Contract Health Care Services
Medical Care Status: Priority One
ELIGIBILITY
To be eligible
for CHS, an individual must meet the eligibility requirements
as defined by CFR Title 42, Section 36.21 through 36.25, and
HIS Manual, Part 2, Chapter 3, "Contract Health Services"
dated January 5, 1993. There are five eligibility factors,
which must be met by every person needing and applying for CHS
assistance.
To ensure the eligibility status,
individuals must update the PAO-21 (yellow form) annually or
when there are address changes. Not having current information
may create a delay in processing CHS referrals because the
eligibility criteria is not current. The eligibility factors
are:
1. An individual must be of Indian
descent and belong to the Indian community, which may be
verified by tribal descendency through the Tribal Enrollment
Office.
* A non-Indian woman pregnant with an
eligible Indian’s child is eligible for CHS during pregnancy
through six weeks post partum.
2. An individual must reside within the
IHS Contract Health Service Delivery Area (CHSDA). The CHSDA
includes the counties of Okanogan, Ferry, Stevens, Lincoln,
Douglas, Chelan and Grant.
* Students enrolled in college full-time,
attending boarding school, vocational, technical or other
academic education must notify the IHS clinic by updating a
PAO-21 eligibility form and attach evidence of full-time
student status.
* Children placed in foster care outside
the CHSDA by court order must also have their PAO-21 updated
by the local Children and Families Program and provide a
copy of the court order showing placement from a court of
proper jurisdiction.
3. CHS funds are limited to medical and
dental services considered medically necessary and listed
within the established Area IHS medical and dental
priorities.
4. An individual must apply for and use
all alternate resources that are available and accessible,
such as Medicare A and B, state Medicaid, state or other
federal health program, private insurance, etc. The IHS is
the "payor of last resort" of persons defined as eligible
for CHS, notwithstanding any state or local law or
regulation to the contrary. The IHS clinic at Nespelem is
also considered a resource, and therefore, the CHS funds may
not be expended for services reasonably accessible and
available at the clinic.
5. The federal regulations require proper
notification of the appropriate IHS official before the CHS
assistance is authorized.
* In non-emergency cases, the patient or
an individual or agency setting on behalf of the patient, or
the medical provider, must notify the respective IHS CHS
specialists at (509) 634-2900 prior to the provision of
medical care and service in a non-IHS facility.
* In emergency cases, the same parties
mentioned above, must notify the respective official within
72 hours after the beginning of treatment or after admission
to a non-IHS facility.
* For an elderly or disabled person, the
notification period may be extended from 72 hours to 30 days
in emergency situation.
To be eligible for CHS, an individual must
meet all five eligibility factors listed above. A referral by
an IHS physician to a non-IHS provider does not automatically
qualify a patient for CHS. The IHS is not obligated to pay for
medical or dental services under the CHS program unless funds
are available and authorized. Therefore, it is important that
every person needing CHS assistance promptly notify and
receive approval from appropriate IHS officials.
Priority Status
The Colville Service Unit is on Priority One. Priority One
care is limited to life or limb emergencies. Some examples of
Priority One that would be considered emergent or acutely
urgent care services are:
Airway obstruction
Amputation, traumatic
Appendicitis
Arrhythmia (heart problem)
Burns
Coma
Congestive heart failure
Dehydration, severe
Delirium tremens
Diabetic ketoacidosis
Eye disease, acute
Eye injuries
Fractures
Gunshot wounds
Head injury or concussion
Heart attacks
Kidney stones, acute
Lacerations
Meningitis or other serious infections
Obstetrical emergencies
Pneumonia, acute
Premature infant
Puncture or stab wounds
Renal failure
Respiratory failure
Spinal cord injuries
Indian Health Service Medical Priorities must be consistent
and integrated with annual spending plans since the
availability of funds determines the level of medical care
that can be provided. There is no authority to provide payment
for services under the CHS program unless funds are, in fact,
“available.”
