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Title	Section
General	2-1.1
Persons to Whom Services May be Provided	2-1.2
Service Policy	2-1.3
Provision of Services	2-1.4
Priorities for Service	2-1.5
Joint Planning for Care of Indians	2-1.6
Terminated Tribes	2-1.7
Patient Rights and Grievances	2-1.8

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2-1.1  GENERAL

This Chapter sets forth the policies, standards and procedures for determining those persons who come within the scope of the Indian Health program.

2-1.2  PERSONS TO WHOM SERVICES MAY BE PROVIDED

A person may be regarded as within the scope of the Indian Health program if he is not-otherwise, excluded therefrom by provision of law, and:

1. Is of Indian and/or Alaska Native descent as evidenced by one or more of the following factors:

   1. Is regarded by the community in which he lives as an Indian OR Alaska Native;

   2. Is a member, enrolled or otherwise, of an Indian or Alaska Native Tribe or Group under Federal supervision;

   3. Resides on tax-exempt land or owns restricted property;

   4. Actively participates in tribal affairs;

   5. Any other reasonable factor indicative of Indian descent; or

2. Is an Indian of Canadian or Mexican origin, recognized by any Indian tribe or group as a member of an Indian community served by the Indian Health program; or

3. Is a non-Indian woman pregnant with an eligible Indian's child for the duration of her pregnancy through post partum (usually 6 weeks); or

4. Is a non-Indian member of an eligible Indian's household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

2-1.3  SERVICE POLICY

1. It is the policy of the Indian Health Service (IHS) to ascertain that needed health services are in fact available to each person who is recognized as within the scope of the Indian Health program.

   The Service is therefore primarily responsible for:

   1. Providing all services available at an IHS facility to any person within the scope of the Indian Health program who presents himself at the facility and for whom the IHS facility is more accessible than other programs and resources.

   2. Identifying alternative resources for which the persons within the scope of the Indian Health program may be eligible.

   3. Coordinating provision, to all persons within the scope of the Indian Health program, of comprehensive health services from existing sources.

   4. Determining whether resource agencies will, in fact, provide necessary assistance.  Alternate resources may be county, State or Federal programs, such as County Welfare, Medicaid, Crippled Children's Program, Medicare, Veterans Administration Hospital, U. S. Army, Air Force, Navy, PHS Hospital, etc.; official or voluntary health agencies; employee health insurance; accident insurance; etc.

2. If the alternate resources cannot or will not provide the necessary assistance, the Service may provide it based on the relative medical urgency of the case and the current availability of Service resources, particularly Contract Medical Care funds.

3. Persons within the scope of the Indian Health program in one area will be provided available medical and/or other related services by any other area in which they may require health services.  The authorization or denial of Contract Health services shall be the responsibility of the Area in which the services are rendered.  The Area in which the services are rendered shall apply the same policies and have the same notification requirements for persons from other Areas as are applied to those persons within the Area.

2-1.4  PROVISION OF SERVICES

1. The preventive and health promotion services at all Facilities shal1 be made available to al1 persons within the scope 0f the Indian Hea1th program.  As part of such service, those persons who are able and willing to utilize local Indian Health Service community preventive health services will be encouraged to do so.

2. The medical care and treatment services, including hospitalization, based on the medical need of the persons within the scope of the program, are provided as available at IHS facilities or on a contractual basis when Contract Medical Care funds arc available.

3. When care from a contract vendor is necessary, determination must be made whether the patient has his own or other available resources.  A person within the scope of the program may have personal resources that allow him to pay all or part of the cost of private medical care without impairing his economic independence. Such resources include income and privately purchased health insurance. In the event the individual's condition, is such that immediate care and treatment are necessary, services: may be-provided pending determination of whether or not the individual is within the scope of-the program and whether or not he is within priority.

4. When other resources are available, the Service will encourage use of such services and will maintain relationships with agencies to facilitate the utilization of those resources.  Every effort should be made to make the most effective use of other resources (see Section 2-1.3A(4)) particularly other Federal medical facilities, wherever appropriate, to assure the best utilization of resources available to the Indian Health program.

5. Persons determined to he within the scope of the program shall be eligible to participate in P.L. 86-121, Sanitation Facilities Construction Projects scheduled for their community.

