Sokaogon Chippewa Community News
Funding Available for Referred Health Care Services
Posted on: August 9, 2018
Purchased Referred Care (PRC) is a financial resource to assist in payment for health care services that cannot be directly provided at the Sokaogon Chippewa Health Clinic, (SCHC).
Congress funds PRC programs annually to assist eligible AI/AN Americans with medical, dental and some hospital services not provided by SCHC. The SCC Health Board approves the PRC policies and determines the levels of care to be covered.
PRC is not an entitlement program. Eligible expenses are covered as funds are available.
PRC is considered a payer of last resort. Patients are required to apply for, and use all alternate resources, such as private insurance, Medicare, Medical Assistance, Disability and Veterans benefits. The IHS facility at the Sokaogon Chippewa Health Clinic is also considered a resource and, therefore, the PRC funds may not be expended for services reasonably accessible and available at any IHS facilities.
Federal regulations require that Purchased Referred Care Service funds are to be used only after all other alternative resources have made payment. If patients qualify for an alternate resource, they must utilize their alternate resources to receive Purchased Referred Care Services.
Eligibility requirements for PRC are in addition to meeting the requirements for direct care services at an IHS or Tribal facility. There are eligibility requirements which must be met by each person needing and applying for PRC assistance.
- All patients seeking Purchased Referred Care funds must complete a Purchased Referred Care Application.
- They must be a Sokaogon Tribal Member or Descendant residing within Forest County with proof of Tribal decent, and one form of proof of residency.
- A member of another federally recognized Tribe residing in Forest County and on Sokaogon Chippewa reservation land, with a social or economic tie to the Sokaogon Chippewa Tribe.
- A non-Indian woman, pregnant with an eligible Indian’s child for the duration of her pregnancy through postpartum (usually six weeks).
- Applications to the state Medicaid program must be completed with either proof of acceptance or denial submitted at the time of enrollment.
- A child of an eligible IHS beneficiary, including adopted, step-child, foster child, orphan or legal ward, until age 19.
If approved for PRC funding, each non-emergency medical or dental visit, procedure or surgery must receive prior authorization from the SCHC PRC program before service is rendered. Emergency services are to be reported to the PRC Administration office within 72 hours following the occurrence.
Denials and Appeals:
In the event of a denial from PRC, a letter will be sent to the provider of service and to the patient stating the reason for the denial and the procedure for filing an appeal. If the patient decides to appeal, the patient may send their written appeal letter and supporting documentation, within 10 days, to:
Sandy Campbell, Health Director
Sokaogon Chippewa Health Clinic
3144 VanZile Road
Crandon, WI 54520
A copy of each notice of denial for services shall be retained at the SCHC facility in the PRC client file, and a copy shall be forwarded in the appeals process to the PRC Review Committee.