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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4077 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4077
To amend title 38, United States Code, and the Social Security Act to
permit recovery from the Department of Veterans Affairs of costs from
Medicare Advantage and Medicare prescription drug plans and to modify
the authority for recovery by the United States of reasonable charges
for certain care or services furnished to veterans for non-service-
connected disabilities, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 23, 2025
Mr. Doggett (for himself, Mr. Murphy, Mr. Takano, Mr. Schweikert, and
Mr. Joyce of Pennsylvania) introduced the following bill; which was
referred to the Committee on Veterans' Affairs, and in addition to the
Committees on Ways and Means, and Energy and Commerce, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title 38, United States Code, and the Social Security Act to
permit recovery from the Department of Veterans Affairs of costs from
Medicare Advantage and Medicare prescription drug plans and to modify
the authority for recovery by the United States of reasonable charges
for certain care or services furnished to veterans for non-service-
connected disabilities, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Guarantee Utilization of All
Reimbursements for Delivery of Veterans' Health Care Act'' or the
``GUARD Veterans' Health Care Act''.
SEC. 2. COST-RECOVERY FROM MEDICARE ADVANTAGE AND MEDICARE PRESCRIPTION
DRUG PLANS.
(a) Cost Recovery.--
(1) In general.--Subchapter III of chapter 17 of title 38,
United States Code, is amended by inserting after section 1729B
the following new section:
``Sec. 1729C. Cost-recovery from Medicare Advantage and Medicare
prescription drug plans
``(a) In General.--Notwithstanding sections 1814(c), 1835(d), and
1862(a)(3) of the Social Security Act (42 U.S.C. 1395f(c), 1395n(d),
and 1395y(a)(3)), if the Secretary provides under this chapter any
health care item or service (including for a service-connected
disability or a non-service-connected disability) covered under the
Medicare program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.), including outpatient and inpatient care,
prescription drugs, medical devices, lab testing, and items or services
delivered in post-acute and long-term care settings, to any individual
who is enrolled in a Medicare Advantage plan, including an MA-PD plan,
offered by a MA organization under part C of such title or a
prescription drug plan offered by a PDP sponsor under part D of such
title, such organization or sponsor shall, to the extent such item or
service is covered under such Medicare Advantage plan or prescription
drug plan, reimburse the Secretary for such item or service regardless
of any additional documentation, utilization management, or other
administrative requirement the plan may impose on the item or service.
``(b) Recovery of Amounts.--
``(1) In general.--The Secretary shall recover amounts
required to be reimbursed under subsection (a) through the use
of procedures under section 1729 of this title to the same
extent as those procedures are used to recover amounts
authorized to be recovered under that section.
``(2) Amount and process.--Except as provided in paragraph
(1), recovery under that paragraph of amounts reimbursed under
subsection (a) shall be in such an amount, and occur in
accordance with such procedures, as the Secretary shall
prescribe for purposes of this section.
``(c) Application.--The provisions of subsection (a) shall apply to
Medicare Advantage and prescription drug plan years beginning on or
after January 1, 2026.
``(d) Treatment of Amounts.--Amounts reimbursed to the Secretary
under subsection (a) shall be deposited in the Department of Veterans
Affairs Medical Care Collections Fund under section 1729A of this
title.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1729B the following new item:
``1729C. Cost-recovery from Medicare Advantage and Medicare
prescription drug plans.''.
(b) Medicare Conforming Amendments.--
(1) Part a.--Section 1814(c) of the Social Security Act (42
U.S.C. 1395f(c)) is amended by inserting ``and section 1729C of
title 38, United States Code'' after ``section 1880''.
(2) Part b.--Section 1835(d) of the Social Security Act (42
U.S.C. 1395n(d)) is amended by inserting ``and section 1729C of
title 38, United States Code'' after ``section 1880''.
(3) Exclusions from coverage.--Section 1862(a)(3) of the
Social Security Act (42 U.S.C. 1395y(a)(3)) is amended by
inserting ``in the case of items and services and prescription
drugs for which reimbursement is made under section 1729C of
title 38, United States Code,'' after ``section 1880(e),''.
SEC. 3. MODIFICATION OF AUTHORITY FOR RECOVERY BY UNITED STATES OF
REASONABLE CHARGES FOR CERTAIN CARE OR SERVICES FURNISHED
TO VETERANS FOR NON-SERVICE-CONNECTED DISABILITIES.
