106thcongress H.R.1547 1stSession Toamendtitle10,UnitedStatesCode,tomakecertainimprovementswith respecttotheTRICAREprogram. IN THE HOUSE OF REPRESENTATR^S April22,1999 Mr.Thornberryintroducedthefollowingbill;whichwasreferredtothe CommitteeonArmedServices A BILL Toamendtitle 10,UnitedStatesCode,tomakecertain improvementswithrespecttotheTRICAREprogram. 1 BeitenactedhytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION.1.IMPROVEMENTOFTRICAREPROGRAM. — 4 (a) ImprovementofTRICARE Program. Chap- 5 ter55 oftitle 10, United States Code, isamendedbyin- 6 sertingaftersection1097athefollowingnewsection: 1 "§1097b. TRICARE: comparability of benefits with 2 benefitsunderFederalEmployeesHealth 3 Benefits program; other requirements 4 andauthorities — 5 "(a) COMPAEABILITYOFBENEFITS. The Secretarv^ 6 ofDefense shall, tothe maximum extentpracticable, en- 7 sure that the health care coverage available through the 8 TRICARE programis substantiallysimilarto the health 9 carecoverageavailableundersunilarhealthbenefitsplans 10 offeredundertheFederalEmplo.yeesHealthBenefitspro- 11 gramestablishedunderchapter89oftitle5. — 12 "(b) PortabilityofBenefits. TheSecretaryof 13 Defenseshallprovidethatanycoveredbeneficiaryenrolled 14 intheTRICAREprogrammayreceivebenefitsunderthat 15 programatfacilitiesthatpro\idebenefitsunderthatpro- 16 gramtlu-oughoutthevariousregionsofthatprogram. — 17 "(c) Patient Management. (1) The Secretar>^of 18 Defense shall, to the maximum extent practicable, mini- 19 mize the authorization or certification requirements im- 20 posed upon covered beneficiaries under the TRICARE 21 program as a condition of access to benefits under that 22 program. 23 "(2) The SecretaryofDefenseshallimplement,mth 24 respectthe firsttwo contracts awarded afterthe date of 25 theenactmentofthissectiontoprovidemanagedcaresup- 26 portundertheTRICAREprogram,redesignedprocedures •HR1547IH 3 1 forpajTiientandprocessingofclaimsundersuchprogram. 2 Suchprocedures shah incorporate bestindustr^^practices 3 for processing claims for health care services in a sim- 4 plified and expedited maimer and shall include electronic 5 claimsprocessing. 6 "(d) AUTHORIIT FOR CERTAIN THIRD-PARTY CoL- 7 LECTIONS.—(1) A medical treatment facility ofthe uni- 8 formedservicesundertheTRICAREprogrammaycollect 9 fromatliird-party^payerthereasonablechargesforhealth 10 careservicesdescribedinparagraph(2)thatareincurred 11 by the facility on behalf of a covered beneficiary under 12 thatprogramtothe extentthatthebeneficiarywouldbe 13 eligibleto receivereimbursementorindemnificationfrom 14 thethird-partypayerifthebeneficiaiyweretoincursuch 15 chargesonthebeneficiary'so-v\tibehalf. 16 "(2) The reasonable charges described inthis para- 17 graphare reasonablechargesfoi"servicesorcarecovered 18 bythe medicareprogramundertitleX\T;II ofthe Social 19 SecurityAct. 20 "(3) The collectionofcharges, andtheutilizationof 21 amounts collected, underthis subsection shall be subject 22 to the provisions ofsection 1095 ofthis title. The term 23 'reasonablecosts',asusedinthatsectionshaUbedeemed 24 forpurposesoftheapphcationofthatsectiontothissub- •HR1547IH 4 1 section to refer to the reasonable charges described in 2 paragraph(2). — 3 "(e) Consultation. The Secretary of Defense 4 shall carrv" out any actions under this section after con- 5 sulfationwiththeotheradministeringSecretaries.". — 6 (b) Clerical Amendment. The table of sections 7 at the beginning ofchapter 55 ofsuch title is amended 8 byinserting afterthe item relatingto section 1097a the 9 followingnewitem: "1097b.TRICARE:comparabilityofbenefitswithbenefitsunderFederalEm- ployeesHealthBenefitsprogram;otherrequirementsandau- thorities.". — 10 (c) Report on Implementation. (1) Not later 11 than6montlisafterthedateoftheenactmentofthisAct, 12 the Secretarj^ ofDefense, in consultation with the other 13 administeringSecretaries, shaU submitto Congress are- 14 portassessingtheeffectsoftheimplementationofthere- 15 quireinents and authorities set forth in section 1097b of 16 title 10,UnitedStatesCode (asaddedbysubsection(a)). 17 (2)Thereportshallincludethefollowing: 18 (A)Anassessmentofthecostoftheimplemen- 19 tationofsuchrequirementsandauthorities. 20 (B) An assessment whether or not the imple- 21 mentation ofany such requirements and authorities 22 will result in the utihzation by the TRICARE pro- 23 gram ofthe best industrj^ practices with respect to m •HR1547 5 1 the matters covered by such requirements and au- 2 thorities. 3 (3)Inthissubsection,theterm"administeringSecre- • 4 taries" has the meaning given that term in section 5 1072(3)oftitle10,UnitedStatesCode. O r «R1547IH