Indian Health Service (IHS)

within 72 hours of the start of treatment or admission; Notice does not guarantee payment, but without it the program cannot authorize the bill, and the expense becomes a claim against the estate.^{1, 2}

within 30 days of the start of treatment or admission^{3, 2}

before the care is provided, or 72 hours where waived for good cause¹

within 30 days of receiving the written denial notice^{4, 5}

within 30 days of the decision affirming the denial^{4, 5}

No IHS benefit is paid out or stopped when a patient dies; IHS pays no cash survivor benefit.⁹

Care at an IHS or tribal facility is direct care. Care from a non-IHS provider is paid only through Purchased/Referred Care (formerly Contract Health Services), and only where the program issued a purchase order.^{10, 1}

Purchased/Referred Care is not an entitlement, and an IHS referral is a recommendation, not a guarantee of payment. Each episode of care is judged separately against residency, notification, medical priority and use of other coverage.^{10, 11}

Where the program authorized the decedent's care, the patient is not liable for any of the charges and the provider has no further recourse against the patient, so the bill is not a claim against the estate.^{12, 13}

Where the program was not notified in time or the care falls outside the Area's funded medical priority level, the expense stays with the patient, and the provider can pursue the estate.^{1, 2}

The program pays only if the decedent met its requirements at the time of the care: Indian descent, residence within the delivery area, timely notice, care within the Area's medical priority levels and use of all other available coverage.^{14, 15, 16, 17}

Each IHS facility, tribally operated 638 program and urban Indian health program holds its own records, not IHS headquarters. A patient who moved between regions may have records at several facilities.⁶

IHS has no death-notification form and no central death registry. The funeral home's report to the Social Security Administration handles the federal death record.⁹

The patient, the provider or anyone acting on the patient's behalf, including a family member, may give the Purchased/Referred Care program notice of emergency care. The clock does not stop because the patient died.^{1, 2}

IHS is the payor of last resort: Medicare, Medicaid, VA coverage and private insurance must be applied first.¹⁷

A denial must be in writing with the reasons stated. Within 30 days of receiving it, ask the Service Unit Director to reconsider, if there is supporting information not submitted before, or appeal to the Area or program director.^{4, 5}

If that decision is affirmed, a further appeal to the Director, Indian Health Service, is available within 30 days, and the Director's decision is final administrative action. Tribally operated health programs may run their own version of this process.^{4, 5}

IHS must respond to a provider's claim notification with a purchase order or denial within 5 working days, and pay a completed claim within 30 days.¹⁸

The HIPAA standard for a records request is 30 days with one 30-day extension. Tribal and urban programs operate under their own internal timelines but generally follow the same HIPAA standards.^{19, 8}

A family member who is not the personal representative may still receive information relevant to their own involvement in the patient's care or payment for care before the death. IHS processes any broader request as a Freedom of Information Act request.^{20, 8}

HIPAA protects a deceased person's health information for 50 years from the date of death, and there is no deadline to request the records. After 50 years state law and the facility's own policies may still control access.⁷

Substance use disorder, HIV/AIDS-related, mental health, sexually transmitted disease and psychotherapy-note records are released only if the matching box on Form IHS-810 is checked.²¹

IHS is the health care system for federally recognized American Indians and Alaska Natives. Direct care is open to persons of Indian descent in the community a facility serves, judged on factors such as tribal membership, enrollment, residence on tax-exempt land or ownership of restricted property.^{22, 15}

Registration is handled by the facility where care is sought, under the Indian Health Manual Part 2, Chapter 1. Purchased/Referred Care adds further requirements on top of direct-care eligibility.²²

IHS runs 12 Area Offices: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma City, Phoenix, Portland and Tucson. They cover roughly 155 IHS and tribally operated service units, mostly health centers and clinics.²³

Tribal trust assets, Individual Indian Money accounts and tribal probate⁹

Survivor benefit claims for American Indian and Alaska Native veterans, which IHS medical records can support⁹