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Requirements: Priorities of Care

Priorities of care and treatment for health care services will be determined on the basis of relative medical need. Medical procedures which are not funded by Federal medical care payment systems will not be considered as within IHS medical priorities. The IHS will not authorize Purchased/Referred Care (PRC) payment for such procedures not meeting this criteria. Because IHS resources are insufficient to meet-all the needs of the Indian people served, regulations at Code of Federal Regulations, at Title 42, section 136.23(e), "Priorities for contract health services. Require that medical priorities be established governing authorization of PRC.

The application of medical priorities of care is necessary to ensure that the funds provided by Congress for the IHS/PRC funds are adequate to provide services that are authorized in accordance with IHS approved policies and procedures.

Under this authority each Area establishes the medical priority of care that set forth which health care services will be covered by PRC. The medical priority of care is determined as levels, I, II, III, IV, and V. The funding and volume of need by the population have required that most Area can only provided PRC authorization the highest priority medical services - Level I. These medical services are generally only emergency care service, i.e., those necessary to prevent the immediate threat to life, limb, or senses.

The IHS Medical Priorities Levels are:

  1. Emergent or Acutely Urgent Care Services
  2. Preventive Care Services
  3. Primary and Secondary Care Services
  4. Chronic Tertiary Care Services
  5. Excluded Services

Detailed information on IHS Medical Priorities can be found below: