,,ii #aaith ,,congress #ast ,session ,s4 #fii ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bd1 #bjbe,mr4 ,rounds 7for himself1 ,ms4 ,cantwell1 ,mr4 ,thune1 and ,mrs4 ,murray7 introduced the following bill2 which was read twice and referred to the ,committee on ,indian ,affairs ,a ,,bill ,to amend the ,indian ,health ,care ,improvement ,act to address liability for payment of charges or costs associated with the provision of purchased_/referred care services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,purchased and ,referred ,care ,improvement ,act of #bjbe4 #b4 ,changes to liability for payment 7a7 ,in general ,section #bbb of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbau7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking ,a patient who receives contract health care services and inserting ,notwithstanding any other provision of law or any agreement1 form1 or other written or electronic document signed by a patient1 a patient who receives purchased_/referred care2 and 7,b7 by striking such services and inserting the purchased_/referred care2 7#b7 by striking subsection 7b7 and inserting the following3 7b7 ,notification ,the ,secretary shall notify a purchased_/referred care provider and any patient who receives purchased_/referred care authorized by the ,service that1 notwithstanding any other provision of law or any agreement1 form1 or other written or electronic document signed by the patient1 the patient is not liable to any provider1 debt collector1 or any other person for the payment of any charges or costs associated with the provision of the purchased_/referred care not later than #e business days after receipt of a notification of a claim by a provider of the purchased_/referred care4 2 7#c7 in subsection 7c7-- 7,a7 by inserting 1 debt collector1 or any other person1 as applicable1 after the provider2 and 7,b7 by striking the services and inserting the purchased_/referred care2 and 7#d7 by adding at the end the following3 7d7 ,reimbursement 7#a7 ,establishment of procedures 7,a7 ,in general ,not later than #abj days after the date of enactment of the ,purchased and ,referred ,care ,improvement ,act of #bjbe1 in consultation with ,indian tribes1 and except as provided in paragraph 7#b71 the ,secretary shall establish and implement procedures to allow a patient that paid out-of-pocket for purchased_/referred care authorized by the ,service under this ,act to be reimbursed by the ,service for that payment not later than #cj days after the date on which the patient submits documentation to the ,service in accordance with subparagraph 7,b74 7,b7 ,submitting documentation ,the ,secretary shall accept documentation from a patient seeking reimbursement under paragraph 7#a7 that was submitted-- 7i7 electronically2 or 7ii7 in-person at a ,service facility4 7#b7 ,limitation ,paragraph 7#a7 shall not apply to purchased_/referred care furnished under a purchased_/referred care services program operated by an ,indian tribe under a contract or compact entered into under the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecja et seq47 unless expressly agreed to by the ,indian tribe4 7e7 ,updating authorities ,not later than #ahj days after the date of enactment of the ,purchased and ,referred ,care ,improvement ,act of #bjbe1 the ,secretary1 in consultation with ,indian tribes1 shall update applicable provisions of and exhibits to the ,indian ,health ,manual1 contracts with providers1 and other relevant documents and administrative authorities to incorporate the provisions of this section4 4 7b7 ,application ,the amendments made by subsection 7a7 shall apply to purchased_/referred care 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 authorized by the ,indian ,health ,service furnished on1 before1 or after the date of enactment of this ,act4 #c4 ,technical and conforming amendments 7a7 ,definitions ,section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc7 is amended-- 7#a7 by striking paragraph 7#e72 7#b7 by redesignating paragraphs 7#f7 through 7#ae7 as paragraph 7#e7 through 7#ad71 respectively2 7#c7 in paragraph 7#ab7 7as so redesignated71 in the matter preceding subparagraph 7,a71 by striking 1 as defined in subsection 7d7 hereof12 7#d7 by inserting after paragraph 7#ad7 7as so redesignated7 the following3 7#ae7 ,purchased_/referred care ,the term purchased_/referred care means any health service that is-- 7,a7 delivered based on a referral by1 or at the expense of1 an ,indian health program2 and 7,b7 provided by a public or private medical provider or hospital that is not a provider or hospital of the ,indian health program4 2 7#e7 