Sponsors (6)
The bill strengthens protections, timeliness, and clarity for Indian Health Service purchased/referred care—reducing surprise billing and improving reimbursement pathways for many tribal patients—while imposing implementation costs and creating uneven reimbursement access for patients served by tribal-run PRC programs.
Indian and Alaska Native patients receiving purchased/referred care are explicitly protected from being billed for provider charges, preventing surprise bills even if other forms were signed or conflicting laws exist.
Indian and Alaska Native patients who paid out-of-pocket for purchased/referred care can seek timely reimbursement (with a required 30-day turnaround after documentation) and may submit claims electronically or in person, lowering barriers to getting refunds.
Tribal patients and providers will receive faster notifications when the Service receives a provider claim (within 5 business days), increasing transparency and reducing surprise-billing uncertainty.
Taxpayers, IHS, and providers will face increased administrative and IT costs to implement notification, reimbursement, terminology, and guidance changes (forms, systems, training) within the bill's timelines.
Tribal members served under PRC programs run by tribes under ISDEAA may not receive reimbursements unless their tribe agrees, creating unequal access to refunds across different tribal programs.
Providers may experience delayed or disputed payments from the Service—potentially complicating provider cash flow and service relationships for hospitals and clinicians who treat referred patients.
Based on analysis of 3 sections of legislative text.
Clarifies that patients receiving purchased/referred care via Indian health programs are not liable for provider charges, requires HHS notices and patient reimbursements, and updates statutory language to use “purchased/referred care.”
Introduced February 24, 2025 by Marion Michael Rounds · Last progress February 24, 2025
Makes clear that patients who receive purchased/referred care through Indian Health Service programs are not financially responsible for provider charges and requires the Department of Health and Human Services to notify providers and patients, set up a reimbursement process for patients who already paid, and update IHS policies and contracts to reflect these protections. The bill also updates statutory language across the Indian Health Care Improvement Act and related public health statutes to use the term “purchased/referred care” and to rename or reformat several headings and cross-references.