C.F.R. » Title 42 » CHAPTER I—PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER M—INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES › PART 136—INDIAN HEALTH › Subpart C—Contract Health Services

42 C.F.R. § 136.23

Persons to whom contract health services will be provided

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(a) In general. To the extent that resources permit, and subject to the provisions of this subpart, contract health services will be made available as medically indicated, when necessary health services by an Indian Health Service facility are not reasonably accessible or available, to persons described in and in accordance with § 136.12 of this part if those persons:

(1) Reside within the United States and on a reservation located within a contract health service delivery area; or

(2) Do not reside on a reservation but reside within a contract health service delivery area and:

(i) Are members of the tribe or tribes located on that reservation or of the tribe or tribes for which the reservation was established; or

(ii) Maintain close economic and social ties with that tribe or tribes.

(b) Students and transients. Subject to the provisions of this subpart, contract health services will be made available to students and transients who would be eligible for contract health services at the place of their permanent residence within a contract health service delivery area, but are temporarily absent from their residence as follows:

(1) Student—during their full-time attendance at programs of vocational, technical, or academic education, including normal school breaks (such as vacations, semester or other scheduled breaks occurring during their attendance) and for a period not to exceed 180 days after the completion of the course of study.

(2) Transients (persons who are in travel or are temporarily employed, such as seasonal or migratory workers) during their absence.

(c) Other persons outside the contract health service delivery area. Persons who leave the contract health service delivery area in which they are eligible for contract health service and are neither students nor transients will be eligible for contract health service for a period not to exceed 180 days from such departure.

(d) Foster children. Indian children who are placed in foster care outside a contract health service delivery area by order of a court of competent jurisdiction and who were eligible for contract health services at the time of the court order shall continue to be eligible for contract health services while in foster care.

(e) Priorities for contract health services. When funds are insufficient to provide the volume of contract health services indicated as needed by the population residing in a contract health service delivery area, priorities for service shall be determined on the basis of relative medical need.

(f) Alternate resources. The term “alternate resources” is defined in § 136.61(c) of subpart G of this part.

[64 FR 58319, Oct. 28, 1999. Redesignated and amended at 67 FR 35342, May 17, 2002]
Notes of Decisions
Cited in 6 cases (5 in the last 5 years), 2020–2024 · leading case: Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan
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Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2023) mied · cites it 2× “42 C.F.R. § 136.23 . The IHS separately funds programs for Contract Health Services3 (CHS), administered by SCIT.”
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2023) mied · cites it 2× “The IHS funds and operates healthcare facilities for tribes, 42 C.F.R. § 136.23 , and separately funds Contract Health Service (CHS)2 Programs.”
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2020) mied “In accordance with 42 C.F.R. 136.23(e), the Tribe prioritized care based on relative medical need to cover all authorized services.”
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2021) mied “” 42 C.F.R. § 136.23 (a). In 2014 the Contract Health Services Program was renamed the Purchased/Referred Care Program, but “[a]ll policies and practices remain[ed] the same.”
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2023) mied “42 C.F.R. § 136.23 (a). The regulations provide that: In nonemergency cases, a sick or disabled Indian, an individual or agency acting on behalf of the Indian, or the medical care provider shall, prior to the provision of medical care and services notify the appropriate ordering…”
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2024) mied “42 C.F.R. §§ 136.23 , 136.24(b); Can CHS Pay for Your Referral Medical Care? Find Out in 3 Stages.”
— 42 C.F.R. § 136.23(e) — 1 case
Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (2020) mied “In accordance with 42 C.F.R. 136.23(e), the Tribe prioritized care based on relative medical need to cover all authorized services.”
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