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NOTES:


Source

(Added , § 1(25)(B), Sept. 2, 1958, ; amended , § 2(1), Sept. 30, 1966, ; , § 8(a), Nov. 2, 1966, ; , title V, § 511(34)(A), (C), (35), (36), Dec. 12, 1980, , 2923; , § 19(2), Oct. 30, 1984, ; , § 9(h), Apr. 30, 1997, ; , div. A, title VII, § 725, title X, § 1066(a)(7), Oct. 5, 1999, , 770; , title XVII, § 1704(b)(1), Nov. 25, 2002, .)

Historical and Revision Notes
Revised section Source (U.S. Code) Source (Statutes at Large)
1073 37:402(b). June 7, 1956, ch. 374, § 102(b), 70 Stat. 251.

The words “armed forces under his jurisdiction” are substituted for the words “Army, Navy, Air Force, and Marine Corps and for the Coast Guard when it is operating as a service in the Navy” to reflect section of this title.

References in Text
The Assisted Suicide Funding Restriction Act of 1997, referred to in subsec. (a), is , Apr. 30, 1997, , which is classified principally to chapter 138 (§ 14401 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under section of Title and Tables.

Prior Provisions
A prior section , act Aug. 10, 1956, ch. 1041, 70A Stat. 82, related to right to vote in war-time presidential and congressional election, prior to repeal by , § 36B(5), Sept. 2, 1958, , as superseded by the Federal Voting Assistance Act of 1955 which is classified to subchapter I–D (§ 1973cc et seq.) of chapter of Title , The Public Health and Welfare.

Amendments
2002—Subsec. (a). substituted “of Homeland Security” for “of Transportation”. 1999—, § 725, designated existing provisions, as amended by , § 1066(a)(7), as subsec. (a), inserted heading, and added subsec. (b). , § 1066(a)(7), inserted “( U.S.C. et seq.)” after “Act of 1997”. 1997— inserted at end “This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997.” 1984— inserted provisions which transferred authority to administer chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy from the Secretary of Health and Human Services to the Secretary of Transportation. 1980— substituted in section catchline “of this chapter” for “of sections 1071–1087 of this title”, and substituted in text “this chapter” for “sections 1071–1087 of this title”, “those sections”, and “them”, “Secretary of Health and Human Services” for “Secretary of Health, Education, and Welfare”, and “National Oceanic and Atmospheric Administration” for “Environmental Science Services Administration”. 1966— substituted “Environmental Science Services Administration” for “Coast and Geodetic Survey”. substituted “1087” for “1085” in section catchline and text.

Effective Date of 2002 Amendment
Amendment by effective on the date of transfer of the Coast Guard to the Department of Homeland Security, see section 1704(g) of , set out as a note under section of this title.

Effective Date of 1997 Amendment
Amendment by effective Apr. 30, 1997, and applicable to Federal payments made pursuant to obligations incurred after Apr. 30, 1997, for items and services provided on or after such date, subject to also being applicable with respect to contracts entered into, renewed, or extended after Apr. 30, 1997, as well as contracts entered into before Apr. 30, 1997, to the extent permitted under such contracts, see section 11 of , set out as an Effective Date note under section of Title , The Public Health and Welfare.

Effective Date of 1980 Amendment
Amendment by effective Dec. 12, 1980, see section 701(b)(3) of , set out as a note under section of this title.

Effective Date of 1966 Amendment
For effective date of amendment by , see section 3 of , set out as a note under section of this title.

Repeals
The directory language of, but not the amendment made by, , § 8(a), Nov. 2, 1966, , cited as a credit to this section, was repealed by , § 6(b), Oct. 12, 1982, .

Surveys on Continued Viability of TRICARE Standard
, div. A, title VII, § 723, Nov. 24, 2003, , provided that: “(a) Requirement for Surveys.—(1) The Secretary of Defense shall conduct surveys in the TRICARE market areas in the United States to determine how many health care providers are accepting new patients under TRICARE Standard in each such market area. “(2) The Secretary shall carry out the surveys in at least 20 TRICARE market areas in the United States each fiscal year after fiscal year 2003 until all such market areas in the United States have been surveyed. The Secretary shall complete six of the fiscal year 2004 surveys not later than March 31, 2004. “(3) In prioritizing the market areas for the sequence in which market areas are to be surveyed under this subsection, the Secretary shall consult with representatives of TRICARE beneficiaries and health care providers to identify locations where TRICARE Standard beneficiaries are experiencing significant levels of access-to-care problems under TRICARE Standard and shall give a high priority to surveying health care providers in such areas. “(b) Supervision.—(1) The Secretary shall designate a senior official of the Department of Defense to take the actions necessary for achieving and maintaining participation of health care providers in TRICARE Standard in each TRICARE market area in a number that is adequate to ensure the viability of TRICARE Standard for TRICARE beneficiaries in that market area. “(2) The official designated under paragraph (1) shall have the following duties: “(A) To educate health care providers about TRICARE Standard. “(B) To encourage health care providers to accept patients under TRICARE Standard. “(C) To ensure that TRICARE beneficiaries have the information necessary to locate TRICARE Standard providers readily. “(D) To recommend adjustments in TRICARE Standard provider payment rates that the official considers necessary to ensure adequate availability of TRICARE Standard providers for TRICARE Standard beneficiaries. “(c) GAO Review.—(1) The Comptroller General shall, on an ongoing basis, review— “(A) the processes, procedures, and analysis used by the Department of Defense to determine the adequacy of the number of health care providers— “(i) that currently accept TRICARE Standard beneficiaries as patients under TRICARE Standard in each TRICARE market area (as of the date of completion of the review); and “(ii) that would accept TRICARE Standard beneficiaries as new patients under TRICARE Standard in each TRICARE market area (within a reasonable time after the date of completion of the review); and “(B) the actions taken by the Department of Defense to ensure ready access of TRICARE Standard beneficiaries to health care under TRICARE Standard in each TRICARE market area. “(2)(A) The Comptroller General shall submit to the Committees on Armed Services of the Senate and the House of Representatives a semiannual report on the results of the review under paragraph (1). The first semiannual report shall be submitted not later than June 30, 2004. “(B) The semiannual report under subparagraph (A) shall include the following: “(i) An analysis of the adequacy of the surveys under subsection (a). “(ii) The adequacy of existing statutory authority to address inadequate levels of participation by health care providers in TRICARE Standard. “(iii) Identification of policy-based obstacles to achieving adequacy of availability of TRICARE Standard health care in the TRICARE market areas. “(iv) An assessment of the adequacy of Department of Defense education programs to inform health care providers about TRICARE Standard. “(v) An assessment of the adequacy of Department of Defense initiatives to encourage health care providers to accept patients under TRICARE Standard. “(vi) An assessment of the adequacy of information available to TRICARE Standard beneficiaries to facilitate access by such beneficiaries to health care under TRICARE Standard. “(vii) Any need for adjustment of health care provider payment rates to attract participation in TRICARE Standard by appropriate numbers of health care providers. “(d) Definitions.—In this section: “(1) The term ‘TRICARE Standard’ means the option of the TRICARE program that is also known as the Civilian Health and Medical Program of the Uniformed Services, as defined in section of title , United States Code. “(2) The term ‘United States’ means the United States (as defined in section of title , United States Code), its possessions (as defined in such section), and the Commonwealth of Puerto Rico.”

Modernization of TRICARE Business Practices and Increase of Use of Military Treatment Facilities
, § 1 [[div. A], title VII, § 723], Oct. 30, 2000, , 1654A–186, provided that: “(a) Requirement To Implement Internet-Based System.—Not later than October 1, 2001, the Secretary of Defense shall implement a system to simplify and make accessible through the use of the Internet, through commercially available systems and products, critical administrative processes within the military health care system and the TRICARE program. The purposes of the system shall be to enhance efficiency, improve service, and achieve commercially recognized standards of performance. “(b) Elements of System.—The system required by subsection (a)— “(1) shall comply with patient confidentiality and security requirements, and incorporate data requirements, that are currently widely used by insurers under medicare and commercial insurers; “(2) shall be designed to achieve improvements with respect to— “(A) the availability and scheduling of appointments; “(B) the filing, processing, and payment of claims; “(C) marketing and information initiatives; “(D) the continuation of enrollments without expiration; “(E) the portability of enrollments nationwide; “(F) education of beneficiaries regarding the military health care system and the TRICARE program; and “(G) education of health care providers regarding such system and program; and “(3) may be implemented through a contractor under TRICARE Prime. “(c) Areas of Implementation.—The Secretary shall implement the system required by subsection (a) in at least one region under the TRICARE program. “(d) Plan for Improved Portability of Benefits.—Not later than March 15, 2001, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a plan to provide portability and reciprocity of benefits for all enrollees under the TRICARE program throughout all TRICARE regions. “(e) Increase of Use of Military Medical Treatment Facilities.—The Secretary shall initiate a program to maximize the use of military medical treatment facilities by improving the efficiency of health care operations in such facilities. “(f) Definition.—In this section the term ‘TRICARE program’ has the meaning given such term in section of title , United States Code.”

