Purchased / Referred Care (PRC)

PRC (formerly known as Contract Health Services) is the payment system provided by the Indian Health Service (IHS) helps to cover the costs for American Indians/Alaska Native and helps provide them with access to specialty services not offered under the roof of the Fallon Tribal Health Center. Patients must meet the eligibility guidelines and must have prior authorization (except in emergencies).

There are restrictions on coverage of services including a review process to determine eligibility and a review committee to ensure services requested meet the requirements of the program. There are established Priority Levels of Care that the FTHC and IHS follow to determine the medical appropriateness of a referral and whether there is funding to cover a referral. The PRC program is funded each year by the United States through appropriations to the IHS so funding is contingent on what is allocated to the FTHC.

Should you have an emergency situation requiring you to obtain care outside of the FTHC please notify the PRC program within 72 hours to ensure costs are PRC eligible. 

The FTHC currently collects and processes referral for review and approval by the U.S. Indian Health Service. The FTHC does not handle approvals, the selection of medical providers, or bills. We can collect any unpaid bills and forward them to the IHS for their processing.

What’s the Difference Between Direct Care and PRC?

Any medical, dental, optical, or behavioral health services provided at the FTHC is called “Direct Care”.  All persons of Native American descent (who provide proof of enrollment or descendency), are able to received “Direct Care” at the FTHC.  

The PRC program is for care provided away from the FTHC.  Any services with providers, hospital services, outside labs, radiology services, etc. received outside of the FTHC may be eligible for the PRC program.  PRC is not an entitlement program and an IHS referral does not imply the care will be paid.  

Am I Eligible for PRC Services?

You may be eligible for PRC services through the FTHC if you have registered with the FTHC or updated that registration within the past twelve months, and:

  • You are an enrolled member of a federally-recognized Indian Tribe or a minor dependent under the age of 19 who is living in a household of an enrolled member; and
  • Reside within the FTHC’s Purchased/Referred Care Delivery Area (PRCDA); or
  • You may be away from the PRCDA and still be eligible for PRC if you are a full-time student, foster child, or transient (migratory/seasonal worker), or you have left the PRCDA less than 180 days before the date of service; and
  • Any other eligibility provisions as detailed in applicable IHS or FTHC regulations and policies.

You MUST apply for all Alternative Resources!

Alternative resources are other resources of health care or health care payment available and accessible to you. PRC is the payor only of last resort. You are required by federal regulation (42 CFR, Chapter 1, Subpart 36.23F) to apply for an alternative resource if there is reason for us or you to believe that you may be eligible. If you are eligible for an alternative resource and you refuse to apply for or use that alternative resource, you will not be allowed to use PRC.