# Patient Eligibility, Rights & Grievances 

Contents

[2.1 Patient Eligibility Criteria 2-2](#patient-eligibility-criteria)

[2.2 Other Eligible Categories of Patients
2-2](#other-eligible-categories-of-patients)

[2.2.1 Commissioned Corp and Dependent Eligibility Criteria
2-2](#commissioned-corp-and-dependent-eligibility-criteria)

[2.2.2 Non-Indian Federal Employees (PHS Field Employees)
2-3](#non-indian-federal-employees-phs-field-employees)

[2.2.3 Other Eligibility Considerations
2-5](#other-eligibility-considerations)

[2.3 Determination of the Degree of Indian or Alaska Native Blood
2-7](#determination-of-the-degree-of-indian-or-alaska-native-blood)

[2.3.1 Computation of the Degree of Indian Blood
2-7](#computation-of-the-degree-of-indian-blood)

[2.3.2 Obtaining a Certificate of Degree of Indian\
or Alaska Native Blood
2-8](#obtaining-a-certificate-of-degree-of-indian-or-alaska-native-blood)

[2.4 Patient Rights and Grievances 2-9](#patient-rights-and-grievances)

[2.4.1 IHS Policy 2-9](#ihs-policy)

[2.4.2 Example of Patients' Rights Statement
2-10](#example-of-patients-rights-statement)

## Patient Eligibility Criteria

A person may be regarded as eligible for services of the IHS Program if
he/she is not otherwise excluded by provision of law, and meets the
criteria set forth below:

-   Is of American Indian and/or Alaska Native descent as evidenced by
    one or more of the following factors:

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-   Is regarded by the community in which he lives as an American Indian
    and/or Alaska Native;

-   Is a member, enrolled or otherwise, of an American Indian or Alaska
    Native Tribe or Group under Federal supervision;

-   Beneficiary resides on tax-exempt land or owns restricted property;

-   Actively participates in tribal affairs;

-   Any other reasonable factor indicative of Indian descent;

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-   Is a non-Indian member of an eligible Indian's household and the
    medical officer in charge determines that services are necessary to
    control a public health hazard or an acute infectious disease which
    constitutes a public health hazard (e.g., TB, HIV, Hepatitis).

Eligibility regulations are defined in the Code of Federal Regulations
(CFR 42, 36 & 36A).

## Other Eligible Categories of Patients 

### Commissioned Corp and Dependent Eligibility Criteria

The following identified Commissioned Corp groups may be provided direct
care that is within the scope of services provided by that facility.

-   Active commissioned officers

-   Active commissioned officer dependents

-   Retired commissioned officers

-   Retired commissioned officer dependents

Any referrals to providers outside of the IHS must follow the referral
policies of TRICARE, which provides coverage for Commission Officers and
their dependents The IHS will bill TRICARE for payment of services
rendered to Commissioned Officers and their dependents.

### Non-Indian Federal Employees (PHS Field Employees)

Non-Indian Federal employees are eligible for emergency treatment for
on-the-job injuries.

At remote facilities Non-Indian Federal employees are eligible for
medical services as defined in Public law 90-174 amended Section 324 of
the Public Health Service Act, as follows:

"The Secretary is authorized to provide medical, surgical, and dental
treatment and hospitalization and optometric care for Federal employees
(as defined in section 8901(1) of title.5 of the United States 80 Stat.
600. Code) and their dependents at remote medical facilities of the
Public Health Service where such care and treatment are not otherwise
available. . . ."

The following facilities are designated as remote facilities.

+---------------------------------------+------------------------------+
| Remote Hospitals                      |                              |
+=======================================+==============================+
| PHS Alaska Native Hospital            | Barrow, Alaska               |
|                                       |                              |
|                                       | Kanakanak, Alaska            |
|                                       |                              |
|                                       | Bethel, Alaska               |
|                                       |                              |
|                                       | Kotzebue, Alaska             |
|                                       |                              |
|                                       | Tanana, Alaska               |
+---------------------------------------+------------------------------+
| Arizona, PHS Indian Hospital          | Fort Defiance                |
|                                       |                              |
|                                       | Keams Canyon                 |
|                                       |                              |
|                                       | Parker                       |
|                                       |                              |
|                                       | Sells                        |
|                                       |                              |
|                                       | Tuba City                    |
|                                       |                              |
|                                       | Whiteriver                   |
+---------------------------------------+------------------------------+
| New Mexico hospitals                  | Crownpoint                   |
|                                       |                              |
|                                       | Shiprock                     |
|                                       |                              |
|                                       | Zuni                         |
+---------------------------------------+------------------------------+
| Oklahoma hospitals                    | Talihina                     |
+---------------------------------------+------------------------------+
| Minnesota hospitals                   | Redlake                      |
+---------------------------------------+------------------------------+
| Montana hospitals                     | Browning                     |
|                                       |                              |
|                                       | Harlem                       |
+---------------------------------------+------------------------------+

+---------------------------------------+------------------------------+
| Other Remote Medical Facilities       |                              |
+=======================================+==============================+
| PHS Alaska Native Health Center       | Fort Yukon                   |
|                                       |                              |
|                                       | Nome                         |
+---------------------------------------+------------------------------+
| Arizona, PHS Indian Health Center     | Kayenta                      |
|                                       |                              |
|                                       | Peach Springs                |
+---------------------------------------+------------------------------+
| Nevada                                | Owyhee                       |
+---------------------------------------+------------------------------+
| New Mexico                            | Dulce                        |
+---------------------------------------+------------------------------+
| Montana                               | Lame Deer                    |
|                                       |                              |
|                                       | Rocky Boy's                  |
+---------------------------------------+------------------------------+
| North Dakota                          | Fort Yates                   |
+---------------------------------------+------------------------------+
| South Dakota                          | Eagle Butte                  |
|                                       |                              |
|                                       | Rosebud                      |
+---------------------------------------+------------------------------+
| Washington                            | Neah Bay                     |
|                                       |                              |
|                                       | Taholah                      |
+---------------------------------------+------------------------------+
| Wyoming                               | Fort Washakie                |
+---------------------------------------+------------------------------+

At a remote medical facility the Service is authorized to provide
medical, surgical, and dental treatment and hospitalization and
optometric care for Federal employees and their dependents that reside
or work within a 30-mile radius of the remote facility.

The remote facility may also provide such services to Federal employees
and their dependents, who reside or work outside of the 30-mile radius
of the remote facility, AND

-   who would otherwise be required to travel a greater distance from
    their residence or place of employment to the remote facility, *or*

-   for whom transportation for private care is greater than the
    distance from their residence or place of employment to the remote
    facility, *or*

-   for whom transportation for private care from their place of
    residence or employment is unavailable, hazardous, protracted, or
    unreasonably expensive, due to unfavorable factors such as unpaved
    or mountainous winding road or toll bridges and roads or adverse
    weather conditions.

The applicant will establish his status as a Federal employee to the
satisfaction of the Service Unit Director.

The Service Unit Director is authorized to establish limitations and
priorities for furnishing medical care to Federal employees and their
dependents, as dictated by the primary mission of circumstances related
to the provision of medical care

The Service unit Director of a remote station or his designee may deny
treatment of care to Federal employees and their dependents

-   who cannot establish their status to the satisfaction of the Service
    Unit Director, OR

-   who cannot establish that they must otherwise travel at least thirty
    miles for private health services, *or*

-   for whom transportation for private care is unavailable, hazardous,
    protracted, or unreasonably expensive due to unfavorable factors
    such as unusual climatic conditions, un-surfaced or mountainous
    winding roads, or toll bridges and roads.

A written notice of such denial will be given and a copy of each notice
of denial will be retained at the remote facility.

### Other Eligibility Considerations

An Indian is not required to be a citizen of the U.S. to be eligible for
contract health services (CHS). The Indian (Canadian or Mexican) must

-   Reside in the U.S. AND

-   Be a member of a tribe whose traditional land is divided by the
    Canadian border (e.g., St. Regis Mohawk, Blackfeet) or Mexican
    border (e.g., Tohono O\'Odham).

Section 709(b) of the Indian Health Care Improvement Act, until such
time as any subsequent law may otherwise provide, states that the
following California Indians shall be eligible for health services
provided by the Service:

\(1\) any member of a federally recognized Indian tribe;

For a list of eligible tribes, see the *Federal Register*, *Part II
Department of the Interior, Bureau of Indian Affairs*, Volume 70/No.
226/November 25, 2005/Notices: "Indian Entities Recognized and Eligible
to Receive Services from the United States Bureau of Indian Affairs." To
view this notice in text or PDF format, go to this website,

<http://www.access.gpo.gov/su_docs/fedreg/a051125c.html>

and scroll to Indian Affairs Bureau.

\(2\) any descendant of an Indian who was residing in California on June
1, 1852, but only if such descendant is

\(A\) living in California,

\(B\) a member of the Indian community served by a local program of the
Service, and

\(C\) regarded as an Indian by the community in which the descendant
lives;

\(3\) any Indian who holds trust interests in public domain, national
forest, or Indian reservation allotments in California; and

\(4\) any Indian in California who is listed on the plans for
distribution of assets of California Rancherias and reservations under
the Act of August 18, 1958 (72 STAT. 619), and any descendant of such an
Indian. Section 709 (c) \[which\] states that nothing in this Section
may be construed as expanding the eligibility of California Indians for
health services provided by the Service beyond the scope of eligibility
for such health services that applied on May 1, 1986.