Improvement of Access to Health Care Under the TRICARE Program
, div. A, title VII, § 735(e), Dec. 28, 2001, , provided that: “Not later than March 1, 2002, the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate a report on the Secretary’s plans for implementing section 721 of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 [, set out below], as amended by this section.” , § 1 [[div. A], title VII, § 721], Oct. 30, 2000, , 1654A–184, as amended by , div. A, title VII, § 735(a)–(d), Dec. 28, 2001, , 1172, provided that: “(a) Waiver of Nonavailability Statement or Preauthorization.—In the case of a covered beneficiary under TRICARE Standard pursuant to chapter of title , United States Code, the Secretary of Defense may not require with regard to authorized health care services (other than mental health services) under such chapter that the beneficiary— “(1) obtain a nonavailability statement or preauthorization from a military medical treatment facility in order to receive the services from a civilian provider; or “(2) obtain a nonavailability statement for care in specialized treatment facilities outside the 200-mile radius of a military medical treatment facility. “(b) Waiver Authority.—The Secretary may waive the prohibition in subsection (a) if— “(1) the Secretary— “(A) demonstrates that significant costs would be avoided by performing specific procedures at the affected military medical treatment facility or facilities; “(B) determines that a specific procedure must be provided at the affected military medical treatment facility or facilities to ensure the proficiency levels of the practitioners at the facility or facilities; or “(C) determines that the lack of nonavailability statement data would significantly interfere with TRICARE contract administration; “(2) the Secretary provides notification of the Secretary’s intent to grant a waiver under this subsection to covered beneficiaries who receive care at the military medical treatment facility or facilities that will be affected by the decision to grant a waiver under this subsection; “(3) the Secretary notifies the Committees on Armed Services of the House of Representatives and the Senate of the Secretary’s intent to grant a waiver under this subsection, the reason for the waiver, and the date that a nonavailability statement will be required; and “(4) 60 days have elapsed since the date of the notification described in paragraph (3). “(c) Waiver Exception for Maternity Care.—Subsection (b) shall not apply with respect to maternity care. “(d) Effective Date.—This section shall take effect on the earlier of the following: “(1) The date that a new contract entered into by the Secretary to provide health care services under TRICARE Standard takes effect. “(2) The date that is two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2002 [Dec. 28, 2001].”. , div. A, title VII, § 712(a), (b), Oct. 5, 1999, , provided that: “(a) Access.—The Secretary of Defense shall, to the maximum extent practicable, minimize the authorization and certification requirements imposed on covered beneficiaries under the TRICARE program as a condition of access to benefits under that program. “(b) Report on Initiatives To Improve Access.—Not later than March 31, 2000, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on specific actions taken to— “(1) reduce the requirements for preauthorization for care under the TRICARE program; “(2) reduce the requirements for beneficiaries to obtain preventive services, such as obstetric or gynecologic examinations, mammograms for females over 35 years of age, and urological examinations for males over the age of 60 without preauthorization; and “(3) reduce the requirements for statements of nonavailability of services.”

TRICARE Managed Care Support Contracts
, § 1 [[div. A], title VII, § 724], Oct. 30, 2000, , 1654A–187, provided that: “(a) Authority.—Notwithstanding any other provision of law and subject to subsection (b), any TRICARE managed care support contract in effect, or in the final stages of acquisition, on September 30, 1999, may be extended for four years. “(b) Conditions.—Any extension of a contract under subsection (a)— “(1) may be made only if the Secretary of Defense determines that it is in the best interest of the United States to do so; and “(2) shall be based on the price in the final best and final offer for the last year of the existing contract as adjusted for inflation and other factors mutually agreed to by the contractor and the Federal Government.” , title VIII, § 8090, Aug. 9, 2000, , provided that: “Notwithstanding any other provision of law, the TRICARE managed care support contracts in effect, or in final stages of acquisition as of September 30, 2000, may be extended for 2 years: Provided, That any such extension may only take place if the Secretary of Defense determines that it is in the best interest of the Government: Provided further, That any contract extension shall be based on the price in the final best and final offer for the last year of the existing contract as adjusted for inflation and other factors mutually agreed to by the contractor and the Government: Provided further, That notwithstanding any other provision of law, all future TRICARE managed care support contracts replacing contracts in effect, or in the final stages of acquisition as of September 30, 2000, may include a base contract period for transition and up to seven 1-year option periods.” Similar provisions were contained in the following prior appropriation act: , title VIII, § 8095, Oct. 25, 1999, . , title VIII, § 8107, Oct. 17, 1998, .

Redesign of Military Pharmacy System
, div. A, title VII, § 703, Oct. 17, 1998, , provided that: “(a) Plan Required.—The Secretary of Defense shall submit to Congress a plan that would provide for a system-wide redesign of the military and contractor retail and mail-order pharmacy system of the Department of Defense by incorporating ‘best business practices’ of the private sector. The Secretary shall work with contractors of TRICARE retail pharmacy and national mail-order pharmacy programs to develop a plan for the redesign of the pharmacy system that— “(1) may include a plan for an incentive-based formulary for military medical treatment facilities and contractors of TRICARE retail pharmacies and the national mail-order pharmacy; and “(2) shall include a plan for each of the following: “(A) A uniform formulary for such facilities and contractors. “(B) A centralized database that integrates the patient databases of pharmacies of military medical treatment facilities and contractor retail and mail-order programs to implement automated prospective drug utilization review systems. “(C) A system-wide drug benefit for covered beneficiaries under chapter of title , United States Code, who are entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( U.S.C. et seq.). “(b) Submission of Plan.—The Secretary shall submit the plan required under subsection (a) not later than March 1, 1999. “(c) Suspension of Implementation of Program.—The Secretary shall suspend any plan to establish a national retail pharmacy program for the Department of Defense until— “(1) the plan required under subsection (a) is submitted; and “(2) the Secretary implements cost-saving reforms with respect to the military and contractor retail and mail order pharmacy system.” , div. A, title VII, § 723, Oct. 17, 1998, , as amended by , div. A, title X, § 1067(3), Oct. 5, 1999, ; , § 1 [[div. A], title VII, § 711(a)], Oct. 30, 2000, , 1654A–175, provided that: “(a) In General.—Not later than April 1, 2001, the Secretary of Defense shall implement, with respect to eligible individuals described in subsection (e), the redesign of the pharmacy system under TRICARE (including the mail-order and retail pharmacy benefit under TRICARE) to incorporate ‘best business practices’ of the private sector in providing pharmaceuticals, as developed under the plan described in section [set out as a note above]. “(b) Program Requirements.—The same coverage for pharmacy services and the same requirements for cost sharing and reimbursement as are applicable under section of title , United States Code, shall apply with respect to the program required by subsection (a). “(c) Evaluation.—The Secretary shall provide for an evaluation of the implementation of the redesign of the pharmacy system under TRICARE under this section by an appropriate person or entity that is independent of the Department of Defense. The evaluation shall include the following: “(1) An analysis of the costs of the implementation of the redesign of the pharmacy system under TRICARE and to the eligible individuals who participate in the system. “(2) An assessment of the extent to which the implementation of such system satisfies the requirements of the eligible individuals for the health care services available under TRICARE. “(3) An assessment of the effect, if any, of the implementation of the system on military medical readiness. “(4) A description of the rate of the participation in the system of the individuals who were eligible to participate. “(5) An evaluation of any other matters that the Secretary considers appropriate. “(d) Reports.—The Secretary shall submit two reports on the results of the evaluation under subsection (c), together with the evaluation, to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives. The first report shall be submitted not later than December 31, 2001, and the second report shall be submitted not later than December 31, 2003. “(e) Eligible Individuals.—(1) An individual is eligible to participate under this section if the individual is a member or former member of the uniformed services described in section of title , United States Code, a dependent of the member described in section 1076(a)(2)(B) or 1076(b) of that title, or a dependent of a member of the uniformed services who died while on active duty for a period of more than 30 days, who— “(A) is 65 years of age or older; “(B) is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( U.S.C. et seq.); and “(C) except as provided in paragraph (2), is enrolled in the supplemental medical insurance program under part B of such title XVIII ( U.S.C. et seq.). “(2) Paragraph (1)(C) shall not apply in the case of an individual who, before April 1, 2001, has attained the age of 65 and did not enroll in the program described in such paragraph.”

