U.S. Department of Health and Human Services

Glossary and Terms

The glossary and terms explaining the terms used by Purchased/Referred Care are in addition to the definitions provided in the PRC Code of Federal Regulations at Title 42, Section 136.10 and Section 136.21. Most of the terms will be found in the PRC Manual Part 2, Chapter 3 of the Indian Health Manual.

Alternate Resources: The available and accessible IHS facilities and those non-IHS health care resources. Such resources include health care providers and institutions, and health care programs for payment of health services including but not limited to programs under Titles XVIII and XIX of the Social Security Act (i.e., Medicare, Medicaid), State and local health care programs and private insurance.
Appropriate Ordering Official: The person with documented procurement authority who signs the purchase order authorizing PRC payment.
Area Director: Director of an Indian Health Service Area designated for purpose of administration of IHS programs.
Catastrophic Health Emergency Fund (CHEF): The fund to cover the IHS portion of medical expenses for catastrophic illnesses and events falling within IHS responsibility.
Contract Health Services: Now known as Purchased/Referred Care. Health services provided at the expense of the Indian Health Service from public or private medical or hospital facilities other than those of the Service, e.g., dentists, physicians, hospitals, and ambulances.
Contract Health Services Eligible Person: Now known as Purchased/Referred Care Eligible Person. A person of Indian descent belonging to the Indian community served by the local IHS facilities and program who: resides within the United States (U.S.) on a reservation located within a Contract Health Service Delivery Area (CHSDA); resides within a CHSDA and is either a member of the tribe or tribes located on that reservation; or maintains close economic and social ties with that tribe or tribes.
Contract Health Services to Support Direct Care: Now known as Purchased/Referred Care to Support Direct Care. These are provided within an IHS facility when the patient is under direct supervision of an IHS physician or a contract physician practicing under the auspices (or authority) of the IHS facility. Examples of direct care services that cannot be reimbursed with PRC funds are: on-call hours, after-hours or weekend pay; and holiday coverage, e.g., for X-ray, laboratory, or pharmacy services.
Eligibility: The established conditions as identified in the Federal Regulations that a person must meet in order to receive the health care services.
Emergency: Any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of an individual.
Federally Recognized Indian: Individual who has obtained a Bureau of Indian Affairs Certificate Degree of Indian Blood for the Tribe under Federal supervision that they are a member.
Fiscal Intermediary: The fiscal agent contracted by IHS to provide and implement a system to process PRC medical and dental claims for payment.
Indian Tribe: Any Indian tribe, band, nation, group, Pueblo or community, including any Alaska Native village or Native group, as defined in or established pursuant to the Alaska Native Claims Settlement Act, which is federally recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.
Program Director: Director of an Indian Health Services "program area" designed for the purposes of administration of Indian Health Service programs.
Purchased/Referred Care: Previously known as Contract Health Services. Health services provided at the expense of the Indian Health Service from public or private medical or hospital facilities other than those of the Service, e.g., dentists, physicians, hospitals, and ambulances.
Purchased/Referred Care Eligible Person: Previously known as Contract Health Services Eligible Person. A person of Indian descent belonging to the Indian community served by the local IHS facilities and program who: resides within the United States (U.S.) on a reservation located within a PRC delivery area; resides within a PRC delivery area and is either a member of the tribe or tribes located on that reservation; or maintains close economic and social ties with that tribe or tribes.
Purchased/Referred Care (PRC) Delivery Area (formerly contract health services delivery area): Geographic area within which purchased/referred care will be made available by the IHS to members of an identified Indian community who reside in the area. (Reference Federal Register, Vol. 72, No. 119 June 21, 2007.) Federal Register provides the entire listing of Tribal PRC delivery area for IHS; the entire State of Oklahoma is a PRC delivery area.
Purchased/Referred Care to Support Direct Care: Previously known as Contract Health Services to Support Direct Care. These are provided within an IHS facility when the patient is under direct supervision of an IHS physician or a contract physician practicing under the auspices (or authority) of the IHS facility. Examples of direct care services that cannot be reimbursed with PRC funds are: on-call hours, after-hours, or weekend pay; and holiday coverage, e.g., for X-ray, laboratory, or pharmacy services.
Reservation: Any federally recognized Indian tribe's reservation, Pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), and Indian Allotments.
Residence: In general usage, a person "resides" where he or she lives and makes his or her home as evidenced by acceptable proof of residency. In practice, these concepts can be very involved. Determinations will be made by the Service Unit Director based on the best information available, with the appeals procedure process as a protector of the individual's rights.
Secretary: Secretary of health and Human Services to whom the authority involved has been delegated.
Self-Referral: Obtaining health care from a non-IHS provider without a PRC authorization for payment of those health care services under any non-emergency situations as defined by IHS.
Service: The Indian Health Service.
Service Unit Director: Director of an Indian Health Service "Service unit area" designated for purposes of administration of Indian Health Service programs.
Tribal Health Director: The Director of a tribally operated program, or his/her designee, authorized to make decisions on payment of PRC funds pursuant to a PL 93-638 contract.
Tribal Member: A person who is an enrolled descendent of a tribe, or is granted tribal membership by some other criteria in the tribal constitution.
Tribally Operated program: A program operated by a tribe or tribal organization that has contracted under PL 93-638 to provide a PRC program.