S. 2145: Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act

This bill, titled the **Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act** (GUARD Veterans’ Health Care Act), aims to make several adjustments to how the U.S. Department of Veterans Affairs (VA) can recover costs from Medicare plans for health care provided to veterans.

Key Provisions

• Cost Recovery from Medicare Advantage and Prescription Drug Plans:

  The bill allows the VA to recover costs from Medicare Advantage plans and Medicare prescription drug plans for any health care items or services provided to veterans, regardless of whether these services are related to service-connected disabilities. This includes reimbursement for outpatient and inpatient care, prescription drugs, medical devices, lab tests, and services in long-term care settings. Medicare plans would be required to reimburse the VA for these costs without imposing additional documentation or administrative requirements.

• Clarification of Recovery Rights:

  The bill modifies existing rights the U.S. has to recover reasonable charges for services paid for certain non-service-connected disabilities. It clarifies that the VA can recover costs from third parties when the veteran received care for these disabilities and to the extent that the care would be eligible for reimbursement from those third parties.

• Procedures for Cost Recovery:

  The Secretary of the VA will establish procedures for recovering these amounts. The bill stipulates that these procedures should be similar to those already in place for recovering amounts authorized under current laws. It provides for certain timelines and processes for third parties to respond to reimbursement claims.

• Compliance and Penalties:

  If a third-party payer fails to reimburse the VA as required, they may incur civil penalties and interest on the unpaid amounts. The bill outlines specific penalties for willfully failing to pay claims and sets forth that the VA may take legal action to enforce these recovery rights.

• Exemption from Certain Fee Schedules:

  The recovery rights established by this legislation will not be limited by non-VA price schedules or fee agreements that apply to non-Department providers, such as those under workers' compensation plans or automobile insurance reimbursement.

• Effective Date:

  The provisions related to cost-recovery from Medicare Advantage and prescription drug plans will apply starting January 1, 2026.

Relevant Companies

• CNC - Centene Corporation: A major provider of Medicare Advantage plans, which may be directly impacted by the requirement to reimburse the VA for services provided to veterans.
• HUM - Humana Inc.: Another significant player in the Medicare Advantage market, likely facing changes in reimbursement processes for veteran care.
• ANTM - Anthem, Inc.: An insurer offering Medicare plans that could see operational changes regarding cost recovery related to veteran care services.
• UNH - UnitedHealth Group Incorporated: A large provider in health insurance, including Medicare Advantage plans, potentially affected by the bill's reimbursement directives.