System for Tracking Data and Measuring Performance in Meeting TRICARE Access Standards
, div. A, title VII, § 713, Oct. 17, 1998, , provided that: “(a) Requirement To Establish System.—(1) The Secretary of Defense shall establish a system— “(A) to track data regarding access of covered beneficiaries under chapter of title , United States Code, to primary health care under the TRICARE program; and “(B) to measure performance in increasing such access against the primary care access standards established by the Secretary under the TRICARE program. “(2) In implementing the system described in paragraph (1), the Secretary shall collect data on the timeliness of appointments and precise waiting times for appointments in order to measure performance in meeting the primary care access standards established under the TRICARE program. “(b) Deadline for Establishment.—The Secretary shall establish the system described in subsection (a) not later than April 1, 1999.”

TRICARE as Supplement to Medicare Demonstration
, div. A, title VII, § 722, Oct. 17, 1998, , as amended by , div. A, title X, §§ 1066(b)(6), 1067 (3), Oct. 5, 1999, , 774, provided that: “(a) In General.—(1) The Secretary of Defense shall, after consultation with the other administering Secretaries, carry out a demonstration project in order to assess the feasibility and advisability of providing medical care coverage under the TRICARE program to the individuals described in subsection (c). The demonstration project shall be known as the ‘TRICARE Senior Supplement’. “(2) The Secretary shall commence the demonstration project not later than January 1, 2000, and shall terminate the demonstration project not later than December 31, 2002. “(3) Under the demonstration project, the Secretary shall permit eligible individuals described in subsection (c) to enroll in the TRICARE program. “(4) Payment for care and services received by eligible individuals who enroll in the TRICARE program under the demonstration project shall be made as follows: “(A) First, under title XVIII of the Social Security Act [ U.S.C. et seq.], but only to the extent that payment for such care and services is provided for under that title. “(B) Second, under the TRICARE program, but only to the extent that payment for such care and services is provided under that program and is not provided for under subparagraph (A). “(C) Third, by the eligible individual concerned, but only to the extent that payment for such care and services is not provided for under subparagraph (A) or (B). “(5)(A) The Secretary shall require each eligible individual who enrolls in the TRICARE program under the demonstration project to pay an enrollment fee. The Secretary shall provide, to the extent feasible, the option of payment of the enrollment fee through electronic transfers of funds and through withholding of such payment from the pay of a member or former member of the Armed Forces, and shall provide the option that payment of the enrollment fee be made in full at the beginning of the enrollment period or that payments be made on a monthly or quarterly basis. “(B) The amount of the enrollment fee charged an eligible individual under subparagraph (A) for self-only or family enrollment in any year may not exceed the amount equal to 75 percent of the total subscription charges in that year for self-only or family, respectively, fee-for-service coverage under the health benefits plan under the Federal employees Health Benefits program under chapter of title , United States Code, that is most similar in coverage to the TRICARE program. “(6) A covered beneficiary who enrolls in TRICARE Senior Supplement under this subsection shall not be eligible to receive health care at a facility of the uniformed services during the period such enrollment is in effect. “(b) Evaluation; Review.—(1) The Secretary shall provide for an evaluation of the demonstration project conducted under this subsection by an appropriate person or entity that is independent of the Department of Defense. The evaluation shall include the following: “(A) An analysis of the costs of the demonstration project to the United States and to the eligible individuals who participate in such demonstration project. “(B) An assessment of the extent to which the demonstration project satisfies the requirements of such eligible individuals for the health care services available under the demonstration project. “(C) An assessment of the effect, if any, of the demonstration project on military medical readiness. “(D) A description of the rate of the enrollment in the demonstration project of the individuals who were eligible to enroll in the demonstration project. “(E) An assessment of whether the demonstration project provides the most suitable model for a program to provide adequate health care services to the population of individuals consisting of the eligible individuals. “(F) An evaluation of any other matters that the Secretary considers appropriate. “(2) The Comptroller General shall review the evaluation conducted under paragraph (1). In carrying out the review, the Comptroller General shall— “(A) assess the validity of the processes used in the evaluation; and “(B) assess the validity of any findings under the evaluation, including any limitations with respect to the data contained in the evaluation as a result of the size and design of the demonstration project. “(3)(A) The Secretary shall submit a report on the results of the evaluation under paragraph (1), together with the evaluation, to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives not later than December 31, 2002. “(B) The Comptroller General shall submit a report on the results of the review under paragraph (2) to the committees referred to in subparagraph (A) not later than February 15, 2003. “(c) Eligible Individuals.—An individual is eligible to participate under this section if the individual is a member or former member of the uniformed services described in section of title , United States Code, a dependent of the member described in section 1076(a)(2)(B) or 1076(b) of that title, or a dependent of a member of the uniformed services who died while on active duty for a period of more than 30 days, who— “(1) is 65 years of age or older; “(2) is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( U.S.C. et seq.); “(3) is enrolled in the supplemental medical insurance program under part B of such title XVIII ( U.S.C. et seq.); and “(4) resides in an area selected by the Secretary under subsection (d). “(d) Areas of Implementation.—(1) The Secretary shall carry out the demonstration project under this section in two separate areas selected by the Secretary. “(2) The areas selected by the Secretary under paragraph (1) shall be as follows: “(A) One area shall be an area outside the catchment area of a military medical treatment facility in which— “(i) no eligible organization has a contract in effect under section 1876 of the Social Security Act ( U.S.C. ) and no Medicare+Choice organization has a contract in effect under part C of title XVIII of that Act ( U.S.C. [et seq.]); or “(ii) the aggregate number of enrollees with an eligible organization with a contract in effect under section 1876 of that Act or with a Medicare+Choice organization with a contract in effect under part C of title XVIII of that Act is less than 2.5 percent of the total number of individuals in the area who are entitled to hospital insurance benefits under part A of title XVIII of that Act. “(B) The other area shall be an area outside the catchment area of a military medical treatment facility in which— “(i) at least one eligible organization has a contract in effect under section 1876 of that Act or one Medicare+Choice organization has a contract in effect under part C of title XVIII of that Act; and “(ii) the aggregate number of enrollees with an eligible organization with a contract in effect under section 1876 of that Act or with a Medicare+Choice organization with a contract in effect under part C of title XVIII of that Act exceeds 10 percent of the total number of individuals in the area who are entitled to hospital insurance benefits under part A of title XVIII of that Act. “(e) Definitions.—In this section: “(1) The term ‘administering Secretaries’ has the meaning given that term in section of title , United States Code. “(2) The term ‘TRICARE program’ has the meaning given that term in section of title , United States Code.”

Study Concerning Provision of Comparative Information
, div. A, title VII, § 703, Nov. 18, 1997, , provided that: “(a) Study.—The Secretary of Defense shall conduct a study concerning the provision of the information described in subsection (b) to beneficiaries under the TRICARE program established under the authority of chapter of title , United States Code, and prepare and submit to Congress a report concerning such study. “(b) Provision of Comparative Information.—Information described in this subsection, with respect to a managed care entity that contracts with the Secretary of Defense to provide medical assistance under the program described in subsection (a), shall include the following: “(1) The benefits covered by the entity involved, including— “(A) covered items and services beyond those provided under a traditional fee-for-service program; “(B) any beneficiary cost sharing; and “(C) any maximum limitations on out-of-pocket expenses. “(2) The net monthly premium, if any, under the entity. “(3) The service area of the entity. “(4) To the extent available, quality and performance indicators for the benefits under the entity (and how they compare to such indicators under the traditional fee-for-service programs in the area involved), including— “(A) disenrollment rates for enrollees electing to receive benefits through the entity for the previous two years (excluding disenrollment due to death or moving outside the service area of the entity); “(B) information on enrollee satisfaction; “(C) information on health process and outcomes; “(D) grievance procedures; “(E) the extent to which an enrollee may select the health care provider of their [sic] choice, including health care providers within the network of the entity and out-of-network health care providers (if the entity covers out-of-network items and services); and “(F) an indication of enrollee exposure to balance billing and the restrictions on coverage of items and services provided to such enrollee by an out-of-network health care provider. “(5) Whether the entity offers optional supplemental benefits and the terms and conditions (including premiums) for such coverage. “(6) An overall summary description as to the method of compensation of participating physicians.”

