II
119THCONGRESS
1
STSESSION S. 699
To amend the Indian Health Care Improvement Act to address liability
for payment of charges or costs associated with the provision of pur-
chased/referred care services, and for other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY24, 2025
Mr. R
OUNDS(for himself, Ms. CANTWELL, Mr. THUNE, and Mrs. MURRAY)
introduced the following bill; which was read twice and referred to the
Committee on Indian Affairs
A BILL
To amend the Indian Health Care Improvement Act to ad-
dress liability for payment of charges or costs associated
with the 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
SEC. 2. CHANGES TO LIABILITY FOR PAYMENT. 6
(a) I
NGENERAL.—Section 222 of the Indian Health 7
Care Improvement Act (25 U.S.C. 1621u) is amended— 8
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(1) in subsection (a)— 1
(A) by striking ‘‘A patient who receives 2
contract health care services’’ and inserting 3
‘‘Notwithstanding any other provision of law or 4
any agreement, form, or other written or elec-5
tronic document signed by a patient, a patient 6
who receives purchased/referred care’’; and 7
(B) by striking ‘‘such services’’ and insert-8
ing ‘‘the purchased/referred care’’; 9
(2) by striking subsection (b) and inserting the 10
following: 11
‘‘(b) N
OTIFICATION.—The Secretary shall notify a 12
purchased/referred care provider and any patient who re-13
ceives purchased/referred care authorized by the Service 14
that, notwithstanding any other provision of law or any 15
agreement, form, or other written or electronic document 16
signed by the patient, the patient is not liable to any pro-17
vider, debt collector, or any other person for the payment 18
of any charges or costs associated with the provision of 19
the purchased/referred care not later than 5 business days 20
after receipt of a notification of a claim by a provider of 21
the purchased/referred care.’’; 22
(3) in subsection (c)— 23
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(A) by inserting ‘‘, debt collector, or any 1
other person, as applicable,’’ after ‘‘the pro-2
vider’’; and 3
(B) by striking ‘‘the services’’ and insert-4
ing ‘‘the purchased/referred care’’; and 5
(4) by adding at the end the following: 6
‘‘(d) R
EIMBURSEMENT.— 7
‘‘(1) E
STABLISHMENT OF PROCEDURES .— 8
‘‘(A) I
N GENERAL.—Not later than 120 9
days after the date of enactment of the Pur-10
chased and Referred Care Improvement Act of 11
2025, in consultation with Indian tribes, and 12
except as provided in paragraph (2), the Sec-13
retary shall establish and implement procedures 14
to allow a patient that paid out-of-pocket for 15
purchased/referred care authorized by the Serv-16
ice under this Act to be reimbursed by the 17
Service for that payment not later than 30 days 18
after the date on which the patient submits doc-19
umentation to the Service in accordance with 20
subparagraph (B). 21
‘‘(B) S
UBMITTING DOCUMENTATION .—The 22
Secretary shall accept documentation from a 23
patient seeking reimbursement under paragraph 24
(1) that was submitted— 25
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‘‘(i) electronically; or 1
‘‘(ii) in-person at a Service facility. 2
‘‘(2) L
IMITATION.—Paragraph (1) shall not 3
apply to purchased/referred care furnished under a 4
purchased/referred care services program operated 5
by an Indian tribe under a contract or compact en-6
tered into under the Indian Self-Determination and 7
Education Assistance Act (25 U.S.C. 5301 et seq.) 8
