79–006 

111TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 111–55 

AMENDING TITLE 38, UNITED STATES CODE, TO EXPAND VETERAN ELIGIBILITY FOR REIMBURSEMENT BY THE SECRETARY OF VETERANS AFFAIRS FOR EMERGENCY TREATMENT FURNISHED IN A NON-DEPARTMENT FACILITY, AND FOR OTHER PURPOSES 

MARCH 26, 2009.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. FILNER, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 1377] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 1377) to amend title 38, United States Code, to expand 

veteran eligibility for reimbursement by the Secretary of Veterans 

Affairs for emergency treatment furnished in a non-Department facility, and for other purposes, having considered the same, report 

favorably thereon with an amendment and recommend that the bill 

as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 2 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Subcommittee Consideration .................................................................................. 3 

Committee Consideration ........................................................................................ 4 

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 4 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmarks and Tax and Tariff Benefits .................................................................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 5 

Federal Mandates Statement ................................................................................. 6 

Advisory Committee Statement .............................................................................. 6 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill as Reported ...................................... 7 


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AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. EXPANSION OF VETERAN ELIGIBILITY FOR REIMBURSEMENT BY SECRETARY OF 

VETERANS AFFAIRS FOR EMERGENCY TREATMENT FURNISHED IN A NON-DEPARTMENT FACILITY. 

(a) EXPANSION OF ELIGIBILITY.—Section 1725 of title 38, United States Code, is 

amended— 

(1) in subsection (b)(3)(C), by striking ‘‘or in part’’; and 

(2) in subsection (f)(2), by striking subparagraph (E). 

(b) LIMITATIONS ON REIMBURSEMENT.—Subsection (c) of such section is amended 

by adding at the end the following new paragraph: 

‘‘(4)(A) If the veteran has contractual or legal recourse against a third party 

that would only, in part, extinguish the veteran’s liability to the provider of the 

emergency treatment, and payment for the treatment may be made both under 

subsection (a) and by the third party, the amount payable for such treatment 

under such subsection shall be the amount by which the costs for the emergency 

treatment exceed the amount payable or paid by the third party, except that 

the amount payable may not exceed the maximum amount payable established 

under paragraph (1)(A). 

‘‘(B) In any case in which a third party is financially responsible for part of 

the veteran’s emergency treatment expenses, the Secretary shall be the secondary payer. 

‘‘(C) A payment in the amount payable under subparagraph (A) shall be considered payment in full and shall extinguish the veteran’s liability to the provider. 

‘‘(D) The Secretary may not reimburse a veteran under this section for any 

copayment or similar payment that the veteran owes the third party or for 

which the veteran is responsible under a health-plan contract.’’. 

(c) EFFECTIVE DATE.— 

(1) IN GENERAL.—The amendments made by subsections (a) and (b) shall take 

effect on the date of the enactment of this Act, and shall apply with respect to 

emergency treatment furnished on or after the date of the enactment of this 

Act. 

(2) REIMBURSEMENT FOR TREATMENT PROVIDED BEFORE EFFECTIVE DATE.—The 

Secretary may provide reimbursement under section 1725 of title 38, United 

States Code, as amended by subsections (a) and (b), for emergency treatment 

furnished to a veteran before the date of the enactment of this Act, if the Secretary determines that, under the circumstances applicable with respect to the 

veteran, it is appropriate to do so. 

PURPOSE AND SUMMARY

H.R. 1377 was introduced on March 6, 2009, by Representative 

Bob Filner of California, Chairman of the Committee on Veterans’ 

Affairs. This legislation would expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs (VA) for emergency 

treatment furnished in a non-Department facility. It would also set 

certain limitations on reimbursement. 

BACKGROUND AND NEED FOR LEGISLATION

VA is required to reimburse veterans or pay for emergency treatment in non-VA facilities. This authority was last revised in 2008 

with the enactment of the Veterans’ Mental Health and Other Care 

Improvements Act of 2008, Public Law 110–387 (122 Stat. 4110), 

which made these provisions mandatory. 

The Committee has learned that under current law the VA does 

not pay for emergency treatment for non-service connected conditions in non-VA facilities if the veteran has third-party insurance 

that pays any portion of the costs associated with such emergency 

treatment. This situation can inadvertently arise if a veteran has 


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minimal health insurance coverage through a state-mandated automobile insurance policy. Consequently, if an emergency does occur, 

and the veteran has a policy containing such minimal coverage, the 

veteran may be responsible for essentially the full cost of emergency treatment. While some veterans are able to negotiate payment plans and debt forgiveness of a portion of their medical bills 

with the non-VA hospital where they received the emergency treatment, many veterans are without the financial resources to shoulder such a cost and are unaware that the VA would not be responsible for such emergency care. 

