PlainBillCongress, translated.Legislation. Context. Public interest.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.
Congressional Research Service
Version 00 · Introduced in House · Feb 18, 2025
Purchased and Referred Care Improvement Act of 2025
This bill specifies that the Indian Health Service (IHS) must reimburse patients for their out-of-pocket costs for authorized purchased/referred care services within 30 days. (The IHS provides medical and dental services directly to American Indian and Alaska Native patients whenever possible. However, when services are not available, IHS beneficiaries may be referred to private providers. This is called purchased/referred care.)
Specifically, the bill requires the Department of Health and Human Services (HHS) to establish and implement procedures to allow a patient who paid out of pocket for purchased/referred care services authorized by the IHS to be reimbursed by the IHS for that payment no later than 30 days after the patient submits required documentation.
Additionally, the bill requires HHS to 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 the bill.
The bill also replaces statutory references to contract health service with purchased/referred care.
People & committees
Rep. Johnson, Dusty [R-SD-At Large] · R–SD
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
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.
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.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: May 14, 2025. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-18 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Purchased and Referred Care Improvement Act of 2025 would revise payment-liability protections for patients and require reimbursement when patients pay out of pocket for care authorized by the Indian Health Service. The reimbursement requirements would apply to certain tribally operated programs only if the Tribe expressly agrees. The bill would also replace older terminology with “purchased/referred care,” the name used for the care covered by these provisions.
This Act may be cited as the Purchased and Referred Care Improvement Act of 2025.
by inserting to any provider, debt collector, or any other person after is not liable
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
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.
by striking contract health service each place it appears (regardless of casing and typeface and including in the headings) and inserting purchased/referred care
Section 2 would add language making the existing patient-liability provisions apply despite conflicting laws or documents signed by a patient. The supplied text does not reproduce the existing provisions in full, so it does not establish every condition of those protections.
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
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
The bill would expressly include providers, debt collectors and any other person in the existing subsection stating that a patient is not liable. It would also add debt collectors and other persons to subsection (c); that subsection's underlying requirements are not reproduced.
by inserting to any provider, debt collector, or any other person after is not liable
in subsection (c), by inserting , the debt collector, or any other person, as applicable after the provider
Within 120 days after enactment, the Secretary would have to establish and implement reimbursement procedures in consultation with Indian Tribes. Patients who paid out of pocket for qualifying care authorized by the Service would have to be reimbursed within 30 days after submitting documentation.
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).
The Secretary would have to accept reimbursement documentation submitted electronically or in person at a Service facility.
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.
The reimbursement subsection would not apply to care furnished through a tribal program operated under an Indian Self-Determination and Education Assistance Act compact or contract—a specified agreement for tribal operation—unless the Tribe expressly agrees. This exception is limited to the reimbursement subsection.
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.
Within 180 days after enactment, the Secretary would have to consult Indian Tribes and update the relevant Indian Health Manual provisions and exhibits, provider contracts, and other documents and administrative authorities to incorporate the payment-liability provisions.
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.
Section 2's amendments would apply to purchased/referred care authorized by the Indian Health Service and furnished before, on or after enactment. Their application would therefore include previously furnished care.
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.
Sections 2 and 3 would replace older “contract” care terminology with “purchased/referred care.” Section 3 would change the heading and opening language of an existing definition and replace “contract health service” throughout the Indian Health Care Improvement Act, including headings. The rest of the definition is not supplied.
by striking contract health care and inserting purchased/referred care
by striking contract care each place it appears and inserting purchased/referred care
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
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).
Section 3 would also direct the Secretary of Health and Human Services to replace the old terminology in the Indian Health Manual and other relevant rules, guidance and materials.
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).
The supplied official-actions snapshot, updated May 14, 2025, records introduction in the House and referral to the Natural Resources and Energy and Commerce committees on February 18, 2025. This snapshot does not establish subsequent action or enactment.
Source snapshot updated 2025-05-14T14:16:33Z.
2025-02-18: Introduced in House
2025-02-18: 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 closer look
Reviewed version: Introduced in House · 2025-02-18. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish what other versions or accompanying materials contain.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark disclosures and accompanying materials are not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied text contains a specific tribal-program exception to the reimbursement requirements. Classifying this exception does not establish that it is improper.
Indian Tribes operating purchased/referred care programs under the specified compacts or contracts would retain the choice whether the new reimbursement subsection applies to their programs. This is a narrow exception within the bill's main reimbursement policy.
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.
Full text preserved for this analysis. Legislative record snapshot: May 14, 2025. How PlainBill uses AI