Office of Resource Access and Partnerships
The Office of Resource Access and Partnerships (ORAP) serves as the lead Office for the Business Office and Purchased/Referred Care (PRC) (formerly known as Contract Health Services) within the Indian Health Service (IHS). ORAP is comprised of two Divisions, the Division of Business Office Enhancement (DBOE) and the Division of Contract Care (DCC).
ORAP Functions
ORAP is responsible for the following functions.
- Provides Agency-wide leadership and consultation to the IHS direct operations and Tribal programs on IHS goals, objectives, policies, standards and priorities regarding the operations and management of the Business Office Services (BOS) and the Contract Health Services (CHS) programs;
- Develops and implements objectives, priorities, standards, measures and methodologies for the BOS and CHS programs;
- Manages and provides leadership, advocacy, consultation and technical support to Headquarters, IHS Areas and local levels on the full scope of BOS and CHS activities;
- Represents the IHS at meetings and in discussions regarding policy, legislation and other national issues;
- Provides oversight and monitors the BOS and CHS programs regarding compliance requirements, utilization reviews, revenue measures and reports;
- Formulates and analyzes BOS and CHS budgets and prepares information for program budget presentations;
- Collaborates and coordinates with IHS information technology staff and external organizations on new technologies, applications and business practices;
- Develops resource opportunities and coordinates the BOS and CHS activities with other governmental and nongovernmental programs, promoting optimum utilization of all available health resources;
- Participates in cross-cutting issues and processes including, but not limited to emergency preparedness/security, budget formulation, self-determination issues, and resolution of audit findings as may be needed and appropriate.
ORAP Divisions
Division of Business Office Enhancement
DBOE serves as the primary focal point for managing the Business Office program within IHS. DBOE provides leadership and consultation to both Headquarters and Area Offices, while also liaising with Tribal organizations and external entities such as the Department of Health and Human Services (HHS) and the Office of Management and Budget (OMB).
DBOE’s key responsibilities include the development, dissemination, and maintenance of policies and procedures related to Business Office operations. It also plays a vital role in ensuring that IHS facilities comply with regulations concerning Medicare, Medicaid, and private insurance reimbursement policies. As the primary liaison to the Centers for Medicare & Medicaid Services (CMS), DBOE handles rate setting and provides guidance on managed care activities, including Medicaid waiver proposals and other healthcare reforms.
In addition, DBOE works to improve local capacity through training, technical assistance, and support for information systems related to patient registration, billing, and collections. DBOE also develops budget materials related to third-party reimbursements and responds to inquiries from Tribal organizations, Congress, and HHS regarding third-party funding issues.
Division of Contract Care
DCC oversees the PRC program within IHS. PRC is designed to assist American Indian/Alaska Native (AI/AN) patients with care that cannot be provided at IHS or Tribal facilities (referred to as Direct Care). The PRC program is not an entitlement program but operates as a payer of last resort. This means that all other available resources, such as Medicare, Medicaid, and private insurance, must be utilized before PRC funds can be applied to cover the costs of care.
Eligibility for PRC services is based on several factors, including residency, notification requirements, medical priorities, and the use of alternate resources. AI/AN patients are responsible for complying with these requirements and understanding that an IHS referral does not guarantee payment through PRC.
DCC ensures the effective management and oversight of PRC operations by adhering to legislative requirements, policies, and guidelines and plays a critical role in monitoring compliance, processing payments, and coordinating with other federal, state, and local health resources to optimize care for AI/AN communities.
