H.R. 4153 would require the Department of Veterans Affairs (VA) to reimburse Urban Indian Organizations (UIOs) for the costs of health care that eligible Indian veterans would receive, without prior authorization, at UIO medical facilities. Except for substance abuse residential programs, nonprofit UIO medical facilities only provide outpatient medical services to American Indians and Alaska Natives in urban settings. Under current law, VA reimburses the Indian Health Services (IHS) and Tribal Operated Health Programs (THPs) for health care provided to eligible Indian veterans at IHS and THP medical facilities, but the agreement excludes UIOs.
Based on information from IHS on the number of patients and the cost of medical care at UIO medical facilities, and information from the VA on the number of American Indian veterans, CBO estimates that there would be, on average, about 1,300 Indian veterans enrolled in the VA health care system who are treated at UIO medical facilities each year over the 2020-2024 period. CBO expects that, over time, a growing number of those Indian veterans would take advantage of other community care options offered by VA. CBO estimates that VA would reimburse UIOs for medical services provided to about 800 veterans each year at an average cost of about $3,000 per patient. CBO estimates that H.R. 4153 would cost $11 million over the 2020-2024 period, assuming availability of appropriated funds.
The costs of the legislation, detailed in Table 1, fall within budget function 700 (veterans benefits and services).