Purchased and Referred Care Improvement Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 699 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                 S. 699

 To 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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           February 24, 2025

  Mr. Rounds (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 address 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 Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Purchased and Referred Care
Improvement Act of 2025''.

SEC. 2. CHANGES TO LIABILITY FOR PAYMENT.

    (a) In General.--Section 222 of the Indian Health Care Improvement
Act (25 U.S.C. 1621u) is amended--
            (1) in subsection (a)--
                    (A) by striking ``A patient who receives contract
                health care services'' and inserting ``Notwithstanding
                any other provision of law or any agreement, form, or
                other written or electronic document signed by a
                patient, a patient who receives purchased/referred
                care''; and
                    (B) by striking ``such services'' and inserting
                ``the purchased/referred care'';
            (2) by striking subsection (b) and inserting the following:
    ``(b) Notification.--The Secretary shall notify a purchased/
referred care provider and any patient who receives purchased/referred
care authorized by the Service that, notwithstanding any other
provision of law or any agreement, form, or other written or electronic
document signed by the patient, the patient is not liable to any
provider, debt collector, or any other person for the payment of any
charges or costs associated with the provision of the purchased/
referred care not later than 5 business days after receipt of a
notification of a claim by a provider of the purchased/referred
care.'';
            (3) in subsection (c)--
                    (A) by inserting ``, debt collector, or any other
                person, as applicable,'' after ``the provider''; and
                    (B) by striking ``the services'' and inserting
                ``the purchased/referred care''; and
            (4) by adding at the end the following:
    ``(d) Reimbursement.--
            ``(1) Establishment of procedures.--
                    ``(A) In general.--Not later than 120 days after
                the date of enactment of the Purchased and Referred
                Care Improvement Act of 2025, in consultation with
                Indian tribes, and except as provided in paragraph (2),
                the Secretary shall establish and implement procedures
                to allow a patient that paid out-of-pocket for
                purchased/referred care authorized by the Service under
                this Act to be reimbursed by the Service for that
                payment not later than 30 days after the date on which
                the patient submits documentation to the Service in
                accordance with subparagraph (B).
                    ``(B) Submitting documentation.--The Secretary
                shall accept documentation from a patient seeking
                reimbursement under paragraph (1) that was submitted--
                            ``(i) electronically; or
                            ``(ii) in-person at a Service facility.
            ``(2) Limitation.--Paragraph (1) shall not apply to
        purchased/referred care furnished under a purchased/referred
        care services program operated by an Indian tribe under a
        contract or compact entered into under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 5301 et
        seq.) unless expressly agreed to by the Indian tribe.
    ``(e) Updating Authorities.--Not later than 180 days after the date
of enactment of the Purchased and Referred Care Improvement Act of
2025, the Secretary, in consultation with Indian tribes, shall update
applicable provisions of and exhibits to the Indian Health Manual,
contracts with providers, and other relevant documents and
administrative authorities to incorporate the provisions of this
section.''.
    (b) Application.--The amendments made by subsection (a) shall apply
to purchased/referred care (as defined in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603)) authorized by the Indian
Health Service furnished on, before, or after the date of enactment of
this Act.

SEC. 3. TECHNICAL AND CONFORMING AMENDMENTS.

    (a) Definitions.--Section 4 of the Indian Health Care Improvement
Act (25 U.S.C. 1603) is amended--
            (1) by striking paragraph (5);
            (2) by redesignating paragraphs (6) through (15) as
        paragraph (5) through (14), respectively;
            (3) in paragraph (12) (as so redesignated), in the matter
        preceding subparagraph (A), by striking ``, as defined in
        subsection (d) hereof,'';
            (4) by inserting after paragraph (14) (as so redesignated)
        the following:
            ``(15) Purchased/referred care.--The term `purchased/
        referred care' means any health service that is--
                    ``(A) delivered based on a referral by, or at the
                expense of, an Indian health program; and
                    ``(B) provided by a public or private medical
                provider or hospital that is not a provider or hospital
                of the Indian health program.'';
            (5) in paragraph (25), by striking ``(25 U.S.C. 450 et
        seq.)'' and inserting ``(25 U.S.C. 5301 et seq.)'';
            (6) in paragraph (26), by striking ``(25 U.S.C. 450b)'' and
        inserting ``(25 U.S.C. 5304)''; and
            (7) in paragraph (28)--
                    (A) by striking ``, as defined in subsection (g)
                hereof,''; and
                    (B) by striking ``subsection (c)(1) through (4) of
                this section'' and inserting ``subparagraphs (A)
                through (D) of paragraph (12)''.
    (b) Technical and Conforming Amendments.--
            (1) The Indian Health Care Improvement Act (25 U.S.C. 1601
        et seq.) is amended--
                    (A) by striking ``contract health service'' each
                place it appears and inserting ``purchased/referred
                care'';
                    (B) by striking ``contract health services'' each
                place it appears and inserting ``purchased/referred
                care'';
                    (C) by striking ``Contract Health Service'' each
                place it appears and inserting ``purchased/referred
                care'';
                    (D) by striking ``Contract Health Services'' each
                place it appears and inserting ``purchased/referred
                care''; and
                    (E) by striking ``contract care'' each place it
                appears and inserting ``purchased/referred care''.
            (2) Section 211 of the Indian Health Care Improvement Act
        (25 U.S.C. 1621j) is amended by striking the section heading
        and designation and all that follows through ``(a) The
        Secretary'' and inserting the following:

