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such contract, existing facilities owned by the Federal Government within his jurisdiction under such terms and conditions as may be agreed upon for their use and maintenance.

$36.351 Application and selection.

(a) Proposals for contracts under this subdivision shall be submitted in such form and manner and at such time as the Secretary acting through the Service may prescribe.

(b) The Secretary, acting through the Service shall select urban Indian organizations with which to contract under this subdivision whose proposals will in his judgment best promote the purposes of title V of the Act taking into consideration the following factors:

(1) The extent of the unmet health care needs of the urban Indians in the urban center involved determined on the basis of the latest available statistics on disease incidence and prevalence, life expectancy, infant mortality, dental needs, housing conditions, family income, unemployment statistics, etc.

(2) The urban Indian population which is to receive assistance in the following order of priority:

(i) 9,000 or more;
(ii) 4,500 to 9,000;
(iii) 3,000 to 4,500;
(iv) 1,000 to 3,000;
(v) Under 1,000.

(3) The relative accessibility which the urban Indian population to be served has to health care services, in the urban center. Factors to be considered in determining relative accessibility include:

(i) Cultural barriers; (ii) Discrimination against Indians; (iii) Inability to pay for health care;

(iv) Lack of facilities which provide free care to indigent persons;

(v) Lack of state or local health programs;

(vi) Technical barriers created by State and local health agencies;

(vii) Availability of transportation to health care services;

(viii) Distance between Indian residences and the nearest health care facility.

(4) The extent to which required activities under $ 36.350(a) of this subdivision would duplicate any previous or

current public or private health services projects in the urban center funded by another source. Factors to be considered in determining duplication include:

(i) Urban Indian utilization of existing health services funded by other sources;

(ii) Urban Indian utilization of existing health services delivered by an urban Indian organization funded by other sources.

(5) The appropriateness and likely effectiveness of the activities required in $36.350(a) of this subdivision in the urban center involved.

(6) The capability of the applicant urban Indian organization to perform satisfactorily the activities required in $36.350(a) of this subdivision and to contract with the Secretary.

(7) The extent of existing or likely future participation in the activities required in $36.350(a) of this subdivision by appropriate health and health related Federal, State, local, and other resource agencies.

(8) Whether the city has an existing urban Indian health program.

(9) The applicant organization's record of performance, if any, in regard to any of the activities required in $36.350(a) of this subdivision.

(10) Letters demonstrating local support for the applicant organization from both the Indian and non-Indian communities in the urban center involved. [42 FR 59646, Nov. 18, 1977; 42 FR 61861, Dec. 7, 1977)

836.352 Fair and uniform provision of

services. Contracts with urban Indian organizations under this subdivision shall incorporate the following clause:

The Contractor agrees, consistent with medical need, and the efficient provision of medical services to make no discriminatory distinctions against Indian patients or beneficiaries of this contract which are inconsistent with the fair and uniform provision of services.

$36.353 Reports and records.

For each fiscal year during which an urban Indian organization receives or expends funds pursuant to a contract under this title, such organization shall submit to the Secretary a report including information gathered pursuant to $36.350(a) (7) and (8) of this subdivision, information on activities conducted by the organization pursuant to the contract, an accounting of the amounts and purposes for which Federal funds were expended, and such other information as the Secretary may request. The reports and records of the urban Indian organization with respect to such contract shall be subject to audit by the Secretary and the Comptroller General of the United States.

tials required for the practice of a health or allied health profession are ineligible for scholarships under this subdivision. Examples of health professions and allied health professions that will not be considered for funding include but are not limited to: nursing, audiology, medical technology, dental hygiene, dental technicians, engineering, radiologic technology, dietitian, nutritionist, social work, health education, physical therapy, occupational therapy and pharmacy. Scholarships for students in these programs are provided under Subdivision J 4 of this subpart.



$36.360 Leases with Indian tribes.

(a) Any land or facilities otherwise authorized to be acquired, constructed, or leased to carry out the purposes of the Act may be leased or subleased from Indian tribes for periods not in excess of twenty years.

(b) Leases entered into pursuant to paragraph (a) shall be subject to the requirements of section 322 of the Economy Act (40 U.S.C. 278a), which limits expenditures for rent and alterations, improvements and repairs on leased buildings.

$36.371 Eligibility.

To be eligible for a pregraduate scholarship grant under this subdivison an applicant must:

(a) Be an Indian;

(b) Have successfully completed high school education or high school equivalency;

(c) Have demonstrated to the satisfaction of the Secretary the desire and capability to successfully complete courses of study in a pregraduate education program meeting the criteria in $36.370;

(d) Be accepted for enrollment in or be enrolled in any accredited pregraduate education curriculum meeting the criteria in $36.370 of this subdivision; and

(e) Be a citizen of the United States.


SOURCE: 49 FR 7381, Feb. 29, 1984, unless otherwise noted.


