Presented by Patient Registration

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Presentation transcript:

Presented by Patient Registration Patient Eligibility Presented by Patient Registration

Law 42 C.F.R. 136 Parts A & B (link to IHS page for eligibility) 2002 Hospital Compact

Eligibility Status CHS & Direct Direct Only Pending Verification Ineligible

Purchased & referred care service Delivery Area (PRCSDA) How is the PRCSDA determined? Map of PRCSDA The contract health services delivery area (CHSDA) shall consist of a county which includes all or part of a reservation, and any county or counties which have a common boundary with the reservation Counties include Cherokee, Graham, Haywood, Jackson and Swain There is Trust land in each of these counties

Referral priorities Priority 1 Priority 3 Emergent or Acutely Urgent Care Services Federally Funded Priority 3 Primary and Secondary Care Services Funded by Tribal Gaming Dollars

Eligibility for ebci enrolled

Eligibility for ebci 1st descendent

Other federally-recognized Tribal members

Eligibility quiz What counties make up the CHSDA? Where does a first descendent have to live to be CHS & Direct eligible? Where does a member of a Federally-Recognized Tribe have to live to be CHS & Direct? Name 3 reasons why a member of a Federally-Recognized Tribe can live within the CHSDA and be CHS & Direct eligible. A member of the Choctaw Nation presents and lives in Franklin. Is this patient eligible for referrals? A member of the EBCI has just moved to Dahlonega, Ga. Is this patient eligible for medications? An EBCI first line descendent is living in Canton. What services is this patient eligible for?

Questions? For further information, please call ext. 6603