Bill Details
S.699 - 119th Congress
Status
Latest action
2026-02-04 - Committee on Indian Affairs. Hearings held.
Introduced Date
2025-02-24
Policy Area
Native Americans
Committees
View committees (1)
Sponsors
Cosponsors
6
0
0
AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would change federal law to better protect Native patients who get health care through the Indian Health Service or an Indian health program outside of a tribal facility. It says that if a patient receives approved referred care, that patient should not be personally responsible for the bill, even if they signed a form saying otherwise. The bill also sets up a faster notice process, allows repayment to patients who paid out of pocket, and updates federal documents and rules to use the newer term “purchased/referred care” instead of older wording.
- Patients who receive approved referred care could not be billed by a provider, debt collector, or anyone else for the cost of that care, even if they signed papers saying they would be responsible.
- The Secretary of Health and Human Services would have to notify the patient and the provider within 5 business days after getting a claim for payment, making it clear the patient is not liable.
- The bill would require the Indian Health Service to create a process, within 120 days, to reimburse patients who paid out of pocket for approved referred care. Once a patient submits the needed documents, payment would be due within 30 days. This would not automatically apply to tribal programs unless the tribe agrees.
- The bill also updates many parts of federal law and agency materials by replacing older terms like “contract health service” with “purchased/referred care,” and it makes these changes apply to care provided before, on, or after the bill becomes law.
Official Summaries
Purchased and Referred Care Improvement Act of 2025
This bill specifies that the Indian Health Service (IHS) must reimburse patients for their out-of-pocket costs for authorized purchased/referred care services within 30 days. (The IHS provides medical and dental services directly to American Indian and Alaska Native patients whenever possible. However, when services are not available, IHS beneficiaries may be referred to private providers. This is called purchased/referred care.)
Specifically, the bill requires the Department of Health and Human Services (HHS) to establish and implement procedures to allow a patient who paid out of pocket for purchased/referred care services authorized by the IHS to be reimbursed by the IHS for that payment no later than 30 days after the patient submits required documentation.
Additionally, the bill requires HHS to 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 the bill.
The bill also replaces statutory references to contract health service with purchased/referred care.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 699 Introduced in Senate (IS)]
<DOC>
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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