Disclosure of Cautionary Information on Prescription Medications
, div. A, title VII, § 744, Nov. 18, 1997, , provided that: “(a) Regulations Required.—Not later than 180 days after the date of the enactment of this Act [Nov. 18, 1997], the Secretary of Defense, in consultation with the administering Secretaries referred to in section of title , United States Code, shall prescribe regulations to require each source described in subsection (d) that dispenses a prescription medication to a beneficiary under chapter 55 of such title to include with the medication the written cautionary information required by subsection (b). “(b) Information To Be Disclosed.—Information required to be disclosed about a medication under the regulations shall include appropriate cautions about usage of the medication, including possible side effects and potentially hazardous interactions with foods. “(c) Form of Information.—The regulations shall require that information be furnished in a form that, to the maximum extent practicable, is easily read and understood. “(d) Covered Sources.—The regulations shall apply to the following: “(1) Pharmacies and any other dispensers of prescription medications in medical facilities of the uniformed services. “(2) Sources of prescription medications under any mail order pharmaceuticals program provided by any of the administering Secretaries under chapter of title , United States Code. “(3) Pharmacies paid under the Civilian Health and Medical Program of the Uniformed Services (including the TRICARE program). “(4) Pharmacies, and any other pharmaceutical dispensers, of designated providers referred to in section 721(5) of the National Defense Authorization Act for Fiscal Year 1997 (Public Law 104–201; ; U.S.C. ).”

Competitive Procurement of Ophthalmic Services
, div. A, title VII, § 745, Nov. 18, 1997, , provided that: “(a) Competitive Procurement Required.—Beginning not later than October 1, 1998, the Secretary of Defense shall competitively procure from private-sector sources, or other sources outside of the Department of Defense, all ophthalmic services related to the provision of single vision and multivision eyeware for members of the Armed Forces, retired members, and certain covered beneficiaries under chapter of title , United States Code, who would otherwise receive such ophthalmic services through the Department of Defense. “(b) Exception.—Subsection (a) shall not apply to the extent that the Secretary of Defense determines that the use of sources within the Department of Defense to provide such ophthalmic services— “(1) is necessary to meet the readiness requirements of the Armed Forces; or “(2) is more cost effective. “(c) Completion of Existing Orders.—Subsection (a) shall not apply to orders for ophthalmic services received on or before September 30, 1998.”

Inclusion of Certain Designated Providers in Uniformed Services Health Care Delivery System
, div. A, title VII, subtitle C, Sept. 23, 1996, , as amended by , div. A, title I, § 101(b) [title VIII, § 8131(a)], Sept. 30, 1996, , 3009–117; , div. A, title VII, §§ 721–723, Nov. 18, 1997, , 1810; , div. A, title VII, § 707, Oct. 5, 1999, ; , title XVII, § 1704(e)(2), Nov. 25, 2002, , as amended by , div. A, title VII, § 714, Nov. 24, 2003, , provided that: “SEC. . DEFINITIONS. “In this subtitle: “(1) The term ‘administering Secretaries’ means the Secretary of Defense, the Secretary of Homeland Security, and the Secretary of Health and Human Services. “(2) The term ‘agreement’ means the agreement required under section 722 (b) between the Secretary of Defense and a designated provider. “(3) The term ‘capitation payment’ means an actuarially sound payment for a defined set of health care services that is established on a per enrollee per month basis. “(4) The term ‘covered beneficiary’ means a beneficiary under chapter of title , United States Code, other than a beneficiary under section 1074(a) of such title. “(5) The term ‘designated provider’ means a public or nonprofit private entity that was a transferee of a Public Health Service hospital or other station under section 987 of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97–35; U.S.C. ) and that, before the date of the enactment of this Act [Sept. 23, 1996], was deemed to be a facility of the uniformed services for the purposes of chapter of title , United States Code. The term includes any legal successor in interest of the transferee. “(6) The term ‘enrollee’ means a covered beneficiary who enrolls with a designated provider. “(7) The term ‘health care services’ means the health care services provided under the health plan known as the ‘TRICARE PRIME’ option under the TRICARE program. “(8) The term ‘Secretary’ means the Secretary of Defense. “(9) The term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter of title , United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. “SEC. 722. INCLUSION OF DESIGNATED PROVIDERS IN UNIFORMED SERVICES HEALTH CARE DELIVERY SYSTEM. “(a) Inclusion in System.—The health care delivery system of the uniformed services shall include the designated providers. “(b) Agreements to Provide Managed Health Care Services.—(1) After consultation with the other administering Secretaries, the Secretary of Defense shall negotiate and enter into an agreement with each designated provider under which the designated provider will provide health care services in or through managed care plans to covered beneficiaries who enroll with the designated provider. “(2) The agreement shall be entered into on a sole source basis. The Federal Acquisition Regulation, except for those requirements regarding competition, issued pursuant to section 25(c) of the Office of Federal Procurement Policy Act ( U.S.C. ) shall apply to the agreements as acquisitions of commercial items. “(3) The implementation of an agreement is subject to availability of funds for such purpose. “(c) Effective Date of Agreements.—(1) Unless an earlier effective date is agreed upon by the Secretary and the designated provider, the agreement shall take effect upon the later of the following: “(A) The date on which a managed care support contract under the TRICARE program is implemented in the service area of the designated provider. “(B) October 1, 1997. “(2) The Secretary may modify the effective date established under paragraph (1) for an agreement to permit a transition period of not more than six months between the date on which the agreement is executed by the parties and the date on which the designated provider commences the delivery of health care services under the agreement. “(d) Temporary Continuation of Existing Participation Agreements.—The Secretary shall extend the participation agreement of a designated provider in effect immediately before the date of the enactment of this Act [Sept. 23, 1996] under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 (Public Law 101–510; [former] U.S.C. [note]) until the agreement required by this section takes effect under subsection (c), including any transitional period provided by the Secretary under paragraph (2) of such subsection. “(e) Service Area.—The Secretary may not reduce the size of the service area of a designated provider below the size of the service area in effect as of September 30, 1996. “(f) Compliance With Administrative Requirements.—(1) Unless otherwise agreed upon by the Secretary and a designated provider, the designated provider shall comply with necessary and appropriate administrative requirements established by the Secretary for other providers of health care services and requirements established by the Secretary of Health and Human Services for risk-sharing contractors under section 1876 of the Social Security Act ( U.S.C. ). The Secretary and the designated provider shall determine and apply only such administrative requirements as are minimally necessary and appropriate. A designated provider shall not be required to comply with a law or regulation of a State government requiring licensure as a health insurer or health maintenance organization. “(2) A designated provider may not contract out more than five percent of its primary care enrollment without the approval of the Secretary, except in the case of primary care contracts between a designated provider and a primary care contractor in force on the date of the enactment of this Act [Sept. 23, 1996]. “(g) Continued Acquisition of Reduced-Cost Drugs.—A designated provider shall be treated as part of the Department of Defense for purposes of section of title , United States Code, in connection with the provision by the designated provider of health care services to covered beneficiaries pursuant to the participation agreement of the designated provider under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 (Public Law 101–510; [former] U.S.C. ) or pursuant to the agreement entered into under subsection (b). “SEC. 723. PROVISION OF UNIFORM BENEFIT BY DESIGNATED PROVIDERS. “(a) Uniform Benefit Required.—A designated provider shall offer to enrollees the health benefit option prescribed and implemented by the Secretary under section 731 of the National Defense Authorization Act for Fiscal Year 1994 (Public Law 103–160; U.S.C. ), including accompanying cost-sharing requirements. “(b) Time for Implementation of Benefit.—A designated provider shall offer the health benefit option described in subsection (a) to enrollees upon the later of the following: “(1) The date on which health care services within the health care delivery system of the uniformed services are rendered through the TRICARE program in the region in which the designated provider operates. “(2) October 1, 1997. “(c) Adjustments.—The Secretary may establish a later date under subsection (b)(2) or prescribe reduced cost-sharing requirements for enrollees. “SEC. 724. ENROLLMENT OF COVERED BENEFICIARIES. “(a) Fiscal Year 1997 Limitation.—(1) During fiscal year 1997, the number of covered beneficiaries who are enrolled in managed care plans offered by designated providers may not exceed the number of such enrollees as of October 1, 1995. “(2) The Secretary may waive the limitation under paragraph (1) if the Secretary determines that additional enrollment authority for a designated provider is required to accommodate covered beneficiaries who are dependents of members of the uniformed services entitled to health care under section of title , United States Code. “(b) Permanent Limitation.—For each fiscal year beginning after September 30, 1997, the number of enrollees in managed care plans offered by designated providers may not exceed 110 percent of the number of such enrollees as of the first day of the immediately preceding fiscal year. The Secretary may waive this limitation as provided in subsection (a)(2). “(c) Retention of Current Enrollees.—An enrollee in the managed care plan of a designated provider as of September 30, 1997, or such earlier date as the designated provider and the Secretary may agree upon, shall continue receiving services from the designated provider pursuant to the agreement entered into under section 722 unless the enrollee disenrolls from the designated provider. Except as provided in subsection (e), the administering Secretaries may not disenroll such an enrollee unless the disenrollment is agreed to by the Secretary and the designated provider. “(d) Additional Enrollment Authority.—(1) Subject to paragraph (2), other covered beneficiaries may also receive health care services from a designated provider. “(2)(A) The designated provider may market such services to, and enroll, covered beneficiaries who— “(i) subject to the limitation in subparagraph (B), have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; or “(ii) are enrolled in the direct care system under the TRICARE program, regardless of whether the covered beneficiaries were users of the health care delivery system of the uniformed services in prior years. “(B) For each fiscal year beginning after September 30, 2003, the number of covered beneficiaries who are newly enrolled by a designated provider pursuant to subparagraph (A)(i) may not exceed 10 percent of the excess (if any) of— “(i) the number of enrollees in managed care plans offered by designated providers as of the first day of such fiscal year; over “(ii) the number of such enrollees as of the first day of the immediately preceding fiscal year. “(3) For purposes of this subsection, a covered beneficiary who has other primary health insurance coverage includes any covered beneficiary who has primary health insurance coverage— “(A) on the date of enrollment with a designated provider pursuant to paragraph (2)(A)(i); or “(B) on such date of enrollment and during the period after such date while the beneficiary is enrolled with the designated provider. “(e) Special Rule for Medicare-Eligible Beneficiaries.—If a covered beneficiary who desires to enroll in the managed care program of a designated provider is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( U.S.C. et seq.), the covered beneficiary shall elect whether to receive health care services as an enrollee or under part A of title XVIII of the Social Security Act. The Secretary may disenroll an enrollee who subsequently violates the election made under this subsection and receives benefits under part A of title XVIII of the Social Security Act. “(f) Information Regarding Eligible Covered Beneficiaries.—The Secretary shall provide, in a timely manner, a designated provider with an accurate list of covered beneficiaries within the marketing area of the designated provider to whom the designated provider may offer enrollment. “(g) Open Enrollment Demonstration Program.—(1) The Secretary of Defense shall conduct a demonstration program under which covered beneficiaries shall be permitted to enroll at any time in a managed care plan offered by a designated provider consistent with the enrollment requirements for the TRICARE Prime option under the TRICARE program, but without regard to the limitation in subsection (b). The demonstration program under this subsection shall cover designated providers, selected by the Secretary of Defense, and the service areas of the designated providers. “(2) The demonstration program carried out under this section shall commence on October 1, 1999, and end on September 30, 2001. “(3) Not later than March 15, 2001, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the demonstration program carried out under this subsection. The report shall include, at a minimum, an evaluation of the benefits of the open enrollment opportunity to covered beneficiaries and a recommendation on whether to authorize open enrollments in the managed care plans of designated providers permanently. “SEC. 725. APPLICATION OF CHAMPUS PAYMENT RULES. “(a) Application of Payment Rules.—Subject to subsection (b), the Secretary shall require a private facility or health care provider that is a health care provider under the Civilian Health and Medical Program of the Uniformed Services to apply the payment rules described in section of title , United States Code, in imposing charges for health care that the private facility or provider provides to enrollees of a designated provider. “(b) Authorized Adjustments.—The payment rules imposed under subsection (a) shall be subject to such modifications as the Secretary considers appropriate. The Secretary may authorize a lower rate than the maximum rate that would otherwise apply under subsection (a) if the lower rate is agreed to by the designated provider and the private facility or health care provider. “(c) Regulations.—The Secretary shall prescribe regulations to implement this section after consultation with the other administering Secretaries. “(d) Conforming Amendment.—[Amended section of this title.] “SEC. 726. PAYMENTS FOR SERVICES. “(a) Form of Payment.—Unless otherwise agreed to by the Secretary and a designated provider, the form of payment for health care services provided by a designated provider shall be on a full risk capitation payment basis. The capitation payments shall be negotiated and agreed upon by the Secretary and the designated provider. In addition to such other factors as the parties may agree to apply, the capitation payments shall be based on the utilization experience of enrollees and competitive market rates for equivalent health care services for a comparable population to such enrollees in the area in which the designated provider is located. “(b) Limitation on Total Payments.—Total capitation payments for health care services to a designated provider shall not exceed an amount equal to the cost that would have been incurred by the Government if the enrollees had received such health care services through a military treatment facility, the TRICARE program, or the Medicare program, as the case may be. In establishing the ceiling rate for enrollees with the designated providers who are also eligible for the Civilian Health and Medical Program of the Uniformed Services, the Secretary of Defense shall take into account the health status of the enrollees. “(c) Establishment of Payment Rates on Annual Basis.—The Secretary and a designated provider shall establish capitation payments on an annual basis, subject to periodic review for actuarial soundness and to adjustment for any adverse or favorable selection reasonably anticipated to result from the design of the program under this subtitle. “(d) Alternative Basis for Calculating Payments.—After September 30, 1999, the Secretary and a designated provider may mutually agree upon a new basis for calculating capitation payments. “SEC. 727. REPEAL OF SUPERSEDED AUTHORITIES. “(a) Repeals.—[Repealed sections and of Title , The Public Health and Welfare, and section 718(c) of and section 726 of , set out as notes under section of Title .] “(b) Effective Date.—The amendments made by paragraphs (1), (2), and (3) of subsection (a) shall take effect on October 1, 1997.” [, div. A, title I, § 101(b) [title VIII, § 8131(b)], Sept. 30, 1996, , 3009–117, provided that: “The amendments made by subsection (a) [amending section 722 of , set out above] shall take effect as of the date of the enactment of the National Defense Authorization Act for Fiscal Year 1997 [Sept. 23, 1996] as if section 722 of such Act had been enacted as so amended.”]

