U.S. Department of Health and Human Services

Part 2, Chapter 4: Manual Appendix E

Statutes that Allow Health Services to be Provided to
Ineligible Individuals at IHS Facilities

Statute	Sec. 813(b)(1)(A) IHCIA (Subject of Draft Circular)	42 USC 251(b)	42 USC 253	Sec. 813(a) IHCIA	Sec. 813(c) IHCIA
Who may be provided services under the statute:	All ineligibles who reside within the service area of the service unit.	Federal employees and dependents	Commissioned Corps of PHS and dependents (Commissioned Corps active duty and retirees. 42 CFR 31.2(c). Dependents of commissioned corp. active duty and retirees. 42 CFR 31.9.)	Children (under 19 and natural or adopted child, step-child, foster-child, legal ward or orphan of an eligible Indian) and Spouses of eligible Indians.	Anyone under Special Limited Situations (medical emergency; prevent spread of disease or public health hazard; women pregnant with eligible Indian's child; and immediate family members if directly related to treatment of eligible person).
Location where services are authorized to be provided at:	An IHS facility where:(1) there are no reasonable alternative facilities or services available and (2) no denial or diminution of services to eligibles will result.	Remote PHS facilities (IHS facilities must be designated as "remote" by Director, IHS under criteria of IHS Manual Part 2-4.7).	PHS facilities (subject to HRSA reimbursement guidelines).	Any IHS facility.	Any IHS facility.
Who has delegated authority to approve:	Area Director. After a request by a tribe or tribes.	Director, IHS.	Director, IHS.	Children - automatic Spouses- by Tribal resolution.	Medical Officer in charge. 42 CFR 136.12.
What services are authorized:	Direct care.	Direct care.	Direct care.	Direct care and CHS.	Direct - limited to the specific situations and services listed.
Conditions:	IHS must be reimbursed for services.	IHS must be reimbursed for services.	IHS must be reimbursed for services under an Economy Act arrangement.	Children are treated as eligibles. Spouses treated as eligibles except they cannot be counted in user population.	Limited to the specific situations listed.