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SGM No. 86-02

Date:  OCT 8, 1985

From: Acting Director
Indian Health Service

Subject: Compliance With Rules and Policy Governing Contract Health Services

To: All Area/Program Directors

Information obtained from many Indian Health Service (IHS) Areas/Programs suggests that rules and policies governing the provision of contract health services (CHS) are not being applied consistently throughout the IHS.  Of particular concern to Headquarters are reports that alternate resources are not being maximally utilized and that medical priorities vary widely, even within an Area/Program.

Our direct care facilities are considered alternate resources and they should be utilized to the extent that facility and staff capabilities allow.  The IHS Manual states, in 2-3.7c 2-(c), that:

"As a general rule routine health services will not be provided through CHS when an IHS facility capable of providing these services is within ninety (90) minutes one way surface transportation time from the person's place of residence until the level of funding permits a less restrictive guideline."

At this time, when many Service Units have reportedly exhausted their CHS funds and in some locations have not been providing CHS assistance for months, even in emergency situations, the IHS cannot justify use of a less restrictive guideline than a 90-minute transportation time.

A copy of Part 2, Chapter 3 of the IHS Manual, which governs the CHS Program, is attached.  You are directed to refresh your familiarity with this Part and to ensure that your staff is fully informed regarding the CHS policies and guidelines it contains.  It is mandatory that these national CHS policies are being applied routinely in each Service Unit and by each tribal program utilizing CHS funds.

/G.H. Ivey/
G.H. Ivey