When funds are “insufficient” to provide the volume of CHS
care; priorities for service shall be determined on the basis
of “relative medical need.” Right now, due to insufficient
funds, our number one priority is to the population residing
on the reservation.
The following services will not be considered unless
appropriations increase. Priority Two care includes acute
primary and preventive care services. Priority Three is
chronic primary and secondary care services. Priority Four
includes chronic tertiary care services.
Back to top>
Oral Health and Pregnancy
A new study shows that bacteria in the
mouth of the pregnant woman could influence the baby’s birth
weight and delivery date. Today, most babies are not born
prematurely or at a low birth weight. Medical advances have
made it possible to keep tiny babies alive that would almost
certainly not have survived in past generations. But the
problem has not gone away. Preterm low birth weight is still
the second leading cause of infant death in general. The
numbers have increased in America over the last few decades.
The preterm delivery rate rose from 10.2% to 11.6% of all live
births from 1987-1998. Low birth weight increased for all
races from 6.8% to 7.6% from 1980-2000.
Certainly, oral health is not the only reason for preterm
delivery or low birth weight. The mother’s overall health,
resources and prenatal care are crucial. Still, bacteria seen
in gum disease and cavities may play a role. The mouth is home
to hundreds of types of bacteria, some of which are linked to
dental problems. Recently, oral bacteria were studied in about
300 pregnant women.
The researchers monitored levels of several types of bacteria
while the women were pregnant. They also noted the babies’
delivery date and birth weight. One type of bacteria was
linked to lower birth weight and earlier delivery. Another was
associated with a slightly higher birth weight and delivery
date.
Harmful oral bacteria have also been linked to greater risk of
heart disease. That is all the more reason to reach for your
toothbrush. Monitoring oral bacteria levels could help reduce
poor pregnancy outcomes.
Submitted by Tribal Health Programs
Back to top>
Sports Physicals Dates for Omak
The Colville Indian Health Center, in
collaboration with Tribal Health Program staff in Omak, will
be giving school sports physicals at the Tribal Health
facility in East Omak on July 19 and July 26.
All students under 18 years of age MUST have a parent or legal
guardian accompany them to their appointments. Appointments
can be made by calling Amanda at 422-7416. It will save
everyone time if the students’ immunization records are
brought with the students.
We want to encourage all students to also have a dental exam,
as well as an eye exam this summer. Our optometrist, Dr. Don
Sanford, is in Nespelem three days a week. Dental exams can be
scheduled either at Omak or Nespelem. For any questions or
assistance, call Amanda at 422-7416.
Back to top>
Women’s Health Clinics in Omak
The Colville Indian Health Center, in
collaboration with Tribal Health Program staff in Omak, will
be offering women’s health exams at the Tribal Health facility
in East Omak on a monthly basis. July 14 and August 11 are the
summer dates, and appointments can be made by calling Amanda
at 422-7416.
Back to top>
CAMP DUKE 2005
Summer is here and youth all across the
reservation are finding ways to spend time outdoors. Tribal
Health Programs will once again be coordinating Camp Duke to
be held at Twin Lakes Youth Camp near Inchelium, August 16th –
19th. We again want to thank our sponsors from previous years;
STEPS to a healthier USA, Community ACTION RESOURCE TEAM
(CART), Colville Tribe Economic Corporation (CTEC), Bonneville
Power, Duke Family, WSU Cooperative Extension, and Camp Duke
Parents. Camp Duke is Sports and Health Camp that encourages
teamwork and physical fitness through the use of fun and
educational activities. It also provides instruction so youth
can improve upon their individual and team sports. If your
child is entering the third through eighth grades and would
like to attend this year’s camp, fill out an application and
return to the address listed below. Applications can be picked
up at all Community Centers on the reservation and Tribal
health Offices. If you have any questions, feel free to
contact Lori Joseph at 634-2943 or Nancy Johnson at 634-2184.
Back to top>