,,ii #aaith ,,congress #ast ,session ,s4 #bade ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bc1 #bjbe,ms4 ,warren 7for herself1 ,mr4 ,blumenthal1 and ,mr4 ,cassidy7 introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to amend title #ch1 ,united ,states ,code1 and the ,social ,security ,act to permit recovery from the ,department of ,veterans ,affairs of costs from ,medicare ,advantage and ,medicare prescription drug plans and to modify the authority for recovery by the ,united ,states of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,guarantee ,utilization of ,all ,reimbursements for ,delivery of ,veterans' ,health ,care ,act or the ,,guard ,veterans' ,health ,care ,act4 #b4 ,cost-recovery from ,medicare ,advantage and ,medicare prescription drug plans 7a7 ,cost recovery 7#a7 ,in general ,subchapter ,,iii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agbi;,b the following new section3 #agbi;,c4 ,cost-recovery from ,medicare ,advantage and ,medicare prescription drug plans 7a7 ,in general ,notwithstanding sections #ahad7;c71 #ahce7;d71 and #ahfb7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7c71 #acien7d71 and #aciey7a77#c771 if the ,secretary provides under this chapter any health care item or service 7including for a service-connected disability or a non-service-connected disability7 covered under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including outpatient and inpatient care1 prescription drugs1 medical devices1 lab testing1 and items or services delivered in post-acute and long-term care settings1 to any individual who is enrolled in a ,medicare ,advantage plan1 including an ,,ma-,,pd plan1 offered by a ,,ma organization under part ,c of such title or a prescription drug plan offered by a ,,pdp sponsor under part ,d of such title1 such organization or sponsor shall1 to the extent such item or service is covered under such ,medicare ,advantage plan or prescription drug plan1 reimburse the ,secretary for such item or service regardless of any additional documentation1 utilization management1 or other administrative requirement the plan may impose on the item or service4 7b7 ,recovery of amounts 7#a7 ,in general ,the ,secretary shall recover amounts required to be reimbursed under subsection 7a7 through the use of procedures under section #agbi of this title to the same extent as those procedures are used to recover amounts authorized to be recovered under that section4 7#b7 ,amount and process ,except as provided in paragraph 7#a71 recovery under that paragraph of amounts reimbursed under subsection 7a7 shall be in such an amount1 and occur in accordance with such procedures1 as the ,secretary shall prescribe for purposes of this section4 7c7 ,application ,the provisions of subsection 7a7 shall apply to ,medicare ,advantage and prescription drug plan years beginning on or after ,january #a1 #bjbf4 7d7 ,treatment of amounts ,amounts reimbursed to the ,secretary under subsection 7a7 shall be deposited in the ,department of ,veterans ,affairs ,medical ,care ,collections ,fund under section #agbi;,a of this title4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agbi;,b the following new item3 #agbi;,c4 ,cost-recovery from ,medicare ,advantage and ,medicare prescription drug plans4 4 7b7 ,medicare conforming amendments 7#a7 ,part ,a ,section #ahad7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7c77 is amended by inserting and section #agbi;,c of title #ch1 ,united ,states ,code after section #ahhj4 7#b7 ,part ,b ,section #ahce7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acien7d77 is amended by inserting and section #agbi;,c of title #ch1 ,united ,states ,code after section #ahhj4 7#c7 ,exclusions from coverage ,section #ahfb7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#c77 is amended by inserting in the case of items and services and prescription drugs for which reimbursement is made under section #agbi;,c of title #ch1 ,united ,states ,code1 after section #ahhj7;e714 #c4 ,modification of authority for recovery by ,united ,states of reasonable charges for certain care or services furnished to veterans for non-service-connected disabilities ,section #agbi of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in subsection 7a7-- 7,a7 by amending paragraph 7#a7 to read as follows3 7#a7 7,a7 ,subject to the provisions of this section1 the ,united ,states has the right to recover or collect the reasonable charges for care or services that the ,united ,states is required by law to furnish or pay for under this chapter for a non-service-connected disability4 7,b7 ,the ,united ,states has the right to recover or collect from a third party the reasonable charges for care or services furnished as described in subparagraph 7,a7 to the extent that the recipient or provider of the care or services would be eligible to receive payment from a third party4 7,c7 ,the