Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB699 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 699
5	5	To amend the Indian Health Care Improvement Act to address liability
6	6	for payment of charges or costs associated with the provision of pur-
7	7	chased/referred care services, and for other purposes.
8	8	IN THE SENATE OF THE UNITED STATES
9	9	FEBRUARY24, 2025
10	10	Mr. R
11	11	OUNDS(for himself, Ms. CANTWELL, Mr. THUNE, and Mrs. MURRAY)
12	12	introduced the following bill; which was read twice and referred to the
13	13	Committee on Indian Affairs
14	14	A BILL
15	15	To amend the Indian Health Care Improvement Act to ad-
16	16	dress liability for payment of charges or costs associated
17	17	with the provision of purchased/referred care services,
18	18	and for other purposes.
19	19	Be it enacted by the Senate and House of Representa-1
20	20	tives of the United States of America in Congress assembled, 2
21	21	SECTION 1. SHORT TITLE. 3
22	22	This Act may be cited as the ‘‘Purchased and Re-4
23	23	ferred Care Improvement Act of 2025’’. 5
24	24	SEC. 2. CHANGES TO LIABILITY FOR PAYMENT. 6
25	25	(a) I
26	26	NGENERAL.—Section 222 of the Indian Health 7
27	27	Care Improvement Act (25 U.S.C. 1621u) is amended— 8
28	28	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
29	29	ssavage on LAPJG3WLY3PROD with BILLS 2
30	30	•S 699 IS
31	31	(1) in subsection (a)— 1
32	32	(A) by striking ‘‘A patient who receives 2
33	33	contract health care services’’ and inserting 3
34	34	‘‘Notwithstanding any other provision of law or 4
35	35	any agreement, form, or other written or elec-5
36	36	tronic document signed by a patient, a patient 6
37	37	who receives purchased/referred care’’; and 7
38	38	(B) by striking ‘‘such services’’ and insert-8
39	39	ing ‘‘the purchased/referred care’’; 9
40	40	(2) by striking subsection (b) and inserting the 10
41	41	following: 11
42	42	‘‘(b) N
43	43	OTIFICATION.—The Secretary shall notify a 12
44	44	purchased/referred care provider and any patient who re-13
45	45	ceives purchased/referred care authorized by the Service 14
46	46	that, notwithstanding any other provision of law or any 15
47	47	agreement, form, or other written or electronic document 16
48	48	signed by the patient, the patient is not liable to any pro-17
49	49	vider, debt collector, or any other person for the payment 18
50	50	of any charges or costs associated with the provision of 19
51	51	the purchased/referred care not later than 5 business days 20
52	52	after receipt of a notification of a claim by a provider of 21
53	53	the purchased/referred care.’’; 22
54	54	(3) in subsection (c)— 23
55	55	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
56	56	ssavage on LAPJG3WLY3PROD with BILLS 3
57	57	•S 699 IS
58	58	(A) by inserting ‘‘, debt collector, or any 1
59	59	other person, as applicable,’’ after ‘‘the pro-2
60	60	vider’’; and 3
61	61	(B) by striking ‘‘the services’’ and insert-4
62	62	ing ‘‘the purchased/referred care’’; and 5
63	63	(4) by adding at the end the following: 6
64	64	‘‘(d) R
65	65	EIMBURSEMENT.— 7
66	66	‘‘(1) E
67	67	STABLISHMENT OF PROCEDURES .— 8
68	68	‘‘(A) I
69	69	N GENERAL.—Not later than 120 9
70	70	days after the date of enactment of the Pur-10
71	71	chased and Referred Care Improvement Act of 11
72	72	2025, in consultation with Indian tribes, and 12
73	73	except as provided in paragraph (2), the Sec-13