unless expressly agreed to by the Indian tribe. 9
‘‘(e) U
PDATINGAUTHORITIES.—Not later than 180 10
days after the date of enactment of the Purchased and 11
Referred Care Improvement Act of 2025, the Secretary, 12
in consultation with Indian tribes, shall update applicable 13
provisions of and exhibits to the Indian Health Manual, 14
contracts with providers, and other relevant documents 15
and administrative authorities to incorporate the provi-16
sions of this section.’’. 17
(b) A
PPLICATION.—The amendments made by sub-18
section (a) shall apply to purchased/referred care (as de-19
fined in section 4 of the Indian Health Care Improvement 20
Act (25 U.S.C. 1603)) authorized by the Indian Health 21
Service furnished on, before, or after the date of enact-22
ment of this Act. 23
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SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS. 1
(a) D
EFINITIONS.—Section 4 of the Indian Health 2
Care Improvement Act (25 U.S.C. 1603) is amended— 3
(1) by striking paragraph (5); 4
(2) by redesignating paragraphs (6) through 5
(15) as paragraph (5) through (14), respectively; 6
(3) in paragraph (12) (as so redesignated), in 7
the matter preceding subparagraph (A), by striking 8
‘‘, as defined in subsection (d) hereof,’’; 9
(4) by inserting after paragraph (14) (as so re-10
designated) the following: 11
‘‘(15) P
URCHASED/REFERRED CARE .—The 12
term ‘purchased/referred care’ means any health 13
service that is— 14
‘‘(A) delivered based on a referral by, or at 15
the expense of, an Indian health program; and 16
‘‘(B) provided by a public or private med-17
ical provider or hospital that is not a provider 18
or hospital of the Indian health program.’’; 19
(5) in paragraph (25), by striking ‘‘(25 U.S.C. 20
450 et seq.)’’ and inserting ‘‘(25 U.S.C. 5301 et 21
seq.)’’; 22
(6) in paragraph (26), by striking ‘‘(25 U.S.C. 23
450b)’’ and inserting ‘‘(25 U.S.C. 5304)’’; and 24
(7) in paragraph (28)— 25
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(A) by striking ‘‘, as defined in subsection 1
(g) hereof,’’; and 2
(B) by striking ‘‘subsection (c)(1) through 3
(4) of this section’’ and inserting ‘‘subpara-4
graphs (A) through (D) of paragraph (12)’’. 5
(b) T
ECHNICAL ANDCONFORMINGAMENDMENTS.— 6
(1) The Indian Health Care Improvement Act 7
(25 U.S.C. 1601 et seq.) is amended— 8
(A) by striking ‘‘contract health service’’ 9
each place it appears and inserting ‘‘purchased/ 10
referred care’’; 11
(B) by striking ‘‘contract health services’’ 12
each place it appears and inserting ‘‘purchased/ 13
referred care’’; 14
(C) by striking ‘‘Contract Health Service’’ 15
each place it appears and inserting ‘‘purchased/ 16
referred care’’; 17
(D) by striking ‘‘Contract Health Services’’ 18
each place it appears and inserting ‘‘purchased/ 19
referred care’’; and 20
(E) by striking ‘‘contract care’’ each place 21
it appears and inserting ‘‘purchased/referred 22
care’’. 23
(2) Section 211 of the Indian Health Care Im-24
provement Act (25 U.S.C. 1621j) is amended by 25
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striking the section heading and designation and all 1
that follows through ‘‘(a) The Secretary’’ and insert-2
ing the following: 3
‘‘SEC. 211. CALIFORNIA PURCHASED/REFERRED CARE DEM-4
ONSTRATION PROGRAM. 5
‘‘(a) The Secretary’’. 6
(3) Section 219 of the Indian Health Care Im-7
provement Act (25 U.S.C. 1621r) is amended by 8
striking the section heading and designation and all 9
that follows through ‘‘(a) The Secretary’’ and insert-10
ing the following: 11