Indians adopted by non-Indian parents must meet all CHS requirements to
be eligible for care, that is, reside in a Contract Health Services
Delivery Area (CHSDA).

**Foster/Custodial Children** -- Indian children who are placed in
foster care outside a CHSDA by order of a court of competent
jurisdiction and who were eligible for CHS at the time of the court
order shall continue to be eligible for CHS while in foster care.

Section 813 of the Indian Health Care Improvement Act, P.L. 94-437, as
amended, states in part:

\(a\) (l) Any individual who

\(A\) has not attained 19 years of age,

\(B\) is the natural or adopted child, step-child, foster-child, legal
ward, or orphan of an eligible Indian, and

\(C\) is not otherwise eligible for the health services provided by the
Service, shall be provided by the Service on the same basis and subject
to the same rules that "apply to eligible Indians until such individual
attains 19 years of age.

\(2\) Any spouse of an eligible Indian who is not an Indian, or who is
of Indian descent but not otherwise eligible for the health services
provided by the Service, shall be eligible for such health services if
all of such spouses are made eligible, as a class, by an appropriate
resolution of the governing body of the Indian tribe of the eligible
Indian.\"

A non-Indian woman pregnant with an eligible Indian\'s child who resides
within a CHSDA is eligible for CHS during pregnancy through post partum
(usually 6 weeks). If unmarried, such a woman is eligible for CHS if the
eligible Indian male states in writing that he is the father of the
unborn child, or such is determined by order of a court of competent
jurisdiction. This will ensure health services to the unborn.

A non-Indian member of an eligible Indian\'s household who resides
within a CHSDA is eligible for CHS if the medical officer in charge
determines that services are necessary to control a public health hazard
or an acute infectious disease, which constitutes a public health
hazard.

1.  Indian people, who are eligible for tribal membership but who do not
    wish to exercise their membership eligibility for whatever personal
    reasons they may have, are free to make this choice. However, it is
    the responsibility of these individuals to provide the necessary
    eligibility information to receive ongoing services at IHS. The IHS
    can assist with this process by providing information on the
    requirements to document tribal enrollment or descendancy.

## Determination of the Degree of Indian or Alaska Native Blood

A Certificate of Degree of Indian or Alaska Native Blood (CDIB), or
proof of eligibility document, certifies that an individual possesses a
specific degree of Indian blood of a federally recognized Indian
tribe(s). A Tribe or Bureau of Indian Affairs official issues the CDIB.
The Certificate is issued to establish the individual's eligibility for
those programs and services based on their status as American Indians
and Alaska Natives.

### Computation of the Degree of Indian Blood

The degree of Indian blood is computed from lineal ancestors of Indian
blood, who were enrolled with a federally recognized Indian tribe or
whose names appear on the designated base rolls of a federally
recognized Indian Tribe.

To calculate your total Indian blood degree, add together your blood
degree obtained from your birth mother and your blood degree obtained
from your proven birth father.

**Examples:**

-   One-half of the Indian blood is obtained from each of your birth
    parents

-   One-half of the Indian blood is from your birth mother.

If your grandmother was full blood, your mother obtained one-half Indian
blood from your grandmother; and if your mother obtained no Indian blood
through her father, you obtain only one-fourth Indian blood from your
mother.

-   One-half of the Indian blood is obtained from your birth father.

If you were born out of wedlock, then you obtain one-half of the Indian
blood from your birth father only if his identity is proven.

2.  An adoptive parent is not a lineal ancestor and blood degree cannot
    be derived from an adoptive parent.

To determine a child's degree of Indian blood, see Part 2, Appendix B,
Blood Quantum Formula (Excel spreadsheet), in which you enter the blood
quantum of the parents and it calculates the child's degree of Indian
blood.

### Obtaining a Certificate of Degree of Indian or Alaska Native Blood

Requirements include the following:

-   The relationship to an enrolled member(s) of a federally recognized
    Indian tribe must be demonstrated.

-   The maiden names of all women listed on the Request for CDIB must be
    documented.

-   A certified copy of a Birth Certificate is required.

-   If a parent is not enrolled with a federally recognized Indian
    tribe, a certified copy of that parent's Birth or Death Certificate
    is required.

-   In the case of adoption, the degree of Indian blood of the natural
    (birth) parent must be proven.

