S. 2145 — GUARD Veterans’ Health Care Act

This section establishes a new VA cost-recovery authority under 38 U.S.C. §1729C, requiring Medicare Advantage (MA) organizations under Medicare Part C and prescription drug plan (PDP) sponsors under Part D to reimburse the Department of Veterans Affairs (VA) for health care items or services (including inpatient and outpatient care, prescription drugs, medical devices, lab testing, and post-acute or long-term care services furnished for service-connected or non-service-connected disabilities) provided by VA to their enrollees if covered under the applicable plan, notwithstanding restrictions under SSA §§1814(c), 1835(d), and 1862(a)(3) (42 U.S.C. §§1395f(c), 1395n(d), 1395y(a)(3)) and regardless of any plan-imposed documentation, utilization management, or administrative requirements. VA must recover such amounts using procedures under 38 U.S.C. §1729, with reimbursed amounts deposited in the VA Medical Care Collections Fund under 38 U.S.C. §1729A; the authority applies to MA and PDP years beginning on or after January 1, 2026. (Thus, VA may bill MA plans and PDPs directly for covered services furnished to dual-eligible veterans, overriding prior Medicare barriers to such third-party payments.) The section also makes conforming amendments to SSA §§1814(c), 1835(d), and 1862(a)(3) by inserting cross-references to 38 U.S.C. §1729C and includes a clerical amendment to the table of sections for 38 U.S.C. ch. 17, subch. III.

This section revises VA's authority under 38 U.S.C. §1729 to recover the reasonable cost of care and services furnished to veterans for non-service-connected disabilities. (As background, current law authorizes such recovery from specified third-party payers—e.g., workers' compensation, no-fault auto insurance, crime victim funds, or health-plan contracts—for enumerated categories of non-service-connected disabilities.) Specifically, the section (1) restructures subsection (a)(1) to establish a general right of recovery for all such care from any third party (including via subrogation to the veteran's tort claims or insurance benefits) to the extent the recipient or provider would otherwise be eligible for payment; (2) adds to subsection (a)(2) a new category (F) covering disabilities incurred under circumstances creating tort liability on a third party; (3) revises subsection (b)(2) to authorize VA enforcement actions (including intervening in suits) with a general six-year statute of limitations from the last day care is furnished (three years from accrual for tort claims, per 28 U.S.C. §2415); (4) inserts "or penalty" after "claim" in subsection (c)(1); and (5) adds new subsections (g) through (i) after (f), including 45-day deadlines for third-party payers to pay clean claims, agreed amounts, or provide denial notices (with Treasury interest under 31 U.S.C. §3717 on late payments); 45-day VA response to information requests and 15-day third-party response thereafter; a bar on third-party refund requests after 18 months; exemption of VA claims from non-VA processes; and a requirement that recoveries are not limited to non-VA provider payments or fee schedules (e.g., under workers' compensation or auto insurance). (Thus, VA gains broader recovery rights, including from tortfeasors; stronger enforcement tools; and incentives for prompt third-party payments.)