Tuesday, July 22, 2014

Contract Health Services

CHSHISTORY
The Muscogee (Creek) Nation Contract Health Services (CHS) Program was established as a result of tribal nations’ ability to receive funds from the Department of Health and Human Services administered by Indian Health Service (IHS) to provide outsourced specialized health care for outpatient and inpatient services for their Contract Health Service Delivery Area.

CHS is a federally funded program and not an insurance company or an entitlement program. Funds are used to supplement and complement other health care resources available to eligible Indian people. Since IHS programs are not fully funded, the CHS program must rely on specific regulations for eligibility, notification, residency and a medical priority rating system.

SERVICES PROVIDED

  • CHS provides the following services:
  • Referral processing (outpatient/inpatient)
  • Case management for emergency room visits and inpatient hospital stays
  • Coordination of care
  • Liaison support between patients and vendors
  • Payment processing for contracted care
  • Emergency Medical Assistance Program (EMA) available for eligible Muscogee (Creek) citizens
  • Vision Program available for eligible Muscogee (Creek) citizens

ELIGIBILITY REQUIREMENTS

  • Federally recognized Indian with proof of membership via a tribal membership card or Certificate Degree of Indian Blood (CDIB)
  • Residence must be within IHS-designated service area or within the Muscogee (Creek) Nation boundaries
  • CHS is a payer of last resort and all other resources must be utilized first including but not limited to: Medicare, Medicaid, Sooner Care, Veteran’s Benefits, Worker’s Compensation, and Private insurance.

EMPLOYEES
CHS is staffed with 19 employees at the Central Office in Okmulgee and 11 coordinators at the five outlying MCN clinics and hospital. Get to know your coordinators in the field as they are an important part of the referral process and serve as the liaison between MCN doctors and contracted providers. Coordinators at each clinic include:

  • Eufaula: Margarette Thurman, 918.689.2547 ext. 263
  • Koweta: Cheryll Posey, 918.279.2317
  • Okemah: Amber Frazier, 918.623.1424 ext. 419
  • Okmulgee: Tricia Van Straten-Tate, 918.591.5772
  • Sapulpa: Anita White, 918.224.9310 ext. 269
  • EMA and Vision Program Contacts:
  • Tiarra Jimboy, Tribal Program Coordinator/EMA: 918.758.2710 ext. 239
  • Minnie Wolfe, Tribal Vision: 918.758.2710 ext. 247
  • Jason Harley, EMA/Vision Payment: 918.758.2710 ext. 225

TRIBAL HEALTH CARE FUNDS
The CHS program also receives health care funds from the Muscogee (Creek) Nation to supplement the IHS funds for referred services and to provide tribal programs for emergency medical assistance (EMA) and vision services. This allows a majority of Creek citizens to get the needed medical services, medicines, durable medical equipment and glasses they require.

Eligibility requirements for use of tribal funds are nearly the same as for the CHS program. Creek citizens must reside within the Muscogee (Creek) Nation boundaries to receive medical health care referral approval. However, for the EMA and Vision Programs, requirements vary in that the vision program covers the entire state, while the EMA program will assist Muscogee (Creek) citizens regardless of residence. Please see the map which shows the Muscogee (Creek) Nation boundaries.

EMERGENCY MEDICAL ASSISTANCE
The Emergency Medical Assistance (EMA) program is a tribal program that provides assistance to eligible Creek citizens regardless of where they live in obtaining:

  • Prescribed medications not available within a tribal or IHS health facility (no over the counter medications)
  • Prescribed medical equipment necessary to sustain health and well-being (oxygen, concentrators, walkers)
  • Prosthesis (artificial limbs)

This program is not intended to cover the total cost of prescriptions and related expenses. An application must be initiated at one of our health facilities and eligibility must be established prior to receiving assistance. There are benefit limit amounts for each category and applicant must furnish documentation verifying all other available resources (Medicaid, Medicare, Private Insurance, etc.) have been exhausted.

BENEFIT LIMITS

  • Health Maintenance: $2,500 per year
  • Life Sustaining: $5,000 per year

TRIBAL VISION PROGRAM
The Tribal Vision Program provides assistance to eligible Creek citizens who reside within the State of Oklahoma in obtaining a vision examination and eye glasses. Citizens are eligible every two years for this program and must fill out an application and follow these general guidelines:

  • Applicant must use MCN contracted optometrist or any Tribal/IHS facility optometrist
  • CONTRACT PROVIDER: Prior approval must be obtained before an appointment can be scheduled with the contract optometrist
  • TRIBAL FACILITY: Applicant must provide their prescription or order form from the optometrist and it must be written within a 6-month period
  • Payer of last resort meaning all resources must be utilized first and there is a benefit limit for exam ($55.00) and glasses ($125.00)

Funding is expended based on priority guidelines with enrolled original allottees and children 18 years of age and under receiving the highest priority. Click here for application.

CASE MANAGEMENT
Case management for the CHS program is a critical component for receiving services and assistance with processing a 72-hour call-in and reporting an emergency room visit. Our staff at CHS provides the liaison support for patients and is the first-step in obtaining help for medical expenses incurred when accidents happen or hospitalization is needed for critical care. Our case management provides the following services:

  • Initial contact for reporting of emergency room visits and inpatient hospital stays
  • Helps patients obtain required documentation to process the call-in e.g. medical records and discharge summaries
  • Coordinates patient care with other resources and ensures continued care when needed after discharge e.g. physical therapy or other rehabilitation services
  • Processes all incoming outpatient and inpatient referrals for medical review purposes
  • Follows up and screens patients for alternate resources
  • Assists with the appeals process

 The case management staff is available to answer questions or provide additional information as needed. Please feel free to contact our staff at any time!

Emergency Call-In Procedures
Emergencies must be reported within 72 hours after the beginning of treatment or admission to a health care facility. The notification is extended to 30 days for the elderly 65 years of age or older who have a limiting physical condition that prevents them from notifying CHS. Steps to follow when calling:

1. Call 918.758.2710 x 238 or toll-free 877.435.2323 x 238

2. Speak with a case manager who will take your information and ask specific questions regarding your emergency

3. If case manager is unavailable, leave your name and number. If after-hours or weekends, your call will be returned the first business day.

CASE MANAGEMENT CONTACTS

  • Laverna Hignite, RN: 918.758.2710 ext. 223
  • Stephanie Culver, LPN: 918.758.2710 ext. 222
  • Patty Starr, LPN: 918.758.2710 ext. 238
  • Gena Niedo: 918.758.2710 ext. 231

Our goal at Contract Health Services is to provide the most effective and efficient services available to ensure those who are entrusted to our care receive quality services. MVTO!

CONTRACT HEALTH SERVICES
206 S. Grand, Ste. 202, Okmulgee, OK 74447 | Phone (918) 758-2710 | Fax (918) 756-1732