H.R. 4077 — GUARD Veterans’ Health Care Act

This section establishes a new VA cost-recovery authority (38 U.S.C. 1729C) requiring Medicare Advantage organizations (under Medicare Part C) and Part D prescription drug plan sponsors to reimburse VA for covered health care items or services—including inpatient and outpatient care, prescription drugs, medical devices, lab testing, and post-acute or long-term care—provided by VA to their enrollees, overriding Medicare non-payment requirements under SSA §§1814(c), 1835(d), and 1862(a)(3) (42 U.S.C. 1395f(c), 1395n(d), 1395y(a)(3)). (Thus, VA may recover such costs using procedures under 38 U.S.C. 1729, with reimbursements deposited to the VA Medical Care Collections Fund.) The requirement applies to Medicare Advantage and Part D plan years beginning on or after January 1, 2026, and includes conforming amendments to the referenced SSA sections.

This section expands VA's authority under 38 U.S.C. §1729 to recover or collect reasonable charges for care or services furnished to veterans for non-service-connected disabilities from third parties (i.e., to any tort recovery rights or benefits under health care policies, plans, or contracts), including by adding tort liability cases to the covered disabilities (as new subsection (a)(2)(F)). (As background, current law limits recovery to five specific scenarios—workers' compensation, motor vehicle accidents under no-fault insurance, state crime victim benefits, health-plan contracts generally, and health-plan contracts for veterans with service-connected disabilities.) The section further (1) authorizes VA to enforce its subrogation rights by intervening or joining actions, with a general six-year statute of limitations from the last day care is furnished (or three years for tort money damages per 28 U.S.C. §2415); (2) inserts new subsection (g) requiring third parties to pay clean claims or provide denial notice within 45 days (or 15 days after receiving additional information), with interest at the Treasury rate under 31 U.S.C. §3717 on late payments and no refunds for payment errors after 18 months; (3) adds new subsection (h) clarifying that recoveries are not limited to non-VA provider payments or non-VA fee schedules (e.g., workers' compensation or auto insurance rates); and (4) makes conforming and technical changes, including inserting "or penalty" in subsection (c)(1) and redesignating subsections (h) and (i) as (l) and (m).