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CONTRACT HEALTH SERVICE

This presentation provides a concise summary of Contract Health Services (CHS) as defined by federal regulations, including eligibility requirements for patients, funding limitations, and coverage specifics. Important points include the necessity for proof of enrollment in a federally recognized tribe, the discretionary nature of CHS funding, and the medical priority system for referrals. The presentation also addresses where patients can seek care, emphasizing the importance of contracting with approved medical providers to ensure quality and compliance.

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CONTRACT HEALTH SERVICE

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Presentation Transcript

  1. CONTRACT HEALTH SERVICE Presenter: Karla Hall, CHS Officer

  2. The information on the following slides are a condensed summary taken from the federal regulations 42CFR, IHCIA, legal opinions and established I.H.S. policies/procedures • DIRECT CARE: Patient is required to provide proof of being an enrolled member, or a descendent of an enrolled member, of a federally recognized tribe. • There are 558 US Federally Recognized Tribes

  3. WHAT IS CONTRACT HEALTH SERVICES?Reference 42CFR • CHS: Care provided away from a direct care facility. This is not an entitlement. • A referral is not an implication that the care will be paid. • A patient must meet residence and notification requirements, medical priority and use of alternate resources.

  4. CHS Eligibility • GENERAL ELIGIBILITY: Patient must meet the direct care requirements and • Permanent residence on a reservation or • Permanent residence on a CHSDA as a member of that specific tribe or • Permanent residence on a CHSDA & meet close economic social ties: married to a tribal member or employed by the tribe (proof required). • OTHER PERSONS ELIGIBLE FOR CHS: Proof is required. • Non-Indian woman pregnant with an eligible Indian’s child-duration of pregnancy & up to 6 weeks postpartum • Non-Indian Member of an eligible Indian’s household for public health hazard • Adopted, foster & step-children up to 19 yrs of age (per IHCIA)

  5. CHS FUNDING CHS is not an entitlement Congressional funding is discretionary. • Funded at only 40% of need • $56 Million for Aberdeen Area – ND, SD, Nebraska and Iowa • Tribal Consultation is used in the distribution of CHS funds • 13 IHS service units • 6 Tribal • 11 Other Tribal Programs

  6. WHAT IS COVERED? • 42 CFR states if funds are insufficient to pay for all care – medical priorities must be established and utilized. • CHS Referrals. The medical provider is required to determine medical priority for each referral. • Medical Priority I. • Most SU’s/Tribes are paying priority I care only.

  7. Where do patients go?Contract Facility Use(IHS only) • The government is required to contract with non-IHS medical providers to obtain a payment rate that benefits the government. • Federal Acquisition Regulations state a contract vendor must be used over a non-contract vendor. • The Medicare-Like Rate rule is a great benefit to the CHS Program. • Contracts will still be in place for quality of care and compliance issues.

  8. QUESTIONS??

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