Purchased and Referred Care Improvement Act of 2025
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Would require the Indian Health Service to reimburse patients for authorized out-of-pocket care costs within 30 days of documentation.
What it does
This bill would require the Indian Health Service (IHS) to reimburse patients for out-of-pocket costs related to authorized medical or dental services received from private providers. Under the proposal, the Department of Health and Human Services would be required to issue these reimbursements within 30 days of receiving the necessary documentation. Additionally, the bill would update the Indian Health Manual and provider contracts to reflect these requirements and officially change statutory references from "contract health service" to "purchased/referred care."
Who is affected
This bill affects American Indian and Alaska Native patients who receive authorized medical or dental services through the Indian Health Service (IHS) purchased/referred care program. It also impacts the Department of Health and Human Services and the IHS, which must implement new reimbursement procedures and update administrative manuals. Additionally, private healthcare providers who contract with the IHS for referred services are affected by required updates to their service contracts.
Key provisions
- Reimbursement for out-of-pocket medical expenses. Requires the Indian Health Service (IHS) to reimburse patients for out-of-pocket costs related to authorized purchased or referred care services. Payments must be issued within 30 days of the patient submitting the necessary documentation.
- Administrative updates to health manuals and contracts. Directs the Department of Health and Human Services to update the Indian Health Manual, provider contracts, and other administrative authorities to reflect the new reimbursement procedures.
- Standardization of program terminology. Replaces existing statutory references to 'contract health service' with the term 'purchased/referred care' to align with current agency terminology.
Fiscal impact
Not applicable: No CBO cost estimate available
Effective dates
Not applicable: Official Summary does not address effective dates
Relationship to existing law
The bill modifies the administration of the Indian Health Service (IHS) purchased/referred care program by requiring updates to the Indian Health Manual and provider contracts. It also replaces the statutory term "contract health service" with "purchased/referred care" throughout relevant administrative authorities.
Stated purpose
The bill aims to ensure timely reimbursement for American Indian and Alaska Native patients who pay out of pocket for authorized medical or dental services received through private providers. It establishes a 30-day deadline for the Indian Health Service to process these reimbursements and requires updates to administrative manuals and contracts to reflect this requirement.