Sponsors (5)
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Amends the Indian Health Care Improvement Act to make clear that patients who receive purchased/referred care through the Indian Health Service (IHS) are not personally liable for bills from those outside providers or collections agents. It requires IHS to notify both providers and patients of that rule, creates a process to reimburse patients who already paid out of pocket, and directs the Department to update manuals, notices, and cross-references to reflect the new wording and the defined term "purchased/referred care." The changes also set firm timelines for notices, reimbursement processing, and required administrative updates.
Amends Section 222 of the Indian Health Care Improvement Act by changing the opening wording in subsection (a) from "A patient who receives contract health care services" to: "Notwithstanding any other provision of law or any agreement, form, or other written or electronic document signed by a patient, a patient who receives purchased/referred care."
In subsection (a), replaces the phrase "such services" with the phrase "the purchased/referred care."
Replaces subsection (b) with a new Notification rule: The Secretary must notify a purchased/referred care provider and any patient who receives purchased/referred care authorized by the Service that the patient is not liable to any provider, debt collector, or any other person for payment of any charges or costs associated with the purchased/referred care. That notice must be provided not later than 5 business days after the Service receives a notification of a claim from a provider of the purchased/referred care.
In subsection (c), the text includes an insertion (text shown in the bill as "by inserting after ; and") and replaces the phrase "the services" with "the purchased/referred care." (The bill text shows this change explicitly for the phrase replacement.)
Adds subsection (d) Reimbursement: Not later than 120 days after enactment, and in consultation with Indian tribes, the Secretary must establish and implement procedures allowing a patient who paid out-of-pocket for purchased/referred care authorized by the Service to be reimbursed by the Service. The Service must reimburse the patient not later than 30 days after the patient submits required documentation.
Who is affected and how:
American Indian and Alaska Native patients who use the IHS purchased/referred care program: They gain explicit legal protection against being billed or pursued by collectors for covered purchased/referred care, and those who already paid can file for reimbursement.
Indian Health Service-operated health facilities and IHS administrative staff: Must implement notice programs, process reimbursement claims within statutory timelines, update internal manuals and guidance, and coordinate with outside providers; these tasks will require staff time and administrative resources.
Indian Tribes and Tribal communities: Benefit from clearer protections for members who access care through IHS and from standardized terminology across IHS materials and legal references.
Health care providers and third-party billing/collection agents who deliver purchased/referred care: Must stop billing eligible patients for covered services and adjust billing practices; they will need to coordinate claims with IHS rather than seeking payment directly from patients.
Overall impact:
Amends 25 U.S.C. 1621u to (1) replace references to 'contract health care services'/'contract care services' with 'purchased/referred care', add qualifying "Notwithstanding any other provision of law or any agreement, form, or other written or electronic document signed by a patient" language regarding patient non-liability, revise the notification provision, update related subsection language, and add new provisions establishing reimbursement procedures and updating authorities.
Amends Section 4 of the Indian Health Care Improvement Act by striking and redesignating multiple paragraphs, inserting a new paragraph (15) defining 'purchased/referred care', and making targeted textual substitutions in paragraphs (12), (25), (26), and (28).
Makes technical amendments throughout the Indian Health Care Improvement Act by replacing unspecified existing text in multiple locations with the term 'purchased/referred care'.
Strikes the existing section heading and designation for section 211 and replaces it with a new heading and text establishing '211 California purchased/referred care demonstration program' with a subsection '(a) The Secretary.'
Replaces the section heading and designation for section 219 with a new heading '219 Purchased/referred care payment study' and inserts subsection '(a) The Secretary.'
Amends the section heading for section 226 by striking and inserting revised heading text (text not reproduced in section).
Replaces the section heading and designation for section 406 by striking the existing text and inserting a new heading '406 Authorization for emergency purchased/referred care' (and associated follow-on text as shown).
Amends section 506(f) by striking specified text (exact text omitted in this section).
Amends section 704(b) by revising the subsection heading through striking and inserting new text (exact text not reproduced here).
Amends section 808 in the section heading by striking and inserting revised wording (specific insertion not shown).
And 5 more affected sections...
Expand sections to see detailed analysis
Read twice and referred to the Committee on Indian Affairs.
Introduced February 24, 2025 by Marion Michael Rounds · Last progress February 24, 2025
Committee on Indian Affairs. Hearings held.
Read twice and referred to the Committee on Indian Affairs.
Introduced in Senate