,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #adah  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,febru>y #ah1         
#bjbe,mr4 ,johnson ( ,s\? ,dakota 7=    
himself & ,ms4 ,s*ri]7 introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,natural ,res\rces1 & 9   
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d ! ,indian ,heal? ,c>e 
,improvem5t ,act to address liability = 
paym5t ( *>ges or co/s associat$ )      
provision ( pur*as$_/ref]r$ c>e s]vices1
 & = o!r purposes4  #a4 ,%ort title ,?is
 ,act may be cit$ z ! ,pur*as$ & ,ref]r$
 ,c>e ,improvem5t ,act ( #bjbe4  #b4    
,*anges to liability = paym5t  7a7 ,9   
g5]al ,section #bbb ( ! ,indian ,heal?  
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afbau7 is am5d$--  7#a7 9 subsection   
7a7-- 7,a7 by /rik+ ,a pati5t & ins]t+  
,not)/&+ any o!r provision ( law or any 

agreem5t1 =m1 or o!r writt5 or          
electronic docum5t sign$ by a pati5t1 a 
pati5t2 &  7,b7 by /rik+ contract heal? 
c>e & ins]t+ pur*as$_/ref]r$ c>e2  7#b7 
9 subsection 7b7--  7,a7 by /rik+       
contract c>e ea* place x appe>s & ins]t+
 pur*as$_/ref]r$ c>e2  7,b7 by /rik+    
contract heal? c>e & ins]t+             
pur*as$_/ref]r$ c>e2  7,c7 by ins]t+ 1  
not)/&+ any o!r provision ( law or any  
agreem5t1 =m1 or o!r writt5 or          
electronic docum5t sign$ by a pati5t1   
aft] by ! ,s]vice t2 &  7,d7 by ins]t+  
to any provid]1 debt collector1 or any  
o!r p]son aft] is n liable2  7#c7 9     
subsection 7c71 by ins]t+ 1 ! debt      
collector1 or any o!r p]son1 z          
applicable aft] ! provid]2 &  7#d7 by   
add+ at ! end ! foll[+3  7d7            
,reimbursem5t  7#a7 ,9 g5]al ,n lat] ?an
 #abj days aft] ! date ( ! enactm5t (   
?is subsection & 9 consultation )       
,indian ,tribes1 ! ,secret>y %all       
e/abli% & implem5t proc$ures to all[ a  
pati5t t paid out-(-pocket =            

pur*as$_/ref]r$ c>e s]vices au?oriz$ by 
! ,s]vice "u ?is ,act to be reimburs$ by
 ! ,s]vice = t paym5t n lat] ?an #cj    
days aft] ! pati5t submits docum5tation 
to ! ,s]vice pursuant to p>agraph 7#b74 
7#b7 ,submitt+ docum5tation ,! ,secret>y
 %all accept docum5tation f a pati5t    
seek+ reimbursem5t "u p>agraph 7#a7 t 0 
submitt$--  7,a7 electronically2 or     
7,b7 9-p]son at a ,s]vice facility4     
7#c7 ,effect ,! prec$+ provisions ( ?is 
subsection %all n apply to              
pur*as$_/ref]r$ c>e s]vice furni%$ "u a 
pur*as$_/ref]r$ c>e s]vices program     
op]at$ by an ,indian ,tribe "u an       
,indian ,self-,det]m9ation & ,education 
,assi/ance ,act 7#be ,u4,s4,c4 #ecja et 
seq47 compact or contract unless        
expressly agre$ to by ! ,indian ,tribe4 
7e7 ,updat+ au?orities ,n lat] ?an #ahj 
days ( ! enactm5t ( ?is subsection & 9  
consultation ) ,indian ,tribes1 !       
,secret>y %all update applicable        
provisions ( & exhibits to ! ,indian    
,heal? ,manual1 contracts ) provid]s1 & 

o!r relevant docum5ts & adm9i/rative    
au?orities to incorporate ! provisions (
 ?is section4  4  7b7 ,application ,!   
am5dm5ts made by ?is section %all apply 
to pur*as$_/ref]r$ c>e s]vices au?oriz$ 
by ! ,indian ,heal? ,s]vice furni%$ on1 
be=e1 or aft] ! date ( ! enactm5t ( ?is 
,act4  #c4 ,te*nical am5dm5ts  7a7      
,def9itions ,section #d7e7 ( ! ,indian  
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #afjc7 is am5d$ by /rik+ !    
p>agraph designation & head+ & all t    
foll[s ?r\gh means & ins]t+ ! foll[+3   
7#e7 ,pur*as$_/ref]r$ c>e ,! t]m        
pur*as$_/ref]r$ c>e means  4  7b7       
,te*nical am5dm5ts ,! ,indian ,heal?    
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afja et seq47 is am5d$ by /rik+        
contract heal? s]vice ea* place x appe>s
 7reg>dless ( cas+ & typeface & includ+ 
9 ! head+s7 & ins]t+ pur*as$_/ref]r$ c>e
 7) appropriate cas+ & typeface74  7c7  
,updat+ au?orities ,! ,secret>y ( ,heal?
 & ,human ,s]vices is direct$ to ensure 
t ! ,indian ,heal? ,manual & all o!r    

relevant rules1 guidance1 manuals1 & o!r
 mat]ials are revis$ su* t contract     
heal? s]vice1 ea* place x appe>s        
7reg>dless ( cas+ & typeface & includ+ 9
 ! head+s7 is revis$ to read            
pur*as$_/ref]r$ c>e 7) appropriate cas+ 
& typeface74