$36.370 Pregraduate scholarship

grants. (a) Pregraduate scholarship grants may be awarded under this subdivision and section 103 of the Act for the period (not to exceed four academic years) necessary to complete a recipient's pregraduate education leading to a baccalaureate degree in a premedicine,

preoptometry, predentistry,

preosteopathy, preveterinary medicine, or prepodiatry curriculum or equivalent.

(b) Students enrolled in accredited health professional or allied health professional programs which lead to eligibility for licensure, certification, registration or other types of creden

8 36.372 Application and selection.

(a) An application for a pregraduate scholarship grant under this subdivision shall be submitted in such form and at such time as the Secretary may prescribe. However, application must indicate:

(1) The pregraduate program in which the applicant is or wishes to enter, and

(2) Whether the applicant intends to provide health services to Indians upon completion of health professions education or training by serving as described in $36.332 or otherwise as indicated on the application.

(b) Within the limits of available funds, the Director, IHS, shall make pregraduate scholarship grant awards for a period not to exceed four academic years




pregraduate education to eligible appli- PART 360-INDIAN HEALTH
cants taking into consideration:
(1) Academic performance;

Subpart A-Purpose (2) Work experience;

Sec. (3) Faculty or employer recommenda

36a.1 Purpose of the regulations. tion;

36a.2 Administrative instructions. (4) Stated reasons for asking for the scholarship, and

Subpart B-What Services are Available (5) The relative needs of the IHS and and Who is Eligible to Receive Care? Indian health organizations for persons in specific health professions.

36a. 10 Definitions.

36a.11 Services available. (Approved by the Office of Management and 36a. 12 Persons to whom health services will Budget under control number 0915-0080)

be provided.

36a.13 Authorization for contract health 8 36.373 Scholarship and tuition.


36a.14 Reconsideration and appeals. (a) Scholarship grant awards under

36a.15 Health Service Delivery Areas. this subdivision shall consist of:

36a.16 Beneficiary Identification Cards and (1) A stipend of $400 per month ad

verification of tribal membership. justed in accordance with paragraph (c) of this section; and

Subpart C [Reserved] (2) An amount determined by the Secretary for transportation, tuition,

Subpart D-Transition Provisions fees, books, laboratory expenses and

369.31 Transition period. other necessary educational expenses.

36a.32 Delayed implementation. (b) The portion of the scholarship for 36a.33 Grace period. the costs of tuition and fees as indi- 36a.34 Care and treatment of people losing cated in the grant award will be paid eligibility. directly to the school upon receipt of an invoice from the school. The stipend

Subpart E-Preference in Employment and remainder of the scholarship grant

36a.41 Definitions. award will be paid monthly to the 36a.42 Appointment actions. grantee under the conditions specified 36a.43 Application procedure for preference in the grant award.

eligibility. (c) The amount of the monthly stipend specified in paragraph (a)(1) of

Subpart F-Abortions and Related Medical this section shall be adjusted by the

Services in Indian Health Service FaSecretary for each academic year end

cilities and Indian Health Service Proing in a fiscal year beginning after Sep- grams tember 30, 1978, by an amount (rounded

36a.51 Applicability. down to the next lowest multiple of $1)

36a.52 Definitions. equal to the amount of such stipend 36a.53 General rule. multiplied by the overall percentage 36a.54 Life of the mother would be endan(as set forth in the report transmitted gered. to the Congress under section 5305 of 36a.55 Drugs and devices and termination of title 5, United States Code) of the ad

ectopic pregnancies. justment in the rates of pay under the

36a.56 Recordkeeping requirements. General Schedule made effective in the

36a.57 Confidentiality. fiscal year in which such academic

Subpart G-Residual Status year ends.

36.61 Payor of last resort. 36.374 Availability of list of recipients.

AUTHORITY: Sec. 3, 68 Stat. 674; 42 U.S.C.

2003, 42 Stat. 208, sec. 1, 68 Stat. 674; 25 U.S.C. The IHS will provide to any person 13, 42 U.S.C. 2001, unless otherwise noted. requesting it a list of the recipients of

EFFECTIVE DATE NOTE: At 64 FR 58318, scholarship grants under this subdivi

58319, Oct. 28, 1999, as corrected at 65 FR sion, including the school attended and

53914, Sept. 6, 2000, Subparts A-G of part 36 tribal affiliation of each recipient.

were redesignated as part 36a and suspended

indefinitely, effective Oct. 28, 1999.

Subpart A-Purpose $36a.1 Purpose of the regulations.

These regulations establish general principles and program requirements for carrying out the Indian health program. (46 FR 40692, Aug. 11, 1981. Redesignated at 52 FR 35048, Sept. 16, 1987)

$36a.2 Administrative instructions.

