Sponsors (8)
The bill expands and clarifies reimbursement rights and administrative consistency for IHS purchased/referred care—improving access and reducing confusion for many tribal patients—while leaving exemptions for some tribal compacts and creating short-term administrative, financial, and legal risks for IHS, tribes, providers, and taxpayers.
Tribal patients (including those with chronic conditions) who paid out-of-pocket for IHS-authorized purchased/referred care can obtain reimbursement from the Indian Health Service, with reimbursements required within 30 days after documentation is submitted.
Tribal health programs, beneficiaries, providers, and IHS staff will use standardized statutory terminology ('purchased/referred care') and updated HHS/IHS materials (Indian Health Manual, rules, guidance, administrative materials), reducing confusion and improving consistent benefits administration.
Tribal patients can submit reimbursement documentation electronically or in person, reducing travel burdens and making claims easier to file.
Members served by tribal PRC programs operated under ISDEAA compacts/contracts may not be entitled to mandatory reimbursements unless the Tribe agrees, leaving some tribal patients without the new reimbursement protections.
Applying the reimbursement rule retroactively to services furnished before enactment could impose substantial administrative and fiscal burdens on the Indian Health Service (and ultimately taxpayers and tribal program administrators).
If the statutory redefinition or terminology changes alter legal meaning or eligibility (even inadvertently), tribal members' access to care or claim approvals could be disrupted until courts or agencies resolve the change.
Based on analysis of 3 sections of legislative text.
Requires the Indian Health Service (IHS) and HHS to replace the phrase “contract health care/contract health service” with “purchased/referred care” across the Indian Health Care Improvement Act and HHS materials, and sets a new process to reimburse patients who paid out-of-pocket for IHS‑authorized purchased/referred care. The bill requires electronic or in-person submission of documentation, a 30‑day target for reimbursement after documentation is submitted, procedural rules to be issued within 120 days, and broader administrative updates within 180 days. It preserves tribal self‑determination by excluding Tribe‑operated PRC programs from the reimbursement requirement unless a Tribe agrees.
Introduced February 18, 2025 by Dustin Johnson · Last progress February 18, 2025