Section 1729 of title 38, United States Code, is amended--
(1) in subsection (a)--
(A) by amending paragraph (1) to read as follows:
``(1)(A) Subject to the provisions of this section, the United
States has the right to recover or collect the reasonable charges for
care or services that the United States is required by law to furnish
or pay for under this chapter for a non-service-connected disability.
``(B) The United States has the right to recover or collect from a
third party the reasonable charges for care or services furnished as
described in subparagraph (A) to the extent that the recipient or
provider of the care or services would be eligible to receive payment
from a third party.
``(C) The right to recover or collect reasonable charges for care
or services under this section shall apply to any and all causes of
action or recovery rights in tort or under any policy, plan, or
contract providing benefits for health care or injury, which accrue to
the individual to whom the care or services were furnished, or to the
legal representatives of the individual, as a result of the non-
service-connected disability that necessitated the care or services.'';
and
(B) in paragraph (2)--
(i) in subparagraph (D), by striking ``;
or'' and inserting a semicolon;
(ii) in subparagraph (E)(2), by striking
the period at the end and inserting ``; or'';
and
(iii) by adding at the end the following
new subparagraph:
``(F) that is incurred by an individual who is entitled to
care (or payment of expenses of care) under circumstances
creating a tort liability upon a third party.'';
(2) in subsection (b), by amending paragraph (2) to read as
follows:
``(2)(A) The United States may take any action necessary to enforce
the subrogation interests of the United States under this section,
including by intervening or joining in an action or proceeding.
``(B) A proceeding under this section may not be brought after the
end of the six-year period beginning on the last day on which the care
or services for which recovery is sought are furnished. Notwithstanding
the previous sentence, subject to section 2415 of title 28, and except
as otherwise provided by law, any action for money damages under this
section brought by the United States or an officer or agency thereof
that is founded upon a tort shall be barred unless the complaint is
filed within three years after the right of action first accrues.'';
(3) in subsection (c)(1), by inserting ``or penalty'' after
``claim'';
(4) by redesignating subsections (h) and (i) as subsections
(l) and (m), respectively;
(5) by inserting after subsection (f) the following new
subsections:
``(g)(1) Not later than 45 days after receipt of a claim to recover
or collect the reasonable charges for care or services described in
subsection (a), or in the case of a tort, not later than 45 days after
settlement, judgment, award, liability determination, or resolution
relating to the cause of action, a third party shall--
``(A) pay a clean claim for reimbursement in accordance
with this section;
``(B) pay the amount agreed to in writing by the
Department; or
``(C) provide notice of the date the third party received
the claim and include a statement that--
``(i) the third party refuses to reimburse all or
part of the claim and specify each reason for the
refusal to pay; or
``(ii) additional information is necessary to
determine if all or part of the claim will be
reimbursed and what specific additional information is
necessary.
``(2) Paragraph (1) shall not apply to a claim if there is a good
faith dispute about the legitimacy of the claim.
``(3)(A) If any third party fails to comply with paragraph (1),
such third party shall be required to pay interest to the United States
at the rate established by the Secretary of the Treasury under section
3717 of title 31 per month on the amount of the claim that remains
unpaid at the end of the 45-day period specified in such paragraph.
``(B) The interest paid pursuant to subparagraph (A) shall be
included in any late reimbursement from a third party without requiring
the Secretary to make any additional claim for such interest.
``(4)(A) Upon receiving a request for additional information by a
third party pursuant to paragraph (1)(C)(ii), the Secretary shall
provide the additional information, if determined relevant by the
Secretary, not later than 45 days after receipt of the request for
additional information.
``(B) Failure to furnish relevant information within the time
required under subparagraph (A) shall not invalidate or reduce any
claim in connection with such information.
``(C)(i) Not later than 15 days after receipt of additional
relevant information under subparagraph (A), a third party shall pay a
clean claim in accordance with this subsection or send a written or
electronic notice that--
``(I) such third party refuses to reimburse all or part of
the claim; and
``(II) specifies each reason for refusal to pay.
``(ii) Any third party that fails to comply with clause (i) shall
pay interest to the United States on any amount of the claim that
remains unpaid at the rate established by the Secretary of the Treasury
under section 3717 of title 31.