``SEC. 211. CALIFORNIA PURCHASED/REFERRED CARE DEMONSTRATION PROGRAM.

    ``(a) The Secretary''.
            (3) Section 219 of the Indian Health Care Improvement Act
        (25 U.S.C. 1621r) is amended by striking the section heading
        and designation and all that follows through ``(a) The
        Secretary'' and inserting the following:

``SEC. 219. PURCHASED/REFERRED CARE PAYMENT STUDY.

    ``(a) The Secretary''.
            (4) Section 226 of the Indian Health Care Improvement Act
        (25 U.S.C. 1621y) is amended, in the section heading, by
        striking ``contract health service'' and inserting ``purchased/
        referred care''.
            (5) Section 406 of the Indian Health Care Improvement Act
        (25 U.S.C. 1646) is amended by striking the section heading and
        designation and all that follows through ``With respect'' and
        inserting the following:

``SEC. 406. AUTHORIZATION FOR EMERGENCY PURCHASED/REFERRED CARE.

    ``With respect''.
            (6) Section 506(f) of the Indian Health Care Improvement
        Act (25 U.S.C. 1656(f)) is amended by striking ``, as defined
        in section 4(f) of this Act,''.
            (7) Section 704(b) of the Indian Health Care Improvement
        Act (25 U.S.C. 1665c(b)) is amended, in the subsection heading,
        by striking ``Contract Health Services'' and inserting
        ``Purchased/referred Care''.
            (8) Section 808 of the Indian Health Care Improvement Act
        (25 U.S.C. 1678) is amended, in the section heading, by
        striking ``contract health service'' and inserting ``purchased/
        referred care''.
            (9) Section 808A of the Indian Health Care Improvement Act
        (25 U.S.C. 1678a) is amended, in the section heading, by
        striking ``contract health service'' and inserting ``purchased/
        referred care''.
            (10) Section 810 of the Indian Health Care Improvement Act
        (25 U.S.C. 1680) is amended by striking the section heading and
        designation and all that follows through ``The State'' and
        inserting the following:

``SEC. 810. CALIFORNIA AS A PURCHASED/REFERRED CARE DELIVERY AREA.

    ``The State''.
            (11) Section 815 of the Indian Health Care Improvement Act
        (25 U.S.C. 1680e) is amended by striking the section heading
        and designation and all that follows through ``(a) The
        Secretary'' and inserting the following:

``SEC. 815. PURCHASED/REFERRED CARE FOR THE TRENTON SERVICE AREA.

    ``(a) The Secretary''.
            (12) Section 830(b) of the Indian Health Care Improvement
        Act (25 U.S.C. 1680t(b)) is amended, in the subsection heading,
        by striking ``Contract Health Services'' and inserting
        ``Purchased/referred Care''.
            (13) Section 506A(a) of the Public Health Service Act (42
        U.S.C. 290aa-5a(a)) is amended--
                    (A) in paragraph (2), by striking ``Tribal health
                program'' the second place it appears and inserting
                ``tribal health program''; and
                    (B) in paragraph (3)--
                            (i) by striking ``health program
                        administered by the Service'' and inserting
                        ``health program administered directly by the
                        Service''; and
                            (ii) by striking ``section 4(12)(A) of the
                        Indian Health Care Improvement Act'' and
                        inserting ``paragraph (11)(A) of section 4 of
                        the Indian Health Care Improvement Act (25
                        U.S.C. 1603)''.
    (c) Updating Authorities.--The Secretary of Health and Human
Services is directed to ensure that the Indian Health Manual and all
other relevant rules, guidance, manuals, and other materials are
revised such that ``contract health service'' each place it appears
(regardless of casing and typeface and including in the headings) is
revised to read ``purchased/referred care'' (with appropriate casing
and typeface).
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