Sioux Empire Today

U.S. Representatives Dusty Johnson and Kim Schrier, along with U.S. Senators Mike Rounds and Maria Cantwell, have reintroduced the Purchased and Referred Care Improvement Act. This legislation aims to address delays in reimbursements for tribal members who receive healthcare outside of Indian Health Service (IHS) facilities.

The Purchased and Referred Care (PRC) program supplements healthcare resources for eligible tribal members when direct care at IHS facilities is unavailable. However, strict rules around residency, notification, and eligibility create barriers for beneficiaries seeking care outside IHS facilities.

Currently, the Indian Health Care Improvement Act mandates that IHS pay approved PRC claims within 30 days. Yet a Department of Health and Human Services analysis revealed that approximately 32,000 claims were not paid within this period over two years, leading to financial burdens on tribal members due to delayed payments.

Representative Dusty Johnson stated: “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.” He emphasized that the new bill would ensure timely payments by IHS.

Kim Schrier highlighted the negative impact of unpaid claims on tribal communities' financial futures: "The damage caused by these unpaid, unprocessed claims can be devastating for members of our tribal communities."

Senator Mike Rounds pointed out that few PRC claims get approved due to strict standards: “It’s crucial that IHS reimburses tribal members for outside care once it’s approved.”

Maria Cantwell added her support by noting feedback from tribes like the Confederated Tribes of the Colville Reservation about reliance on reimbursements from IHS. She said: “This bill would help put an end to delays in medical cost reimbursements.”

The legislation has support from Senate Majority Leader John Thune and Senator Patty Murray. Jarred-Michael Erickson from the Confederated Tribes of the Colville Reservation emphasized past obstacles faced due to mismanagement by IHS.

J. Garret Renville from the Coalition of Large Tribes remarked on treaty obligations unmet by current practices: "Some of the most significant and broad scale failures occur with respect to timely and appropriate payment for Purchased and Referred Care."

Frank Star Comes Out of the Oglala Sioux Tribe thanked Senator Rounds for addressing long-standing issues affecting tribal health care: "We thank Senator Rounds for his thoughtful leadership on this issue."

The proposed act requires IHS to establish procedures ensuring reimbursement within 30 days if patients initially cover costs themselves. It also allows beneficiaries to submit documentation as evidence when seeking reimbursement while strengthening liability provisions against wrongfully charged debts.