Access To Contract Health Services In Indian Country PDF Download

Access to health care services for American Indians and Alaska Natives has been a long standing concern.1 The Indian Health Service (IHS), an agency within the Department of Health and Human Services (HHS), is charged with providing health care to the approximately 1.9 million American Indians and Alaska Natives who are members or descendants of federally recognized tribes.2 These services are provided at federally or tribally operated health care facilities,3 which receive IHS funding and are located in 12 geographic regions overseen by IHS area offices.4 These IHS-funded facilities vary in the services that they provide. For example, some facilities offer comprehensive hospital services, while others offer only primary care services. When services are not available at these facilities, the agency's contract health services (CHS) program may pay for services from external health care providers, including hospital- and office-based providers. The CHS program is administered at the local level by individual CHS programs generally affiliated with IHS-funded facilities in each area. These individual CHS programs may be federally or tribally operated. These federal and tribal CHS programs determine whether or not to pay for the referral of a patient to an external provider or pay an external provider for a service already provided. IHS requires that patients meet certain eligibility and administrative requirements to have the services paid by the CHS program. In addition, the CHS program, which is funded through the annual appropriations process, must operate within the limits of its appropriations. Therefore, committees associated with each CHS program meet at least weekly to review cases and approve payment based on the relative medical need of each case. When the requirements have not been met or funds are not available, CHS programs defer or deny requests to pay for services. Services for which patients otherwise meet necessary requirements, but for which CHS program funds are not available for payment, are known as unfunded services. Limits on available resources have affected the specific types of services available to American Indians and Alaska Natives through the CHS program. For example, in a 2005 report examining 13 IHS-funded health care facilities, we reported that primary care services were generally offered at the facilities, but certain specialty and other services were not always directly available to American Indians and Alaska Natives.5 These facilities also generally lacked funds to pay for all of these services through their CHS programs. We also noted that, in some cases, gaps in services resulted in diagnosis or treatment delays that exacerbated the severity of a patient's condition and required more intensive treatment.