Purchased and Referred Care Improvement Act of 2025
The Purchased and Referred Care Improvement Act of 2025 would overhaul how the Indian Health Service’s Purchased/Referred Care (PRC) program handles charges, payer liability, and reimbursements. Key changes include renaming the program terminology from “contract health care” to “purchased/referred care,” expanding protections to prevent patients from being liable for PRC charges (even if they signed agreements or forms that would otherwise make them responsible), and extending liability protections to providers and debt collectors. The bill also creates a new requirement that the Secretary reimburse patients who paid out-of-pocket for PRC services within 30 days after the patient submits documentation, with documentation accepted electronically or in person. It sets a 120-day deadline to establish reimbursement procedures and requires updates to relevant manuals and documents. Tribal PRC programs would be able to opt out of the reimbursement provision unless a Tribe expressly agrees otherwise. The changes apply to PRC services furnished on or after enactment.
Key Points
- 1Terminology reform: Counts “purchased/referred care” as the official term, replacing “contract health care” throughout the Indian Health Care Improvement Act and related documents.
- 2Expanded patient protection: A patient is not liable for PRC charges, and this protection applies notwithstanding any other law or any patient-signed agreement or document; language also shields providers, debt collectors, or other persons from liability to the patient for PRC-related charges.
- 3Reimbursement for out-of-pocket payments: If a patient pays out-of-pocket for PRC services authorized by the Service, the Secretary must reimburse the patient within 30 days after the patient submits documentation (which may be electronic or in-person). Reimbursement procedures must be established within 120 days of enactment.
- 4Tribal PRC programs: Reimbursement provisions do not automatically apply to PRC services provided under tribal self-determination contracts or compacts unless the Tribe expressly agrees.
- 5Implementation and updates: The bill requires updating the Indian Health Manual and other documents to reflect the new terminology and processes within defined timelines (e.g., 180 days for updating manuals).