119-s699

[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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