GUARD Veterans’ Health Care Act
The GUARD Veterans’ Health Care Act would (1) require Medicare Advantage (MA) plans and Medicare prescription drug plans (Part D) to reimburse the Department of Veterans Affairs (VA) for covered health care items and services the VA provides to veterans, and (2) expand the federal government’s authority to recover reasonable charges from third parties for care provided to veterans with non-service-connected disabilities. The cost-recovery from MA/Part D would apply to items and services that are covered by the Medicare program and provided by VA, and the collected funds would go to the VA Medical Care Collections Fund. The bill also broadens and modernizes the government’s right to recover reasonable charges from third parties in tort or other situations, with new procedures, timelines, penalties, and definitions to encourage prompt payment. The changes would take effect for MA/Part D years beginning in 2026 and would modify related Medicare and Social Security Act provisions to align with these new authorities.
Key Points
- 1Cost-recovery from Medicare Advantage and Medicare prescription drug plans
- 2- Creates a new 38 U.S.C. 1729C allowing VA to bill MA organizations and PDP sponsors for items/services VA provides that are covered under a veteran’s MA or Part D plan, with reimbursement due to the VA to the extent the item/service is covered by the plan.
- 3- Recovered amounts are deposited into the VA Medical Care Collections Fund (1729A).
- 4- Applies to MA/MA-PD and Part D plan years starting on or after January 1, 2026.
- 5- Requires conforming amendments to the Social Security Act to recognize this new recovery pathway.
- 6Modifications to federal recovery for non-service-connected disability care
- 7- Expands the United States’ right to recover or collect reasonable charges for care or services VA furnishes for non-service-connected disabilities, including recovery from third parties when applicable.
- 8- Broadens the scope to include tort recoveries and reimbursements from other payers, with specific timing, coordination-of-benefits, and settlement rules.
- 9- Introduces a robust “clean claim” process with deadlines (typically 45 days for third parties to pay or respond) and procedures for disputes, information requests, and penalties for noncompliance.
- 10- Establishes penalties for nonpayment (civil penalties, possible triple damages or up to a statutory cap with inflation adjustment) and allows the U.S. to seek damages doubled for certain failures to reimburse.
- 11- Allows the VA to intervene in or join third-party actions and imposes time limits on lawsuits (with certain exceptions and coordination with other law).
- 12- Defines key terms like “clean claim” and “non-service-connected disability,” and clarifies that recovery can occur regardless of existing non-Department claim processes.