I 119th CONGRESS 1st Session H. R. 1418 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 consideration of such provisions as fall within the jurisdiction of the committee concerned 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.

1. Short title This Act may be cited as the Purchased and Referred Care Improvement Act of 2025 . 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 electronic 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 collector, or any other person after is not liable ; (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 Secretary shall establish and implement procedures to allow a patient that paid out-of-pocket for purchased/referred care services authorized by the Service 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 pursuant to paragraph (2). (2) Submitting documentation The Secretary 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 an Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5301 et seq. ) compact or contract unless expressly agreed to by the Indian Tribe. (e) Updating authorities Not later than 180 days of the enactment of this subsection and in consultation with Indian Tribes, the Secretary shall update applicable provisions of and exhibits to the Indian Health Manual, contracts with providers, and other relevant documents 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 authorized by the Indian Health Service furnished on, before, or after the date of the enactment of this Act. 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 amended by striking contract health service each place it appears (regardless of casing and typeface and including in the headings) and inserting purchased/referred care (with appropriate casing and typeface). (c) Updating authorities The Secretary of Health and Human Services is directed to ensure that the Indian Health Manual and all other relevant rules, guidance, manuals, and other materials are revised such that contract health service , each place it appears (regardless of casing and typeface and including in the headings) is revised to read purchased/referred care (with appropriate casing and typeface).