Resources: Purchased/Referred Care (PRC) Rates Information
The Secretary of the Department of Health and Human Services (HHS) hereby issued the ruling to implement a methodology and payment rates for the Indian Health Service (IHS) Purchased/Referred Care (PRC), formerly known as the Contract Health Services (CHS), to apply Medicare payment methodologies to all physician and other health care professional services and non-hospital-based services. Specifically, it will allow the health programs operated by IHS, Tribes, Tribal organizations, and urban Indian organizations (collectively, I/T/U programs) to negotiate or pay non-I/T/U providers based on: the applicable Medicare fee schedule, prospective payment system, Medicare Rate, or, in the event of a Medicare waiver, the payment amount will be calculated in accordance with such waiver; the amount negotiated by a repricing agent, if applicable; or the provider or supplier's most favored customer (MFC) rate. This final rule will establish payment rates that are consistent across Federal health care programs, align payment with inpatient services, and enable the I/T/U to expand beneficiary access to medical care.
These regulations were published in a final rule in the Federal Register on March 21, 2016, with an effective date of May 20, 2016. The regulations describe the payment methodologies and other requirements covered providers must adhere to when processing claims for services authorized for purchase by a PRC or urban Indian program. This applies to programs operated by the IHS, Tribes, or Tribal organizations, and urban Indian programs. A Tribal Leader letter was sent to Tribal leaders and urban program directors from the Principal Deputy Director IHS announcing the final rule implementing
Purchased/Referred Care payment rates.
- Review the Tribal Leader Letter. [PDF - 26 KB]
Take Advantage of Purchased/Referred Care Rate
- Notify providers in your area of the PRC regulations.
You may want to use a letter similar to this sample: Dear Provider Letter Sample [PDF - 793 KB]
- How to calculate the amount your program should pay under the PRC regulations.
- Contract with IHS/PRC or other fiscal intermediary that will calculate the PRC rate for you.
- Contract with a vendor to provide software for you to use in calculating the PRC rate.
Frequently Asked Questions
- Purchased/Referred Care Rates FAQ [PDF - 106 KB]
- Purchased/Referred_Rates Fiscal Intermediary Q&A [PDF - 111 KB]
- Purchased/Referred Care Rates Presentation - January 18, 2017 [PDF - 118 KB]
- Purchased/Referred Care Rates Presentation - November 15, 2016 [PDF - 118 KB]
- Dear Tribal Leader Letter - May 24, 2016 [PDF - 26 KB]
- IHS Press Release — IHS Implements New Regulation for Tribes to Negotiate Medicare-Like Rates
- Purchased/Referred Care Rates Presentation - May 17, 2016 [PDF - 98 KB]
- Purchased/Referred Care Rates Presentation - August, 17, 2016 and August 22, 2016 [PDF - 115 KB]
- Federal Register - March 21, 2016
Email your questions and comments to Terri Schmidt. (Please read through the information on this page and FAQs before submitting questions)