Summary — H.R. 1418: Purchased and Referred Care Improvement Act of 2025

Status: Introduced in House (May 27, 2025) — referred to Natural Resources and Energy & Commerce; placed on Local & Consent Calendars and subsequently laid before the House and adopted (nonrecord vote), reported enrolled (June 1, 2025).

Purpose and intent

Based on the bill title, H.R. 1418 is intended to improve the Purchased and Referred Care (PRC) program — the Indian Health Service (IHS) mechanism that pays for care referred outside of IHS/tribal facilities for eligible American Indian and Alaska Native (AI/AN) patients. The stated aim would be to increase access to specialty, emergency, and non-IHS care, and to address administrative, funding, or coordination barriers that limit timely care for eligible individuals.

Note: The full bill text was not provided with the request. The summary below describes the bill’s procedural history and the likely scope and impacts based on the title and typical PRC reform legislation. Consult the official bill text and committee reports for precise provisions.

Sponsors and committees

• Primary sponsor: Rep. Dusty Johnson
• Cosponsors: Joe Neguse, Teresa Leger Fernandez, Donald G. Davis, Tom Cole, Dan Newhouse, Kim Schrier, Michael Baumgartner
• Referred to: Committee on Natural Resources; Committee on Energy and Commerce (for provisions in their jurisdiction)

Likely key provisions (inferred from title and prior PRC reform efforts)

Common reforms in PRC improvement bills typically include one or more of the following:
- Clarify or expand PRC eligibility and priorities to reduce denials for care considered medically necessary.
- Increase or stabilize funding authority and appropriations treatment for PRC services.
- Improve coordination between IHS/Tribal health programs and external providers (referral pathways, prior authorization, streamlined billing).
- Require data-sharing, reporting, or performance measures to monitor timely access, referral outcomes, and financial obligations.
- Address interaction with Medicaid, Medicare, and third-party payers to maximize federal reimbursement and reduce uncompensated care.
- Support telehealth and remote specialty access as alternatives to outside referrals.
- Enhance emergency coverage rules and retroactive authorizations.

Who would be affected

• Primary: American Indian and Alaska Native patients eligible for IHS/tribal services who rely on PRC for care outside IHS facilities.
• Secondary: IHS, tribal and urban Indian health programs, non-IHS providers who receive PRC payments, state Medicaid agencies, and federal payers.
• Potential fiscal effects: changes to federal discretionary or mandatory spending related to PRC; exact costs would depend on enacted text and appropriations.

Procedural and timeline notes

• Introduced: May 27, 2025.
• Referred to committees (Natural Resources; Energy & Commerce) on Feb 18, 2025 (date order in metadata may reflect internal processing).
• Placed on Local & Consent Calendars and considered/laid before the House in late May–early June 2025; adopted via nonrecord vote and reported enrolled on June 1, 2025 (per House actions listed).
• Next steps to track: committee reports, Congressional Budget Office cost estimate, floor debate materials, and the enrolled bill text.

Recommendations for readers/stakeholders

• Review the official bill text and committee report for precise changes.
• Watch for a CBO score to understand budgetary impact.
• Tribal health programs and external providers should monitor implementation guidance and funding appropriations if the bill is enacted.