Beginning July 21st, 2025, all patients will be required to come to the clinic to sign their PRC referral and hand carry a copy of the referral to their appointment.

Requiring patients to come in and sign the referral will help to ensure patients met eligibility requirements, prior to going to a PRC referred appointment. PRC eligibility requires patients to show proof of residency and alternate resource screening. Proof of residency needs to be completed every 3 years, and alternate resource screening is required annually. These requirements are set forth by IHS for referrals paid by federal dollars. By requiring the in-person signature PRC can better ensure that patients are completing these requirements and reduce the number of denials.

Screening for alternate resources is an important step that is required by IHS. More importantly, alternate resources such as Medicaid help the Tribe to preserve limited PRC funds. Each year, the clinic spends all the IHS provided PRC funds. Usually, these funds are fully spent by April or May. The clinic then uses Tribal funds to continue offering the PRC program. Using Tribe funds to continue the PRC is not required by IHS and is not an action that most Tribes do. The Stockbridge-Munsee Community uses Tribal funds to continue the PRC program through the remainder of the year so enrolled members and first line descendants will continue receiving specialized healthcare at no cost.

Another important reason we will begin requiring patients to take a hard copy referral to their PRC covered appointments is to help prevent patients being sent to collections. The clinic has seen an increase in the number of vendors who are not following PRC requirements mandated by federal law. For example, a vendor who takes Medicare, is required to accept Medicare-like rates as payment in full for a PRC covered visit. Unfortunately, some of our vendors have refused to accept the Medicare like rate as payment in full. Another problem that we have seen is vendors sending patients with a PRC referral to collections. According to IHS and HHS, a vendor is not allowed to send a patient to collections if they are referred by a Tribally operated health care facility through a PRC referral. The clinic will include a letter explaining both federal protections with each referral. We believe this action will help reduce the chance that a patient may be sent to collections.

The clinic will continue to offer no sign referrals as defined in the PRC Referral Signature Exempt policy. Patients with one of the following can request to be exempt from the referral signature requirement:

a. Long Term Chronic illness or terminal illness
b. Unable to travel due to illness or personal mobility issues
c. Mentally or physically unable to travel
d. Residing in nursing home or assisted living facility
e. For purposes of continuation of services for a specific time period i.e. chemotherapy, cardiac rehabilitation, dialysis etc.

Patients who are offered a no sign referral will be informed by PRC that they do not need to come in for a hard copy referral for each visit. These patients will still need to inform referral staff when their scheduled appointments are. Residents of the Ella Besaw Center are exempt from being required to pickup a hard copy referral.