The Passamaquoddy Tribe's Pleasant Point Health Center Needs To Improve Its Medical-Referral Process

The Passamaquoddy Tribe at Pleasant Point did not always meet Federal requirements for medical referrals. Specifically, we found that the Pleasant Point Health Center (PPHC) did not utilize a Managed Care Committee (MCC), composed of the required medical and administrative staff, to review medical referrals on a weekly basis. In addition, PPHC did not always maintain accurate and complete documentation of medical referrals.

PPHC did not follow the Indian Health Service's policies and procedures to utilize an MCC to review medical referrals on a weekly basis and maintain accurate and complete documentation of medical referrals because the Passamaquoddy Tribe at Pleasant Point's health director did not provide adequate supervision of the administrative staff and the referral process, and PPHC did not implement safeguards to prevent the loss of referral data. As a result, there was an increased risk that patients did not receive critical health services for time-sensitive medical conditions, and clinical providers did not always have accurate or complete medical documentation to assess and prioritize patients' clinical treatment progress.

We recommend that the Passamaquoddy Tribe at Pleasant Point (1) reestablish an MCC, comprised of the required medical and administrative staff, to review medical referrals on a weekly basis in accordance with Federal requirements and (2) implement policies and procedures to maintain complete and accurate documentation of medical referrals.

In written comments on our draft report, the Passamaquoddy Tribe at Pleasant Point concurred with our recommendations and described the actions that it has taken or planned to take to address them.