H.R. 1418 — Purchased and Referred Care Improvement Act of 2025

This section provides the short title of the Act as the “Purchased and Referred Care Improvement Act of 2025.”

This section revises the Indian Health Care Improvement Act’s patient-liability rules for purchased/referred care services under 25 U.S.C. § 1621u by (1) making clear that a patient is not liable for charges or costs notwithstanding any other law or any agreement, form, or other written or electronic document signed by the patient; (2) replacing references to “contract health care” and “contract care” with “purchased/referred care”; and (3) extending the no-recourse rule to bar claims by the provider, debt collector, or any other person, as applicable, against the patient after notice is provided or a claim is deemed accepted. This section also establishes a reimbursement process for patients who paid out of pocket for Service-authorized purchased/referred care, requiring the Secretary of Health and Human Services, within 120 days of enactment and in consultation with Indian Tribes, to implement procedures to reimburse the patient within 30 days after documentation is submitted electronically or in person at a Service facility. As background, purchased/referred care is the Indian Health Service’s system for paying outside providers when care is not available directly through Service facilities. The reimbursement requirements do not apply to tribal purchased/referred care programs operated under an Indian Self-Determination and Education Assistance Act compact or contract unless the Tribe expressly agrees. Finally, this section requires the Secretary, within 180 days of enactment and in consultation with Indian Tribes, to update the Indian Health Manual, provider contracts, and related administrative authorities, and applies these changes to Service-authorized purchased/referred care furnished on, before, or after enactment.

This section revises the Indian Health Care Improvement Act’s terminology by replacing “contract health service” with “purchased/referred care” throughout the Act, including in headings, and by amending 25 U.S.C. § 1603 to strike the existing definition heading and replace it with “(5) Purchased/referred care The term ‘purchased/referred care’ means.” It also directs the Secretary of Health and Human Services to update the Indian Health Manual and all other relevant rules, guidance, manuals, and related materials to conform to the new terminology. (Thus, the provision makes a technical, non-substantive terminology change across the statute and implementing materials for the Indian Health Service’s referral-based purchased care program.)