right to recover or collect reasonable charges for care or services under this section shall apply to any and all causes of action or recovery rights in tort or under any policy1 plan1 or contract providing benefits for health care or injury1 which accrue to the individual to whom the care or services were furnished1 or to the legal representatives of the individual1 as a result of the non-service-connected disability that necessitated the care or services4 2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,d71 by striking 2 or and inserting a semicolon2 7ii7 in subparagraph 7,e77#b71 by striking the period at the end and inserting 2 or2 and 7iii7 by adding at the end the following new subparagraph3 7,f7 that is incurred by an individual who is entitled to care 7or payment of expenses of care7 under circumstances creating a tort liability upon a third party4 2 7#b7 in subsection 7b71 by amending paragraph 7#b7 to read as follows3 7#b7 7,a7 ,the ,united ,states may take any action necessary to enforce the subrogation interests of the ,united ,states under this section1 including by intervening or joining in an action or proceeding4 7,b7 ,a proceeding under this section may not be brought after the end of the six-year period beginning on the last day on which the care or services for which recovery is sought are furnished4 ,notwithstanding the previous sentence1 subject to section #bdae of title #bh1 and except as otherwise provided by law1 any action for money damages under this section brought by the ,united ,states or an officer or agency thereof that is founded upon a tort shall be barred unless the complaint is filed within three years after the right of action first accrues4 2 7#c7 in subsection 7c77#a71 by inserting or penalty after claim2 7#d7 by redesignating subsections 7h7 and 7i7 as subsections 7l7 and 7m71 respectively2 7#e7 by inserting after subsection 7f7 the following new subsections3 7g7 7#a7 ,not later than #de days after receipt of a claim to recover or collect the reasonable charges for care or services described in subsection 7a71 or in the case of a tort1 not later than #de days after settlement1 judgment1 award1 liability determination1 or resolution relating to the cause of action1 a third party shall-- 7,a7 pay a clean claim for reimbursement in accordance with this section2 7,b7 pay the amount agreed to in writing by the ,department2 or 7,c7 provide notice of the date the third party received the claim and include a statement that-- 7i7 the third party refuses to reimburse all or part of the claim and specify each reason for the refusal to pay2 or 7ii7 additional information is necessary to determine if all or part of the claim will be reimbursed and what specific additional information is necessary4 7#b7 ,paragraph 7#a7 shall not apply to a claim if there is a good faith dispute about the legitimacy of the claim4 7#c7 7,a7 ,if any third party fails to comply with paragraph 7#a71 such third party shall be required to pay interest to the ,united ,states at the rate established by the ,secretary of the ,treasury under section #cgag of title #ca per month on the amount of the claim that remains unpaid at the end of the #de-;day period specified in such paragraph4 7,b7 ,the interest paid pursuant to subparagraph 7,a7 shall be included in any late reimbursement from a third party without requiring the ,secretary to make any additional claim for such interest4 7#d7 7,a7 ,upon receiving a request for additional information by a third party pursuant to paragraph 7#a77;,c77ii71 the ,secretary shall provide the additional information1 if determined relevant by the ,secretary1 not later than #de days after receipt of the request for additional information4 7,b7 ,failure to furnish relevant information within the time required under subparagraph 7,a7 shall not invalidate or reduce any claim in connection with such information4 7,c7 7i7 ,not later than #ae days after receipt of additional relevant information under subparagraph 7,a71 a third party shall pay a clean claim in accordance with this subsection or send a written or electronic notice that-- 7,i7 such third party refuses to reimburse all or part of the claim2 and 7,,ii7 specifies each reason for refusal to pay4 7ii7 ,any third party that fails to comply with clause 7i7 shall pay interest to the ,united ,states on any amount of the claim that remains unpaid at the rate established by the ,secretary of the ,treasury under section #cgag of title #ca4 7#e7 ,a third party shall not be entitled to request a refund to correct a payment error to the ,department if the request by the third party for such payment correction is submitted more than #ah months after the date that the ,department received payment from the third party4 7#f7 ,any claim by the ,department under this section shall not be subject to non-,department claims processes1 policies1 