74	74	retary shall establish and implement procedures 14
75	75	to allow a patient that paid out-of-pocket for 15
76	76	purchased/referred care authorized by the Serv-16
77	77	ice under this Act to be reimbursed by the 17
78	78	Service for that payment not later than 30 days 18
79	79	after the date on which the patient submits doc-19
80	80	umentation to the Service in accordance with 20
81	81	subparagraph (B). 21
82	82	‘‘(B) S
83	83	UBMITTING DOCUMENTATION .—The 22
84	84	Secretary shall accept documentation from a 23
85	85	patient seeking reimbursement under paragraph 24
86	86	(1) that was submitted— 25
87	87	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
88	88	ssavage on LAPJG3WLY3PROD with BILLS 4
89	89	•S 699 IS
90	90	‘‘(i) electronically; or 1
91	91	‘‘(ii) in-person at a Service facility. 2
92	92	‘‘(2) L
93	93	IMITATION.—Paragraph (1) shall not 3
94	94	apply to purchased/referred care furnished under a 4
95	95	purchased/referred care services program operated 5
96	96	by an Indian tribe under a contract or compact en-6
97	97	tered into under the Indian Self-Determination and 7
98	98	Education Assistance Act (25 U.S.C. 5301 et seq.) 8
99	99	unless expressly agreed to by the Indian tribe. 9
100	100	‘‘(e) U
101	101	PDATINGAUTHORITIES.—Not later than 180 10
102	102	days after the date of enactment of the Purchased and 11
103	103	Referred Care Improvement Act of 2025, the Secretary, 12
104	104	in consultation with Indian tribes, shall update applicable 13
105	105	provisions of and exhibits to the Indian Health Manual, 14
106	106	contracts with providers, and other relevant documents 15
107	107	and administrative authorities to incorporate the provi-16
108	108	sions of this section.’’. 17
109	109	(b) A
110	110	PPLICATION.—The amendments made by sub-18
111	111	section (a) shall apply to purchased/referred care (as de-19
112	112	fined in section 4 of the Indian Health Care Improvement 20
113	113	Act (25 U.S.C. 1603)) authorized by the Indian Health 21
114	114	Service furnished on, before, or after the date of enact-22
115	115	ment of this Act. 23
116	116	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
117	117	ssavage on LAPJG3WLY3PROD with BILLS 5
118	118	•S 699 IS
119	119	SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS. 1
120	120	(a) D
121	121	EFINITIONS.—Section 4 of the Indian Health 2
122	122	Care Improvement Act (25 U.S.C. 1603) is amended— 3
123	123	(1) by striking paragraph (5); 4
124	124	(2) by redesignating paragraphs (6) through 5
125	125	(15) as paragraph (5) through (14), respectively; 6
126	126	(3) in paragraph (12) (as so redesignated), in 7
127	127	the matter preceding subparagraph (A), by striking 8
128	128	‘‘, as defined in subsection (d) hereof,’’; 9
129	129	(4) by inserting after paragraph (14) (as so re-10
130	130	designated) the following: 11
131	131	‘‘(15) P
132	132	URCHASED/REFERRED CARE .—The 12
133	133	term ‘purchased/referred care’ means any health 13
134	134	service that is— 14
135	135	‘‘(A) delivered based on a referral by, or at 15
136	136	the expense of, an Indian health program; and 16
137	137	‘‘(B) provided by a public or private med-17
138	138	ical provider or hospital that is not a provider 18
139	139	or hospital of the Indian health program.’’; 19
140	140	(5) in paragraph (25), by striking ‘‘(25 U.S.C. 20
141	141	450 et seq.)’’ and inserting ‘‘(25 U.S.C. 5301 et 21
