IB 

Union Calendar No. 748 

118TH CONGRESS 

2D SESSION H. R. 7516 

[Report No. 118–916, Part I] 

To amend the Indian Health Care Improvement Act to address liability 

for payment of charges or costs associated with provision of purchased/ 

referred care services, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 1, 2024 

Mr. JOHNSON of South Dakota (for himself, Ms. SCHRIER, Mrs. RODGERS of 

Washington, Ms. LEGER FERNANDEZ, and Mr. ZINKE) introduced the 

following bill; which was referred to the Committee on Natural Resources, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

DECEMBER 18, 2024 

Additional sponsors: Mr. NEWHOUSE, Ms. DAVIDS of Kansas, Mr. DAVIS of 

North Carolina, Mr. COLE, Ms. STANSBURY, Mrs. PELTOLA, and Mr. NEGUSE

DECEMBER 18, 2024 

Reported from the Committee on Natural Resources with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

DECEMBER 18, 2024 

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on March 1, 2024] 


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•HR 7516 RH

A BILL 

To amend the Indian Health Care Improvement Act to address liability for payment of charges or costs associated 

with provision of purchased/referred care services, and 

for other purposes. 


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•HR 7516 RH

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Purchased and Referred 

5 Care Improvement Act of 2024’’. 

6 SEC. 2. CHANGES TO LIABILITY FOR PAYMENT. 

7 (a) IN GENERAL.—Section 222 of the Indian Health 

8 Care Improvement Act (25 U.S.C. 1621u) is amended— 

9 (1) in subsection (a)— 

10 (A) by striking ‘‘A patient’’ and inserting 

11 ‘‘Notwithstanding any other provision of law or 

12 any agreement, form, or other written or elec13 tronic document signed by a patient, a patient’’; 

14 and 

15 (B) by striking ‘‘contract health care’’ and 

16 inserting ‘‘purchased/referred care’’; 

17 (2) in subsection (b)— 

18 (A) by striking ‘‘contract care’’ each place it 

19 appears and inserting ‘‘purchased/referred care’’; 

20 (B) by striking ‘‘contract health care’’ and 

21 inserting ‘‘purchased/referred care’’; 

22 (C) by inserting ‘‘, notwithstanding any 

23 other provision of law or any agreement, form, 

24 or other written or electronic document signed by 

25 a patient,’’ after ‘‘by the Service that’’; and 


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1 (D) by inserting ‘‘to any provider, debt col2 lector, or any other person’’ after ‘‘is not liable’’; 

3 (3) in subsection (c), by inserting ‘‘, the debt col4 lector, or any other person, as applicable’’ after ‘‘the 

5 provider’’; and 

6 (4) by adding at the end the following: 

7 ‘‘(d) REIMBURSEMENT.— 

8 ‘‘(1) IN GENERAL.—Not later than 120 days 

9 after the date of the enactment of this subsection and 

10 in consultation with Indian Tribes, the Secretary 

11 shall establish and implement procedures to allow a 

12 patient that paid out-of-pocket for purchased/referred 

13 care services authorized by the Service under this Act 

14 to be reimbursed by the Service for that payment not 

15 later than 30 days after the patient submits docu16 mentation to the Service pursuant to paragraph (2). 

17 ‘‘(2) SUBMITTING DOCUMENTATION.—The Sec18 retary shall accept documentation from a patient 

19 seeking reimbursement under paragraph (1) that was 

20 submitted— 

21 ‘‘(A) electronically; or 

22 ‘‘(B) in-person at a Service facility. 

23 ‘‘(3) EFFECT.—The preceding provisions of this 

24 subsection shall not apply to purchased/referred care 

25 service furnished under a purchased/referred care 


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1 services program operated by an Indian Tribe under 

2 an Indian Self-Determination and Education Assist3 ance Act (25 U.S.C. 5301 et seq.) compact or contract 

4 unless expressly agreed to by the Indian Tribe. 

5 ‘‘(e) UPDATING AUTHORITIES.—Not later than 180 

6 days of the enactment of this subsection and in consultation 

7 with Indian Tribes, the Secretary shall update applicable 

8 provisions of and exhibits to the Indian Health Manual, 

9 contracts with providers, and other relevant documents and 

10 administrative authorities to incorporate the provisions of 

11 this section.’’. 

12 (b) APPLICATION.—The amendments made by this sec13 tion shall apply to purchased/referred care services author14 ized by the Indian Health Service furnished on, before, or 

15 after the date of the enactment of this Act. 

16 SEC. 3. TECHNICAL AMENDMENTS. 

17 (a) DEFINITIONS.—Section 4(5) of the Indian Health 

18 Care Improvement Act (25 U.S.C. 1603) is amended by 

19 striking the paragraph designation and heading and all 

20 that follows through ‘‘means’’ and inserting the following: 

21 ‘‘(5) PURCHASED/REFERRED CARE.—The term 

22 ‘purchased/referred care’ means’’. 

23 (b) TECHNICAL AMENDMENTS.—The Indian Health 

24 Care Improvement Act (25 U.S.C. 1601 et seq.) is amended 

25 by striking ‘‘contract health service’’ each place it appears 


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1 (regardless of casing and typeface and including in the 

2 headings) and inserting ‘‘purchased/referred care’’ (with 

3 appropriate casing and typeface). 

4 (c) UPDATING AUTHORITIES.—The Secretary of 

5 Health and Human Services is directed to ensure that the 

6 Indian Health Manual and all other relevant rules, guid7 ance, manuals, and other materials are revised such that 

8 ‘‘contract health service’’, each place it appears (regardless 

9 of casing and typeface and including in the headings) is 

10 revised to read ‘‘purchased/referred care’’ (with appropriate 

11 casing and typeface). 


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Union Calendar No. 748 

118TH CONGRESS 

2D SESSION H. R. 7516 

[Report No. 118–916, Part I] 

A BILL 

To amend the Indian Health Care Improvement 

ferred care services, and for other purposes. costs associated with provision of purchased/reAct to address liability for payment of charges or 

DECEMBER 18, 2024 

Reported from the Committee on Natural Resources with 

an amendment 

DECEMBER 18, 2024 

Committee on Energy and Commerce discharged; comState of the Union and ordered to be printed mitted to the Committee of the Whole House on the 


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