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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Contract Health Services (CHS)

Medical/dental care provided at an Indian Health Service (IHS) or tribal health care facility is called Direct Care. The Contract Health Services (CHS) Program at IHS is for medical/dental care provided away from an IHS or tribal health care facility. CHS is not an entitlement program and an IHS medical referral does not imply the care will be paid. If IHS is requested to pay, then a patient must meet the American Indian/Alaska Native tribal affiliation, residency requirements, notification requirements, medical priority, and use of alternate resources (including IHS facility).

Medical Staff

All American Indians and Alaska Natives should be aware of the following requirements each time he/she is referred or requests IHS to pay for medical care away from an IHS or tribal health care facility:

  • Patient responsibility to comply with ALL CHS requirements
  • CHS is not an entitlement program
  • CHS Eligibility Requirements
  • CHS Notification Requirements
  • CHS Patient Process for Authorization for Payment Diagram [PDF - 251KB]
  • Medical/Dental Priority of Care
  • Use of Alternate Resource (Medicare, Medicaid, VA, Private Insurance, charity, etc.)
  • Appeal Process for Denial of CHS care
  • Patient Rights & Responsibilities
  • Directory for an IHS or tribal health care facility near your location

Learn more about the IHS Contract Health Services (CHS) program