Definition of TRICARE Program
, div. A, title VII, § 711, Feb. 10, 1996, , provided that: “For purposes of this subtitle [subtitle B (§§ 711–718) of title VII of div. A of , amending section of this title, enacting provisions set out as notes below, and amending provisions set out as a note below], the term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter of title , United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services.”

Training in Health Care Management and Administration for TRICARE Lead Agents
, div. A, title VII, § 715, Feb. 10, 1996, , as amended by , § 1 [[div. A], title VII, § 760(a)], Oct. 30, 2000, , 1654A–200, provided that: “(a) Provision of Training.—The Secretary of Defense shall implement a professional educational program to provide appropriate training in health care management and administration— “(1) to each commander, deputy commander, and managed care coordinator of a military medical treatment facility of the Department of Defense, and any other person, who is selected to serve as a lead agent to coordinate the delivery of health care by military and civilian providers under the TRICARE program; and “(2) to appropriate members of the support staff of the treatment facility who will be responsible for daily operation of the TRICARE program. “(b) Limitation on Assignment Until Completion of Training.—No person may be assigned as the commander, deputy commander, or managed care coordinator of a military medical treatment facility or as a TRICARE lead agent or senior member of the staff of a TRICARE lead agent office until the Secretary of the military department concerned submits a certification to the Secretary of Defense that such person has completed the training described in subsection (a).” [, § 1 [[div. A], title VII, § 760(c)], Oct. 30, 2000, , 1654A–200, provided that: “The amendments made by subsection (a) to section 715 of such Act [section 715 of , set out above]— [“(1) shall apply to a deputy commander, a managed care coordinator of a military medical treatment facility, or a lead agent for coordinating the delivery of health care by military and civilian providers under the TRICARE program, who is assigned to such position on or after the date that is one year after the date of the enactment of this Act [Oct. 30, 2000]; and [“(2) may apply, in the discretion of the Secretary of Defense, to a deputy commander, a managed care coordinator of such a facility, or a lead agent for coordinating the delivery of such health care, who is assigned to such position before the date that is one year after the date of the enactment of this Act.”]

