Hoeven Introduces Legislation to Hold IHS Accountable to 30-Day Timeline For Outside Care Reimbursements

WASHINGTON – Senator John Hoeven (R-N.D.), former chairman of the Senate Committee on Indian Affairs, introduced the Purchased and Referred Care Improvement Act to require the Indian Health Service (IHS) to reimburse tribal members for care sought outside of IHS in a timely manner. The bill, which is sponsored by Senators Mike Rounds (R-S.D.) and Maria Cantwell (D-Wash.) and cosponsored by Senator John Thune (R-S.D.), would prevent tribal members from being wrongfully charged with medical debt that is incurred when IHS doesn’t reimburse tribal members for Purchased/Referred Care (PRC) claims in a reasonable timeframe.


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, and is a critical resource for tribal communities.

“Our legislation would help ensure that tribal members receive reimbursements for approved outside health care services in a timely manner,” said Hoeven. “This is all about improving health care and ensuring that IHS upholds its commitment to provide timely and quality care in our tribal communities.”

“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. As such, it’s crucial that IHS reimburses tribal members for outside care once it’s approved. I’m pleased to introduce 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.”

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.

The full bill text can be read here.