HR5261-119

What This Bill Does

The Veterans Emergency Care Reimbursement Act changes VA emergency-treatment reimbursement rules for veterans who receive non-VA emergency care through a health-plan contract. It revises the limitation in 38 U.S.C. 1725(c)(4)(D) so the Secretary's restriction applies to a copayment of less than $100 rather than broader similar cost sharing. It defines a copayment as a fixed amount for a covered health service and excludes deductibles and coinsurance from that definition. The bill applies to emergency treatment furnished on or after February 1, 2012, including claims by the Wolfe v. McDonough certified class. It defines reimbursement claims to include veteran claims for copayments, deductibles, coinsurance, or other cost share for emergency treatment in a non-VA facility where a health-plan contract existed, including reasonable-value claims rejected or denied by VA final decisions or still unresolved. The practical effect is to make VA reimbursement available for more veterans' emergency-care cost shares, especially deductible and coinsurance claims tied to the Wolfe litigation.

Who Benefits and How

Veterans with non-VA emergency care claims benefit because deductibles, coinsurance, and other cost shares are treated as reimbursement claims. Wolfe v. McDonough class members benefit because the bill expressly covers emergency treatment furnished on or after February 1, 2012. Veterans' families benefit when unexpected non-VA emergency-care bills are reimbursed rather than absorbed by household budgets. Veterans service organizations benefit from a clearer statutory basis for assisting members with denied emergency-care cost-share claims.

Who Bears the Burden and How

Department of Veterans Affairs payment staff must reopen, process, or pay qualifying emergency-treatment cost-share claims. VA budget officials bear higher reimbursement exposure for previously rejected deductible and coinsurance claims. Federal taxpayers fund the expanded reimbursement obligations for covered emergency treatment. VA legal staff must apply the statute to claims affected by final decisions and Wolfe class litigation.

Key Provisions

• Modifies VA emergency-care reimbursement limitations for copayments below $100.
• Defines copayment as a fixed amount and excludes deductibles and coinsurance from that term.
• Applies the reimbursement rule to emergency treatment furnished on or after February 1, 2012.
• Protects Wolfe v. McDonough class claims and other VA-denied emergency-treatment cost-share claims.
• Requires VA to treat deductibles, coinsurance, and other cost shares as reimbursement claims when statutory conditions are met.