Pilot Program of Individualized Residential Mental Health Services
, div. A, title VII, § 716, Feb. 10, 1996, , provided that: “(a) Program Required.—(1) During fiscal year 1996, the Secretary of Defense, in consultation with the other administering Secretaries under chapter of title , United States Code, shall implement a pilot program to provide residential and wraparound services to children described in paragraph (2) who are in need of mental health services. The Secretary shall implement the pilot program for an initial period of at least two years in a military health care region in which the TRICARE program has been implemented. “(2) A child shall be eligible for selection to participate in the pilot program if the child is a dependent (as described in subparagraph (D) or (I) of section of title , United States Code) who— “(A) is eligible for health care under section 1079 or 1086 of such title; and “(B) has a serious emotional disturbance that is generally regarded as amenable to treatment. “(b) Wraparound Services Defined.—For purposes of this section, the term ‘wraparound services’ means individualized mental health services that are provided principally to allow a child to remain in the family home or other least-restrictive and least-costly setting, but also are provided as an aftercare planning service for children who have received acute or residential care. Such term includes nontraditional mental health services that will assist the child to be maintained in the least-restrictive and least-costly setting. “(c) Pilot Program Agreement.—Under the pilot program the Secretary of Defense shall enter into one or more agreements that require a mental health services provider under the agreement— “(1) to provide wraparound services to a child described in subsection (a)(2); “(2) to continue to provide such services as needed during the period of the agreement even if the child moves to another location within the same TRICARE program region during that period; and “(3) to share financial risk by accepting as a maximum annual payment for such services a case-rate reimbursement not in excess of the amount of the annual standard CHAMPUS residential treatment benefit payable (as determined in accordance with section 8.1 of chapter 3 of volume II of the CHAMPUS policy manual). “(d) Report.—Not later than March 1, 1998, the Secretary of Defense shall submit to the Committee on Armed Services of the Senate and the Committee on National Security of the House of Representatives a report on the program carried out under this section. The report shall contain— “(1) an assessment of the effectiveness of the program; and “(2) the Secretary’s views regarding whether the program should be implemented throughout the military health care system.”

Evaluation and Report on TRICARE Program Effectiveness
, div. A, title VII, § 717, Feb. 10, 1996, , provided that: “(a) Evaluation Required.—The Secretary of Defense shall arrange for an on-going evaluation of the effectiveness of the TRICARE program in meeting the goals of increasing the access of covered beneficiaries under chapter of title , United States Code, to health care and improving the quality of health care provided to covered beneficiaries, without increasing the costs incurred by the Government or covered beneficiaries. The evaluation shall specifically address— “(1) the impact of the TRICARE program on military retirees with regard to access, costs, and quality of health care services; and “(2) identify noncatchment areas in which the health maintenance organization option of the TRICARE program is available or is proposed to become available. “(b) Entity To Conduct Evaluation.—The Secretary may use a federally funded research and development center to conduct the evaluation required by subsection (a). “(c) Annual Report.—Not later than March 1, 1997, and each March 1 thereafter, the Secretary shall submit to Congress a report describing the results of the evaluation under subsection (a) during the preceding year.”

Use of Health Maintenance Organization Model as Option for Military Health Care
, div. A, title VII, § 731, Nov. 30, 1993, , as amended by , div. A, title VII, § 715, Oct. 5, 1994, ; , div. A, title VII, § 714, Feb. 10, 1996, , provided that: “(a) Use of Model.—The Secretary of Defense shall prescribe and implement a health benefit option (and accompanying cost-sharing requirements) for covered beneficiaries eligible for health care under chapter of title , United States Code, that is modelled on health maintenance organization plans offered in the private sector and other similar Government health insurance programs. The Secretary shall include, to the maximum extent practicable, the health benefit option required under this subsection as one of the options available to covered beneficiaries in all managed health care initiatives undertaken by the Secretary after December 31, 1994. “(b) Elements of Option.—The Secretary shall offer covered beneficiaries who enroll in the health benefit option required under subsection (a) reduced out-of-pocket costs and a benefit structure that is as uniform as possible throughout the United States. The Secretary shall allow enrollees to seek health care outside of the option, except that the Secretary may prescribe higher out-of-pocket costs than are provided under section or of title , United States Code, for enrollees who obtain health care outside of the option. “(c) Government Costs.—The health benefit option required under subsection (a) shall be administered so that the costs incurred by the Secretary under the TRICARE program are no greater than the costs that would otherwise be incurred to provide health care to the members of the uniformed services and covered beneficiaries who participate in the TRICARE program. “(d) Definitions.—For purposes of this section: “(1) The term ‘covered beneficiary’ means a beneficiary under chapter of title , United States Code, other than a beneficiary under section 1074(a) of such title. “(2) The term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter of title , United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. “(e) Regulations.—Not later than December 31, 1994, the Secretary shall prescribe final regulations to implement the health benefit option required by subsection (a). “(f) Modification of Existing Contracts.—In the case of managed health care contracts in effect or in final stages of acquisition as of December 31, 1994, the Secretary may modify such contracts to incorporate the health benefit option required under subsection (a).”

Managed Health Care Program and Contracts for Military Health Services System
, title VI, Dec. 1, 1995, , provided in part: “That the date for implementation of the nation-wide managed care military health services system shall be extended to September 30, 1997”. , title VIII, § 8025, Nov. 11, 1993, , provided that: “Notwithstanding any other provision of law, to establish region-wide, at-risk, fixed price managed care contracts possessing features similar to those of the CHAMPUS Reform Initiative, the Secretary of Defense shall submit to the Congress a plan to implement a nation-wide managed health care program for the military health services system not later than December 31, 1993: Provided, That the program shall include, but not be limited to: (1) a uniform, stabilized benefit structure characterized by a triple option health benefit feature; (2) a regionally-based health care management system; (3) cost minimization incentives including ‘gatekeeping’ and annual enrollment procedures, capitation budgeting, and at-risk managed care support contracts; and (4) full and open competition for all managed care support contracts: Provided further, That the implementation of the nation-wide managed care military health services system shall be completed by September 30, 1996: Provided further, That the Department shall competitively award contracts in fiscal year 1994 for at least four new region-wide, at-risk, fixed price managed care support contracts consistent with the nation-wide plan, that one such contract shall include the State of Florida (which may include Department of Veterans Affairs’ medical facilities with the concurrence of the Secretary of Veterans Affairs), one such contract shall include the States of Washington and Oregon, and one such contract shall include the State of Texas: Provided further, That any law or regulation of a State or local government relating to health insurance, prepaid health plans, or other health care delivery, administration, and financing methods shall be preempted and shall not apply to any region-wide, at-risk, fixed price managed care contract entered into pursuant to chapter of title , United States Code: Provided further, That the Department shall competitively award within 13 months after the date of enactment of this Act [Nov. 11, 1993] two contracts for stand-alone, at-risk managed mental health services in high utilization, high-cost areas, consistent with the management and service delivery features in operation in Department of Defense managed mental health care contracts: Provided further, That the Assistant Secretary of Defense for Health Affairs shall, during the current fiscal year, initiate through competitive procedures a managed health care program for eligible beneficiaries in the area of Homestead Air Force Base with benefits and services substantially identical to those established to serve beneficiary populations in areas where military medical facilities have been terminated, to include retail pharmacy networks available to Medicare-eligible beneficiaries, and shall present a plan to implement this program to the House and Senate Committees on Appropriations not later than January 15, 1994.”

Condition on Expansion of CHAMPUS Reform Initiative to Other Locations
, div. A, title VII, § 712, Oct. 23, 1992, , as amended by , div. A, title VII, § 720, Nov. 30, 1993, ; , div. A, title VII, § 714(c), Oct. 5, 1994, , provided that: “(a) Condition.—(1) Except as provided in subsection (b), the Secretary of Defense may not expand the CHAMPUS reform initiative underway in the States of California and Hawaii to another location until not less than 90 days after the date on which the Secretary certifies to Congress that expansion of the initiative to that location is the most efficient method of providing health care to covered beneficiaries in that location. In determining whether the expansion of the CHAMPUS reform initiative to a location is the most efficient method of providing health care to covered beneficiaries in that location, the Secretary shall consider the cost-effectiveness of the initiative (while assuring that the combined cost of care in military treatment facilities and under the Civilian Health and Medical Program of the Uniformed Services will not be increased as a result of the expansion) and the effect of the expansion of the initiative on the access of covered beneficiaries to health care and on the quality of health care received by covered beneficiaries. “(2) To the extent any revision of the CHAMPUS reform initiative is necessary in order to make the certification required by this subsection, the Secretary shall assure that enrolled covered beneficiaries may obtain health care services with reduced out-of-pocket costs, as compared to standard CHAMPUS. “(b) Exception.—The Secretary of Defense may waive the operation of the condition on the expansion of the CHAMPUS reform initiative specified in subsection (a) in order to expand the initiative to a location adversely affected by the closure or realignment of a military installation in that location, as determined by the Secretary. “(c) Evaluation of Certification.—The Comptroller General of the United States and the Director of the Congressional Budget Office shall evaluate each certification made by the Secretary of Defense under subsection (a) that expansion of the CHAMPUS reform initiative to another location is the most efficient method of providing health care to covered beneficiaries in that location. They shall submit their findings to Congress if these findings differ substantially from the findings upon which the Secretary made the decision to expand the CHAMPUS reform initiative. “(d) Definitions.—For purposes of this section: “(1) The terms ‘CHAMPUS reform initiative’ and ‘initiative’ mean the health care delivery project required by section 702 of the National Defense Authorization Act for Fiscal Year 1987 (Public Law 99–661; U.S.C. ). “(2) The term ‘covered beneficiary’ has the meaning given that term in section of title , United States Code. “(3) The terms ‘Civilian Health and Medical Program of the Uniformed Services’ and ‘CHAMPUS’ have the meaning given the term ‘Civilian Health and Medical Program of the Uniformed Services’ in section of title , United States Code.”