``(5) A third party shall not be entitled to request a refund to
correct a payment error to the Department if the request by the third
party for such payment correction is submitted more than 18 months
after the date that the Department received payment from the third
party.
``(6) Any claim by the Department under this section shall not be
subject to non-Department claims processes, policies, or forms.
``(h) The recovery rights of the United States under this section
are not limited to the amounts paid to non-Department providers and are
not subject to non-Department fee schedules or non-Department
reimbursement rates, including those administered under workers'
compensation plans or automobile accident reparations insurance.
``(i)(1) A third party shall--
``(A) determine whether a recipient of care or services
covered by this section (including a recipient whose claim is
unresolved) has received benefits under this chapter; and
``(B) submit the information described in paragraph (2)
with respect to the recipient to the Secretary in a form and
manner (including frequency) specified by the Secretary.
``(2) The information required to be submitted under this paragraph
with respect to a recipient of care or services is--
``(A) the identity of the recipient; and
``(B) such other information as the Secretary shall specify
in order to enable the Secretary to make an appropriate
determination concerning coordination of benefits, including
any applicable recovery claim.
``(3) A third party shall submit the information required under
paragraph (1)(B) with respect to a recipient of care or services
covered by this section (including a recipient whose claim is
unresolved) not later than 30 days, or such other time period as
prescribed by the Secretary, after the date on which the third party
knows or has reason to know that the recipient has received benefits
under this chapter.
``(4) A third party shall not distribute proceeds of a settlement,
judgment, award, or other payment in connection with a recipient of
care or services covered by this section (including a recipient whose
claim is unresolved), regardless of whether there has been a
determination or admission of liability, without satisfaction of a
claim by the Department.
``(j)(1) A third party that fails to comply with the requirements
under this section, including any regulations prescribed to implement
this section, with respect to any individual receiving care furnished
or paid for by the Department as described in this section, shall be
subject to a civil penalty in an amount published on a website of the
Department for each day of noncompliance with respect to each claim
violation. A civil penalty under this paragraph shall be in addition to
any other penalties prescribed by law.
``(2)(A) A third party that willfully fails or refuses to pay a
clean claim under this section, including any regulations prescribed to
implement this section, with respect to any individual receiving care
furnished or paid for by the Department as described in this section,
shall be subject to paying the higher of triple the amount of the claim
or an amount not to exceed $50,000, which may be adjusted for
inflation, for each claim violation.
``(B) A penalty under subparagraph (A) is in addition to any other
penalty under this subsection and any other penalty prescribed by law.
``(C) Before enforcing any penalty under this paragraph with
respect to a third party, the Secretary shall provide to the third
party written notice of the amount due and a 30-day opportunity to pay
the clean claim, including penalties, interests, and costs.
``(3) Notwithstanding any other applicable civil or criminal
remedies, the United States shall have a cause of action for damages
(which shall be in an amount double the amount otherwise provided) in
the case of a third party that fails to provide payment, or appropriate
reimbursement, for the reasonable value of the care or services
furnished, to be furnished, paid for, or to be paid for in accordance
with a clean claim.
``(k) Notwithstanding any other provision of law, the Secretary may
implement this paragraph by prescribing regulations, program
instructions, or otherwise.''; and
(6) in subsection (m), as redesignated by paragraph (4)--
(A) in paragraph (3)--
(i) in subparagraph (C), by striking ``;
or'' and inserting a semicolon;
(ii) in subparagraph (D), by striking the
period at the end and inserting a semicolon;
and
(iii) by adding at the end the following
new subparagraphs:
``(E) a person or entity responsible in tort for
damages incurred as a result of negligence; or
``(F) a person or entity responsible for payment of
medical expenses other than under a health-plan
contract, including medical expenses coverage, medical
payments coverage, or underinsured motorist
coverage.''; and
(B) by adding at the end the following new
paragraphs:
``(4) The term `clean claim' means a claim to recover or
collect reasonable charges under subsection (a) that can be
processed without obtaining additional information.
``(5) The term `non-service-connected disability'
includes--
``(A) a non-service-connected disability, injury,
illness, health care need, or condition; and
``(B) an aggravation or exacerbation of a service-
connected disability.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Committee Hearings Held
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