[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2145 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                S. 2145

 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 SENATE OF THE UNITED STATES

                             June 23, 2025

 Ms. Warren (for herself, Mr. Blumenthal, and Mr. Cassidy) introduced 
the following bill; which was read twice and referred to the Committee 
                          on Veterans' Affairs

_______________________________________________________________________

                                 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.''.
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