Contract Care

Introduction Overview
Contract Health Service (CHS) is a restrictive program and not a comprehensive program. It is not an entitlement program or an insurance program and operates as funds are available. It is designed to provide for the purchase of a limited number of services not available at our clinics. Due to budget limitations, health care provided outside IHS facilities require a complicated eligibility and payment process.

Scope of the Program
The CHS Program has guidelines set forth that determine services which it may not pay for. In general, CHS may pay for specialty physician services, in-patient transportation (i.e. via ambulance) and other authorized health care support services for eligible Indian persons.

Newborns
During the first two months, if a newborn requires CHS services and the parents are CHS qualified clients, then the CHS Program can extend services to the newborn for the first two months without a registered birth certificate.

Services Not Covered
  • Services or supplies which are related to a condition not within established medical priorities.
  • Nursing Home Care
  • Services or supplies which may be covered by other resources (i.e. insurance, Medi-Cal, Medicare or other
  • Federal Programs).
  • Personal comfort and/or convenience items.
  • Sterilization that does not meet IHS regulation.

Eligibility
In order to qualify for CHS you must meet certain Federal requirements. In general, you must be screened by CHS staff to determine eligibility for CHS.

Referral Process
Eligible persons who may require a covered service that is not provided at one of the Toiyabe clinics may be referred to another provider. The referral process must be initiated by a Toiyabe provider; then sent to the Managed Care Committee for further processing. Preauthorization is required for all non-emergency services and follow-up care.

For more information, contact Toiyabe Indian Health Project Contract Health Services at 760-873-6111 or toll free 1-877-701-6313.