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Special General Memorandum 86-13


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DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
     Memorandum

SGM 86-13

Date:  SEP 5, 1986

From: Director
Indian Health Service
Subject: Experimental Medical Procedures - Not Within IHS Medical Priorities
To: IHS Area/Program Directors

The Indian Health Service (IHS) is increasingly being requested to provide financial assistance for medical procedures not generally funded by other Federal medical care payment systems.  Because IHS resources are insufficient to meet all the needs of the Indian people served, regulations at 42 CFR 36.23(e) require that medical priorities be established governing authorization of contract health services.  Medical procedures which are experimental and not funded by Federal medical care payment systems will not be considered as within IHS medical priorities.  Consequently, the IHS will not authorize contract health services payment for such procedures.  In general, the IHS will use the criteria employed by other Federal payment systems such as the one used by the Health Care Financing Administration in making determinations regarding particular medical procedures.

The IHS resources may be utilized to provide support services incident to an experimental procedure.  Support Services to approved candidates for experimental procedures include those normally provided patients by the IHS including, but not limited to, coordination of benefits from other payment sources; escort and travel expenses and other services available at an IHS facility.  The Area Chief Medical Officer must be notified of all patients who are potential candidates for experimental procedures with IHS support services.  Except for coordination of benefits to the patient, expenditure of IHS resources to provide support services must be approved by the Area Chief Medical Officer, in full consultation with the Associate Director, Office of Health Programs or his designee.

Questions concerning applicability of this policy to a particular case should be addressed to the Associate Director, Office of Health Programs or the Chief, Contract Health Services Branch, IHS.

Sincerely yours,

/Everett R. Rhoades, M.D./
Everett R. Rhoades, M.D.
Assistant Surgeon General
Director, Indian Health Service


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