Veterans Emergency Care Reimbursement Act of 2025
The Veterans Emergency Care Reimbursement Act of 2025 (H.R. 5261) would modify how the Department of Veterans Affairs reimburses veterans for emergency treatment obtained at non-VA facilities when the veteran has health-plan coverage. The bill tightens and clarifies the reimbursement rules by creating a threshold tied to copayments (the fixed amount a patient pays for a covered service) and by clarifying what counts as a copayment. It also broadens the types of costs that can be reimbursed (copayments, deductibles, coinsurance, and other cost shares) and extends eligibility to include claims that VA previously denied, retroactive to claims submitted after February 1, 2012, including those from a specified class action. In short, the bill aims to standardize and limit reimbursements to emergency costs tied to small copayments (under $100) and to clarify and expand what is eligible for reimbursement, with retroactive relief for certain past claims.
Key Points
- 1Threshold for reimbursement: The bill changes the reimbursement authority so that eligible emergency-treatment reimbursements are limited to copayment-related amounts that are less than $100.
- 2Copayment definition: It adds a formal definition of copayment as a fixed amount paid by the veteran for a covered health service, explicitly excluding deductibles and coinsurance.
- 3Expanded reimbursement scope: Reimbursement claims can cover copayments, deductibles, coinsurance, or other cost shares for emergency treatment received outside a VA facility, including cases where VA previously denied the claim.
- 4Retroactive application: The amendments apply to reimbursement claims for emergency treatment furnished on or after February 1, 2012, including claims in Wolfe v. McDonough (a U.S. Veterans Court case addressing related reimbursement issues).
- 5Definitions tied to existing terms: The bill uses the existing meanings of “emergency treatment” and “health-plan contract” as defined in 38 U.S.C. 1725(f).