Purchased and Referred Care Improvement Act of 2025

Bill Number

H.R. 1418

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Native Americans

Status

Introduced

Latest Action

2025-02-18: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2025-05-14T14:16:33Z

AI-Generated Summary

Purpose

The Purchased and Referred Care Improvement Act of 2025 aims to protect Native American patients from unexpected medical bills related to health services arranged through the Indian Health Service (IHS). It clarifies that patients are not personally responsible for costs beyond what the IHS agrees to cover, streamlines reimbursement for out-of-pocket payments, and updates outdated terminology in federal law to better reflect current practices.

Key Provisions

• Patient Liability Protections: Patients receiving purchased/referred care services (healthcare arranged and funded by the IHS when its facilities cannot provide needed treatment) are not liable for any charges or costs exceeding the IHS's approved payment, regardless of any agreements, forms, or documents they may have signed. This protection extends to preventing debt collection by providers, debt collectors, or others.
• Reimbursement Process: The Secretary of Health and Human Services (HHS), in consultation with Indian Tribes, must establish procedures within 120 days of enactment allowing patients to seek reimbursement for out-of-pocket payments on authorized services. Reimbursements must be issued within 30 days of submitting documentation, which can be done electronically or in person at an IHS facility. This does not apply to tribal-run programs under self-determination contracts unless the Tribe agrees.
• Terminology Updates: Replaces all instances of "contract health care" or "contract health service" in the Indian Health Care Improvement Act (IHCIA) with "purchased/referred care" for consistency. The HHS Secretary must update the Indian Health Manual, contracts, rules, guidance, and other materials within 180 days to reflect this change.
• Retroactive Application: The liability protections apply to services provided before, on, or after the date of enactment.

Significant Changes to Existing Law

• Overrides Patient Agreements: Amends Section 222 of the IHCIA to explicitly state that no patient-signed document can impose liability beyond IHS-approved amounts, strengthening protections against surprise billing that may have existed under prior interpretations.
• Expands Non-Liability Scope: Broadens exemptions from debt collection to include not just providers but also debt collectors and any other persons, closing potential gaps in enforcement.
• Introduces Formal Reimbursement Mechanism: Adds a new subsection requiring timely reimbursements with flexible submission options, which was not previously mandated in the IHCIA.
• Standardizes Language: Conducts a comprehensive replacement of outdated terms throughout the IHCIA and related HHS materials, eliminating confusion from legacy phrasing like "contract health care."

Potential Impacts

• On Government Agencies: The IHS and HHS will need to implement new administrative procedures, update contracts and manuals, and handle reimbursements promptly, potentially increasing short-term workload but improving long-term efficiency in managing purchased/referred care (which accounts for a significant portion of IHS expenditures).
• On Citizens: Native American patients and their families will face reduced financial risks from medical debt, making healthcare more accessible and less burdensome, especially for those in remote or underserved areas reliant on IHS services.
• On International Relations: No direct impacts, as the bill focuses on domestic tribal health programs under U.S. federal law.
• Broader Effects: Could lower overall healthcare costs for Tribes and patients by deterring aggressive billing practices, while encouraging better coordination between IHS, providers, and Tribes.

Main Stakeholders Affected

• Native American Patients: Primary beneficiaries, gaining stronger safeguards against personal liability and easier access to reimbursements.
• Indian Tribes: Involved in consultations for procedures; can choose whether to adopt reimbursement rules in their self-governed health programs, preserving tribal sovereignty.
• Indian Health Service (IHS): Responsible for implementing changes, processing reimbursements, and updating systems, which may require additional resources.
• Healthcare Providers and Debt Collectors: Restricted from pursuing patients for uncovered costs, potentially shifting financial recovery expectations to IHS negotiations.
• U.S. Department of Health and Human Services (HHS): Oversees updates to manuals and guidance, ensuring compliance across federal operations.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Reinforces federal obligations under the IHCIA to provide healthcare to Native Americans without imposing undue financial burdens, potentially reducing litigation over medical debt by clarifying liability rules. The retroactive application could resolve ongoing disputes for past services but may face challenges if providers claim vested rights in prior agreements.
• Constitutional Implications: Aligns with the U.S. government's trust responsibility to Tribes (rooted in treaties and the Indian Commerce Clause), promoting equity in healthcare delivery without infringing on tribal self-determination, as Tribes retain opt-out flexibility.
• Political Implications: Supports bipartisan efforts to modernize tribal health policy, as evidenced by introduction by representatives from diverse regions, and could serve as a model for broader healthcare reforms addressing surprise billing in underserved communities. No overt partisan elements in the bill text.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Johnson, Dusty [R-SD-At Large]

Cosponsors (7)

Rep. Schrier, Kim [D-WA-8], Rep. Neguse, Joe [D-CO-2], Rep. Newhouse, Dan [R-WA-4], Rep. Cole, Tom [R-OK-4], Rep. Baumgartner, Michael [R-WA-5], Rep. Davis, Donald G. [D-NC-1], Rep. Leger Fernandez, Teresa [D-NM-3]

Recent Actions

• 2025-02-18: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-02-18: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-02-18: Introduced in House
• 2025-02-18: Introduced in House

Bill Versions

• Purchased and Referred Care Improvement Act of 2025 — issued 2025-02-18 — PDF (5 pages)