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CONTRACT HEALTH SERVICE

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

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CONTRACT HEALTH SERVICE

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  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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