‘‘SEC. 219. PURCHASED/REFERRED CARE PAYMENT STUDY. 12
‘‘(a) The Secretary’’. 13
(4) Section 226 of the Indian Health Care Im-14
provement Act (25 U.S.C. 1621y) is amended, in the 15
section heading, by striking ‘‘
CONTRACT HEALTH 16
SERVICE’’ and inserting ‘‘PURCHASED /RE-17
FERRED CARE ’’. 18
(5) Section 406 of the Indian Health Care Im-19
provement Act (25 U.S.C. 1646) is amended by 20
striking the section heading and designation and all 21
that follows through ‘‘With respect’’ and inserting 22
the following: 23
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‘‘SEC. 406. AUTHORIZATION FOR EMERGENCY PURCHASED/ 1
REFERRED CARE. 2
‘‘With respect’’. 3
(6) Section 506(f) of the Indian Health Care 4
Improvement Act (25 U.S.C. 1656(f)) is amended by 5
striking ‘‘, as defined in section 4(f) of this Act,’’. 6
(7) Section 704(b) of the Indian Health Care 7
Improvement Act (25 U.S.C. 1665c(b)) is amended, 8
in the subsection heading, by striking ‘‘C
ONTRACT 9
H
EALTHSERVICES’’ and inserting ‘‘PURCHASED/RE-10
FERREDCARE’’. 11
(8) Section 808 of the Indian Health Care Im-12
provement Act (25 U.S.C. 1678) is amended, in the 13
section heading, by striking ‘‘
CONTRACT HEALTH 14
SERVICE’’ and inserting ‘‘PURCHASED /RE-15
FERRED CARE ’’. 16
(9) Section 808A of the Indian Health Care 17
Improvement Act (25 U.S.C. 1678a) is amended, in 18
the section heading, by striking ‘‘
CONTRACT 19
HEALTH SERVICE ’’ and inserting ‘‘PURCHASED / 20
REFERRED CARE ’’. 21
(10) Section 810 of the Indian Health Care Im-22
provement Act (25 U.S.C. 1680) is amended by 23
striking the section heading and designation and all 24
that follows through ‘‘The State’’ and inserting the 25
following: 26
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‘‘SEC. 810. CALIFORNIA AS A PURCHASED/REFERRED CARE 1
DELIVERY AREA. 2
‘‘The State’’. 3
(11) Section 815 of the Indian Health Care Im-4
provement Act (25 U.S.C. 1680e) is amended by 5
striking the section heading and designation and all 6
that follows through ‘‘(a) The Secretary’’ and insert-7
ing the following: 8
‘‘SEC. 815. PURCHASED/REFERRED CARE FOR THE TREN-9
TON SERVICE AREA. 10
‘‘(a) The Secretary’’. 11
(12) Section 830(b) of the Indian Health Care 12
Improvement Act (25 U.S.C. 1680t(b)) is amended, 13
in the subsection heading, by striking ‘‘C
ONTRACT 14
H
EALTHSERVICES’’ and inserting ‘‘PURCHASED/RE-15
FERREDCARE’’. 16
(13) Section 506A(a) of the Public Health 17
Service Act (42 U.S.C. 290aa–5a(a)) is amended— 18
(A) in paragraph (2), by striking ‘‘Tribal 19
health program’’ the second place it appears 20
and inserting ‘‘tribal health program’’; and 21
(B) in paragraph (3)— 22
(i) by striking ‘‘health program ad-23
ministered by the Service’’ and inserting 24
‘‘health program administered directly by 25
the Service’’; and 26
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(ii) by striking ‘‘section 4(12)(A) of 1
the Indian Health Care Improvement Act’’ 2
and inserting ‘‘paragraph (11)(A) of sec-3
tion 4 of the Indian Health Care Improve-4
ment Act (25 U.S.C. 1603)’’. 5
(c) U
PDATINGAUTHORITIES.—The Secretary of 6
Health and Human Services is directed to ensure that the 7
Indian Health Manual and all other relevant rules, guid-8
ance, manuals, and other materials are revised such that 9
‘‘contract health service’’ each place it appears (regardless 10
of casing and typeface and including in the headings) is 11
revised to read ‘‘purchased/referred care’’ (with appro-12
priate casing and typeface). 13
Æ
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