Urban_response_to_Questions_08062018.docx

What is the definition of an Urban Center?

“The Indian Health Care Improvement Act (IHCIA) defines an urban center as “any community which has a sufficient urban Indian population with unmet health needs to warrant assistance under subchapter IV, as determined by the Secretary.” 25 U.S.C. 1603(27). The unmet health care needs are determined on the basis of several factors, including “disease incidence and prevalence, life expectancy, infant mortality, dental needs, housing conditions, family income, unemployment statistics, etc.” 42 C.F.R. § 136.351. Other factors for selecting Urban Indian Organizations include the size of the Urban Indian population, accessibility to other health care services, and duplication of existing health care services, among other factors. 25 U.S.C. § 1653 (b). When IHS announces a solicitation to establish a contract or grant for an Urban Indian Organization (UIO) to serve an urban center, IHS confirms the IHCIA’s requirements are met, including confirming that the organization serving that urban area is a UIO as defined by the IHCIA. 25 U.S.C. § 1603(29) (a UIO is defined as “…a nonprofit corporate body situated in an urban center, governed by an urban Indian controlled board of directors, and providing for the maximum participation of all interested Indian groups and individuals…”). Upon confirmation of UIO status, the IHCIA authorizes that “…the Secretary, through the Service, shall enter into contracts with, or make grants to, urban Indian organizations for the provision of health care and referral services for urban Indians residing in the urban centers in which such organizations are situated.” 25 U.S.C. § 1653(a). Criteria listed in 42 C.F.R. § 136.351 provide additional instruction on selecting Urban Indian Organizations to contract with pursuant to the IHCIA.

In the 2009 Report to Congress: New Needs Assessment of the Urban Indian Health Program and the Communities it Serves, the IHS noted 17 Metropolitan Statistical Areas (MSAs) with the largest Urban Indian populations not currently being served by IHS, Tribal, or Urban Indian Organizations funded by IHS. This report can be found on the IHS website, https://www.ihs.gov/urban/includes/themes/responsive2017/display_objects/documents/ReportToCongressUrbanNeedsAssessment.pdf.”

What is the definition of eligible Urban beneficiary?

Consistent with the Indian Health Care Improvement Act (IHCIA), an urban Indian beneficiary is an individual who both:

(1) Resides in an urban center; and

(2) Meets one or more of the following criteria:

(A) Irrespective of whether he or she lives on or near a reservation, is a member of a tribe, band, or other organized group of Indians, including those:

(i) Federally-recognized by the United States of America,

(ii) Whose Federal recognition was terminated by the United States of America since 1940, and

(iii) Recognized now or in the future by the State in which the tribe, band, or other organized group is located; or

(B) Is a descendant, in the first or second degree, of any such member described in (A); or

(C) Is an Eskimo or Aleut or other Alaska Native; or

(D) Is a California Indian; or

(E) Is considered by the Secretary of the Department of the Interior to be an Indian for any purpose; or

(F) Is determined to be an Indian under regulations pertaining to the eligibility of urban Indians that are promulgated by the Secretary of HHS.