42 C.F.R. § 136.21

Definitions

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(a) Alternate resources is defined in § 136.61 of subpart G of this part.

(b) Appropriate ordering official means, unless otherwise specified by contract with the health care facility or provider, the ordering official for the contract health service delivery area in which the individual requesting contract health services or on whose behalf the services are requested, resides.

(c) Area Director means the Director of an Indian Health Service Area designated for purposes of administration of Indian Health Service programs.

(d) Contract health service delivery area means the geographic area within which contract health services will be made available by the IHS to members of an identified Indian community who reside in the area, subject to the provisions of this subpart.

(e) Contract health services means 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.

(f) Emergency means any medical condition for which immediate medical attention is necessary to prevent the death or serious impairment of the health of an individual.

(g) Indian tribe means any Indian tribe, band, nation, group, Pueblo, or community, including any Alaska Native village or Native group, 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.

(h) Program Director means the Director of an Indian Health Service “program area” designated for the purposes of administration of Indian Health Service programs.

(i) Reservation means 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.

(j) Secretary means the Secretary of Health and Human Services to whom the authority involved has been delegated.

(k) Service means the Indian Health Service.

(l) Service Unit Director means the Director of an Indian Health Service “Service unit area” designated for purposes of administration of Indian Health Service programs.

[64 FR 58320, Oct. 28, 1999. Redesignated and amended at 67 FR 35342, May 17, 2002]

Notes of Decisions

Cited in 5 cases (3 in the last 5 years), 2017–2023 · leading case: Rancheria v. Hargan, 296 F. Supp. 3d 256 (D.C. Cir. 2017).

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Rancheria v. Hargan, 296 F. Supp. 3d 256 (D.C. Cir. 2017). “" 42 C.F.R. § 136.21 (2017). CHS pays only for services that are medically necessary and "not reasonably accessible or available" through an IHS or tribal facility.”

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2020). “” 42 C.F.R. § 136.21 . CHS services are provided “when necessary health services by an Indian Health Service facility are not reasonably accessible or available.”

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2021). “” 42 C.F.R. § 136.21 . CHS services are provided “when necessary health services by an Indian Health Service facility are not reasonably accessible or available.”

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2023). “§ 1603 (5), (12) (2018); 42 C.F.R. §§ 136.21 , 136.23. Indians may only receive CHS care “when necessary health services by an Indian Health Service facility are not reasonably accessible or available,” and they must obtain pre-approval from the healthcare facility to receive…”

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2023). “” 42 C.F.R. § 136.21 . Indeed, the IHS emphasizes that CHS is “for medical[] care provided away from an IHS or tribal health care facility[,]” Purchased/Referred Care (PRC), INDIAN HEALTH SERVS.”

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