To address this problem, Representative Filner introduced H.R. 

5888 during the 110th Congress. At a June 5, 2008, legislative 

hearing, the VA supported the intent of H.R. 5888 but expressed 

concerns about the reimbursement responsibilities of the VA. 

H.R. 1377, as amended, would allow the VA to reimburse veterans for treatment in a non-VA facility if they have a third-party 

insurer that would pay a portion of the emergency care. In addition, in response to the concerns put forth by the VA last Congress, 

H.R. 1377 would clarify the reimbursement responsibilities of the 

VA. 

H.R. 1377, as amended, provides for an effective date which is 

the date of the enactment of the Act. However, many veterans have 

been adversely affected by the VA’s non-reimbursement for emergency treatment under the current law. The Committee strongly 

urges the Secretary to use the discretionary authority provided by 

this bill to reimburse veterans for emergency treatment provided 

prior to the date of enactment who have been financially harmed 

under the VA’s current non-reimbursement policy. 

HEARINGS

On March 3, 2009, the Subcommittee on Health held a legislative 

hearing on a number of bills introduced during the 111th Congress, 

including a discussion draft of the emergency care reimbursement 

bill. 

The following witnesses testified: The Honorable Niki Tsongas of 

Massachusetts; The Honorable Stephanie Herseth Sandlin of South 

Dakota; Ms. Joy Ilem, Assistant National Legislative Director, Disabled American Veterans; Mr. Joseph L. Wilson, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, The American Legion; Mr. Eric Hilleman, Deputy Director, National Legislative 

Service, Veterans of Foreign Wars of the United States; Mr. Todd 

Bowers, Director of Government Affairs, Iraq and Afghanistan Veterans of America; Gerald Cross, M.D., FAAFP, Principal Deputy 

Under Secretary for Health, Veterans Health Administration, U.S. 

Department of Veterans Affairs, accompanied by Mr. Walter A. 

Hall, Assistant General Counsel, U.S. Department of Veterans Affairs. Those submitting statements for the record included: The 

Honorable Bob Filner of California; the Vietnam Veterans of America; and the Paralyzed Veterans of America. 

SUBCOMMITTEE CONSIDERATION

On March 19, 2009, the Subcommittee on Health met in open 

markup session and ordered favorably forwarded to the full ComVerDate Nov 24 2008 05:16 Mar 27, 2009 Jkt 079006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR055.XXX HR055

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mittee H.R. 1377, as amended, by voice vote. During consideration 

of the bill the following amendment was considered: 

An amendment by Mr. Rodriguez of Texas to amend the 

effective date was agreed to by voice vote. 

COMMITTEE CONSIDERATION

On March 25, 2009, the full Committee met in an open markup 

session, a quorum being present, and ordered H.R. 1377, as amended, favorably reported to the House of Representatives, by voice 

vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report the legislation and amendments thereto. There were no 

record votes taken on amendments or in connection with ordering 

H.R. 1377 reported to the House. A motion by Mr. Buyer of Indiana 

to order H.R. 1377, as amended, reported favorably to the House 

of Representatives was agreed to by voice vote. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are reflected in the descriptive portions of this report. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 1377 does not contain any congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9(d), 9(e), 

or 9(f) of rule XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 1377 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 


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CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 1377 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, Washington, DC, March 25, 2009. 

Hon. BOB FILNER, 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1377, a bill to amend title 

38, United States Code, to expand veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment 

furnished in a non-Department facility, and for other purposes. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Sunita D’Monte. 

Sincerely, 

DOUGLAS W. ELMENDORF, 

Director. 

Enclosure. 

H.R. 1377—A bill to amend title 38, United States Code, to expand 

veteran eligibility for reimbursement by the Secretary of Veterans Affairs for emergency treatment furnished in a non-Department facility, and for other purposes 

H.R. 1377 would require the Department of Veterans Affairs 

(VA) to pay for the emergency care that certain veterans receive at 

non-VA medical facilities, or to reimburse veterans if they have 

paid for that care. It also would permit VA, subject to the Secretary’s discretion, to reimburse veterans for emergency treatment 

that was provided prior to the date of enactment. CBO estimates 

that implementing the bill would cost $5 million over the 2010– 

2014 period, assuming appropriation of the estimated amounts. Enacting the bill would not affect direct spending or revenues. 

