Purchased and Referred Care Improvement Act of 2025
Summary
The Purchased and Referred Care Improvement Act of 2025 amends the Indian Health Care Improvement Act to update how the Indian Health Service (IHS) handles liability and reimbursement for purchased/referred care services, which are outside medical services authorized by IHS. The bill makes clear that patients are not liable for charges or costs for authorized care, even if they signed an agreement or form suggesting otherwise, and it extends that protection to claims made by providers, debt collectors, or other third parties.
The bill also creates a reimbursement process for patients who paid out of pocket for authorized purchased/referred care. Within 120 days of enactment, the Secretary of Health and Human Services must establish procedures, in consultation with Tribes, to reimburse patients within 30 days after they submit documentation, including electronically or in person at an IHS facility. The bill further directs HHS to update the Indian Health Manual, provider contracts, and related guidance, and it applies these changes to services furnished before, on, or after enactment. It also makes technical terminology changes throughout the statute, replacing older references to “contract health service” with “purchased/referred care.”
Impact
If enacted, the bill would strengthen federal protections for Native patients receiving IHS-authorized outside care by limiting billing liability and requiring a formal reimbursement mechanism for out-of-pocket payments. It would amend sections of the Indian Health Care Improvement Act, revise statutory definitions, and require HHS to conform manuals, contracts, rules, and other administrative materials to the new terminology and payment rules. The bill also preserves tribal sovereignty by exempting tribal self-determination compact or contract programs unless a Tribe expressly agrees to the new requirements.
Sentiment
The available context suggests generally positive and bipartisan support for the bill’s purpose, as reflected by its introduction by Representative Johnson of South Dakota with Representative Schrier, indicating cross-party sponsorship. No committee transcripts or votes are provided, so there is no recorded opposition or formal vote history in the materials. The bill’s framing as an improvement to patient protections and reimbursement procedures suggests a constructive, technical, and health-care-focused policy effort.
Contention
The main potential point of contention is the scope of federal reimbursement and liability protections, especially the requirement that IHS reimburse patients who paid out of pocket and the retroactive application to services furnished before enactment. Another possible issue is the interaction with tribal self-determination programs, since the bill excludes tribal-operated purchased/referred care programs unless a Tribe agrees otherwise. No specific objections are documented in the provided materials, but these are the areas most likely to raise implementation or jurisdictional concerns.