Name Application for Tribal Health Paid Care
Description

TRIBAL HEALTH PAID CARE (THPC)

Formerly known as Contract Health Services and/or Purchased and Referred Care (PRC) On December 1, 2016, the Confederated Salish and Kootenai Tribes assumed management of the Indian Health Service Purchased and Referred Care (PRC), also known as Contract Health Services. The Tribes

administer the program through Tribal Health, renaming the program Tribal Health Paid Care (THPC). THPC has been assigned the following tasks— The first is to determine a Tribal Health recipient's eligibility for THPC and to ensure that all the recipient’s health care coverage options have been exhausted. Second, THPC staff receive referrals from providers for health care services and review for possible payment. Finally, staff works with eligible recipients to navigate the care they may need to the fullest extent possible.

Tribal Health uses the THPC funds in conjunction with other health care coverage or insurance, such as Medicaid; Medicare; Veterans Health Administration; Affordable Care Act; Healthy Montana Kids; employer insurance; private insurance; and self-pay. THPC by law, is a payer of last resort (under regulations of the Public Law 93-638 Indian Self-Determination and Education Assistance Act), meaning that the program can only pay when all options for other health care coverage or insurance have been exhausted.

Each Tribal Health recipient requesting THPC will be asked to complete the necessary application to determine eligibility for payment. Tribal Health’s goal is to “Get to Yes” for recipients seeking health care services. Through recipient cooperation and utilization of all available resources, Tribal Health works to get recipients the care they need.

Tribal Health Paid Care (THPC) Facts

Formerly known as Contract Health Services Purchased and Referred Care (PRC)

  • Enrolled members of the Confederated Salish and Kootenai Tribes (CSKT) living on the Flathead Indian Reservation or in the service areas of Lake, Missoula, Sanders and Flathead counties.
  • Enrolled members of a federally recognized tribe living within the Flathead Indian Reservation.
  • Any generation of federally recognized tribal descendants living on the Flathead Indian Reservation.
  • Full-time students, who have previously met THPC eligibility requirements, carrying a minimum of 12 credits in college (undergraduate and graduate), vocational, technical or other academic institution during their attendance and established school breaks. Eligible for 180 days after completing course of study.
  • THPC eligibility extends for 180 days after an eligible recipient moves from the service area.

Eligibility Requirements

In addition to a completed application, recipients will be asked to provide proof of residency. Acceptable forms for proof of residency must show a current physical address as follows:

  • Current bill, lease, or other legal document with physical address
  • Drivers license (active)
  • State ID

The following examples are some of the potential services funded by THPC, including but not limited to:

  • Primary health care
  • Hospitalization
  • Surgery
  • Maternity care
  • Emergency room
  • Dialysis
  • Health care services referred by an identified Primary Care Provider (PCP) and meeting a medical priority
  • Cost of eligible recipient copays for Medicare part B

Recipient Obligations

By federal law, THPC is a payer of last resort. This obligates Tribal Health and eligible recipients to use any and all alternative health care coverage before THPC is available to cover costs.

  • All referrals specialists or procedures must be requested through your Primary Care Provider and be preapproved by THPC prior to scheduling appointments and/or procedures. THPC will not be responsible for payment of services without proper prior authorization.
  • Emergency room and urgent care medical and dental visits must be reported to THPC within 72 hours.
  • Emergency room and urgent care medical and dental visits must demonstrate an emergent situation, and will be reviewed by THPC to determine eligibility for payment.
  • Changes to Primary Care Providers must be reported prior to the initial visit with a new provider, as well as updating contact information, mailing address and physical address.

FOR MORE INFORMATION CONTACT TRIBAL HEALTH PAID CARE (THPC):

Susan Johnson, THPC Business Office - (406) 745-3525 ext. 5029 susan.johnson@cskthealth.org 

Clarice Cooper, THPC Medical Review - (406) 745-3525 ext. 5013 clarice.cooper@cskthealth.org 

License
File name THPC Application 4.28.17.pdf
Version
Size 419.43 KB
File type pdf (Mime type application/pdf)
Owner CSKT
Date added 06/07/2017 07:28 AM
Hits 336
Last modified on 06/07/2017 07:33 AM
MD5 checksum e7fbfef24db8d576d35e6d585e2fc9a3
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