Contract Health Services (CHS)

 

CHS Eligibility Requirements

UIHS clients must meet certain eligibility requirements in order to participate in the CHS program:

  • Clients must be registered at UIHS as an "Eligible Indian Beneficiary" (EIB) and must be a resident of one of the nine federally recognized Indian reservations within the UIHS Service Area; or
  • Clients must be registered at UIHS as an EIB and must be a resident of the  UIHS Service Area and be "an enrolled member" of a federally recognized California Indian Tribe; or "an enrolled member" of a Tribe within the UIHS Service Area currently seeking federal recognition; or
  • Clients must be registered at UIHS as an EIB and must be a resident of the UIHS Service Area and be married to, or a child of a person who is "an enrolled member" of a federally recognized California Indian Tribe; or "an enrolled member" of a Tribe within the  UIHS Service Area currently seeking federal recognition; or
  • Client must be registered at UIHS as an EIB and must be a resident of the UIHS Service Area and be a "regular full-time" employee of one of the nine federally recognized Indian tribes or their tribal organizations.

Screening for Alternative Resources

The UIHS CHS program is the "payer of last resort."  Therefore, in order for CHS to be used, the client requesting the CHS assistance will be screened to determine if there are other possible sources of payment such as private insurance, Medi-Cal, Medicare, etc.  The ability of the client to pay for the outside service is not considered in the screening.  If another source of payment is available, they must be utilized before CHS can be used.  If the client chooses not to participate in the screening process, or chooses not to apply for alternate resources they are found eligible for, CHS assistance will be denied. 


Utilization of Outside Services

CHS assistance is only available for referrals made by UIHS providers or in the event of emergency care.

  • A "General Referral" is a UIHS referral for non-urgent outside services.  This type of service can be delayed until the CHS eligibility screening process is completed.  Therefore, prior authorization for CHS assistance is required for all general referrals.  Clients must contact the CHS office prior to utilizing the outside service.
  • An "Urgent Referral" is a UIHS referral for urgent outside services which cannot wait for the outcomme of the eligiblity screening process.  Since prior authorization for CHS assistance is not feasible, the client remains responsible for payment of the bill for such services unless CHS authorization is obtained.  Clients must contact the CHS office within 3 working days of utilizing the outside services.
  • "Emergency Cases" require immediate attention without a referral from a UIHS provider.  When this occurs, the client remains responsible for payment of the bill for such services unless CHS authorization is obtained.  Clients must contact our CHS office within 3 working days of utilizing the outside service  (exception: 30 days if you are disabled or 65  years of age or older).

Covered Services

The UIHS CHS program operates within a system developed from federal guidelines, medical staff consultation, and approved by the UIHS Board of Directors.  It is important to note that not all outside services are within the UIHS list of "Covered Services." At the current time, out CHS program covered services include the following:

  • Priority Level I - Care that must be done within 30 days to preserve life, limb, function or senses.
  • Priority Level II - Non-emergent care that is needed within 30-60 days, but enought time in which alternate resources can be evaluated.
  • Priority Level III - Hearing aids, eye glasses, and limited other services that are determined to be medically necessary.