persons.

§ 36.34 Transfer of patients.

(a) A patient admitted to a facility of the Service, pursuant to this subpart, may be transferred to any other facility of the Service within or without the jurisdiction of the committing court for necessary care and treatment.

(b) A patient admitted to a facility of the Service under this subpart may be transferred to a hospital operated by a State or local government which is authorized to receive him within or without the jurisdiction of the committing court.

(c) The transfer of a patient authorized in this section shall be made only if such transfer is in the judgment of the Medical Officer in Charge in the best interest of the health of the ratient.

Subparts E-G [Reserved]

Subpart H-Grants for Development, Construction, and Operations of Facilities and Services

AUTHORITY: Secs. 104, 107, 25 U.S.C. 450h(b), 450k; Sec. 3, Pub. L. 83-568, 42 U.S.C. 2003.

SOURCE: 40 FR 53143, Nov. 14, 1975, unless otherwise noted.

§ 36.101 Applicability.

The regulations of this subpart are applicable to grants awarded pursuant to section 104(b) of Pub. L. 93-638, 25 U.S.C. 450h(b) for (a) projects for development including feasibility studies, construction, operation, provision, or maintenance of services and facilities provided to Indians and, (b) for projects for planning, training, evaluation or other activities designed to improve the capacity of a tribal organization to enter into a contract or contracts pursuant to section 103 of the Act. Such grants may include the cost of training personnel to perform grant related activities.

§ 36.102 Definitions.

As used in this subpart:

(a) "Act" means Title I of the Indian Self-Determination and Education Assistance Act, Pub. L. 93-638 (88 Stat. 2203).

(b) "Indian" means a person who is a member of an Indian tribe.

(c) "Indian tribe" means any Indian tribe, band, nation, rancheria, Pueblo, colony or community, including any Alaska Native Village or regional or village corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act, Pub. L. 92-203 (85 Stat. 688 which is recognized as eligible by the United States Government for the special programs and services provided by the United States to Indians because of their status as Indians.

(d) "Tribal organization" means: (1) The recognized governing body of any Indian tribe; or

(2) Any legally established organization of Indians which is:

(i) Controlled, sanctioned or chartered by such governing body or bodies; or

(ii) Democratically elected by the adult members of the Indian community to be served by such organization and which includes the maximum participation of Indians in all phases of its activities.

(e) "Secretary" means the Secretary of the Department of Health, Education, and Welfare and any other offi

(a) An application for a grant under this subpart shall be submitted to the Secretary at such time and in such manner as the Secretary may prescribe.

(b) The application shall be executed by an individual or individuals authorized to act for the applicant and to assume on behalf of the applicant the obligations imposed by the Act, the regulations of this subpart and the terms and conditions of any grant award.

(c) In addition to such other pertinent information as the Secretary may require, the application for a grant under this subpart shall contain the following:

(1) A description of the applicant including an indication whether the applicant is a Tribe or tribal organization, and if the latter:

(i) The legal and organizational relationship of the applicant to the Indians in the Area to be served or effected by the project.

(ii) A description of the current and proposed participation of Indians in the activities of applicant.

(iii) Whether applicant is controlled, sanctioned or chartered by the governing body of the Indians to be served, and if so, evidence of such fact.

(iv) If elected, a description of the election process, voting criteria, and extent of voter participation in the election designating the organization.

(2) A narrative description of the project including its goals and objectives and the manner in which the proposed project is compatible with published Indian Health Service statements of availability of funds, the manner in which those goals and objectives are to be attained, and a work and time schedule which will be utilized to accomplish each goal and objective.

(3) A description of applicant's staff, present or proposed, including their qualifications, academic training, responsibilities and functions.

(4) A description of the manner in which the staff is or will be organized and supervised to carry out proposed activities.

(5) A description of training to be provided as part of the proposed project.

(6) A description of the administrative, managerial, and organizational arrangements and resources to be utilized to conduct the proposed project.

(7) A budget for the entire period of the project for which support is sought.

(8) The intended financial participation, if any, of the applicant, specifying the type of contributions such as cash or services, loans of full or parttime staff, equipment, space materials or facilities, or other contributions.

(9) Where health services are to be provided, a description of the nature of the services to be provided and the population to be served.

(10) A description of the Federal property, real and personal, equipment, facilities and personnel which applicant proposes to utilize and a description of the arrangements which applicant has made or will make to assume responsibility for the operation and management of those facilities.

(d) The application shall contain assurances satisfactory to the Secretary that the applicant will:

(1) Obtain adequate liability insurance coverage or an explanation of why such insurance cannot or should not be obtained. Such insurance shall

provide that prior to cancellation the Secretary must be notified and must further provide that each such policy of insurance carrier shall waive any right it may have to raise as a defense the tribe's sovereign immunity from suit but such waiver shall extend only to claims the amount and nature of which are within the coverage and limits of the policy and shall not authorized or empower such insurance carrier to waive or otherwise limit the tribe's sovereign immunity outside or beyond the coverage and limits of the policy of insurance.

(2) Where applicant is providing services, provide such services at a level and range which is not less than that provided by the Indian Health Service or that identified by the Service after negotiation with the applicant, as an appropriate level, range ard standard of care.

(3) Where providing services, provide services in accordance with law and applicable Indian Health Service policies and regulations.

(4) Where providing services, provide services in a fair and uniform manner, consistent with medical need, to all Indian people.

§ 36.105 Project elements.

A project supported under this subpart must:

(a) Have sufficient, adequately trained staff in relation to the scope of the project.

(b) Maintain a mechanism for dealing with complaints regarding the delivery of health services or performance of project activities.

(c) Hold confidential all information obtained by the personnel of the project from participants in the project related to their examination, care, and treatment, and shall not release such information without the individuals' consent except as may be required by law, as may be necessary to provide service to the individual, or as may be necessary to monitor the operations of this program or otherwise protect the public health. Information may be disclosed in a form which does not identify particular individuals.

(d) Utilize appropriate bookkeeping and accounting procedures and mecha