Purchased and Referred Care Improvement Act of 2025
Summary
SB 699, 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 purchased/referred care, the system under which IHS authorizes care from outside providers when services are not available directly through an Indian health program. The bill makes clear that patients receiving authorized purchased/referred care are not personally liable for charges or costs associated with that care, even if they signed forms or agreements suggesting otherwise. It also requires the Secretary of Health and Human Services to notify providers and patients of that protection within five business days after a claim is received.
Impact
The bill would revise multiple provisions of the Indian Health Care Improvement Act and related statutes by replacing the older term “contract health services” with “purchased/referred care” throughout the law, manuals, contracts, and guidance. It creates a reimbursement process for patients who paid out-of-pocket for authorized purchased/referred care, requiring the Service to reimburse eligible patients within 30 days after documentation is submitted, while preserving tribal control where a tribe operates its own program under self-determination contracts or compacts unless the tribe agrees otherwise. The measure also makes conforming and technical changes to section headings, definitions, and related Public Health Service Act references, and applies the liability protections to purchased/referred care furnished on, before, or after enactment.
Sentiment
The available context suggests generally favorable treatment of the bill. It was introduced by Senator Rounds with bipartisan support from Senators Cantwell, Thune, and Murray, and the committee status indicates hearings were held in the Senate Committee on Indian Affairs. No recorded votes or opposing statements are provided in the materials, which suggests the measure was being advanced as a technical and patient-protection update rather than a controversial policy overhaul.
Contention
The main policy issue is the scope of patient liability protection and reimbursement. The bill bars providers, debt collectors, and others from pursuing patients for covered charges, which strongly favors patients but could raise implementation concerns for providers and administrators about payment recovery and notice procedures. A second point of sensitivity is tribal authority: the reimbursement requirement does not automatically apply to tribally operated purchased/referred care programs unless the tribe expressly agrees, reflecting an effort to avoid federal overreach into tribal self-determination. The bill also requires broad terminology changes across statutes and administrative materials, which is largely technical but may require significant agency updating and coordination.