Under current law, VA has the authority to reimburse certain 

veterans or pay for emergency treatment of a nonservice-connected 

condition, if VA is the payer of last resort. Veterans who have recourse against a third party that would partly cover those medical 

expenses are ineligible for reimbursement from VA. H.R. 1377 

would remove that requirement and make them eligible for such 

reimbursements. 

Based on information from VA, CBO estimates that under the 

bill VA would approve about 700 new claims a year over the 2010– 

2014 period and about 2,000 claims for emergency treatment provided over the 2005–2009 period. (CBO assumes that few veterans 

retain records for emergency treatment provided before 2005.) CBO 

estimates that VA would pay an average of $730 per claim in 2010, 

rising to about $900 per claim in 2014, for total costs of $1 million 

a year. 


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H.R. 1377 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

not affect the budgets of state, local, or tribal governments. 

The CBO staff contact for this estimate is Sunita D’Monte. The 

estimate was approved by Theresa Gullo, Deputy Assistant Director for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 1377 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 1377. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 1377 is provided by Article I, section 8 of the Constitution of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Expansion of veteran eligibility for reimbursement by Secretary of Veterans Affairs for emergency treatment furnished in 

a non-department facility 

This section would amend section 1725 of title 38, United States 

Code, to expand the eligibility for reimbursement by the VA for 

emergency treatment received in a non-Department facility. 

It also clearly establishes that the VA is responsible for the cost 

of the emergency treatment which exceeds the amount payable or 

paid by the third-party insurer. However, the reimbursement may 

not exceed the maximum amount payable established by the VA. 

It further defines the VA as a secondary payor where a third-party 

insurer is financially responsible for a part of the veteran’s emergency treatment expenses. Next, it protects veterans by clarifying 

that they are not liable for any remaining balance due to the provider after the third-party insurer and the VA have made their 

payments. Finally, it prohibits the Secretary from reimbursing the 

veteran for copayments or similar payments that the veteran owes 

to the third party under a health-plan contract. 

This section, as amended, would provide for an effective date of 

the date of the enactment of the Act. In addition, the Secretary of 

the VA has the authority to reimburse certain veterans for emergency treatment provided before the effective date of this Act if the 

Secretary determines that it is appropriate to do so. 


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CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 

SECTION 1725 OF TITLE 38, UNITED STATES CODE 

§ 1725. Reimbursement for emergency treatment 

(a) * * * 

(b) ELIGIBILITY.—(1) * * * 

* * * * * * * 

(3) A veteran is personally liable for emergency treatment furnished the veteran in a non-Department facility if the veteran— 

(A) * * * 

* * * * * * * 

(C) has no other contractual or legal recourse against a third 

party that would, in whole øor in part¿, extinguish such liability to the provider; and 

* * * * * * * 

(c) LIMITATIONS ON REIMBURSEMENT.—(1) * * * 

* * * * * * * 

(4)(A) If the veteran has contractual or legal recourse against a 

third party that would only, in part, extinguish the veteran’s liability to the provider of the emergency treatment, and payment for the 

treatment may be made both under subsection (a) and by the third 

party, the amount payable for such treatment under such subsection 

shall be the amount by which the costs for the emergency treatment 

exceed the amount payable or paid by the third party, except that 

the amount payable may not exceed the maximum amount payable 

established under paragraph (1)(A). 

(B) In any case in which a third party is financially responsible 

for part of the veteran’s emergency treatment expenses, the Secretary 

shall be the secondary payer. 

(C) A payment in the amount payable under subparagraph (A) 

shall be considered payment in full and shall extinguish the veteran’s liability to the provider. 

(D) The Secretary may not reimburse a veteran under this section 

for any copayment or similar payment that the veteran owes the 

third party or for which the veteran is responsible under a healthplan contract. 

* * * * * * * 

(f) DEFINITIONS.—For purposes of this section: 

(1) * * * 

(2) The term ‘‘health-plan contract’’ includes any of the following: 

(A) * * * 

* * * * * * * 


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ø(E) A law of a State or political subdivision described 

in section 1729(a)(2)(B) of this title.¿ 

* * * * * * * 

Æ 


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