Sponsors (8)
The bill expands and clarifies reimbursement rights and statutory protections for IHS patients and standardizes agency language to simplify claims, but it creates short‑term administrative and cash‑flow burdens and leaves coverage gaps for tribes that do not opt in.
Indigenous patients who paid out-of-pocket for IHS-authorized purchased/referred care can be reimbursed and those reimbursements must be paid within 30 days after required documentation is submitted.
Patients (especially tribal members) are protected from being forced by provider or payer forms to waive statutory protections or accept shifted costs.
Hospitals, providers, tribes, and HHS will have clearer, consistent statutory and agency language and updated manuals/contracts/training, simplifying administration and claims processing.
Tribes operating their own purchased/referred care programs under ISDEAA are not automatically covered unless they opt in, so some patients served by Tribal programs may not get reimbursements.
Retroactive reimbursement requirements and the 30-day payment deadline could create substantial short‑term administrative burdens, processing costs, and cash‑flow strain for IHS and tribal providers, potentially diverting staff/time from care delivery or requiring additional funding.
Tribal organizations, HHS, and state partners will incur short‑term staff and administrative costs to update policies, forms, and training to reflect new terminology and materials.
Based on analysis of 3 sections of legislative text.
Standardizes the term to "purchased/referred care," requires IHS reimbursements for eligible out-of-pocket payments with set timelines, and directs HHS to update manuals and contracts.
Replaces the phrase "contract health care" across the Indian Health Care Improvement Act with "purchased/referred care," requires the Indian Health Service (IHS) to create and implement a process to reimburse patients who paid out-of-pocket for IHS-authorized purchased/referred care, and directs the Department of Health and Human Services to update manuals, contracts, and materials. The bill sets specific deadlines: IHS must establish reimbursement procedures within 120 days after consulting tribes, reimburse eligible patients within 30 days of receiving required documentation (submitted electronically or in-person at an IHS facility), and update the Indian Health Manual and related documents within 180 days. The changes apply retroactively and prospectively to purchased/referred care furnished on, before, or after enactment, and do not force tribal-operated purchased/referred care programs under ISDEAA compacts/contracts to follow the reimbursement rules unless the tribe agrees.
Introduced February 18, 2025 by Dustin Johnson · Last progress February 18, 2025