Alternative Health Care Delivery Methodologies
, div. A, title VII, § 713, Oct. 23, 1992, , as amended by , div. A, title VII, § 719, Nov. 30, 1993, , provided that: “(a) Continuation of Health Care Reform Initiatives.—(1) During fiscal years 1993 through 1996, the Secretary of Defense shall continue to conduct a broad array of reform initiatives for furnishing health care to persons who are eligible to receive health care under chapter of title , United States Code. “(2) The health care reform initiatives conducted in accordance with paragraph (1) shall include CHAMPUS alternatives, the CHAMPUS reform initiative, catchment area management, coordinated care, and such other reform initiatives as the Secretary of Defense considers to be appropriate. “(3) Not later than September 30, 1994, the Secretary shall submit to Congress a report regarding the health care reform initiatives conducted during fiscal years 1993 and 1994. The report shall include a discussion of the cost effectiveness of the initiatives and the extent to which the persons who received health care under such initiatives are satisfied with that health care. “(b) Continuation of CHAMPUS Reform Initiative in Hawaii and California.—(1) The Secretary of Defense shall ensure that a replacement or successor contract for the CHAMPUS reform initiative contract applicable to the States of California and Hawaii is awarded in sufficient time for the contractor to begin to provide health care in those States under the replacement or successor contract as soon as practicable after the date of the enactment of the National Defense Authorization Act for Fiscal Year 1994 [Nov. 30, 1993]. “(2) The Secretary shall use competitive procedures for awarding a replacement or successor contract under paragraph (1). “(c) Evaluation of CHAMPUS Reform Initiative.—(1) Not later than June 1, 1994, the Secretary of Defense shall enter into a contract with a non-Federal entity under which the entity will perform an evaluation of the performance of the CHAMPUS reform initiative in the States of California and Hawaii. The evaluation shall cover each of the fiscal years during which the initiative is carried out in those States under the replacement or successor contract referred to in subsection (b) and under the predecessor contracts. The evaluation shall include a comparison of the cost savings and claims experience resulting in each such fiscal year from carrying out the CHAMPUS reform initiative in those States. “(2) Not later than one year after the date on which the contract for evaluation is entered into under paragraph (1), the non-Federal entity making the evaluation shall submit to the Secretary and to Congress a report on the results of the evaluation. “(d) Definitions.—For purposes of this section: “(1) The term ‘CHAMPUS’ means the Civilian Health and Medical Program of the Uniformed Services, as defined in paragraph (4) of section of title , United States Code. “(2) The term ‘covered beneficiary’ has the meaning given that term in paragraph (5) of such section. “(3) The term ‘CHAMPUS reform initiative’ means the health care delivery project required by section 702 of the National Defense Authorization Act for Fiscal Year 1987 (Public Law 99–661; U.S.C. ). “(4) The term ‘catchment area management’ means the methodology provided for demonstration in accordance with section 731 of the National Defense Authorization Act for Fiscal Years 1988 and 1989 (Public Law 100–180; U.S.C. ).”

Military Health Care for Persons Reliant on Health Care Facilities at Bases Being Closed or Realigned
, div. A, title VII, § 722, Oct. 23, 1992, , as amended by , div. A, title VII, § 726, Nov. 24, 2003, , provided that: “(a) Establishment.—Not later than December 31, 2003, the Secretary of Defense shall establish a working group on the provision of military health care to persons who rely for health care on health care facilities located at military installations— “(1) inside the United States that are selected for closure or realignment in the 2005 round of realignments and closures authorized by sections 2912, 2913, and 2914 of the Defense Base Closure and Realignment Act of 1990 (part A of title XXIX of Public Law 101–510; U.S.C. ), as added by title XXX of the National Defense Authorization Act for Fiscal Year 2002 (Public Law 107–107; 155 [115] Stat. 1342); or “(2) outside the United States that are selected for closure or realignment as a result of force posture changes. “(b) Membership.—The members of the working group shall include, at a minimum, the following: “(1) The Assistant Secretary of Defense for Health Affairs, or a designee of the Assistant Secretary. “(2) The Surgeon General of the Army, or a designee of that Surgeon General. “(3) The Surgeon General of the Navy, or a designee of that Surgeon General. “(4) The Surgeon General of the Air Force, or a designee of that Surgeon General. “(5) At least one independent member (appointed by the Secretary of Defense) from each TRICARE region, but not to exceed a total of 12 members appointed under this paragraph, whose experience in matters within the responsibility of the working group qualify that person to represent persons authorized health care under chapter of title , United States Code. “(c) Duties.—(1) In developing the recommendations for the 2005 round of realignments and closures required by sections 2913 and 2914 of the Defense Base Closure and Realignment Act of 1990 [, U.S.C. 268 note ], the Secretary of Defense shall consult with the working group. “(2) The working group shall be available to provide assistance to the Defense Base Closure and Realignment Commission. “(3) In the case of each military installation referred to in paragraph (1) or (2) of subsection (a) whose closure or realignment will affect the accessibility to health care services for persons entitled to such services under chapter of title , United States Code, the working group shall provide to the Secretary of Defense a plan for the provision of the health care services to such persons. “(d) Special Considerations.—In carrying out its duties under subsection (c), the working group— “(1) shall conduct meetings with persons entitled to health care services under chapter of title , United States Code, or representatives of such persons; “(2) may use reliable sampling techniques; “(3) may visit the areas where closures or realignments of military installations will adversely affect the accessibility of health care for such persons and may conduct public meetings; and “(4) shall ensure that members of the uniformed services on active duty, members and former members of the uniformed services entitled to retired or retainer pay, and dependents and survivors of such members and retired personnel are afforded the opportunity to express their views. “(e) Application of Advisory Committee Act.—The provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the working group established pursuant to this section. “(f) Termination.—The working group established pursuant to subsection (a) shall terminate on December 31, 2006.”

Authorization for Extension of CHAMPUS Reform Initiative
, div. A, title VII, § 722, Dec. 5, 1991, , provided that: “(a) Authority.—Upon the termination (for any reason) of the contract of the Department of Defense in effect on the date of the enactment of this Act [Dec. 5, 1991] under the CHAMPUS reform initiative established under section 702 of the National Defense Authorization Act for Fiscal Year 1987 [] ( U.S.C. ), the Secretary of Defense may enter into a replacement or successor contract with the same or a different contractor and for such amount as may be determined in accordance with applicable procurement laws and regulations and without regard to any limitation (enacted before, on, or after the date of the enactment of this Act) on the availability of funds for that purpose. “(b) Treatment of Limitation on Funds for Program.—No provision of law stated as a limitation on the availability of funds may be treated as constituting the extension of, or as requiring the extension of, any contract under the CHAMPUS reform initiative that would otherwise expire in accordance with its terms.”

Extension of CHAMPUS Reform Initiative for Certain States
, title VIII, § 8032, Nov. 26, 1991, , provided: “That notwithstanding any other provision of law, the CHAMPUS Reform Initiative contract for California and Hawaii shall be extended until February 1, 1994, within the limits and rates specified in the contract: Provided further, That the Department shall competitively award contracts for the geographic expansion of the CHAMPUS Reform Initiative in Florida (which may include Department of Veterans Affairs medical facilities with the concurrence of the Secretary of Veterans Affairs), Washington, Oregon, and the Tidewater region of Virginia: Provided further, That competitive expansion of the CHAMPUS Reform Initiative may occur in any other regions that the Assistant Secretary of Defense for Health Affairs deems appropriate.”