142	142	seq.)’’; 22
143	143	(6) in paragraph (26), by striking ‘‘(25 U.S.C. 23
144	144	450b)’’ and inserting ‘‘(25 U.S.C. 5304)’’; and 24
145	145	(7) in paragraph (28)— 25
146	146	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
147	147	ssavage on LAPJG3WLY3PROD with BILLS 6
148	148	•S 699 IS
149	149	(A) by striking ‘‘, as defined in subsection 1
150	150	(g) hereof,’’; and 2
151	151	(B) by striking ‘‘subsection (c)(1) through 3
152	152	(4) of this section’’ and inserting ‘‘subpara-4
153	153	graphs (A) through (D) of paragraph (12)’’. 5
154	154	(b) T
155	155	ECHNICAL ANDCONFORMINGAMENDMENTS.— 6
156	156	(1) The Indian Health Care Improvement Act 7
157	157	(25 U.S.C. 1601 et seq.) is amended— 8
158	158	(A) by striking ‘‘contract health service’’ 9
159	159	each place it appears and inserting ‘‘purchased/ 10
160	160	referred care’’; 11
161	161	(B) by striking ‘‘contract health services’’ 12
162	162	each place it appears and inserting ‘‘purchased/ 13
163	163	referred care’’; 14
164	164	(C) by striking ‘‘Contract Health Service’’ 15
165	165	each place it appears and inserting ‘‘purchased/ 16
166	166	referred care’’; 17
167	167	(D) by striking ‘‘Contract Health Services’’ 18
168	168	each place it appears and inserting ‘‘purchased/ 19
169	169	referred care’’; and 20
170	170	(E) by striking ‘‘contract care’’ each place 21
171	171	it appears and inserting ‘‘purchased/referred 22
172	172	care’’. 23
173	173	(2) Section 211 of the Indian Health Care Im-24
174	174	provement Act (25 U.S.C. 1621j) is amended by 25
175	175	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
176	176	ssavage on LAPJG3WLY3PROD with BILLS 7
177	177	•S 699 IS
178	178	striking the section heading and designation and all 1
179	179	that follows through ‘‘(a) The Secretary’’ and insert-2
180	180	ing the following: 3
181	181	‘‘SEC. 211. CALIFORNIA PURCHASED/REFERRED CARE DEM-4
182	182	ONSTRATION PROGRAM. 5
183	183	‘‘(a) The Secretary’’. 6
184	184	(3) Section 219 of the Indian Health Care Im-7
185	185	provement Act (25 U.S.C. 1621r) is amended by 8
186	186	striking the section heading and designation and all 9
187	187	that follows through ‘‘(a) The Secretary’’ and insert-10
188	188	ing the following: 11
189	189	‘‘SEC. 219. PURCHASED/REFERRED CARE PAYMENT STUDY. 12
190	190	‘‘(a) The Secretary’’. 13
191	191	(4) Section 226 of the Indian Health Care Im-14
192	192	provement Act (25 U.S.C. 1621y) is amended, in the 15
193	193	section heading, by striking ‘‘
194	194	CONTRACT HEALTH 16
195	195	SERVICE’’ and inserting ‘‘PURCHASED /RE-17
196	196	FERRED CARE ’’. 18
197	197	(5) Section 406 of the Indian Health Care Im-19
198	198	provement Act (25 U.S.C. 1646) is amended by 20
199	199	striking the section heading and designation and all 21
200	200	that follows through ‘‘With respect’’ and inserting 22
201	201	the following: 23
202	202	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
203	203	ssavage on LAPJG3WLY3PROD with BILLS 8
204	204	•S 699 IS
205	205	‘‘SEC. 406. AUTHORIZATION FOR EMERGENCY PURCHASED/ 1
206	206	REFERRED CARE. 2
207	207	‘‘With respect’’. 3
208	208	(6) Section 506(f) of the Indian Health Care 4
209	209	Improvement Act (25 U.S.C. 1656(f)) is amended by 5
210	210	striking ‘‘, as defined in section 4(f) of this Act,’’. 6
211	211	(7) Section 704(b) of the Indian Health Care 7
212	212	Improvement Act (25 U.S.C. 1665c(b)) is amended, 8
