GUARD Veterans’ Health Care Act
- Bill Number
- H.R. 4077
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Armed Forces and National Security
- Status
- Introduced
- Latest Action
- 2025-12-03: Committee Hearings Held
- Last Updated
- 2026-05-14T08:08:01Z
AI-Generated Summary
Purpose of the Legislation
The GUARD Veterans' Health Care Act (H.R. 4077) aims to improve funding for veterans' health care by allowing the Department of Veterans Affairs (VA) to recover costs from Medicare Advantage plans, Medicare prescription drug plans, and other third-party payers for medical services provided to veterans. It seeks to ensure that these entities reimburse the VA for covered care, reducing financial burdens on the VA and directing recovered funds back into veterans' health programs.
Key Provisions
- Cost Recovery from Medicare Plans (New Section 1729C of Title 38, U.S. Code):
- Requires Medicare Advantage (MA) organizations and prescription drug plan (PDP) sponsors to reimburse the VA for health care items or services (e.g., inpatient/outpatient care, prescription drugs, medical devices, lab tests, and post-acute/long-term care) provided to enrolled veterans, regardless of whether the care is for service-connected or non-service-connected disabilities.
- Overrides certain Medicare rules that previously limited such reimbursements, eliminating requirements for additional documentation or administrative hurdles imposed by the plans.
- Recovery uses existing VA procedures, with amounts deposited into the VA Medical Care Collections Fund.
- Applies to plan years starting January 1, 2026.
- Modifications to Recovery Authority for Non-Service-Connected Care (Amendments to Section 1729 of Title 38, U.S. Code):
- Expands the U.S. government's right to recover "reasonable charges" from third parties (e.g., health insurers, tort liable parties like those responsible for accidents) for VA-furnished care related to non-service-connected disabilities, injuries, or conditions (including aggravations of service-connected issues).
- Includes recovery from any health plan, policy, or contract benefits, as well as tort claims (legal actions for harm caused by negligence).
- Establishes timelines and processes:
- Third parties must pay "clean claims" (claims processable without extra info) within 45 days, agree in writing, or provide denial reasons/request more info.
- Interest accrues on unpaid amounts after 45 days (at a Treasury-set rate).
- Third parties must report veteran care details to the VA within 30 days and cannot distribute settlement/judgment funds without satisfying VA claims.
- No refunds for payment errors if requested more than 18 months after VA receipt.
- Enforcement:
- VA can intervene in legal actions and pursue claims without non-VA processes.
- Civil penalties for non-compliance (daily fines published by VA); triple damages (up to $50,000, inflation-adjusted) for willful refusal to pay clean claims.
- Double damages for failures to reimburse reasonable care value.
- Six-year limit for proceedings (three years for tort-based claims under existing law).
- Conforming Changes to the Social Security Act:
- Amends Medicare sections (1814(c), 1835(d), 1862(a)(3)) to align with the new VA recovery rules, excluding VA-reimbursed services from certain Medicare coverage limits.
- Definitions:
- Clean claim: A reimbursable claim that doesn't need additional information.
- Non-service-connected disability: Broadly includes injuries, illnesses, or conditions not linked to military service, plus worsenings of service-connected issues.
- Third party: Includes health plans, tort-responsible entities (e.g., negligent parties), and payers like auto insurance for medical expenses.
Significant Changes to Existing Law
- Overrides Medicare exclusions that previously barred reimbursements to the VA for services to veterans in MA or PDP plans, removing barriers like utilization reviews.
- Broadens recovery under Section 1729 to explicitly include tort liabilities and all health benefit sources, previously more limited to specific insurance types.
- Introduces strict timelines, interest, and penalties (e.g., daily fines, triple damages) not in prior law, shifting from voluntary compliance to mandatory enforcement.
- Prohibits third parties from withholding settlement funds or delaying payments, and limits their ability to demand VA-specific forms or processes.
- Extends recovery to non-Department providers without tying to external fee schedules (e.g., workers' compensation rates).
Potential Impacts
- On Government Agencies: Increases revenue for the VA (via the Medical Care Collections Fund), potentially funding more veteran services without raising taxes; requires administrative updates for recovery processes and may strain Medicare administration due to new reimbursement mandates.
- On Citizens: Veterans benefit indirectly through better-funded VA health care; enrollees in MA/PDP plans may face higher plan costs if reimbursements increase premiums, but gain coordinated care without coverage gaps.
- On International Relations: No direct impact, as the bill focuses on domestic U.S. health programs.
- Overall, could reduce VA's annual costs for non-service-connected care (estimated in billions) by shifting burdens to private payers, improving efficiency but possibly leading to disputes or litigation.
Main Stakeholders Affected
- Department of Veterans Affairs (VA): Gains expanded recovery tools and funding, but must implement new processes and handle enforcement.
- Veterans: Primary beneficiaries through sustained or enhanced health services; includes those with mixed service/non-service-connected needs.
- Medicare Advantage Organizations and PDP Sponsors: Must reimburse VA promptly, facing penalties for delays; may need to adjust operations and pricing.
- Third-Party Payers: Health insurers, auto/workers' compensation providers, and tort defendants (e.g., in accident lawsuits) face stricter payment rules, reporting, and penalties.
- U.S. Taxpayers: Potential savings on VA budget, reducing federal spending needs.
- Congressional Committees: Veterans' Affairs, Ways and Means, and Energy and Commerce oversee implementation.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens VA's subrogation rights (government stepping into a person's shoes to claim benefits), but may invite challenges from payers arguing federal overreach into private contracts or Medicare's structure; aligns with existing tort recovery laws while adding time-barred actions.
- Constitutional: No apparent issues, as it involves Congress's spending and veterans' benefits powers under Article I; promotes equal treatment in health reimbursements without infringing on due process.
- Political: Bipartisan support (introduced by members from both parties) highlights focus on veteran care funding amid rising VA costs; could spark debates on balancing veteran priorities with private insurance burdens, potentially influencing future health policy reforms like Medicare expansions.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (7)
Rep. Murphy, Gregory F. [R-NC-3], Rep. Takano, Mark [D-CA-39], Rep. Schweikert, David [R-AZ-1], Rep. Joyce, John [R-PA-13], Rep. Landsman, Greg [D-OH-1], Rep. Downing, Troy [R-MT-2], Rep. DelBene, Suzan K. [D-WA-1]
Recent Actions
- 2025-12-03: Committee Hearings Held
- 2025-06-23: Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-06-23: Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-06-23: Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Ways and Means, and Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-06-23: Introduced in House
- 2025-06-23: Introduced in House
Bill Versions
- Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act — issued 2025-06-23 — PDF (14 pages)