S 699119th CongressIn Committee

Purchased and Referred Care Improvement Act of 2025

Introduced: Feb 24, 2025

Standard Summary

Comprehensive overview in 1-2 paragraphs

Purchased and Referred Care Improvement Act of 2025 (S. 699) would reform how liability for charges related to purchased/referred care (PRC) is handled under the Indian Health Care Improvement Act. The bill shifts liability protections to patients receiving PRC, clarifies that patients and debt collectors cannot seek payment from patients for PRC services, and imposes a mandatory notification process. It also creates a reimbursement pathway for patients who have already paid out-of-pocket and updates terminology and numerous statutory provisions to reflect the shift from “contract health services” to “purchased/referred care.” In addition, the bill establishes a California PRC demonstration program and a PRC payment study, and directs updates to the Indian Health Manual and related documents to reflect these changes. The changes would apply to PRC authorized by IHS regardless of when the care is furnished (before, on, or after enactment). In short, the bill aims to protect American Indian and Alaska Native patients from paying for PRC services out-of-pocket, standardize how such charges are handled, and modernize the statutory framework to reflect PRC as the operating term for external care paid for or arranged by IHS.

Key Points

1Liability protections for PRC patients and debt collectors
2- Notwithstanding other laws or signed documents, a patient who receives PRC cannot be held liable to any provider, debt collector, or other person for charges or costs of PRC.
3- The patient’s lack of liability is communicated to both the PRC provider and the patient within 5 business days after the provider submits a claim, ensuring prompt clarity.
4Reimbursement for out-of-pocket PRC payments
5- The Secretary must establish procedures to reimburse a patient who paid out-of-pocket for PRC within 30 days after the patient submits documentation.
6- Documentation can be submitted electronically or in person at a Service facility.
7- The reimbursement provision does not apply to PRC furnished under a tribal program operated under a contract/compact unless the tribe expressly agrees.
8Terminology and structural updates
9- Replaces references to “contract health services” with “purchased/referred care” throughout the Indian Health Care Improvement Act and related laws and headings.
10- Creates and updates related sections (e.g., California PRC Demonstration Program, PRC Payment Study, emergency PRC authorization) to align with the purchased/referred care framework.
11- Requires updating the Indian Health Manual, provider contracts, and other materials to consistently use “purchased/referred care.”
12Demonstration and study components
13- Sec. 211 establishes a California purchased/referred care demonstration program.
14- Sec. 219 creates a PRC payment study to examine payments and related issues.
15Scope and implementation
16- The changes apply to PRC authorized by IHS and furnished on, before, or after enactment.
17- The act requires administrative updates within defined timeframes (e.g., reimbursement procedures within 120 days for establishment; updating materials within 180 days).

Impact Areas

Primary group/area affected- American Indian and Alaska Native patients who receive purchased/referred care through IHS, and the PRC providers who serve them.- Indian Health Service and tribal health programs administering PRC.Secondary group/area affected- Private and public PRC providers and debt collectors; providers would receive notifications and be barred from patient liability for PRC charges.- Tribal governments operating PRC under self-determination contracts/compacts, which may have exceptions if expressly agreed to by the tribe.Additional impacts- Administrative and fiscal: potential cost implications for reimbursing out-of-pocket payments and implementing new notification and documentation procedures.- Data and oversight: creation of CA demonstration program and a PRC payment study to inform policy, with potential implications for future reforms.- Operational terminology: widespread rebranding of contracts, manuals, and guidance to reflect the purchased/referred care framework, affecting internal workflows and communications.

Generated by gpt-5-nano on Nov 18, 2025