Rounds, Cantwell, Johnson and Schrier Introduce Legislation to Remove Burdensome Regulations for Tribal Health Care

WASHINGTON – U.S. Senators Mike Rounds (R-S.D.) and Maria Cantwell (D-Wash.), members of the Senate Committee on Indian Affairs, and Representatives Dusty Johnson (R-S.D.) and Kim Schrier (D-Wash.) today reintroduced the Purchased and Referred Care Improvement Act, legislation to require the Indian Health Service (IHS) to reimburse tribal members for care sought outside of IHS in a timely manner.

The PRC program is used to supplement health care resources outside of IHS facilities for eligible tribal members. PRC funds are only available when a patient has no access to direct care at an IHS facility, including emergency care or specialty care. While PRC is a critical resource for tribal communities, many beneficiaries encounter a number of barriers when attempting to access care outside of IHS. This includes strict residency, notification and eligibility rules.

If a PRC claim is approved, IHS is expected to process the claim in a 30-day timeframe. While the Indian Health Care Improvement Act currently requires IHS to pay outside providers for approved PRC claims within 30 days, a previous analysis by the Department of Health and Human Services found that an estimated 32,000 claims over a two year period were not paid within this time frame. As such, payments to outside providers are often delayed, ultimately contributing to wrongfully-charged medical debt for tribal members.

“The Indian Health Service has made a commitment to care for tribal members across the United States, and they need to honor that commitment,” said Rounds. “Because of the strict standards for PRC claims, approved claims are few and far between. It’s crucial that IHS reimburses tribal members for outside care once it’s approved. I’m pleased to reintroduce this legislation, which would hold IHS accountable to make certain they get their work done and follow their mission of providing health care for tribal members.”

“This bill would help put an end to delays in medical cost reimbursements that have created serious financial hardships for Tribal members,” said Cantwell. “I have heard from the Confederated Tribes of the Colville Reservation and many of its Tribal members that receive medical treatment at non-Tribal facilities rely on the Indian Health Service to reimburse for the cost of care -- but when that doesn’t happen, Tribal members are then financially harmed to the point of some not wanting to seek care at all to avoid negative credit score impacts. To fix this, Senator Rounds and I are introducing the Purchased and Referred Care Improvement Act so Tribal patients don't have to worry about being sent to debt collectors or losing points on their credit score while they wait for the federal government to reimburse their provider.”

This legislation is cosponsored in the Senate by Majority Leader John Thune (R-S.D.) and Senator Patty Murray (D-Wash.).

“The Indian Health Service is not upholding the required service to Native American patients in the Purchased and Referred Care program, leaving financial debts to be paid by the patient that they do not owe,” said Johnson. “Our bill will right this wrong and ensure these bills are paid in full by IHS.”

“The damage caused by these unpaid, unprocessed claims can be devastating for members of our tribal communities - the outstanding debt and impact on their credit score are incredibly harmful to their financial future,” said Schrier. "I'm proud to introduce bipartisan legislation to make commonsense, much-needed reforms to ensure tribal citizens can receive the care they need without fear of undue financial burdens."

"The United States has a solemn obligation to provide healthcare under our Treaties, yet often falls short,” said J. Garret Renville, President of the Coalition of Large Tribes and Chairman of the Sisseton-Wahpeton Oyate. “Some of the most significant and broad scale failures occur with respect to timely and appropriate payment for Purchased and Referred Care. That creates wrongful and very detrimental tribal medical debt. This bill will reduce those burdens and protect tribal citizens' access to care and our financial stability, consistent with our Treaty rights.”

“Senator Rounds’ bill will help tackle a problem that has plagued tribal health care patients and providers for too long: the timely reimbursement of claims by IHS for services purchased from and referred to providers outside the IHS,” said Frank Star Comes Out, President of the Oglala Sioux Tribe. “We thank Senator Rounds for his thoughtful leadership on this issue and for listening to the concerns of Tribes and tribal health care advocates about the need for IHS reform and oversight on this matter. Under no circumstance should a Native person be paying for approved Purchase and Referred Care. We look forward to working with the Senator to enact this bill this session.”

“For decades, the Colville Tribes and its members have endured severe obstacles to accessing critical health care due to the Indian Health Service’s management of the Purchased/Referred Care program,” said Jarred-Michael Erickson, Chairman of the Confederated Tribes of the Colville Reservation. “On the Colville Reservation, these management deficiencies have resulted in tribal members having their credit negatively impacted because of unpaid medical bills, fewer health providers, and even deaths. The Purchased and Referred Care Improvement Act will strengthen and clarify the Service’s obligations to inform health providers that tribal members should not be pursued for medical bills that the Service is legally obligated to pay."

Specifically, the Purchased and Referred Care Improvement Act would:

• Require IHS to develop procedures to reimburse beneficiaries for approved PRC services within 30 days, if the patient paid out of pocket.
• Allow a beneficiary to submit documentation to the agency as evidence when seeking reimbursement.
• Strengthen liability provisions of the statute, making it clear that outside providers cannot collect wrongfully charged debt from beneficiaries with approved PRC claims.

Click HERE for full bill text.

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