GUARD Veterans’ Health Care Act

Summary

Requires Medicare Advantage (MA) plans and Part D prescription drug sponsors to reimburse the Department of Veterans Affairs (VA) for covered items and services the VA furnishes to enrollees, without imposing extra plan documentation or utilization-management hurdles. It also strengthens and clarifies the VA’s recovery and subrogation powers for non-service-connected care, sets timelines and interest for third-party payments, and creates enforcement tools and deadlines for claim resolution. The MA/Part D reimbursement rule takes effect for plan years beginning January 1, 2026; related changes expand the VA’s recovery authorities, shorten/clarify statutes of limitations for recoveries, and require third parties to respond or pay within specific timeframes, with interest on unpaid amounts and explicit remedies for enforcement.

• MA plans and Part D sponsors must reimburse the VA for covered items and services provided by the VA, regardless of extra plan documentation or utilization requirements.
• Reimbursements recovered by the VA are payable into the VA Medical Care Collections Fund.
• The reimbursement rule applies to plan years beginning January 1, 2026, and later.
• VA recovery authority (38 U.S.C. 1729) is expanded to cover all causes of action and to allow intervention in third‑party proceedings to protect subrogation interests.
• Third parties have 45 days to pay a clean claim, pay an agreed amount, or provide a written refusal or request for specific information; good‑faith disputes are exempt.
• A six‑year limitation applies for recovery proceedings tied to Medicare‑type payments; a separate three‑year tort limit applies for certain claims by the U.S.
• Unpaid amounts accrue interest at the federal rate under 31 U.S.C. 3717; the bill establishes explicit timelines and enforcement tools to speed collection.
• The bill creates a statutory priority for VA recovery against liable third parties and private plans when veterans receive covered care from the VA.