The Service periodically issues administrative instructions to its officers and employees which are primarily found in the Indian Health Service Manual and the Area Office and Program Office supplements. These instructions are operating procedures to assist officers and employees in carrying out their responsibilities, and are not regulations establishing program requirements which are binding upon members of the general public. [46 FR 40692, Aug. 11, 1981. Redesignated at 52 FR 35048, Sept. 16, 1987)

Subpart B-What Services are

Available and Who is Eligible to Receive Care?

Health Service Delivery Area means a geographic area designated pursuant to § 36.15 of this subpart.

Indian tribe means any Indian tribe, band, nation, or other organized group 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, 43 U.S.C. 1601 et. seq., which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.

Reservation means any Federally recognized Indian tribe's reservation, Pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), and Indian allotments if considered reservation land by the Bureau of Indian Affairs.

Reside means living in a locality with the intent to make it a fixed and a permanent home. The following persons will be deemed residents of the Health Service Delivery Area:

(1) Students who are temporarily absent from the Health Service Delivery Area during full time attendance at programs of vocational, technical, or academic education including normal school breaks;

(2) Persons who are temporarily absent from the Health Service Delivery Area for purposes of travel or employment (such as seasonal or migratory workers);

(3) Indian children placed in foster care outside the Health Service Delivery Area by order of a court of competent jurisdiction and who were residents within the Health Service Delivery Area at the time of the court order.

Secretary means the Secretary of Health and Human Services and any other officer or employee of the Department of Health and Human Seryices to whom the authority involved has been delegated.

Service means the Indian Health Service.

Service Unit Director means the Director of Indian Health Service programs for a designated geographical or tribal area of responsibility or the equivalent

$36a.10 Definitions. As used in this subpart: Appropriate ordering official means, unless otherwise specified by contract with the health care facility or provider or by a contract with a tribe or tribal organization, the ordering official for the Service Unit in which the individual requesting contract health services or on whose behalf the services are requested, resides.

Area Director means the Director of an Indian Health Service Area Office designated for purposes for administration of Indian Health Service Programs.

Contract health services means health services provided at the expense of the Indian Health Service from public or private medical or hospital facilities other than those of the Service or those funded by the Service.

Emergency means any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of an individual.

official of a contractor administering an IHS program. (52 FR 35048, Sept. 16, 1987, as amended at 55 FR 4609, Feb. 9, 1990)

8 36a.11 Services available.

(a) Type of services that may be available. Services for the Indian community served by the local facilities and program may include hospital and medical care, dental care, public health nursing and preventive care including immunizations, and health examination of special groups such as school children.

(b) Where services are available. Available services will be provided at hospitals and clinics of the Service, and at contract facilities (including tribal facilities under contract with the Service).

(c) Determination of what services are available. The Service does not provide the same health services in each area served. The services provided to any particular Indian community will depend upon the facilities and services available from sources other than the Service and the financial and personnel resources made available to the Service.

(d) 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. (46 FR 40692, Aug. 11, 1981, as amended at 52 FR 35048, Sept. 16, 1987)

(2) Reside within a Health Service Delivery Area designated under $36a.15; or

(3) Are not members of a federally recognized Indian tribe but are the natural minor children (18 years old or under) of a member of a Federally recognized tribe and reside within a Health Service Delivery Area designated under $36a.15.

(b) Subject to the requirements of this subpart, the Indian Health Service will also provide direct services at its facilities and, except where otherwise provided, contract health services, as medically indicated and to the extent that funds and resources allocated to the particular Health Service Delivery Area permit, to people in the circumstances listed below:

(1) To persons who meet the eligibility criteria in paragraph (a) of this section except for the residency requirement, who formerly resided within a Health Service Delivery area designated under $ 36a.15, and who present themselves to any Indian Health Service or Indian Health Service funded facility (and to minor children of such persons if the children meet the eligibility criteria in paragraph (a) of this section except for the residency requirement). Contract health services may not be authorized for these individuals;

(2) To a non-Indian woman pregnant with an eligible Indian's child but only during the period of her pregnancy through post-partum (generally about 6 weeks after delivery). In cases where the woman is not married to the eligible Indian under applicable state or tribal law, paternity must be acknowledged in writing by the Indian or determined by order of a court of competent jurisdiction;

(3) To non-Indian members of an eligible Indian's household if the medical officer in charge determines that the health services are necessary to control acute infectious disease or a public health hazard; and

(4) To an otherwise eligible person for up to 90 days after the person ceases to reside in a Health Service Delivery Area when the Service Unit Director has been notified of the move.

(c) Contract health services will not be authorized when and to the extent

$36a.12 Persons to whom health sery

ices will be provided. (a) Subject to the requirements of this subpart, the Indian Health Service will provide direct services at its facilities, and contract health services, as medically indicated, and to the extent that funds and resources allocated to the particular Health Service Delivery Area permit, to persons of Indian or Alaska Native descent who:

(1) Are members of a federally recognized Indian tribe; and

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