Elbowoods Memorial Health Center - Patient Referred Care
Patient Referred Care
Formerly known as Contract Health, Patient Referred Care is a federally funded program created to assist in payment for healthcare services received by Tribal members that are unavailable at Elbowoods Memorial Health Center.
How does Patient Referred Care Operate?
The funding received each year is not based on each enrolled tribal member of that reservation but on the number of patients who have received care at the Elbowoods Memorial Health Center within the last three years. The United States Congress determines this federal appropriation. Appropriations are determined by Congress and allocated by the Indian Health Service to Direct Service Tribes and Public Law 93.638 Programs such as Elbowoods Memorial Health Center.
How do you, as a patient, access these funds?
You will need to schedule an appointment with an Elbowoods Memorial Health provider or any of the field clinic providers. They will then refer your medical care to an outside non-IHS facility. This referral is then reviewed by the PRC committee, which consists of:
- Medical Provider - Reviews medical notes and the referral to determine the medical priority.
- Eligibility Specialist - To determine whether or not the patient may be eligible for an alternate resource or to verify if the patient has active insurance coverage.
- CEO - To decide to approve or deny the use of PRC funds.
- PRC Staff - To process the referral once approved or denied.
In an emergency, the individual, provider, hospital, or someone on behalf of the individual must submit a 72-hour notification toent. For the elderly or disabled, it is 30 days. Who is eligible for the PRC department, EMHC, for PRC coverage and field clinics?
- Enrolled members of the MHA Nation that reside on the Fort Berthold Reservation or in a county bordering the Fort Berthold Reservation.
- Enrolled members of a federally recognized tribe residing on the Fort Berthold Reservation.
- Students who meet the eligibility guidelines at their permanent residence before leaving for school. Students must submit a PRC service application with a copy of full-time student status each semester.
- Non-Indian women pregnant with an eligible Native American child.
ALL PATIENTS SEEKING PATIENT REFERRED CARE FUNDS MUST:
- Provide proof of tribal affiliation and/or descendency. Acceptable forms of tribal affiliation include:
- Tribal identification cards
- Certification of Indian Blood
- Descendency letters from the respective Tribal Enrollment Office or Birth Certificates and enrollment verification of enrolled members from which the descendent is affiliated.
- Apply for alternate resources for care or provide proof through pay stubs that are not eligible for alternate resources such as Medicaid or Medicare due to not meeting income requirements. Examples of alternate resources include:
- Medicare
- Medicaid
- Disability
- Express enrollment for pregnant women and children
- Failure to apply for alternate resources may result in a denial of PRC coverage, and you will be financially responsible for the entire bill.
- Proof of residency that you live within the Elbowoods PRC coverage area is required and can be in the form of a driver's license, rental agreement, or utilities.
Please ensure that all your information is current within our system. Your mailing address, phone number, and insurance, are all pertinent data to receiving your referral and getting it processed on time.