Contact your local Tribal agency to obtain a Certificate of Degree of
Indian Blood (CDIB) and specific requirements.

## Patient Rights and Grievances

### IHS Policy

Each Indian health Service Area will develop and promulgate a written
statement of patient rights. Such statements of patient rights should be
developed in cooperation with the Area Indian Health Boards and must
have their concurrence.

At the minimum, these statements must include an affirmation of the
patient's rights to:

-   Services, within their availability or capability of being provided

-   Considerate and respectful treatment

-   Privacy and confidentiality of medical information

-   Information on his or her condition, including the right to give or
    withhold consent for treatment, referral, or transfer

-   Continuity of care and information regarding what health services
    are available, and where and how they may be obtained

-   Knowledge of hospital rules and regulations applying to patient
    conduct

-   Access to an established patient grievance procedure

-   Selection of an interpreter when requested and available

Each Area will have in place a mechanism to insure that patient
grievances are given full and fair consideration to the highest level of
appeal. The Area's grievance procedure will include a provision that a
designated grievance committee exist at each Service Unit. This
committee may be the local Indian Health Board, or it may be another
group or committee that includes Indian representatives and has been
approved for this purpose by the local tribal government and Service
Unit Administration.

Ultimate appeal at the local level will be to the Service Unit Director,
who must initiate an investigation and provide a written reply, both
within specified periods of time. Unresolved complaints may then be
appealed to Area Health Board and/or the Area Director. Final decisions
will be made by the Area Director.

The Area will insure that each Service Unit has a positive mechanism for
disseminating information on patient rights and the grievance process.
At the minimum, written explanations of the grievance process and
patient rights must be

-   Posted prominently in the waiting areas of all IHS facilities.

-   Periodically distributed to the community.

-   Included in the orientation process for all new IHS staff.

### Example of Patients' Rights Statement

Each patient has a right to

-   **Access to Care**

Individuals shall be accorded impartial access to treatment or
accommodations that are available or medically indicated regardless of
race, creed, sex, national origin, or sources for payment of care.

-   **Respect and Dignity**

The patient has the right to considerate, respectful care at all times
and under all circumstances, with recognition of his or her personal
dignity.

-   **Privacy and Confidentiality**

The patient has the right, within the law, to personal and informational
privacy, as follows:

-   To refuse to talk with or see anyone not officially connected with
    the hospital/clinic, including visitor or persons officially
    connected with the hospital/clinic but not directly involved in his
    or her care

-   To wear appropriate personal clothing and symbolic items, as long as
    they do not interfere with diagnostic procedures or treatment

-   To be interviewed and examined in surroundings designed to ensure
    reasonable visual and auditory physical examination, treatment, or
    procedure performed by a health professional of the opposite sex,
    and the right not to remain disrobed any longer than is required for
    accomplishing the medical purpose for which the patient was asked to
    disrobe.

-   To expect that any discussion or consultation involving his or her
    case will be conducted discreetly and that individuals not directly
    involved in his or her care will not be present without the
    patient's permission.

-   To have his or her medical record read only by individuals directly
    involved in his or her treatment, or in the monitoring of its
    quality. Other individuals can only read the patient's medical
    record on his or her written authorization or that of his or her
    legally authorized representative.

-   To expect all communications and other records pertaining to his or
    her care, including the source of payment for any treatment, to be
    treated as confidential.

-   To request a transfer to another room if another patient or a
    visitor in the room is unreasonably disturbing the patient by any
    actions.

-   To be placed in protective privacy when considered necessary for
    personal safety.

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-   **Personal Safety**

The patient has the right to expect reasonable safety insofar as the
hospital practices and environment are concerned.

-   **Identity**

The patient has the right to know the identity and professional status
of individuals providing service to him or her and to know which
provider or other practitioner is primarily responsible for his or her
care. This includes the patient's right to know the existence of any
professional relationship among individuals who are treating him or her,
as well as the relationship to any other health care or educational
institutions involved in the patient's care. Participation by patients
in clinical training programs or in the gathering of data for research
purposes should be voluntary.

-   **Information**

The patient has the right to obtain from the practitioner responsible
for coordinating his or her care, complete and current information
concerning the patient's diagnosis (to the degree known), treatment, and
any know prognosis. This information should be communicated in terms
that the patient can reasonably be expected to understand. When it is
not medically advisable to give such information to the patient, the
information should be made available to a legally authorized individual.

-   **Communication**

The patient has the right of access to people outside the hospital by
means of visitors and by oral and written communication. When the
patient does not speak or understand the language of the community, he
or she should have access to an interpreter