,,ii  #aai? ,,congress  #a/ ,session    
,s4 #fii  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #bd1 #bjbe,mr4
 ,r\nds 7= himself1 ,ms4 ,cantwell1 ,mr4
 ,?une1 & ,mrs4 ,murray7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,indian ,affairs  ,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$-- 7#a7 9 subsection    
7a7-- 7,a7 by /rik+ ,a pati5t :o        
receives contract heal? c>e s]vices &   
ins]t+ ,not)/&+ any o!r provision ( law 
or any agreem5t1 =m1 or o!r writt5 or   
electronic docum5t sign$ by a pati5t1 a 
pati5t :o receives pur*as$_/ref]r$ c>e2 
&  7,b7 by /rik+ su* s]vices & ins]t+ ! 

pur*as$_/ref]r$ c>e2  7#b7 by /rik+     
subsection 7b7 & ins]t+ ! foll[+3  7b7  
,notification ,! ,secret>y %all notify a
 pur*as$_/ref]r$ c>e provid] & any      
pati5t :o receives pur*as$_/ref]r$ c>e  
au?oriz$ by ! ,s]vice t1 not)/&+ any o!r
 provision ( law or any agreem5t1 =m1 or
 o!r writt5 or electronic docum5t sign$ 
by ! pati5t1 ! pati5t is n liable to any
 provid]1 debt collector1 or any o!r    
p]son = ! paym5t ( any *>ges or co/s    
associat$ ) ! provision ( !             
pur*as$_/ref]r$ c>e n lat] ?an #e       
bus9ess days aft] receipt ( a           
notification ( a claim by a provid] ( ! 
pur*as$_/ref]r$ c>e4  2  7#c7 9         
subsection 7c7-- 7,a7 by ins]t+ 1 debt  
collector1 or any o!r p]son1 z          
applicable1 aft] ! provid]2 &  7,b7 by  
/rik+ ! s]vices & ins]t+ !              
pur*as$_/ref]r$ c>e2 &  7#d7 by add+ at 
! end ! foll[+3  7d7 ,reimbursem5t  7#a7
 ,e/abli%m5t ( proc$ures  7,a7 ,9 g5]al 
,n lat] ?an #abj days aft] ! date (     
enactm5t ( ! ,pur*as$ & ,ref]r$ ,c>e    

,improvem5t ,act ( #bjbe1 9 consultation
 ) ,indian tribes1 & except z provid$ 9 
p>agraph 7#b71 ! ,secret>y %all e/abli% 
& implem5t proc$ures to all[ a pati5t t 
paid out-(-pocket = pur*as$_/ref]r$ c>e 
au?oriz$ by ! ,s]vice "u ?is ,act to be 
reimburs$ by ! ,s]vice = t paym5t n lat]
 ?an #cj days aft] ! date on :i* !      
pati5t submits docum5tation to ! ,s]vice
 9 accordance ) subp>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$-- 7i7 electronically2 or  7ii7 
9-p]son at a ,s]vice facility4  7#b7    
,limitation ,p>agraph 7#a7 %all n apply 
to pur*as$_/ref]r$ c>e furni%$ "u a     
pur*as$_/ref]r$ c>e s]vices program     
op]at$ by an ,indian tribe "u a contract
 or compact ent]$ into "u ! ,indian     
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecja et 
seq47 unless expressly agre$ to by !    
,indian tribe4  7e7 ,updat+ au?orities  
,n lat] ?an #ahj days aft] ! date (     

enactm5t ( ! ,pur*as$ & ,ref]r$ ,c>e    
,improvem5t ,act ( #bjbe1 ! ,secret>y1 9
 consultation ) ,indian tribes1 %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 
subsection 7a7 %all apply to            
pur*as$_/ref]r$ c>e 7z def9$ 9 section  
#d ( ! ,indian ,heal? ,c>e ,improvem5t  
,act 7#be ,u4,s4,c4 #afjc77 au?oriz$ by 
! ,indian ,heal? ,s]vice furni%$ on1    
be=e1 or aft] ! date ( enactm5t ( ?is   
,act4  #c4 ,te*nical & con=m+ am5dm5ts  
7a7 ,def9itions ,section #d ( ! ,indian 
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #afjc7 is am5d$-- 7#a7 by     
/rik+ p>agraph 7#e72  7#b7 by r$esignat+
 p>agraphs 7#f7 ?r\gh 7#ae7 z p>agraph  
7#e7 ?r\gh 7#ad71 respectively2  7#c7 9 
p>agraph 7#ab7 7z s r$esignat$71 9 !    
matt] prec$+ subp>agraph 7,a71 by /rik+ 
1 z def9$ 9 subsection 7d7 h]e(12  7#d7 

by ins]t+ aft] p>agraph 7#ad7 7z s      
r$esignat$7 ! foll[+3  7#ae7            
,pur*as$_/ref]r$ c>e ,! t]m             
pur*as$_/ref]r$ c>e means any heal?     
s]vice t is-- 7,a7 deliv]$ bas$ on a    
ref]ral by1 or at ! exp5se (1 an ,indian
 heal? program2 &  7,b7 provid$ by a    
public or private m$ical provid] or     
hospital t is n a provid] or hospital ( 
! ,indian heal? program4  2  7#e7 9     
p>agraph 7#be71 by /rik+ 7#be ,u4,s4,c4 
#dej et seq47 & ins]t+ 7#be ,u4,s4,c4   
#ecja et seq472  7#f7 9 p>agraph 7#bf71 
by /rik+ 7#be ,u4,s4,c4 #dej;b7 & ins]t+
 7#be ,u4,s4,c4 #ecjd72 &  7#g7 9       
p>agraph 7#bh7-- 7,a7 by /rik+ 1 z def9$
 9 subsection 7g7 h]e(12 &  7,b7 by     
/rik+ subsection 7c77#a7 ?r\gh 7#d7 (   
?is section & ins]t+ subp>agraphs 7,a7  
?r\gh 7,d7 ( p>agraph 7#ab74  7b7       
,te*nical & con=m+ am5dm5ts  7#a7 ,!    
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afja et seq47 is am5d$--
 7,a7 by /rik+ contract heal? s]vice ea*
 place x appe>s & ins]t+ pur*as$_/ref]r$

