Purchased and Referred Care Improvement Act of 2025
- Sponsor
- Sen. Rounds, Mike [R-SD]
- Committees
- Indian Affairs Committee (primary)
- Last action
- Feb 4, 2026
Bottom line
The bill aims to protect Native American patients from medical debt for IHS-authorized care by clarifying financial liability, mandating notifications, and creating a patient reimbursement system, thereby strengthening the federal trust responsibility for healthcare.
What it actually does
This bill amends the Indian Health Care Improvement Act to explicitly state that Native American patients are not liable for charges or costs associated with purchased/referred care services authorized by the Indian Health Service (IHS). It mandates IHS to notify both providers and patients of this non-liability and establishes a process for patients to be reimbursed for out-of-pocket payments for such care, including retroactively. Additionally, it redefines 'purchased/referred care' and makes numerous technical and conforming amendments throughout related statutes.
Proponents argue
Proponents argue that this bill closes a critical loophole that has historically left Native American patients vulnerable to medical debt for services they believed were covered by IHS. It ensures that the promise of healthcare through IHS is fully realized by removing financial barriers and administrative burdens on patients, aligning with the federal trust responsibility and rectifying past injustices.
Opponents contend
No direct opposition is immediately apparent for a bill that clarifies patient non-liability and improves reimbursement for a specific population. Potential concerns might arise from the administrative burden on IHS or the financial implications if not adequately funded, but these are typically framed as implementation challenges rather than opposition to the core intent of protecting patients.
The bill is concise and its core provisions are clearly articulated, allowing for a quick and informed evaluation by interested readers.
Section 2(a)(1) amending Section 222(a) of the Indian Health Care Improvement Act
Establishes Patient Non-Liability for Purchased/Referred Care Costs
This provision clarifies that Native American patients receiving purchased/referred care authorized by the Indian Health Service (IHS) are not financially responsible for any charges or costs associated with that care. This applies regardless of any agreements or forms the patient may have signed, explicitly overriding other laws or documents to protect patients from unexpected bills.
Supporters argue
Supporters argue this provision is crucial for fulfilling the federal trust responsibility to provide healthcare to Native Americans. It removes a significant financial barrier to care, preventing medical debt and ensuring patients can access necessary services without fear of unexpected bills.
Critics contend
No direct opposition to the principle of patient non-liability, but some might raise concerns about the potential administrative burden on IHS or the need for adequate funding to cover all authorized services without shifting costs elsewhere.
Tradeoffs
Balances patient protection from medical debt against the administrative and financial capacity of the IHS to manage all authorized care payments.
Section 2(a)(2) amending Section 222(b) of the Indian Health Care Improvement Act
Mandates Notification of Patient Non-Liability
This provision requires the Secretary of Health and Human Services (via IHS) to notify both the purchased/referred care provider and the patient that the patient is not liable for costs associated with authorized care. This notification must occur within 5 business days of receiving a claim from the provider, ensuring all parties are aware of the payment structure.
Section 2(a)(4) adding Section 222(d) to the Indian Health Care Improvement Act
Establishes Patient Reimbursement for Out-of-Pocket Payments
This provision mandates the Secretary, in consultation with Indian tribes, to establish procedures within 120 days for reimbursing patients who paid out-of-pocket for IHS-authorized purchased/referred care. Reimbursement must occur within 30 days of the patient submitting documentation, which can be done electronically or in-person. This reimbursement requirement does not apply to tribal-operated programs unless the tribe expressly agrees.
Section 3(a) and 3(b)
Redefines 'Purchased/Referred Care' and Makes Conforming Amendments
This section strikes the old definition of 'contract health services' and introduces a new definition for 'purchased/referred care' as any health service delivered based on a referral by, or at the expense of, an Indian health program, and provided by a non-IHS public or private medical provider or hospital. It then makes numerous technical and conforming amendments throughout the Indian Health Care Improvement Act and other related statutes, replacing 'contract health service(s)' with 'purchased/referred care' to standardize terminology.
States that the amendments made by subsection (a) (regarding patient non-liability and reimbursement) shall apply to purchased/referred care authorized by the Indian Health Service furnished 'on, before, or after the date of enactment of this Act.'
Section 2(b)
Why it matters:This is standard legislative practice for effective dates, but its retroactive nature is highly significant for patients who have historically faced these issues.
Case for: Supporters would argue that retroactive application is critical to address historical injustices where Native American patients were wrongly billed or paid out-of-pocket for services that should have been covered. It ensures that the protections extend to past cases, providing comprehensive relief.
Case against: Critics might raise concerns about the administrative complexity and potential financial burden on IHS to process potentially a large volume of retroactive reimbursement claims, especially if records are incomplete or difficult to verify for older cases.
Estimated impact: Potentially significant financial impact on IHS due to past reimbursements, and a major positive impact for patients who previously incurred costs.