213	213	in the subsection heading, by striking ‘‘C
214	214	ONTRACT 9
215	215	H
216	216	EALTHSERVICES’’ and inserting ‘‘PURCHASED/RE-10
217	217	FERREDCARE’’. 11
218	218	(8) Section 808 of the Indian Health Care Im-12
219	219	provement Act (25 U.S.C. 1678) is amended, in the 13
220	220	section heading, by striking ‘‘
221	221	CONTRACT HEALTH 14
222	222	SERVICE’’ and inserting ‘‘PURCHASED /RE-15
223	223	FERRED CARE ’’. 16
224	224	(9) Section 808A of the Indian Health Care 17
225	225	Improvement Act (25 U.S.C. 1678a) is amended, in 18
226	226	the section heading, by striking ‘‘
227	227	CONTRACT 19
228	228	HEALTH SERVICE ’’ and inserting ‘‘PURCHASED / 20
229	229	REFERRED CARE ’’. 21
230	230	(10) Section 810 of the Indian Health Care Im-22
231	231	provement Act (25 U.S.C. 1680) is amended by 23
232	232	striking the section heading and designation and all 24
233	233	that follows through ‘‘The State’’ and inserting the 25
234	234	following: 26
235	235	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
236	236	ssavage on LAPJG3WLY3PROD with BILLS 9
237	237	•S 699 IS
238	238	‘‘SEC. 810. CALIFORNIA AS A PURCHASED/REFERRED CARE 1
239	239	DELIVERY AREA. 2
240	240	‘‘The State’’. 3
241	241	(11) Section 815 of the Indian Health Care Im-4
242	242	provement Act (25 U.S.C. 1680e) is amended by 5
243	243	striking the section heading and designation and all 6
244	244	that follows through ‘‘(a) The Secretary’’ and insert-7
245	245	ing the following: 8
246	246	‘‘SEC. 815. PURCHASED/REFERRED CARE FOR THE TREN-9
247	247	TON SERVICE AREA. 10
248	248	‘‘(a) The Secretary’’. 11
249	249	(12) Section 830(b) of the Indian Health Care 12
250	250	Improvement Act (25 U.S.C. 1680t(b)) is amended, 13
251	251	in the subsection heading, by striking ‘‘C
252	252	ONTRACT 14
253	253	H
254	254	EALTHSERVICES’’ and inserting ‘‘PURCHASED/RE-15
255	255	FERREDCARE’’. 16
256	256	(13) Section 506A(a) of the Public Health 17
257	257	Service Act (42 U.S.C. 290aa–5a(a)) is amended— 18
258	258	(A) in paragraph (2), by striking ‘‘Tribal 19
259	259	health program’’ the second place it appears 20
260	260	and inserting ‘‘tribal health program’’; and 21
261	261	(B) in paragraph (3)— 22
262	262	(i) by striking ‘‘health program ad-23
263	263	ministered by the Service’’ and inserting 24
264	264	‘‘health program administered directly by 25
265	265	the Service’’; and 26
266	266	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S699.IS S699
267	267	ssavage on LAPJG3WLY3PROD with BILLS 10
268	268	•S 699 IS
269	269	(ii) by striking ‘‘section 4(12)(A) of 1
270	270	the Indian Health Care Improvement Act’’ 2
271	271	and inserting ‘‘paragraph (11)(A) of sec-3
272	272	tion 4 of the Indian Health Care Improve-4
273	273	ment Act (25 U.S.C. 1603)’’. 5
274	274	(c) U
275	275	PDATINGAUTHORITIES.—The Secretary of 6
276	276	Health and Human Services is directed to ensure that the 7
277	277	Indian Health Manual and all other relevant rules, guid-8
278	278	ance, manuals, and other materials are revised such that 9
279	279	‘‘contract health service’’ each place it appears (regardless 10
280	280	of casing and typeface and including in the headings) is 11
281	281	revised to read ‘‘purchased/referred care’’ (with appro-12
282	282	priate casing and typeface). 13
283	283	Æ
284	284	VerDate Sep 11 2014 20:51 Mar 13, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S699.IS S699
285	285	ssavage on LAPJG3WLY3PROD with BILLS