 c>e2  7,b7 by /rik+ contract heal?     
s]vices ea* place x appe>s & ins]t+     
pur*as$_/ref]r$ c>e2  7,c7 by /rik+     
,contract ,heal? ,s]vice ea* place x    
appe>s & ins]t+ pur*as$_/ref]r$ c>e2    
7,d7 by /rik+ ,contract ,heal? ,s]vices 
ea* place x appe>s & ins]t+             
pur*as$_/ref]r$ c>e2 &  7,e7 by /rik+   
contract c>e ea* place x appe>s & ins]t+
 pur*as$_/ref]r$ c>e4  7#b7 ,section    
#baa ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afba;j7 is am5d$  
by /rik+ ! section head+ & designation &
 all t foll[s ?r\gh 7a7 ,! ,secret>y &  
ins]t+ ! foll[+3  #baa4 ,cali=nia       
pur*as$_/ref]r$ c>e demon/ration program
  7a7 ,! ,secret>y  4  7#c7 ,section    
#bai ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afbar7 is am5d$ by
 /rik+ ! section head+ & designation &  
all t foll[s ?r\gh 7a7 ,! ,secret>y &   
ins]t+ ! foll[+3  #bai4 ,pur*as$_/ref]r$
 c>e paym5t /udy  7a7 ,! ,secret>y  4   
7#d7 ,section #bbf ( ! ,indian ,heal?   
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    

#afbay7 is am5d$1 9 ! section head+1 by 
/rik+ ,contract heal? s]vice & ins]t+   
,pur*as$_/ref]r$ c>e4  7#e7 ,section    
#djf ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afdf7 is am5d$ by 
/rik+ ! section head+ & designation &   
all t foll[s ?r\gh ,) respect & ins]t+ !
 foll[+3  #djf4 ,au?orization = em]g5cy 
pur*as$_/ref]r$ c>e ,) respect  4  7#f7 
,section #ejf7;f7 ( ! ,indian ,heal?    
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afef7;f77 is am5d$ by /rik+ 1 z def9$ 9
 section #d7;f7 ( ?is ,act14  7#g7      
,section #gjd7;b7 ( ! ,indian ,heal?    
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#affe;c7b77 is am5d$1 9 ! subsection    
head+1 by /rik+ ,contract ,heal?        
,s]vices & ins]t+ ,pur*as$_/ref]r$ c>e4 
7#h7 ,section #hjh ( ! ,indian ,heal?   
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afgh7 is am5d$1 9 ! section head+1 by  
/rik+ contract heal? s]vice & ins]t+    
pur*as$_/ref]r$ c>e4  7#i7 ,section     
#hjh;,a ( ! ,indian ,heal? ,c>e         
,improvem5t ,act 7#be ,u4,s4,c4 #afgh;a7

 is am5d$1 9 ! section head+1 by /rik+  
contract heal? s]vice & ins]t+          
pur*as$_/ref]r$ c>e4  7#aj7 ,section    
#haj ( ! ,indian ,heal? ,c>e ,improvem5t
 ,act 7#be ,u4,s4,c4 #afhj7 is am5d$ by 
/rik+ ! section head+ & designation &   
all t foll[s ?r\gh ,! ,/ate & ins]t+ !  
foll[+3  #haj4 ,cali=nia z a            
pur*as$_/ref]r$ c>e deliv]y area ,!     
,/ate  4  7#aa7 ,section #hae ( !       
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afhj;e7 is am5d$ by     
/rik+ ! section head+ & designation &   
all t foll[s ?r\gh 7a7 ,! ,secret>y &   
ins]t+ ! foll[+3  #hae4 ,pur*as$_/ref]r$
 c>e = ! ,tr5ton s]vice area  7a7 ,!    
,secret>y  4  7#ab7 ,section #hcj7;b7 ( 
! ,indian ,heal? ,c>e ,improvem5t ,act  
7#be ,u4,s4,c4 #afhjt7b77 is am5d$1 9 ! 
subsection head+1 by /rik+ contract     
heal? s]vices & ins]t+ pur*as$_/ref]r$  
c>e4  7#ac7 ,section #ejf;,a7a7 ( !     
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bij;aa-#e;a7a77 is am5d$--   
7,a7 9 p>agraph 7#b71 by /rik+ ,tribal  

heal? program ! second place x appe>s & 
ins]t+ tribal heal? program2 &  7,b7 9  
p>agraph 7#c7-- 7i7 by /rik+ heal?      
program adm9i/]$ by ! ,s]vice & ins]t+  
heal? program adm9i/]$ directly by !    
,s]vice2 &  7ii7 by /rik+ section       
#d7ab77;,a7 ( ! ,indian ,heal? ,c>e     
,improvem5t ,act & ins]t+ p>agraph      
7#aa77;,a7 ( section #d ( ! ,indian     
,heal? ,c>e ,improvem5t ,act 7#be       
,u4,s4,c4 #afjc74  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]vice 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