in paragraph 7#be71 by striking 7#be ,u4,s4,c4 #dej et seq47 and inserting 7#be ,u4,s4,c4 #ecja et seq472 7#f7 in paragraph 7#bf71 by striking 7#be ,u4,s4,c4 #dej;b7 and inserting 7#be ,u4,s4,c4 #ecjd72 and 7#g7 in paragraph 7#bh7-- 7,a7 by striking 1 as defined in subsection 7g7 hereof12 and 7,b7 by striking subsection 7c77#a7 through 7#d7 of this section and inserting subparagraphs 7,a7 through 7,d7 of paragraph 7#ab74 7b7 ,technical and conforming amendments 7#a7 ,the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afja et seq47 is amended-- 7,a7 by striking contract health service each place it appears and inserting purchased_/referred care2 7,b7 by striking contract health services each place it appears and inserting purchased_/referred care2 7,c7 by striking ,contract ,health ,service each place it appears and inserting purchased_/referred care2 7,d7 by striking ,contract ,health ,services each place it appears and inserting purchased_/referred care2 and 7,e7 by striking contract care each place it appears and inserting purchased_/referred care4 7#b7 ,section #baa of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afba;j7 is amended by striking the section heading and designation and all that follows through 7a7 ,the ,secretary and inserting the following3 #baa4 ,california purchased_/referred care demonstration program 7a7 ,the ,secretary 4 7#c7 ,section #bai of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbar7 is amended by striking the section heading and designation and all that follows through 7a7 ,the ,secretary and inserting the following3 #bai4 ,purchased_/referred care payment study 7a7 ,the ,secretary 4 7#d7 ,section #bbf of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbay7 is amended1 in the section heading1 by striking ,contract health service and inserting ,purchased_/referred care4 7#e7 ,section #djf of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afdf7 is amended by striking the section heading and designation and all that follows through ,with respect and inserting the following3 #djf4 ,authorization for emergency purchased_/referred care ,with respect 4 7#f7 ,section #ejf7;f7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afef7;f77 is amended by striking 1 as defined in section #d7;f7 of this ,act14 7#g7 ,section #gjd7;b7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affe;c7b77 is amended1 in the subsection heading1 by striking ,contract ,health ,services and inserting ,purchased_/referred care4 7#h7 ,section #hjh of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afgh7 is amended1 in the section heading1 by striking contract health service and inserting purchased_/referred care4 7#i7 ,section #hjh;,a of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afgh;a7 is amended1 in the section heading1 by striking contract health service and inserting purchased_/referred care4 7#aj7 ,section #haj of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhj7 is amended by striking the section heading and designation and all that follows through ,the ,state and inserting the following3 #haj4 ,california as a purchased_/referred care delivery area ,the ,state 4 7#aa7 ,section #hae of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhj;e7 is amended by striking the section heading and designation and all that follows through 7a7 ,the ,secretary and inserting the following3 #hae4 ,purchased_/referred care for the ,trenton service area 7a7 ,the ,secretary 4 7#ab7 ,section #hcj7;b7 of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afhjt7b77 is amended1 in the subsection heading1 by striking contract health services and inserting purchased_/referred care4 7#ac7 ,section #ejf;,a7a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;aa-#e;a7a77 is amended-- 7,a7 in paragraph 7#b71 by striking ,tribal health program the second place it appears and inserting tribal health program2 and 7,b7 in paragraph 7#c7-- 7i7 by striking health program administered by the ,service and inserting health program administered directly by the ,service2 and 7ii7 by striking section #d7ab77;,a7 of the ,indian ,health ,care ,improvement ,act and inserting paragraph 7#aa77;,a7 of section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7c7 ,updating authorities ,the ,secretary of ,health and ,human ,services is directed to ensure that the ,indian ,health ,manual and all other relevant rules1 guidance1 manuals1 and other materials are revised such that contract health service each place it appears 7regardless of casing and typeface and including in the headings7 is revised to read purchased_/referred care 7with appropriate casing and typeface74