Central South Dakota News

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

The Purchased and Referred Care (PRC) program supplements health care resources for eligible tribal members when direct care at an IHS facility is unavailable. However, many beneficiaries face barriers such as strict residency, notification, and eligibility rules when accessing this care.

Currently, the Indian Health Care Improvement Act mandates that IHS pay outside providers within 30 days for approved PRC claims. Despite this requirement, a Department of Health and Human Services analysis revealed that 32,000 claims were not paid on time over two years. These delays often result in tribal members facing medical debt they should not owe.

"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 Senator Rounds. He emphasized the importance of reimbursing tribal members promptly once their claims are approved.

Senator Cantwell noted that delayed reimbursements create financial hardships for Tribal members. "I have heard from the Confederated Tribes of the Colville Reservation...when [reimbursements] don’t happen, Tribal members are then financially harmed," she said.

The bill is cosponsored by Senate Majority Leader John Thune and Senator Patty Murray. Representative Johnson added that the bill would ensure bills are paid in full by IHS rather than leaving debts to patients.

Representative Schrier highlighted the damaging impact of unpaid claims on credit scores: "The damage caused by these unpaid...claims can be devastating."

J. Garret Renville expressed support for the bill, stating it would reduce burdens and protect access to care consistent with Treaty rights.

Frank Star Comes Out praised Senator Rounds' leadership: "We thank Senator Rounds for his thoughtful leadership...Under no circumstance should a Native person be paying for approved Purchase and Referred Care."

Jarred-Michael Erickson shared concerns about management deficiencies impacting credit scores and health outcomes on the Colville Reservation.

The act proposes procedures requiring IHS to reimburse beneficiaries within 30 days if they paid out-of-pocket for approved services. It also allows beneficiaries to submit documentation as evidence when seeking reimbursement and strengthens liability provisions preventing providers from collecting wrongfully charged debt from beneficiaries with approved claims.