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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Planning, Evaluation & Research

RRM Category: ADMINISTRATION

RRM Module: Contract Health Services

Overview:
The RRM Contract Health Services (CHS) staffing module estimates the requirements for CHS staff to include: CHS Supervisor, RCIS Data Entry Clerk, and CHS Staff. The CHS staff performs the day-to-day management functions of the contracted health services program for the facility. The workload parameter that is the key variable is number of CHS authorizations for health care for eligible individuals.

Services Description:
The CHS staff performs the following activities:
  • Patient eligibility for contract health care
  • Processing procurement orders for requested contract health services
  • Tracking allocation of CHS funds to assure the program stays within budget
  • Coordination of activities associated with contract health care

Staffing Criteria:
Fixed CHS Manager staff of 1.0 FTE for each facility that processes 50 or more CHS authorizations for health care services.

Fixed RCIS Data Entry Clerk of 1.0 FTE for each facility that uses RCIS for automation of referrals.

CHS Staff of 1.0 FTE for every 700 CHS authorizations for health care services at facilities that have over 50 CHS authorizations a year.

NOTE: In order to consider the time it takes to process CHS denials the authorization driver has been reduced to reflect this work load. This is based on a review that showed that authorizations and denials at a facility are similar.

STAFFING FORMULAE

Personnel Categories:
CHS Manager
RCIS Data Entry Clerk
CHS Staff

Driving Variables:
CHS Authorizations

MINIMUM STAFFING LEVELS (fixed):

Personal Category FTEs Per Driving Variables Min. Max.
CHS Manager 1 Per facility   50  
RCIS Data Entry Clerk 1 Per facility   50  

Plus, VARIABLE STAFFING LEVELS:

Personal Category FTEs per Driving Variables Min. Max.
CHS Staff 1 700 CHS Authorizations 50 n/a


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