or forms4 7h7 ,the recovery rights of the ,united ,states under this section are not limited to the amounts paid to non-,department providers and are not subject to non-,department fee schedules or non-,department reimbursement rates1 including those administered under workers' compensation plans or automobile accident reparations insurance4 7i7 7#a7 ,a third party shall-- 7,a7 determine whether a recipient of care or services covered by this section 7including a recipient whose claim is unresolved7 has received benefits under this chapter2 and 7,b7 submit the information described in paragraph 7#b7 with respect to the recipient to the ,secretary in a form and manner 7including frequency7 specified by the ,secretary4 7#b7 ,the information required to be submitted under this paragraph with respect to a recipient of care or services is-- 7,a7 the identity of the recipient2 and 7,b7 such other information as the ,secretary shall specify in order to enable the ,secretary to make an appropriate determination concerning coordination of benefits1 including any applicable recovery claim4 7#c7 ,a third party shall submit the information required under paragraph 7#a77;,b7 with respect to a recipient of care or services covered by this section 7including a recipient whose claim is unresolved7 not later than #cj days1 or such other time period as prescribed by the ,secretary1 after the date on which the third party knows or has reason to know that the recipient has received benefits under this chapter4 7#d7 ,a third party shall not distribute proceeds of a settlement1 judgment1 award1 or other payment in connection with a recipient of care or services covered by this section 7including a recipient whose claim is unresolved71 regardless of whether there has been a determination or admission of liability1 without satisfaction of a claim by the ,department4 7j7 7#a7 ,a third party that fails to comply with the requirements under this section1 including any regulations prescribed to implement this section1 with respect to any individual receiving care furnished or paid for by the ,department as described in this section1 shall be subject to a civil penalty in an amount published on a website of the ,department for each day of noncompliance with respect to each claim violation4 ,a civil penalty under this paragraph shall be in addition to any other penalties prescribed by law4 7#b7 7,a7 ,a third party that willfully fails or refuses to pay a clean claim under this section1 including any regulations prescribed to implement this section1 with respect to any individual receiving care furnished or paid for by the ,department as described in this section1 shall be subject to paying the higher of triple the amount of the claim or an amount not to exceed #ej1jjj1 which may be adjusted for inflation1 for each claim violation4 7,b7 ,a penalty under subparagraph 7,a7 is in addition to any other penalty under this subsection and any other penalty prescribed by law4 7,c7 ,before enforcing any penalty under this paragraph with respect to a third party1 the ,secretary shall provide to the third party written notice of the amount due and a #cj-;day opportunity to pay the clean claim1 including penalties1 interests1 and costs4 7#c7 ,notwithstanding any other applicable civil or criminal remedies1 the ,united ,states shall have a cause of action for damages 7which shall be in an amount double the amount otherwise provided7 in the case of a third party that fails to provide payment1 or appropriate reimbursement1 for the reasonable value of the care or services furnished1 to be furnished1 paid for1 or to be paid for in accordance with a clean claim4 7k7 ,notwithstanding any other provision of law1 the ,secretary may implement this paragraph by prescribing regulations1 program instructions1 or otherwise4 2 and 7#f7 in subsection 7m71 as redesignated by paragraph 7#d7-- 7,a7 in paragraph 7#c7-- 7i7 in subparagraph 7,c71 by striking 2 or and inserting a semicolon2 7ii7 in subparagraph 7,d71 by striking the period at the end and inserting a semicolon2 and 7iii7 by adding at the end the following new subparagraphs3 7,e7 a person or entity responsible in tort for damages incurred as a result of negligence2 or 7,f7 a person or entity responsible for payment of medical expenses other than under a health-plan contract1 including medical expenses coverage1 medical payments coverage1 or underinsured motorist coverage4 2 and 7,b7 by adding at the end the following new paragraphs3 7#d7 ,the term clean claim means a claim to recover or collect reasonable charges under subsection 7a7 that can be processed without obtaining additional information4 7#e7 ,the term non-service-connected disability includes-- 7,a7 a non-service-connected disability1 injury1 illness1 health care need1 or condition2 and 7,b7 an aggravation or exacerbation of a service-connected disability4 4