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IHS Publishes Catastrophic Health Emergency Fund Notice of Proposed Rulemaking

The Indian Health Service published the Catastrophic Health Emergency Fund, or CHEF, Notice of Proposed Rulemaking in the Federal Register on July 18, 2023. The NPRM proposes regulations governing CHEF and includes a 60-day comment period that closes on September 18, 2023.

CHEF was established by section 202 of the Indian Health Care Improvement Act to meet the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the responsibility of the IHS.

The IHS administers the CHEF to reimburse certain IHS and tribal Purchased/Referred Care costs that exceed the cost threshold. The key changes incorporated in the proposed rule are:

  • A reduction in the threshold from $25,000 to $19,000, with an annual adjustment matching the Consumer Price Index for all urban consumers;
  • Implementation of an appeal process for CHEF cases that are denied reimbursement; and
  • Removal of tribal self-insurance as an alternate resource for the purposes of the CHEF program.

IHS will consider all comments received before the Final Rule is published.

For technical questions concerning this rule, contact: Carl Mitchell, Director, Division of Regulatory and Policy Coordination, Office of Management Services, Indian Health Service, 301–443–6384,; or CAPT John Rael, Director, Office of Resource Access and Partnerships, Indian Health Service, 301–443–0969,

Related Content:
Catastrophic Health Emergency Fund Notice of Proposed Rulemaking