U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Contract Health Services

Resources

QUICK MENU: Laws  |  Regulations  |  CHS Manual  |  Priorities of Care  |  Case Management


Laws



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Regulations

The regulations establish the principles and program requirements for carrying out the CHS program. The CHS program regulations are published in the Code of Federal Regulations at Title 42; and the Federal Register.

Indian Health Service Eligibility
Subpart B - What Services Are Available and Who is Eligible To Receive Care

Contract Health Services Requirements
Subpart C - Contract Health Services (CHS)

Medicare Like Rates Payment
Subpart D - Limitations on Charges for Services Furnished by Medicare-Participating Hospitals to Indians

Alternate Resources
Subpart G - Residual Status

Contract Health Service Delivery Area

Issued under Federal Register (FR)/Notice Volume 72, No.119/Thursday, June 21, 2007

This notice is the revised and updated listing of CHSDA as defined in CFR at Title 42, Part 136. This replaces and suppliments the FR notice dated January 10, 1998 establishing CHSDAs and FR notice dated August 25, 1988 establishing Health Service Delivery Areas. The listing provides the Tribe/Reservation and the Counties/State under the scope of the program. Information on background and procedures on determining the delivery area of a Tribe is also provided.

Federal Register - CHSDA [DOC-328KB]

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Contract Health Services (CHS) Manual

The manual defines effective management based on Congressional legislation, funding, and authority for CHS program. The CHS program's responsibility is in support of the IHS direct care services by contracting services with non-IHS providers for health care services. The manual is application of the legislation with the governing regulations, policies, and other guidance's published for the program's management. The program management is the administrative resources, patient eligibility, contracting (authorizing purchase), fiscal functions, alternate resources identification, CHS delivery area, catastrophic health emergency fund (CHEF), patient education, provider education, appeal process, applying the IHS medical priority requirements, fiscal intermediary, patient transportation, and CHS related information systems.

IHS-843-1A, Order for Health Services, the CHS purchase order form

The CHS program when authorizing a patient medical services for CHS payment, will issue the "Order for Health Services", IHS-843-1A form (the CHS purchase order form), to the provider contracted to provide medical care for the patient. Authorization occurs when the patient is determined to be CHS eligible, then the CHS program authorize patient to receive specific services with the services scheduled by CHS staff. Exception to the IHS-843-1A authorization prior to medical services provided occurs in urgent emergency care situations. The potential authorization is dependent on patient complying with all CHS requirements for eligibility. Requirements of CHS program being notified within 72 hours of the episode of care, the level of medical need is within the IHS medical priority determination, medical summary provided to CHS after discharge, use of available or potential alternate resources, patient resides within his health care service delivery area. Patient's compliant with federal requirements are authorized CHS, the IHS-843-1A will be issued. The provider will complete the bottom part of form, then mail form with EOB to the CHS fiscal intermediary for payment. Provided is the IHS-843-1A fill-in form for use by CHS programs as an alternative when the IHS data system is not available to process/issue the form.



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Priorities of Care

Priorities of care and treatment for health care services will be determined on the basis of relative medical need. Medical procedures which are not funded by Federal medical care payment systems will not be considered as within IHS medical priorities. The IHS will not authorize contract health services (CHS) payment for such procedures not meeting the criteria. Because IHS resources are insufficient to meet-all the needs of the Indian people served, regulations at Code of Federal Regulations, at Title 42, section 136.23(e), "Priorities for contract health services require that medical priorities be established governing authorization of CHS payment.

Detailed information on IHS Medical Priorities can be found below:

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Case Management

Case Management Flow 2011 Combined Council [PDF-424KB]
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