I
119THCONGRESS
1
STSESSION H. R. 1418
To amend the Indian Health Care Improvement Act to address liability
for payment of charges or costs associated with provision of purchased/
referred care services, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY18, 2025
Mr. J
OHNSONof South Dakota (for himself and Ms. SCHRIER) introduced the
following bill; which was referred to the Committee on Natural Resources,
and in addition to the Committee on Energy and Commerce, for a period
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend the Indian Health Care Improvement Act to ad-
dress liability for payment of charges or costs associated
with provision of purchased/referred care services, and
for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Purchased and Re-4
ferred Care Improvement Act of 2025’’. 5
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SEC. 2. CHANGES TO LIABILITY FOR PAYMENT. 1
(a) I
NGENERAL.—Section 222 of the Indian Health 2
Care Improvement Act (25 U.S.C. 1621u) is amended— 3
(1) in subsection (a)— 4
(A) by striking ‘‘A patient’’ and inserting 5
‘‘Notwithstanding any other provision of law or 6
any agreement, form, or other written or elec-7
tronic document signed by a patient, a patient’’; 8
and 9
(B) by striking ‘‘contract health care’’ and 10
inserting ‘‘purchased/referred care’’; 11
(2) in subsection (b)— 12
(A) by striking ‘‘contract care’’ each place 13
it appears and inserting ‘‘purchased/referred 14
care’’; 15
(B) by striking ‘‘contract health care’’ and 16
inserting ‘‘purchased/referred care’’; 17
(C) by inserting ‘‘, notwithstanding any 18
other provision of law or any agreement, form, 19
or other written or electronic document signed 20
by a patient,’’ after ‘‘by the Service that’’; and 21
(D) by inserting ‘‘to any provider, debt col-22
lector, or any other person’’ after ‘‘is not lia-23
ble’’; 24
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(3) in subsection (c), by inserting ‘‘, the debt 1
collector, or any other person, as applicable’’ after 2
‘‘the provider’’; and 3
(4) by adding at the end the following: 4
‘‘(d) R
EIMBURSEMENT.— 5
‘‘(1) I
N GENERAL.—Not later than 120 days 6
after the date of the enactment of this subsection 7
and in consultation with Indian Tribes, the Sec-8
retary shall establish and implement procedures to 9
allow a patient that paid out-of-pocket for pur-10
chased/referred care services authorized by the Serv-11
ice under this Act to be reimbursed by the Service 12
for that payment not later than 30 days after the 13
patient submits documentation to the Service pursu-14
ant to paragraph (2). 15
‘‘(2) S
UBMITTING DOCUMENTATION .—The Sec-16
retary shall accept documentation from a patient 17
seeking reimbursement under paragraph (1) that 18
was submitted— 19
‘‘(A) electronically; or 20
‘‘(B) in-person at a Service facility. 21
‘‘(3) E
FFECT.—The preceding provisions of this 22
subsection shall not apply to purchased/referred care 23
service furnished under a purchased/referred care 24
services program operated by an Indian Tribe under 25
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an Indian Self-Determination and Education Assist-1
ance Act (25 U.S.C. 5301 et seq.) compact or con-2
tract unless expressly agreed to by the Indian Tribe. 3
‘‘(e) U
PDATINGAUTHORITIES.—Not later than 180 4
days of the enactment of this subsection and in consulta-5
tion with Indian Tribes, the Secretary shall update appli-6
cable provisions of and exhibits to the Indian Health Man-7
ual, contracts with providers, and other relevant docu-8
ments and administrative authorities to incorporate the 9
provisions of this section.’’. 10
(b) A
PPLICATION.—The amendments made by this 11
section shall apply to purchased/referred care services au-12
thorized by the Indian Health Service furnished on, be-13
fore, or after the date of the enactment of this Act. 14
SEC. 3. TECHNICAL AMENDMENTS. 15
(a) D
EFINITIONS.—Section 4(5) of the Indian Health 16
Care Improvement Act (25 U.S.C. 1603) is amended by 17
striking the paragraph designation and heading and all 18
that follows through ‘‘means’’ and inserting the following: 19
‘‘(5) P
URCHASED/REFERRED CARE.—The term 20
‘purchased/referred care’ means’’. 21
(b) T
ECHNICALAMENDMENTS.—The Indian Health 22
Care Improvement Act (25 U.S.C. 1601 et seq.) is amend-23
ed by striking ‘‘contract health service’’ each place it ap-24
pears (regardless of casing and typeface and including in 25
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the headings) and inserting ‘‘purchased/referred care’’ 1
(with appropriate casing and typeface). 2
(c) U
PDATINGAUTHORITIES.—The Secretary of 3
Health and Human Services is directed to ensure that the 4
Indian Health Manual and all other relevant rules, guid-5
ance, manuals, and other materials are revised such that 6
‘‘contract health service’’, each place it appears (regard-7
less of casing and typeface and including in the headings) 8
is revised to read ‘‘purchased/referred care’’ (with appro-9
priate casing and typeface). 10
Æ
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