Conditions on Expansion of CHAMPUS Reform Initiative
, div. A, title VII, § 715, Nov. 5, 1990, , provided that: “(a) Certification of Cost-Effectiveness.—The Secretary of Defense may not proceed with the proposed expansion of the CHAMPUS reform initiative underway in the States of California and Hawaii until not less than 90 days after the date on which the Secretary certifies to the Congress that— “(1) such CHAMPUS reform initiative has been demonstrated to be more cost-effective than the Civilian Health and Medical Program of the Uniformed Services or any other health care demonstration program being conducted by the Secretary; “(2) the contractor selected to underwrite the delivery of health care under the CHAMPUS reform initiative will accomplish the expansion without the disruption of services to beneficiaries under the Civilian Health and Medical Program of the Uniformed Services or delays in the processing of claims; and “(3) such contractor is currently, and projected to remain, financially able to underwrite the CHAMPUS reform initiative. “(b) Report on Certification.—Not later than 30 days after the date on which the Secretary of Defense submits the certification required by subsection (a), the Comptroller General of the United States and the Director of the Congressional Budget Office shall jointly submit to Congress a report evaluating such certification. “(c) CHAMPUS Reform Initiative Defined.—For purposes of this section, the term ‘CHAMPUS reform initiative’ has the meaning given that term in section 702(d)(1) of the Department of Defense Authorization Act for Fiscal Year 1987 [] ( U.S.C. ).”

Requirements Prior to Termination of Medical Services at Military Medical Treatment Facilities
, div. A, title VII, § 716, Nov. 5, 1990, , provided that: “(a) Prohibition.—During the period beginning on the date of the enactment of this Act [Nov. 5, 1990] and ending on September 30, 1995, the Secretary of a military department may not take any action to close a military medical facility under the jurisdiction of that Secretary or reduce the level of care provided at such a medical facility until 90 days after the date on which the Secretary submits to Congress a report described in subsection (b). “(b) Elements of Report.—A report referred to in subsection (a) shall include the following: “(1) The reason for the action. “(2) The projected savings to the Government from the action. “(3) The impact on CHAMPUS and MEDICARE costs in the catchment area of the facility. “(4) The impact on beneficiary cost-sharing. “(5) An examination of alternative ways to provide care to the persons served by the facility that the Secretary determines would not result in adverse consequences to such persons. “(6) An explanation of how care will be provided for and the cost, if any, to those persons to receive such care. “(c) Exception.—Subsection (a) shall not apply with respect to the closing of a military medical facility (or the reduction of the level of care provided at a military medical facility) as a result of a base closure or an operational deployment.”

Requirement for Availability of Additional Insurance Coverage; Funding Limitations; Definition
, div. A, title VII, § 732(e)–(g), Dec. 4, 1987, , 1121, provided that: “(e) Requirement for Availability of Additional Insurance Coverage.—(1) The Secretary of Defense shall make every effort to enter into an agreement, similar to the one being negotiated with a private insurer on the date of the enactment of this Act [Dec. 4, 1987], that would provide an insurance plan that meets the requirements described in paragraph (3). “(2) If an agreement referred to in paragraph (1) is not entered into before a request for proposals with respect to the second phase of the CHAMPUS reform initiative is issued, the Secretary shall provide for an insurance plan which meets the requirements described in paragraph (3) through either of the following means: “(A) By including, in any request for proposals with respect to the second (and any subsequent) phase of the CHAMPUS reform initiative, a requirement for the contractor to offer an option to elect an insurance plan which meets the requirements described in paragraph (3). “(B) By including, in any request for proposals for a contract to process claims for CHAMPUS, a requirement for the contractor (known as a fiscal intermediary) to offer an option to elect an insurance plan which meets the requirements described in paragraph (3). “(3) The insurance plan requirements referred to in paragraphs (1) and (2) are the following: “(A) At the election of the individual, the plan shall be available to an individual losing eligibility (by reason of discharge, release from active duty, a change in family status (including divorce or annulment, or, in the case of a child, reaching age 22), or other similar reason) to be a covered beneficiary under chapter of title , United States Code. “(B) The plan shall provide for coverage of benefits similar to the coverage of benefits available to the individual under CHAMPUS, regardless of any pre-existing condition. “(C) The plan shall provide that enrollees in the plan shall pay the full periodic charges for the benefit coverage. “(f) Funding Limitations.—(1) None of the funds appropriated or otherwise made available to the Department of Defense may be obligated or expended for the purpose of entering into a contract for the demonstration phase of the CHAMPUS reform initiative required by section 702(a)(1) of the National Defense Authorization Act for Fiscal Year 1987 [section 702(a)(1) of , set out as a note below] until the requirements of section 702(a)(4) of such Act (as added by subsection (a)) are met. “(2) None of the funds appropriated or otherwise made available to the Department of Defense may be obligated or expended for the purpose of requesting a proposal for the second (or any subsequent) phase of the CHAMPUS reform initiative as described in section 702(c) of the National Defense Authorization Act for Fiscal Year 1987 until the requirements of paragraph (2) of section 702(c) of such Act (as added by subsection (c)) are met. “(g) CHAMPUS Defined.—In this section, the term ‘CHAMPUS’ has the meaning given such term by section of title , United States Code.”

CHAMPUS Reform Initiative
, div. A, title VII, § 702, Nov. 14, 1986, , as amended by , div. A, title VII, § 732(a), (c), Dec. 4, 1987, , provided that: “(a) Demonstration Project.—(1) The Secretary of Defense shall conduct a project designed to demonstrate the feasibility of improving the effectiveness of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) through the competitive selection of contractors to financially underwrite the delivery of health care services under the program. “(2) The demonstration project required by paragraph (1)— “(A) shall begin not later than September 30, 1988, and continue for not less than one year; “(B) shall include not more than one-third of covered beneficiaries; and “(C) shall include a health care enrollment system that meets the requirements specified in section of title , United States Code (as added by section ). “(3)(A) The Secretary shall submit to the Committees on Armed Services of the Senate and House of Representatives a report on the development of the demonstration project required by paragraph (1). Such report shall include— “(i) a description of the scope and structure of the project; “(ii) an estimate of the costs of the care to be provided under the project; and “(iii) a description of the health care enrollment system included in the project. “(B) The report required by subparagraph (A) shall be submitted— “(i) not later than 60 days before the initiation of the project, if the project is to be restricted to a contiguous area of the United States; or “(ii) not later than 60 days before a solicitation for bids or proposals with respect to such project is issued, if the project will not be restricted to a contiguous area of the United States. “(4) The Secretary of Defense shall develop a methodology to be used in evaluating the results of the demonstration project required by paragraph (1) and shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on such methodology. “(b) Study of Health Care Alternatives.—(1) The demonstration project required by subsection (a)(1) shall include a study of— “(A) methods to guarantee the maintenance of competition among providers of health care to persons under the jurisdiction of the Secretary; “(B) the merits of the use of a voucher system or a fee schedule for provision of health care to such persons; and “(C) methods to guarantee that community hospitals are given equal consideration with other health care providers for provision of health care services under contracts with the Department of Defense. “(2) The Secretary shall submit to Congress a report discussing the matters evaluated in the study required by paragraph (1) before the end of the 90-day period beginning on the date of the enactment of this Act [Nov. 14, 1986]. “(c) Phased Implementation of CHAMPUS Reform Initiative.—(1) The Secretary of Defense may proceed with implementation of the CHAMPUS reform initiative, to be carried out in two phases during a period of not less than two years, if— “(A) the Secretary determines, based on the results of the demonstration project required by subsection (a)(1), that such initiative should be implemented; “(B) not less than one year elapses after the date on which the demonstration project required by subsection (a)(1) is initiated; and “(C) 90 days elapse after the date on which the Secretary submits to the Committees on Armed Services of the Senate and House of Representatives a report that includes— “(i) a description of the results of the demonstration project, evaluated in accordance with the methodology developed under subsection (a)(4); “(ii) a description of any changes the Secretary intends to make in the initiative during the proposed implementation; and “(iii) a comparison of the costs of providing health care under CHAMPUS with the costs of providing health care under the demonstration project and the estimated costs of providing health care under the CHAMPUS reform initiative if fully implemented. “(2) The Secretary may not issue a request for proposals with respect to the second (or any subsequent) phase of the CHAMPUS reform initiative until— “(A) all principal features of the demonstration project, including networks of providers of health care, have been in operation for not less than one year; and “(B) the expiration of 60 days after the date on which the report described in paragraph (1)(C) has been received by the committees referred to in such paragraph. “(d) Definitions.—In this section: “(1) The term ‘CHAMPUS reform initiative’ means the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. “(2) The term ‘Civilian Health and Medical Program of the Uniformed Services’ has the meaning given such term in section of title , United States Code (as added by section ). “(3) The term ‘covered beneficiary’ has the meaning given such term in section of title , United States Code (as added by section ).”

Section Referred to in Other Sections
This section is referred to in section of this title.

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