Sponsors (6)
The bill protects patients from liability and speeds reimbursement while making statutory and administrative definitions clearer for IHS, tribes, and providers — but it imposes transition costs, may leave tribal‑run programs out unless they opt in, and risks coverage gaps or reimbursement delays if definitions or documentation rules are narrow or burdensome.
Patients receiving IHS‑authorized purchased/referred care (including tribal members) will not be held financially liable for those services even if they previously signed forms saying otherwise.
Patients who paid out‑of‑pocket for IHS‑authorized purchased/referred care can be reimbursed by IHS and must receive payment within 30 days after submitting acceptable documentation.
Tribes, IHS, and HHS will have clearer, standardized statutory and administrative definitions/terminology for 'purchased/referred care,' improving consistency across manuals, contracts, and guidance.
Tribal programs operating purchased/referred care under ISDEAA contracts/compacts are excluded from the automatic reimbursement requirement unless the tribe expressly agrees, so some patients served under tribal programs may not receive reimbursement.
If the new statutory definition narrows prior informal meanings of purchased/contract care, some referred services previously paid may no longer qualify, potentially reducing access or increasing out‑of‑pocket costs for patients.
Reimbursement will require documentation and administrative steps that, if strict or burdensome, could delay or deny payments despite the 30‑day timeline, leaving patients temporarily or permanently out‑of‑pocket.
Based on analysis of 3 sections of legislative text.
Defines "purchased/referred care," bars patient liability for IHS‑authorized outside care, and creates a reimbursement process for patients who paid out‑of‑pocket.
Official title: Amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated with the provision of purchased/referred care services, and for other purposes.
Introduced February 24, 2025 by Marion Michael Rounds · Last progress February 24, 2025
Updates the Indian Health Care Improvement Act to rename and define “purchased/referred care,” strengthen a patient non‑liability rule so patients are not held responsible for bills for IHS‑authorized outside care, and create a process for reimbursing patients who paid out‑of‑pocket. It requires HHS to issue reimbursement procedures within 120 days and to update agency manuals, provider contracts, and administrative authorities within 180 days. The bill replaces older contract‑care language across the IHCIA and related public health provisions with the new defined term, clarifies who must be notified that patients are not liable (including providers and debt collectors), and limits reimbursement to IHS‑authorized purchased/referred care unless a tribe operating under an ISDEAA contract or compact expressly agrees to reimbursements under the new process.