Johnson Introduces Bills to Reform IHS, Protect Native Americans’ Credit

Washington, D.C. – U.S. Representative Dusty Johnson (R-S.D.) and Rep. Kim Schrier (D-WA) introduced two bills to hold the Indian Health Service (IHS) accountable for disregarding health care bills owed to providers and to protect Native Americans’ credit from wrongfully charged medical bills owed by IHS through Purchased/Referred Care claims.

“Many know the frustration when debt is sent to collections, especially when the bill isn’t ours to pay,” said Johnson. “IHS often falls short in its obligation to pay medical bills from Purchased/Referred Care in a timely manner and Native Americans are often forced to pay the bills they don’t owe, or else risk taking substantial hits to their credit, hindering their ability to get a loan, buy a home, and more. My bills seek to rectify this unfair negligence 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."

“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. 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. The Protecting Native Americans’ Credit Act will help those tribal members who have already been sent to collection agencies by deleting that information from their credit reports. The Colville Tribes is grateful for the introduction of these bills and looks forward to both being enacted into law,” said Jarred-Michael Erickson, Chairman of the Confederated Tribes of the Colville Reservation.

The Purchased and Referred Care Improvement Act of 2024 would:

• Ensure that IHS – not the tribal citizen – is liable for payments for PRC services that are or were authorized by IHS.
• Directs the Secretary to notify PRC providers and patients that the patients are not liable to any provider or debt collector for charges associated with authorized PRC services.
• Permits IHS to establish and implement procedures to allow patients that paid out-of-pocket for IHS-authorized PRC services to be reimbursed by IHS no later than 30 days after a patient submits the necessary documentation.

View Purchased and Referred Care Improvement Act bill text here.

The Protecting Native Americans’ Credit Act of 2024 would:

• Excludes medical debt attributable to IHS-authorized PRC services received at a non-IHS facility from a Native American’s Consumer Report.
• Provides Native Americans with a dispute process for inclusion of debt for authorized medical services rendered on a consumer report.
• Requires HHS to send a notice to the individual that HHS has assumed liability for part of or all of the medical debt.
• Directs reporting agencies to delete all information related to medical debt from file and notify furnisher and consumer of deletion upon receiving required documentation of HHS’s liability of debt.

View Protecting Native Americans’ Credit Act bill text here.

Additional cosponsors of both bills include Cathy McMorris Rodgers (R-WA), Teresa Leger Fernandez (D-N.M.), Ryan Zinke (R-MT), and Dan Newhouse (R-WA).

Background:

Certain tribes are “direct service” tribes, meaning their citizens receive healthcare directly from the Indian Health Service (IHS). These individuals will often require care that is outside the capacity of the IHS facility where they receive care. In that case, IHS can utilize the Purchased/Referred Care (PRC) program to acquire specialty or different care for an eligible individual through non-IHS providers.

However, IHS’s management of the PRC program has resulted in negative impacts for many Native Americans. A Department of Health and Human Services (HHS) Office of Inspector General (OIG) report from April 2020 found that an estimated 658,025 of 802,470 IHS PRC claims for 2019 were not reviewed, approved, or paid in accordance with federal law. Current law requires IHS to pay a completed claim for PRC services within 30 days after completion of the claim. This HHS OIG report found an estimated 32,099 claims were not paid within that time frame.

The Indian Heath Care Improvement Act (IHCIA) states that no patient should be liable for PRC services received that were authorized by IHS. However, as PRC bills go unpaid by IHS, tribal citizens are left to bear the brunt of these costs.

When non-IHS providers are not paid, they may seek payment from the individual who received the care. Those individuals are often referred to collection agencies for these unpaid bills. If those bills continue to go unpaid, Native Americans risk taking hits to their credit scores, limiting their opportunities for acquiring loans, purchasing a home or vehicle, and more.