6. The cost of medical and related health services for persons in custody of (non-Indian) law enforcement agencies is not the responsibility of the Public Health Service, but is the responsibility of that particular agency.

2-1.5  PRIORITIES FOR SERVICE

1. Priorities for Service.  Limitations of funds, facilities, or staff may result in services not being available to all persons who come within the scope of the program.

2. Guidelines for Priorities.  All services available at any IHS facility will be provided as needed to any person within the scope of the program who presents himself at that facility and for whom the IHS facility is more accessible than other programs and resources.  Services needed but not available at the IHS facility will be provided through the Contract Medical Care program depending upon:

   1. The person's medical need, determined by a physician whenever possible.

   2. The actual availability and accessibility of alternate resources.

   3. The financial resources available to the Service facility at that time.

   4. His personal resources.

3. Denial of Services

   1. The Service Unit Director or his designee may deny services to persons who according to his determination do not come within the scope of the program.

   2. When services are denied, a written notice of such denial shall be given the person.  Such written notice shall include:

      1. The basis for denial, listing the specific circumstances and facts upon which the priority decision was made.

      2. The name of the Service Unit Director or of his designated representative.

      3. The statement, "If you have any information which may affect this decision, you may submit it with a copy of this letter for review by the Area Director (Address).

   3. A copy of each notice of denial shall be retained at the IHS facility, preferably in the person's case folder and a copy shall be forwarded to the Area Office.

2-1.6  JOINT PLANNING FOR CARE OF INDIANS

Within the guidelines listed below the Area Director is responsible for conducting joint planning with local, State and Federal resource agencies and with tribal officials and leaders for care of Indians.  He will --

1. Recognize the principle that the Indian people are entitled to State and local services when they meet the same requirements as other citizens of the State and locality.

2. Work with Indian groups affected and the State and local agencies for the utilization of available community Services.

3. Identify gaps between comprehensive health needs of Indians and those services available through Federal, State and local community agencies and will jointly plan with those agencies, ways and means of bridging these gaps.

4. Recognize the fact that in order to assure that the total services available to Indians are as comprehensive as possible, the Indian Health Service program and policy requirements may vary according to State and local situations.

5. Recognize the fact that indigency may be a criterion for receipt of State or local services and that such a requirement should not preclude the utilization by Indians of these services.

2-1.7  TERMINATED TRIBES

During the past few years Congress has enacted legislation providing for termination of Federal trust relationships and responsibilities to certain Indian tribal groups.  Federal services to members of the Indian Tribes listed below having been terminated, such members are no longer within the scope of the Indian Health program and there is no authority to provide them with health services.

2-1.8  PATIENT RIGHTS AND GRIEVANCES

1. Purpose.  To establish Indian Health Service, policy concerning the publication of information on patient rights and the development of effective patient grievance procedures.

2. Policy.

   1. Each Indian Health Service Area will develop and promulgate a written statement of patient rights.

   2. Such statements of patient rights should be developed in cooperation with the Area Indian Health Boards and must have their concurrence.  At the minimum these statements must include an affirmation of the patient's rights to:

   • services, within their availability or capability of being provided.

   • considerate and respectful treatment.

   • privacy, and confidentiality of medical information.

   • information on his or her condition, including the right to give or withhold consent for treatment, referral or transfer.

   • continuity of care, and information regarding what health services are available, and where and how they may be obtained.

   • knowledge of hospital rules and regulations applying to patient conduct.

   • access to an established patient grievance procedure.

   • selection of an interpreter when requested and available.

3. Each Area will have in place a mechanism to insure that patient grievances are given full and fair consideration to the highest level of appeal.  The Area's grievance procedure will include a provision that a designated grievance committee exist at each Service Unit.  This committee may be the local Indian Health Hoard or it may be another group or committee which includes Indian representatives, and which has been approved for this purpose by the local tribal government and Service Unit administration Ultimate appeal at the local level will be to the Service Unit Director, who must initiate an investigation and provide a written reply, both within specified periods of time.  Unresolved complaints may then be appealed to the Area Health.  Board and/or the Area Director.  Final decisions will be made by the Area Director.

4. The Area will insure that each Service Unit has a positive mechanism for disseminating information on patient rights and the grievance process.  At the minimum, written explanations of the grievance process and patient rights must be posted prominently in the waiting areas of all IHS facilities, periodically distributed to the community, and included in the orientation process for all new IHS staff.