Bill Overview
Title: VA Preventing Duplicate Payments Act of 2022
Description: This bill requires the Department of Veterans Affairs (VA) to establish policies and procedures for the detection and prevention of duplicate billings and payments of non-VA health care providers under the Veterans Community Care Program Such policies and procedures should compare billings or payments made by the VA for a medical service to a billing or payment made for the same service by the Centers for Medicare & Medicaid Services (CMS) under the Medicare program or the Department of Defense (DOD) under the TRICARE program. The VA, the CMS, and DOD must (1) enter into data-matching agreements to share and match relevant data in the systems of records for the purposes of this bill, and (2) establish and implement policies that clarify which department or agency is financially responsible for payment or reimbursement for a medical service. The established policies must also provide for the recoupment of payments if duplicate payments are made for the same medical service.
Sponsors: Rep. Luria, Elaine G. [D-VA-2]
Target Audience
Population: People using VA, Medicare, or TRICARE healthcare services
Estimated Size: 30000000
- The bill targets policy changes within the Department of Veterans Affairs, particularly affecting veterans who use the Veterans Community Care Program.
- The Veterans Community Care Program serves veterans who receive care from non-VA providers, so the legislation will impact these veterans by potentially reducing administrative errors and preventing duplicate payments.
- The legislation also involves Medicare and TRICARE, suggesting that the population covered by these programs might indirectly be affected if policies regarding payment responsibilities shift.
Reasoning
- The VA Preventing Duplicate Payments Act is specifically targeted at minimizing administrative errors and ensuring financial efficiency within the Veteran's Community Care Program, Medicare, and TRICARE. Therefore, populations who are directly utilizing these programs are likely to perceive the impacts more evidently, particularly due to the expected changes in service delivery and possibly an eventual decrease in unnecessary expenditures, which could relate to improved service quality or coverage.
- Many veterans currently rely on the Veterans Community Care Program to receive care from non-VA providers. By reducing duplicate payments, the aim is to potentially redirect saved funds to improve service delivery, thereby enhancing veterans' access to healthcare services and reducing financial liability.
- Indirectly, by establishing more robust policies on which agency pays for services, the policy may enhance clarity and reduce administrative hassle for veterans and healthcare providers.
- The policy's implementation would primarily affect older veterans and those actively using the specified healthcare systems, reflecting a target population that already navigates complex healthcare and billings.
- Considering the significant overlap between the populations using these healthcare programs, individuals dealing with multiple billing systems would likely appreciate simplified and clarified billing processes, thus impacting their perceptions of service quality more positively.
Simulated Interviews
Retired Army Veteran (Texas)
Age: 67 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- I hope this policy can straighten out the billing mess. Often, I'm left wondering about who covers what.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 8 | 5 |
Nurse (California)
Age: 35 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- It would help if we didn't have to spend so much time fighting duplicate issues in billing for my husband's care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Retired School Teacher (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- A clearer process for determining who pays would be helpful. It often feels like pulling teeth to get things paid correctly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Mechanic (Ohio)
Age: 45 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- It's embarrassing how often I've had to hound people to sort out billing mess-ups. Fixing this would be a relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
Administrative Assistant (Virginia)
Age: 62 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- It's been a headache managing both VA and Medicare payments. If this could help clarify things, it would be a blessing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Active Duty Marine (North Carolina)
Age: 31 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- I'm not directly impacted, but I see how complicated billing gets for my family members.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Retired Air Force Nurse (Washington)
Age: 58 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- I see a lot of misplaced invoicing in my consultations, this needs resolution for efficiency.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 9 | 5 |
Freelance Writer (New York)
Age: 39 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- While it doesn't directly concern me, I notice that better processes for billing would ease my partner's struggles.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Logistics Manager (Georgia)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 8/20
Statement of Opinion:
- If this legislation reduces confusion about bills, it might help in managing family health finances better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 9 | 6 |
Software Developer (Colorado)
Age: 28 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 11/20
Statement of Opinion:
- It's indirect for me, but it might mean less fighting over bills for my mom, who is a veteran.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $5000000 (Low: $4000000, High: $6000000)
Year 2: $3500000 (Low: $3000000, High: $4000000)
Year 3: $3500000 (Low: $3000000, High: $4000000)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Coordination among VA, CMS, and DOD is crucial for the success of the policy.
- Implementation may face challenges due to the interoperability of data systems between different departments.
- The actual savings depend heavily on the current extent of duplicate payments and the effectiveness of the new procedures in stopping them.