Cherokee Nation Contract Health Care Changes

CHEROKEE CHAT: Week of June 1, 2014
By Cara Cowan Watts

 

The Indian Health Service (IHS) Contract Health Service (CHS) program funds referrals for care in the private sector when those services cannot be provided in the IHS facility. 

Congress requested IHS propose a new name for the program since it was often confused for other budget items.  In the FY 2014 President's Budget proposal, the name was changed to Purchased/Referred Care (PRC).  The name change was official with passage of the FY 2014 appropriation and IHS and Cherokee Nation Health Services (CNHS) will transition the name from CHS to PRC during the coming year.  

The new name better describes the purpose of the program funding for both purchased care and referral care outside of IHS.  The name change will not otherwise change the program, and all current policies, practices, and improvements will continue. 

FY 2014's appropriation included a $77 million increase for CHS/PRC, which means there is more funding available to pay for the referrals outside of IHS.

In addition to the name change, Rogers County, Tulsa County and Craig County Cherokees will now be partially served by CNHS CHS/PRC.

Effective June 1, 2014, Cherokee Nation compacted a portion of Claremore IHS CHS/PRC.  Now, all Federally-recognized Tribal citizens in Craig County will be outpatient CHS/PRC Cherokee Nation and inpatient Claremore IHS.  Cherokee Nation citizens, only, in Rogers County and Tulsa County will be outpatient CHS/PRC Cherokee Nation and inpatient Claremore IHS.

One example of inpatient versus outpatient CHS/PRC is knee surgery.  If a patient needs knee surgery, Claremore IHS is unable to perform knee surgery.  The medical care for knee surgery must be done in an outside facility.  Outpatient CHS/PRC is the doctor visit where the doctor does a diagnosis and determines knee surgery is needed.  Inpatient is when the doctor performs the surgery and you have to stay overnight in a hospital.

All of this means, you will quickly be approved and know you need knee surgery.  However, you will have to be denied by IHS before Cherokee Nation monies are used for the actual surgery.

Councilman Lee Keener and I were promised the Cherokee Nation would staff Claremore IHS with Cherokee Nation CHS/PRC staff, so the June 2014 IHS CHS/PRC Compact and the five percent dividend promised Cherokee Nation citizens would be more effective and readily accessible.  So, you should see Tribal staff on site at Claremore to help you get the surgeries and cancer treatment you need in a timely manner.

In the meantime, please write us if your health care is being stalled.  If a family member including a spouse needs to advocate on your behalf, please have them sign HIPAA forms for patient approval to release your health care information.

If you have questions, issues or concerns about the Cherokee Nation government, please email me at This email address is being protected from spambots. You need JavaScript enabled to view it. or write me at P.O. Box 2922, Claremore, OK 74018. 

For daily news and event notices, ask to be added to my Cherokee Nation News and Events email listserv.  You may, also, find me on Facebook, Pinterest, Instagram, LinkedIn, Google+ and Twitter.  Lee Keener is at This email address is being protected from spambots. You need JavaScript enabled to view it..

To contact the Tribe, call (918) 453-5000 or visit www.cherokee.org.

Cara Cowan Watts is an elected Tribal legislator within the Cherokee Nation for portions of Rogers and Tulsa Counties.