Understanding the Purchased/Referred Care Program: Part 1

Posted on September 19, 2011

This posting is the beginning of a series of postings on understanding the Purchased/Referred Care (PRC) Program. When IHS is unable to provide certain types of healthcare services directly in our hospitals and clinics, we may refer patients to receive services in the private sector. These referrals are paid for by the PRC program appropriations to IHS. However, the IHS PRC budget does not have enough funding to pay for all referrals that our healthcare providers make and our patients need. We are working actively with Congress to help them understand the enormous need for PRC funding to pay for needed referrals and to request increases in our appropriations for this purpose. The PRC budget is currently $779 million. That sounds like a lot, but the additional need for PRC referrals beyond what the budget pays for is an additional $861 million. Last year, we received a $144 million increase in PRC funding, and that has helped us pay for more referrals, but there still is a great need. We only received a small increase this year. We know that patients are upset that we cannot pay for all referrals, but we do try to pay for the most urgent referrals possible through our medical priority system. The next blog posts on this topic will explain the eligibility for PRC, what we do to determine if we can pay for a referral, and the medical priority system.