Purchased and Referred Care Improvement Act of 2025

Bill Number

S. 699

Origin Chamber

Senate

Congress

119th Congress, Session 1

Policy Area

Native Americans

Status

Introduced

Latest Action

2026-02-04: Committee on Indian Affairs. Hearings held.

Last Updated

2026-04-29T11:03:31Z

AI-Generated Summary

Purpose

The Purchased and Referred Care Improvement Act of 2025 aims to protect Native American patients from unexpected financial liability for health services provided through the Indian Health Service (IHS). It clarifies that patients are not responsible for costs beyond what the IHS authorizes, improves reimbursement processes for out-of-pocket payments, and standardizes terminology in federal law to better reflect these services.

Key Provisions

• Patient Liability Protections: Patients receiving "purchased/referred care" (health services referred by or paid for by an IHS program but provided by non-IHS facilities) are not liable for any charges or costs not covered by the IHS, regardless of any agreements, forms, or documents they may have signed.
• Notification Requirements: The Secretary of Health and Human Services (through the IHS) must notify both the care provider and the patient within 5 business days of receiving a payment claim, stating that the patient is not responsible for unauthorized costs. This applies to providers, debt collectors, or any other parties.
• Reimbursement Procedures:
• Within 120 days of enactment, the IHS must establish processes (in consultation with tribes) to reimburse patients for out-of-pocket payments on authorized care within 30 days of submitting documentation.
• Documentation can be submitted electronically or in person at an IHS facility.
• This does not apply to care programs run directly by tribes under self-determination contracts unless the tribe agrees.
• Updates to Policies and Documents: Within 180 days of enactment, the IHS must revise the Indian Health Manual, provider contracts, and other administrative materials to reflect these changes.
• Retroactive Application: These protections apply to all authorized purchased/referred care, whether provided before, on, or after the law's enactment.
• Terminology Standardization: Replaces outdated terms like "contract health service" with "purchased/referred care" throughout the Indian Health Care Improvement Act (IHCIA) and related documents. Defines "purchased/referred care" as health services delivered based on an IHS referral or at IHS expense by non-IHS public or private providers.

Significant Changes to Existing Law

• Strengthened Patient Safeguards: Previously, under Section 222 of the IHCIA, patient liability protections were limited and could be undermined by signed agreements. The bill overrides such agreements explicitly and extends protections against debt collectors or other parties.
• New Reimbursement Mechanism: Introduces a mandatory, time-bound reimbursement process for patient payments, which was not previously required in the IHCIA.
• Terminology Overhaul: Eliminates "contract health service" references (over 20 instances) and updates definitions, section headings, and cross-references in the IHCIA to use "purchased/referred care," making the law more precise and consistent. This includes revisions to programs like the California demonstration and emergency care authorizations.
• Administrative Directives: Requires proactive updates to manuals and guidance, ensuring broader implementation beyond the statute itself.

Potential Impacts

• On Government Agencies: The IHS will face initial administrative workload to develop procedures, update documents, and handle reimbursements, but this could streamline long-term operations by reducing disputes over billing. It reinforces the federal government's trust responsibility to provide health care to Native Americans without financial burden.
• On Citizens: Native American patients (primarily those eligible for IHS services) gain stronger protections from medical debt, potentially reducing financial stress and improving access to care. Non-Native providers may see fewer successful collections from these patients.
• On International Relations: No direct impact, as the bill focuses on domestic U.S. tribal health programs.

Main Stakeholders Affected

• Native American Patients and Tribes: Primary beneficiaries through liability shields, easier reimbursements, and input on procedures; tribes operating their own programs have flexibility to opt in or out.
• Indian Health Service (IHS): Responsible for implementation, notifications, and reimbursements, which may require additional resources.
• Healthcare Providers and Debt Collectors: Limited in pursuing payments from patients, potentially shifting reliance on IHS reimbursements; must adhere to new notifications.
• Secretary of Health and Human Services: Oversees updates to manuals and policies.

Notable Legal, Constitutional, or Political Implications

• Legal: Enhances enforceability of patient rights under the IHCIA by preempting conflicting agreements, potentially reducing litigation over medical debts. The retroactive application could affect ongoing claims but provides clarity to avoid future disputes.
• Constitutional: Aligns with the U.S. government's constitutional trust obligation to tribes (rooted in treaties and federal law), promoting equitable health care without imposing undue financial barriers.
• Political: Bipartisan support (introduced by senators from both parties) signals consensus on tribal health issues; may encourage further reforms in IHS funding and efficiency, though implementation costs could spark debates in Congress over agency budgets.

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

Sponsor

Sen. Rounds, Mike [R-SD]

Cosponsors (5)

Sen. Cantwell, Maria [D-WA], Sen. Thune, John [R-SD], Sen. Murray, Patty [D-WA], Sen. Hoeven, John [R-ND], Sen. Cortez Masto, Catherine [D-NV]

Recent Actions

• 2026-02-04: Committee on Indian Affairs. Hearings held.
• 2025-02-24: Read twice and referred to the Committee on Indian Affairs.
• 2025-02-24: Introduced in Senate

Bill Versions

• Purchased and Referred Care Improvement Act of 2025 — issued 2025-02-24 — PDF (10 pages)