I 
119TH CONGRESS 
1ST SESSION H. R. 1418 
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 
FEBRUARY 18, 2025 
Mr. JOHNSON of South Dakota (for himself and Ms. SCHRIER) 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 consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend the Indian Health Care Improvement Act to ad-
dress liability for payment of charges or costs associated 
with provision of purchased/referred care services, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Purchased and Re-
ferred Care Improvement Act of 2025’’. 
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SEC. 2. CHANGES TO LIABILITY FOR PAYMENT. 
(a) IN GENERAL.—Section 222 of the Indian Health 
Care Improvement Act (25 U.S.C. 1621u) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘A patient’’ and inserting 
‘‘Notwithstanding any other provision of law or 
any agreement, form, or other written or elec-
tronic document signed by a patient, a patient’’; 
and 
(B) by striking ‘‘contract health care’’ and 
inserting ‘‘purchased/referred care’’; 
(2) in subsection (b)— 
(A) by striking ‘‘contract care’’ each place 
it appears and inserting ‘‘purchased/referred 
care’’; 
(B) by striking ‘‘contract health care’’ and 
inserting ‘‘purchased/referred care’’; 
(C) by inserting ‘‘, notwithstanding any 
other provision of law or any agreement, form, 
or other written or electronic document signed 
by a patient,’’ after ‘‘by the Service that’’; and 
(D) by inserting ‘‘to any provider, debt col-
lector, or any other person’’ after ‘‘is not lia-
ble’’; 
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(3) in subsection (c), by inserting ‘‘, the debt 
collector, or any other person, as applicable’’ after 
‘‘the provider’’; and 
(4) by adding at the end the following: 
‘‘(d) REIMBURSEMENT.— 
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of the enactment of this subsection 
and in consultation with Indian Tribes, the Sec-
retary shall establish and implement procedures to 
allow a patient that paid out-of-pocket for pur-
chased/referred care services authorized by the Serv-
ice under this Act to be reimbursed by the Service 
for that payment not later than 30 days after the 
patient submits documentation to the Service pursu-
ant to paragraph (2). 
‘‘(2) SUBMITTING DOCUMENTATION.—The Sec-
retary shall accept documentation from a patient 
seeking reimbursement under paragraph (1) that 
was submitted— 
‘‘(A) electronically; or 
‘‘(B) in-person at a Service facility. 
‘‘(3) EFFECT.—The preceding provisions of this 
subsection shall not apply to purchased/referred care 
service furnished under a purchased/referred care 
services program operated by an Indian Tribe under 
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an Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 5301 et seq.) compact or con-
tract unless expressly agreed to by the Indian Tribe. 
‘‘(e) UPDATING AUTHORITIES.—Not later than 180 
days of the enactment of this subsection and in consulta-
tion with Indian Tribes, the Secretary shall update appli-
cable provisions of and exhibits to the Indian Health Man-
ual, contracts with providers, and other relevant docu-
ments and administrative authorities to incorporate the 
provisions of this section.’’. 
(b) APPLICATION.—The amendments made by this 
section shall apply to purchased/referred care services au-
thorized by the Indian Health Service furnished on, be-
fore, or after the date of the enactment of this Act. 
SEC. 3. TECHNICAL AMENDMENTS. 
(a) DEFINITIONS.—Section 4(5) of the Indian Health 
Care Improvement Act (25 U.S.C. 1603) is amended by 
striking the paragraph designation and heading and all 
that follows through ‘‘means’’ and inserting the following: 
‘‘(5) PURCHASED/REFERRED CARE.—The term 
‘purchased/referred care’ means’’. 
(b) TECHNICAL AMENDMENTS.—The Indian Health 
Care Improvement Act (25 U.S.C. 1601 et seq.) is amend-
ed by striking ‘‘contract health service’’ each place it ap-
pears (regardless of casing and typeface and including in 
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