Sec. 102. Expansion of reimbursement of veterans for emergency treatment and urgent care
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Section 1725 of title 38, United States Code, is amended to read as follows: Subject to the provisions of this section, the Secretary shall reimburse a veteran described in subsection
(b)for the reasonable value of emergency treatment or urgent care furnished the veteran in a non-Department facility. In any case in which reimbursement of a veteran is authorized under paragraph (1), the Secretary may, in lieu of reimbursing the veteran, make payment of the reasonable value of the furnished emergency treatment or urgent care directly— to the hospital or other health care provider that furnished the treatment or care; or to the person or organization that paid for such treatment or care on behalf of the veteran. A veteran described in this subsection is an individual who— is enrolled in the patient enrollment system of the Department established and operated under section 1705 of this title; and has received care under this chapter during the 24-month period preceding the furnishing of the emergency treatment or urgent care for which reimbursement is sought under this section. Notwithstanding section 111 of this title, reimbursement of emergency treatment or urgent care under this section shall include reimbursement for the reasonable value of emergency transportation. The Secretary shall be primarily responsible for reimbursing or otherwise paying the reasonable value of emergency treatment or urgent care under this section. The Secretary, in accordance with regulations prescribed by the Secretary for purposes of this section, shall— establish the maximum amount payable under subsection (a); and delineate the circumstances under which such payments may be made, including such requirements on requesting reimbursement as the Secretary may establish. Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment or urgent care shall, unless rejected and refunded by the provider within 30 days of receipt— constitute payment in full for the emergency treatment or urgent care provided; and extinguish any liability on the part of the veteran for that treatment or care. Neither the absence of a contract or agreement between the Secretary and a provider of emergency treatment or urgent care nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirements of subparagraph (A). A provider of emergency treatment or urgent care may not seek to recover from any third party the cost of emergency treatment or urgent care for which the provider has received payment from the Secretary under this section. The United States has the right to recover or collect reasonable charges for emergency treatment or urgent care furnished under this section in accordance with the provisions of section 1729 of this title. Except as provided in paragraph (2), a veteran shall pay to the Department a copayment (in an amount prescribed by the Secretary for purposes of this section) for each episode of emergency treatment or urgent care for which reimbursement is provided to the veteran under this section. The requirement under paragraph
(1)to pay a copayment does not apply to a veteran who— would not be required to pay to the Department a copayment for emergency treatment or urgent care furnished at facilities of the Department; meets an exemption specified by the Secretary in regulations prescribed by the Secretary for purposes of this section; or is admitted to a hospital for treatment or observation following, and in connection with, the emergency treatment or urgent care for which the veteran is provided reimbursement under this section. The requirement that a veteran pay a copayment under this section shall apply notwithstanding the authority of the Secretary to offset such a requirement with amounts recovered from a third party under section 1729 of this title. In this section: The term emergency treatment means medical care or services furnished, in the judgment of the Secretary— when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and until— such time as the veteran can be transferred safely to a Department facility or community care provider authorized by the Secretary and such facility or provider is capable of accepting such transfer; or such time as a Department facility or community care provider authorized by the Secretary accepts such transfer if— at the time the veteran could have been transferred safely to such a facility or provider, no such facility or provider agreed to accept such transfer; and the non-Department facility in which such medical care or services was furnished made and documented reasonable attempts to transfer the veteran to a Department facility or community care provider. The term health-plan contract includes any of the following: An insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement under which health services for individuals are provided or the expenses of such services are paid. An insurance program described in section 1811 of the Social Security Act ( 42 U.S.C. 1395c ) or established by section 1831 of such Act ( 42 U.S.C. 1395j ). A State plan for medical assistance approved under title XIX of such Act ( 42 U.S.C. 1396 et seq. ). A workers’ compensation law or plan described in section 1729(a)(2)(A) of this title. The term third party means any of the following: A Federal entity. A State or political subdivision of a State. An employer or an employer's insurance carrier. An automobile accident reparations insurance carrier. A person or entity obligated to provide, or to pay the expenses of, health services under a health-plan contract. The term urgent care shall have the meaning given that term by the Secretary in regulations prescribed by the Secretary for purposes of this section. . The table of sections at the beginning of chapter 17 is amended by striking the item relating to section 1725 and inserting the following new item: 1725. Reimbursement for emergency treatment and urgent care. . Section 1728 is repealed. Section 1781(a)(4) is amended by striking (as defined in section 1725(f) of this title) and inserting (as defined in section 1725(h) of this title) . Section 1787(b)(3) is amended by striking (as defined in section 1725(f) of this title) and inserting (as defined in section 1725(h) of this title) . Not later than 270 days after the date of the enactment of this Act, the Secretary shall prescribe regulations to carry out the amendments made by this section. The amendments made by this section shall take effect one year after the date of the enactment of this Act.
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Sec. 102
Expansion of reimbursement of veterans for emergency treatment and urgent care
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